MINISTRY OF HEALTH OF THE REPUBLIC OF BASHKORTOSTAN

HEALTH CENTER GUZ REPUBLICAN MEDICAL-PHYSICAL DISPENSER

School of health

Lecture number 7

"OBESITY IS A RISK FACTOR FOR THE DEVELOPMENT OF DISEASES

AND HOW TO FIGHT WITH IT "
Obesity is a widespread disease and occurs in 35% of the population, and after 40 years of age, obesity, to one degree or another, is expressed in 40-60% of the population.

American studies show that 63% of men are overweight in the United States and 55% of women are overweight, and the number of obese American adults has increased from 15% to 27% from 1980 to 1999.

Overweight and obesity are urgent problems of modern medicine. The statistics are disappointing: more than a third of the adult population of Russia suffers from this disease.

The difficult situation with obesity is determined by a sharp increase in the number, including young, patients and a decrease in overall life expectancy due to severe concomitant obesity diseases. In 1998. The World Health Organization has recognized obesity as a chronic disease. Over the past decade, the number of such patients has almost doubled. According to experts, by 2025 the number of obese patients in the world will reach 300 million.

To the history of the issue

Humanity's views on obesity have changed over the centuries. In the distant past, the ability to store fat was an evolutionary advantage that allowed humans to survive during periods of forced starvation. Overweight women served as a symbol of motherhood and health.

However, with the development of medicine, the attitude towards obesity has gradually changed. She no longer seemed blessed: long-term observations of scientists, medical practitioners, and the patients themselves for their own health showed that excessive obesity is dangerous to health. Adipose tissue, located not only under the skin, but, enveloping many internal organs, complicates their work and the whole organism as a whole - from the simplest functions to work at the cellular level.

An overweight person often develops cardiovascular diseases, diabetes mellitus, diseases of the joints, spine and, as a result, decreases life expectancy. In addition, obese patients have a lot of social problems. Moreover, they begin from childhood. Children often get offensive nicknames, they are embarrassed to go to physical education classes, to visit the beach. Adults sometimes experience problems in career growth, in the arrangement of their personal lives.

Obesity is considered today as a disease requiring serious treatment. In developed countries, the cost of treating obesity and related comorbidities is about 10 percent. of all annual health care costs. Nevertheless, many people still consider overweight and obesity a personal problem that can be solved on their own, mobilizing only willpower, and rarely go to the doctor.

Many are trying to self-medicate, "falling into" advertising all kinds of weight loss products. The result, as a rule, is deplorable: as soon as the intake of such a remedy ends, the dropped kilograms come back, often in much larger quantities. Having lost faith in treatment, many obese people lose faith in the fact that they will ever be able to lose weight.

"Apple" or "pear"?

Obesity can be defined as excess body fat. It develops as a result of energy imbalance. Excess calories (overeating only 50-200 kcal per day leads to slow but progressive weight gain) is used to synthesize fat, which is stored in fat stores. Gradually fat depots increase, body weight is growing steadily.

An increase in the standard of living, a change in the structure of nutrition, an increase in the use of high-calorie foods with a high content of carbohydrates and fats, physical inactivity - all this contributes to the absorption of excess energy, and hence the growth of obesity.

The gender of a person is also of some importance. Women are more likely to be overweight than men (after pregnancy, childbirth, during menopause). With age, people of both sexes are more likely to develop obesity. In some cases, the cause of its development may be endocrine diseases, the use of certain drugs. Hereditary predisposition is also of great importance in the occurrence of obesity.

Many factors - socio-economic, ethnic, traditional, and personal - have a significant impact on the prevalence of obesity. An interesting example. In China, the prevalence of obesity is extremely low - only 2 percent suffer from this disease. population of the country. But if you take the Chinese diaspora in the United States, the prevalence of obesity there is many times higher than that of the indigenous Chinese. This difference in weight is due to the eating habits that the "Americans" have become different than at home. Therefore, obesity treatment should be primarily associated with changes in lifestyle, attitudes towards food and the idea of \u200b\u200bideal body weight.

There are a variety of methods for assessing obesity. One of the most common indicators for assessing the degree of obesity is the index body weight (BMI), sometimes called kutelet index, by the name of the scientist who proposed it (see Table 1). It is calculated as follows:

Treatment is particularly required in patients with a BMI of 30 kg / m 2 or more and a BMI of 27 kg / m 2 or more, whose obesity is associated with risk factors such as type 2 diabetes or dyslipidemia.

There are three types of obesity, depending on the distribution of body fat.

Abdominal, android, or upper, type of obesity is characterized by excess deposition of fatty tissue in the abdomen and upper body. The shape becomes like an apple. Obesity of the "apple" type is more common in men and is the most unfavorable for health, usually accompanied by the development of diseases of the cardiovascular and respiratory systems, diabetes mellitus.

The lower, or hip-gluteal, type of obesity is characterized by the development of adipose tissue mainly in the buttocks or thighs. In this case, the floating figure looks more and more like a pear. Pear-type obesity most often occurs in women and is usually accompanied by the development of diseases of the spine, joints and veins of the lower extremities.

Mixed or intermediate obesity is characterized by an even distribution of fat throughout the body.

There is also a hypoid type, which is distinguished by a uniform distribution of fat with a predominance of it in the buttocks and thighs. With this type of obesity, the number of fat cells is increased, and often from early childhood.

The type of obesity can be determined by examination, but, in addition, it can be calculated from the ratio of the waist circumference to the hip circumference (T / B): with android (trunk) obesity, T / B is more than 1.0 for men and more than 0.84 - 0 .85 for women; with hypoid (peripheral) obesity, T / B is less than 1.0 for men and less than 0.84 for women.

Weight gain goes through several stages, from a condition called "overweight" to grade III obesity, which can be considered a serious illness.

The diagnosis of obesity is determined strictly by mathematical methods. Calculated, the so-called body mass index (BMI): body weight (kg) divided by height (m) 2. For example: body weight \u003d 70 kg; height \u003d 1.6 m. BMI \u003d 70: 1.62 2 \u003d 70: 2.56 \u003d 27.34. This BMI value: more than 25, but less than 30 kg / m 2 indicates overweight, but it is not obesity yet.

With a BMI of more than 30 kg / m 2, they talk about obesity, and depending on how much more, three degrees of obesity are distinguished.

According to other sources, an excess of BMI by 15 - 29% is considered obesity

I degree, 30 - 49% - II, 50 - 100% - III, and more than 100% - IV - degree.

Table 1a

Body weight in depending on BMI (index masses body)

Body mass index,	Body weight assessment	Body weight in kg
		For growth 160 cm	With growth 170 cm	With growth 180 cm
Less than 18.5	Underweight	Less than 52	Less than 58	Less than 65
18,5-25	Normal body weight	52-64	58-72	65-8!
25-30	Mild obesity	64-77	72-87	81-97
30-35	Moderate obesity	77-90	87-101	97-113
35-40	Severe obesity	90-102	101-116	113-130
Over 40	(Pathological obesity	More than 102	More than 116	Over 130

Table 1.

Classification of overweight in adults according to BMI (prepared in accordance with the WHO 1998 report)

Classification	BMI (kg / m 2)	The likelihood of a concomitant disease
Insufficient weight	Less than 18.5	Low (but the risk of other clinical problems is increasing)
Normal range	18,5-24,9	Average
Preobesity	25,0-29,9	Increased
Obesity class I	30,0-34,9	Moderately increased
Obesity class II	35,0-39,9	Significantly increased
Obesity class III	More than 40.0	Very increased

Many experts believe that the ideal weight for each person is their own weight, which was at the age of 25. Anything that is typed later is a deviation from the ideal weight.

"Overweight" is, as a rule, the first step on a well-known path, it speaks, firstly, of the predisposition to obesity, and secondly, that this predisposition has begun to be realized.

Obesity and morbidity.

Maybe nothing terrible is happening, and it’s not such a dangerous “disease” to take urgent measures? Maybe this is just a cosmetic defect, which, in the end, can be treated in different ways?

But this, alas, is not so. First, obesity leads to a significant decrease in performance, deterioration of health and mood. Secondly, it is a risk factor for so many diseases that it is easier to list diseases that have nothing to do with obesity. With overweight, atherosclerosis, hypertension and coronary artery disease are more common. Among obese people, hypertension occurs in 60% (without obesity - in 18%), coronary heart disease - in 47% (without obesity - in 25%), atherosclerosis - in 52% (without obesity - in 24%). Obesity also aggravates the course of these diseases, and treatment is ineffective until it is possible to reduce body weight.

Overweight people also more often develop diabetes mellitus, cholecystitis, cholelithiasis, thrombophlebitis of the veins of the lower extremities, lymphostasis, destruction of joints, bones and spine, hyperlipidemia, hypercholesterolemia, gout, shortness of breath, oxygen deficiency, etc. Thus, obesity in the end leads to a deterioration in the quality of life and shortens its duration.

Diseases associated with obesity

Metabolic diseases (metabolic disorders in the body)	Type 2 diabetes, impaired glucose sensitivity, increased blood insulin. Violation of fat and cholesterol metabolism, fatty degeneration of the liver.
Cardiovascular diseases	Arterial hypertensionIschemic heart disease, left ventricular hypertrophy, heart failure, venous insufficiency.
Neoplasms	Increased risk of developing neoplasmshormone-dependent carcinomas (endometrium of the cervix, ovaries, breast, prostate), non-hormone-dependent carcinomas (colon, rectum, pancreas, liver, kidneys, gallbladder)
Blood clotting disorders	Hyperfibrinogenemia, an increase in plasminogen activator inhibitor
Respiratory system dysfunctions	Sleep apnea (stopping breathing), Pickwick syndrome

Abdominal obesity is the earliest manifestation of insulin disorders, in most patients it develops at the age of 30-39 years and precedes other diseases.

Numerous studies have shown that obesity is an independent, independent risk factor for cardiovascular diseases, characterized by high mortality.

As a result of a 26-year study, it was found that the incidence of cardiovascular disease is constantly increasing depending on the excess body weight in both men and women. The increase in the initial weight was an independent risk factor for the development of coronary heart disease, deaths from ischemic heart disease, and heart failure, regardless of age, blood cholesterol level, smoking, systolic blood pressure, left ventricular hypertrophy and impaired glucose tolerance.

Symptoms of diseases complicating obesity develop by the age of 40, sometimes even earlier, and by the age of 50, as a rule, a definite clinical picture of diseases requiring active drug treatment is fully formed.

The most serious obesity-related medical problems that threaten the patient's life or significantly reduce the quality of life and require special therapy are coronary artery disease, cerebrovascular accident, hypertension, diabetes mellitus, malignant neoplasms, sleep apnea syndrome.

Obese people are more likely to experience various malignant diseases, including tumors of the gastrointestinal tract and kidneys, as well as some hormone-dependent tumors (cancer of the cervix, endometrium, breast, ovaries, prostate).

There is no doubt that obesity is an integral part of sleep apnea (respiratory arrest) syndrome.

More than 70% of obese people are worried about shortness of breath, which is observed in obese people as in physical activity, and at rest.

Increased accumulation of fat in the abdominal cavity and increased intra-abdominal pressure lead to a high standing of the dome of the diaphragm, a decrease in total lung capacity and a decrease in ventilation even at rest.

Obesity also has a negative effect on the respiratory muscles and the energy cost of breathing. The efficiency of breathing decreases - the ratio of mechanical work produced by the lungs to the total energy used during breathing.

Difficulty breathing in obese individuals can also be caused by compression of the veins of the posterior mediastinum, leading to venous congestion in the pleura and the accumulation of fluid in the pleural cavities. In this case, intrapleural pressure increases, the airways narrow, atelectasis appears, and the gas exchange surface decreases.
With physical exertion, the work of the lungs increases even more, but since it can only increase up to a certain limit, respiratory failure occurs with a relative decrease in lung ventilation.

Thus, obesity is accompanied by the development of ventilation failure. Hypoventilation in obesity contributes to a more frequent development of inflammatory processes in the lungs, a more severe course of pneumonia and postoperative complications.

Obesity contributes to the development of fatty degeneration of the liver and gallstone disease.

06.04.2016

The increase in the number of obesity cases has become an epidemic among both adults and children (1,2). An adult is considered to be overweight if his body mass index (BMI) is between 25 and 29.9 kg / m2, and obesity if his BMI is more than 30 kg / m2. If the body weight is two or more times the normal weight, then they speak of morbid obesity.

Last Updated on 07/04/2019 16:07

Obesity is now a serious problem in the United States. During the 1980s and 1990s, the prevalence of obesity increased by 50% and continues to increase (3). If 40 years ago only 25% of American adults were overweight or obese, today this figure has risen to almost 70% (3-5). In addition, the proportion of the population with morbid obesity is growing faster than the proportion of Americans who are overweight or moderately obese (1,2,3,5). According to the latest data, smoking, alcoholism and poverty increase the risks of overweight. If current trends continue, obesity in the United States will soon overtake smoking and become the leading cause of preventable deaths (4-6). Moreover, if we do not succeed in stopping the obesity epidemic in the near future, then the growth of human life expectancy will stop, and the process may turn in the opposite direction (7, 8).

