Internal obesity - what does it threaten? Features of visceral obesity in women and men Obesity of the abdominal organs.

Obesity of internal organs

Obesity is the most massive epidemic that is prevalent throughout the world. One part of experts considers the main cause of excess weight to be excessive consumption of fatty, sweet and fast food. Another speaks of a change in the lifestyle of a modern person, who every year shows less and less physical activity.

But do not forget about genetic, biochemical and hormonal factors that can lead to an imbalance in the accumulation of energy.

For example, due to damage to the hypothalamus (a small area in the brain that regulates the pituitary gland and energy balance), there is an excessive appetite and accumulation of adipose tissue. A person with endocrine disorders will not be able to lose weight only with the help of proper nutrition and sports. As a result of research, it was found that disorders in the hypothalamus lead to an increase in insulin levels, as a result of increased activity of the vagus nerve, which connects the brain to the pancreas.

And if the hypothalamus is damaged as a result of any disease or surgery, the person will feel hungry, even with enough calories in the total amount of food.

Endocrine diseases contribute to an increase in body weight, the features of its formation depend on the specific pathology:

Hypothyroidism is a disease in which hyaluronic acid accumulates in tissues, fluid accumulates in the body, cardiac output decreases and thermogenesis (fat burning) decreases;

Polycystic ovaries - increases the level of androgens in the female body, which contributes to an increase in adipose tissue, a coarsening of the voice and the appearance of hair above the upper lip;

Cushing's syndrome - disrupts the production of growth hormone by the thyroid gland, due to which the number of fat cells begins to increase.

Visceral fat and what is its danger

Excess adipose tissue worsens the general state of human health, increases the likelihood of cancer, liver disease, cardiovascular system and diabetes. It is generally accepted that obese people are distinguished by an obese body build, but this is not always the case. There are people with a normal body composition, whose adipose tissue exceeds the allowable limits.

Probably, everyone knows at least one person who, no matter how much he eats, remains in the same form, even without going in for sports. In the West, such people are called "skinny fat" - thin fat people who have fat deposits inside. You should not envy them, since obesity of internal organs and the lack of muscle mass will not bring anything good to health.

Detection of adipose tissue around the organs can be done using MRI or ultrasound. People whose body weight exceeds 20% have visceral or visceral fat. It is he who provokes an increase in cholesterol levels, the development of inflammatory processes, an increase in blood pressure and blockage of blood vessels.

Inflammatory markers produced by internal fat cells, entering the bloodstream, cause the development of chronic diseases, increase the level of insulin, leptin. The amount of testosterone in the female body begins to increase, while in the male, on the contrary, it decreases.

Signs of obesity of internal organs

A thin fat man, although he does not have subcutaneous fat, he cannot boast of a slender and toned figure. His skin is devoid of elasticity and has an unhealthy softness with signs of cellulite, as the muscle tissue is poorly developed.

A more obvious sign is the volume of the waist and a pronounced belly, since fat reserves are deposited in this particular part of the body. This physique is more common in men, when there are no signs of obesity on the hips, arms and chest, which cannot be said about the stomach. In women, due to estrogen receptors, fat is deposited in the hips, but after menopause, they can also experience the formation of fat deposits in the waist.

What other forms of internal obesity are there

Fatty liver is the formation of fatty deposits in the liver. This disease is often experienced by overweight people. The disease is characterized by pain and discomfort in the abdomen, upset and heaviness in the stomach. You can detect such violations with the help of ultrasound of the liver. Fat deposits in the liver over 10-15% threaten the health of the body as a whole.

Excessive alcohol consumption, diabetes, malnutrition and elevated levels of iron in the blood can provoke the disease.

Fatty hepatosis is manifested by: fatigue, nausea, weakness, loss of appetite, poor concentration. Over time, a person begins to feel heaviness in the hypochondrium, and the neck becomes covered with dark spots.

Overweight of the endocrine type

Signs of the thyroid type: thinning of the outer part of the eyebrows, arched palate, dry skin, hair loss, redness in the cheeks, bags under the eyes, memory loss, sensitivity to cold. The accumulation of fat deposits predominates in the upper body (arms, shoulders), and stones can also appear in the gallbladder.

Signs of the pituitary type in women: deposition of fat on the chest, buttocks, thighs, in the lower abdomen. Headache, decreased vision, menstrual irregularities, thickening of the skin at the base of the nail plate, the appearance of a large number of moles.

General symptoms of obesity are manifested by weakness, heaviness in the legs, shortness of breath, headache. Due to the increase in adipose tissue, muscles weaken, which subsequently develops metabolic syndrome and diabetes mellitus.

How to deal with obesity

First of all, you need to adjust your lifestyle and eliminate the factors that contribute to weight gain.

Refuse fast food, fatty and fried foods, sweet, canned and soda;
Cut down on alcoholic beverages;
Avoid stressful situations;
Eat fractionally, in small portions;
Sleep at least 7 hours a day;
Drink more clean water (1.5-2 liters)

If the above recommendations have not had an effect, we recommend that you contact an endocrinologist. Hormonal disorders require taking medications, which should be selected by the attending physician.

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Visceral obesity is represented by the deposition of excess fat in the structures of internal organs. Excess weight and an increased body mass index always entail serious complications in the form of diabetes mellitus, diseases of the musculoskeletal and articular apparatus, metabolic disorders, and cardiovascular pathologies. The main reason is often typical overeating, inactive lifestyle, lack of diet, sleep and wakefulness. Treatment of fatty deposits is long, requires special discipline of the patient in relation to the doctor's recommendations. Therapeutic nutrition and a healthy lifestyle already after a few weeks give the first tangible results, significantly improving the quality of life of a patient at any age with visceral obesity.

The nature of the disease

Visceral obesity (internal) is the formation of an excess mass of subcutaneous adipose tissue near vital organs, reducing their resources, up to the development of functional failure. Normally, each person has certain reserves of internal fat, which performs the following functions:

cushioning effect when walking, falling, bruising;
creation of an internal reserve of the body for nutrition in atypical circumstances;
protection of internal organs from negative factors.

Internal type of obesity appears not only in overweight people. Excess internal adipose tissue is often recorded in lean patients. To determine the true amount of fat in people of any physique is possible only by carrying out diagnostic measures. Frequent localization of deposits of internal fat - the iliac region of the peritoneum, thighs, middle back. Known in clinical practice, "beer bellies" of men and women, even against the background of a slender constitution, are formed precisely because of the buildup of visceral fat. In women, visceral fat is more often deposited in the hips on all sides and on the abdomen.

Important! Excessive accumulation of excess fat around the internal organs can cause respiratory problems. So, strong snoring in a dream with respiratory arrest and asthma attacks are often formed precisely against the background of body fat.

Development mechanisms and causes

The formation of visceral fat is directly related to all links of metabolic processes. Metabolic obesity is accompanied by increased body weight, a violation of the susceptibility of the cellular structures of internal organs to the insulin hormone. In addition to the risks of developing diabetes in patients, blood pressure rises, the volume of cholesterol deposits increases, and overall well-being worsens. Clinicians believe that it is violations in the sensitivity of cells to the hormone insulin in the absence of a high glycemic index that is the trigger for the development of diabetes, metabolic imbalance, and the appearance of excess weight. Impaired insulin sensitivity depends on the following factors:

gender and age of the patient;
heredity;
features of intrauterine development of the fetus;
systematic effects of negative factors on the body;
hormonal disorders.

Visceral fat leads to a violation of carbohydrate metabolism and hormonal imbalance. With a burdened endocrinological history, complications may arise from the ratio of thyroid hormones.

Features of internal fat

The rate of development of cell sensitivity to insulin and obesity depends on the following features of visceral adipose tissue:

multiple nerve and vascular plexuses;
a large number of receptors responsible for excitability;
low density of nerve receptors, accelerating the breakdown of fats;
high density of receptors in relation to the hormones of the adrenal cortex and estrogens;
many cells that make up adipose tissue.

With an intense rate of lipid breakdown in the subcutaneous adipose tissue, fatty acids are released from cellular structures, penetrating into the bloodstream and entering the liver. Hepatocytes (liver cells) reduce the ability to bind insulin.

