Mkb 10 obesity of the 1st degree. Obesity - principles of treatment. Medication for obesity

Obesity is most commonly treated with a weight-loss diet and increased exercise. Usually, the daily calorie intake is reduced by 500-1000 from the number recommended for people of the same height, gender and age as the patient. The individual diet is designed in such a way as to ensure a slow, gentle weight loss. The diet can be tailored by a doctor or nutritionist, although in addition the patient can join a self-help group. To lose weight, it is imperative to exercise regularly. physical exercise moderate intensity.

Pharmacotherapy.

Appetite suppressants can be effective. Sibutramine regulates appetite by acting on neurotransmitters in the brain. In addition, medications such as orlistat may be helpful in reducing the ability of the digestive tract to absorb nutrients. In rare cases, obesity is treated with surgery. For example, the stomach can be stapled together to reduce its size.

Obesity is a condition in which excess body fat accumulates in the human body. A person is admitted to have this disease if his weight exceeds the maximum allowable for his height by at least 20 percent.

Causes of occurrence

Obesity occurs when the energy value of the food entering the body exceeds the body's needs. The predisposition to obesity can be inherited both as a result of established eating habits and due to the fault of a genetic factor. In rare cases, obesity may be a symptom of hormonal disorders, such as hypothyroidism. Certain drugs, especially, can also lead to obesity.

Risk factors

The risk of developing the disease increases with age. Women suffer more often. Sometimes the predisposition to obesity is inherited. The main risk factors are intemperance in food and a sedentary lifestyle.

Complications

Obesity can cause various health problems, as it puts additional stress on the organs and joints of the human body. For example, shortness of breath, back pain, hip and knee pain are among the most common problems. Obesity increases the risk of developing some common, potentially life-threatening diseases such as arteritis, stroke, and high blood pressure.

Diagnostics

If you develop obesity, you should consult a doctor. To exclude concomitant diseases, the patient will take a blood sugar test (to exclude diabetes) and cholesterol. Additionally, blood tests may be taken to detect other hormonal disorders. At the appointment, most likely, the patient's weight and height will be measured, and an individual diet will be developed. In addition, exercise of a certain intensity will be recommended.

Non-drug methods treatment

Obesity is most often treated with a weight-loss diet and increased exercise. Typically, the daily calorie intake is reduced by 500-1000 from the number recommended for people of the same height, gender and age as the patient. The individual diet is designed in such a way as to ensure a slow, gentle weight loss. The diet can be tailored by a doctor or nutritionist, although in addition the patient can join a self-help group. Regular moderate-intensity exercise is essential for weight loss.

Pharmacotherapy

Appetite suppressants can be effective. regulates appetite by acting on neurotransmitters in the brain. In addition, medications, such as those that weaken the ability of the digestive tract to absorb nutrients, may be helpful. In rare cases, obesity is treated with surgery. For example, the stomach can be stapled together to reduce its size.

This article discusses grade 2 obesity. We will tell you about the reasons for its appearance, symptoms, diagnostics and methods of treatment,. You will find out what drugs are used to treat this disease, whether they are taken into the army with such a diagnosis, the possible consequences and nutritional characteristics for women, men and adolescents.

Obesity 2 (moderate) degree (ICD code 10 - E66) is a serious disease resulting from overweight and after the first stage of obesity. It occurs as a result of leading an incorrect and sedentary lifestyle, due to various diseases, taking certain medications and ignoring treatment.

This pathology is an increase in the thickness and volume of internal and subcutaneous fat. Large amounts of fat accumulating around internal organs and squeezing them, becomes the cause of a violation of their structure and work (visceral obesity), which entails a dangerous condition for human life and health, as it further leads to the development of various complications.

Adults and the elderly, as well as adolescents and children, are equally susceptible to this condition. You can find out more about childhood obesity here.

The main indicator characterizing this condition is BMI in the range of 35-39.9 kg / m2. The calculation of the body mass index is carried out according to the formula:

I = m / h2

Where the weight in kg is divided by the height squared (height is measured in meters).