Obesity is a significant factor in determining the likelihood of a person dying. Thus, it has been proven that both general obesity and abdominal (mainly in the abdomen and upper body) are associated with an increased risk of premature death (9). However, doctors talk about the "obesity paradox": despite the fact that it is a risk factor for hypertension, heart failure and ischemic disease heart disease, studies indicate that those with extra pounds often have a better prognosis than those with normal weight.

Obesity Physiology

Adipocytes (fat cells) function as an endocrine organ and play an essential role in the development of obesity and its consequences (1,10). Adipocytes produce leptin, the “satiety hormone”. When it enters the hypothalamus (part of the brain), appetite suppression occurs (10,11).

With obesity, the level of leptin increases, which affects food intake and energy metabolism, a state of resistance (resistance) to leptin develops, when the body ceases to correctly assess its amount. Even when the level of the satiety hormone is elevated, the brain thinks that the body is hungry and produces ghrelin, the "hunger hormone" that stimulates appetite and makes people look for food.

In the development of leptin resistance, C-reactive protein (CRP) also plays a role - a key protein in the acute phase of inflammation, the level of which increases in obesity (12). It binds to leptin, leads to hyperleptinemia (a condition in which leptin levels are chronically elevated) and contributes to the development of resistance to it.

Impact of obesity on the cardiovascular system

The heart is an organ mainly made up of special cardiac striated muscle tissue (myocardium). The two atria and two ventricles of the heart are organized in two circles of blood circulation: the small (pulmonary), through which the blood is enriched with oxygen, and the large, with the help of which the blood carries oxygen throughout the body.
They talk about two main phases of the heart: systole (contraction) and diastole (relaxation). In the systole phase, two stages can be distinguished:

1) first, atrial contraction occurs and blood from them enters the ventricles;

2) then the ventricles contract, and the blood from them enters: from the left ventricle - to the organs of the body, from the right - to the lungs.

In the diastole phase, the heart muscle relaxes and the atria are filled with blood: the left atrium - with oxygen-rich blood from the lungs, the right one - with oxygen-poor blood from organs and tissues.

Obesity affects the volume of blood that passes through the heart. A larger volume of blood puts more pressure on the walls of the vessels of the circulatory system, that is, the body is forced to adapt to heavy loads. Let's see how this happens.

With obesity, the total blood volume increases and, accordingly, cardiac output - the amount of blood expelled by the heart per unit of time. Basically, an increase in cardiac output occurs due to an increase in the stroke (systolic) volume of the heart - the amount of blood ejected by the heart in one contraction (systole). Also, the heart rate usually rises slightly - due to the activation of the sympathetic nervous system (13). Usually, in obese patients, the volume of cardiac output increases with increasing weight, and the level of peripheral vascular resistance at any blood pressure remains low (14,15), that is, the tone of the vascular walls decreases inversely with obesity. It is believed to be an adaptive mechanism that allows, to a certain extent, to maintain normal pressure and resistance of the walls of blood vessels in the body. However, it cannot fully compensate for the negative effect of obesity. With an increase in the stretching of the heart muscle, the strength of the heart contractions increases, that is, the load on the vessels increases. Therefore, obese patients are more likely to have hypertension than lean people, and, as a rule, weight gain is associated with an increase in blood pressure (13,15).

As the volume and pressure increase when the heart is filled with blood in overweight and obese people, the chamber of the left ventricle often enlarges (13,14,16). Moreover, the risk of hypertrophy (increase) of the left ventricle (LVH) increases regardless of age and blood pressure. The likelihood of changes in the structure of the heart increases: concentric remodeling of the myocardium and left ventricle (17). Remodeling is understood as a whole complex of changes occurring in the heart: thickening of the walls and muscle fibers themselves, an increase in the number of components of the heart striated muscles, etc. In addition to left ventricular hypertrophy, obesity is often the cause of left atrial enlargement, this is associated with an increase in circulating blood volume and a change in the filling volume of the left atrium during diastole (relaxation) (14,18). All of these changes increase the risk of developing heart failure. An increase in the left atrium also increases the risk of atrial fibrillation and related complications (19).

Clinical consequences of obesity

Hypertension is a disease in which there is a constant or regular increase in blood pressure. Typically, hypertension leads to a thickening of the walls of the ventricle of the heart without expansion of the chamber itself - this process refers to concentric remodeling, if the mass of the left ventricle does not increase. If it grows, then we are talking about concentric hypertrophy of the left ventricle. In obesity, the expansion of the left ventricular chamber usually occurs without a noticeable increase in the thickness of its walls - eccentric hypertrophy of the left ventricle (muscle fibers increase in length and width) (4,17).

At the same time, obese hypertensive patients, paradoxically, have a better chance of survival. All-cause mortality in people with hypertension, as well as overweight and obesity, is 30% lower than in people of normal weight (20), i.e. there is a paradox of obesity. Similar results were obtained in other studies of hypertension, which showed that increased mortality in all cases was observed at the extreme values \u200b\u200bof BMI at both ends of the scale - both too high and too low (21,22,23). One of the explanations is the adaptation of the mechanism for maintaining blood pressure - the renin-angiotensin-aldosterone system (RAAS), a hormonal system that regulates blood pressure and blood volume in the human body (24). The lower the RASC activity, the lower the blood pressure.

Heart failure is a syndrome in which an acute or chronic disruption of the heart develops, which leads to a deterioration in the blood supply to the rest of the body. At the same time, many studies claim that such patients have better prognosis than people with heart failure, but with a normal weight.
The Framingham Heart Study found that for every 1 kg / m2 increase in BMI, the risk of developing heart failure increased by 5% in men and by 7% in women (25). This stepwise increase in risk has been observed for people with any BMI. In another study involving patients with morbid obesity, about one third of them had clinical symptoms of the disease, and the likelihood of developing it increased as the duration of this condition increased (26). Finally, compared with individuals whose BMI was not increased, overweight and obesity patients showed a decrease in mortality from cardiovascular diseases (by 19% and 40%, respectively) and from all causes (by 16% and 33% , respectively) (27). And according to another study, for every 5 units of increase in BMI, the risk of death decreases by 10% (28).

Researchers believe that being overweight may be a form of defense (27-30). Progressive heart failure is a catabolic state (a state of decay) and metabolic reserve is higher in patients with heart failure and obesity (31-33). It has also been shown that adipose tissue produces soluble tumor necrosis factor alpha (TNF-α) receptors and may play a protective role in patients with obesity and acute or chronic heart failure by binding TNF-α and neutralizing their negative biological effects (34). In addition, circulating lipoproteins (cholesterol), the level of which is elevated in obese patients, bind and detoxify lipopolysaccharides, which play a role in stimulating the production of inflammatory cytokines, thereby protecting the patient (31,35).

Coronary artery disease (CHD)- a disease in which the blood supply to the heart muscle is impaired due to damage to the coronary arteries. Obesity plays a negative role in the formation of such risk factors for the development of coronary artery disease as hypertension, dyslipidemia and diabetes mellitus (DM) (4,24,36,37). Excessive obesity is closely associated with primary myocardial infarction (MI) without ST-segment elevation, a type of infarction that often occurs at a young age (38).

Atrial fibrillation - a life-threatening condition in which the electrical activity of the atria is 350-700 pulses per minute, which prevents them from contracting in a coordinated manner. Obesity increases the risk of disease by 50% in parallel with an increase in BMI (39).

Stroke is a violation of cerebral circulation. They talk about two types of stroke: hemorrhagic, when an artery ruptures due to excessive blood flow to the brain; and ischemic, when some parts of the brain, on the contrary, suffer from disturbances in blood flow due to interruptions in the work of the heart or atherosclerotic plaques that clog the vessels. It has been proven that an increase in BMI per unit increases the risk of ischemic stroke by 4% and hemorrhagic stroke by 6% (1.40). An increased risk of stroke is correlated with an increased incidence of hypertension and a prothrombotic / pro-inflammatory condition that develops as excess fatty tissue accumulates, which also increases the likelihood of atrial fibrillation.

Sudden cardiac death - practically healthy obese patients receive this postmortem diagnosis 40 times more often than people with normal weight (13). Doctors associate this fact with an increased sensitivity of the heart to electrical impulses in obesity, which can be the cause of frequent and extensive ventricular arrhythmias.

Sleep apnea - a sleep disorder in which a sleeping person stops breathing several times during the night. The body needs a certain amount of oxygen, which flows through the walls of the alveoli in the lungs. With obesity, a state of alveolar hypoventilation develops (41), in which there is insufficient oxygen supply due to the fact that obese people are unable to breathe "deeply". Sleep apnea contributes to the development of hypertension, as well as activates inflammation and increases the level of C-reactive protein (CRP). Such patients have an increased risk of hypertension, arrhythmias, pulmonary hypertension (15-20% of cases), heart failure, myocardial infarction, stroke, and mortality in general (42).

Vein disease - Another side effect of obesity, which develops against the background of a combination of growing intravascular volume and an overloaded lymphatic system. In addition, decreased physical activity has a negative effect. As a result, obesity often develops venous insufficiency and edema (43), which lead to venous thromboembolism and pulmonary embolism, especially in women (44,45).

The importance of weight loss

The obesity paradox has become the basis of the theory that targeted weight loss is not only unprofitable, but may even harm patients with cardiovascular disease (46,47-49). However, mortality estimates not only based on BMI, but also depending on the percentage of body fat and lean muscle mass, showed that mortality among people who lose weight by reducing the amount of fat, rather than muscle, on the contrary, decreases (48,50).

You should also consider the possible side effects of losing weight. Fasting, super-low-calorie diets, liquid protein diets, and obesity surgery are associated with an increased risk of life-threatening arrhythmias (1). A similar situation is observed with various drugs for weight loss, which have limited effectiveness or are quite toxic (51-53).

At the same time, it has been proven that lifestyle changes, including the introduction of exercise and gradual weight loss against the background of caloric restriction, lead to a 60% decrease in the risk of developing diabetes mellitus, which is significantly more effective in preventing diabetes than treatment with metformin (54,55). The introduction of cardiac rehabilitation with exercise into medical practice reduced the prevalence of metabolic syndrome by 37% (56). And weight loss in patients with coronary artery disease improves CRP, lipid and blood glucose levels (57,58). In hypertension, a weight loss of only 8 kg reduces left ventricular wall thickness (59). Even with morbid obesity, gastroplasty (gastric closure) leads to an improvement in all mortality rates (26), including for cancer patients, patients with diabetes mellitus and cardiovascular diseases (60).

conclusions

The vast majority of studies confirm the effect of obesity on the development and progression of cardiovascular disease. Despite the obesity paradox, according to which people with excess pounds and cardiovascular disease have a better prognosis than thin patients with the same diagnosis, research suggests that weight loss is effective in preventing and treating cardiovascular disease. According to scientists, more research is needed, because if the current obesity epidemic continues, we may soon witness a sad end to the epic of increasing life expectancy.

