Abdominal obesity in men and women

Most people with excess weight consider themselves not fat, but "moderately well-fed".Abdominal obesity does not occur suddenly. It has its own reasons: some of them - the person provides himself, the other - inherits as a predisposing factor. This means that it will manifest itself in the right conditions.

Judging by the name, with abdominal obesity, one should expect a predominant deposition of fat masses in the abdominal region. But excess weight is always manifested throughout the body: on the hips, face, buttocks, shoulders, neck. We will not touch on the opinions of beauty, we will only talk about medical problems and treatment options.

What do endocrinologists say?

Doctors, experts in the treatment of obesity - endocrinologists - call the deposition of excess fat on the abdomen android, because it is more typical of the male. Abdominal enlargement may depend:

• from the subcutaneous fat layer;
• growth of visceral fat.

The second type is caused by an excess of adipose tissue surrounded by internal organs located in the abdominal cavity:

• in the gland zone;
• on mesentery of intestinal loops;
• around the connective tissue shells and walls.

In the International Classification of Diseases, obesity is allocated to a separate nosology with code E 66.

Prevalence of

Over the past 30 years, the prevalence of obesity has increased 2.5-fold. In a developed country like the US, over 50% of men and 70% of women aged 50-80 years are overweight. The combination of obesity with diabetes is more susceptible to men.

The diagnosed "metabolic syndrome" is typical for 32% of the adult population. Among the queen fed the UK, obesity suffers up to 24%.According to the Brazilian doctors, 27% of boys and 35% of girls are 7-10 years old.

of the Academy of Sciences notes that in Russia in 2005 obesity was registered in 23%, in 2012 - in 25.3%.Obesity in women is found at 8-15% more often than in men. Territorially the maximum prevalence coincides with the mortality from noncommunicable diseases. By rating the countries of the world, our country stands on the eleventh place.

Differences between countries may be related:

• with the demographic structure of the population;
• economic and social situation;
• traditional way of life and food;
• genetic characteristics of Aboriginal people.

Causes of

The main cause of abdominal obesity is the imbalance between the physiologically needed energy requirement and what actually enters the body. In other words, the arrival of calories exceeds the consumption.

The risk factors for this disorder are:

• excess in the carbohydrate and fat diet, leading to accumulation of triglycerides in fatty white tissue cells;
• inadequate motor activity - reduces caloric intake;
• abdominal obesity in men is associated with the abuse of alcoholic beverages and beer( even non-alcoholic beer contains 5% pure ethanol, and the total dosage is summed up due to the large amount of alcohol), the nutritional value for the body does not have alcohol, fat reserves increase;
• wrong "eating behavior", this term psychologists call the habit of some people "zaedat" troubles in life, conflict situations, rewarding oneself for success.

Internal( endogenous) causes are caused by a violation of the neuroendocrine regulation of fat metabolism. They involve hormones, neurotransmitter mediators, enzyme systems, the receptor apparatus of cells, which ensures the assimilation of the incoming signal. It is at this level that obesity in a particular person can be hereditary.

Often, endogenous causes are provoked by external factors. For example, with abdominal obesity in men, there is a decrease in the level of dihydrotestosterone, the precursor of the sex hormone testosterone. And this process has a direct impact of liver damage caused by alcohol. As a result, the transfer of "instructions" from the hypothalamus to assimilate fats is violated.

Abdominal obesity in women in most cases begins in the climacteric period. It is caused by a significant decrease in the production of estradiol in the sex glands( ovaries).This process disrupts the cleavage of brown adipose tissue and its distribution. Perhaps the appearance of an enlarged abdomen with a normal body mass index.

The "female" risk factors include:

• polycystic ovary due to decreased production of sex hormones;
• hypothyroidism - a deficiency of thyroxine and thyroid-stimulating hormone of the pituitary gland affects visceral obesity.

Abdominal obesity occurs after delivery in women who gain excessive weight during pregnancy.

During breastfeeding, women have an increased synthesis of the hormone prolactin, and it is an active stimulator of the process of transformation of glucose into fat. Abdominal obesity after childbirth may be associated with severe uterine bleeding, leading to damage to the pituitary cells( Shihan syndrome).

Among the hormonal causes are:

• increase in production in the pituitary gland of adrenocorticotropic hormone with a decrease in somatotropin, β and γ-lipotropins;
• excess of glucocorticoids due to dysfunction of the adrenal cortex;
• increase in insulin production in the pancreas with the simultaneous decrease in the synthesis of glucagon, which normally stimulates the cleavage of triglycerides.

The entire mechanism of abnormal obesity disorders is part of the metabolic syndrome:

• on the one hand, it is associated with the development of an increase in the resistance of cells to insulin, the accumulation of insulin and glucose in the blood;
• , on the other hand, causes hyperlipidemia( growth of fats in the plasma) due to an increase in the level of triglycerides, a reduction in the number of high-density lipoproteins.

The causes of visceral type of obesity can be:

• Ithenko-Cushing's disease( growth of adrenal cortex hormone production under the influence of anterior pituitary tumor and high adrenocorticotropic hormone level);
• benign neoplasm of pancreas( insulinoma);
• damage to the hypothalamic-pituitary brain system in trauma to the skull, inflammatory processes, the effects of radioactive radiation;
• rare genetic syndromes;
• in childhood and adolescence after suffering birth traumas of the skull, meningitis or encephalitis reveal adipozogenital dystrophy( Frohlich syndrome).

We should not forget about the artificial negative consequences of fat metabolism, caused by prolonged use of medicines( steroid hormones, drugs for the therapy of mental illnesses).

What causes increased appetite?

