The relationship between overweight and obesity and the risk of premature death. Principles of rehabilitation of patients with obesity

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

Aging is characterized by the gradual weakening of many vital functions, a decrease in the intensity of metabolism, a decrease in the activity of biological catalysts - enzymes. True, sometimes signs of obvious aging are found at 40 and even at 30 years old, and sometimes at 60 and even at 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 physiological state organism.

There are about 250 theories of aging. Some scientists consider old age as a result of a decrease in the adaptive capabilities of the body, others - as a result of a decrease in the activity of the glands. internal secretion, others see the main reason in chronic intoxications, fourth - 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 premature old age. Imbalance also plays a significant role certain types exchange. Most common sign premature aging is an energy imbalance with accompanying obesity, decrepitude of the muscles of the body and heart muscle, decreased mobility, shortness of breath.

As we can see, it is no coincidence that obesity is given a prominent place among other factors. Many mistakenly believe that not too redundant body fat in middle and old age are an indicator of health. Actually it is not. The fact is that a violation 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 a rational, purposeful nutrition, we can see an opportunity to put into action powerful levers that help to actively resist the process of aging and decrepitude.

With age, you should gradually limit the calorie intake. In order to prevent a sharp break in the dynamic stereotype World Organization Health recommends the following reduction in calorie intake with age over decades:

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

Human old age must be especially demanding of himself in observing the diet. known to decrease with age functionality organism. Therefore, proper food intake, adherence to the principle of "what" and "how much" are important. Enthusiasm big amount food is extremely harmful. No wonder the people say: "A glutton digs his own grave with his teeth." No less detrimental to the life of the body eating at long intervals. It is necessary to adhere to the rule: less and more often. An elderly person should avoid fatty foods, strong broths, fried foods.

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

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

It is necessary to warn the elderly against the immoderate consumption of sugar, sweets, all kinds of sweets. We recommend more often to use in the diet products containing fiber and pectin substances: carrots, cabbage, beets, prunes, flour bread coarse grinding. Fruits are very useful, rich in carbohydrates and have a positive effect on metabolic processes in the body. In cases where the intake of fruits in old age is associated with unpleasant subjective sensations (stool retention, increased gas formation), the method of their preparation should be changed - they should be taken in boiled and baked form. In winter and spring (when food lacks vitamins), it is necessary to take multivitamins, while strictly adhering to the doctor's recommendations.

As for products containing protein, here you need to remember about the optimal daily rate squirrel. For the elderly, it is 1.4 g per 1 kg of body weight (for people over 70 years old, it is desirable to reduce the amount of protein to 1 g per 1 kg of body weight).

Protein needs are best met with animal products. Special attention should be given a balance in the diet of amino acids. To do this, we recommend combining products that provide 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 a particular group is determined by the nature of their amino acid composition.

Of course, the daily diet should be tailored to the lifestyle, individual characteristics organism. For example, older people who have switched to less intensive work due to age are advised 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.

Older people should strictly limit their intake of fats, as obtained in numerous scientific research data indicate a significant participation of fatty substances in the pathogenesis of atherosclerosis. The optimal daily requirement of fats in the elderly is 0.8-1 g per 1 kg of weight. Their share in the total daily calorie intake should not exceed 25%. Fats are especially important plant origin(sunflower and cottonseed oil), which have a stimulating effect on oxidative processes in organism.

With premature aging, redox processes slow down, which leads to dysfunction individual bodies and systems, the intensity of which can be increased with the help of vitamins. They seem to be specially designed for the elderly, as they accelerate physiological processes in organism. It should be borne in mind that vitamins should enter 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, permeability decreases vascular wall increases its elasticity and strength. Vessels become less fragile. In addition, vitamin C also regulates cholesterol metabolism, contributing to the stabilization of the physiological balance between the production of cholesterol and its utilization in tissues. However, you should not oversaturate the body with this vitamin. The norm is 70-80 mg per day.

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

This can explain the high 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 (it is found in cabbage, fish, legumes), as well as inositol (a vitamin from group B), which have a beneficial effect on the state of the nervous system, involved in the regulation of the motor function of the stomach and intestines. Inositol is found in oranges, melons, green peas.

vitamins, improving metabolic processes in the body, they 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, pangeksavit and others). The results of studies conducted at the Institute of Gerontology of the Russian Academy of Medical Sciences indicate that the systematic (3-4 courses per year) intake of multivitamin complexes has a stimulating effect, has a positive effect on the function of the heart, blood vessels, nervous system, and significantly improves the mental state.

The fight against obesity in the complex of therapeutic measures to improve the health of the population in last years came to the fore. As the sad medical statistics, this problem hung over the sword of Damocles modern society, and in the vast majority of cases, the onset of the disease is provoked by the people themselves.

Most often "guilty" in the occurrence of obesity wrong image life, and by adjusting it, it is quite possible to return your weight to stable indicators that correspond to the norm.

Overweight and obesity are rightly called the most important factor (along with physical inactivity and hereditary predisposition) that provokes the disease. hypertension. If you are overweight, obese, or have other predisposing circumstances, then this article is for you.

Eat different points vision of what the weight should be. It is unlikely that a modern fashion model with a weight of 55 kg and a height of 180 cm is a model that everyone should strive for. And how to calculate the stage of obesity and what weight is normal?

It is customary to distinguish four stages of obesity:

1 stage - excess weight by 10-29%; .
2 stage - by 30-49%;
3 stage - by 50-99%;
4 stage - 100% or more.

In the first and second stages of obesity, the ability to work and vital activity of patients are not impaired or only slightly impaired. The disease is still in its infancy, and to draw a line between "healthy fatness" and initial degree obesity is not always possible.

Hence the common joke about degrees of obesity: the first degree - when others envy, the second - when they laugh and the third - when they sympathize with the patient.

Factors contributing to the development of obesity: foods and alcohol

What contributes to the development of obesity in most cases? Most often, obesity is caused by systematic overeating. If the amount and calorie content of the food consumed exceeds the energy costs associated with the characteristics labor activity, physical activity, conditions of absorption of food in the gastrointestinal tract, obesity inevitably develops.

In addition to malnutrition, the development of obesity is facilitated by the predominant content of animal fats and easily digestible carbohydrates in food: the consumption of fatty meats, lard, butter. Also foods that contribute to obesity are flour and potatoes.

contributes to obesity and systematic use alcoholic beverages: they themselves have a high calorie content, besides, alcohol stimulates the appetite and contributes to immoderation in eating.