How to calculate body mass index

In young women, stage II obesity occurs as a result of overeating and a sedentary lifestyle. After 35 years, a slow metabolism can provoke such a condition. But, as a rule, the main reason is hormonal imbalance. The disease develops according to the gynoid type, the figure is in the shape of a pear.

In men, this pathology is less often diagnosed due to the fact that the man's body does not have such a tendency to hoarding as the woman's. The main factors for gaining excess body weight are the use of fatty foods, physical inactivity, as well as an excessive passion for alcoholic products, especially beer. The disease develops according to the abdominal type, in which the figure is an apple.

In babies under 1.5 years old, obesity develops due to hereditary factors or through the fault of parents. The main reasons are overuse of formula milk and inappropriate introduction of complementary foods. One of the most dangerous stages is puberty, during which the body responds inadequately to the changing hormonal background. Pathology develops in a mixed type.

Obesity types

Experts distinguish between primary and secondary forms of obesity. Primary obesity (alimentary, exogenous-constitutional) occurs as a result of a sedentary lifestyle and overeating. Secondary obesity (endocrine, hypothalamic) is caused by disorders in the functioning of various parts of the brain, adrenal glands and endocrine organs.

Primary obesity is the most common form of pathology. According to statistics, the appearance of excess and overweight is associated with:

• improper diet - consumption of large amounts of alcohol, carbonated drinks, sweet, spicy and salty products, as well as meals with a large amount of fats and carbohydrates;
• low physical activity - ignoring sports, sedentary work, spending weekends in front of the TV and computer.

Secondary obesity is associated with malfunctioning of the endocrine system and hypothalamus. But the quality of nutrition also plays an important role in the appearance of excess weight, so it will not be superfluous to adhere to the principles.

Causes

The main reason for the development of stage 2 obesity is the neglect of the first stage of the disease.

The provoking external and internal factors include:

• hormonal disorders;
• endocrine system diseases;
• various viruses and infections;
• iodine deficiency;
• the consequences of poisoning;
• complications after TBI;
• low physical activity;
• chronic lack of sleep;
• the use of psychotropic medications;
• frequent stress and nervous tension;
• unbalanced diet;
• lack of thyroid hormones;
• genetic predisposition to obesity.

Improper diet causes obesity

If the cause of the disease is rare physical activity, stress and unhealthy diet, then coping with this problem will be quite simple. It is much more difficult to deal with pathology if it is caused by various diseases... To begin with, you will have to undergo a course of treatment, but therapy is not always effective.

Signs

The signs of second degree obesity are:

• shortness of breath at rest;
• deterioration of health;
• visible ugly fullness;
• body mass index over 35;
• decreased performance, physical activity;
• weakness for no reason;
• the formation of puffiness on the arms and legs in the summer;
• increased heart rate during physical activity;
• increased sweating.

Each of these signs cannot indicate the presence of stage II obesity. But in the aggregate, they make up the clinical picture of pathology. The final diagnosis can only be established by a specialist on the basis of an examination.

According to the location of body fat, pathology is divided into 5 types:

• gynoid - buttocks and thighs;
• abdominal - abdomen;
• mixed - the whole body;
• cushingoid - the whole body, with the exception of the limbs;
• visceral - internal organs.

Photo of obesity degree 2

Photo of obesity of the 2nd degree in women
Photo of obesity stage 2 in men
Photo of obesity of the second type in children

Treatment

Therapy for the second stage of obesity involves taking certain medications and surgery. The statement that taking pills will allow you to lose up to 20 kg per month is just an opinion, since the doctors themselves doubt the effectiveness of such drugs. However, without these drugs, the process of losing weight will be longer.

What pills help to properly lose weight with obesity of the second stage? These are anorectics and fat and carbohydrate blockers, let's take a closer look at each of them.

Anorectics

This group of drugs has a direct effect on the human brain, namely, on the saturation center in the hypothalamus. Helps to dull hunger and makes it easier to tolerate food restrictions.

