Excess weight as a risk factor. The dangers of obesity and methods of combating excess weight. Risk Factors for Obesity - Lack of Physical Activity

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Many girls think that obesity– this is a couple of extra pounds that spoil the appearance. But in fact, there are certain medical criteria that determine whether a person is obese or not.

Obesity is excess accumulation of fat in the body. This is a chronic metabolic pathology leading to increased morbidity and mortality in developed countries.

Fat tissue in the body increases in volume when the amount of calories eaten exceeds the number of calories burned. As a rule, the caloric content of the diet exceeds the norm due to fast carbohydrates, which easily turn into fat deposits.

- This is a disease that can be called narcotic carbohydrate addiction.

Obesity is the second leading cause of preventable death in the United States, after tobacco smoking. There are also special public organizations that fight against weight discrimination and defend the rights of obese people, engaging in educational work, protecting them in specific situations and creating support groups. Since obese people have a lot of complexes and they suffer from severe depression.

The most dangerous is visceral fat, which accumulates around the internal organs.

Visceral fat produces substances that contribute to the development of many diseases, including:

• Atherosclerosis, which can result in myocardial infarction or stroke;
• Colon cancer;
• Breast cancer and ovarian cancer in women;
• In men, obesity leads to a decrease in testosterone levels in the blood and to impotence.

Other problems associated with obesity:

• Gallbladder diseases
• Osteoarthritis of the lower back, hips and knees, partly caused by increased stress on them.
• Gout - deposits of uric acid salts; most often feels like arthritis in a single joint.
• Apnea syndrome - loud snoring and temporary pauses in breathing during sleep.

Obesity symptoms

With the exception of extremely muscular people, if a person's weight is 20% or more above the average weight on the standard height-to-weight chart, they are considered obese.

The following degrees of obesity are distinguished: mild (20-40% excess weight), moderate (41-100% excess weight) and severe (more than 100% excess weight). Only 0.5% of obese people have severe obesity.

Causes of obesity

It should be remembered that obesity can be not only a consequence of overeating and poor lifestyle, but also a symptom of a serious genetic or endocrine disease. Therefore, if obesity is combined with symptoms such as swelling, dry skin, constipation, bone pain, stretch marks (“stretch marks”) on the skin, changes in skin color, blurred vision, you should consult an endocrinologist as soon as possible to exclude secondary forms of obesity.

The cause of obesity can be endocrine pathology, which results in an imbalance in metabolism, which is manifested by excessive deposition of fat reserves.

Causes and risk factors of obesity:

• Sedentary lifestyle . Your risk of developing obesity increases if you sit at your desk or on the couch a lot. The best results come from a combination of an active lifestyle and a low-calorie diet.
• Heredity causing increased activity of lipogenesis enzymes and decreased activity of lipolysis enzymes.
• Endocrine pathology (hypothyroidism, insulinoma).
• Psychological eating disorders (for example, psychogenic overeating).
• Tendency to stress
• Psychotropic drugs.

Diagnosis of obesity

Obesity is diagnosed when actual weight exceeds the average statistical norm. If your body mass index is exceeded.

Central obesity is diagnosed if the waist to hip ratio is greater than 0.9 for women or 1 for men. If men have a waist of more than 100 cm, and women have a waist of 89 cm, then we can already talk about metabolic syndrome.

There are hardware methods for determining the percentage of fatty tissue in the body.

In addition to a waist that is larger than normal, there are other signs of obesity, such as high blood pressure (over 130/85 Hg). In addition, doctors prescribe a special blood test and check the blood lipid profile, or blood fat formula.

Measures fasting blood glucose levels greater than 100 mg/dL (5.6 mmol/L) or taking medications that lower blood glucose levels.

Obesity treatment

Principles of obesity therapy:

A diet with limited simple carbohydrates and reduced total calories. Eat as many vegetables and fruits as possible. Bran will be useful. Try to exclude foods that are too fatty, fried and too salty from your diet. Don't forget to eat legumes (not canned ones). Tidy up your intestinal microflora. To do this, drink a glass of kefir every day. Completely avoid fast food and processed foods. Better cook at home from natural products. Also, do not buy products with food additives. Any additives inhibit intestinal microflora.

Consult a doctor - he will prescribe a drug to treat obesity.

Follow three basic rules for losing weight:

• Stop useless fasting! To become slimmer, you need to eat. You need to eat food at least 5 times, every 2.5-3 hours, a day and always in small portions. Due to this, the level of glucose in the blood will be constant, and the feeling of terrible hunger will not occur. Calories are consumed due to the constant work of the gastrointestinal tract;
• The secret to losing weight is in “one glass” (eat no more than 200-300 g at a time);
• Water is more important than food (drink 2 liters of water per day). Water helps fill the stomach, and maintaining a normal level of fluid in the body allows a person to feel good, including due to the normalization of stool. Avoid carbonated drinks and packaged juices. It is not advisable to drink more than one cup of coffee per day.

Today, 2 groups of drugs for the treatment of obesity are registered in Russia:

• drugs that delay the absorption of fat in the intestines (for example, Xenical);
• drugs that suppress appetite (for example, reduxin).

If you are obese, be sure to consult your doctor before enrolling in any weight loss program! This is especially important if you have high blood pressure, other medical conditions, or severe obesity. Beware of fad diets and quick weight loss programs.

Don't strive for quick weight loss or some ideal weight. Something else is important. Research confirms that losing even 10-15% of your initial weight reduces the risk of diabetes and other diseases.

And also, if you have led a sedentary lifestyle for years, do not overdo it. When half-hour walks become too easy for you, try quickening your pace or choosing a more challenging route, such as cross-country. Gradually increase and complicate your training program.

Go to bed on time, don’t get overtired, avoid stressful situations, be happy and smile more.

Obesity prevention

A healthy lifestyle will reduce the risk of developing heart disease, diabetes and stroke:

• Healthy eating. It is recommended to eat plenty of vegetables and fruits, replace red meat with chicken and fish, eliminate fried and processed foods, and use herbs and spices instead of salt.
• Active lifestyle. It is recommended to engage in as much moderate-intensity exercise as possible every day.
• Regular medical examination. It is necessary to regularly monitor blood pressure, cholesterol and glucose levels in the blood plasma. If these indicators increase, additional measures should be taken.

In addition to diets, especially in the most severe cases accompanied by diabetes, there is the possibility of surgical treatment. This directly applies to people whose stomach volume is increased to several liters. The operation consists of reducing the volume of the stomach to 300 g by cutting off its excess part with a special apparatus and simultaneously applying sutures. Currently, operations to reduce the volume of the stomach can be performed even using an endoscopic apparatus, i.e. without a cut.

95% of people, with the help of diets, sports and even medications, cannot cope with deadly morbid obesity, that is, combined with other diseases (arterial hypertension, diabetes, diseases of the joints, spine, varicose veins of the lower extremities, respiratory failure, coronary heart disease and a whole range of other ailments). Its danger is obvious: the life expectancy of such patients is reduced by an average of 12-15 years. With extremely severe forms of morbid obesity, patients become deeply disabled and are deprived of the opportunity to leave the house and take care of themselves. In this case, the only possible solution may be to undergo gastric reduction surgery.

Despite the good results of operations, expressed in weight loss, doctors around the world urge patients to be careful. Any surgical intervention, and especially this one, is associated with significant health risks. Children and young people under 18 years of age are not recommended to undergo surgery because their bodies are just developing. It is better for them to engage in prevention (follow a diet and exercise). Gastric reduction surgery should only be performed by adults and should be the last option for losing excess weight. As noted by Yuri Ivanovich Yashkov, doctor of the “Drop the Excess” project, professor, head of the “Obesity Surgery” service at CELT CJSC, such people have a much greater risk of losing their lives without surgery than its likely negative consequences.