What else contributes to the development of obesity

In addition to obesity as a consequence of malnutrition, hereditary (constitutional) features of a person can play a certain role in the development of the disease. Families are quite common, all members of which have increased weight; however, even with “family fullness”, the whole thing is most often in the traditions of family nutrition, when children are overfed from an early age. Over the years addictions take root. A kind of vicious circle is created: adipose tissue, like any living tissue, requires nutrition, which leads to an increase in appetite, overeating and the transition of obesity to increasingly severe stages.

There are cases when the factors contributing to the development of obesity are a violation of the activity of the endocrine glands and the nervous system. Then obesity acts as one of the manifestations of another disease and requires special medical treatment.

But much more often, obesity is due to malnutrition and lack of physical activity.

Obesity is a risk factor for the occurrence and development of diseases

Obesity is a risk factor for the following diseases:

The increased load on the bones and joints in obesity leads to changes in musculoskeletal system, there are pains in the joints, limited mobility in the joints of the lower half of the body.
With pronounced obesity, the risk of cardiac disorders and the development of heart failure increases.
Obesity is a risk factor for the development of diseases such as atherosclerosis, gallstone disease, myocardial infarction. Obesity is also a risk factor for spinal diseases and, of course, hypertension.

Methods for the treatment of overweight and obesity: fasting days

The main method of treating obesity is a strict and long-term adherence to a low-calorie diet in combination with dosed physical activity. The calorie content of food should be reduced to 1100-1400 kcal per day. Salt should be limited to 2 grams per day. Instead of salt, you need to use spicy seasonings. One of the methods of combating obesity is limiting the amount of free fluid to 1-2 liters per day.

It is better to eat often, from 4 to 6 times a day, but in small portions - this dulls the feeling of hunger.

Once a week, with obesity, fasting days are arranged:

milk (kefir) - drink 6 glasses of milk (kefir) during the day;
meat - 300 g of boiled meat divided into 5-6 doses and additionally drink rosehip infusion without sugar up to 1 liter per day;
lettuce - combine fresh raw vegetables and fruits 250 g 5 times a day.

But the main principle of diet therapy for obesity in any case is to reduce energy value diet.

At the same time, sufficient intake of protein from food is necessary, but meat and fish are preferred. low-fat varieties and boiled. Daily consumption bread (mainly rye or bran) should be reduced to 100 g per day.

Rational nutrition for obesity: what foods are prohibited and what can be

Here are some foods you can with obesity: fresh cabbage, radishes, cucumbers, tomatoes, zucchini, eggplant. In limited quantities, you can consume fruits of sweet and sour varieties.

As for fats, you can’t completely refuse them. Some nutritionists recommend that obese people consume at least 80 grams of fat per day. But at the same time, most of the recommended amount of fat should come from vegetable fats used in cooking, including those added to salads and vinaigrettes.

Of course, vegetable fats are preferred: sunflower oil, cottonseed oil, corn oil, olive oil, etc.

Also to enhance the energy use of fat stores in the body balanced diet Obesity means limiting fluid intake.

Diet for obesity, diet therapy and therapeutic starvation

It is also necessary to strictly observe the diet for obesity, and best of all - prescribed by a qualified nutritionist.

In addition to diet therapy for obesity, systematic monitoring of body weight is necessary. If it turns out that all the measures taken do not give the desired results, you can enter a one-day fast once a week.

In general, fasting treatment has become a fashionable tool today in the fight against overweight, and this remedy is used uncontrollably, and this is very, very dangerous, which, by the way, also applies to irrationally or simply illiterately compiled “fashionable” diets.

Mechanism of action therapeutic fasting in obesity is still not well understood. In addition to positive experiences in using fasting to treat, for example, diseases of the central nervous system and other diseases, there are also negative experiences.

With uncontrolled fasting, a wide variety of and often dangerous complications are possible!

In addition, after an illiterate course of fasting, there is a high probability of gaining the same weight again very quickly.

Thus, without medical supervision, it is better not to engage in fasting.

Still much more reliable low calorie diet, which, albeit slowly, gives its results, especially if you combine it with constant physical activity.

Start at least by walking to and from work at a brisk pace. Race walking, jogging, swimming, morning exercises - these are your assistants in the fight against excess weight.

Disadvantages of laxative drugs for the treatment of obesity

In addition to starvation, today people with overweight bodies often resort to medicines. To lose weight, many, especially women, use laxatives.

Laxatives medicines for the treatment of obesity - both chemical and biological - have serious disadvantages:

Firstly , it is easy to get used to them;
Secondly , they weaken the work of the stomach and intestines;
Thirdly , they contribute to the leaching of potassium from the body, and potassium deficiency can contribute to the weakening of the kidneys and even the development kidney failure, weakening of all muscles, deterioration of mental activity, as well as heart disease.

You need to be very careful with all anti-obesity drugs that artificially reduce appetite. Most of these drugs contain amphetamine derivatives, which, although they eliminate the feeling of hunger, but at the same time excite the central nervous system.

And this can lead to insomnia, a feeling of anxiety, through the autonomic nervous system, the rhythmic work of the heart can be disturbed, and such unpleasant phenomena as sweating and muscle trembling may appear.

Phytotherapy for obesity caused by malnutrition

Phytotherapy for obesity is one of the effective ways treatment, because there are plants that improve metabolism and promote weight loss.

For example, you can take the collection: corn stigmas, dandelion (leaf), yarrow (herb), sage (herb), chicory (root, herb), buckthorn (bark), parsley (fruit), mint (herb) - only 20 g of dry chopped raw materials. 2 tbsp. spoons of the mixture pour 0.5 liters of boiling water. Take 100 ml 3 times a day 15 minutes before meals.

This infusion in the treatment of obesity and overweight regulates metabolism, activates ovarian function (which is important for women who develop obesity in the postpartum or menopause), improves the functioning of the intestines, pancreas, enhances the function of the kidneys to remove salts from the body.

The fight against obesity as a consequence of malnutrition: massage and baths

Baths are another way to combat obesity:

salt (2 kg salt per bath);
maritime ;
(mustard powder diluted in warm water, approximately 200-300 g per bath; water temperature - 36-37 °C, duration - 5-10 minutes; after the bath you need to wash yourself under warm shower and wrap yourself in a blanket)
turpentine (yellow solution for turpentine bath is prepared from 500 ml castor oil, 40 g of sodium hydroxide, 200 ml of water, 225 ml of oleic acid, 750 ml of turpentine; take 15 ml of emulsion per bath, gradually bring to 60 ml; water temperature - 36-39 ° С. The course of treatment - 10 baths for 15 minutes every other day).

