Abdominal obesity

Abdominal obesity (visceral obesity, male-type obesity, apple-type obesity, central obesity) is a pathology with an excess of fat deposited in the area of internal organs and torso. The main feature of the disease is a waist circumference of more than 100 cm. This situation is formed against a background of overeating, a craving for sweets and a strong thirst. You will learn about the symptoms of abdominal obesity, its diagnosis and therapy from the article.

Contents:

1. General information.
2. Causes.
3. Pathogenesis.
4. Classification and symptoms.
5. Diagnosis.
6. Treatment of abdominal obesity.
7. Prognosis and prevention.

General Information

The problem of excess weight has been known since time immemorial, even Hippocrates paid attention to it. But even today the task of correcting excess weight has not been solved, and the increase in the number of patients with obesity is obvious.

It is connected with the rapid development of food industry, physical inactivity, bad habits. Today, according to WHO, about one third of the world’s population is overweight, but abdominal obesity develops more often in men. In recent decades they have been overtaken by children and adolescents. The pathology has no age restrictions, seasonality, endemicity, or racial differences.

Causes

Obesity is divided by etiology into alimentary-constitutional and symptomatic. The first variant is the most common, as it is considered a consequence of inherited genetic mutations and the patients’ lifestyle. This refers to a person’s eating behavior, which is controlled by leptin. If the trigger of adipose tissue cumulation is an endocrine or other pathology, this type of obesity is much less common.

The main causes of abdominal fat deposition are:

1. The constitutional characteristics of patients (30 to 70%): inherited type of metabolic processes, metabolism, diabetes.
2. Eating behavior: caloric intake, the amount of food consumed, especially at night, industrial food – on the go, fast snacks with a predominance of fats and light carbohydrates, alcohol consumption. This is where leptin becomes a beneficiary.
3. Food cravings are correlated with family and national traditions, mental health. Emotional disorders provoke an imbalance in the production of endorphins, serotonin, high consumption of sugar and alcohol, to which addiction is formed, dependence occurs.
4. Low mobility causes accumulation of fat reserves, which is explained by the minimal expenditure of energy on the background of the excess of incoming food. Fats and carbohydrates, which the body does not spend on movement, are stored in fat depots.
5. Endocrine disorders provoke obesity against the background of changes in the secretion of hormones, which activate the appetite, overeating habits occur, and lipolysis is inhibited. Examples of pathologies that cause this situation are: hypercorticism, insulinoma, hypogonadism and hypothyroidism.

Pathogenesis

In the vast majority of cases, visceral obesity is the result of alimentary and constitutional disorders. The essence is a hereditary predisposition, plus overeating and hypodynamia. An excess of calories provokes a spike in blood glucose, hyperinsulinemia development due to increased insulin synthesis, increases appetite and activates liposynthesis. In other words, a vicious circle is formed, which in turn provokes an increase in food intake.

Hunger and satiety are controlled by the activity of hypothalamic centers and the ratio of the hormones leptin and ghrelin:

• the hunger center is controlled by dopamine in concert with ghrelin;
• the satiety center is controlled by adrenergic regulation in concert with leptin.

In the development of abdominal obesity, neuroendocrine regulation disorders are diagnosed in the pituitary-hypothalamic system, pancreas, thyroid and sex glands, adrenal glands.

Classification and symptoms

In addition to the division of obesity into alimentary-constitutional and symptomatic, there is a gradation of the pathology according to the clinical-pathogenetic component:

1. Abdominal-constitutional, which is associated with the features of the diet, sedentary lifestyle, hereditary predisposition to the accumulation of adipose tissue. In this case, BMI is no more than 40 points.
2. Hypothalamic or leptin-grelin, which is caused by an eating disorder due to a perverse sense of hunger and satiety. BMI is not indicative.
3. Endocrine – the result of hormonal abnormalities in hyperthyroidism, hypercorticism, hypogonadism. BMI over 50 points.
4. Iatrogenic – inadequate correction of obesity by drugs.

