Alimentary obesity 3rd degree.

Obesity is the excessive deposition of fat in the body that lead to overweight. Distinguish between obesity as independent suffering (alimentary obesity) as a symptom of other diseases (for example, lesions of the Central nervous system and endocrine glands). Sometimes obesity is accompanied by the development of painful knotted tumors (lipomas)- the so-called disease Dercum.
Obesity often occurs at the age of 50-60 years old and rare in young adults. More than half of all cases of obesity referred to alimentary obesity, is associated with malnutrition. Redundant power supply with primary consumption of fats and carbohydrates, rich food before bed, abuse of high-calorie products (chocolate, sweets, cakes) lead to increased formation and deposition of fat in the body. The development of obesity also contributes to a lack of physical activity. Play some role hereditary constitutional factors.
There are four degrees of obesity: 1 degree of body weight (see) exceeds normal for no more than 29%; stage 2 - from 30 to 49%; 3 - from 50 up to 99%; 4 - 100% and more. Patients who are obese 1 and 2 degree work capacity is not usually limited.
The clinical picture depends mainly on the degree of obesity and associated diseases. The most frequent complaints: shortness of breath, weakness, tiredness, weakening of memory and other objective examination at the places of greatest deposits of fat identifies white stripes - "stretch marks" pregnant. The skin, as a rule, high humidity. Sometimes the skin with subcutaneous fat belly hangs down in the form of apron (Fig). At high obesity rates by violations of water-salt metabolism may experience moderate pain and limited mobility of joints, the configuration changes of the spine. In the result of the high standing of the diaphragm is reduced lung capacity and develop respiratory failure. Patients are obese are more prone to diseases of the lungs. Cardio - vascular system most often found degeneration of myocardium and atherosclerosis. Often there are an increase or decrease of gastric secretion and the weakening of the motor function of the intestines, leading to constipation.
A common complication in obesity are cholecystitis, pielity, stones in the gall bladder and kidneys. Women are often menstrual irregularities.
Diagnosis alimentary obesity put on the basis of the statement of overweight, typical complaints, accounting for family and hereditary factors, occupation, mode of life, nutrition, etc.
Differential diagnosis should be carried out with Itsenko - Kushinga disease (see), and hypothyroidism (see).
Forecast for obesity depends on concomitant diseases, particularly cardiovascular system, which in obesity are two times more likely than people of normal weight, resulting in lethal outcome.
Treatment. The main is a low-calorie diet and physical culture. Moderate obesity is recommended limit foods rich in carbohydrates (pasta, cereals, potatoes, sugar, confectionery), and fats with sufficient protein, vegetables and fruits.
In patients with severe obesity apply daily diet (approximately 2000 kcal) of the following composition: meat 250-300 g, cheese 250-300 g, 1-2 glasses of milk, bread black 50-100 g, oil 5-10 g, sugar 5-10 g, vegetables (except potatoes and legumes), 700 g, fruit (except for grapes and bananas) to 700, Useful purpose 2-3 drops of vitamins a and D. 3-4 weeks weight loss is usually 4-5 kg, Then to the diet, add 50 grams of black bread, 5 g of oil and 5 grams of sugar. In a month the number of bread lead up to 150 g, oil-up to 15 g sugar, 15 g per day. This diet is used to stabilize the weight. If weight loss does not reach the expected results, it is 15-20 days from the start of treatment appropriate to apply different fasting days (see).
Drugs that decrease appetite (farnon, dezopimon, avikal and others), can be assigned only under careful medical supervision.
In the absence of contraindications cardio-vascular system shows LFC. Therapeutic exercises conducted within 20-60 minutes
In practice, use of the exercise, with a maximum amplitude of movements involving the major muscle groups. Exercise is recommended in various positions (lying, sitting, and so on).
Great importance is the mode of the day. In the morning should be hygienic gymnastics (15-20 minutes) or walk (30-90 minutes) followed by a reception water procedures (shower, rubbing). Hygienic gymnastics useful to combine with various kinds of sports (volleyball, badminton and others), tourism, and water treatments and massages.
After each meal recommended dosed walking (30-60 minutes). The last meal should be 3-4 hours before bedtime.
Prevention - rational diet and adequate physical activity (physical training and sport, tourism, and others).