The most important thing that people who decide to undergo gastric reduction surgery should remember is that surgery alone is not enough to remain slim, healthy and beautiful. A person must change his life and really want it. The operation only changes the digestive processes, but no one except the person himself can change his eating habits and lifestyle.

Important! Treatment is carried out only under the supervision of a doctor. Self-diagnosis and self-medication are unacceptable!

– excess fat deposits in subcutaneous tissue, organs and tissues. It manifests itself as an increase in body weight by 20 percent or more of the average due to adipose tissue. It causes psycho-physical discomfort, causes sexual disorders, diseases of the spine and joints. Increases the risk of developing atherosclerosis, coronary artery disease, hypertension, myocardial infarction, stroke, diabetes mellitus, kidney damage, liver damage, as well as disability and mortality from these diseases. The most effective treatment for obesity is the combined use of 3 components: diet, physical activity and appropriate psychological adjustment of the patient.

General information

According to WHO international experts, obesity is a global epidemic of our time, affecting millions of people on the planet, regardless of professional, social, national, geographical, gender and age groups. In Russia, up to 30% of the working population are obese and another 25% are overweight. Women are susceptible to developing obesity twice as often as men; the critical age for the appearance of excess weight is from 30 to 60 years.

Obese patients are 2-3 times more likely to suffer from hypertension, 3-4 times more likely to suffer from angina pectoris and coronary heart disease than people with normal weight. Almost any disease, even such as ARVI, influenza and pneumonia, in obese patients takes longer and is more severe, and has a higher percentage of complications.

Causes of obesity

The development of obesity is most often caused by an imbalance between energy intake from food and energy expenditure of the body. Excess calories that enter the body and are not consumed by it are converted into fat, which accumulates in the body’s fat depots (mainly in the subcutaneous tissue, omentum, abdominal wall, internal organs, etc.). An increase in fat reserves leads to an increase in body weight and disruption of the functioning of many body systems. Overeating leads to obesity in more than 90%; another 5% of obesity cases are caused by metabolic disorders.

A number of factors contribute to the development of obesity:

• inactive lifestyle;
• genetically determined disorders of enzymatic activity (increased activity of lipogenesis enzymes and decreased activity of enzymes that break down fats (lipolysis);
• errors in the nature and diet (excessive consumption of carbohydrates, fats, salt, sweet and alcoholic drinks, eating at night, etc.);
• some endocrine pathologies (hypothyroidism, hypogonadism, insulinoma, Itsenko-Cushing's disease);
• physiological conditions (lactation, pregnancy, menopause);
• stress, lack of sleep, taking psychotropic and hormonal drugs (steroids, insulin, birth control pills), etc.

Pathogenesis

Changes in eating behavior occur as a result of disruption of the hypothalamic-pituitary regulation, which is responsible for controlling behavioral reactions. Increased activity of the hypothalamic-pituitary-adrenal system leads to an increase in ACTH production, the rate of cortisol secretion and an acceleration of its metabolism. There is a decrease in the secretion of somatotropic hormone, which has a lipolytic effect, hyperinsulinemia develops, a violation of the metabolism of thyroid hormones and tissue sensitivity to them.

Classification

In 1997, the World Health Organization proposed a classification of degrees of obesity based on the definition of an indicator - body mass index (BMI) for persons from 18 to 65 years. BMI is calculated using the formula: weight in kg / height in meters squared. Based on BMI, the following types of body weight and the risk of developing associated complications are distinguished:

• BMI<18,5 (низкий) – указывает на дефицит массы тела и повышенный риск развития других патологий;
• BMI from 18.5 to 24.9 (usual) – corresponds to normal body weight. With this BMI, the lowest morbidity and mortality rates are observed;
• BMI from 25.0 to 29.9 (increased) - indicates overweight or pre-obesity.
• BMI from 30.0 to 34.9 (high) – corresponds to stage I obesity;
• BMI from 35.0 to 39.9 (very high) – corresponds to stage II obesity;
• A BMI of 40 or more (excessively high) indicates obesity of III and IV degrees.

A BMI of 30 or more indicates the presence of obesity and a direct threat to health, requiring a medical examination and the development of an individual treatment regimen. By comparing actual and ideal body weight, obesity is divided into 4 degrees:

• in grade I, excess weight is no more than 29%
• II degree is characterized by excess weight by 30-40%
• III – by 50-99%
• at grade IV, there is an increase in actual body weight compared to the ideal by 2 or more times. Ideal body weight is calculated using the formula: “height, cm - 100.”

Based on the predominant localization of fat deposits on the body, the following types of obesity are distinguished:

1. Abdominal(upper or android) – excessive deposition of adipose tissue in the upper half of the torso and abdomen (the figure resembles an apple in shape). It develops more often in men and is most dangerous to health, as it is associated with the risk of arterial hypertension, diabetes, stroke and heart attack.
2. Femorogluteal(lower) – predominant deposition of adipose tissue in the hips and buttocks (the figure resembles a pear in shape). It is more common in women and is accompanied by dysfunction of the joints, spine, and venous insufficiency.
3. Intermediate (mixed) - uniform distribution of fat deposits throughout the body.

Obesity can be progressive in nature with an increase in the volume of fat deposits and a gradual increase in body weight, or be in a stable or residual stage (residual after weight loss). According to the mechanism and causes of development, obesity can be primary (nutritional-metabolic or exogenous-constitutional, or simple), secondary (hypothalamic or symptomatic) and endocrine.

1. The development of primary obesity is based on an exogenous, or nutritional, factor associated with the increased energy value of the diet with low energy consumption, which leads to the accumulation of fat deposits. This type of obesity develops as a result of the predominance of carbohydrates and animal fats in food or a violation of the diet (rich and rare meals, consumption of the main daily calorie intake in the evening) and often has a family predisposition. Calories contained in fats contribute more to weight gain than those contained in proteins and carbohydrates. If fats supplied with food exceed the capabilities of their oxidation in the body, then excess fat accumulates in fat depots. Physical inactivity significantly reduces the ability of muscles to oxidize fat.
2. Secondary obesity accompanies such hereditary syndromes as Babinski-Froelich disease, Gelineau syndrome, Lawrence-Myn-Bardet-Biedl syndrome, etc. Also, symptomatic obesity can develop against the background of various cerebral lesions: brain tumors, dissemination of systemic lesions, infectious diseases, mental disorders, traumatic brain injuries.
3. The endocrine type of obesity develops with pathology of the endocrine glands: hypothyroidism, hypercortisolism, hyperinsulinism, hypogonadism. With all types of obesity, hypothalamic disorders are observed to one degree or another, which are either primary or occur during the course of the disease.

Obesity symptoms

A specific symptom of obesity is excess body weight. Excess fat deposits are found on the shoulders, abdomen, back, sides of the body, back of the head, hips, and pelvic area, while underdevelopment of the muscular system is noted. The patient’s appearance changes: a double chin appears, pseudogynecomastia develops, fat folds on the abdomen hang down in the form of an apron, and the hips take the shape of riding breeches. Umbilical and inguinal hernias are typical.

Patients with degrees I and II obesity may not present any special complaints; with more severe obesity, drowsiness, weakness, sweating, irritability, nervousness, shortness of breath, nausea, constipation, peripheral edema, pain in the spine and joints are noted.