In the Russian Federation, it is allowed to take pills with sibutramine, which are prohibited in some countries:

• Reduksin;
• Lindax;
• Meridia;
• Goldline;
• Slimia.

Drugs containing amfepramone (Fepranone) or phenylpropanolamine (Dietrin) may also be prescribed.

Fat and carbohydrate blockers

Such drugs prevent the absorption of fats and carbohydrates in the intestines, which provoke an increase in body weight. In combination with diet and sports activities for obesity of the second stage, such drugs show a decent result.

Most often, drugs are prescribed containing orlistat in the form of the main active ingredient:

• Listata;
• Orsoten;
• Glucobay.

At the same time, various dietary supplements, for example, Chitosan, show the worst result.

If obesity is in an advanced stage, therapy is not limited to taking pills, surgery is also necessary. In the case when other methods of weight loss have not yielded any result, and obesity threatens with serious complications, including death, experts prescribe bariatrics (gastric bypass, or banding). Liposuction is not advisable, since the procedure has only a temporary effect.

It is permissible to use traditional medicine (diuretic and fat-burning herbs). But only after the permission of the attending physician.

Contraindications

Drug therapy for obesity type 2 is prohibited in the following situations:

• age up to 16 and over 65;
• breast-feeding;
• pregnancy.

In addition, each medicine has its own list of contraindications, which must be studied in advance.

Nutrition (diet) for obesity type 2

Diet

Since unbalanced nutrition is a common cause of obesity, therapy will be ineffective without diet correction. Many experts are inclined to believe that diet therapy is the main method of fighting type 2 obesity, therefore it is referred to as therapeutic measures.

There is no one-size-fits-all diet that can help all overweight people cope with their problem. In some cases, you have to sit on several diets in order to find one that would be effective in a particular case. It can be noted that it is definitely not suitable for obesity, since it belongs to the category of hard and involves the use of alcohol.

When choosing a suitable diet, you should adhere to certain requirements:

• Dishes should be simple and nutritious. The body of losing weight must necessarily receive vitamins, trace elements and important amino acids.
• Eating a lot of fiber helps to cleanse the intestines, so that excess weight will quickly go away.
• An important condition for all dishes is their low calorie content. In this case, we recommend that you give it a try.
• During the diet, carbonated drinks should be completely excluded from the diet, replacing them with mineral water, natural berry and fruit compotes. Also banned are honey, smoked meats, sausages, sweets, pickles, flour products, alcohol, hot spices and sauces, ice cream. It is necessary to minimize the consumption of granulated sugar and salt, oil and fats. Bread can be eaten only black and gray, mostly bran.
• Allowed the use of dairy products, but with a minimum content of fat, best of all - low-fat. Fruit can also be eaten, but must contain minimal amount sugar, no grapes and bananas!
• During weight loss, you should reduce the amount of servings, eat fractionally (6 times a day).
• It is useful to include unsweetened fruits, fresh vegetables and herbs in the diet. You can eat apples, but only green ones.
• Be sure to arrange a fasting day at least once a week. It helps to cleanse the body of harmful substances that prevent excess weight from going away. At this time, you can only eat certain dishes, for example, apples or cottage cheese (preferably low-fat). It is permissible to use only vegetables on a fasting day, except for potatoes.
• The importance of drinking regimen has long been proven in weight loss. You need to drink at least 2 liters of clean water per day, if there are no problems with edema. The principle is based on the drinking regime. It is also good to know.

The calorie content of the products of the daily diet should be lower than before losing weight. But at the same time, the figure should not be less than 1200 kcal.

Below is the sample menu with obesity of the second stage. Remember, portions should be reduced, and the frequency of their intake increased.

Menu:

• first breakfast - unsweetened coffee with milk, boiled meat, sauerkraut;
• second breakfast - unsweetened green tea, skim cheese;
• lunch - unsweetened fruit and berry compote, borscht cooked in vegetable broth without meat, boiled chicken, baked vegetables;
• afternoon tea - green apple;
• first dinner - baked potatoes, boiled lean fish;
• second dinner (before bedtime) - a glass of fat-free kefir.