Obesity (obesity; synonymous with alimentary obesity) - deposition of fat in the body in excess of his deposition in healthy persons To obesity as a separate nosological unit include all cases in which excessive deposition of fat is not the result of some other diseases (e.g., the syndrome Itsenko-Cushing syndrome, hypothyroidism, and others), but the main pathological disturbance with unknown primary defeat of any organ or organ system.
The young people Acting is relatively rare, but there are indications about the increasing frequency of O. among young people. Most often Acting at the age of 50-59 years. At older ages, the frequency decreases. Maximum weight described in the literature, reached 268 kg widespread O. and reduction of life expectancy among overweight people compared to people of normal weight makes the problem of obesity one of the most important public health problems. Sometimes on the background of the already existing Acting in subcutaneous adipose tissue develops painful diffuse education or knotted tumors (lipomas), the so-called disease Dercum, etiology which is still not installed.
The etiology and pathogenesis. One of the essential components in the development O. is overeating. Etiological factors that lead to overeating, may be harmful family habits (a habit from childhood to consume too much food). Obesity is often seen in people who have changed the nature of the work (for example, when moving from physical work on administrative and consequently decreased energy consumption, but the consumption of foods corresponding to their previous jobs, become a part of the stereotype and preserved, despite the depressed demand. The increased consumption of food as one of the etiological factors observed in workers food units (chefs and others), faced with the need for frequent sampling of food. The increased consumption of food is also on after shock after prolonged fasting. However, taking this etiological factors, because some people of unquestionable importance in the development O., we can assume that along with this, they had also a violation of neurohormonal mechanisms in a healthy person, the correspondence between the issue and receipt of calories and retention of body fat and body weight in physiological limits.

Experimental data give grounds to take a significant role in the pathogenesis of obesity certain centers of the hypothalamus. It is established that the destruction ventromedial nuclei of the hypothalamus causes the animals voracity and development sharp O. These nuclei of the hypothalamus called "centers of saturation". The destruction of the lateral nucleus, close from ventromedial, causes, on the contrary a reduced need for food and weight loss, which occurs even in the preliminary destruction ventromedial nuclei. Irritation lateral nuclei leads to increased needs for food. These lateral nucleus is called "centers of appetite". Consider that ventromedial and lateral nucleus are in close functional relationship. Damage ventromedial nuclei in mice and development O. may also be caused by putting them aurothioglucose. There are indications about the impact of the centers of the hypothalamus not only on the regulation of appetite, but also on the change of production of growth hormone and metabolic processes.
There are known cases of obesity in people after encephalitis, brain tumors occurring damage diencephalic region. It is possible that various etiologic factors that lead to long meal in amounts not corresponding to the power consumption, are connected with violation of the functional state of the centers of the hypothalamus and the failure to regulate the energy arrival at the level of its consumption, and to maintain the normal chemical composition of various tissues and organs, including the subcutaneous fatty tissue. A person with a well-functioning body of the regulation of appetite decrease appetite would prevent excessive eating and would help to hold weight in the physiological limits.
Unquestionable importance in the Genesis of O. is a violation of the functional state of cerebral cortex, which is especially necessary to consider development of overeating and O. as a result, development and fastening of bad habits and mental injuries. But the role of these cortical factors cannot be considered outside the close functional dependence of the cerebral cortex and hypothalamus. Cortical influence in the Genesis of overeating, probably largely implemented through changes of the functional state of the centers of the hypothalamus. With the development Acting as the result of psychological factors overeating in some patients, combined with a decrease in physical activity.
There are indications that the change of the functional state of the centers that regulate appetite, based on the level of glucose utilization, an indication of which is the change arteriovenous difference in respect of glucose: increased this difference decreases appetite and decrease increases. Probably has a value of recycling of other substances and their metabolites, temperature changes of blood.
It is necessary to consider the role of afferent nerve information from the tissues status in their metabolism and especially the nerve receptors. Increased activity of the sympathoadrenal system contributes to the strengthening of the processes of lipolysis. A change of activity of this system can be set cortical impact and centers posterior hypothalamus, the institution which increases the secretion of catecholamines. With the status of sympathetic ganglia should be considered when local disturbances of fat deposition. The problem of the participation hormone of the pancreas and the hormones in the development of obesity deserves further study.
Of hormones lipolytic effect is the growth hormone, thyroid hormones, reinforcing also lipolytic effect of catecholamines.
The origin O. attach importance of genetic factor, however, his rating is very difficult due to the presence in families where parents are overweight, improper diet of plants and over-nutrition of children.
Pathological anatomy. In addition to excess fat in places of its typical concentrations (subcutaneous fatty tissue, packing and others), with more severe forms of obesity is observed the growth of fatty tissue in the epicardium, the mesentery of thin intestines, retroperitoneal space, etc. in Addition, there may be fatty infiltration of the liver. A number of changes (atherosclerosis of different localization, inflammation of the biliary tract and the formation of these stones, acute pancreatitis l others), often seen in people with Acting, not specific to Acting, although found it more often than usual.
The obesity rates by M. N. Yegorov (1965): grade 1 - overweight to 29% above normal; 11 - excess body weight from 30 to 49%; III - from 50 up to 99% and IV degree - the body weight by 100% or more above normal.
For determination of normal weight, the main indicator is the ratio of height and weight of body (see). For the evaluation of obesity also applied to the determination of thickness skin folds in several parts of the body (in the field triceps shoulder, Chuck area, on the thigh, abdomen, and others).