Bibliography

• Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scienti fi c statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation 2006; 113: 898-918.
• Klein S, Burke LE, Bray GA, et al. Clinical implications of obesity with speci fi c focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2004; 110: 2952-67.
• Flegal JN, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723-7.
• Lavie CJ, Milani RV. Obesity and cardiovascular disease: the Hippocrates paradox? J Am Coll Cardiol 2003; 42: 677-9.
• Manson JE, Bassuk SS. Obesity in the United States: a fresh look at its high toll. JAMA 2003; 289: 229-30.
• Sturm R, Well KB. Does obesity contribute as much to morbidity as poverty or smoking? Public Health 2001; 115: 229–35.
• Litwin SE. Which measures of obesity best predict cardiovascular risk? J Am Coll Cardiol 2008; 52: 616-9.
• Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol 2007; 50: 2128–32.
• Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105-20.
• Martin SS, Qasim A, Reilly MP. Leptin resistance. J Am Coll Cardiol 2008; 52: 1201-10.
• Lavie CJ, Milani RV, Ventura HO. Untangling the heavy cardiovascular burden of obesity. Nat Clin Pract Cardiovasc Med 2008; 5: 428-9.
• Enriori PJ, Evans AE, Sinnayah P, Crowley MA. Leptin resistance and obesity. Obesity 2006; 14 Suppl 5: 254S – 8S.
• Messerli FH, Nunez BD, Ventura HO, Snyder DW. Overweight and sudden death: increased ventricular ectopy in cardiomyopathy of obesity. Arch Intern Med 1987; 147: 1725-8.
• Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001; 321: 225-36.
• Messerli FH, Ventura HO, Reisin E, et al. Borderline hypertension and obesity: two prehypertensive states with elevated cardiac output. Circulation 1982; 66: 55-60.
• Messerli FH. Cardiomyopathy of obesity: a not-so-Victorian disease. N Engl J Med 1986; 314: 378-80.
• Lavie CJ, Milani RV, Ventura HO, Cardenas GA, Mehra MR, Messerli FH. Disparate effects of left ventricular geometry and obesity on mortality in patients with preserved left ventricular ejection fraction. Am J Cardiol 2007; 100: 1460-4.
• Lavie CJ, Amodeo C, Ventura HO, Messerli FH. Left atrial abnormalities indicating diastolic ventricular dysfunction in cardiopathy of obesity. Chest 1987; 92: 1042-6.
• Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fi brillation. JAMA 2004; 292: 2471-7.
• Uretsky S, Messerli FH, Bangalore S, et al. Obesity paradox in patients with hypertension and coronary artery disease. Am J Med 2007; 120: 863-70.
• Wassertheil-Smoller S, Fann C, Allman RM, et al., For the SHEP Cooperative Research Group. Relation of low body mass to death and stroke in the systolic hypertension in the elderly program. Arch Intern Med 2000; 160: 494-500.
• Stamler R, Ford CE, Stamler J. Why do lean hypertensive patients have higher mortality rates than other hypertensive patients? Findings of the hypertension detection and follow-up program. Hypertension 1991; 17: 553-64.
• Tuomilehto J. Body mass index and prognosis in elderly hypertensive patients: a report from the European Working Party on High Blood Pressure in the Elderly. Am J Med 1991; 90: 34S-41S.
• Lavie CJ, Milani RV, Ventura HO. Obesity, heart disease, and favorable prognosis-truth or paradox? Am J Med 2007; 120: 825-6.
• Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347: 305-13.
• Alpert MA, Terry BE, Mulekar M, et al. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol 1997; 80: 736-40.
• Oreopoulos A, Padwal R, Kalantar-Zadeh K, et al. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008; 156: 13-22.
• Fonarow GC, Srikanthan P, Costanzo MR, et al. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the acute decompensated heart failure national registry. Am Heart J 2007; 153: 74–81.
• Lavie CJ, Osman AF, Milani RV, Mehra MR. Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol 2003; 91: 891-4.
• Lavie CJ, Milani RV, Artham SM, et al. Does body composition impact survival in patients with advanced heart failure (abstr). Circulation 2007; 116: II360.
• Lavie CJ, Mehra MR, Milani RV. Obesity and heart failure prognosis: paradox or reverse epidemiology. Eur Heart J 2005; 26: 5-7.
• Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004; 43: 1439–44.
• Anker S, Negassa A, Coats AJ, et al. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting enzyme inhibitors: an observational study. Lancet 2003; 361: 1077-83.
• Mohamed-Ali V, Goodrick S, Bulmer K, et al. Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. Am J Physiol 1999; 277: E971-5.
• Rauchhaus M, Coats AJS, Anker SD. The endotoxin-lipoprotein hypothesis. Lancet 2000; 356: 930-3.
• Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67: 968-77.
• Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training programs in metabolic syndrome and diabetes. J Cardiopulm Rehabil 2005; 25: 59-66.
• Madala MC, Franklin BA, Chen AY, et al. Obesity and age of fi rst non-ST-segment elevation myocardial infarction. J Am Coll Cardiol 2008; 52: 979-85.
• Wanahita N, Messerli FH, Bangalore S, et al. Atrial fi brillation and obesity-results of a meta-analysis. Am Heart J 2008; 155: 310-5.
• Kurth T, Gaziano JM, Berger K, et al. Body mass index and the risk of stroke in men. Arch Intern Med 2002; 162: 2557-62.
• Trollo PJ Jr., Rogers RM. Obstructive sleep apnea. N Engl J Med 1996; 334: 99-104.
• Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest 1988; 94: 1200-4.
• Sugerman HJ, Suggerman EI, Wolfe L, Kellum JM Jr., Schweitzer MA, DeMaria EJ. Risks and bene fi ts of gastric bypass in morbidly obese patients with severe venous stasis disease. Ann Surg 2001; 234: 41-6.
• Tsai AW, Cushman M, Rosamond WD, Heckbert SR, Polak JF, Folsom AR. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002; 162: 1182-9.
• Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997; 277: 642-5.
• Horwich TB, Fonarow GC, Hamilton MA, et al. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 2001; 38: 789–95.
• Fonarow GC, Horwich TB, Hamilton MA, et al. Obesity, weight reduction and survival in heart failure: reply. J Am Coll Cardiol 2002; 39: 1563-4.
• Allison DB, Zannolli R, Faith MS, et al. Weight loss increases and fat loss decreases all-cause mortality rates: results from two independent cohort studies. Int J Obes Relat Metab Disord 1999; 23: 603-11.
• Sierra-Johnson J, Romero-Corral A, Somers VK, et al. Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index. Eur Cardiovasc Prev Rehabil 2008; 15: 336-40.
• Sorensen TI. Weight loss causes increased mortality: pros. Obes Rev 2003; 4: 3-7.
• Connolly HM, Crary JL, McGroom MD, et al. Valvular heart disease associated with fen fl uramine-phentermine. N Engl J Med 1997; 337: 581-8.
• Albenhaim L, Moride Y, Brenot F, et al. Appetite-suppressant drugs and the risk of primary pulmonary hypertension. International primary pulmonary hypertension study group. N Engl J Med 1996; 335: 609-16.
• Zannad F, Gille B, Grentzinger A, et al. Effects of sibutramine on ventricular dimensions and heart valves in obese patients during weight reduction. Am Heart J 2002; 144: 508-15.
• Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.
• Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-50.
• Milani RV, Lavie CJ. Prevalence and pro fi le of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation. Am J Cardiol 2003; 92: 50-4.
• Lavie CJ, Milani RV. Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients. Am J Cardiol 1997; 79: 397-401.
• Lavie CJ, Morshedi-Meibodi A, Milani RV. Impact of cardiac rehabilitation on coronary risk factors, in fl ammation, and the metabolic syndrome in obese coronary patients. J Cardiometab Syndr 2008; 3: 136-40.
• MacMahon S, Collins G, Rautaharju P, et al. Electrocardiographic left ventricular hypertrophy and effects of antihypertensive drug therapy in hypertensive participants in the multiple risk factor intervention trial. Am J Cardiol 1989; 63: 202-10.
• Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg 2004; 199: 543-51.

Adapted from Lavie C.J., Milani R.V., Ventura H. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss // J Am Coll Cardiol. 2009 May 26; 53 (21): 1925-32. doi: 10.1016 / j.jacc.2008.12.068.

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

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

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

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

As we can see, obesity is not accidentally given a prominent place among other factors. Many people mistakenly believe that not overly excess body fat in middle and old age is an indicator of health. In fact, this is not the case. The fact is that a violation of fat metabolism is usually accompanied by an imbalance of mineral (salt), cholesterol and energy metabolism.

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

With age, you should gradually limit the calorie intake. In order to prevent a sharp breakdown of the dynamic stereotype, the World Health Organization recommends the following to reduce the caloric content of the diet with age by decades:

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

An elderly person should be especially demanding of himself in compliance with the diet. It is known that the functional capabilities of the body decrease over the years. Therefore, proper food intake, adherence to the principle of "what" and "how much" are important. Passion for a large amount of food is extremely harmful. No wonder the people say: "Glutton digs his own grave with his teeth." No less detrimental effect on the life of the body is eating at long intervals. You must adhere to the rule: less and more often. An elderly person should avoid fatty foods, strong broths, fried foods.

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

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

Elderly people should be warned against excessive consumption of sugar, sweets, all kinds of sweets. We recommend using foods containing fiber and pectin substances more often in the diet: carrots, cabbage, beets, prunes, wholemeal bread. Fruits rich in carbohydrates and positively affecting metabolic processes in the body are very useful. In cases where the intake of fruits in old age is associated with unpleasant subjective sensations (stool retention, increased gas formation), you should change the way they are prepared - take them boiled and baked. In winter and spring (when food lacks vitamins), it is necessary to take multivitamins, strictly adhering to the doctor's recommendations.

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

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

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

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

With premature aging, oxidation-reduction processes slow down, which leads to dysfunction of individual organs and systems, the intensity of which can be increased with the help of vitamins. They are, as it were, specially designed for the elderly, as they accelerate the physiological processes in the body. It should be borne in mind that vitamins must enter the body in a moderate and complex manner. Of particular importance are those that have the ability to strengthen blood vessels and thereby prevent the development of atherosclerosis.

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

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

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

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

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

Obesity can be called a biological process that has been present in human life for a long time. This is evidenced by the figures that have come down to us from the Stone Age. There are two ways to talk about obesity: on the one hand, obesity is a consequence of overeating, and on the other, it is a health problem.

It is likely that humans had the same view of obesity in antiquity. Of course, when food was scarce, when they ate meat of killed animals and plant foods, which did not contribute to overeating, obesity was encountered in very rare cases.

In those days, completeness was the envy of fellow tribesmen. From disease and poverty, they lost weight, and on the basis of this, the connection between excess body weight and health was easily arose.

In general, we can say that the understanding of the process of obesity as a violation of energy metabolism came over time. The need for scientific research on obesity has been driven by the social and civilizing changes of our time.

Various physiological factors have now been studied that relate to the way obesity occurs, maintains and cures. It has been found that this syndrome is caused by a variety of physiological, metabolic and clinical disorders.

Research reveals different aspects of the balance of the system that regulates the body's energy metabolism, the storage and release of fat.

This book contains information on the effective use of massage for obesity. Describes the types of massage, its physiological effect on the body, the variety of techniques for its implementation, as well as technical performance. In addition, the book includes materials on studies of the genetic predisposition to obesity in humans, on its social conditioning and dependence on psychological factors.

With obesity, there is an increase in the mass of adipose tissue as an integral part of the whole organism. Consequently, this process can be accompanied by many complications that negatively affect the health of a person, as well as his life expectancy.

This condition causes the development of diabetes, degenerative heart diseases, atherosclerosis, some diseases of the kidneys, liver, lungs, skin, osteoarticular system, gout and many other diseases.

Obesity is a factor that complicates surgical treatment. With the help of rational nutrition and physical activity, you can control the course of this process. However, nutritional rationalization has its limits in the impact on the mass of adipose tissue. It must correspond to the requirement that the amount of muscle work be kept at a physiological level.

Muscle work is the main factor in energy balance, as well as a stimulus that increases the performance of tissues and organs.

Obesity is not just an excess of fat in the body, but a complex pathology, which is currently regarded as a chronic disease leading to complications: arterial hypertension, heart disease, diabetes mellitus, etc. In other words, obesity is not a cosmetic problem, but a disease that contributes to reduction of human life expectancy and reducing its quality.

It is possible to classify the obesity process depending on the morphological properties of adipose tissue. This classification is of clinical importance, as it corresponds to a different degree of risk of complications, as well as shortening of life expectancy.

Hypertrophic obesity... This group should include people who are too obese, in whom an increase in the size of fat cells can be observed without a large increase in their total number in the body. As a rule, such obesity with a not very large excess of adipose tissue is most common in adults.

Hypertrophic obesity is mainly associated with metabolic disorders, which include increased insulin secretion, the incidence of diabetes, and the occurrence of cardiovascular complications. Obesity of this type appears, as a rule, due to the fact that the energy depot in the body is overloaded above the physiological level.

Symptoms such as a decrease in glucose uptake can be considered as a result of overflowing energy stores, which makes it difficult for energy substrates to pass from the blood to cells. It is possible that the reason for this is a primary decrease in the sensitivity of muscle tissue to insulin, which may be caused by motor inertia.

Hyperplastic obesity... This type of obesity is much less common. Its occurrence is due to an increase in the number of fat cells. This depends mainly on genetic factors or on influences that regulate the morphogenesis of adipose tissue and act during embryonic development or in early childhood.

Chapter 1. Managing the body's free energy

The cells of our body generate a certain amount of energy (which is spent by them) to support their vital processes. However, in our body there are systems that generate energy not only for themselves, but also provide the entire body with it.

According to their ability to generate energy, such systems are divided into active and passive. The muscular system is primarily active. Our physical vitality depends on the development and fitness of muscle tissue. It is not for nothing that when a virus enters the body, we feel weakness, malaise and loss of strength. People with a detrained muscular system also experience constant malaise.

Muscle tissue is of two types: striated and smooth (a special type of tissue is the heart muscle, we will not consider it). Striated muscle tissue forms our entire body. Our physical strength and endurance depend on it. It is controlled by the central nervous system.

The situation is completely different with smooth muscle tissue. It lines all the systems associated with the movement and transportation of certain substances in the body, giving these systems smoothness, elasticity, elasticity. These include vessels, intestines, skin, etc. Smooth muscles are also controlled by the central nervous system.

If striated muscle tissue picks up strong vibrations from the brain without changing its functions, then smooth muscles react painfully to these impulses, which causes collapse. It is for this reason that people exposed to stress develop vascular dystonia, intestinal atony, displacement of the vertebrae, and obesity progresses (the skin and its subcutaneous tissue change their functions).

The main function of muscle tissue is to capture vital energy and direct it for storage in reservoirs for subsequent transportation to its destination. One of the energy reservoirs is the abdominal cavity. The abdominal cavity is separated from the thoracic diaphragm. It contains smooth muscle tissue. The diaphragm is abundantly supplied with blood vessels and nerve endings. In all the medical literature, little attention is paid to the diaphragm, however, if nature has provided it with such a powerful blood supply, then its function is large enough. Indeed, the diaphragm captures all the free energy in the body and directs it into the reservoir, that is, into the abdominal cavity (abdominal canal). The diaphragm works most actively during breathing.