Meals for obesity type 2 should be varied and low in calories. If desired, borscht can be replaced with vegetable stew or soup, baked potatoes - with a salad of boiled beets and low-fat sour cream or baked carrots.

The most important thing in stage 2 obesity is the desire to lose weight and become healthier. This means that you need to be patient in order to achieve your goal.

Sports for obesity type 2

Physical activity

Excess weight will not go away on its own if you only follow a diet and sit on the couch or at the computer the rest of the time. Movement is life, so behavioral therapy plays a huge role in losing weight.

If you want to lose excess weight, you will have to change your lifestyle. For this:

1. Try to move more. If you are at home, put on some rhythmic music and start cleaning. Walk up the stairs, forget what an elevator is, take walks in the fresh air.
2. Practice all methods of complex therapy for obesity.
3. Be less nervous and worried. Enjoy life!
4. Find the motivation to lose weight and do whatever it takes to get what you want.
5. Give up bad habits, forget about alcohol and high-calorie foods.
6. If you have mental health problems, take antidepressant medication.
7. Exercise regularly. Exercise in the morning, visit the pool at lunchtime, take a bike ride in the evenings. All these activities are at the heart of exercise therapy ( physiotherapy), which can be appointed by a specialist.
8. Get enough sleep. Sleep at least 8 hours a day.
9. Strictly follow all the recommendations of your healthcare professional.

Stick to these rules, as well as follow the recommended diet therapy, and in a short time you will be able to achieve amazing results.

Obesity and the army

Many parents and guys are interested in the question of whether they are being taken into the army with a second degree of obesity. Above, we have already described how to calculate the body mass index, now we will consider by what criteria a specialist identifies whether an overweight guy is suitable for service.

• Category "A" - full suitability for military service.
• Category “B” - suitability for military service with some restrictions. When passing a medical examination, the presence of minor pathologies is confirmed, for example, slightly impaired vision.
• Category “B” - assignment of limited fitness status. This category exempts from military service in peacetime, but in case of martial law, the conscript is enrolled in the 2nd turn.
• Category “D” - assignment of the status of “temporarily unusable”. It means that the conscript has some pathologies that can be treated, for example, fractures or obesity. In such a case, a delay of six months is provided, which in the future, if necessary, can be extended.
• Category "D" - complete exemption from military service due to unsuitability.

Based on this, it should be noted that a conscript with stage 2 obesity can be drafted into the army only after weight correction and undergoing the necessary therapy.

Complications

Due to the fact that visceral fat puts pressure on most of the internal organs, their functioning is disrupted and slowed down.

In the absence of therapy and control by specialists, obesity of the second stage becomes the cause of the following diseases:

• illness gastrointestinal tract- pancreatitis with complications;
• diseases of the gallbladder (more often manifested in women);
• haemorrhoids;
• hypertension;
• type 2 diabetes;
• fatty hepatosis;
• cardiac ischemia;
• myocardial infarction;
• ailments of the musculoskeletal system;
• labored breathing;
• impotence, infertility.

If treatment is ignored, pregnancy may not occur. Such a diagnosis during pregnancy is dangerous, since in this case the risk of developing various complications on early dates pregnancy, anemia and respiratory ailments - in the later.

Obesity of the 2nd degree is not a death sentence and is not as dangerous as the last stage of the disease. But at the same time, it carries more serious consequences than the initial stage of obesity. Therefore, it is important to seek help from specialists, and not wait for the problem to pass by itself.

Video: Three tests for obesity

Obesity(lat. adipositas- literally: "obesity" and lat. obesitas- literally: fullness, obesity, fattening) - fat deposition, weight gain due to adipose tissue. Adipose tissue can be deposited both in places of physiological deposits and in the area of ​​the mammary glands, thighs, and abdomen.

Obesity is divided into degrees (by the amount of adipose tissue) and types (depending on the reasons that led to its development). Obesity leads to an increased risk of diabetes, hypertension and other diseases associated with being overweight. The causes of excess weight also affect the spread of adipose tissue, the characteristics of the adipose tissue (softness, firmness, percentage of fluid content), as well as the presence or absence of skin changes (stretching, enlarged pores, so-called "cellulite").