Another great addition to diet therapy are saunas, steam baths, massage. Saunas (dry heat) and steam baths (moist heat) stimulate profuse sweating and therefore weight loss, which, however, is quickly restored if a large amount of water is drunk afterwards. The main point of such procedures is to remove toxins, improve blood circulation and stimulate metabolism, and all this contributes to weight loss.

But it is important to remember that only strong enough people can afford such procedures.

Massage for obesity helps to lose weight, because it activates blood circulation, has a calming effect on the nervous system, which is very important when following a diet when a person is subjected to severe nervous tension.

Tips for Treating Obesity: Diet and a Healthy Lifestyle

These tips relate to physical activity, diet in the treatment of obesity, useful skills And healthy lifestyle life:

1. If you want to lose weight only a few kilograms, then it is most reasonable to exclude all sweets, alcohol, and reduce fat from your diet. If you lose weight in this way, then later, even with good nutrition, you will not gain the lost kilograms.

2. If you need to lose more than 10 kg, first of all, consult with your doctor and take tests (the main thing is a blood test). Depending on the results, select best way for weight loss.

3. When you lose two-thirds of the unwanted weight figure, you can afford some of those foods that were banned. However, continue to monitor your weight, and if you notice that the weight has stopped falling, eliminate unwanted foods again.

4. Remind yourself more often about the motives that led you to lose weight (illness, shortness of breath, unaesthetic appearance, the inability to find a finished one of your size, etc.), this will strengthen your will.

5. Another tip for obesity: don't give in to whispers. inner voice: "I'm not that fat," be firm in the task.

6. In a moment of temptation, fight your weaknesses. If you can’t resist and eat a high-calorie meal, you will regain the lost kilogram, and it will take several days to lose it. If this has already happened, then the next day, eat only very light food, increase physical activity, visit the sauna. Remember that because of one sin, you doom yourself to a painful state.

7. Most nutritionists believe that losing weight should be slow. However, keep in mind that a lot depends on your individual characteristics. If you resort to a long half-diet, your efforts may be in vain, as you simply cannot keep such a regimen for a long time and will soon return to normal nutrition. So you need a strict diet, which must be carefully observed.

8. You can not quickly switch to a normal diet after you have achieved the desired weight. During this period, it is very important to find the diet that would provide you with a vigorous state and a stable weight.

9. All those habits of nutrition and a healthy lifestyle with obesity that you have learned during the diet should be preserved forever.

10. If after the diet you have gained 1-2 kg, immediately switch back to the diet that helped you: do not expect an avalanche of weight gain.

11. Remember that bad habits take root very quickly.

12. In the process of treating obesity, do not forget that your diet should be regular and harmonious. Don't eat on the go hastily. Find time to sit quietly at the table. Eat slowly, chewing your food thoroughly.

13. Give preference to healthy foods that are rich in protein and vitamins.

14. Foods with the highest protein content: fish, caviar, chicken meat, milk, curdled milk, eggs, nuts.

15. Foods with the highest content of vitamin A: parsley, spinach, liver, dried apricots, carrots, egg yolk, cheese, tomatoes.

16. Foods with the highest content of vitamin B ((thiamine): peanuts, peas, soybeans, pork, wheat bran, corn, barley, raisins, cucumbers, orange juice.

17. Foods with the highest content of vitamin C (ascorbic acid): parsley, blackcurrant, lemon, spinach, oranges, kiwi, pineapples.

18. Foods with the highest vitamin B content: fish fat, salmon, sardines, herring, chicken liver, yolk, sour cream.

19. Foods with the highest content of vitamin E (tocopherol): butter, eggs, spinach, beans, soybeans, peanuts, beef, lamb.

20. Foods with the highest calcium content: milk, cheese, almonds, soybeans, caviar, beans, egg yolk, cauliflower, lemon.

21. Foods with the highest iron content: beef broth, parsley, yolk, beans, raisins, dried apricots, dates, chestnuts, almonds, pears, mushrooms.

And always remember that diet is not a punishment. On the contrary, thanks to the diet, you can cultivate the strength of mind and the ability to obey the mind.

Diet will help you avoid later severe complications that inevitably leads to obesity.

Physiotherapy in the treatment of obesity

Weight loss in obesity is achieved primarily with the help of a low-calorie diet. Means of physiotherapy for obesity occupy the second place in importance and play an important role in complex treatment.

Most often, physical activity in obesity is used in combination with a diet. The success of treatment depends on the degree and stage of obesity. More favorable results are observed in the so-called dynamic stage, in which the deposition of fat occurs due to sharp increase appetite and acceptance a large number food. In the stable stage, there is inertness of fat depots due to metabolic disorders. Weight in such patients remains relatively constant regardless of diet and other therapeutic measures.

The purpose of physical activity in obesity is to disrupt the positive energy balance that has arisen as a result of overeating and reduced motor mode.

In order to achieve weight loss, a negative energy balance should be obtained by reducing the caloric content of food and increasing the energy expenditure of the body through physical means.

In diabetes, endocrine forms of obesity are not so rare, accounting for 5-10% of total number obese patients in general. With these forms, the main therapeutic measure is the appropriate correction of endocrine disorders.

In addition, one should keep in mind the so-called cerebral obesity and obesity of the lipodystrophic type, in which fat depots are concentrated in certain areas of the body.

pledge successful treatment in the most frequently observed forms of obesity, a complex and systematic application medical measures within 1-2 years. Failure is mainly due to the fact that patients fail to overcome appetite and established eating habits.

When compiling a physiotherapy complex, first of all, they include physiotherapy exercises, and then diaphoretic and other physiotherapy procedures, depending on general condition the patient and his ability to endure procedures of greater or lesser load.

Sweatshops are indicated for obese patients who do not have disorders of the cardiovascular system (hypertension, atherosclerosis, coronary disease, cardiac decompensation, etc.). These procedures are aimed at regulating water and electrolyte disorders, reducing the hydrophilicity of adipose tissue and reducing the tendency to edema. Under their influence, the metabolism also increases, and the energy costs of the body increase.

Weight loss caused by sweatshops is unstable; if the treatment is not combined with an appropriate diet and an active motor regimen, the mass is quickly restored.

General light baths are also used (55-60 ° C, 15-20 minutes per procedure every other day, 10-15 procedures per course), with the help of which an abundant release of water and salt with sweat is achieved - up to 1-2 liters. Light baths alternate with salt baths (38-39 ° C, 10-15 minutes per procedure, 10-15 procedures per course.