Patients with grade III-IV obesity develop disturbances in the functioning of the cardiovascular, respiratory, and digestive systems. Objectively, hypertension, tachycardia, and muffled heart sounds are detected. A high position of the dome of the diaphragm leads to the development of respiratory failure and chronic pulmonary heart disease. Fatty infiltration of the liver parenchyma, chronic cholecystitis and pancreatitis occurs. Pain in the spine and symptoms of arthrosis of the ankle and knee joints appear.

Obesity is often accompanied by menstrual irregularities, including the development of amenorrhea. Increased sweating causes the development of skin diseases (eczema, pyoderma, furunculosis), the appearance of acne, stretch marks on the abdomen, hips, shoulders, hyperpigmentation of the elbows, neck, and places of increased friction.

Nutritional obesity

Obesity of different types has similar general symptoms; differences are observed in the pattern of fat distribution and the presence or absence of signs of damage to the endocrine or nervous systems. With nutritional obesity, body weight increases gradually, fat deposits are uniform, sometimes predominant in the thighs and abdomen. There are no symptoms of damage to the endocrine glands.

Hypothalamic obesity

With hypothalamic obesity, obesity develops quickly, with a predominant deposition of fat on the abdomen, thighs, and buttocks. There is an increase in appetite, especially in the evening, thirst, night hunger, dizziness, and tremor. Trophic skin disorders are characteristic: pink or white stretch marks (stretch stripes), dry skin. Women may develop hirsutism, infertility, menstrual irregularities, and men may experience deterioration in potency. Neurological dysfunction occurs: headaches, sleep disturbance; autonomic disorders: sweating, arterial hypertension.

Endocrine obesity

The endocrine form of obesity is characterized by a predominance of symptoms of underlying diseases caused by hormonal imbalances. The distribution of fat is usually uneven, with signs of feminization or masculinization, hirsutism, gynecomastia, and cutaneous stretch marks. A unique form of obesity is lipomatosis – benign hyperplasia of adipose tissue. Manifested by numerous symmetrical painless lipomas, it is more often observed in men. There are also painful lipomas (Dercum lipomatosis), which are located on the limbs and trunk, are painful on palpation and are accompanied by general weakness and local itching.

Complications

In addition to psychological problems, almost all obese patients suffer from one or a number of syndromes or diseases caused by excess weight.

• cardiovascular system: coronary artery disease, arterial hypertension, angina pectoris, heart failure, stroke
• metabolic processes: type 2 diabetes mellitus
• digestive system: cholelithiasis, liver cirrhosis, chronic heartburn
• musculoskeletal system: arthritis, arthrosis, osteochondrosis
• reproductive organs: polycystic ovary syndrome, decreased fertility, libido, menstrual dysfunction, etc.

Obesity increases the likelihood of breast, ovarian and uterine cancer in women, prostate cancer in men, and colon cancer. There is also an increased risk of sudden death due to existing complications. The mortality rate for men aged 15 to 69 years with an actual body weight that is 20% greater than ideal body weight is one third higher than for men of normal weight.

Diagnostics

When examining patients with obesity, attention is paid to the medical history, family predisposition, the minimum and maximum weight after 20 years, the duration of the development of obesity, the activities carried out, the patient’s eating habits and lifestyle, and existing diseases are determined. To determine the presence and degree of obesity, the method of determining body mass index (BMI) and ideal body weight (IB) is used.

The nature of the distribution of adipose tissue on the body is determined by calculating a coefficient equal to the ratio of the waist circumference (WC) to the hip circumference (HC). The presence of abdominal obesity is indicated by a coefficient exceeding 0.8 for women and 1 for men. It is believed that the risk of developing concomitant diseases is high in men with WC > 102 cm and in women with WC > 88 cm. To assess the degree of subcutaneous fat deposition, the size of the skin fold is determined.

The most accurate results of determining the location, volume and percentage of adipose tissue from the total body weight are obtained using auxiliary methods: ultrasound, nuclear magnetic resonance, computed tomography, x-ray densitometry, etc. If patients are obese, they need to consult a psychologist, nutritionist and physical therapy instructor.

To identify changes caused by obesity, determine:

• blood pressure indicators (to detect arterial hypertension);
• hypoglycemic profile and glucose tolerance test (to detect type II diabetes mellitus);
• level of triglycerides, cholesterol, low- and high-density lipoproteins (to assess lipid metabolism disorders);
• changes in ECG and echocardiography (to identify disturbances in the circulatory system and heart);
• uric acid level in a biochemical blood test (to detect hyperuremia).

Obesity treatment

Each obese person may have their own motivation for losing weight: a cosmetic effect, reducing health risks, improving performance, the desire to wear smaller clothes, the desire to look good. However, goals for weight loss and its pace should be realistic and aimed, first of all, at reducing the risk of complications associated with obesity. Treatment for obesity begins with diet and exercise.

Diet therapy

For patients with BMI< 35 назначается гипокалорийное питание с уменьшением калорийности пищи на 300-500 ккал и усиление физической активности. Ограничение калорийности идет за счет уменьшения суточного потребления жиров (особенно, животных), углеводов (в первую очередь, рафинированных), при достаточном количестве белка и клетчатки. Предпочтительные виды термической обработки пищи – отваривание и запекание, кратность питания – 5-6 раз в сутки небольшими порциями, из рациона исключаются приправы, алкоголь.

When following a hypocaloric diet, basal metabolism decreases and energy is conserved, which reduces the effectiveness of diet therapy. Therefore, a hypocaloric diet must be combined with physical exercise, which increases the processes of basal metabolism and fat metabolism. The prescription of therapeutic fasting is indicated for patients undergoing hospital treatment with severe obesity for a short period.

Drug therapy

Drug treatment of obesity is prescribed when a BMI is >30 or the diet is ineffective for 12 weeks or more. The action of drugs from the amphetamine group (dexafenfluramine, amfepramone, phentermine) is based on inhibition of hunger, acceleration of satiety, and anorectic effect. However, side effects are possible: nausea, dry mouth, insomnia, irritability, allergic reactions, addiction.

In some cases, the administration of the fat-mobilizing drug adiposine, as well as the antidepressant fluoxetine, which changes eating behavior, is effective. The most preferred drugs today in the treatment of obesity are sibutramine and orlistat, which do not cause significant adverse reactions or addiction. The action of sibutramine is based on accelerating the onset of satiety and reducing the amount of food consumed. Orlistat reduces the absorption of fats in the intestines. For obesity, symptomatic treatment of underlying and concomitant diseases is carried out. In the treatment of obesity, the role of psychotherapy (conversation, hypnosis) is high, changing the stereotypes of developed eating behavior and lifestyle.

Surgical treatment of obesity

Prognosis and prevention

Timely, systematic interventions for the treatment of obesity bring good results. Already with a decrease in body weight by 10%, the overall mortality rate decreases by >20%; mortality caused by diabetes > than 30%; caused by cancer concomitant with obesity, > than 40%. Patients with I and II degrees of obesity remain able to work; with degree III - they receive disability group III, and in the presence of cardiovascular complications - disability group II.

To prevent obesity, a person with normal weight only needs to spend as many calories and energy as he receives during the day. With a hereditary predisposition to obesity, after the age of 40, with physical inactivity, it is necessary to limit the consumption of carbohydrates, fats, and increase protein and plant foods in the diet. Reasonable physical activity is required: walking, swimming, running, visiting gyms. If you are dissatisfied with your own weight, in order to reduce it you need to contact an endocrinologist and nutritionist to assess the degree of violations and draw up an individual weight loss program.