What provokes Obesity:

Obesity can develop as a result of:

• imbalance between food intake and energy expended, that is, increased food intake and reduced energy expenditure;
• obesity of non-endocrine pathology appears due to disturbances in the systems of the pancreas, liver, small and large intestines;
• genetic disorders.

Obesity contributing factors

• Sedentary lifestyle
• Genetic factors, in particular:
  • Increased activity of lipogenesis enzymes
  • Decreased activity of lipolysis enzymes
• Increased intake of easily digestible carbohydrates:
  • drinking sweet drinks
  • a diet rich in sugars
• Certain diseases, in particular endocrine diseases (hypogonadism, hypothyroidism, insulinoma)
• Eating disorders (for example, binge eating disorder), in the Russian literature called eating disorders, a psychological disorder leading to an eating disorder
• Tendency to stress
• Lack of sleep
• Psychotropic drugs

In the process of evolution, the human body has adapted to accumulate a supply of nutrients in conditions of abundance of food in order to spend this supply in conditions of a forced absence or restriction of food - a kind of evolutionary advantage that allowed survival. In ancient times, completeness was considered a sign of well-being, wealth, fertility and health. An example is the sculpture "Venus of Willendorf", dated to the 22nd millennium BC. NS. (possibly the earliest known illustration of obesity).

Viruses

Human infection with adenovirus-36 (Ad-36) ( long time considered a causative agent of respiratory and eye diseases) converts mature stem cells of adipose tissue into adipose cells; moreover, those cells in which the virus was not detected remained unchanged.

Pathogenesis (what happens?) During Obesity:

The regulation of the deposition and mobilization of fat from fat depots is carried out by a complex neurohormonal mechanism (cerebral cortex, subcortical formations, sympathetic and parasympathetic nervous system, as well as endocrine glands). The main role in the pathogenesis of obesity is played by dysfunctions of the central nervous mechanisms - the cerebral cortex and hypothalamus, where the centers regulating appetite are located. Impaired coordination between energy expenditure and appetite, which determines the arrival of energy material and the intensity of metabolic processes, leads to the accumulation of fat. Apparently, the functional state of the centers that regulate eating behavior may have congenital features or acquired (brought up) from childhood in connection with the lifestyle of the family, the nature of nutrition, etc. inflammatory process or injuries accompanied by damage to the hypothalamus.

In the pathogenesis of obesity, one cannot but attach importance to the endocrine organs and, first of all, the pituitary gland, adrenal glands, islet apparatus of the pancreas, thyroid and sex glands.

An increase in the functional activity of the pituitary-adrenal cortex and the insular apparatus of the pancreas contributes to the accumulation of fat in the fat depots. A decrease in the somatotropic activity of the adenohypophysis, accompanied by a weakening of the processes of mobilization of fat from the depot and its subsequent oxidation in the liver, also acts as a pathogenetic factor, especially in the alimentary-constitutional form of obesity. A certain pathogenetic role in hypothalamic-pituitary obesity is played by the thyroid gland (due to a lack of thyroid hormones, the release of fat from fat depots and its oxidation in the liver are inhibited).

Reduced production of adrenaline, an active lipolytic factor, is essential in reducing fat mobilization and is one of the pathogenetic factors of obesity. The role of the gonads in the pathogenesis of primary obesity has not been adequately studied.

Obesity Symptoms:

The clinical manifestations of different types of obesity are generally similar. There are differences in the distribution of excess body fat and in the presence or absence of symptoms of damage to the nervous or endocrine system.

Most common alimentary obesity, usually in individuals with a hereditary predisposition to obesity. It develops in cases where the caloric content of food exceeds the energy consumption of the body, and is noted, as a rule, in several members of the same family. This type of obesity is more common among middle-aged and elderly women who lead a sedentary lifestyle. When collecting anamnesis with a detailed clarification of the daily diet, it is usually established that patients are systematically overeating. Alimentary obesity is characterized by a gradual increase in body weight. Subcutaneous adipose tissue is evenly distributed, sometimes to a greater extent accumulates in the abdomen and thighs. At the same time, there are no signs of damage to the endocrine glands.