The volume of unclaimed pancreatic hormone increases, leading to a lack of insulin response of cells in the muscle layers. Thus, in the blood plasma there is an accumulation of products of underoxidized fats. Under the influence of these factors, glucose uptake by skeletal muscles and cardiac tissues is disrupted. As visceral fat builds up, insulin synthesis decreases, leading to serious endocrinological disorders.

Important! In addition to reducing the sensitivity of cells to insulin, fat metabolism is disturbed, muscle cells are intensively formed and collagen synthesis inside the organs is intensively formed. All these processes entail dystrophic deformations of the vascular walls, provoking the formation of atherosclerotic plaques.

Norm and pathology

Nutritionists and endocrinologists can determine the presence of visceral fat only with severe manifestations and with a characteristic symptomatic picture. Usually the final diagnosis is registered on the basis of clinical data (laboratory and instrumental research methods). There is a theory that if a person's figure is more and more like a circle and an apple, then this is evidence of an increase in visceral fat. To detect excess fat, simply measure the circumference of the male or female waist in a relaxed state.

Safe indicators are:

limit up to 90 cm in women;
limit up to 102 cm in men.

In women with a pear-shaped silhouette, deposits accumulate more on the hips, rarely immediately affecting the stomach. Subcutaneous fat on the thighs secretes a specific hormone that protects the tissues of the myocardium and pericardium. To reliably determine the volume of visceral fat, experts resort to an MRI study. The method of magnetic resonance imaging allows you to study all the tissues of the human body in layers, to give a reliable assessment of excess fat deposits, as well as the general condition of tissue, muscle and joint structures as a whole.

The volume of internal fat up to 15% of the human body weight is considered normal, the level of lipoprotein density should not decrease below 1.5 mmol / l. In this case, the body mass index should not be higher than 25, especially in the absence of an active lifestyle, physical activity.

Deposit localization

Visceral fat has "favorite" areas of excessive deposition in men and women, which is due to the anatomical features and physiological purpose of both sexes.

Deposits in women

Features of the formation of excess fat in women depends not only on the anatomy, but also on the influence of certain factors (pregnancy, lactation, weight loss). Fat is usually localized in the thighs, chest and pelvic organs. The impact of internal deposits on a woman's health is colossal:

hormonal disorders (impossibility of full bearing pregnancy and lactation);
menstrual irregularities;
obesity of the ovaries (decreased reproductive function);
obesity of the calf muscles (due to the ability of visceral fat to be deposited evenly in women).

Develops more slowly, gradually distributed throughout the body, including spread to the internal organs. The first symptoms in women develop brighter, more intense, rarely latent.

Features in men

The rapid formation of obesity in men is due to larger muscle structures. Soft tissue fibers are located at some distance from each other and fat molecules are clogged into these peculiar depots. The localization of deposits in men is as follows:

belly (appears in both thin and overweight men);
shoulders and forearms (the result of a decrease in the level of estrogen hormones);
obesity of hepatic structures (disturbances in the work of corticosteroids);
(malfunctions in hormonal balance).

Diagnostic measures are aimed at studying the possible causes of obesity in patients of any gender and age. Usually, only after the full picture of the disease is revealed, effective treatment is possible. In idiopathic obesity (in the absence of objective causes), treatment is prescribed according to the symptomatic picture.

Symptoms and complications

Obesity in men and women in many clinical cases leads to the formation of persistent disorders of many organs and systems up to the patient's disability. The main symptoms include:

shortness of breath even with slight exertion;
difficulty breathing during sleep (sometimes there is a feeling of insufficient filling of the lungs);
nausea, periodic vomiting (internal intoxication due to fatty liver);
arterial hypertension (high blood pressure always coexists with excess weight, diseases of the heart, lungs, liver);
phlebeurysm;
infertility in men and women.

The appearance of atherosclerotic plaques, the risk of thrombosis, disorders of the epigastric organs, intestines - all these mechanisms are involved in the pathological process of obesity. Complications of atherosclerosis and cardiac diseases can even provoke a fatal outcome.

Treatment tactics

Regardless of the cause of the formation of excess accumulations, therapeutic measures are aimed at eliminating symptomatic manifestations. With a burdened clinical history, a stable remission of chronic pathologies that can accelerate excess deposits should be achieved. To achieve a therapeutic effect, it is necessary to stop smoking, streamline your lifestyle, create a diet, sleep, and wakefulness. Sport or regular exercise is important. Against the background of existing diseases, multidirectional therapeutic exercises, long walks in the fresh air are suitable. The main methods of eliminating excess weight include:

proper nutrition;
regular physical activity;
physiotherapy (massages, heating, thermal wraps);
drug correction for severe disorders;
plastic surgery.

Nutrition should be complete, balanced, divided into several small portions per day. You can’t lose weight on protein-free diets, because protein deficiency can backfire: body weight will go away, and visceral deposits will remain in the same place and become significantly stronger.

A special drug for treatment is Orlistat, which replenishes a person's needs for food compounds without affecting the patient's mental health. In severe cases of obesity, especially in life-threatening conditions, surgical correction is carried out. Surgery is performed in two main ways:

shunting of the gastric cavity (artificial conditions to reduce the absorption of fats);
sleeve resection of the stomach (reduction of the volume of the stomach).

Metabolic disorders are the basis for the formation of visceral fat, which is why it is so important to consult an endocrinologist, gynecologist (for women) and an andrologist-urologist (for men). Treatment tactics are gastroenterologist, nutritionist and endocrinologist.

Visceral fat in the abdominal cavity forms an omentum or fat sac that protects the internal organs from damage and maintains the necessary temperature optimum. With the growth of the volume of visceral deposits, the organs are subjected to compression, provoke the formation of persistent functional disorders. Treatment of excess weight is very important for maintaining the health of internal organs, the normal functioning of all systems.

Timely therapy allows you to quickly get rid of the pathology. The later treatment is started, the longer the process of fat removal will be. The duration of therapy depends not only on its timeliness, but also on the age of the patient, his medical history and heredity. Medicine today allows you to achieve tangible results in a short time.

It is important to know that primary obesity is realized under the influence of external factors ( lots of food, stress), but usually in the presence of a hereditary predisposition to obesity.

The following factors contribute to the development of abdominal obesity:

age ( risk increases after age 40 due to slower metabolic rate);
the presence of obesity and other metabolic disorders in family members;
low birth weight less than 3 kg);
low physical activity;
chronic stressful situations;
alcohol abuse.

Eating disorder

Eating behavior - an adequate feeling of hunger and satiety. Fat accumulates when the body expends less energy than it consumes, that is, there is more food than is necessary for the normal functioning and functioning of the body. Obesity that develops according to this mechanism is called primary exogenous, that is, associated with external causes ( exogenous - coming from outside), in other words, due to overeating. Overeating in medicine is called "hyperalimentation". Hyperalimentation is considered a form of impaired adaptation of the human psyche under stress, therefore, overeating is often referred to as a borderline psychological disorder.

Overeating is possible in the following cases:

habit- the habit once established to eat in a certain way ( three meals a day, "night meal" syndrome);
communication- eating "for the company";
rituals- eating while watching movies ( especially in the cinema), football and other events, while a person eats without feeling hungry;
stress snacks- with unpleasant experiences, worries, a desire to protect oneself, a person, eating a certain product, feels calmer, which is due to psychological comfort and a sense of security when eating;
gourmetism- love for gourmet food, from which a person enjoys, becomes the main source of positive emotions.

In women, appetite increases a few days before the onset of menstruation, which is associated with the so-called premenstrual syndrome ( PMS) due to hormonal changes and the need to calm down and relax ( more of a psychological).

There is an assumption that the desire to consume food at the time of stress is associated with an incorrectly memorized program in the brain, in which the brain does not distinguish between anxiety and hunger. As a result of such a program, at the moment of stress, a feeling of hunger is included, and not anxiety. This is especially pronounced in people who survived the famine, and in new conditions ( even if it is possible to provide yourself with enough food) live according to the old program.