General wet wraps are used to obtain a diaphoretic effect - from 45 minutes to 1 hour daily. The procedures end with a rain shower at a water temperature of 36-37 ° C, a total of 15-20 procedures per course.

Ultraviolet rays also have a beneficial effect on metabolism, including fat metabolism. General body irradiation up to 2 biodoses (20-25 procedures per course) is used in order to stimulate the body as a whole and improve the patient's mood.

From thermal procedures with a diaphoretic effect, one can also keep in mind general mud baths, steam baths, etc. In addition to these procedures, jet, circular and underwater shower massages are prescribed.

In the absence of contraindications, hydrotherapy procedures (baths, showers, etc.) with low temperatures (33-25 ° C) are recommended in order to stimulate metabolism. Most effective procedure- contrast baths after underwater jet massage. Complex treatment contributes not only to weight loss, but also to the normalization of impaired metabolism.

Therapeutic exercise and physical activity in obesity

The most commonly used means for the treatment of obesity is exercise therapy.

The main task physiotherapy exercises in obesity - regulation of metabolism by enhancing oxidative and lipolytic processes. Under the influence of physical exercises, the functions of the cardiovascular and respiratory systems, motor activity gastrointestinal tract, reduced congestion in the lungs, in abdominal organs and the body as a whole. Under the influence of increased motor activity body weight is reduced mainly due to fat and to a lesser extent due to active mass body. In some cases, there is even an increase in active body weight with an increase in muscle strength and volume, which is especially favorable.

The choice of physical therapy for obesity depends on the severity of obesity and the presence of functional disorders on the part of the cardiovascular system, on the one hand, and on the other hand, on the age and fitness of the patient. Gymnastic exercises are used in different dosage, and the principle gradual increase loads.

Motor mode and physical activity in obesity

Physical activity should be properly distributed throughout the day: in the morning - hygienic gymnastics for 10-15 minutes; in the first half of the day - a set of physical exercises for various muscle groups and, in particular, for the abdominal press, exercises on shells, exercises on the Swedish wall, walking, bouncing; and all this combined with breathing exercises. Duration of classes - from 30-45 minutes to 1 hour. Between lunch and dinner - walking, walking in the air or physical labor.

In general, the entire motor regimen for obesity should be radically changed: from sedentary image life, you need to switch to an active motor mode. It's not always easy, as obese people usually don't get enough strong-willed people who tend to spend time in their room, lie down or sleep.

It is advisable to build a complex of physical exercises on the basis of bicycle ergometric tests, since with an increase in the degree of obesity, the functional capabilities of the cardiovascular system also decrease. However, people who are overweight should definitely consult a doctor about the regimen of exercise therapy.

For citation: Lupanov V.P. Obesity as a risk factor for the development of cardiovascular catastrophes // BC. 2003. No. 6. S. 331

Institute of Clinical Cardiology named after A.L. Myasnikova RKNPK Ministry of Health of the Russian Federation, Moscow

ABOUT obesity is a chronic polyetiological disease associated with the influence of a number of genetic and neurological factors, changes in the functions of the endocrine system, lifestyle and eating behavior patient, and not just those with energy imbalances. Distinguish alimentary-constitutional form obesity, which is the most common, and "endocrine" obesity caused by any primary endocrine disease - hypothyroidism, dysfunction of the ovaries, adrenal glands and other causes. Obesity can be defined as excess accumulation fat in the body, which is a health hazard. It occurs when the intake of energy in the body with food exceeds the energy expenditure (composed of basal metabolism or metabolism at rest and during physical activity). Overweight means only that the body weight of a particular person exceeds that which is considered normal for his height. Importance of obesity as a risk factor for development cardiovascular diseases(CVD) has recently increased significantly as the prevalence of obesity in the world population has increased. In Western European countries, more than half of the adult population aged 35-65 years are either overweight (body mass index / BMI / from 25 to 29.9 kg / m 2) or obese (BMI over 30 kg / m 2); In the United States, one third of the total population is overweight (20% or more overweight). ideal weight); in Russia, about 30% of people of working age are obese, and 25% are overweight. Table 1 presents the classification of obesity by BMI and risk concomitant diseases.

Obesity is a risk factor for the development of cardiovascular diseases (CVD), diabetes mellitus, and the presence of obesity in patients with coronary artery disease contributes to its progression and increased mortality. The relationship between BMI and the relative risk of mortality is shown in Figure 1.

Rice. 1. The relationship of body mass index with the relative risk of mortality (WHO Report, 1998) .

The increased risk associated with obesity is largely due to the high incidence of coronary and cerebral disorders in obese individuals. High rates of mortality and the incidence of cardiac complications are mainly due to vascular damage, because. obesity is an important predisposing factor: to the development of dyslipidemia (up to 30% of obese people have hyperlipidemia), type 2 diabetes mellitus (up to 80% of type 2 diabetics are overweight or obese), arterial hypertension (about half of obese people at the same time have hypertension) and sudden death. In addition, the independent effect of obesity on the cardiovascular system can be explained by its influence: on the function and structure of the myocardium, increased cardiac output, development of eccentric left ventricular hypertrophy (LVH), dystrophic disorders, and the appearance of congestive heart failure. LVH is more common in obese people than in thin people, regardless of the presence of arterial hypertension, which confirms the independent role of obesity in the origin of LVH, which in turn is an independent factor in the development of congestive heart failure, acute infarction myocardial infarction, sudden death and other cardiovascular events. In patients with coronary artery disease, a combination of lesions caused by a violation of fat metabolism, with foci of cardiosclerosis after myocardial infarction myocardium significantly reduces the functionality of the heart.

Obesity is associated with a number of dyslipidemias that predispose to CHD, including hypercholesterolemia, hypertriglyceridemia, decreased high-density lipoprotein (HDL) cholesterol, increased levels of apoprotein B and small, dense particles of low-density lipoprotein (LDL). In obesity, there is also a decrease in the activity of various tissue and plasma lipoprotein lipases, and the level of fibrinogen increases. Some authors find a connection between obesity and the level of lipoprotein a (small) and C-reactive protein. Obesity is accompanied by a violation of the action of insulin at the level of peripheral tissues - insulin resistance , which is one of the reasons for the formation of arterial hypertension (due to increased sodium reabsorption). In addition, the development of hypertension in obesity is associated with an increase in the load on the heart and an increase in blood volume, hypercortisolemia, and an increase in the activity of the renin-angiotensin system. Obesity is characterized by hypertrophy of fat cells, and with a pronounced form of obesity, the number of fat cells in the tissues of fat depots also increases. The adipose tissue itself performs and endocrine function, secreting substances that reduce the sensitivity of tissues to insulin. The role of leptin (a peptide hormone that carries out information communication between the hypothalamus and adipose tissue and is involved in the regulation of the center of hunger and satiety) in the pathogenesis of obesity has not yet been fully studied.