Factors contributing to the development of obesity

Obesity classification

Obesity treatment, weight loss programs

Non-drug weight loss program

About the dangers of dosed fasting in the fight against excess weight, side effects and complications

Measures to prevent obesity

The student must be able to:

Determine and evaluate waist circumference and body mass index

Identify individuals with risk factors for obesity

Conduct a conversation with the patient about the general principles of obesity prevention

Conduct a conversation about rational “eating” behavior

The student must own:

Conducting a health assessment (determining weight, height, body mass index, waist circumference)

5. Topic study plan:

5.1. Control of the initial level of knowledge.

5.2. Basic concepts and provisions of the topic.

Obesity is a polyetiological chronic recurrent disease characterized by excessive deposition of adipose tissue in the body.

Traditionally, obesity is defined as excessive accumulation of fat that increases body weight by more than 20% relative to the ideal weight corresponding to a given age and sex group.

Obesity is a common pathological condition that represents a serious medical and social problem in most countries of the world. According to statistics from the World Health Organization (WHO), more than 30% of the world's population suffers from obesity, and according to some data, from 40% to 80% of the population of developed countries over the age of 25 are overweight. According to WHO data published in 2003, about 1.7 billion people on our planet are overweight or obese. It is most often found in the USA (34% overweight, 27% obesity), Germany and Canada. The results of sample studies conducted in Russia indicate that currently at least 30% of the working population of our country are overweight and 25% are obese. WHO experts suggest an almost twofold increase in the number of obese people by 2025, which, compared to data for 2000, amounts to 45–50% of the adult population of the United States, 30–40% of Australia, Great Britain and more than 20% of the population of Brazil. In this regard, obesity was recognized by WHO as a new non-infectious “epidemic” of our time.

The beginning of the 21st century was marked by a sudden awareness of the fact that obesity has become a truly serious problem for humanity. The increasing number of new cases of type 2 diabetes mellitus (T2DM), which often develops at a young age and is associated with severe complications and mortality from cardiovascular pathology, has begun to influence the consciousness of the public and the state. As we have recognized the importance of obesity, our view of adipose tissue has changed. Nobody views it anymore as a tissue that only stores fat. Now adipose tissue is the main “culprit” of many pathological conditions. But why does it happen that tissue, the sole purpose of which we recognized only as the accumulation of fat, suddenly leads, under certain circumstances, to the development and progression of many diseases?

Perhaps the answer lies in understanding the metabolism of animals that hibernate over the winter. This diverse group, including brown bears, golden ground squirrels, bats and frogs, experiences marked phenotypic changes during hibernation, which is thought to increase the body's resistance to hypothermia, ischemia, bacterial infection and muscle wasting. Animals that overwinter in this way prepare for winter by storing fat in existing fat cells. It has been proven that immediately before hibernation, peripheral resistance (insensitivity) to insulin increases, and glucose utilization by body tissues decreases. During hibernation, mammals lose 10% of their body weight, and after it they wake up thin and healthy. This seasonal change in phenotype, characterized by periodic development of insulin resistance and weight gain, is considered solely in terms of the animals acquiring a number of advantages, not the least of which is increased life expectancy.

In contrast, man has built his lifestyle on constant food consumption with a gradual increase in body weight from year to year. It’s as if we are preparing for hibernation, but we never hibernate in this way. It is possible that a reaction that protects the body for a short time later becomes the cause of long-term insulin resistance and the associated risk of developing cardiovascular pathology. This constant and unrelenting process over the years ultimately leads to depletion of pancreatic β-cells and an overt form of diabetes mellitus.

The effect of obesity on the risk of death.

Of course, obesity is an independent chronic disease, however, at the same time, it is also the most important risk factor for the development of many diseases.

Numerous prospective studies have convincingly demonstrated a clear association between increased body weight and an increased risk of developing a range of diseases. Thus, the risk of developing type 2 diabetes increases by 2 times with class I obesity, by 5 times with class II obesity, and by more than 10 times with class III–IV obesity. In addition, it is well known that more than 80% of patients with type 2 diabetes have varying degrees of obesity.

It must be emphasized that excess body weight often leads to an increased risk of a number of cardiovascular diseases and is currently identified as an independent and most significant risk factor compared to factors such as high blood pressure or smoking.

The contribution of obesity to the development of cardiovascular diseases appears to be complex, and an obvious confirmation of this is the established direct relationship between excess body weight and an increase in the incidence of not only coronary artery disease, but also other cardiovascular diseases. Moreover, obesity is associated with the development of lipid metabolism disorders. It is also known that against the background of obesity (both in combination with type 2 diabetes and without it), there is a violation of blood coagulation processes.

Obesity leads to accelerated progression of joint diseases, as well as a number of diseases accompanied by hypoxia (sleep apnea, respiratory failure).

Other dangerous conditions that develop against the background of obesity are infertility, gallstones, back pain and a number of malignant processes that often develop in the endometrium, prostate gland, mammary glands and colorectal area. Thus, a relationship has been established between obesity and cancer.

Numerous studies have convincingly proven that losing body weight significantly reduces blood pressure, multifactorially improves the lipid profile, and reduces the risk of developing type 2 diabetes mellitus (DM). In contrast, the progression of obesity leads to an increase in disability and mortality.

At the same time, the authors of a number of studies deny the role of obesity as an independent predictor of death from cardiovascular diseases or believe that the influence of this factor on mortality is much less than that of smoking, arterial hypertension or hyperlipidemia.

The relationship between mortality and body mass index is presented in Fig. 1.

Increased mortality among obese individuals is primarily due to type 2 diabetes and cardiovascular diseases.

Adipose tissue depot.

It should be noted that white adipose tissue (BJT) is the main tissue that stores energy in humans. And when energy is needed, it is not taken from circulating “fuel” or carbohydrate reserves, but is mobilized from BAT through the process of lipolysis and the breakdown of triglycerides to glycerol and non-esterified fatty acids.

Brown adipose tissue (BAT)“specializes” more in the production of heat than in organizing “fuel” reserves. The IAT consists of multi-stage fat droplets and a large number of mitochondria. SAT innervates sympathetic nerves, which provides direct stimulation of thermogenesis through β 3 -adrenoreceptors. The heat production process protects against cold and regulates energy balance.

Obesity in humans is mainly characterized by hypertrophy (increase in volume) of fat cells. However, in individuals with severe, severe obesity, the number (hyperplasia) of fat cells is additionally increased due to the attraction of “sleeping” preadipocytes, which are quite numerous in all fat depots.

The amount and distribution of fat depends on gender, age and lifestyle. In both men and women, the amount of fat increases with age.

In young men who are not overweight, the proportion of fat is no more than 20%, and in older men it can exceed 25% of weight. In young women, the proportion of fat may be less than 30%, but then gradually increases and in older women it exceeds 35% of weight. Women of childbearing age, on average, always have more fat than their male peers. The amount of fat can change under the influence of many medications. The type of obesity and fat distribution are important for diagnosis and prognosis.

Currently, there are 6 specialized fat depots:

1. subcutaneous

2. deep abdominal

3. retro-orbital

4. mesotherial

5. para-aortic

6. stuffing box

Moreover, it is known that each of the specialized fat depots has certain functional characteristics. The severity of obesity complications does not necessarily depend on the severity of total fat accumulation. At the same time, they are associated with the distribution of fat in the patient’s body.

Classification of obesity according to the distribution of adipose tissue.

1. Android (metabolic, visceral, abdominal)- the accumulation of fat mainly in the abdominal area and in the upper half of the torso is called male obesity (“apple”).