Along with exogenous obesity, there is also obesity associated with internal causes - factors that regulate human eating behavior.

The hunger and satiety centers are located in the brain, in a structure called the hypothalamus. Substances that increase or inhibit appetite act on the hypothalamus. These substances are produced in the nervous system, in the stomach and adipose tissue. If the balance of these substances is disturbed, then the person's eating behavior changes.

The desire to consume fatty foods occurs with increased production of the hormone ghrelin in the stomach. Appetite inhibition is due to the hormone leptin. All obese patients have a violation of the ratio of ghrelin and leptin - the amount of ghrelin is sharply reduced in the blood, and there is a lot of leptin, but the saturation center is not sensitive to it. It is important to consider that many products, especially fast food ( fast food) and carbonated drinks contain appetite-enhancing substances.

Low physical activity

Low physical activity or physical inactivity is a socially significant factor in abdominal obesity. Hypodynamia occurs in people living in big cities, working while sitting, in people with chronic fatigue, who do not play sports. With such a lifestyle, the energy balance or balance between the amount of energy consumed and expended is disturbed. In addition, in the absence of physical training, the regulatory systems of the body “lose their knack”. This means that the body ceases to adapt to any stress, begins to respond inappropriately to physical or emotional overstrain. That is why people gradually begin to move less and less, and the energy received from food is consumed by the body not so much during physical activity, but to maintain the level of metabolism ( biochemical processes) and for heat production. However, to maintain these processes, the amount of food that a person absorbs in the modern world is already becoming redundant.

A sedentary lifestyle and related health changes have been called the "three chairs" syndrome. The three armchairs are an office chair, a car chair and a sofa.

Genetic factors

Genetic factors are often the main cause of abdominal obesity, which means that in many cases fat will not be stored in the abdominal cavity even with a large amount of food and a sedentary lifestyle. The distribution of adipose tissue in specific places in the human body is associated with the work of the genes that encode ( are responsible for the process) the formation of a special type of receptors that enhance the destruction of adipose tissue. These receptors include beta-3-adrenergic receptors. Adrenoceptors are receptors that are activated by adrenaline ( stress hormone), which is why, with physical or emotional stress, the destruction of fats occurs. The fact that during stress fats disappear from a particular area, but do not decrease in another, is connected precisely with the number of these receptors.

Genetic control over hunger and satiety is also important. The Ob gene is responsible for the development of obesity ( abbreviation for the word "obesity", which in English means "obesity). The Ob gene controls the production of the hormone leptin in adipose tissue.

In addition, many people have the so-called "thrifty genotype" ( genotype - all the genes of an organism). The genotype tends to change in the course of human evolution. The economical genotype is a complex of genes that work on the principle of "putting aside fats in case of hunger." If in the process of active human life this mechanism was really saving, then in the conditions of the modern world with a sedentary lifestyle and a large amount of food consumed, the “thrifty genotype” acts to the detriment. The body accumulates too much fat, "not knowing" that, in fact, it does not need to be stored, there will always be enough food.

Symptoms of abdominal obesity

In contrast to severe general obesity, abdominal obesity itself may not cause any complaints, but cause more serious disorders and, at first glance, have nothing to do with fat accumulation. Severe shortness of breath, which is characteristic of general obesity, is not an obligatory symptom with abdominal obesity. A pronounced appetite in abdominal obesity is not only the cause of excess weight gain, but also its consequence, since in obesity the satiety center loses sensitivity to substances that inhibit appetite.

Abdominal obesity is one of the components of the so-called metabolic syndrome ( syndrome - a collection of symptoms). Metabolic syndrome is a hormonal and metabolic disorder that increases the risk of developing cardiovascular disease. It is abdominal obesity in combination with arterial hypertension ( high blood pressure), type 2 diabetes mellitus ( no insulin deficiency) and high triglycerides ( fatty acid) make up the so-called "death quartet". This name was given to the metabolic syndrome because it was found that the combination of these disorders significantly increases the likelihood of death from myocardial infarction and stroke.

Abdominal Obesity Disorders

Name of violation	Development mechanism	How is it manifested?
*Dyslipidemia*		sexual dysfunction in men; violation of the menstrual cycle in women; hirsutism ( male pattern hair growth in women);
*Hypercoagulability*	Hypercoagulability is a tendency to increased blood clotting. This tendency increases the risk of vascular thrombosis ( blockage of a vessel by a blood clot). Hypercoagulation develops in abdominal obesity due to the production of many proteins by adipose tissue that increase blood clotting ( fibrinolysis inhibitors). Their release is associated with the effect of insulin, which necessarily increases in the blood with abdominal obesity.	an increase in the level of fibrinogen, plasminogen activator, von Willebrand factor in the analysis of the blood coagulation system.

Diagnosis of abdominal obesity

Diagnosis of abdominal obesity is carried out not only visually, since abdominal obesity can also be observed in, at first glance, thin people. Visceral fat is not visible from the outside, so abdominal obesity in such people, often with parameters corresponding to the model, is described as "outwardly thin, but fat inside." To assess the degree of abdominal obesity, the doctor uses various methods based on measurement and calculations, as well as instrumental diagnostic methods.

Methods for diagnosing abdominal obesity include:

Determination of body mass index ( BMI) - allows you to assess the correspondence between height and weight of a person, that is, to determine normal, insufficient or overweight. To calculate BMI, you need to divide your weight by your height squared. BMI for assessing abdominal obesity has both advantages and disadvantages. The advantages of this method include its simplicity and lack of costs, so it is used for screening assessment among the population ( screening - a mass examination of a certain contingent to identify risk factors for the development of pathology). The disadvantages of the method are the inability to correctly assess the thickness of the adipose tissue itself, since BMI does not allow separating muscle tissue from adipose tissue, that is, obesity can be overestimated or, conversely, not detected.
Waist circumference- allows you to determine the actual abdominal obesity. The method allows you to clearly establish the presence of adipose tissue and the risk of developing complications of abdominal obesity. This figure is clearly correlated interconnected) with metabolic diseases. It also doesn't cost anything. It is important to know that, even with a normal BMI, an increase in waist circumference is considered a risk factor for metabolic disorders and some complications ( cardiovascular). To measure waist circumference, the patient is asked to stand up straight. A centimeter tape is wrapped around the abdomen at the level that is located in the middle between the lower part of the chest and the iliac crest ( a bone that can be felt in the pelvis on both sides). Thus, you need to measure not at the level of the navel, but a little higher. Obesity is diagnosed if the waist circumference in men is more than 94 cm, and in women more than 80 cm. In men, this figure is higher, since normally their waist is thicker than women's.
Central index ( abdominal) obesity- the ratio of waist circumference to hip circumference. Abdominal obesity is considered if this indicator in women is more than 0.85, and in men it is more than 1.0. This index distinguishes abdominal obesity from other types of obesity.
Evaluation of the thickness of the skin-fat fold- carried out using a special device called a caliper ( the measurement procedure itself - caliperometry) and is something similar to a caliper. The skin fold in the abdomen is taken with the thumb and forefinger at the level of the navel and 5 cm to the left of it. After that, the caliper itself captures the fold. The measurement is carried out three times with an interval of 1 minute. This indicator evaluates the thickness of subcutaneous fat, however, with the accumulation of fat in the waist area, it is important to evaluate the amount of subcutaneous fat in order to identify the type of obesity.
Instrumental methods to visualize adipose tissue- CT scan ( CT) , Magnetic resonance imaging ( MRI) , ultrasonography ( ultrasound). The above methods allow you to see the fat itself and assess the severity of abdominal obesity.

It is important to know that the amount of abdominal or visceral fat is reflected in the waist circumference, but obesity of the internal organs can only be detected using instrumental research methods.

If abdominal obesity is detected, the doctor will prescribe a number of laboratory tests and instrumental diagnostic methods. This is necessary in order to assess the state of organs and metabolism in the body, which could be affected due to disorders that accompany abdominal obesity.