A clear association between obesity and the development of cardiovascular complications has been established according to data obtained in Framingham Study . In a 26-year follow-up of 5209 men and women without CVD at inclusion, obesity was shown to be an independent risk factor for cardiovascular complications, especially in women. Multiple logistic analysis showed that relative body weight (actual weight/ideal weight) at baseline played a predictive role in the development of CAD (angina pectoris, unstable angina, myocardial infarction, sudden death), cardiac mortality, heart failure in men. The effect of obesity on prognosis was independent of age, systolic BP, cholesterol, daily cigarette smoking, degree of LVH, and the presence of impaired glucose tolerance. In women, the value of relative body weight had a statistically significant relationship with the development of myocardial infarction, cerebral stroke, heart failure, and also with the level cardiovascular mortality. Obesity has had a long-term predictive value for CVD, especially in patients under 50 years of age. Further increase in body weight with age increases the risk of CVD in both men and women, regardless of initial body weight or the presence of other risk factors associated with weight gain (Fig. 2 and Fig. 3).

Rice. 2. The results of the Framingham study (26-year observation) showed that the incidence of cardiovascular diseases in general, coronary artery disease, myocardial infarction increased depending on excess body weight (as a percentage of ideal) in men and women.

Rice. 3. The results of the Framingham study (26-year follow-up) showed that the frequency of sudden death increased depending on the excess body weight (as a percentage of the ideal) in men and women.

Although obesity is an independent risk factor for CVD, there is a strong relationship between obesity and dyslipidaemia, arterial hypertension, impaired glucose tolerance, LVH. In the Framingham Study, only 8% of overweight men and 18% of women (30% of ideal body weight) did not have these classic CVD risk factors.

A study of the relationship between obesity (BMI) and mortality in 115,195 women aged 30 to 55 years, without CVD at inclusion, was conducted over a period of 16 years in " Nurses' Health Study (The Nurses Health Study)". The primary endpoint in this study was all deaths. Secondary end points were: death from coronary artery disease, occurrence of CVD and cancer. A trend towards higher mortality from coronary artery disease and other CVDs among women with an average body weight and a slight excess of it was revealed. The lowest mortality was observed among women who had a body weight of at least 15% less than the average body weight of a woman of the same age in the United States. The relative risk between BMI and mortality was a J-curve. Women who never smoked and had a BMI greater than 32 kg/m 2 had a relative risk of death from CVD of 5.8.

In the United States, a prospective study was conducted in American adults to study the relationship between body mass index and mortality. The study looked at the effects of age, gender, smoking and past illnesses on the relationship between BMI and mortality. It included 4,576,785 men and 588,369 women. The main criterion for "effectiveness" were deaths caused by any cause. Along with this, the relationship of BMI and deaths due to CVD was studied, oncological diseases and other reasons. For 14 years of observation 201622 registered deaths. In 4 subgroups, identified depending on the adherence to smoking and the presence of a current or past disease, the ratio of BMI and the risk of total mortality was studied. Relative risk was used to assess the relationship between BMI and mortality. It was shown that the relationship between BMI and mortality risk was significantly influenced by the smoking factor and the presence of concomitant diseases . In healthy never-smokers, the trough of the BMI-mortality curve was in the BMI range of 23.5 to 24.9 for men and 22.0 to 23.4 for women. Compared with those whose BMI was in the range of 23.5-24.9, white men and women with the highest BMI values had a relative risk of mortality of 2.58 and 2.00, respectively. High BMI was a strong predictor of CVD mortality, especially in men (relative risk 2.9; CI 2.37 to 3.56). An increased risk of mortality was found in obese men and women of all major groups. Based on the results, it was concluded that the risk of mortality from all causes, including cardiovascular and cancer, increased throughout the range from moderate to severe obesity in men and women of all age groups. Thus, the results of this study confirm the previously established relationship between the risk of mortality and severe obesity, as well as an increase in the risk of mortality with moderate overweight.

For the risk of developing CVD, not only the degree of obesity, but also the nature of the distribution of subcutaneous fat is of great importance. The relationship between obesity and CVD is often seen in the so-called. central or visceral obesity (which is most pronounced in the abdomen and chest) than with general obesity(which affects the lower half of the body). Visceral adipose tissue is characterized by pronounced lipolytic activity and metabolic disorders. Clinical diagnosis obesity of the central type is put on the basis of changes in waist circumference and hip circumference. Waist circumference of more than 100 cm at the age of 40 years and more than 90 cm at the age of 40-60 years (for both men and women) is an indicator visceral obesity. If the ratio of the circumference of the waist to the circumference of the hips in men exceeds 0.95, and in women 0.85, then we can talk about the pathological deposition of fat in the abdominal region. Determination of violations of the accumulation and distribution of subcutaneous and intra-abdominal adipose tissue (mass or volume of visceral fat) in recent years has been most effectively carried out using computed tomography and magnetic resonance imaging, but high price These methods limit their wide application.

The combination of visceral (abdominal) obesity, arterial hypertension, hyperinsulinemia, impaired glucose tolerance or type 2 diabetes mellitus, dyslipidemia (HDL level less than 1.0 mmol / l, TG more than 2.2 mmol / l), hyperuricemia, microalbuminemia, hemostasis disorders is Name metabolic syndrome and is associated with an increased risk development of coronary artery disease . It has been proven that a more significant severity of this syndrome in men is associated with a greater prevalence of atherosclerotic lesions in the coronary bed, an increase in the frequency of detection of occlusions and hemodynamically significant stenoses.

The main goal of the treatment of obesity is to reduce the risk of developing diseases associated with obesity and increase the life expectancy of the patient. At present, the method of gradual (0.5-1.0 kg per week) weight loss over 4-6 months and maintaining the result for a long time has been adopted. A long-term, prospective study of never-smoking US white women aged 40-64 years examined the relationship between body weight and mortality. After a 12-year follow-up of 43,457 patients, it was shown that a decrease in body weight of only 5-10% (from 0.5 to 9.0 kg) and then long-term maintenance of body weight reduces mortality and morbidity, improves health status and treatment prognosis concomitant diseases (overall mortality decreased by 20%, mortality from CVD by 9%).

