Obesity (fatness) is considered one of the most widespread chronic, complex, endocrine disorders of pandemic proportions, especially in highly developed countries. We can define it as an excessive accumulation of fatt tissue in the body, which results in an increase in body weight and represents a significant risk factor for endangering health with the development of a number of chronic diseases and conditions. Overnutrition differs from obesity and is defined as increased body mass in relation to agreed standards according to tables that take into account the ratio of height and weight. Body mass can be estimated most easily by calculating the body mass index (BMI), which represents the resultant of the quotient of body weight in kilograms and the square of body height in meters. It is considered that the normal BMI for men is about 22.5 kg/m2 and for women 23.5 kg/m2. The prevalence of obesity in Europe is currently between 15% and 22%, while in the United States it is around 30%. It is believed that by 2030, 35% - 50% of the world's population will be obese with a trend of further deterioration. Obesity is a striking example of a combination of heredity (multifactorial genetic changes) and environmental factors. So far, a large number of genes involved in the physiology of appetite and control metabolic mechanisms have been identified, the changes of which play a role in the development of obesity, such as mutations in the FTO gene, the gene for the melanocortin receptor (MC4R), proopiomelanocortin (PMOC), the transcription factor PPAR-γ (Peroxisome proliferator-activated receptor-γ) and leptin receptors. In 1994, an American team of scientists led by Jeffrey Friedmann identified the hormone leptin and demonstrated its function in inhibiting hunger and the development of obesity, which occurs as a result of reduced sensitivity to the action of leptin. This process results in the impossibility of developing a feeling of satiety and inhibiting the feeling of hunger, despite high levels of leptin in the blood (so-called leptin resistance or leptin resistance).
Among the most important environmental factors, let's mention eating habits (excessive intake of high-calorie foods of plant, animal and refined origin rich in sugars and fats), insufficient physical activity, ethnic, cultural and socioeconomic factors, lack of physical activity, existence of other chronic and endocrine diseases (damage of the hypothalamus, hyperinsulinemia, Cushing's syndrome, reduced thyroid function (hypothyroidism), reduced pituitary function (hypopituitarism), polycystic ovary syndrome, reduced ovarian and testicular function (hypogonadism) and taking some medications (antidepressants, glucocorticoids)). Obesity also occurs as an accompanying symptom of various natural, genetically determined disorders.
Forms of obesity
In clinical practice, we distinguish between three forms of obesity:
- hypertrophic (with an increase in the size of fat cells)
- hyperplastic (it is characterized by an increase in the number of fat cells)
- mixed (has features of both hypertrophic and hyperplastic form)
Type 1 obesity includes BMI of 25 - 29.9 kg/m2, Type 2 BMI of 30 - 39.9 kg/m2 and Type 3 BMI ≥ 40 kg/m2. The centripetal type of obesity is characterized by the central accumulation of fat tissue in and around the abdomen, while the centrifugal (peripheral) type of obesity is dominantly characterized by the subcutaneous accumulation of fat tissue. The central type is associated with more severe metabolic consequences and the development of more severe complications.
The type of obesity, gender, BMI value, distribution of fat tissue on the body, and accompanying complaints and complications that occur as a result of obesity determine the clinical picture. It typically consists of cosmetic defects, impaired movement, psychological problems and various clinical entities such as endocrinological and metabolic (elevated blood sugar level or type 2 diabetes, elevated levels of urate (uric acid) in the blood (hyperuricemia), fat (hyperlipidemia), reduced function of the testicles and ovaries (hypogonadism), the occurrence of cardiovascular and cerebrovascular disorders (varicose veins, elevated blood pressure (arterial hypertension), heart attack and stroke)) and other complications such as pulmonary complications (obstructive sleep apnea, pulmonary embolism, asthma, frequent respiratory infections system), oncological (cancer of the breast, uterus, prostate, pancreas, ovary, kidney, gall bladder, stomach, bile and bile ducts, colon), gynecological/obstetric (eclampsia, polycystic ovary syndrome), psychiatric (depression), gastroenterological (fatty liver, gallstones) and orthopedic (degenerative diseases of bones and joints).
Diagnosis and treatment of obesity
The diagnosis is established by a specialist examination, laboratory and hormonal tests and various additional tests in relation to the clinical indication. Treatment of obesity is an extremely complex process that includes hygienic and sanitary measures, medication, and sometimes endoscopic or surgical therapy.