In case of abdominal obesity, the following tests are required:

general blood analysis;
fasting blood glucose test;
lipidogram ( cholesterol, lipoproteins, triglycerides);
coagulogram ( analysis of indicators of the blood coagulation system);
blood chemistry ( liver enzymes, creatinine, urea, C-reactive protein, uric acid);
the level of insulin in the blood;
blood test for hormones.

With abdominal obesity, the doctor may prescribe the following instrumental studies:

Ultrasound of the abdomen and pelvis;
Ultrasound of the heart and blood vessels;
X-ray of the chest and skull.

Classification of abdominal obesity

Abdominal obesity is also called central or android ( male). The male type of fat distribution is characterized by the severity of the fat layer in the torso and a small amount of fat on the thighs. Figuratively, this type of obesity is called "apple-type obesity" ( the width of the apple is maximum in its middle part). In contrast to abdominal or male obesity, "female" obesity is called gluteofemoral, lower, or gynoid. With such obesity, there is a normal waist, and fat is deposited in the buttocks and thighs. Such a figure resembles a pear, which is why it is called “pear-type obesity”. These two types of obesity are fundamentally different from each other. The deposition of fat in the thighs does not affect health, unlike fat in the waist.

Obesity "like a pear" even has some advantages. In women, adipose tissue produces a large amount of estrogen. These female hormones tend to protect the walls of blood vessels and prevent the accumulation of cholesterol in them ( Therefore, before menopause in women, atherosclerosis does not progress.). In abdominal obesity, the opposite occurs - the fat itself becomes a source of free fatty acids.

Obesity "like an apple" is usually combined with abdominal obesity, that is, at the same time there is an accumulation of fat in the subcutaneous fat of the body and in the abdominal cavity. At the same time, obesity of the internal organs can occur without visible obesity. This is an important difference between the abdominal type of obesity.

There is also a mixed type of obesity, in which there is obesity of the whole body.

According to the international classification, obesity by BMI can be of the following types:

overweight- BMI 25 - 30;
obesity 1 degree- BMI 30 - 35;
obesity of the 2nd degree ( serious) - BMI 35 - 40;
obesity 3 degrees ( morbid or morbid obesity) - BMI 40 - 50;
overweight- BMI 50 - 60;
super obese- BMI over 60.

The normal BMI is 18.5 - 25 kg / m 2.

Depending on the stage, abdominal obesity is:

progressive;
stable.

Treatment of abdominal obesity

Treatment of abdominal obesity is necessary not only and not so much from an aesthetic point of view ( especially for women with fat deposits in the waist area), how much to prevent the development of pathologies that develop with abdominal obesity. If obesity has a hereditary predisposition, then treatment will be long and even lifelong. If abdominal obesity is observed against the background of a decrease in physical activity and an increase in food intake, then you can easily get rid of extra pounds, but you will have to constantly make sure not to gain abdominal fat again.

Methods of treatment of abdominal obesity are:

diet therapy;

drug treatment;

psychotherapy;

some surgical procedures.

In any case, the treatment of abdominal obesity is always approached comprehensively.

Exercise stress

Physical activity is an important stimulus for burning fat, because fat is a source of energy, and in order for a person to perform physical exercises, he needs additional energy. Exercise also increases the production of the hormone testosterone, which is low in obese men. It is important to know that exercise is effective when dieting. If a person eats the same amount of food and exercises, the effect will be insignificant, because the body will first destroy the existing fats, and then create new ones from the incoming food. If physical activity requires more energy than the food taken per day contains, then an energy deficit will occur. This is precisely the goal of treatment - to spend more than receive.

It is important to know that in the presence of severe diseases of the internal organs, heavy physical activity is contraindicated. The level of physical activity is always determined on an individual basis.

moderate physical activity is preferred ( the load that a person can perform for an hour without feeling severe fatigue), such as walking, cycling, swimming, skiing, running;
You should start with a load of low intensity ( obese people have a harder time doing any physical work), gradually increasing its duration;
exercise regularly;
the ideal option is dosed non-intensive ( moderate) physical activity for 2 - 3 hours, since fats begin to be burned 30 - 40 minutes after the start of the workout.

Medical treatment of abdominal obesity

Drug treatment for abdominal obesity is indicated when BMI is greater than 30 and there is no effect of non-drug treatment ( diet and exercise) within 3 months. The effect of non-drug treatment is considered unsatisfactory if the weight of a person during the specified time, despite the implementation of all the doctor's recommendations, has decreased by less than 5%.

Drugs used to treat abdominal obesity

Drug group	Representatives	Mechanism of therapeutic action	Efficiency
*Anorectics* *(appetite suppressant drugs)*	sibutramine ( )	These drugs act on the center of hunger. Their effect is due to an increase in the duration of exposure to norepinephrine and serotonin ( appetite suppressants) to the satiety center in the brain. Fast satiety helps to reduce the amount of food consumed. At the same time, the drug increases the expenditure of energy in the form of heat. Additional positive effects are a decrease in total cholesterol and triglycerides, as well as insulin.	Sibutramine is effective in patients who cannot control the amount of food they take. This is especially true in cases where a person constantly thinks about food and constantly feels hungry. The drug is indicated for use in young people who "seize" depression and who do not have severe pathology of the cardiovascular system or arterial hypertension ( in these cases, the drug is contraindicated). Sibutramine most effectively allows you to lose weight in the first months of its use. The drug should not be used for longer than 1 year. After stopping the drug, if you do not follow the diet, the fat begins to accumulate again.
*Means that reduce the absorption of fats*	orlistat ( xenical)	Orlistat inhibits the activity of the lipase enzyme in the intestine, as a result of which the amount of triglycerides that are absorbed from the intestine into the blood is reduced by 30%.	Orlistat is effective in people who like to eat delicious food, especially fatty foods, if they find it difficult to keep track of the caloric content of food ( often eat in restaurants), but who retained a sense of fullness after eating. The drug can be used in old age and in the presence of cardiovascular pathology. The drug effectively prevents excessive absorption of triglycerides during the entire period of its administration. The effectiveness of the drug in non-compliance with the diet is minimal.
*Hypoglycemic drugs* *(reducing glucose levels)*	liraglutide ( victoza); metformin ( siofor, glyukofazh).	The mechanism of action of liraglutide is due to its ability to act as a satiety hormone, that is, to reduce appetite and reduce the amount of food consumed. In addition to this action, the drug reduces the level of glucose in the blood, which improves metabolism and contributes to the normalization of body weight. Siofor promotes the absorption of glucose by tissues, and also inhibits the formation of glucose from their fats in the liver, the formation of fats when taking this drug also decreases.	Liraglutide is effective in patients who do not feel full and cannot control their appetite and the amount of food they eat. At the same time, unlike sibutramine, liraglutide is indicated in the presence of a high risk of cardiovascular complications and type 2 diabetes mellitus. The drug is not prescribed if there is evidence of thyroid cancer in the patient himself or in his relatives. Siofor is prescribed for people with abdominal obesity, which is combined with insulin resistance.

Surgical methods for the treatment of abdominal obesity

An important difference between abdominal or visceral obesity and ordinary obesity is that it cannot be cured with surgical treatment. With normal, "external" obesity, fat accumulates in the subcutaneous fat, so its removal by surgery or destruction by injection ( through the administration of substances) methods is not difficult. It is impossible to remove the fat that surrounds the internal organs, because it is technically impossible to isolate and remove the fatty tissue in which the vessels and nerves pass so as not to damage anything.

Surgical options for abdominal obesity are:

Banding of the stomach- the imposition of a ring in the upper part of the stomach, which divides the stomach into two parts. The small upper part can hold a small amount of food at one time, while the stomach will send signals to the brain that it is full. This will create a feeling of fullness.
Reducing the volume of the stomach- in some people who eat a lot, the volume of the stomach is enlarged, so saturation occurs only if the stomach is full ( and this is possible when eating a large amount of food). Removing part of the stomach and creating a "small stomach" contributes to the rapid onset of satiety.

These operations do not guarantee a cure for visceral obesity, but they allow you to stop the process of fat accumulation and reduce the amount of fat deposits, since a person after the operation will not be able to eat a lot. The effectiveness of such an operation is individual.