Rapid weight loss, especially in patients with CVD, can lead to a number of serious complications and the development of arrhythmias and sudden death (insufficient dietary protein intake, myocardial atrophy can lead to a prolongation of the QT interval on the ECG and the development of severe arrhythmias). Sudden changes in body weight significantly increase the risk deaths therefore, in the process of losing weight, regular electrocardiographic monitoring and measurement of blood pressure are necessary. In the treatment of obesity in patients with chronic coronary artery disease, it is necessary: to keep in mind the danger of both drug and non-drug means for rapid weight loss; exercise caution in advising both on protein restriction and on key electrolytes; recommend an increase in physical activity only with a stable condition of the patient and a thorough cardiological examination (tests with physical activity, measurement of blood pressure, Holter ECG monitoring); avoid forced weight loss in an unstable state, frequent seizures angina pectoris, with small and moderate exercise, the presence of frequent painless episodes of myocardial ischemia or unstable angina pectoris or myocardial infarction during the previous 6 months; consider rapid weight loss contraindicated in the presence of concomitant diabetes mellitus or signs of heart failure; exercise caution when prescribing new pharmacological drugs, given the possible high risk for patients of their side effects on the cardiovascular system.

Traditional non-drug treatments for obesity, based on diet therapy (caloric restriction) and increased physical activity, do not provide stable weight loss over a long time. Only with their ineffectiveness can the question of drug therapy be considered. Drugs for the treatment of obesity are indicated for patients with a BMI of more than 30 kg / m 2, as well as for patients with a BMI of more than 27 and abdominal obesity, or with other risk factors (diabetes, hypertension, dyslipidemia) or with concomitant diseases, in the absence positive impact lifestyle changes within 6 months. Medical therapy is prescribed in combination with hypocaloric nutrition and increased physical activity.

One of the options for treating obesity is very low calorie diet . It allows you to quickly achieve weight loss, which in patients with moderate and severe obesity is accompanied by a decrease in the complications of overweight. However, it is rarely possible to maintain body weight at such a reduced level, and in patients with CVD diseases this can lead to complications. Diet therapy should be carried out for life and continuously. Currently, the following drugs are used to treat obesity.

Phentermine - sympathomimetic, it suppresses appetite, stimulating the release of norepinephrine and dopamine by nerve endings in the hypothalamus satiety center. In addition, the drug suppresses gastric secretion and increases energy expenditure. Usual dose phentermine - 8 mg 3 times a day 30 minutes before meals, or 15-37.5 mg once. The most common side effects of phentermine include nervousness, dry mouth, constipation, and arterial hypertension. In this regard, the appointment of phentermine is not recommended for patients with arterial hypertension and concomitant cardiovascular pathology, arrhythmias, anxiety states.

One of the approaches to the treatment of obesity is the administration of drugs that inhibit the absorption of nutrients, primarily fats. Fats are the main nutritional factor responsible for excess weight, therefore, they should be reduced in the first place, correcting body weight.

Orlistat is an inhibitor of lipases of the gastrointestinal tract. The drug is practically not absorbed when taken orally and reduces the absorption of fats from the intestine by 30% or more. In a European randomized placebo-controlled study of 743 obese patients (with a BMI of 28-43 kg / m 2), it was shown that the combination of a moderately hypocaloric diet with orlistat (360 mg / day) for 2 years contributed to a persistent decrease in body weight, reduced the risk of developing comorbidities.

In another study, during a 6-month trial, 605 obese patients with a BMI of 28-43 kg/m 2 were given either placebo or orlistat in various doses(90,180,360 or 720 mg/day). It was found that the optimal dose of the drug is 360 mg / day (or 120 mg 3 times a day with each main meal), and an increase in the dose of the drug does not increase its therapeutic effect.

We evaluated the effect of the drug orlistat and diet therapy in patients with coronary artery disease with stable angina, hyperlipidemia and increased body weight. In an open comparative randomized study, the effectiveness of orlistat and diet therapy was studied in 30 patients with functional class I-II chronic stable angina pectoris, aged 45 to 65 years ( average age 55±6 years old), the diagnosis of which was verified (the presence of angina attacks, a positive test on a bicycle ergometer with ischemic depression of the ST segment by 1 mm or more, the presence of stenosing coronary atherosclerosis according to coronary angiography). In all patients at inclusion in the study: BMI exceeded 25 kg/m 2 and averaged 33.5 kg/m 2 ; hyperlipidemia was determined (the level of LDL cholesterol exceeded 4.14 mmol / l, HDL cholesterol was less than 0.9 mmol/l, or the level of triglycerides was more than 2.2 mmol/l, but not higher than 4.5 mmol/l). Patients observed lipid-lowering diet and took within 6 months. orlistat at a dose of 360 mg / day. If the patient received antianginal drugs at the time of inclusion in the study, then their intake was not changed during the entire period of taking orlistat. In both groups (orlistat+diet and diet alone) it was observed a significant decrease in BMI, however, in the main group taking orlistat, it decreased by 9.9%, and in the control group only by 4.2% . Importance had stabilization of body weight for 6 months. treatment and the fact that the process of losing weight was slow and gradual. Orlistat was effective tool treatment of obesity in patients with coronary artery disease: at the end of 1 month of taking the drug, the decrease in body weight was 4.2%, 3 months. - 6.6% and 6 months. - 9.4%. The drug at a dose of 360 mg/day was well tolerated by patients for 6 months. and did not cause serious side effects. Biochemical indicators blood samples did not change significantly during treatment with orlistat. The drug did not reduce the effectiveness of antianginal therapy in patients with coronary artery disease, increased exercise tolerance according to repeated bicycle ergometry at the end of 6 months. treatment. There was also a positive dynamics of lipid metabolism: total cholesterol by 6 months. treatment decreased by 10.9%, LDL cholesterol by 12.2% (p<0,05). Уровень холестерина ЛПВП и триглицеридов достоверно не изменялся. Следует отметить отсутствие достоверного влияния орлистата на другие биохимические показатели крови (глюкозу, билирубин, трансаминазы). При соблюдении диеты и потреблении жира не более 30% от суточной калорийности наблюдавшиеся побочные эффекты при приеме орлистата по стороны желудочно-кишечного тракта (жирный стул, учащение дефекации и др.) обычно были минимальными. Было отмечено, что в группе больных, получавших препарат, уровни общего холестерина и ХС ЛПНП в плазме снижаются больше, чем этого можно было бы ожидать только от уменьшения массы тела как таковой. Вероятно, это самостоятельное гипохолестеринемическое действие препарата отражает тот факт, что он уменьшает массу тела именно за счет снижения поступления энергии от жира в организм .