2. Gynoid– in the area of ​​the hips and buttocks - female type obesity (“pear”).

The distribution of fat in the body is of fundamental importance. Increasingly, the indicator is used as an indicator of the risk of developing pathologies associated with obesity. waist circumference (WC), reflecting the predominant accumulation of fat in the abdomen (abdominal region), clearly correlating with CT, MRI and densitometry data. The WC indicator is recognized as a more reliable marker of the risk of developing most pathological conditions associated with obesity, including the risk of increased mortality. It is the visceral fat depot that is most clearly associated with all the negative consequences of both a metabolic and vascular nature. Visceral adipose tissue, in contrast to adipose tissue of other localizations, is richer innervated and has a wider network of capillaries. Hormonal disorders accompanying abdominal obesity are expressed in increased levels of cortisol, testosterone in women, insulin, norepinephrine and decreased testosterone levels in men. All of these factors together can contribute directly or indirectly to the development of metabolic disorders. It should be especially emphasized that obesity is accompanied by a violation of the action of insulin at the level of peripheral tissues - insulin resistance, which in turn causes an increase in the levels of insulin, cortisol, growth hormone in the blood and changes in the secretion of sex hormones, as well as a violation of the lipid profile. In this regard, insulin resistance, which develops against the background of obesity, is often associated with the development of type 2 diabetes, arterial hypertension and lipid metabolism disorders. Why exactly visceral fat accumulation is so dangerous is not completely clear.

Table 2. Waist circumference and risk of metabolic complications(WHO, 1997)

Factors contributing to the development of metabolic obesity.

1. Genetic – often signs of visceral obesity occur within the same family.

   Male gender - visceral obesity is much more common in men than in women, with no difference in age and BMI.

Functions of adipose tissue.

Recently, a lot of evidence has accumulated that fat cells, in addition to their role as the most important reservoir of energy, perform a number of endocrine and auto/paracrine functions.

Functions of adipose tissue:

1. Energy reserves and metabolism.

2. Immune

3. Mechanical

4. Temperature

5. Endocrine, paracrine

Thus, it has now been established that the secretion products of adipocytes are estrogens, angiotensinogen, prostaglandins, tumor necrosis factor α (TNF-α), other cytokines (interleukin-6), leptin, insulin-like growth factor 1 and binding proteins, plasminogen activator inhibitor 1.

Diagnosis of obesity.

The indicator that is most often used to assess the stage of obesity is body mass index (BMI). This index is calculated as the ratio of body weight expressed in kilograms to height in meters squared. It has been proven that BMI has a high level of correlation with the amount of adipose tissue in the body, therefore it is recommended by WHO as the main indicator in diagnosing obesity.

BMI is calculated using the following formula:

BMI = B/P2,

where BMI is body mass index, B is weight (kg), P2 is height squared (m2).

Weight deficit – below 18.5 kg/m 2 ;

Normal body weight – 18.5 -24.9 kg/m 2 ;

Excess body weight corresponds to an indicator of 25.0–29.9 kg/m 2 ;

Obesity I degree - 30.0–34.9 kg/m 2 ;

Obesity II degree - 35.0–39.9 kg/m 2

Obesity III degree - above 40.0 kg/m 2 .

Causes of obesity.

The causes of obesity are varied. To varying degrees, body weight and the distribution of adipose tissue in the body are influenced by both external (nature of nutrition, level of physical activity), and psychological, hereditary, and medical factors.

According to the literature, the main reasons contributing to the development of obesity are “bad genes” and “too good environmental factors.”

Based on this, obesity can be defined as a syndrome that occurs as a result of the interaction of many factors: physical, biochemical, metabolic, behavioral, which lead to increased accumulation of fat and weight gain.

Factors contributing to the development of obesity.

Genetic factors.

Environmental factors (poor nutrition, sedentary lifestyle, stress, etc.)

Genetic predisposition to the development of obesity is the subject of the most intensive research. Thus, it has been shown that the genetic basis accounts for 40 to 70% of the risk of developing obesity. Genes are known to be involved in the regulation of appetite, food selection, energy homeostasis, physical activity tolerance, etc. Attaching great importance to the genetic basis in the development of obesity, however, it is quite difficult to explain the progressive increase in the prevalence of this disease only by genetic defects.

Classification of obesity by cause.

Exogenous-constitutional

Pathological – obesity associated with endocrine pathology and some genetic syndromes.

Obesity represents a heterogeneous group of disorders, in most cases of unknown etiology. Of the total mass of obese people, only some are able to determine the true cause of the disease. Often, these are those forms of obesity that are associated with endocrine pathology (Itsenko-Cushing's disease and syndrome, etc.) or some genetic syndromes. Obesity is observed in the following genetic syndromes: Lawrence-Moon-Bardet-Biedl, Morgagni-Stuart-Morel, Prader-Willi, Kleine-Levin, Ahlström-Halgren, Edwards, Barraquer-Simons. With the listed genetic syndromes, excess body weight is combined with neurological disorders, growth disorders, physical and sexual development, psychovegetative and sympathoadrenal reactions. Patients with genetic syndromes and obesity require genetic testing. In most cases, obesity is classified as alimentary-constitutional. However, such a definition is superficial in nature and states only the external manifestations of the pathological process, since obesity represents a heterogeneous group of conditions that are quite similar in their clinical characteristics, but which have different etiologies.

Currently, it is believed that energy homeostasis consists of 3 main components: energy intake, energy expenditure and energy reserves.

It is important to note that energy intake and expenditure are processes of integration of many different factors. Thus, in terms of food intake, the role of society, the gastrointestinal tract, the nervous system, adipose tissue, and the endocrine system are discussed. At the same time, in terms of energy expenditure, an important role is played by: habits, motivation, life circumstances, basal metabolism, and climatic factors.

Weight loss programs.

Obesity is a serious medical problem that requires appropriate effective correction with the involvement of specialists in various fields.

The generally accepted strategy is to apply a non-drug therapy program to all patients, which, if necessary, can be supplemented by medical and (or) surgical treatment of obesity.

The non-drug treatment program for obesity includes diet therapy, dosed exercise and behavioral therapy. Drug treatment of obesity is performed in case of insufficient effectiveness of non-drug therapy in obese patients. Surgical treatment of obesity is used in patients with a BMI equal to or exceeding 40 kg/m2 (in case of ineffective conservative treatment). Surgical treatment is permitted only in adult patients with a history of obesity of at least 5 years - in the absence of alcoholism and mental illness.

When carrying out non-drug treatment, in most cases, a method of moderate gradual weight loss is used, within which three main stages are distinguished.

At the first stage, which lasts from 1 to 6 months. treatment, achieve weight loss of approximately 10% of the original value. From 7 to 12 months. (second stage of treatment) maintain weight at such a level that it is 5–10% lower than the original one.

At this stage, you should not strive for further weight loss due to the decrease in basal metabolism that occurs after 6 months. since the start of obesity treatment. An attempt to force weight loss at this stage causes such a significant decrease in basal metabolism that patients develop a relapse of obesity. The basal metabolism stabilizes at a new level only after 1 year from the start of treatment. From this time on, the third stage of weight loss begins, in which further reduction in body weight is achieved.

Losing 5 to 10% of initial body weight reduces the risk of obesity-related diseases. The goal of treatment should be moderate weight loss, maintained over the long term, using therapeutic measures that would be individualized for each patient after a thorough assessment of all associated pathological conditions.

Specific treatment goals should be developed for each patient, defining an energy deficit that can be achieved by reducing food intake and increasing physical activity. All this must be observed at all times.