Stomach surgery for abdominal obesity is performed in the following cases:

abdominal obesity is combined with general obesity:
there is a pronounced abdominal obesity;
BMI is more than 35 and there is a pathology associated with abdominal obesity;
BMI greater than 40 even in the absence of other diseases.

Surgical treatment is not performed if the patient has not followed a diet and exercise regimen for at least 6 months or does not agree to follow the doctor's recommendations.

Psychotherapy

The effectiveness of the treatment of abdominal obesity depends on the psychological state of the patient and his motivation. Since a change in lifestyle is required of a person, the participation of a psychologist or psychiatrist may be required. In addition, abdominal obesity itself, especially in women, causes self-doubt. Self-doubt often causes overeating. That is why the elimination of psychological discomfort allows you to increase the effectiveness of physical training and other methods of treatment.

It is important that the patient is psychologically prepared before starting diet therapy.

To determine readiness for treatment of abdominal obesity, the patient must answer the following questions:

Is the patient willing to change their habits and lifestyle over an extended period?
What are the reasons that motivate you to lose weight?
Is the patient aware of the dangers and risks associated with abdominal obesity?
Is there emotional support for family members in the issue of weight loss?
Does the patient realize that the effect will not be immediately, but after a certain period of time?
Is the patient ready to constantly monitor himself, keep a diary and monitor body weight?

Alternative methods of treatment of abdominal obesity

Traditional methods of treating abdominal obesity promote fat burning, but without diet and exercise, such treatment is ineffective.

Folk remedies for the treatment of abdominal obesity can act as follows:

reduce appetite and increase satiety- infusions and decoctions of oats, barley, algae ( spirulina, kelp), flax seeds, marshmallow root;
remove excess fluid from the body- anise seeds, green watermelon peel ( powder or pulp), birch buds, lingonberries, St. John's wort, corn stigmas, celery root, pumpkin seeds, rose hips;
have a laxative effect- calendula, flax seeds, cucumber fruit, linden blossom, dandelion roots, plantain leaf, beetroot, dill seeds, anise and cumin.

The following folk recipes help reduce appetite:

A decoction of corn stigmas. To prepare the tincture, you need to take 10 grams of stigmas, pour them with water and boil for 30 minutes. After the resulting decoction has cooled, it can be taken 1 tablespoon 4 to 5 times a day before meals. The decoction is taken for a month, after which they take a break for 5-10 days. Corn silk should not be used with increased blood clotting.
A decoction of licorice root. 1-2 roots can be consumed per day, a decoction of which is prepared in the same way as a decoction of corn stigmas.
Dandelion infusion. You need to take a tablespoon of dandelion herb ( crushed), pour a glass of boiled water and leave to infuse for 6 hours. After that, the tincture must be filtered. Drink in small portions throughout the day.
young bran. Pour bran with boiling water for 30 minutes, and then drain the water. The resulting slurry can be added to any dish. The first 7 - 10 days it is recommended to add 1 teaspoon, after which 1 - 2 tablespoons of the mixture 2 - 3 times a day.
Decoction of burdock root. Take 2 teaspoons of plant roots ( ground), pour them with a glass of boiling water, and then put on a slow fire for 30 minutes. The resulting decoction is taken in small portions throughout the day.
Laminaria ( seaweed, seaweed). Take kelp and fill it with water, leave for a day. Drink in small sips when you feel hungry. Laminaria is contraindicated in kidney pathology.
Beet cake ( squeezes). The beets should be peeled and grated, the juice squeezed out, and small balls the size of beans should be rolled from the resulting squeeze. The balls should be left to dry, and then take 3 tablespoons of cake at a time. It is allowed to use low-fat sour cream to make it easier to swallow cakes. It is important to know that you can’t eat anything with cake ( the digestion process is disturbed).

For abdominal obesity, the following herbal preparations are used:

Gathering 1- consists of buckthorn bark, sea grass, rose hips, raspberry leaves, blackberries, nettles, St. John's wort and yarrow. 1 tablespoon of the collection should be poured into a glass ( 200 ml) boiling water.
Gathering 2- consists of rowan berries, mistletoe, linden flowers, water pepper, linden bark. Prepare as well as collection 1.
Gathering 3- consists of dill seeds, chamomile, flowers. It is prepared in the same way as collection 1.

Acupuncture may be effective for abdominal obesity ( acupuncture), especially if obesity occurs in women after menopause.

Diet for abdominal obesity

An important aspect of the treatment of abdominal obesity is the formation of proper eating behavior. Before starting a diet, the attending physician will ask a few questions to obtain information about the patient's eating habits. This information is called diet history ( anamnesis - information about something). The doctor may ask the patient to write down everything he eats for 3 to 7 days, as well as portion sizes, amount of food, frequency of meals, and caloric content of foods. Diet for any type of obesity is desirable to be individually.

The basic principle of the diet for abdominal obesity is to reduce the caloric content or energy value of food. This creates a nutrient deficiency that will force the body to begin the process of breaking down fat.

The deficit is calculated taking into account the energy ( calories), which is necessary for a person per day to perform his work and maintain his usual lifestyle. Gender, age, climatic conditions and characteristics of the character and personality of a particular person are also taken into account. There are no absolute values. A person who leads a sedentary lifestyle will need fewer calories than someone whose work involves intense physical activity. To calculate calories, there are special formulas that take into account weight, height and other indicators listed above. In any case, the doctor will reduce the amount of daily calorie intake received so that a calorie deficit occurs.

Reducing the energy value of food in abdominal obesity is carried out as follows:

with BMI 27 - 35 a deficit equal to 300 - 500 kcal / day should be created, while a person will lose approximately 40 - 70 grams per day;
with a BMI over 35- the deficit should be 500 - 1000 kcal / day, and weight loss - 70 - 140 grams per day.

It is important to know that absolute fasting is not effective as it slows down the metabolism. A slow metabolism is characterized by the fact that the same fats that a person wants to get rid of will be destroyed more slowly. In addition, the processes of formation of various biologically active substances from fats will slow down.

It is undesirable to use diets with a sharp energy deficit. Such diets are worse tolerated, and the results of "slow" and "fast" diets are not very different from each other.

The general principles of diet therapy for abdominal obesity include:

frequent meals ( 4 - 5 times a day), which allows you to maintain metabolism at the right level;
small portions;
abstaining from alcohol it has a lot of calories);
reduction in the amount of fat consumed by 25% of the daily requirement ( you can eat no more than 250 grams of cholesterol per day);
the exclusion of such products as butter, mayonnaise, margarine, fatty meats and sausages, sour cream and cream, fatty cheeses, canned meat and fish, lard;
specially produced sweets for people with diabetes ( "diabetic" chocolates, sweets, jam, cakes), should also be excluded;
exclusion of fast-digesting carbohydrates ( sugar, honey, grapes, bananas, melon, jam, confectionery, sweet juices);
reducing the amount of slowly digestible carbohydrates ( potatoes, bakery products, pasta, corn, cereals);
limiting the amount of table salt, as well as the exclusion of all salty foods ( smoked meats, marinades);
exclusion of spices, sauces and snacks that increase appetite;
adding dietary fiber to the diet vegetables and fruits up to 1 kg per day);
the diet should contain a sufficient amount of animal proteins, that is, boiled meat ( lean beef, lamb, lean pork, chicken, turkey), dairy products ( kefir, curdled milk, yogurt, unleavened milk, low-fat cottage cheese) and eggs, while it is desirable not to eat the visible fatty parts of such products ( chicken skin, milk foam);
be sure to use plant-based proteins ( soybeans, beans, mushrooms, cereals, peas), given that the body's total protein requirement per day is 1.5 g/kg of body weight.

Proteins are the staple in the diet. The fact is that, firstly, along with fat, part of the muscle tissue is always lost ( and these are squirrels), and it is required to restore muscle mass. Secondly, the body spends a lot of energy to digest and assimilate proteins, that is, protein food helps to increase metabolism and burn fat. Provided that the diet does not consist of carbohydrates, adipose tissue becomes the main source of energy for the needs of the body.

grapefruit;
green tea;
hot spices ( pepper, mustard, horseradish);
cinnamon;
ginger.