There is a huge variety of energy flows in the human body. Some of them are completely hidden from our attention, but there are three main streams of energy input into the body, which ensure human life. Two of them are associated with the intake of energy in the body with food and water, the third - with the intake of energy during breathing. Let's take a look at some of the features of this phenomenon.

A person can go without food for a long time. You can also live without water for some time, but without breathing we can do very shortly. This means that food is not the main source of energy. The most important energy supplier is water, and the most important is breathing. That is why yogis pay great attention to breathing exercises. The respiratory organs pick up subtle vibrations of vital energy from the air. Part of it is transferred into the blood, and part of it is transferred to the abdominal reservoir.

The work of all internal organs depends on the condition of the diaphragm: liver, kidneys, pancreas, intestines, spleen, lungs, heart, etc. They adhere to the diaphragm, are massaged by it, thereby improving their tone and energy exchange.

So, all the free energy generated in the body "flows" into the abdomen and concentrates there. There is one more point here. If the body for some reason lacks energy (for example, with underdeveloped muscle tissue), then the missing part is removed from the abdominal organs (of course, not without damage to them).

Is it not for this reason that there are currently no people who do not have problems with the stomach, intestines, liver, etc.? No wonder the abdominal cavity is popularly called "stomach" (from the word "life"). It has long been noticed that our health completely depends on her condition.

Therefore, it is very important to pay due attention to this part of the body: to do breathing and ordinary gymnastics. This is how nature ordered it: it gave the abdominal cavity very important functions, and made the abdominal muscles passive, and gymnastics and breathing exercises are necessary to activate them.

Peripheral nerve factors that regulate food intake

All behavioral reactions that regulate the physiological state of the body occur due to the impact on the central nervous system of stimuli from within the body or stimuli from the external environment. Internal stimuli arise as deviations from the physiological state of equilibrium; they are accompanied by corresponding changes in behavior.

With such internal deviations from physiological equilibrium, the central nervous system becomes agitated. The result of such a reaction is an increase in the impact of stimuli from the external environment, which generate behavior changes, support them or inhibit them.

There are many types of external impulses that affect the nervous system. Before eating, these are visual and olfactory stimuli, and after the introduction of food into the oral cavity - gustatory stimuli, additional olfactory (chemoreceptors) and mechanical stimuli.

The ability of food to influence the maintenance of appetite through these stimuli could be summed up in the word "edibility." It affects the amount of food consumed simultaneously with internal stimuli. Therefore, the amount of food consumed depends on two systems of stimuli: internal (hunger or satiety) and external (edibility of food). These systems can be caused by various factors and situations.

Weight gain reasons

Obesity is a disorder of energy metabolism homeostasis. A number of factors of internal and external exchange take part in its occurrence. They cause significant functional changes in the neuropsychiatric regulation of instinctive behavior in the field of nutrition. Less often, the cause of obesity is primary pathological disorders in the secretion of hormones.

Indeed, obesity is often noted already in the first year of life (overfeeding of the child is affected), at the beginning of school (physical activity decreases), before puberty, at the end of growth (nutrition usually remains the same, and the energy that was previously used for growth, converted to body fat).

Obesity is also noted after a sharp decrease in physical activity (due to the transition to sedentary work), while taking hormonal contraceptives, during pregnancy, menopause.

The dynamic phase of obesity is characterized by a constant increase in body weight. This condition can last for decades, and weight gain can be either gradual or abrupt.

The reason for the gradual increase in weight is usually the formation of too much energy and not enough energy consumption. A sharp increase in weight (for example, by 10 - 15 kg in 1 year) may be the result of any disease or a sudden decrease in physical activity with the same calorie intake.

After reaching a certain weight, the stabilization phase begins. At the same time, those hormonal and metabolic disorders that have arisen in the dynamic phase of obesity become persistent. They are often considered already as independent diseases.

In the stabilization phase, obese people sometimes eat even less than those who are of normal weight, but, despite this, they do not lose weight. To lose weight, they have to make much more effort than during the dynamic phase of obesity.

Under the pressure of negative stress factors, the body produces a large amount of a specific hormone, which activates an enzyme that accelerates the process of fat deposition in the abdomen. It is now generally accepted that this type of obesity carries the highest risk of diabetes and cardiovascular disorders.

Many scientists believe that obesity could turn into a global epidemic in the 21st century. And this will pose a serious threat to the health of the world's population. But let's not be unfounded: according to the WHO, in economically developed countries of Europe, from 45 to 60% of residents are overweight. In Russia, by the way, despite everything, today almost 60% of the population is overweight.

Modern medicine views obesity as a chronic disease that requires medical attention. There is no single point of view on obesity. There are several scientific theories. And there are more than enough rumors and myths. For example, many are convinced that excess weight is only a cosmetic flaw, but this is not the case.

Scientific data show that overweight people are 3 times more likely to have arterial hypertension and diabetes mellitus, twice as often - atherosclerosis. Obese people have a significantly higher risk of developing cancer, damage to blood vessels, joints, gall bladder, and other organs. Obesity dramatically increases mortality.

For example, in patients with diabetes mellitus with a body weight 25% higher than the norm, the probability of premature death increases 5 times. The Heart Association has even listed obesity as a major risk factor for heart disease.

And, of course, there are many pseudoscientific theories about the causes of weight gain. Many believe that it is all about heredity. However, in fact, the reason is that each family has its own eating habits and habits. Naturally, children with early years overfed, in adulthood will suffer from excess weight.

That is, most of the overweight children and adults simply overeat, this is how the genetic tendency to obesity manifests itself, without an excess of food it could not develop into a disease. Most women believe that weight inevitably increases during pregnancy, after childbirth and breastfeeding.

The development of the female body from birth to withering is usually divided into periods that are characterized by certain features: the period of childhood; pubertal (adolescent) period with the formation of menstrual function; childbearing period with periods of pregnancy and lactation; climacteric and postmenopausal period. In any of them, the occurrence of obesity has an extremely adverse effect on a woman's health.

In order to understand the causes of postpartum obesity, let's take a short excursion into physiology.

The center of the body's energy metabolism is a section of the brain called the hypothalamus. The hypothalamus controls the expenditure of energy through the autonomic nervous system (a part of the nervous system independent of our consciousness that controls the activity of all internal organs) and hormones.

In addition, the hypothalamus is the main regulator of the reproductive system. It is extremely important for understanding the processes of obesity that interests collide in the hypothalamus endocrine system, which controls the function of the reproductive organs and energy metabolism, and the autonomic nervous system, which controls the vital activity of all internal organs, including genital and endocrine, and the same energy metabolism.

Considering how complicated everything is by nature, one can understand why obesity and impaired fertility in women go hand in hand. Thus, the hormones of the hypothalamus, which act on the pituitary gland, play a key role in the regulation of fertility, and the ultimate goal of the action of these hormones is the production of female sex hormones - estrogens.

In the postpartum period, the hypothalamus has not yet had time to rest from the extreme control of the hormonal and autonomic nervous system of the pregnant woman, but a new task is set before it - milk production.

Such an increased load can lead to disruptions in the functioning of this part of the brain. The secretion of hypothalamic hormones is impaired, which, in turn, affects both the amount of adipose tissue and the menstrual cycle. Understanding this hormonal chaos is difficult.

Experts believe that there is a direct relationship between the increase in body weight and the severity of ovarian dysfunction; most often obesity is primary. Therefore, timely correction of body weight often leads to the normalization of the menstrual cycle, even without the use of any special therapy.

There is a misconception that, in order to lose weight, it is necessary to limit flour, sweets in the diet, consume more protein foods. But our food is made up of fat, protein, carbohydrates, fiber, and water. One gram of fat contains 9 kcal, 1 gram of alcohol - 7 kcal, 1 gram of protein - 4 kcal, 1 gram of carbohydrates - 4 kcal.

The main sources of carbohydrates are potatoes, bread, milk, fruits, berries, flour products. Proteins are found in lean meat, fish, poultry, cheese, and fats are found in all types of butter, lard, sour cream, fatty meats, as well as in any meat products and cheese.

There are no calories in water, which means that there are almost no calories in vegetables and herbs, which contain a lot of water. A large number of studies and observations of thousands of patients leads to an unambiguous conclusion: the body weight is the more, the more fat in the food. To lose weight, it is not enough to give up rolls and sweets, you must limit yourself in the consumption of meat.

There are several theories explaining the causes of obesity. So, according to some experts, this is a consequence of the malfunctioning of the centers of the brain, which are responsible for hunger, appetite or satiety. Other scientists believe that the whole point is in chronic metabolic disorders, in diseases and stress.

The possibility of obesity may increase during some periods. So, it occurs more easily during the period of increased secretion of hormones that contribute to the formation of fat, during the period of deliberate overeating for various reasons, and, finally, during a period when a person cannot, due to circumstances, influence his nutrition and motor regime.

Obesity development factors are manifold. The most common of them are overeating, decreased physical activity, genetic predisposition, pathology of the endocrine system.

Genetic factor in obesity

The genetic factor is increasingly considered by specialists as a possible, main or additional element of obesity. A number of studies have been carried out in the course of which several types of genetic obesity with various metabolic disorders have been discovered.

Research material is special laboratory strains of mice or rats. Different forms of obesity in mice, rats and dogs are inherited in different ways - recessive or dominant. In both of these cases, the polygenic substrate of heredity allows for fluctuations within the parameter of fat deposition and contributes to the appearance of obesity only with high energy production.

The possibility of obtaining, by means of animal breeding, races with a predisposition to an excessive amount of adipose tissue, inherited, indicates the role of heredity in the formation of this property. Body weight depends on the influence of many genes. They are inherited according to the principles of polygenic transmission.

The way genes influence the formation of excess body weight may lie in the genetic predominance of the structure and function of systems that regulate alimentary behavior, as well as in determining the course of intermediate reactions in the course of intracellular metabolism.

The conclusions following from studies of the significance of the genetic factor in obesity in experimental animals are significant due to the analogy in the occurrence and action of impaired appetite regulation, impaired hormone secretion and metabolism.

Studies of genetic predisposition in humans

From the point of view of genetics, a person is a very complex species and therefore difficult to research. In addition, the influence of the environment is usually very strong and differentiated.

Compared with experimental research, they are enriched with a whole range of social, civilizing and mental stimuli. It was possible, however, to accumulate a lot of observations and evidence that indicate the etiological significance of the genetic factor in the obesity clinic.

There have been many studies to investigate the effects of dieting in obese families. After comparing the results, experts came to conclusions that indicate the existence of a genetic predisposition.

Already in the middle of the 19th century, a number of works were published, which cited examples of obesity in many generations of the same family. Explaining the occurrence of such obesity, experts pointed to the reasons for the fact that families quickly adopt the lifestyle and way of eating.

But at the same time, some doubts were expressed about the possibility of proving the direct role of the genetic factor in families whose members were obese, since the influence of the environment and habits that relate to the type of food intake and its distribution, as well as lifestyle.

Experts have collected a lot of material on the comparison of anthropological measurements of three generations of the examined families.

Conventionally, at least three genetic factors can be distinguished that lead to obesity. The difference in appetite and metabolic rate is due to hereditary factors.

A number of surveys of identical twins have shown more pronounced similarities in body weight fluctuations, relatively independent of environmental conditions, than in fraternal twins or siblings. However, the establishment of a relationship between obesity in parents and children does not indicate a genetic factor, since children learn from their parents the same skills that relate to nutrition and lifestyle.

Even if we recognize that heredity is the main factor regulating individual body weight, this does not mean that heredity accurately predetermines this property. As well as in relation to other biological properties, the hereditary factor, quite possibly, determines the limits within which the amount of mass inherent in a given individual fluctuates, depending on the way of nutrition and his physical activity.

Clinical definition and differentiation of such situations is not yet possible, therefore, testing the hypothesis of genetic causation of obesity in humans encounters a number of very significant obstacles.

In addition, gender, intensity, as well as the frequency of obesity are significantly influenced by the environment: this is especially true for the influence of nutrition, physical activity, profession, geographical factor, climate, psychological environment.

Many experts have established a pronounced hereditary manifestation of obesity. The percentages that determine the incidence of parental obesity for overly obese children range from 40 to 80. It has been found that obesity in parents and children is much less common in cases where children were adopted than in families with children of their own.

Research on the relationship between obesity and gender

Studies have found that the gender proportions of children from families whose members are obese differ from the proportions of the sex of children from families whose members are of normal weight.

It was also found that the number of males among children from families of normal body weight, as well as among children of married couples consisting of an overly obese man and a woman with normal body weight, is less than among children whose parents are overweight. weight, as well as among children, those families where the father has a normal body weight, and the mother is overweight.

Based on these results, one could hypothesize that obesity is dependent on a gene associated with female sex.

It is possible that this gene is common in women whose husbands are of normal body weight, but who, however, have at least one daughter obese. Based on this, it is assumed that the interaction of non-recessive genes that cause obesity in such situations will be less frequent than in married couples where one of the parents is obese.

Studies of different ethnic groups

If we draw conclusions about the genetic causation of obesity, which are based on a comparison of the frequency of occurrence of this syndrome in different ethnic or racial groups, then such conclusions will not be fully justified.

Groups of this kind are very different in their customs, lifestyle and diet, which, in general, mask the influence of genetic factors. However, it has been found that there are ethnic groups with large differences in the incidence of obesity.