You can reduce the caloric content of food by observing the following: Basic Rules:

1. Limit the consumption of high-calorie (“harmful”) foods:

b) sugar and sugar-containing sweets (average calorie content, but satiating ability and stomach distension are weak), dried fruits;

c) alcoholic drinks.

2. Reduce the consumption of foods of average calorie content (“suitable foods”) by half the usual amount, if the weight loss is insufficient on a low-calorie diet with limited fat or there is type 2 diabetes:

rich in starch and fiber (potatoes, all types of bread, cereals, pasta, legumes, fruits and berries - except dried fruits and olives);

Increase the consumption of low-calorie foods (“healthy foods”, contain a lot of water, fill the stomach, but do not add weight) - mineral water, coffee and tea without sugar, all types of greens and vegetables (except potatoes and legumes).

As medical practice shows, reduced diets containing 500-800 kcal, with a sharp restriction of carbohydrates, high protein or fat content have no advantage over a balanced low-calorie diet. Complete fasting with the use of mineral waters is considered insufficiently justified due to the proven lack of effect and the risk of complications (ketoacidosis, dyspeptic disorders, collapse, cardiac arrhythmias, myocardial ischemia). There are also other recommendations for dietary therapy for obesity: the Atkins diet, the protein diet (Zone), the Ornish vegetarian diet, and even a diet that provides nutrition for the patient depending on his blood type. The disadvantages of all these types of dietary therapies are that they have not been tested in multicenter clinical trials, and when followed, significant side effects have been observed. The effectiveness of various types of diet therapy for obesity was assessed by specialists compiling the National Registry of Body Weight Correction (USA). 3,000 cases of successful non-drug treatment of obesity were analyzed. It turned out that in 98.1% of cases, success in the treatment of obesity was achieved in patients on a low-calorie diet, in 0.9% in patients on the Atkins diet, and in 1% in other types of dietary treatment.

The optimal type of physical activity used to treat obesity is dynamic aerobic exercise. In patients with a BMI up to 40 kg/m2, it is recommended to begin physical training with walking at an average pace - 100 steps per minute. The duration of such training is 30 minutes, and their frequency is 3-4 times a week. Gradually, the intensity of the load is increased: the pace of walking is increased to high (160 steps per minute), duration - up to 45–60 minutes, frequency - up to 1 time per day. This amount of physical activity allows you to increase energy expenditure by 200–300 kcal per day.

In patients with a BMI of 40 kg/m2 or more, physical training begins with walking at a slow pace (65 steps per minute) for 10 minutes 3 times a week. Gradually, the intensity of the load is increased to an average level - 100 steps per minute for 30–45 minutes 4–7 times a week.

Non-pharmacological treatment of obesity cannot be successful without adequate behavioral therapy. The latter involves creating motivation for the patient to lose weight, orienting the patient to a lifelong program to combat obesity, self-control by keeping a diary of weight, nutrition and physical activity, limiting the use of drugs that contribute to weight gain, treating sexual dysfunction and depressive disorders, combating stress, a “sedimentary” lifestyle, compliance with food intake rules and other activities.

Medication methods Treatments for obesity can only be effective against the backdrop of a dietary regimen and physical activity. Under these conditions, drug therapy promotes more intensive weight loss and maintaining it at the achieved level. Drug therapy is not recommended for children, pregnant women, or during lactation.

When prescribing medications against obesity, it is necessary to take into account their possible side effects.

All obese patients taking medications should be examined regularly by a physician.

Rapid weight gain is common with short-term use of anti-obesity medications (12 weeks or less).

The duration of use of anti-obesity drugs should not exceed the period of time recommended in the instructions for use.

In cases of effective weight loss, it is necessary to adjust the dose of other medications that the patient may be taking. For example, the dose of glucose-lowering drugs may be reduced because Insulin sensitivity increases with weight loss.

According to the mechanism of action, drugs for the treatment of obesity can be divided into three groups:

drugs that reduce appetite and help reduce food consumption: sibutramine (Meridia);

drugs that increase energy expenditure: caffeine, sibutramine (Meridia);

drugs that reduce nutrient absorption: orlistat (Xenical).

It is not recommended to use medicinal plant herbs and nutritional supplements for obesity. Many medicinal mixtures used for weight loss contain nephrotoxic plants (stephania, magnolia), hepatotoxic herb germander, as well as ephedra, which has a toxic effect on the kidneys, liver and overstimulates the cardiovascular and nervous systems. When using preparations containing ephedra, cases of acute myocardial infarction, stroke, acute liver and kidney failure have been reported. Components such as caffeine, chromium picolinate, chitosan, fiber, and soluble dietary fiber are used in medicinal preparations and in the form of dietary supplements for weight loss. Their ability to influence the severity of obesity has been assessed in various studies. It turned out that of all the remedies listed above, only soluble fiber (guar gum) significantly reduced body weight, but this reduction was only 5%. When using guar gum, some patients developed intestinal obstruction and esophageal obstruction.

Surgery used for severe obesity, when other methods have been unsuccessful. There are several options for surgical treatment: the use of intraventricular balloons, bariatric surgery: bypass surgery, restrictive surgery, vertical gastroplasty, gastric banding, gastric bypass, biliopancreatic bypass, gastric pacemaker technique and plastic aesthetic surgery: liposuction, dermatolipectomy.

On average, patients can lose more than 50-80% of excess weight over the next 12-18 months. All patients treated surgically should follow a weight loss program and be monitored by a specialist for the first 2 years at least quarterly and then annually.

Gastroplasty (vertical and bandage), gastric bypass and biliopancreatic bypass are currently used as surgical methods for treating obesity. Gastroplasty allows you to lose from 50 to 70% of excess adipose tissue, with gastric bypass it is possible to get rid of 65–75% of excess fat, and with biliopancreatic bypass - from 70–75%. Gastroplasty is the most common bariatric surgery in Western Europe, as it is less likely than other types of surgery to lead to chronic metabolic complications and gastrointestinal disorders. In the United States, for severe obesity, they prefer to perform gastric bypass surgery, since in this case there is no decrease in effectiveness even many years after its implementation. However, gastric bypass is accompanied by a much greater number of complications. The most severe complications occur in patients undergoing biliopancreatic bypass. The National Institutes of Health (USA) does not recommend the use of this operation due to the frequent development of severe hypoproteinemia and chronic painful diarrhea. To prevent chronic metabolic complications, all patients undergoing bariatric surgery receive high-quality multivitamins, a diet containing at least 60 g of high-quality animal protein per day, and, if necessary, calcium, iron and vitamin B12 supplements are prescribed.

Principles of rehabilitation of obese patients.

at the stage of weight loss - reducing it by 5-10 kg over 6 months;

at the stage of maintaining body weight - maintaining the achieved weight over the next three years of observation;

a sustainable decrease in waist circumference by at least 4 cm.

Below are quantitative standards for assessing the results of obesity treatment (WHO):

Less than 5% of initial body weight – insufficient effect;

5-10% - satisfactory

More than 10% - good

Currently, according to the criteria of evidence-based medicine, patient management based on the physiological principles of a low-calorie diet with limited fat and sufficient protein and carbohydrates, with adequate physical activity and additional drug therapy (as indicated), gives the best long-term positive result.

Prevention of obesity.