Hypothalamic obesity observed in diseases of the central nervous system with damage to the hypothalamus (with tumors, in the outcome of injuries, infections). This type of obesity is characterized by the rapid development of obesity. Fat deposition is noted mainly on the abdomen (in the form of an apron), buttocks, and thighs. Often there are trophic changes in the skin: dryness, white or pink streaks of stretching (striae). According to clinical symptoms (for example, headache, sleep disorders) and the data of the neurological examination of the patient, it is usually possible to establish the pathology of the brain. As a manifestation of hypothalamic disorders, along with obesity, various signs of autonomic dysfunction are observed - an increase in blood pressure, sweating disorders, etc.

Endocrine obesity develops in patients with certain endocrine diseases (for example, hypothyroidism, Itsenko-Cushing's disease), the symptoms of which predominate in the clinical picture. On examination, along with obesity, which is usually characterized by uneven deposition of fat on the body, other signs of hormonal disorders are revealed (for example, masculinization or feminization, gynecomastia, hirsutism), striae are found on the skin.

A kind of obesity is the so-called painful lipomatosis(Derkum's disease), which is characterized by the presence of fatty nodes, painful to palpation.

In sick obesity II-IV degrees there are changes from the outside of cardio-vascular system, lungs, digestive organs. Tachycardia, muffled heart sounds, increased blood pressure are often observed. Sometimes respiratory failure and chronic cor pulmonale develop due to the high standing of the diaphragm. Most obese patients have a tendency to constipation, the liver is enlarged due to fatty infiltration of its parenchyma, symptoms of chronic cholecystitis and pancreatitis are often revealed. There are pains in the lower back, arthrosis of the knee and ankle joints. Obesity is also accompanied by menstrual irregularities, and amenorrhea is possible. Obesity is a risk factor for the development of diabetes mellitus, atherosclerosis, hypertension, coronary heart disease, with which it is often combined.

Obesity in children, like in adults, develops against the background of hereditary characteristics or as a result of acquired metabolic and energy disorders. More often obesity is observed in the 1st year of life and at 10-15 years. As in adults, exogenous constitutional obesity is more common in children, which is based on a hereditary (constitutional) predisposition to excessive fat deposition, often combined with family tendencies to overeating and overfeeding children. Excessive fat deposition usually begins as early as the 1st year of life and is unequally prevalent in boys and girls. Girls are born with more subcutaneous fatty tissue already developed than boys; this difference increases with age, reaching a maximum in adults, and is responsible for a higher incidence of obesity in girls and women.

In children 10-15 years old, the most common cause of obesity is the hypothalamic syndrome of puberty, which is characterized by the appearance of thin striae on the skin of the thighs, mammary glands, buttocks, and the inner surface of the shoulders. There is, as a rule, a transient increase in blood pressure; in some cases, signs of increased intracranial pressure are found. Less commonly, the cause of hypothalamic obesity in children is the consequences of traumatic brain injury, neuroinfection.

Obesity Diagnosis:

The most commonly used diagnostic criterion for obesity is the determination of the excess of the total body weight in relation to the statistically established norm. However, to determine the severity of the disease, it is not so much an excess of the total body weight that is important as an excess of adipose tissue mass, which can differ significantly even in persons of the same age, height and body weight. In this regard, the development and implementation of diagnostic methods for determining body composition and specifically fat mass in the clinic is quite relevant.

The starting point for determining the degree of obesity is the concept of normal body weight. Normal body weight is determined according to special tables, taking into account gender, height, body type and age, and is the average value corresponding to each group.