Many observations concern the field of investigation of the influence of morphological constitution on the occurrence and course of obesity. Among attempts to determine such indicators, Wag's observations are the most popular. He distinguished between two types of obesity.

Android and hyperandroid are characterized by a special deposition of adipose tissue in the upper body tissue. It is associated with the development of skeletal muscle and can apply to both men and women. This type of obesity leads to metabolic disorders.

Gynoid and hyperginoidal obesity is associated with an increase in the amount of adipose tissue in the abdomen, thighs and legs. Muscular development is generally poor. This type of obesity is characterized by complications accompanied by degenerative changes in the system of the organs of movement.

Experts have found that overweight girls differ from lean ones not only in the amount of adipose tissue, but also in other morphological parameters.

Obese individuals showed a greater width of the skeletal system, as well as better skeletal muscle development. Therefore, it can be assumed that obesity is associated with factors of constitutional development.

Evidence that obesity is hereditary exists only for many strains of experimental animals. In humans, obesity is hereditary, although common family eating and lifestyle habits can play a very significant role. Thus, in humans, the hereditary factor has an indirect significance.

Obesity factors

The main cause of obesity is a positive energy balance, that is, an excess of energy intake in the body compared to its expenditure. Overweight can be due to several reasons.

First, excessive, periodic, uncontrolled food intake (especially high-calorie food) in a state of emotional discomfort, when food is the easiest way to feel better.

Secondly, the unhealthy nature of the diet. Moreover, even in the absence of overeating, high-calorie foods contribute to weight gain.

Thirdly, inappropriate meal times (in the evening), which leads to disruptions in daily cycles.

And all this happens, as a rule, against the background of a decrease in daily muscle activity. Of course, there is also a genetic predisposition to obesity (especially in individuals with a picnic physique), but it should not be overestimated.

Overweight is mainly caused by high-calorie foods, and especially easily digestible carbohydrates. The problem is that the overwhelming majority of people with a pycnic body type and an athletic and even asthenic constitution are prone to developing sub-depressive states when their mood drops for a while. And here a tempting snake awaits many in the form of thoughts about a bar of chocolate, smoked meats, sausages, etc.

It is this type of food that leads to a short-term (15 - 20 minutes) improvement in mood. But then it inevitably worsens, and for a longer period, which, in turn, leads to the activation of the appetite center and the next trip to the kitchen. According to a very similar mechanism, a closed cycle of drug addiction is formed, therefore the name "food substance abuse", which is found in a number of works on alimentary obesity, is fully justified.

Social conditioning of obesity

The frequency and intensity of obesity in the epidemiological sense varies depending on the era and geographic location.

When studying this phenomenon, one can find a number of factors of the social environment that are capable of provoking the appearance of this disorder. There is a dependence of the frequency of obesity on two factors, namely, the calorie content of the most consumed food products and the introduction of technology into daily life.

Many studies confirm the fact of a clear dependence of the incidence of obesity on the availability of food. However, the adult groups of the population, especially the female sex, react more strongly in this regard.

Men are less susceptible to this phenomenon because they are in a state of greater physical activity, and also due to the fact that their physiological composition of their bodies contains less adipose tissue.

Similar phenomena, but caused by other reasons, are observed in old age. In the group of old people, the frequency of obesity decreases to the number characteristic of young people. This is especially true for women.

On the one hand, this may indicate that elderly people have difficulties in purchasing food, and on the other, about the influence of the aging process, which is associated with a decrease in the water content in the body and active cell mass of the body, which masks an increase in fat mass.

Weight loss in old age is thus natural, which is different from weight loss in adulthood and before puberty.

Chapter 2. Prevention of obesity

The cumbersomeness of treatment and its low effectiveness point to the great importance of obesity prevention. Nutritional education for families is one of the most cost-effective health investments. Very often, the rationalization of food is hampered by the influence of local traditions, attitudes, and customs. The media (television, radio, press) are spreading an avalanche of advice that directly relate to these issues. The quality of such advice leaves much to be desired: since these recommendations are massive in nature, it is very difficult to apply them in each individual case.

The school must play an important role in health education. The dissemination of information about good nutrition should be included in the school curriculum. In such educational work, it is necessary to emphasize that obesity develops as a result of malnutrition and is very harmful to health. Prevention should broaden the coverage of circumstances that predispose to obesity, such as psychological and neurotic factors.

In order to reduce body weight, you need to adhere to two principles. First, reduce calories and increase physical activity. Secondly, switch to fractional meals.

To reduce the caloric content of food, you need to try to eliminate fats, starting with animals, as the most high-calorie component. It is not recommended to eat sweets after the main meal. It is necessary to exclude the combination of fatty foods with sweet ones, since while the sweet is digested, fats accumulate.

To increase physical activity, you should engage in physical exercise and switch to active forms of recreation. The type and intensity of physical exercise should be selected based on the physiological capabilities of the body.

In order to reduce weight and improve the general functioning of the body, long-term exercise with little burden should be preferred. The duration of the training, if possible, should be at least one and a half hours.

Fractional nutrition with a reduced total calorie content is used not only for weight loss, but also for the treatment of obese patients. Eating should be carried out six times a day (one meal can be considered a sandwich with cheese and a glass of juice, kefir, tea).

You can not limit yourself in drinking, while it is better to drink green tea or mineral water... Weight loss while limiting fluid intake is simply dehydration, leading to a delay in toxins, blood clots, and kidney stones.

The food consumed should be rich in proteins, since a sharp decrease in their amount, the more complete exclusion of proteins from food, leads to intoxication with the breakdown products of its own proteins, since the body has to rebuild its tissues to maintain normal life, and this process is extremely irrational.

Prolonged restriction of protein intake leads to a decrease in immunity, increases the incidence of caries, creates a risk of fatty degeneration of the liver. The amount of proteins consumed depends on how they are assimilated (the calculation of 1.6 g of proteins per 1 kg of body weight is conventionally accepted, but it can be much less). In order to reduce the amount of fat consumed, you need to eat not fried foods, but boiled, stewed or steamed ones. Food must necessarily contain vegetable fibers (grain or bran bread, porridge from unrefined grains, vegetables). Periodically add some unheated vegetable oil to your food (for example, extra virgin olive oil). It is necessary to take multivitamin preparations.

As an additional measure to combat overweight sometimes it is recommended to arrange fasting days. It should be remembered that before changing the nature of your diet, you should consult your doctor.

Regulation of food intake

To begin with, it is necessary to provide definitions of the main physiological phenomena that play a role in the regulation of food intake. Such phenomena include starvation, appetite, satiety, anorexia, and gluttony.

Fasting is a complex of unpleasant sensations, which consist in a feeling of emptiness and stomach cramps.

Appetite is expressed in the desire to consume food. In contrast to starvation, which occurs when the body's nutritional reserves are below the level required to maintain energy balance, appetite can be kept above this level, and under the influence of various conditioned stimuli, it can increase or decrease.

Such a phenomenon as satiety arises when there is no desire to eat. In a way, satiety is the opposite of appetite.

Anorexia means not feeling hungry in situations where the physiological condition usually causes this feeling.

Gluttony is a condition in which food intake does not cause the normal feeling of fullness and the feeling of hunger is maintained regardless of food intake.

For many people, the amount of food consumed is in direct proportion to the feeling of hunger, satiety or appetite at the subconscious level, that is, consciousness does not take any significant part in this. Physiologist Carlson believed that the place where the perception of stimuli that cause hunger or satiety occurs is the stomach. He suggests linking hunger with violent, rhythmic spasms of an empty stomach. In the course of his studies, it was found that the glucose content in the blood is of no small importance for the appearance of a feeling of hunger or satiety. With the help of post-insulin hypoglycemia, he got hungry stomach cramps, which were stopped by intravenous glucose. In this respect, his hypothesis lost its significance when it turned out that both animals and humans are very good at maintaining energy balance.

Food consumption in humans is more associated with a feeling of appetite, much less often - hunger. Appetite development depends on several positive conditioned food reflexes caused by taste, smell and appearance of food. The civilized person has developed appetite in such a way that it usually becomes the main driving force regulating food intake. Even after satisfying hunger, some dishes can whet the appetite, for example ice cream, cakes, etc. The formation of appetite is influenced by factors such as the environment, the distribution of food into several meals, the rhythm of these techniques, the selection of dishes established by the custom, and emotional experiences. Starting from infancy, numerous conditioned reflexes are superimposed on congenital unconditioned food reflexes, which after some time form a fixed stereotype of alimentary behavior.

Etiology and pathogenesis of obesity

The reason for the development of obesity can be determined in no more than 3 - 5 cases out of 100, namely in the so-called secondary obesity associated with some endocrine diseases and damage to the central nervous system.

In the remaining 95 - 97 cases out of 100, when obesity develops primarily and, therefore, is not associated with any specific cause, the mechanism of its development is not completely clear. And we believe there is no need to clarify that it is the lack of accurate scientific ideas about the mechanisms of the growth of excess fat mass that creates the unsatisfactory situation that is now emerging in the treatment of obesity.

To explain the nature of the disease, a fairly large number of hypotheses have been proposed, many of which have not lost their relevance to this day; discussion of others may be of interest only in the historical aspect.

In general, the history of the development of our ideas about the etiology and pathogenesis of obesity reflects the interesting situation when the hypotheses, which seemed obvious from the very beginning, later, when new data appeared, were no longer satisfying. The truth all slipped away, the explanations became more intricate, there was a feeling that this was far from so simple. For example, there were hypotheses about obesity as a complex polyetiological and polypathogenetic disease, which immediately contradicted the obvious fact that the disease is based on a physiological phenomenon, namely the ability of adipose tissue to accumulate fat.

The scheme of the development of the disease looked very logical, focusing on the energy imbalance. According to this hypothesis, obesity develops when energy consumption prevails over energy expenditure. This situation can develop both with excessive food intake and with low mobility (transition to a quieter work, cessation of sports, etc.). A logical confirmation of this scheme is the well-known facts: with an increase in food consumption, a person's body weight most often increases, and with refusal of food, it decreases; with a decrease in physical activity, body weight can increase, and with intense training, it can decrease.

Eating disorders in obese patients

In about 30 - 40% of cases, obese patients have some type of eating disorder, among which the most common are hyperphagic reaction to stress, compulsive hyperphagia, carbohydrate thirst and premenstrual hyperphagia. These disorders are often combined, that is, in one patient, some or even all of them may be expressed to one degree or another. The latter, by the way, may indicate similar mechanisms of their occurrence and development.

The hyperphagic reaction to stress as an eating disorder manifests itself as follows: with psycho-emotional stress, excitement or immediately after the end of the action of the factor that caused the stress, a person's appetite increases sharply. Most often, food is not differentiated, in other words, people eat everything, although there is research showing that preference in this state is still given to fatty and sweet foods. Since the stressor can act for a long time, excessive food intake can be observed for a long period, which, in turn, will lead to an increase in excess body weight.

The concept of “compulsive hyperphagia” is very close to the concept of “hyperphagic response to stress”. In this case, patients for no apparent reason consume a large amount of food, again, as a rule, sweet and fatty, and more often in the form of snacks, that is, as additional meals in between the main meals.

"Carbohydrate craving" - this term came into use when the main cause of obesity was associated with excess consumption of carbohydrates. Now more often they simply talk about food thirst, believing that to satisfy it, people need both sweet and fatty foods, for example, chocolate, ice cream, cream, etc. In the case of carbohydrate thirst, this kind of food is similar in its effect to a drug, in the absence which patients develop a painful depressive state.

Premenstrual hyperphagia can be considered as one of the manifestations of premenstrual tension syndrome. The phenomena of hyperphagia are observed in women for 4 to 7 days before menstruation.

It would be logical to assume that the presence of eating disorders leads to the development of obesity, but most authors refrain from such categorical assessments. The fact is that these violations, firstly, are observed with approximately the same frequency both in obese patients and in persons with normal body weight. Secondly, they often develop in patients after they become obese. Third, violations are often intermittent. Many patients note that stress hyperphagia is observed only occasionally.

The mechanisms of occurrence of eating disorders are not fully understood. It is believed that they are associated with impaired transmission of serotonin in the structures of the brain responsible for the regulation of eating behavior.

One cannot but agree with the opinion of many authors that eating disorders are a very serious problem for the treatment of obesity, since the desire to eat extends, as a rule, to those foods that are undesirable to consume in large quantities (chocolate, cakes with cream, ice cream, etc.). P.).

Energy consumption by obese persons

At the level of everyday consciousness, the point of view is very popular that overweight people eat a lot. This idea is so popular that it is actively supported by many doctors. However, to date, there is not a single serious study demonstrating that overweight people actually consume more energy on average than thin people.

Experts have applied a rather original method for studying energy consumption. Obese patients, as well as those selected for control, called the research center every time after a meal for three months and reported on the food used and their quantity. At the same time, it was found that both with obesity and with control there was approximately the same daily calorie content, about 2700 kcal. Fat people consumed more protein, and thin people more alcohol. The authors did not note a significant difference in the consumption of other nutrients. Both the fat and thin ate more food on weekends. Both overweight and thin there were people who consume a lot of energy (about one third of all subjects). And in both cases, this increase in daily food energy was achieved due to higher fat intake.