Primary prevention of obesity must be carried out: with a genetic and family predisposition, with a predisposition to the development of diseases associated with obesity (type 2 diabetes, arterial hypertension, coronary heart disease), with risk factors for metabolic syndrome, with a BMI > 25 kg/m2 especially in women. It is necessary to remember the critical periods of risk for the formation of exogenous constitutional obesity:

The period of intrauterine development (3rd trimester), when the mass of fetal adipose tissue increases 10-15 times.

The period of early childhood, especially the first 2 years of life, when the processes of adipocyte hyperplasia prevail over hypertrophy.

The period of puberty, when the hypothalamic-pituitary regulation of hormonal homeostasis is increased.

In all cases, the basis for primary prevention of obesity is a healthy lifestyle, including:

Rational balanced nutrition

Systematic physical education, constant physical activity

Avoidance of smoking, alcohol abuse

WHO recommendations for preventing obesity include keeping a healthy lifestyle diary for people with risk factors. It is recommended to record in a diary the dynamics of changes in key indicators (BP, BMI, WC, blood glucose and cholesterol levels), daily physical activity, and nutritional patterns. Keeping a diary disciplines and promotes lifestyle modification to prevent obesity.

This manual examines only some aspects related to the epidemic of our time - obesity. This condition is truly dangerous to health, requiring medical intervention and constant monitoring, because associated with the development of a number of diseases. Without a doubt, only the unification of the efforts of scientists from various specialties, the intensification of research related primarily to the final determination of the role of adipose tissue in the human body, will make it possible to develop adequate measures for the treatment and prevention of this disease.

The 21st century has seen an increase in obesity rates. Obese people include both adults and children. The diagnosis of obesity is made if the BMI (body mass index) exceeds 30 kg/m2. Morbid obesity is considered when weight exceeds normal body weight by 2 or more times. In Russia, approximately 30% of the working population is obese.

WHO (World Health Organization) recognized obesity in 1998 as a disease that progresses if left untreated.

Obesity contributes to a reduction in human life expectancy. Obesity contributes to the development of diseases such as hypertension, atherosclerosis, ischemic heart disease (coronary heart disease), angina pectoris, myocardial infarction. Obesity affects the quality of life of patients, leads to early disability and a significant reduction in life expectancy for people suffering from this disease.

The mechanism of obesity development is as follows. Human adipose tissue consists of fat cells (adipocytes) that are capable of producing leptin, a hormone that causes a feeling of fullness. Leptin enters the brain and leads to decreased appetite. With excess adipose tissue, leptin levels are elevated, and the body stops correctly assessing its amount. And in this case, a person begins to produce the hormone ghrelin, which leads to an increase in appetite. Resistance to the hormone leptin develops. This explains the increased appetite in obese individuals.

Obesity is generally a risk factor for cardiovascular disease.

The mechanism of the effect of obesity on heart function is as follows. Obesity increases the volume of blood passing through the heart, which leads to greater compression of the vessel walls. In order to adapt to increased loads, the heart is forced to pump out more blood per unit of time. Thus, there is an increase in the amount of blood that the heart is forced to eject in one systole (one contraction). In this case, an increase in the number of heart contractions is observed, and the level of peripheral vascular resistance is reduced. With an increase in the amount of adipose tissue in an obese patient, the force of heart contractions increases, the heart muscle stretches, and the load on the blood vessels increases. As a result, an obese patient develops hypertension and metabolic syndrome. In obese people, the chamber of the left ventricle of the heart enlarges and the myocardial walls hypertrophy. The left atrium also enlarges. This circumstance does not depend on the patient’s age and blood pressure (blood pressure). All these changes contribute over time to the development of heart failure, heart rhythm disturbances, and the development of atrial fibrillation.

According to statistics, in obesity the incidence of hypertension is 75%, type 2 diabetes is 60%, and coronary heart disease is 20%.

Obesity contributes to the development of dyslipidemia; about 30% of obese people have elevated levels of cholesterol and its fractions in the blood, which in turn leads to the formation of atherosclerotic plaques, including on the walls of the heart vessels.

The high percentage of mortality and incidence of cardiovascular diseases is due to vascular damage, since obesity is a factor leading to atherosclerosis, arterial hypertension, and the risk of myocardial infarction.

The link between obesity and the development of cardiovascular disease and complications was established during the Framingham Study, which followed 5,209 men and women without cardiovascular disease over a 26-year period. This study found that obesity is a risk factor for cardiovascular complications, especially in women. The study showed that with an increase in BMI to 25.0-29 kg/m2, the risk of IHD increased by 2 times, and with a BMI above 29 kg/m2, the risk of IHD increased by 3 times.

Attention should be paid to the fact that an increased risk of cardiovascular diseases is present not only with obesity, but also with increased body weight. This circumstance was also established during the Framingham study, which revealed a relationship between the influence of body weight after 25 years and the risk of cardiovascular diseases and a decrease in the risk of cardiovascular diseases with a decrease in body weight.

In the United States, a study was conducted over 14 years among the adult population (4,576,785 men and 588,369 women), which showed that high BMI was a predictor of mortality from cardiovascular diseases, mostly in men. An increased risk of mortality has also been found in overweight men and women. Based on the results of the study, it was concluded that the risk of mortality increased from cardiovascular diseases in all individuals with excess body weight in all age groups. The results of the study confirm the established relationship between the risk of mortality and the presence of obesity, as well as an increased risk of mortality even with a moderate increase in body weight.

The main goal in the treatment of obesity is to reduce the risk of developing cardiovascular diseases (hypertension, coronary heart disease, angina, myocardial infarction) and other diseases such as diabetes, atherosclerosis, etc. In the case of successful treatment of obesity, the health of patients not only improves, but also their life expectancy increases, and the level of quality of life of patients suffering from obesity increases.

For the treatment of obesity, it is most advisable to reduce body weight from 0.5 - 1.0 kg per week for six months and maintain the achieved result for a long time.

A sharp decrease in body weight, especially if the patient suffers from cardiovascular disease, can contribute to the occurrence of serious complications, the development of arrhythmia, sudden death (with a lack of protein intake from food, atrophy of the heart muscle, especially in the elderly). Therefore, in the process of losing body weight, it is necessary to regularly conduct electrocardiography and blood pressure measurements. Recommending increased exercise in obese patients with cardiovascular pathology should be done with caution - only if the patient’s condition is stable and a thorough cardiac examination, after performing exercise tests, measuring blood pressure, and performing Holter monitoring). It is necessary to avoid rapid weight loss in case of frequent attacks of angina, the unstable condition of the patient, unstable angina, for six months after myocardial infarction. Rapid weight loss is contraindicated if the patient suffers from diabetes or has signs of heart failure.

It has been established that changing lifestyle, increasing physical activity and gradually reducing body weight by reducing calories leads to a reduction in the risk of developing cardiovascular diseases. With a weight loss of 1 kg. blood pressure decreases by 1 mmHg. In case of hypertension, weight loss of 8-10 kg reduces the thickness of the wall of the left ventricle.

It is advisable to treat obese patients with the participation of a nutritionist or nutritionist. Currently, diet therapy, increased physical activity, pharmacotherapy and surgical treatment are used to treat obesity.

Thus, it has been proven that weight loss is effective for the prevention and treatment of cardiovascular diseases, improves the quality of life and increases life expectancy.