Along with the concept of normal body weight, the concept of ideal body weight is of essential importance in the clinic. This indicator was developed by order of health insurance companies and was supposed to determine at what body weight insured events (illness or death) are least likely. It turned out that the body weight at which life expectancy is maximum is about 10% less than the normal body weight. Ideal body weight is determined taking into account the human constitution (normosthenic, asthenic and hypersthenic). Exceeding the value of this indicator is considered overweight. Obesity is talked about when the excess body weight is more than 10%.

A number of methods have been proposed for calculating the ideal body weight. The simplest formula was proposed by the anthropologist and surgeon Brock (1868):

Mi = P- 100 ,

where Mi- ideal body weight, kg, R- height, see

Depending on the value of this indicator, 4 degrees of obesity are distinguished: the 1st degree of obesity corresponds to an excess of the ideal body weight by 15-29%, the 2nd degree - by 30-49%, the 3rd - by 50-99%, 4- I am more than 100%.

Currently, the most widely used measure of obesity is the body mass index (BMI), or Quetelet index:

BMI = body weight (kg) / height (m 2).

It is believed that for people aged 20-55 years with a height close to the average (men - 168-188 cm, women - 154-174 cm) BMI quite accurately reflects the situation. Most studies on the relationship of body weight with morbidity and mortality confirm that the maximum permissible body weight corresponds to a BMI of 25 kg / m 2.

Classification of excess mBody mass in adults by BMI (WHO report, 1998)

Measurement of the circumference of the waist and hips. Of great clinical importance is not only the severity of obesity, but also the distribution of fat. It must be determined primarily in patients with average overweight, since this does not take into account BMI. It is believed that the risk of complications in obesity largely depends not on overweight, but on the localization of adipose tissue deposits. Visceral fat can be measured with MRI. However, a simpler and more accurate criterion reflecting the distribution of fat is the ratio of the circumference of the waist and hips (OTB).

Measurement of HRT is important in determining body fat deposition, which is of particular importance in assessing the risk of morbidity. Depending on the distribution of fat, two types of obesity are distinguished: android and ganoid. Android, or obesity in the form of an apple, is called the distribution of fat around the waist. The deposition of fat around the buttocks and thighs is known as hypoid, or pear obesity. In the case of the android distribution of fat, the likelihood of morbidity and mortality is higher than in the ganoid type. With the deposition of the bulk of fat on the trunk and in the abdominal cavity, the likelihood of complications associated with obesity (hypertension, ischemic disease heart, type 2 diabetes mellitus). It is believed that, normally, OTB in women does not exceed 0.8, and in men - 1, the excess of these parameters is associated with metabolic disorders. If the waist circumference in men reaches 102 cm, and in women - 88 cm, in this case there is a serious risk of increasing the risk of morbidity and a decrease in body weight should be recommended (Table 40.3).

Determination of overweight and obesity by waist circumference (cm)

Obesity Treatment:

The main treatments for overweight and obesity

• These include adherence to a diet high in fiber, vitamins and other biologically active ingredients(cereals and whole grains, vegetables, fruits, nuts, herbs, etc.) and limiting the use of easily digestible carbohydrates (sugar, sweets, baked goods, bakery and pasta made from premium flour), as well as exercise.
• General approach for drug treatment obesity consists in testing all known drugs for the treatment of obesity. For this purpose, drugs are used to treat obesity.
• If the result of drug treatment is insignificant or not, then it is necessary to stop such treatment.

Then the question of surgical treatment is considered. Liposuction, as an operation in which fat cells are sucked out, is currently not used to combat obesity, but only for the cosmetic correction of small local fat deposits. Although the amount of fat and body weight may decrease after liposuction, a recent study by British doctors suggests that this operation is useless for health. Apparently, the damage to health is caused not by the subcutaneous fat, but by the visceral fat located in the omentum, as well as around the internal organs located in the abdominal cavity. Previously, there were isolated attempts to do liposuction for weight loss (the so-called megaliposuction with the removal of up to 10 kg of fat), but now it is left as an extremely harmful and dangerous procedure, which inevitably gives many serious complications and leads to gross cosmetic problems in the form of unevenness of the body surface ...