It is believed that overweight people knowingly or unknowingly underestimate food intake. However, there is evidence that underreporting of food intake is equally common for both overweight and thin.

Reflex segmental massage

It was found that the most pronounced response to physiotherapeutic effects on organs and tissues can be obtained in certain areas, especially those rich in autonomic innervation and associated with the skin metameric relationships. According to AE Shcherbak, the clearest character of metameric segmental reactions is revealed when exposed to the following areas.

Cervico-occipital and upper thoracic, covering the skin of the back of the neck, starting from the scalp, shoulder girdle and upper back and chest. Irritation of the skin receptors of this reflexogenic zone causes a reaction of the cervical autonomic apparatus, including some formations. These include three lower cervical and two upper thoracic spinal segments; the cervical part of the border sympathetic trunk with the corresponding connecting branches; three cervical ganglia (upper, middle and lower) of the sympathetic trunk, including vegetative fibers coming from the ganglia and ending in the skin, muscles, vascular walls, etc.; the nucleus of the vagus nerve with peripheral nerve nodes.

Massage of this area, which AE Shcherbak gave the name collar (in shape it resembles a wide folding collar), has a regulating, normalizing effect on the most important functions of organs and systems located within the above segments of the spinal cord.

Excitation of the cervical autonomic apparatus with its complex connections can cause significant functional changes in all parts of the central nervous system, in which all the control of the autonomic activity of the body is concentrated - trophism of organs and tissues, metabolic processes, heat regulation, etc.

The method of reflex-segmental impact developed by the school of A.E. Shcherbak with the help of a massage collar is very successfully used in hypertension, neurotic conditions, especially in sleep disorders, migraines of vasomotor origin, trophic disorders of the upper extremities, etc.

The lumbosacral region covers the skin of the lumbar region, buttocks to the lower gluteal fold, the lower half of the abdomen and the upper third of the thighs. The impact on this reflexogenic zone causes a reaction of the lumbosacral autonomic apparatus associated with the lower thoracic, lumbar, sacral segments of the spinal cord and with the corresponding part of the border sympathetic trunk and its autonomic ganglia.

Massage of the lumbosacral region has a reflex effect on the functional state of the organs innervated by the lumbosacral autonomic apparatus (intestines, pelvic organs, external genitalia, lower extremities). Also, this technique of reflex-segmental action, called the belt one, stimulates the hormonal functions of the gonads, and has a neurotrophic effect in vascular diseases and injuries of the lower extremities, thereby reducing vascular spasms and activating reparative processes in tissues (healing of wounds, trophic ulcers).

The school of A.E. Shcherbak developed methods based on the study therapeutic action local or regional reflexes (vibration of the cervical vertebrae, which has a positive therapeutic effect in the treatment of pharyngeal catarrh, vibration of the symphysis in order to stimulate the sexual reflex, etc.).

According to AE Shcherbak, the influence on the body when exposed to the above reflexogenic zones is carried out mainly through the autonomic nervous system, since it is connected with all organs and physiological systems and provides trophic innervation of all tissues and organs of the body.

Modern physiology, in accordance with the teachings of I.P. Pavlov, considers the autonomic nervous system not as an autonomous and self-sufficient system, but as a specialized part of a single nervous system, the most important task of which is the adaptive-trophic function that regulates the level of metabolism in the body. The autonomic nervous system, which is involved in the process under the influence of any factor, like the humoral one, is one of the most important links in the chain of regulatory mechanisms subordinate to the central nervous system, and forms with it a single neurohumoral system.

It follows from this that the metameric segmental reaction is not isolated from the central nervous system, but is inextricably linked with it. She, as it is figuratively characterized, is only a "figure" that develops and is found against a certain background created by a general adaptive reaction.

This "figure in the background" - a segmental reflex - can manifest itself under the condition:

a) the integrity and safety of all pathways;

b) a relatively limited area of \u200b\u200birritation (with a significant area of \u200b\u200birritation, the segmental effect is obscured or extinguished, since in this case the response takes a generalized character);

c) small strength and short duration of irritation.

Studies by a number of authors have established a therapeutic effect, which is based on the same mechanism of segmental reflexes when exposed to the mammary glands (an increase in the contractile function of the muscles and vessels of the uterus, which causes the cessation of uterine bleeding), as well as on the epigastric region, covering the skin surface, corresponding to the segments.

Massage of this area causes functional changes in the stomach, duodenum, liver, gallbladder, spleen.

One of the forms of the reflex-segmental massage technique is also a selective effect on reflexogenic zones, reflecting the segmental connections of the visceral organs with certain parts of the body integument. These reflex zonal changes in diseases of individual internal organs can occur on the skin in the form of hyperesthesia in the dermatomes corresponding to the spinal cord segments.

Zonal changes in skin sensitivity, representing the projection of irritations coming from a diseased internal organ, can depend not only on sympathetic, but also on its parasympathetic innervation, because the sensitivity of a number of internal organs (heart, lungs, esophagus, stomach, etc.) is associated with a vagus nerve.

This nature of innervation provides a more subtle regulation of the activity of the corresponding internal organs, causing an increase or decrease in their activity under the influence of certain conditions of the organism's vital activity.

In diseases of a number of internal organs (heart, lungs, intestines, etc.), Zakharyin-Ged zones can be localized in the head, face and upper neck, because the sensory nucleus of the vagus nerve has a connection with the trigeminal nerve.

Irritations from internal organs can also spread along the sensory fibers of the phrenic nerve, the nucleus of which is located in the III-IV cervical segments of the spinal cord, which explains the appearance of these zones in the shoulder girdle and lower neck in heart diseases.

To identify zonal disorders of skin sensitivity, namely, violations of pain sensitivity, injections are applied with a pin or a pointed match on different parts of the body in accordance with the segmental localization of the affected internal organ. At the same time, the patient is offered to respond to each touch with the words "sharp" or "stupid" to assess his feelings.

Injections or streak irritation should be applied superficially and as evenly as possible, on symmetrical areas of the skin to the right and left, while the patient's eyes should be closed. Normally, the contact of a pin to the skin is not painful; in the presence of a lesion of one or another visceral organ, skin sensitivity in some places is sharply increased - a gentle and dull touch is felt as sharp and painful.

Within the Zakharyin-Ged zone, as a rule, one can find an area characterized by an even more significant increase in skin sensitivity - the so-called maximum point of the Zakharyin-Ged zone. The identification of such a point is of great therapeutic importance when using reflex-segmental massage.

Particular care is required to determine the degree of impairment of pain sensitivity of the skin in neuropaths, who often have a perverse assessment of their sensations. To clarify the boundaries of individual reflexogenic zones, it is recommended to conduct repeated studies, and to assess the results of treatment - periodic studies of reflex changes in various layers of the outer layers of the body.

With diseases of the internal organs, one can also observe in the area of \u200b\u200bthe reflexogenic zones of Zakharyin-Ged soreness of the skin when it is captured in a fold, which in these places is usually significantly thickened and its mobility is limited.

In addition, reflex zone changes are reflected in the muscles (Mekenzie visceromotor reflex). These changes consist in tonic prolonged tension of the striated muscles of the body. So, for example, with angina pectoris, there is an increase in the muscle tone of the pectoral muscles on the left, with diseases of the gallbladder, tension of the intercostal muscles can be detected. The mechanism of the origin of this phenomenon lies in the fact that the irritation that occurs in the diseased internal organ is transmitted to the cells of the anterior horn of the spinal cord, resulting in a contraction of the striated muscles.

Also, the above changes can, to one degree or another, manifest themselves in the subcutaneous connective tissue, in the vessels (viscero-vasomotor reflex), in the periosteal tissue (Vogler-Kraus viscero-periosteal reflex), skin electrical conductivity, skin bioelectric potential, etc.

Most often, patients do not know about the existence of reflexogenic zones, but sometimes they note itching, burning and other unpleasant sensations, which are determined in these places. From what has been said, it follows that the condition of not only the skin, but also the deep tissues may indicate diseases of the visceral organs, in other words, when the visceral organ becomes ill, a response occurs in all layers of the tissues of the integument of the body.

Given the segmental innervation of these tissues, reflex-segmental massage is also successfully used for diseases of the musculoskeletal system (damage to bones, muscles, joints), vascular, nervous and other systems.

The most studied and summarized to date are data on the natural relationship between internal organs and skin metameres - dermatomes (Zakharyin-Ged zone). A change in the zonal sensitivity of the skin is observed mainly in the acute and subacute stages of the disease or during periods of exacerbation. The size of the zone and the time of its occurrence can vary considerably.

From the data presented, it is clear that the Zakharyin-Ged zones with diseases of individual internal organs are located both on the front and on the back of the body. Noteworthy is the same location of the Zakharyin-Ged zones in diseases of various internal organs. So, the zones of the heart and lungs, stomach and liver, etc. almost coincide. All these phenomena are based on complex innervation relationships, which have not yet been finally clarified. The double sensitive innervation of some internal organs - sympathetic and somatic - is of undoubted importance, and these two systems of sensory neurons enter the spinal cord at different levels.

Regarding the identification of the boundaries of the Zakharyin-Ged zones, it should be emphasized that their localization, as well as their boundaries, cannot always be accurately determined, since, as a number of internal organs, as mentioned above, are innervated from the same segments of the spinal cord. In some cases, with diseases of the internal organs, the Zakharyin-Ged zone may be absent.

The relationship between internal organs and body integuments is also significantly complicated due to the so-called generalization of visceral irritations. So, even S.P.Botkin (1868) pointed out the reflex genesis of pain in the region of the heart with biliary colic. This phenomenon is based on the viscero-visceral reflex.

Finally, the cerebral divisions (brain stem, reticular substance, hypothalamic region, optic tubercle), participating in the unconditioned reflex regulation of the function of internal organs, have a deep influence on the ratio of the segmental connections of internal organs with the integuments of the body.

All this creates great difficulties for identifying reflexogenic zones, determining their boundaries in diseases of internal organs and, consequently, for the correct application of reflex-segmental massage. The object of influence in this case, as already mentioned above, is not the initially diseased visceral organ, joint or affected vessels, but the reflected reflex changes in the tissues of the body integument caused and supported by them. The earlier these reflex changes are identified, the more precisely the boundaries of the reflexogenic zones are determined, the more successful the results of the use of reflex-segmental massage are.

There are various methods of reflex-segmental massage, in accordance with which it is first necessary to identify signs that characterize the increased tension of the subcutaneous connective tissue. The latter include:

a) tense subcutaneous connective tissue, due to an increase in its resistance, always has a pronounced resistance to the massaging finger; the finger, during its stretching, periodically gets stuck in this tissue, and only after several vibrational movements it is possible to move it forward. Healthy tissue does not resist the massaging finger;

b) while massaging tense subcutaneous connective tissue, a person experiences pain; when massaging healthy tissue, even with significant stretching, there is no pain;

c) when massaging tense subcutaneous connective tissue, a dermographic reaction occurs in the form of a relatively wide band; the wider and longer it is, the more pronounced the tension of the subcutaneous connective tissue. The color of the dermographic reaction can vary from light red to brownish red.

The latter type of coloration is observed in the area of \u200b\u200bmaximum points of reflexogenic zones. With a sharp increase in voltage, a skin fold may form at the site of the stroke. This skin reaction sometimes lasts up to 24 hours.

Of all the massage techniques, only rubbing with the palmar surface of the fingertip (preferably III or IV) in the form of a stroke is used, with the aim of stretching a certain area of \u200b\u200bthe overstressed subcutaneous connective tissue.

The dash movement is slow. The amount of pressure depends on the desired depth of impact. The stroke massage movement can be short or long. A longer stroke has a more intense effect on fabrics. The slower it is produced, the deeper its impact. Shading, for example, when massaging the muscles of the back, can be done within 30 seconds.

Rubbing, performed as a stroke movement and in the form of stretching, differs significantly from the massage rubbing technique used in classical massage, when the massaging finger during this technique moves sagittally in order to maximize penetration into the tissues.

Rubbing can be done in different directions - longitudinal, transverse and zigzag. With segmental massage, the massaging finger, having penetrated into the subcutaneous layer of connective tissue and remaining in it, moves tangentially, rectilinearly or slightly arcuate.

It is very important that the massaging finger should not move forward in jerks, but slowly slide, stretching the tense subcutaneous connective tissue, and at the same time feel the gradually leaving tension of this tissue. When massaged with the pads of 2 to 4 fingers, this massage technique has a calming effect on the tissues. The wider and more superficial the stroke massage effect, the more pronounced its soothing effect.

1. During the first massage sessions, the root exit points in the back are processed. First, the lower (sacral and lower thoracic) segments are massaged, and only after the tension in the tissues innervated by these segments has been weakened, do they proceed to massage the overlying segments.

2. When massaging, first of all, tension in the surface layers of tissues (skin, subcutaneous connective tissue, etc.) should be eliminated. As the tension relaxes, deeper tissues should be massaged, while it is important that the massaging finger consistently and gradually penetrates deep into the reflexively changed tissues. The better the massage therapist will know in which layer and to what extent reflex changes in the tissues are expressed, the more clearly he will be able to identify them, the more successful the therapeutic effect of the reflex-segmental influence will be.