The goal of dietary therapy for abdominal obesity is not to achieve any fixed or ideal BMI. It is important that the diet helps to reduce the amount of abdominal fat, that is, you need to focus, first of all, on reducing the waist circumference.

The effectiveness of the diet is evaluated after 3 - 6 months. The diet is considered effective if the body weight has decreased by 5 - 15%, while the waist circumference has also decreased. It should be borne in mind that a decrease in the thickness of visceral fat in apparently not fat people may not cause a sharp decrease in the number of kilograms. Evaluate the effectiveness in this case allows laboratory diagnostics ( normalization of analysis indicators) and magnetic resonance imaging. index of central obesity ). The fact is that by the way fat is distributed throughout the body, one can determine its danger to health. If the ratio of the circumference of the waist and hips in women is more than 0.8, and in men more than 0.9, then this indicates abdominal obesity.

A narrow waist is not always a sign of the absence of abdominal obesity. The most reliable way to find out if there is an excessive accumulation of fat inside the abdomen is magnetic resonance imaging.

Are abdominal and visceral obesity the same thing?

Abdominal and visceral obesity are names for the same pathology, which is characterized by the accumulation of fat in the abdomen ( abdomen - belly), that is, at the waist and inside the abdomen, around the internal organs ( visceral - pertaining to the viscera). The fat inside the abdomen is called visceral fat. It is present and normal, envelops the internal organs, being part of their anatomy ( blood vessels and nerves pass through this fat). With abdominal obesity, the amount of this fat increases, so organ function begins to suffer.

What are the criteria for abdominal obesity?

Abdominal obesity ( accumulation of fat inside the abdomen and around the waist) is diagnosed during the examination and measurement of the waist. Abdominal obesity is recorded if the waist circumference in men exceeds 94 cm, and in women more than 80 cm. The waist circumference is measured not at the level of the navel, but at the middle of the distance between the lower part of the chest ( conventionally, this is the lower edge of the costal arch) and ilium ( pelvic bone that can be felt under the skin).

The second important criterion for abdominal obesity is the ratio of waist circumference to pelvic circumference ( hips). To calculate this figure, you need to divide the waist circumference by the hip circumference. If this index is less than 0.8, then obesity is considered not abdominal, but gluteal-femoral ( fat is more pronounced below the waist). If, when measured in men, an indicator of more than 1.0 is obtained, and in women more than 0.85, then this is abdominal obesity.

Normally, the waist circumference and hip circumference for women should be less than 0.8, and for men less than 0.9.

Severe obesity is visible to the eye, but there are cases when a person has abdominal obesity, which is not visible. People with invisible obesity began to be called "thin on the outside, fat on the inside." This can be observed in both models and athletes. The accumulation of fat in thin people is diagnosed by magnetic resonance imaging ( MRI), which allows you to see the thickening of the fat layer of internal organs ( visceral or visceral fat).

Are abdominal obesity and metabolic syndrome the same thing?

Abdominal obesity and metabolic syndrome are two pathologies that are often combined, or rather, abdominal obesity is one of the components and cause of the metabolic syndrome. It is for this reason that doctors, when talking about abdominal obesity, have in mind the metabolic syndrome.

Metabolic syndrome is a complex of metabolic disorders ( metabolism), which is observed in abdominal obesity. An important point of both the metabolic syndrome and abdominal obesity is the presence of a high risk of developing myocardial infarction and stroke.

The metabolic syndrome includes the following components:

abdominal obesity- waist circumference in men more than 94 cm, and in women more than 80 cm;
dyslipidemia ( lipid or fat metabolism disorders) - increased levels of cholesterol and triglycerides in the blood;
insulin resistance- insensitivity of cells to insulin, which is necessary for the use of glucose;
type 2 diabetes- high blood glucose levels with normal or even elevated insulin levels;
arterial hypertension- increase in blood pressure more than 130/80 mm Hg.

Does abdominal obesity occur in children?

Abdominal obesity ( obesity in the waist) also develops in children, leading to the development of the same disorders as in adults ( metabolic disorder or metabolic syndrome). Most often, abdominal obesity in children and adolescents develops against the background of general obesity, less often fat accumulates in the waist area separately. The accumulation of fat in the limbs makes it difficult for the child to move, but does not pose a serious health hazard, however, if general obesity causes an increase in waist circumference, then this is a serious reason to see a doctor.

The causes of abdominal obesity in children are external factors in the presence of a genetic predisposition of the body.

Depending on the cause, abdominal obesity in children can be:

primary- an independent disease;
secondary- develops against the background of other diseases.

Children are more likely to experience primary abdominal obesity, which is caused either by overeating and a sedentary lifestyle, or by hereditary metabolic disorders. In any case, obesity develops in the presence of a genetic predisposition, but necessarily under the influence of external factors (a lot of food, little physical activity). This type of obesity is called exogenous-constitutional (exogenous - due to external factors, the constitution is a feature of this organism).

Unlike exogenous-constitutional obesity, there are forms of primary obesity that lead to increased fat accumulation in the waist and around internal organs, regardless of external factors. These forms are called monogenic diseases ( mono - one). Monogenic diseases are caused by a single mutation in genes that are associated with obesity. Such obesity develops during the first year of a child's life. Most often, monogenic obesity develops with a deficiency of leptin. Leptin is a “satiety” hormone that acts on the brain to reduce appetite and make you feel full. With its deficiency, the child constantly wants to eat. Unlike monogenic obesity, with exogenous constitutional obesity, leptin is elevated, but the brain does not respond to it.

Abdominal obesity in children and adolescents is diagnosed in the same way as in adults - by measuring waist circumference ( FROM) and hip circumference ( ABOUT). The first value is divided by the second and the OT/OB index is obtained. The presence of abdominal obesity is established if OT / OB in girls is more than 0.8, and in boys it is more than 0.9.

Less commonly, abdominal obesity in children has secondary causes. Usually it is a pathology of the endocrine organs ( thyroid, adrenal, pituitary).

The consequences of abdominal obesity in children are:

type 2 diabetes ( an increase in blood sugar that is not associated with insulin deficiency);
high levels of cholesterol and triglycerides in the blood ( increases the risk of early development of vascular and cardiac pathology);
increased blood pressure;
hormonal disorders (adolescents may have delayed puberty, menstrual irregularities in girls).

Is abdominal obesity the same for women and men?

Abdominal obesity in women and men has some features. Common to both sexes is an increase in waist circumference, but in women, abdominal obesity is considered to be an increase in this indicator of more than 80 cm, and in men, more than 94 cm. This is due, of course, to the fact that the female figure is distinguished by a narrow waist and pronounced hips. In men, on the contrary, fat is initially distributed more in the torso than in the limbs.

Abdominal obesity has common manifestations in both men and women, such as high blood pressure, increased sugar and cholesterol in the blood. In addition to these disorders, in men, abdominal obesity can be manifested by a violation of sexual function, since male sex hormones are converted into female sex hormones in adipose tissue. In women, hormonal imbalances are also disturbed, which is associated with the production of stress hormones during obesity, and this leads to menstrual irregularities and infertility.

In women before menopause ( hormonal changes, which are accompanied by a decrease in the level of female sex hormones in the blood) the risk of developing adverse complications of abdominal obesity ( heart attacks and strokes) much lower. This is due to the presence in the female body of the hormone estrogen, which protects the walls of blood vessels, slows down the accumulation of fats. In men, the level of estrogen is several times lower, so the risk of developing atherosclerosis ( fatty plaques in the vessels narrowing the lumen) much higher.

Another difference between abdominal obesity in men and women is the method of treatment. Women find it easier to lose weight through diet and exercise. In men, the most effective help is the introduction of testosterone, the male sex hormone. This therapy is called hormone replacement therapy. By restoring the level of testosterone in the blood of men, doctors achieve fat burning and the disappearance of the "beer belly".

How is abdominal obesity treated if there is another disease?