Sibutramine hydrochloride - a sympathomimetic drug that blocks the uptake of both norepinephrine and serotonin receptors. The drug affects the regulation of the activity of the hunger / satiety center, allows you to reduce food intake (due to rapid satiety) and increases thermogenesis (increased energy consumption), and in combination with a low-calorie diet and increased physical activity leads to a significant decrease in body weight. It should be noted that the drug increases blood pressure by 1-3 mm Hg. and increases heart rate by an average of 3-7 beats / min, so sibutramine should not be taken with coronary artery disease, myocardial infarction and stroke. The initial dose of sibutramine is 10 mg once in the morning, after 4 weeks it can be increased to 15 mg 1 time per day. Side effects include: increased blood pressure, tachycardia, dry mouth, anorexia, insomnia, constipation. An increase in blood pressure can be compensated by both weight loss and the appointment of b-blockers.

Orlistat and sibutramine are the drugs of choice in obese patients and can be used long-term (at least 1 year).

Conclusion

The World Health Organization (WHO) has recognized obesity as a new non-communicable "epidemic of the 21st century". According to the latest WHO estimates, over a billion people in the world are overweight . In recent years, there has been a constant increase in the number of overweight people, especially among the working population, so the problem of obesity is one of the urgent problems of medicine. Excess body weight is now regarded as an independent risk factor, since it often leads to an increased risk of CVD. Moreover, obesity is not inferior in importance to such risk factors as increased blood pressure or smoking. Obesity is closely related to other risk factors and affects the survival of patients with coronary artery disease; it contributes to early disability and a decrease in both overall life expectancy and quality of life due to the development of concomitant diseases. Stabilization and further correction of body weight increases the survival rate of patients with coronary artery disease. Epidemiological studies have shown that the combination of several CHD risk factors in one patient greatly increases the total risk of CHD and its fatal complications in the coming years. The impact of obesity on the development of CVD is complex, because with excess body weight, not only the incidence of coronary artery disease increases, but also heart, venous insufficiency and other diseases.

Traditional non-drug treatments for obesity, based on diet and exercise, usually do not provide weight loss for a long time, so many patients have to prescribe drugs. Drug treatment should be used as part of a comprehensive weight loss and maintenance program that includes diet, physical activity, and lifestyle changes. Currently, various approaches to the drug treatment of obesity are used: effects on the centers of hunger and satiety (blockade of the reuptake of norepinephrine and serotonin), blocking the absorption of dietary fat (suppression of intestinal lipase activity), stimulation of thermogenesis. Some of the drugs for the treatment of obesity are contraindicated in patients with coronary artery disease and arterial hypertension. In the treatment of obesity, it is important that the process of losing weight takes place slowly, gradually (weight loss by about 5-10% of the original in 6-12 months) - then, simultaneously with weight loss in patients with CVD, the state of health will also improve. The development of adequate methods for the prevention and treatment of obesity with an impact on other risk factors will significantly improve the prognosis of patients with coronary artery disease with a high risk of complications.

Literature:

1. Melnichenko G.A. Obesity in the practice of an endocrinologist. Russian medical journal 2001, volume 9, no. 2: 82-87.

2. WHO. Prevention and management of the global epidemic of obesity. Report of the WHO consultation on obesity. Geneva; 1997

3. Garrison R.J., Higgins M.W., Kannel W.B. Obesity and coronary heart disease. Curr Opin Lipidol 1996; 7:199-202.

4. Ribero A.B., Zanella M.T. Obesity as a risk factor for the development of cardiovascular complications. International Trends in Hypertension Research 1999; No. 9: 7-9.

5. Ametov A.S., Demidova T.Yu., Tselikovskaya A.L. Obesity and cardiovascular disease. Ter. archive 2001; No. 8: 69-72.

6. Obesity - prevention and management of the global epidemic. WHO Report, 1998

7. Stevens J., Cai J., Pamuk E.R. et al. The effect of age on the association between body-mass index and mortality. New Engl J Med 1998; 338:1-7.

8. Sharma A.M. Obesity and the risk of cardiovascular disease. Obesity. Topical Issues 2001; No. 5: 4-6.

9. Khaltaeva E.D., Khaltaev N.G. Overweight as a risk factor for coronary heart disease. Bull VKNTs AMS USSR 1983; No. 1: 66-69.

10. Van Gaal L.F, Zhang A., Steijaert M.M. et al. Humen obesity: from lipid abnormalities to lipid oxidation. Int J Obesity 1995; 19:521-526.

11. Melnichenko G.A., Pyshkina E.A. Obesity and insulin resistance are risk factors and an integral part of the metabolic syndrome. Ter archive 2001; No. 12:5-8.

12. Hubert H.B., Feinleib M., McNamara P.T., Castell W.P. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants of the Framingham Heart Study. Circulation 1983; 67:968-977.

13. Manson J.E., Willet W.C., Stampfer M..J., et al. Body weight and mortality among women. N Engl J Med 1995; 333:677-685.

14. Calle E.E., Thun M.J., Petrelli J.M. et al. Body-mass index and mortality in prospective cohort of US adults. N Engl J Med 1999; 341:1097-1110.

15. Stern M. Epidemiology of obesity and its link to heart disease. Metabolism 1995; 44, 9 (suppl. 3): 1-3.

16. Dvoryashina I.V. Obesity and metabolic insulin resistance syndrome in coronary heart disease. Abstract diss... doc. medical sciences, Arkhangelsk, 2001, 46 p.

18. Williamson D.F., Pamuk E., Thun M. et al. Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40-64 years. Am J Epidemiol 1995; 141:1128-1141.

19. Metelitsa V.I. Handbook of clinical pharmacology of cardiovascular drugs. - 2nd ed. M., BINOM - St. Petersburg: Nevsky Dialect - pp. 265-268.

20. Starostina E.G. Principles of rational nutrition in the treatment of obesity. Part I. Cardiology 2001; No. 5: 94-99; Part II. Cardiology 2001; No. 8: 87-92.

21. Khorosheva G.A., Melnichenko G.A. Possibilities of drug therapy for obesity yesterday and today. Russian medical journal 2002; vol. 10, no. 11: 517-522.