3. While massaging tense tissues, strong stretching or pressure should be avoided. When penetrating to the appropriate depth, the masseur must make sure that the “leaving” of the tense tissue from under the massaging finger is felt all the time.

4. The depth of the layer chosen once should not change during massaging. For example, when stretching the subcutaneous connective tissue, the underlying tissue is not affected.

5. The tissues of the back and front surfaces of the body are massaged towards the spine. Massage of the tissues of the extremities is performed in a centripetal direction, while the technique of suction massage is applied.

6. When massaging in the area of \u200b\u200breflexogenic zones, the massaging finger should move along the border of the zone. Crossing the zone causes an increase in tissue tension in this area.

7. During the first massage sessions, until the sensitivity of the skin is normalized, and the tension of the subcutaneous connective tissue and muscles in the reflexogenic zones of the back remains, these zones, especially their maximum points located on the front surface of the body, should not be massaged ...

8. The course of reflex-segmental massage should not end with the elimination clinical manifestations disease, since this is not yet evidence of the restoration of the normal state of the body.

Thus, the massage should not be stopped even after the disappearance of the zonal reflex changes in tissues, but it should be continued for some more time, lengthening the breaks between massage sessions.

When massaging reflexogenic zones during the initial massage sessions, exposure to the maximum points of these zones should be avoided. To massaging the zones located on the front surface of the body, they proceed only when the zonal reflex changes in the tissues of the back are weakened.

The most important thing when using reflex-segmental massage belongs to the correct dosage, which is difficult to determine. First, it is impossible to establish what the degree of irritability of the nervous, in particular the vegetative, system of the patient is at one time or another. Secondly, it is impossible to objectively assess the intensity of the massage effect. To this it must be added that it is not always possible to accurately establish the boundaries of reflexogenic zones in various diseases and, therefore, to avoid complications that arise when the segments innervating this organ are displaced.

The initial functional state of the patient's body is of great importance. It is the basis on which the dosage of massage movements should be based. Given the danger of an overdose, reflex-segmental massage should be started with mild irritations and gradually move, guided by the patient's reaction, to more energetic techniques.

It is important to remember that violation of the rules for performing massage can lead to pronounced negative reactions in the patient, manifested in a general deterioration in his health, increased overvoltage in various layers of tissues. The masseur needs to know when and where the danger of such a "movement" may arise and how to eliminate it by means of massage. We provide the relevant instructions.

1. When massaging the lumbar and lower thoracic segments, unpleasant sensations may appear in the bladder (pain, heaviness in the lower abdomen). To eliminate these disorders, massage the lower abdomen above the symphysis.

2. During back massage, there may be an increase in muscle tension in the neck and chest area (primarily in the angle between the collarbone and the sternum), which can be eliminated by massage of the front surface of the chest.

3. Massage in the area of \u200b\u200bthe scapula can cause a feeling of numbness, itching in the hands. Vigorous massage in the axillary cavity helps to get rid of this.

4. With vigorous massage of the occipital muscles and cervical segments (root exit sites), patients often develop headaches, nausea, dizziness, and general weakness. Stroking the eyelids and frontal muscle eliminates these negative reactions.

5. Patients suffering from angina pectoris may experience unpleasant sensations in the region of the heart when massaging the muscles in the area between the medial edge of the scapula, especially its upper angle, and the left spine. You can improve the situation by massaging the left half of the chest, closer to the sternum, as well as the lower edge of the chest.

6. Massaging the area of \u200b\u200bthe left axillary cavity can cause discomfort in the area of \u200b\u200bthe heart, which are eliminated by massaging the left half of the chest, and especially its lower edge.

When constructing a reflex-segmental massage, the massager should be guided not only by the existing patterns of the location of reflexogenic zones in this or that disease, but also to determine them himself before proceeding with the massage. This is necessary because not all segments can be equally involved in the process.

In addition, the localization and severity of the reflected reflex changes in the tissues can vary from the age, the stage of the disease and, especially, from the reactivity of the organism. For the same reasons, in order to clarify the massage technique and its subsequent dosage, it is necessary to periodically conduct functional control studies already during the procedure.

The number one problem in the prevention of many widespread diseases of internal organs is now considered to be measures to prevent obesity. The frequency of overweight among the population is increasing, and in developed countries the disease is becoming a socially significant problem. This is due to the peculiarities of nutrition and a decrease in physical activity of a modern person.

Exogenous constitutional obesity

Obesity can be caused by various diseases. Much more often (75% of all obese people), excess body weight is associated with an energy imbalance, that is, with a greater intake of energy from food and less energy consumption. In this case, part of the energy is not utilized by the motor and other activities of the body. A number of individuals have a hereditary predisposition to excessive obesity. This type of obesity is called differently:

1. exogenous constitutional,
2. alimentary-exchange,
3. simple.

The Institute of Nutrition of the Academy of Medical Sciences of Russia, together with a number of medical institutes, examined 38 thousand people in various regions of the Russian Federation. Overweight was noted in 50%, among them 26% were people with true obesity. These figures are close to the number of obese people in other countries. So, in Great Britain, 20-40% of residents from different groups of the surveyed were found to be overweight, in France 50% of the population aged 40 and over had a body weight of 10% or more above the norm. In the United States, persons with such excess body weight account for 32%, in Italy - 33%.

Age

The majority of those observed with overweight and obesity are persons over 45 years old. So, among the unorganized population aged 40-49 years, overweight was noted in 15%, and obesity - in 20% of the surveyed, and among patients of one of the medical units of the same age group - in 27.6 and 37 4%, respectively. However, the proportion of obese people at a younger age (20-29 years) is also quite high: 7.2 and 6.5% among the unorganized population and 18.0 and 7.0% among medical units, respectively.

The large number of obese children is of particular concern. According to various researchers, at the age of 8-15 years, 5-6% of children suffer from this disease, and fluctuations in this indicator in different european countries very insignificant. Obesity in girls and boys is more common in the families of skilled manual workers and knowledge workers. In children from large families, from families of unskilled manual workers, excess body weight is less common.

In Western Europe, obesity among adolescents was noted in 15%, and in Russia - in 10%. An increase in the number of children and adolescents over the past 20-30 years has been observed everywhere.

Floor

The incidence of obesity is significantly influenced by gender. According to the results of various studies carried out in our country and abroad, women suffer from the disease 2.6-3.0 times more often than men.

Place of residence and profession

It is not possible to establish any connection between the number of overweight people and their place of residence. The connection of these indicators with the profession is quite obvious. There are fewer overweight workers among workers engaged in heavy physical labor. Thus, among the workers of the press shop, excess weight was found only in 10.05% of cases, and obesity - in 10.2%, while in collective farms where labor mechanization is sufficiently high, the prevalence of the disease reaches 23.8%. Obesity is even more common among female operators in highly mechanized labor (68-88%).

A survey in 1980 of a large number of Lviv residents revealed that 24% of the unorganized adult population aged 18-80 suffer from obesity. The highest proportion of people with obesity was found among food industry workers:

• at the Lviv Dairy Plant, obesity was found in 52%,
• at a confectionery factory - at 48,
• at the meat processing plant - 33%.

It should be noted that the workers at the meat processing plant had no contact with the finished product.

Thus, obesity affects about 25% of Russian citizens. It occurs especially often in women, in the second half of life and in people with little physical activity at work.

As noted above, the main cause of obesity is a violation of the energy balance of the body, in which the energy received with food exceeds the energy expenditure of the body. At the same time, unrealizable excess food is a resource for fat synthesis in adipocytes, which leads to an increase in body weight.

Depending on the severity of energy costs arising at work, the entire adult working-age population in our country was divided into five groups:

1. mostly intellectual work;
2. physical labor without pronounced energy consumption;
3. automated physical labor;
4. automated work of medium severity;
5. hard manual labor.

Within-group daily energy requirements may vary depending on gender and age:

1. 2100-2700 kcal,
2. 2250-3100 kcal,
3. 2600-3300 kcal,
4. 3000-3800 kcal,
5. 4000-4500 kcal.

There are data that clarify the required calorie content of food for children, adolescents and the elderly. However, these figures can be considered only indicative, since when distributing into groups, energy costs are not taken into account, which occur in their free time from work and are very significant.

Analysis of the nature and caloric content of the diet of the majority of overweight persons showed that they ate proteins, fats and carbohydrates with food, in terms of the total calorie content 1.5-2.0 times higher than the individual norm. The diet of overweight people is usually characterized by an increased consumption of all chemical food ingredients, especially carbohydrates, due to baked goods, sugar, and potatoes. Also, the causes of obesity are (in particular, the use of alcoholic beverages), the abuse of spicy, salty foods, various spices that increase appetite, as well as holiday and Sunday feasts, banquets, comradely dinners, which have many different dishes, spicy and salty snacks, flour products.

In recent decades, attention has been paid to the increase in fat consumption, which in central Russia makes 38% of the total calorie content of food and reaches even higher figures in some other regions of the CIS. For example, in Tbilisi, fats account for an average of 48% of the total daily caloric intake, which is significantly higher than the recommended norms (30-33%). It should be noted especially that animal fat is mainly used together with high-fat meat products, and the amount of vegetable fats consumed, containing polyunsaturated fatty acids necessary for the body, was reduced in all studied contingents and amounted to no more than 15% instead of the recommended 30% of the total fatty component of food. At the same time, there is a high proportion of carbohydrates in the diets of the surveyed population. An increase in carbohydrate consumption is characteristic of central Russia, mainly due to potatoes and bread, and for the inhabitants of the Caucasus - due to an excess of wheat bread and national dishescontaining a lot of sugar.

The negative effect of the increased use of refined fats and carbohydrates in food can be illustrated by the increased consumption of ice cream in the United States. Many American doctors are alarmed at the harmful health effects of such ice cream consumption in the United States, aided by the introduction of Ice Cream Day by US President Ronald Reagan. Now the American consumes an average of 30 kg of this easily digestible, high-calorie product per year. This is associated with a significant increase in the number of obese people in the United States with all the ensuing consequences.

Obesity risk factors

Although excessive food intake is the main cause of being overweight, there are several additional risk factors for obesity:

• low physical activity;
• cerebral motivation to eat;
• mode and time of meals;
• financial situation;
• hereditary predisposition;
• family habits;
• education.

Low physical activity

Low physical activity significantly contributes to the development of obesity. Modern realities are such that in conditions of scientific progress, against the background of the habitual attitude to food, less and less energy is spent on physical activity. But according to the norms for physical activity, you need to spend more than 600 kcal per day, but usually the body's energy costs for physical activity are only 200-300 kcal. It should be noted that in some patients who do not exceed the normal daily amount of calories from food, but have little physical activity, there is an increase in body weight.

Obesity, in turn, leads to the fact that obese people are trying to find a sedentary job, which will have a minimum of energy consumption. This type of activity promotes weight gain, which in turn favors the progression of the disease - a vicious circle is formed.

It should be especially noted that a sedentary lifestyle is spreading among schoolchildren. For example, in Estonian schoolchildren, it occurs in 75% of cases, and this is especially typical for obese children who are on the move 40-50% less than necessary during the day. As a result of special studies conducted in Ukraine, it turned out that overweight children less often (on average by 20%) than children with normal weight do morning exercises, exercise, and spend more time watching TV. The desire for physical inactivity in overweight persons is aggravated by the fact that muscle work requires more energy than normal.

Food cerebral motivation

Cerebral food motivation, that is, cortical processes that form an increased appetite in persons with exogenous constitutional obesity, is excessive. Scientists studied the presence and severity of increased food motivation in obese individuals and came to the conclusion that two types of increased food motivation can be distinguished:

• First type (23.8% of patients) is characterized by the presence of persistent and persistent hyperphagic reactions, a persistent increase in appetite. Restriction of the diet is accompanied by severe food discomfort, not controlled by volitional efforts.
• Second type (76.2% of patients) is characterized by periodic occurrence of hyperphagic reactions. Periods of increased appetite last from 2-4 weeks to 2-3 months. If during periods of increased appetite volitional efforts to overcome food discomfort that appear when restricting the diet are not always effective, then during periods of normalization of appetite, restriction of food intake is easily and stably controlled by volitional efforts.

The neuroendocrine effect on weight gain is associated with a hyperphagic stress response, which occurs in 30% of people. Among them are mainly obese women with a high degree of neurotic disorders and emotionally labile personality traits. The hyperphagic stress response in these people occurs as a result of a prolonged and significant conflict situation. The inability to find the right way out of a conflict situation or to use modern methods of psychological defense due to the existing personality traits facilitates the possibility of such a primitive and at the same time socially acceptable defense mechanism, which is the hyperphagic response to stress. A certain level of training in the hyperphagic way of responding to a stressful situation in childhood is possible, when food becomes a reward for performing any action associated with, or a means of consolation during fright, discomfort, nervous tension etc.

Mode and time of meals

The development of obesity contributes to a violation of the diet. Among those who eat 1-2 times a day, in the Russian Federation, 62% were found to be obese, IHD, chronic cholecystitis, and when they eat 3 times a day or more, 38%. In Georgia these figures are 66 and 34%, respectively.