Increased consumption of high-calorie foods is also associated with impaired hormonal regulation. After all, the cells adipocytes of adipose tissue themselves synthesize leptin, suppressing appetite. With abdominal obesity, the level of leptin is even raised, but a person does not feel hunger is quenched. Scientists believe that this is related to:

• with the development of resistance( resistance) and the lack of perception of the body by leptin;
• by frequent gene mutations;
• by cortisol suppression( in stressful situations);
• reduced level of estrogen.

This mechanism leads to uncontrolled hunger and constant overeating. Increasing the level of insulin in the blood causes the transformation of carbohydrates( glucose) into triglycerides, followed by accumulation in white adipose tissue.

Signs of

The main signs of abdominal obesity are:

• increased deposition of fat masses on the abdomen;
• uncontrolled feeling of hunger;
• feeling of heaviness in the stomach;
• belching;
• bloating.

Because of the increase in heart burden, patients develop:

• tachycardia;
• shortness of breath during movements;
• swelling on the legs;
• increases pressure.

Changes in the autonomic nervous system cause constant sweating. To determine the degree of obesity, use the body mass index. It is equal to the figure obtained by dividing the weight in kg by the height in meters, squared. The unit is kg / m2.

In assessing obesity, the following are important:

• normal level( 18,5-24,99);
• pregres- sion( 25-30);
• I initial degree( 30-35);
• II medium degree( 35-40);
• III degree( heavy) 40 and above.

There are special tables with a discount for age and sex. An indisputable criterion for enlarging the abdomen with abdominal obesity is the size of the circumference of the waist. It was adopted by the World Health Organization.

Normal is considered for men less than 94 cm, for women up to 80 cm. Accordingly, the indices of 94-101.9 cm and 80-87.9 cm indicate excess weight. About abdominal obesity can be said at the circumference in men more than 102 cm, in women 88 cm or more.

In addition, the calculation of the ratio of the circumference of the waist and hips. Excess fat in the abdomen in men shows a result of 0.95 and higher, in women - 0.85.

Consequences of

Surplus adipose tissue is secreted into the blood:

• fatty acids;
• hormones;
• cytokines.

Abdominal obesity causes an increased risk:

• of heart and vascular disease;
• hypertension;
• of diabetes mellitus with insulin resistance;
• of bronchial asthma;
• stopping breathing during sleep( apnea) - increasing the dome of the diaphragm reduces the volume of pulmonary ventilation;
• in men - impotence;
• in women with early menopause and infertility.

Interesting studies confirm the relationship of a significant accumulation of visceral fat with a decrease in the volume of the brain( regardless of the weight category).It matters in the risk of Alzheimer's.

Diagnosis

The diagnosis is made after weighing the patient and measuring the main circles. The coefficients are taken into account. Some doctors consider it necessary to additionally measure the thickness of fat in the intestinal zone. The index is called the "sagittal abdominal diameter."

When examined in blood tests, they detect:

• increased cholesterol, triglycerides and low-density lipoproteins;
• for fasting blood on an empty stomach, the glucose level is above normal;
• reduction of leptin.

In the analysis of urine, cortisol is determined. From instrumental techniques use:

• ultrasound-densitometry;
• magnetic resonance imaging and computed tomography.

They allow to diagnose visceral fat deposition. Each case of obesity is considered in terms of differential diagnosis with endocrine diseases.

Treatment of

Diet is the main way to reduce the intake of high-calorie food in the body. It must be calculated individually. The patient is recommended to walk at least one hour a day in any weather. For burning calories:

• swimming;
• strength training exercises under the supervision of a coach in fitness centers;
• long distance cycling;
• playing badminton, tennis.

Doctors after the examination of the patient prescribe as an additional therapy:

• drugs that violate the absorption of fats in the intestine( Orlimax);
• means for lowering blood glucose levels( Victoria, Liraglutide, Saxenda);
• medications that reduce the feeling of hunger( Fepranon, Mirapont, Regenon, Desopimon);
• vitamins, especially recommend nicotinic acid.

It is impossible to take these medicines without consulting a doctor, they have many contraindications, cause bowel disorders, headaches, bouts of urolithiasis and pancreatitis.

The advertised soda and salt baths have no effect. Fat through the skin does not come out and does not melt. In a sanatorium, they can prescribe balneotherapy in the form of special baths, but they have the task to calm the patient, normalize metabolism, help to tolerate a low-calorie diet.

In severe cases, surgical methods are used:

• plastic surgery that reduces the volume of the stomach;
• installation in the gastric cavity of a balloon inflated with air;
• using the principle of compression( banding).

Features of the diet

Dietary food does not require complete hunger. It is based:

• at a total calorie reduction of no more than 500 kcal compared to the individual norm;
• exclusion from the diet of animal fats and digestible carbohydrates with a sufficient number of proteins, fiber, vitamins;
• fractional and frequent meals, the volume of a single meal should not exceed a glass;
• refusal from fried, smoked food, pickles, you can cook only by cooking, quenching, steaming;
• stop consuming spices, fast food, alcohol, soda water.

Not recommended for use in food:

• fat;
• fatty broth;
• cold;
• sausages;
• mayonnaise;
• candy;
• chocolate;
• ice cream;
• confectionery.

The menu includes:

• dried rye bread;
• poultry, fish;
• vegetable and milk soups;
• stewed vegetables;
• porridge buckwheat, millet, rice( not recommended oatmeal, semolina, pearl barley);
• salads, greens, vinaigrette;
• seafood;
• raw fruits and berries, fresh juices, compote without sugar.

You can use a low-calorie sugar substitute in consultation with your doctor. Patients with abdominal obesity need the support of relatives, understanding problems, assessing success. Therefore, in many cities there are special clubs."Comrades in misfortune" better understand each other, it is easier to overcome difficulties together.