Treatment for abdominal obesity begins with diet and exercise modifications. If the patient has a serious disease of the internal organs in a state of exacerbation, then the doctor first seeks to stabilize the condition, and then proceeds to treat abdominal obesity. If within 3 months, while following a diet and doing physical activity, the patient loses less than 5% of the initial body weight, then the doctor prescribes medication.

The choice of drug for the treatment of abdominal obesity depends on the following factors:

age;
eating habits ( gourmandism, increased appetite, uncontrollable hunger, inability to get enough);
the presence of comorbidities.

Abdominal obesity is the cause of the development of such pathologies as arterial hypertension, type 2 diabetes mellitus ( loss of cell sensitivity to glucose), arterial atherosclerosis ( narrowing of the arteries by plaque). The main organ that suffers from all of the above causes is the heart. In addition to the heart, abdominal obesity also affects the kidneys, brain and liver, although all organs experience stress in their own way. The fact is that abdominal obesity disrupts almost all types of metabolism, so the combination of abdominal obesity and the above pathologies is called the metabolic syndrome.

For abdominal obesity, the doctor may prescribe the following drugs:

Sibutramine ( reduxin, meridia, goldline, lindax) - reduces appetite by affecting the satiety center in the brain, and also enhances heat production ( to generate heat, the body also burns fats and expends energy). The drug is not prescribed to patients with diseases of the heart and blood vessels, as well as high blood pressure.
Orlistat ( xenical) - reduces the amount of fatty acids ( triglycerides), which, together with food, enter the intestines and from there are absorbed into the blood. This drug can be used in the presence of heart disease, as well as in the elderly.
Liraglutide ( victoza) - inhibits appetite and improves the process of glucose uptake by tissues. For this reason, it is used if abdominal obesity is accompanied by type 2 diabetes, including the development of complications ( damage to the kidneys, heart, brain), as well as at a high risk of developing severe heart disease. Liraglutide is contraindicated in the presence of a malignant tumor of the thyroid gland in a person, as well as if this tumor was observed in any of the family members.
Metformin ( siofor, glyukofazh) - this drug is used to treat diabetes mellitus, it helps to normalize carbohydrate and fat metabolism.

If the cause of abdominal obesity is a specific pathology ( most often it is hormonal disorders), then obesity is called secondary. In this case, not only a nutritionist is involved in treatment, but also a narrow specialist ( endocrinologist, gynecologist and others).

Is Glucophage Used for Abdominal Obesity?

Glucophage is a drug that is used to treat diabetes. With abdominal obesity, it can also be prescribed. There are two indications for this. Firstly, with abdominal obesity, there is almost always a violation of carbohydrate metabolism - the initial form of diabetes mellitus, which is called insulin resistance. Secondly, glucophage tends to enhance the oxidation of fatty acids, that is, to stimulate the process of using fat as an energy source. In addition, glucophage inhibits the formation of new fatty acids. All this contributes to lowering the level of glucose and total cholesterol, causing an energy deficit in the body, to compensate for which the body begins to burn fat. An important condition for the effectiveness of glucophage in the treatment of abdominal obesity is a diet with a sharp restriction of carbohydrates and fats.

Obesity of internal organs, especially the pancreas, leads to a serious disruption of its normal functioning. Fatty infiltration of the pancreas or steatosis, as this pathology is otherwise called, develops as a result of the accumulation of fats in the cells of organs.

Fat cells interfere with the normal functioning of healthy cells. The reasons, first of all, should be sought in the violation of metabolic processes. Despite the severity of the disease, with timely initiation of treatment, it is possible to stop its progression and restore the functioning of the organs.

Reasons for the development of pathology

The essence of the disease is that healthy pancreatic tissue is replaced by fat cells. The process of obesity is characterized by slow development and can last for years. In most cases, pancreatic obesity is not an independent disease, it is the result of the development of other disorders in the body, that is, it is a secondary pathology.

Obesity of the pancreas occurs for various reasons, but in most cases it is associated with metabolic disorders. Against this background, normal cells of the organ die off and are replaced by fatty ones. The onset of the disease can be triggered by the following factors:

alcohol abuse;
acute or chronic pancreatitis;
hereditary predisposition;
diabetes;
chronic hepatitis;
excess body weight;
thyroid disease.

Symptoms

Symptoms of the disease in the initial stages are absent due to the fact that fat cells, located in separate areas of the pancreas, are still unable to squeeze nearby organs and therefore their functionality does not temporarily suffer.

As the disease progresses and the accumulation of fat cells in the gland, the following signs appear:

nausea and vomiting;
cramps in the abdomen;
increased gas formation;
feeling of heaviness;
rapid stool with fatty admixture;
diarrhea;
pain in the right hypochondrium.

Symptoms of the disease appear when the third part of the organ is replaced by adipose tissue. As a result of this, there is a violation of the functioning of the pancreas itself and squeezing of other surrounding organs. Since the full process of digestion is provided by enzymes secreted by the gland, if its functioning is disturbed due to obesity, fatty and protein foods are especially difficult to digest.

Depending on the extent of damage to the gland by fat cells, there are 3 degrees of such obesity. The first degree is characterized by the defeat of 1/3 of healthy cells of the gland, for the second degree 2/3 and for the third more than 60%. The crowding of fat cells and the place of their accumulation also affect the severity of the disease.

What is the danger of being overweight

Methods of diagnosis and treatment

Any violations of the pancreas affect the functioning of other nearby organs, in particular, the stomach and, as well as the spleen and kidneys. In addition, the endocrine and cardiovascular systems suffer. All this necessitates the adoption of therapeutic measures to restore the normal functioning of the pancreas.

Methods for the treatment of pancreatic obesity are determined after diagnostic procedures. To detect this disease, ultrasound is used, which allows you to determine the foci of increased echogenicity in the tissues of the pancreas. In addition, magnetic resonance imaging of the abdominal cavity is used, with the help of which it is possible to accurately determine where the fat areas are localized in the organ. The patient is also assigned a urine and blood test.

With pancreatic obesity, treatment is carried out mainly by methods of conservative medicine and subject to the principles of proper nutrition. Surgical treatment is used only in advanced and complex cases of the disease. But operational methods are rarely used. In general, obesity of the pancreas can be successfully treated if adequate measures are taken in a timely manner and a special diet is observed.

Pancreatic obesity is characterized by a slow course and therefore the patient has time to normalize the disorders that have arisen in the work of the organ. For the success of treatment, the patient must completely refuse to take any kind of alcoholic products and adhere to a diet. If a patient with pancreatic obesity takes any drugs that affect the diseased organ, then they should be canceled or replaced by others.

The goals of treatment are to reduce the load on the pancreas and stop the process of cell death. The therapy is long and complex. It is selected individually in each case. For the treatment of pathologies of the pancreas, the following groups of drugs are prescribed:

eliminating pancreatic insufficiency and stimulating digestion - Pancreatin, Festal, Mezim;
antispasmodics that relieve pain - Platifillin or No-shpa;
drugs that normalize hormonal levels and metabolism.

Nutrition Features

Since the pancreas plays a key role in the process of digestion, in order to get rid of obesity, it is necessary to reduce the load on it. For this, a special diet is provided. It will help improve metabolic processes and prevent further deposition of fat in the tissues of the pancreas.

Strict control over nutrition will help correct the violations that have arisen in the functioning of the pancreas. Diet is necessary not only after the elimination of the acute phase of the disease, but also during remission, to prevent relapses.

The main point in such a diet is the exclusion or minimum consumption of foods that slow down digestion and increase inflammation in the gland. This applies primarily to spicy, fried, salty and sweet foods and alcohol. Meals should be frequent and fractional.

The therapeutic diet involves the use of a large amount of fluid, at least 3 liters per day. You can drink any water. It is useful to include dried fruit compote in the drinking regimen, but without adding sugar. Do not drink carbonated drinks, coffee or cocoa, as well as grape juice. Weak tea with lemon is allowed. Among the permitted drinks are decoctions of herbs and berries diluted with water.