Financial situation

An analysis of the relationship between the financial situation and the development of obesity led to a somewhat unexpected conclusion: it turned out that obese people (especially women) are more likely to meet the environment of the population with a low material standard. This is probably due to the fact that the cheapest are carbohydrate-rich foods, which cause fat deposition faster than protein foods.

Heredity

Often the analyzed disease is of a family nature. In more than 65% of patients, the parents also had an increased body weight. It was shown that in families where both parents have a normal body weight, only 9% of children suffered from increased BMI. In those families where at least one parent is obese, the probability of passing on the propensity to overweight to the child is about 50%, and if both parents are obese, it is 75-80%. At the same time, studies of identical twins carried out in this direction did not confirm the data on the role of heredity in the development of obesity.

The relationship of the pycnic constitution with the development of obesity in last years criticized. More and more attention is being paid to the traditional habit of such families with the so-called "family obesity" to eat with the use of rich and high-calorie foods and to overfeed children from an early age.

Obesity development mechanisms

Analyzing the mechanisms of development of exogenous-constitutional obesity, one should start with the fact that in persons with a tendency to this disease, scientists have found a significant (by several hours compared to the norm) slowdown in the passage of food mass through the digestive organs, which creates favorable conditions for enhancing the absorption of fat into intestines. The assimilation of fat absorbed from the intestine is carried out in two ways:

1. In the first way, the transformation occurs in the liver, where b-lipoproteins arise from the breakdown products of fat and protein.
2. The second way consists in the partial cleavage of fat triglycerides by lipoprotein lipase into non-esterified fatty acids and b-lipoproteins.

In obesity, the mechanism of development of the disease lies in the violation of both ways of transforming the absorbed fat from food.

Violation of the breakdown of fat triglycerides from food by lipoprotein lipase leads to an increase in their concentration in the blood serum, to hyperlipidemia. It should be emphasized that the excessive accumulation of fat in the body is carried out not so much due to the fats and endogenously formed fats introduced into the body with food, but due to the carbohydrates ingested with food, which are converted into fats. The predominance of lipogenesis (fat formation) over lipolysis (fat breakdown) characteristic of the disease leads to increased deposition of triglycerides in fat cells (lipocytes). The number of lipocytes in an adult is constant, so excessive deposition of triglycerides leads to an increase in the size of lipocytes, which ultimately increases body weight. It was found that the size of lipocytes correlates with body weight.

The breakdown of fat, concentrated in adipose tissue, is carried out by several types of lipases. Fat-mobilizing lipase hydrolyzes triglycerides, leading to the entry into the blood of non-esterified fatty acids with their subsequent use as an energetic material.

Exogenous-constitutional obesity leads to significant metabolic and metabolic disorders. Of particular importance for the development and progression of the disease are disorders of secretion and response to insulin. Along with hyperinsulinism, insulin resistance develops, glucose tolerance increases, which also contributes to intensive fat deposition.

An increase in adipose tissue and an increase in body weight leads to greater energy requirements of the body, which is accompanied by an increase in appetite and an increase in food intake with all the negative health consequences set out above. Thus, another vicious circle is closed:

obesity ⇒ increased appetite ⇒ increased food intake ⇒ energy overload of the body ⇒ excess fat deposition

Obesity

Ways of occurrence and consequences of exogenous constitutional obesity

Exogenous-constitutional obesity is currently considered a disease that contributes to many diseases (see diagram above). They develop in almost all organs and systems of the body.

The manifestation of pathological symptoms depends on the degree of obesity. When determining the severity, the excess of the actual body weight in comparison with the due one is taken into account:

1. with obesity of 1 degree, excess weight exceeds normal by 15-29%,
2. at 2 degrees - by 30-49,
3. at 3 degrees - by 50-100,
4. at grade 4 - more than 100%.

The symptoms of exogenous constitutional obesity develop gradually. At first, the patient's state of health does not change. Then fatigue, weakness, sometimes apathy, shortness of breath, drowsiness, increased appetite and thirst appear. Initially, fat deposits are noted on the trunk, in the shoulder area, on the thighs, on the face, then in the area of \u200b\u200bthe forearms and legs. With a pronounced excess of body weight, folds of skin with subcutaneous fatty tissue of greater thickness hang down on the abdomen and back. Obesity symptoms such as dry or sweating skin, fungal and inflammatory diseases skin, diaper rash.

The consequences of obesity

The asterisk marks data for people with low energy consumption (office work); tolerance limits ± 5%

Obesity is accompanied by dysfunction of all organs and systems of the body (diagram above). With insufficient and excessive nutrition, a wide variety of diseases are observed. Most often, atherosclerosis, chronic cholecystitis, diabetes mellitus, osteochondrosis, osteoarthritis develop.

Convincing data have been obtained about the higher incidence of obese people compared with those of normal body weight. Among those surveyed in one of the districts of Moscow, the incidence of people with normal body weight was 33%, and in patients with obesity, various diseases were noted in 47.8% of cases. In Ryazan, among the 5 thousand examined atherosclerosis of the coronary and cerebral vessels, as well as:

• myocardial infarction and stroke were registered in 16% of persons with normal body weight and in 25% - with overweight,
• hypertension - in 10 and 64,
• gallstone disease - in 1.5 and 9.0,
• lesions of the musculoskeletal system - in 7.8 and 36.0%, respectively.

Diabetes mellitus was not diagnosed in any person with normal body weight and was detected in 5% of obese individuals. Similar data were obtained in Ukraine. Those who are overweight are much more likely than those with normal weight, observed:

• diseases of the cardiovascular system (by 54% in men and by 11% in women),
• urolithiasis (2.0 and 3.4 times, respectively),
• gallstone disease (3.3 and 1.3 times),
• gout (4.0 and 4.7 times).

With any degree of obesity, the increased energy value of food contributes to the addition of various diseases (see the table below).

Nutritional structure of persons with uncomplicated (1) and complicated (2) forms of obesity (atherosclerosis, hypertension, diabetes mellitus, cholelithiasis)

A similar relationship between overweight and various diseases is observed everywhere. Thus, the studies carried out have shown the following: if the total morbidity among the urban population with normal body weight is 20%, then among people with overweight it reaches 80%. At the same time, 90% of them have diabetes, 50% have hypertension, and 65% have gout.

Thus, the above and many other data clearly indicate that various diseases of vital organs in people with increased body weight occur much more often than in those with normal weight.

Now let's dwell on such a consequence of overweight as visceral obesity, which affects the vital organs.

Obesity of the heart

The cardiovascular system suffers most of all with the disease being examined. Due to the deposition of fat in the heart, its mass increases by 1.5-2 times.

Symptoms

Shortness of breath appears first with physical exertion, and then at rest, short-term pain in the region of the heart, decreased performance. The size of the heart increases, its tones become muffled, and a systolic murmur of functional origin often appears. In an electrocardiographic study, a slowdown in the electrical conduction of the heart, rhythm disturbances are determined, and with an increase in blood pressure, a deviation of the electrical axis of the heart to the left. All these changes are largely reversible and may disappear completely or partially with a decrease in body weight.

The severity of changes in the heart and blood vessels is in direct proportion to obesity. Thus, a 10% increase in body weight leads to an increase in systolic blood pressure by 6.5 mm Hg. Art. As a result of long-term studies of large groups of the population, it was noted that lesions of the coronary vessels of the heart in overweight people develop 16 years earlier than in people without this pathology. A close relationship between obesity of the heart and myocardial infarction was demonstrated in a study of 420 patients who underwent this disease, among whom overweight was diagnosed in 76% of women and 34% of men.

Obesity of the intestines and stomach

Pronounced changes in obesity occur in the intestines and stomach. The function of the gastrointestinal tract is changed in more than 55% of patients. 64% have an increase in gastric secretory activity and chronic gastritis, 20% have chronic colitis.

Obesity and diabetes

Diabetes mellitus is noted in 60% of obese individuals. This is due to the fact that with excess body weight, the work of beta cells of the islet apparatus of the pancreas is enhanced. On glucose load, the pancreas of obese people secretes more insulin than normal, and the concentration of immunoreactive (insufficiently active in relation to glucose metabolism) insulin in these individuals is increased, which together creates the prerequisites for the development of diabetes mellitus.

Breathing disorders

With obesity, the functions of the respiratory system are impaired. Due to the high standing of the diaphragm, the vital capacity of the lungs decreases, ventilation of the lungs and gas exchange are damaged. Patients with excess weight often suffer from acute respiratory diseases, pneumonia, bronchitis.

Dysfunction of the endocrine glands

With alimentary-constitutional obesity, the function of the pituitary gland is reduced, and in this regard, the function of the thyroid gland.

In most patients, the glucocorticoid and mineralocorticoid functions of the adrenal cortex are increased, and the androgenic function of the adrenal cortex is reduced.

In this regard, very often obese people have dysfunctions of the gonads. In men, this is manifested by impotence at a young age, and in women - by irregularities in the menstrual cycle in the form, etc. Even with a regular menstrual cycle, conception often does not occur. More than half of sick obese women suffer from infertility.

Musculoskeletal disorders

Disruption of all types of metabolism in overweight people leads to dysfunction musculoskeletal system, which is manifested by pain in the limbs and spine. Due to the heavy load of excess body weight on the spine, the nutrition of the intervertebral cartilage is disturbed (osteochondrosis), nerve roots are compressed, numbness in the limbs is felt, they begin to swell.

Obesity and Oncology

Of particular concern is the work that has appeared in the last 20 years, which traces the connection between obesity and oncology. The results of many recent studies indicate that excess nutrition and excessive consumption of fats and animal protein may play a decisive role in the occurrence and development of cancer of the colon and pancreas. At least 50% of oncology in women and 33% in men are caused by excessive food intake. The population of the countries with the highest prevalence of cancer consumes 29.5% more fat, 320% more protein and 2 times less fiber than the inhabitants of the countries with the lowest cancer incidence.

Many scientists are convinced that the hormone-like substances of adipose tissue, if it is in excess, turn into a carcinogen that contributes to the occurrence of cancer, in particular of the breast.

Studies in the United States have concluded that 60% of tumors in women and more than 40% of tumors in men are nutritionally related in some way. Direct close correlations have been established between mortality from intestinal cancer and excessive consumption of fat, meat, sugar, eggs, beer, as well as between mortality from stomach cancer and the consumption of increased amounts of sugar and grain products.

Death from obesity

Relationship between body weight (abscissa - deviation from the mean,%) and mortality (ordinate,%) in men 40-49 years old in North America

This disease is an extremely serious medical and social problem, as it leads to sad consequences - many diseases arise, the quality of life worsens, it shortens and mortality increases. These findings are based on numerous studies carried out in different countries research. According to data from foreign insurance companies, death among obese people in comparison with those with normal body weight (taken as 100%) at the age of 20-29 for men was 180%, and for women - 134%; 30-39 years - 169 and 152, 40-49 years - 152 and 150, 50-64 years - 131 and 138%, respectively.

In 1978, the WHO confirmed, based on US data (see graph above), the relationship between obesity and premature death. It was found that overweight reduces the expected (probable) life expectancy by an average of 7 years. This reduction is significantly higher in cases where the body mass index (BMI - the ratio of body weight to height) is more than 30% higher than its average value for the norm. Such people have increased mortality rates by 35-42% in men and by 25-35% in women. In this case, the cause of death was not obesity itself, but diseases arising in connection with it or sharply aggravated by it. Among these diseases, the most common were myocardial infarction, stroke, diabetes and diseases of the gastrointestinal tract.

Eliminating obesity would increase the average life expectancy of an entire generation by 4 years. For comparison, it can be indicated that the elimination of oncological diseases would extend the life of a generation by only 2 years.

All those severe health consequences, deterioration in the quality of life due to associated diseases and shortening of life can be completely or partially prevented by restoring body weight to a normal level. The main direction of obesity prevention is a balanced diet. Academician N.M. Amosov, when he states:

It is known that the overwhelming majority of people are much more useful an unobtrusive feeling of hunger than a state of oversaturation. It is much healthier and healthier to under-eat a little than to overeat.

At the same time, excessively limited nutrition cannot serve as a means of preventing early aging, associated diseases and malignant neoplasms. The main negative consequences of malnutrition have been described above. To maintain the vital activity of an adult healthy person, even in a state of complete rest, from 1200 to 1800 kcal are needed per day.

The nutritional program developed in the USA, which includes seven main tasks, demonstrates how important it is to maintain human health normalization of nutrition in terms of calorie content and composition:

1. do not overeat;
2. eat more complex carbohydrates (from 28% of total calories to 48%);
3. consume less refined sugars (from 45% of total calories to 10%);
4. eat less fat (from 42% of total calories to 30%);
5. eat less saturated fat (up to 10% of total calories);
6. consume less cholesterol (from 500 to 300 mg per day);
7. consume less sodium (no more than 5 g of table salt per day).

The second area of \u200b\u200bobesity prevention and control is no less important than dietary measures. It consists in the fight against hypodynamia and normalization of the motor regime.

Thus, a reasonable restriction of nutrition, an active motor regime is the path to health and longevity. Gluttony and the associated excessive food intake, laziness and a sedentary lifestyle are the path to illness, deterioration in the quality of life, early aging and death.