22. Sjestrem L., Rissanen A., Andersen T. et al. Randomized placebo-controlled trial of the use of orlistat to reduce body weight and prevent its re-gain in obese individuals. Ter archive 2000; No. 8: 50-54.

23. Van Gaal L.F., Broom J.I., Enzi G et al. Efficacy and tolerability of orlistat in the treatment of obesity: a 6-month dose-ranging study. Eur J Pharmacol 1998; 54:125-132.

24. Naumov V.G., Lupanov V.P., Dotsenko Yu.V., Tvorogova M.G. Experience of 6-month use of Xenical (orlistat) in patients with stable angina pectoris with obesity and hyperlipidemia. Ter archive 2002; No. 1: 47-51.

25. Orlistat (tetrahydrolipstatin) - a new drug for the treatment of obesity. International Journal of Medical Practice 2000; No. 10: 30-32.

26. National Task Force on Obesity. Overweight, obesity, and health risk. Arch Intern Med 2000; 160: 898-904.

27. Ametov A.S. Obesity is an epidemic of the 21st century. Ter archive 2002; No. 10: 5-7.

28. Eskel R.H., Krauss R.M. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. Circulation 1998; 97: 2099-2100.

29. Rao S.V., Donahue M., Pi-Sunyer F.X., Fuster V. Obesity as a risk factor in coronary artery disease. Am Heart J 2001; 142:1002-1007.

30. Betteridge D.J. How does obesity increase cardiovascular risk? In: Obesity and cardiovascular disease. London: 1998, 15-17.

Most doctors agree that being overweight accelerates the aging process. The accumulation of excess fat can occur due to catabolic processes, but at the same time it accelerates the processes aging. There are many factors for the accumulation of excess fat.

Types of obesity

constitutional obesity develops in people who are hereditarily predisposed to fullness. In such people, the breakdown of fats is extremely slow, and at the same time carbohydrates and proteins are quite intensively converted into fats.

Ordinary obesity develops against the background of physical inactivity, accompanied by an unbalanced and immoderate diet. With this lifestyle, excess fat is formed from nutrients that are not used in energy production. And physical inactivity reduces the need for energy to a minimum, contributing to the preservation and increase in body fat.

Causes of obesity

One of the factors of age-related accumulation of fat mass is hyperadaptation. In the nervous system, the supply of neurotransmitters is depleted, and mainly those that cause cell excitation. This leads to an excess concentration of glucocorticosteroids in the blood plasma.

Glucocorticosteroids contribute to the predominance of catabolism over anabolism. At the same time, catabolic processes occur both in muscles and in adipose tissue. However, the breakdown of protein structures occurs more intensively. The body responds to this process by rapidly releasing large amounts of the hormone insulin into the bloodstream. Insulin inhibits the destructive effect of glucocorticosteroids on protein structures, enhancing anabolic processes. At the same time, insulin promotes an even more intense anabolism of fats, which leads to obesity.

A decrease in the amount of sex hormones in the blood, as well as a loss of sensitivity of cell receptors to them, also contributes to obesity. This is because sex hormones are able to function like neurotransmitters, stimulating the process of splitting fats, and their absence leads to the opposite consequences.

Pathologies of the endocrine system, regardless of their origin, lead to excessive accumulation of fat. The following deviations lead to the accumulation of excess fat: lack of growth hormone in the blood, decreased secretion of insulin-like growth factor (observed in liver diseases), hypothyroidism, adrenal hyperactivity, non-insulin dependent diabetes.

Why does excess body fat accelerate the aging process?

Adipose tissue is not just a static store of fat. Adipose tissue cells are completely self-sufficient, and they live according to the same laws as the cells of other tissues. They require a fairly large amount of nutrients - proteins, carbohydrates, vitamins and amino acids. Adipose tissue is self-sufficient, and in some ways even more independent and self-sustaining. Its independence is manifested in the fact that it absorbs a considerable amount of thyroid and sex hormones, and at the same time enhances the release of the hormone insulin and glucocorticosteroids into the blood plasma. Thus, a rather complicated situation arises: the more metabolic processes are disturbed in the body, the more intensively fat reserves grow, and the more fat, the more metabolic processes are disturbed.

The human body undergoes a process called lipolysis. Lipolysis is the continuous breakdown of fat into glycerol and fatty acids, which enter the bloodstream. It follows that the more fat reserves the body has, the higher the concentration of fatty acids in the blood.

In the process of "lipid peroxidation" (LPO), when fatty acids are oxidized by oxygen-containing free radicals, they break down into extremely toxic substances, much more dangerous than oxygen-containing free radicals. Products of "lipid peroxidation" are extremely toxic. They react with DNA, causing mutagenesis, which shortens the life of the DNA. Breaking cell membranes, products of lipid peroxidation damage mitochondria - energy producers. Damaged mitochondria cannot break down fatty acids, which makes the process of lipid peroxidation even more intense.

Weighing the disadvantages of obesity, it seems that there is no such disease that is not aggravated in its course due to the accumulation of excess body fat.

People often fall into vicious circles. For example: the amount of insulin released into the blood depends on the amount of food consumed. Insulin is secreted by the pancreas and enters the bloodstream even after absorption of nutrients. It provokes a decrease in the concentration of glucose in the blood. It stimulates the appetite. Here a vicious dependence emerges: the more a person eats, the more he wants to eat. Getting out of these vicious circles can be very difficult.

How to slow down the aging process?

Modern medicine claims that life expectancy depends on a combination of the hereditary factor and the interaction of a person with the environment throughout life. The hereditary factor cannot be corrected today. However, our way of life is completely in our hands.

In order to minimize the aging process, many scientists and nutritionists, in addition to a healthy lifestyle, advise using the following antioxidants every day (including with the use of Tianshi dietary supplements):
vitamin E - 400 IU (contained in the Veikan preparation);
β-carotene - 250,000 IU (contained in Veykan);
zinc - 15 mg (contained in the Biozinc preparation);
selenium - 0.1 mg (contained in the Spirulina preparation);
magnesium - 0.25 g (contained in the Spirulina preparation);

This course of antioxidants:
halves the likelihood of sudden death;
reduces the likelihood of death from a malignant tumor by 14%;
halves the likelihood of heart failure and cerebral infarction;
reduces the likelihood of developing cataracts - by 35-40%.

Scientific studies on volunteers conducted in China have shown that daily consumption of 20-30 mg of β-carotene, together with tocopherol and selenium, reduces the likelihood of developing malignant tumors in tobacco smokers.