It is recommended to include more fermented milk products in the diet - yogurt, curdled milk, kefir. Food should be chopped or pureed. Preference should be given to boiled and baked or steamed food. Do not eat too hot or cold food. The last meal should be 2 hours before bedtime.

According to the diet for obesity of the pancreas, the following foods are allowed to be consumed:

dried bread made from wheat flour of not the highest grade, crackers unleavened dry biscuits;
cottage cheese products and milk;
soups and dishes from boiled and stewed vegetables with the addition of a small amount of butter or sour cream;

cereals from rice, oatmeal, buckwheat and semolina;
boiled pasta;
lean meats and fish, chicken eggs;
soft and sweet berries and fruits, baked apples.

With obesity of internal organs, high-fat dairy products and soups in broths, fatty meats, canned foods and offal should be excluded from the diet. Wheat, barley, pearl barley and corn porridge are banned. You can not eat fruits and vegetables with a high content of coarse fiber.

Video: Abdominal obesity

From medicine, the etiology of obesity is excessive fat deposits in the subcutaneous tissue, tissues, organs. The disease is manifested by an increase in weight by 20% or more of the normal body mass index (BMI). Obesity causes psychophysical discomfort, sexual disorders, diseases of the joints and spine. The risk of developing coronary heart disease, hypertension, atherosclerosis, diabetes mellitus increases. Advanced cases can result in disability and death. Women aged 30-60 are twice as likely to develop the disease.

Types of obesity

Weight is controlled using the BMI coefficient, which is the ratio of a person's weight to height squared. The normal value of the coefficient ranges from 18.5-24.9 kg/m2. There is also Broca's index, which is calculated as body height in cm minus 100. The values \u200b\u200bof the indicator cannot be considered completely reliable. With the help of arithmetic, the degree of obesity is also calculated, as the ratio of the proper mass to the measured and multiplied by 100%. The disease has several classifications: according to the mechanism of development, the places of localization of deposits, the cause of occurrence.

Classification by development mechanism:

hyperplastic (an increase in the number of adipocytes, i.e. fat cells);
hypertrophic (increase in the size of adipocytes and their fat content).

Classification by localization of fat:

Android (like an apple). Fat deposits accumulate in the torso (armpits, abdomen). It is more common in men, therefore it is also called by the male type.
Gynoid (like a pear). Fat accumulates mainly in the thighs, buttocks, lower abdomen. The second name is for the female type.
Mixed type. Deposits are evenly distributed throughout the body.

Classification by reason of occurrence:

Primary or alimentary-constitutional.
Secondary.

In addition, secondary obesity is divided into:

cerebral;
endocrine;
against the background of taking neuroleptics, mental illness.

Symptoms

The characteristic symptoms will help determine the presence and degree of the disease. There are 4 main stages with the following BMI indicators, depending on age:

First stage

This species is more common in children. It is characterized by a slight weight gain, approximately 20% of the ideal weight. It does not cause discomfort. Women with the appearance of minor visible manifestations begin to deplete themselves with diets. Frequent breakdowns turn into even more weight gain, psychological trauma. Symptoms of obesity of the first degree:

increased appetite;
chronic overeating.

Second stage

In the second degree, the risk of impaired functioning increases, the metabolism slows down even more. The percentage of fat from the muscle mass of the body is 30-50%. Obesity in the second stage is characterized by the following symptoms:

dyspnea;
pain in the spine;
dysfunction of the endocrine system
discomfort in the joints;
profuse sweating.

Third degree

Obesity is hard to bear. The weight of a person in the third stage exceeds the normal body weight (NBW) by 50% or more. BDC is a weight that corresponds to the height of a particular person, given the type of his figure. In the third degree, a person can hardly tolerate even minimal physical activity. The following symptoms are noted:

drowsiness;
decreased mood;
nervousness;
swelling of the lower extremities;
liver enlargement.

In addition to the listed symptoms of the third stage, complications of obesity occur:

arthrosis of the joints;
myocardial infarction;
strokes.

fourth degree

The body weight of a person is doubled compared to the normal figure. This stage is rarely reached, since a neglected third degree often turns into a fatal outcome, a person simply does not live up to it. Rare people with the fourth stage of the disease lead a bed lifestyle. Symptoms of obesity of the fourth degree:

the usual contours of the body are no longer visible;
inability to perform elementary actions independently;
respiratory failure;
decreased appetite.

Signs of obesity

The development of alimentary-constitutional or primary obesity is due to an exogenous (alimentary) factor. Weight gain is associated with a high energy value of the diet at low energy costs. Secondary obesity is often accompanied by hereditary syndromes:

Lawrence-Moon-Barde;
Zhelino;
Babinski-Frelich disease.

This type of ailment can develop against the background of cerebral lesions:

dissemination of systemic lesions;
brain tumors;
traumatic brain injury;
infectious diseases;
consequences of surgical operations;
mental disorders.

Alimentary-constitutional

In women, the main fat trap is often the thigh area, in men - the abdomen. Unlike the secondary type of obesity, with alimentary-constitutional there are no symptoms of damage to the endocrine glands, however, the disease manifests itself as follows:

overweight increases gradually;
fat deposits are evenly distributed throughout the body.

hypothalamic

Signs of hypothalamic obesity:

obesity develops very quickly;
fat is deposited in the buttocks, on the hips, abdomen;
trophic skin disorders are characteristic (white and pink striae on the skin of the thighs, buttocks, dryness);
increased appetite, especially in the evening.

Endocrine

Obesity of the endocrine type is divided into the following subgroups:

pituitary;
hypothyroid;
climacteric;
adrenal;
mixed.

The endocrine form of obesity is characterized by the presence of symptoms associated with underlying and concomitant diseases caused by hormonal imbalance. It manifests itself with such symptoms:

feminization (masculinization);
hirsutism;
gynecomastia;
lipomatosis.

Signs of obesity of internal organs

Subcutaneous or visceral fat settles on the internal organs and makes it difficult for them to work. It is localized in the trunk, envelops the liver, heart and kidneys. The presence of this type of fat can be determined by measuring the waist circumference (WC). There is a high risk of developing diseases associated with visceral fat in women with a WC > 88 cm, in men with a WC > 102 cm. This type of fat:

increases the level of cholesterol in the blood;
increases blood pressure;
provokes inflammatory processes;
increases the amount of testosterone in women, reduces - in men.

Why is obesity dangerous?

The disease can completely destabilize the body. Excess weight affects the psycho-emotional state, causes depression, complete rejection of oneself. The disease can provoke diseases of the spine, joints, cardiovascular system, destabilization of liver functions, development of endocrine diseases, decreased function of the genital organs, menstrual irregularities in women and premature menopause. Obesity stage III and IV can be fatal.

Treatment

An important stage of treatment is the diagnosis of obesity. Depending on the degree of development of the disease, the appropriate treatment is selected. In the first stages, a low-calorie hypocarbohydrate diet and moderate physical activity are prescribed. With a sufficient amount of protein and fiber in the diet, it is necessary to reduce the consumption of fats and carbohydrates. Mostly fractional meals (5-6 times a day) and aerobic exercise.

Starting from the advanced second stage of the disease and above, drug treatment is prescribed. Drugs of the amphetamine group (phentermine, amfepramone, dexafenfluramine) are used. They dull the feeling of hunger, contribute to faster satiety. Some side effects are possible, for example, mild nausea, dry mouth, irritability, insomnia, allergies, addiction. In this case, fat-mobilizing drugs such as sibutramine and orlistat are prescribed.

At stages III and IV, in order to save a person's life and lose weight, surgical intervention is necessary. Popular methods of bariatric surgery today: gastric banding, vertical gastroplasty, gastric bypass. For cosmetic purposes, a procedure is used to remove local fat deposits on the body called liposuction.

Most people are already in the pre-obesity stage. In order not to start the development of the disease, it is necessary to reconsider your eating habits, adhere to the balance of calories, proteins, fats, carbohydrates, based on your norm. It is necessary to periodically measure OT, track the results of weight loss by photo. Photos not only reflect progress, but also serve as a kind of motivator. To regulate lipid metabolism, you need to maintain water balance and sleep patterns, increase physical activity.