Abdominal obesity is a disease accompanied by the deposition of excess fat in the trunk and internal organs. The main signs are a waist circumference of more than 100 cm, systematic overeating, craving for sweets, increased thirst. Arterial hypertension, sleep apnea syndrome, apathy, drowsiness, fatigue, chronic constipation and other digestive disorders are often determined. The endocrinologist is engaged in diagnostics, a clinical survey is used, an examination with measurement of waist circumference, calculation of BMI. Treatment includes adherence to a diet, regular physical activity, and additionally prescribed medication therapy.
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Abdominal obesity is also called central, visceral, male-type obesity and “apple” type obesity. In the ICD-10, it is classified as “Diseases of the endocrine system, eating disorders and metabolic disorders”. The problem of excess weight has been known since the time of Hippocrates, but progress in the treatment of this disease is very modest, and epidemiological indicators are gradually increasing.
The latter fact is associated with the development of the food industry, unhealthy eating habits and sedentary people. According to WHO, 30% of the world’s population is overweight. Abdominal type of obesity is more susceptible to men, in recent decades the prevalence of this pathology among children and adolescents has been increasing.
Causes of abdominal obesity
On the etiological basis, obesity can be alimentary-constitutional and symptomatic. The first option is much more common, due to heredity and the way of life of a person. According to the clinical experience of doctors, weight gain based on endocrine and other pathology is less common. The list of causes of abdominal obesity includes the following items:
- Constitutional features. Genetic predisposition is one of the causes of the disease in 25-70% of cases. The characteristics of metabolic processes, factors of the development of metabolic syndrome and diabetes are inherited.
- Type of food. Obesity is promoted by excessive caloric content of food, the use of a large amount of it in the evening and at night, the transition from traditional national nutrition to industrial. The diet of patients is dominated by fats, light carbohydrates, alcohol.
- Eating disorders. Food preferences are determined by family and national stereotypes regarding food and the state of mental health. With emotional disorders, the exchange of endorphins and serotonin is disrupted, the use of sweets and alcohol becomes “doping”, addiction is formed.
- Physical inactivity. An increase in the amount of fat is often caused by lack of mobility in everyday life – insufficient consumption of energy coming from food. Fats and carbohydrates that are not wasted by the body on motor activity are processed and deposited in the “depot”.
- Endocrine disorders. Hypercorticism, insulinoma, hypogonadism and hypothyroidism lead to obesity. The disease is provoked by a change in hormone secretion, as a result, appetite increases, the habit of overeating is formed, lipolysis slows down.
In most cases, abdominal obesity by the mechanism of origin is exogenous-constitutional. The disease is based on hereditary factors, regular overeating and insufficient physical activity. Excessive food intake leads to an increase in the concentration of glucose in the blood and the development of hyperinsulinemia – increased insulin production, appetite stimulation, activation of liposynthesis. Thus, a vicious circle is formed, contributing to an increase in food consumption.
The occurrence of hunger and satiety depends on the activity of the ventrolateral and ventromedial hypothalamic nuclei. The activity of the hunger center is controlled by the dopaminergic system, the satiety center functions according to adrenergic regulation. With the development of abdominal obesity, primary or secondary (exogenous) abnormalities are determined in all parts of neuroendocrine regulation – in the pancreas, hypothalamus, pituitary gland, thyroid gland, adrenal glands and gonads.
In the practice of communication between doctors and patients, there is a spontaneous division of abdominal obesity into primary, alimentary and secondary, provoked by an endocrine or other disease, taking medications. The first type is more common, due to nutrition and the nature of physical activity of the patient, requires the application of volitional efforts for recovery.
In the second case, treatment of the underlying disease is necessary, the responsibility for a positive outcome is shifted by the patient to the doctor, the effect of drugs. In clinical endocrinology, there is also a more complex clinical and pathogenetic classification, according to which 4 forms of obesity are distinguished:
- Abdominal-constitutional. It is associated with the peculiarities of diet, physical inactivity and hereditary conditionality of fat accumulation. BMI usually does not exceed 40 points.
- Hypothalamic. Develops with pathologies of the hypothalamus. It is based on increasing the feeling of hunger, dulling the feeling of satiety.
- Endocrine. Occurs as a result of hormonal failure. It is characteristic of hypothyroidism, hypercorticism, hypogonadism. The BMI coefficient is above 40-50 points.
- Iatrogenic. A medical form of obesity. Its development is provoked by the use of drugs – corticosteroids, antidepressants, antipsychotics, contraceptives.
Symptoms of abdominal obesity
The key sign of the disease is an excessive accumulation of fat deposits in the abdomen, upper half of the trunk. The silhouette of the patient becomes rounded, hence the common name of this type of obesity – apple. The waist circumference of men exceeds 94 cm, women – 80 cm. At the same time, BMI may remain within the normal range, because in other parts of the body the fat layer is normal or hypotrophied, muscle tissue is underdeveloped.
The diet consists of high-calorie foods. Eating behavior is characterized by frequent snacks, heavy dinners, eating at night, abuse of sweets, smoked and fried dishes, low-alcohol drinks. Often patients do not notice or incorrectly assess the high calorie content of food: they do not take into account random snacks, the addition of fatty sauces, the method of cooking (deep-frying, regular frying).
Another characteristic feature of patients is the reassessment of their daily activity. Many people have a low tolerance to physical exertion – insufficient fitness of the body, inability to perform exercises to develop endurance and muscle strength. This contributes to the formation of an energy-saving activity mode. Obese people refuse to walk in favor of transportation, do not participate in team games or remain sedentary in them, avoid housework that requires physical effort (washing floors, cleaning).