Diets often increase obesity. The reason is that a strict diet (a sharp reduction in calorie intake) can help you lose weight quickly, but after stopping the diet, appetite increases, food digestibility improves, and weight gains more than before the diet. If an obese patient tries to lose weight again with a rigid diet, each time losing weight becomes more difficult, and weight gain becomes easier, and the weight gained increases each time. Therefore, diets focused on fast results (to lose as much weight as possible in a short time) are harmful and dangerous practices. In addition, many weight loss products contain diuretics and laxatives, which results in water loss rather than fat loss. Loss of water is useless for fighting obesity, unhealthy, and weight is restored after stopping the diet.

Moreover, according to a study by American psychologist Tracy Mann and her colleagues, diets are generally useless as a means of fighting obesity.

However, it should be noted that without adequate control of food calories and taking into account the adequacy of the amount of incoming calories to physical activity, successful treatment of obesity is impossible. For successful weight loss, the WHO recommends calculating the usual calorie content of food, and then monthly reducing the calorie content by 500 kcal until the figure reaches 300-500 kcal below the adequate energy requirement. For people who are not active physical labor, this value is 1500-2000 kcal.

Surgical treatment of morbid obesity

Long-term studies have shown that surgery (bariatric surgery) is most effective in treating obesity. Only surgical treatment makes it possible to solve this problem completely. Currently, there are mainly two types of obesity surgery used in the world. Roux-en-Y gastric bypass is used in the USA and Canada (90% of all operations). It makes it possible to get rid of 70-80% of excess weight. In Europe and Australia, regulated gastric banding is dominant (90% of all operations), which makes it possible to get rid of 50-60% of excess weight.

Currently, all bariatric surgeries are performed laparoscopically (that is, without incision, through punctures) under the control of a miniature optical system.

Surgery for obesity has strict indications; it is not intended for those who believe that they are simply overweight. It is believed that the indications for surgical treatment of obesity having a BMI above 40. However, if the patient has problems such as type 2 diabetes, hypertension, varicose veins and leg joints problems arise even when reading a BMI of 35. Recently, works have appeared in the international literature that have studied the effectiveness of gastric banding in patients with a BMI of 30 and above.

Obesity Prevention:

Prevention of obesity is to eliminate hypodynamia and rational nutrition... In children, it is necessary to adhere to the rules of feeding and regular monitoring of the physical development of the child by systematic measurement of height and body weight (especially with a constitutional predisposition to obesity). Early detection and treatment of diseases associated with hypothalamic and endocrine obesity is important.

International classification of diseases 10th revision (ICD-10)

Version 2016

E65-E68 Obesity and other types of excess nutrition

E65 Localized fat deposition

Including: fat cushions

E66 Obesity

Excluded:
E66.0 Obesity due to excess energy supply

E66.1 Obesity due to ingestion medicines

If it is necessary to identify a medicinal product, an additional code of external causes (class XX) is used.

E66.2 Extreme obesity with alveolar hypoventilation

Pickwick syndrome

E66.8 Other obesity
E66.9 Obesity, unspecified

Simple obesity NOS

E67 Other types of redundancy in power supply

Excluded:

overeating NOS (R63.2)
consequences of excess nutrition (E68)

E67.0 Hypervitaminosis A

E67.1 Hypercarotenemia

E67.2 Vitamin B6 megadoses syndrome

E67.3 Hypervitaminosis D

E67.8 Other specified forms of nutritional excess
E68 Consequences of excess power supply

Note. Should not be used for chronic overeating. This code is for the current overeating.

Notes. 1. This version corresponds to the 2016 version of the WHO (ICD-10 Version: 2016), some positions of which may differ from the version of ICD-10 approved by the Ministry of Health of Russia.

2. NOS - no additional clarifications.

3. The translation into Russian of some terms in this article may differ from the translation in the ICD-10 approved by the Ministry of Health of Russia. All comments and clarifications on translation, design, etc. are accepted with gratitude for e-mail.

4. An asterisk marks optional additional codes related to the manifestation of the disease in a separate organ or area of ​​the body, which is an independent clinical problem.