Bibliography:

1. Kalinchenko S.Yu. Obesity and reproductive dysfunction in men.-M., 2004 -35 p.
2. Melnichenko G.A., Romantsova T.I. Obesity: epidemiology, classification, pathogenesis, clinical symptoms and diagnosis: A guide for doctors. - M.: MIA, 2004. -56 p.
3. Obesity. Guide for doctors / N.A. Belokova, V.I. Mazurova. – St. Petersburg: St. Petersburg MAPO, 2003 – 312 p.
4. Ametov A.S., Demidova T.Yu., Tselikovskaya A.L. Obesity and cardiovascular diseases // Therapist. arch. -2001.- No. 8.-S. 69-72.
5. Clinical recommendations for the treatment of morbid obesity in adults / Bondarenko I.Z. // Obesity and metabolism. - 2011. - No. 3. -P. 12-14.

The main property of a living organism is constant self-renewal, which is much more intense during work than at rest. Active work increases the vitality of the body and slows down aging. “Muscular joy” was what I. Pavlov called the feeling of elation and vigor that he experienced as a result of work. Here is what he notes about this: “All my life I have loved and love mental and physical work, and, perhaps, even more than the second. And I especially felt satisfied when I made some good guess into the last one, that is, I connected my head with my hands.”

Aging is characterized by a gradual weakening of many vital functions, a decrease in metabolic rate, and a decrease in the activity of biological catalysts - enzymes. True, sometimes signs of obvious aging are detected at 40 or even 30 years old, and sometimes at 60 or even 70 years old a person is young and full of energy. Thus, old age is a concept that should be associated not only with calendar age, but also with the physiological state of the body.

There are about 250 theories of aging. Some scientists view old age as a result of a decrease in the adaptive capabilities of the body, others - as a consequence of a decrease in the activity of the endocrine glands, others see the main cause in chronic intoxication, and others - in the processes of replacement of vital tissues with elements of connective tissue.

Some researchers believe that aging occurs mainly due to the gradual weakening of metabolic processes. However, this is not the only reason for the onset of premature old age. Imbalance (disturbance of equilibrium) of certain types of metabolism also plays a significant role. The most common sign of premature aging is energy imbalance with accompanying obesity, decrepitness of body muscles and heart muscle, decreased mobility, and shortness of breath.

As we can see, it is no coincidence that obesity is given a prominent place among other factors. Many people mistakenly believe that not too much body fat in middle and old age is an indicator of health. Actually this is not true. The fact is that a disorder of fat metabolism is usually accompanied by an imbalance of mineral (salt), cholesterol and energy metabolism.

Naturally, all types of metabolism are closely related to the nature of nutrition. The conclusion involuntarily suggests itself that in rational, targeted nutrition we can see the opportunity to put into action powerful levers that help actively combat the process of aging and decrepitude.

As you age, you should gradually limit your caloric intake. In order to prevent a sharp break in the dynamic stereotype, the World Health Organization recommends reducing the caloric content of the diet with age over the decades as follows:

It is also important to take into account the anti-sclerotic orientation of the diet: reducing the total calorie content of food, reducing animal fats in its composition by increasing vegetable oils, ensuring a sufficient content of vitamins in the diet, consuming foods that are easily digested by digestive enzymes.

An elderly person should be especially demanding of himself in maintaining a diet. It is known that over the years the functional capabilities of the body decrease. Therefore, proper food intake and adherence to the principle of “what” and “how much” become important. Indulging in large amounts of food is extremely harmful. No wonder people say: “A glutton digs his own grave with his teeth.” Eating food at large intervals has no less detrimental effect on the body’s functioning. You must adhere to the rule: less and more often. An elderly person should avoid fatty foods, strong broths, and fried foods.

We advise older people to reduce the amount of carbohydrates per day in their diet (up to 300-320 g for men, up to 280-290 g for women). It should be no more than 50% of daily calories. This recommendation is based on the fact that carbohydrates have the ability to easily turn into fats in the body.

It should be remembered that with age, the regulation of carbohydrate metabolism changes, the ability of the liver to metabolize glucose decreases, and the activity of insulin circulating in the blood decreases, which disrupts the absorption of carbohydrates and can lead to the development of diabetes.

It is worth warning older people against excessive consumption of sugar, sweets, and all kinds of sweets. We recommend more often using foods containing fiber and pectin in your diet: carrots, cabbage, beets, prunes, wholemeal bread. Fruits that are rich in carbohydrates and have a positive effect on metabolic processes in the body are very useful. In cases where eating fruits in old age is associated with unpleasant subjective sensations (stool retention, increased gas formation), you should change the method of preparing them - take them boiled and baked. In winter and spring (when food lacks vitamins), it is necessary to take multivitamins, strictly adhering to the doctor’s recommendations.

As for foods containing protein, you need to remember the optimal daily protein intake. For older people, it is 1.4 g per 1 kg of body weight (for people over 70 years old, it is advisable to reduce the amount of protein to 1 g per 1 kg of body weight).

The need for proteins is best met through animal products. Particular attention should be paid to the balance of amino acids in food. To do this, we recommend combining products that ensure good protein absorption (for example, dairy and meat) with cereals, as well as “less valuable” proteins (bread, porridge) with “more valuable” ones (meat, milk, cheese, cottage cheese). The assignment of proteins to one group or another is determined by the nature of their amino acid composition.

Of course, the daily diet should be compiled taking into account the lifestyle and individual characteristics of the body. For example, older people who have switched to less intensive work due to age are recommended to reduce the total amount of protein contained in food, primarily by reducing animal protein, which is very much found in meat. Animal protein should be no more than 40% of the total amount of protein in the diet.

Elderly people should strictly limit their fat intake, since data obtained in numerous scientific studies indicate a significant participation of fatty substances in the pathogenesis of atherosclerosis. The optimal daily requirement of fat in old age is 0.8-1 g per 1 kg of body weight. Their share in the total daily calorie intake should not exceed 25%. Particularly important are fats of vegetable origin (sunflower and cottonseed oil), which have a stimulating effect on oxidative processes in the body.

With premature aging, redox processes slow down, which leads to dysfunction of individual organs and systems, the intensity of which can be increased with the help of vitamins. They seem to be specially designed for older people, as they accelerate physiological processes in the body. It should be borne in mind that vitamins should be supplied to the body moderately and comprehensively. Of particular importance are those that have the ability to strengthen blood vessels and thereby prevent the development of atherosclerosis.

Under the influence of, for example, vitamin C, the permeability of the vascular wall decreases, its elasticity and strength increase. Vessels become less brittle. In addition, vitamin C regulates cholesterol metabolism, helping to stabilize the physiological balance between the production of cholesterol and its utilization in tissues. However, you should not oversaturate your body with this vitamin. The norm is 70-80 mg per day.

In addition to natural ascorbic acid (vitamin C), food products contain substances that enhance its biological effect. These are so-called P-active substances that maintain the normal condition of the smallest vessels - capillaries, increase their strength and reduce permeability.

This can explain the greater activity of natural sources of vitamin C - fruits, vegetables, berries, which also contain vitamin P. There is especially a lot of vitamin P in black currants, blueberries, lingonberries, and chokeberries.

Elderly people need vitamin preparations such as choline (found in cabbage, fish, legumes), as well as inositol (a B vitamin), which have a beneficial effect on the nervous system and are involved in regulating the motor function of the stomach and intestines. . Inositol is found in oranges, melons, and green peas.

Vitamins, improving metabolic processes in the body, also have an anti-sclerotic effect. However, it should be remembered that with age they are less absorbed in the intestines. Therefore, it is advisable for older people to take ready-made multivitamin complexes (decamevit, undevit, panhexavit and others). The results of studies conducted at the Institute of Gerontology of the Russian Academy of Medical Sciences indicate that systematic (3-4 courses per year) intake of multivitamin complexes gives a stimulating effect, has a positive effect on the function of the heart, blood vessels, nervous system, and significantly improves mental state.