Patients often have disorders from other body systems. Obesity is accompanied by arterial hypertension, coronary heart disease, type 2 diabetes mellitus and its complications, obstructive sleep apnea syndrome, cholelithiasis, constipation, polycystic ovary syndrome, urolithiasis, osteoarthritis. Disorders of the nervous system are manifested by apathy, drowsiness, fatigue. Patients complain of depression, increased anxiety, communication problems, feelings of insecurity and an inferiority complex associated with excess weight.
In people with a central form of obesity, the likelihood of type 2 diabetes mellitus increases, which occurs as a result of impaired glucose tolerance, the appearance of stable hyperinsulinemia, arterial hypertension. Most complications are associated with metabolic syndrome, which is characterized by hyperglycemia, improper carbohydrate metabolism, dyslipidemia. Against the background of metabolic disorders, atherosclerotic plaques form on the walls of blood vessels.
In women, abdominal obesity provokes hormonal dysfunction, in particular, it leads to increased activity of the adrenal glands that produce androgens. This is manifested by the growth of hair on the face, chest and back (male type). In the late stages of obesity, infertility is diagnosed, in men – deterioration of potency, violation of reproductive function.
Examination of patients is carried out by an endocrinologist. In the process of differential diagnosis and detection of concomitant diseases, other specialists take part – a cardiologist, a neurologist, a doctor of functional diagnostics, laboratory assistants. The complex of procedures includes:
- Collecting anamnesis. The specialist finds out the presence of obesity, type II diabetes, insulin resistance syndrome among the closest relatives. Asks about the peculiarities of nutrition, motor activity of the patient. Since patients tend to underestimate the caloric content of their diet and overestimate the amount of exercise, diary entries are assigned for a week with their subsequent analysis.
- Inspection. The specialist visually and with the help of a caliper assesses the presence of excess fat, the nature of its distribution (in the upper torso, waist area). Patients often have increased activity of sweat and sebaceous glands, which is manifested by skin gloss, greasiness, pustular rashes, furunculosis, pyoderma.
- Volume measurement, weighing. Weight, height, hip circumference and waist are measured. With abdominal obesity in girls and women FROM more than 80-84 cm, the ratio FROM / ABOUT more than 0.85; in boys and men from over 94-98 cm, the index FROM / ABOUT more than 1.0. Based on the data on the patient’s height and weight, the body mass index is calculated. Alimentary obesity is characterized by a BMI of more than 30, for endocrine obesity – more than 40.
- Laboratory tests. To diagnose complications of obesity, to identify the causes of the disease, a lipid profile study is prescribed. It is characterized by an increase in plasma triglyceride levels (≥ 150 mg / dl) and glucose levels (> 5.6 mmol/L), a decrease in the concentration of high-density lipoproteins (
- Instrumental research. The assessment of the amount and location of the fat layer is performed by computed tomography and magnetic resonance imaging of the abdominal region, dual-energy X-ray absorptiometry. The area and volume of adipose tissue are calculated. The visceral fat area is most often located at the level of 3 and 4 or 4 and 5 lumbar vertebrae.
Treatment of abdominal obesity
With secondary or symptomatic obesity, therapy of the underlying disease is required. A significant part of patients have an alimentary-constitutional type of disease, in which the most important correction of lifestyle is a change in eating habits, the introduction of regular physical activity. The treatment regimen is compiled individually by an endocrinologist, nutritionist, sports instructor. The degree of obesity, the presence of severe somatic pathologies in the patient (coronary heart disease, osteoarthritis, diabetes and others) is taken into account. The program may include:
- Diet. The main principle of therapeutic nutrition is to reduce the caloric content of the diet: for women up to 1200-1500 kCal, for men up to 1400-1800 kCal. The consumption of fats and simple carbohydrates is minimized, the menu includes products containing proteins and fiber. A nutrition plan is drawn up by a nutritionist, it is recommended to keep a nutrition diary to monitor its implementation.
- Increased physical activity. The degree of load and the mode of training depend on the general physical fitness, the state of health of the patient. With severe obesity, classes begin with an increase in the duration of walking, at the second stage gymnastics and swimming complexes are assigned, at the third – visiting fitness halls, running, and other sports of medium and high intensity.
- Medical correction. Taking medications is indicated for severe obesity, ineffective diet, the presence of complications that do not allow to increase physical activity. Treatment is aimed at reducing the process of splitting and absorption of fats, increasing the activity of serotonin and adrenaline receptors (acceleration of saturation, appetite suppression, increased thermal production). Therapy is carried out with HMG-CoA reductase inhibitors (statins), fibrates, ACE inhibitors.
- Surgical treatment. Bariatric surgery can be used in severe forms of obesity, the absence of general contraindications for surgery. A positive result can be achieved by forming a small stomach, bypass gastric bypass, resection of part of the intestine.
Prognosis and prevention
Compliance with two main doctor’s prescriptions – diet and increased motor activity – allows you to cope with abdominal obesity in the vast majority of clinical cases. Prevention includes visits to dispensary examinations, moderate food intake, regular sports. People with a predisposition to fullness are recommended to limit high-carbohydrate and fatty foods, increase the amount of vegetables, fruits, lean meat and dairy products, refuse to eat 3 hours before bedtime, allocate time daily for hiking, morning exercises, and 2-3 times a week for sports.