Despite the different etiology of the disease, the main sign remains the accumulation of fat deposits in the area of the abdomen, the upper half of the torso. The patient is rounded. His silhouette resembles an apple. In women, the waistline reaches 80 cm or more, and in men – 94 cm. At the same time, BMI may remain normal, since subcutaneous fatty tissue in other parts of the body is normal or even hypotrophic, and muscles are underdeveloped. The diet consists of high-calorie foods, and eating behavior includes frequent and quick snacks, large dinners, eating at night, abuse of sweets, smoked and fried foods, and low-alcohol beverages.

Another typical feature of patients with abdominal obesity is overestimation of their motor activity. They are found to have low endurance, lack of exercise capacity, and inability to perform physical exercises to develop muscular strength. This helps to form an energy-saving mode of activity.

Patients with obesity travel by transport, do not exercise, and avoid housework. Often such patients are diagnosed with pathological changes in other body systems. Obesity is usually accompanied by hypertension, CHD, diabetes mellitus 2, nocturnal apnea, GI, dyspepsia, constipation, polycystic ovarian disease. Neurological disorders are manifested by apathy, somnolence, and rapid fatigability.

Patients are bothered by depression, high anxiety, problems in communication, a feeling of inferiority associated with extra pounds.

Complications

The most frequent negative result of abdominal obesity is considered diabetes mellitus 2. This is the result of impaired glucose tolerance, the appearance of stable hyperinsulinemia, arterial hypertension. Insulin is affiliated with leptin, so hyperinsulinemia is accompanied by hyperletinsulinemia, metabolic syndrome, which is typical, dyslipidemia.

Amid metabolic disorders form atherosclerotic plaques in blood vessels. In women, visceral obesity provokes hormonal dysfunction with active production of androgens. It starts with hair growth on the face, chest, and back. The extreme degree is infertility, and in men it also causes erectile dysfunction.

Diagnosis

The examination of patients is performed by an endocrinologist. If necessary, narrow specialists are involved according to the identified comorbidities, laboratory physicians and functional diagnosticians.

The examination algorithm is standard:

1. Thorough questioning of the patient for a history of diabetes mellitus 2, insulin- or leptin-resistance, and relatives. Since patients tend to underestimate caloric intake and overestimate physical activity, it is advisable to keep a diary and analyze it afterwards.
2. Physical examination is performed visually and with the help of a caliper, a device for measuring the thickness of the skin fold. Often increased activity of sebaceous and sweat glands is noted, which provokes furunculosis and pyoderma.
3. Anthropometry: height, weight, hip and waist circumference. If the waist circumference in women is greater than 84 cm and the waist-to-hip circumference ratio is greater than 0.85 and in men the waist circumference is greater than 98 and the waist-to-hip circumference ratio is greater than one, visceral obesity is diagnosed and BMI is calculated. For alimentary obesity, the index is greater than 30; for endocrine obesity, it is greater than 40.
4. Laboratory testing is prescribed to identify the triggers of obesity, diagnose complications of the pathology. A lipid profile study is performed, which is characterized by an increase in triglycerides ≥ 150 mg/dL and glucose levels > 5.6 mmol/L, while minimizing high-density lipoproteins.
5. Instrumental techniques are necessary to assess the amount and location of fat and are 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 counted. localization of visceral fat is at the level of 3-5 lumbar vertebrae.

Treatment of abdominal obesity

The therapy for different forms of obesity differs from each other. With secondary or symptomatic accumulation of extra pounds, correction of the underlying disease is implied. In constitutional-alimentary obesity, the most important is the correction of lifestyle: changes in eating behavior, physical activity. The therapy regimen is individual. In its composition is involved not only endocrinologist, but also a nutritionist and sports doctor. The degree of obesity, concomitant pathologies are taken into account.

The complex of therapeutic measures includes:

1. A therapeutic diet (diet), the main principle of which is a minimum of calories. For women it is no more than 1,500 kcal, for men it is 1,800 kcal. This a priori assumes limitation of fats and simple carbohydrates against the background of the inclusion in the menu of foods containing the doctor.
2. Drug correction is shown in severe obesity, ineffectiveness of the diet, complications that do not give proteins and fiber. The diet plan is the prerogative of the dietitian, but it must include a food diary and increased physical activity. This can be swimming, complex gymnastics, fitness training, other sports on the recommendation of the possibility of high physical activity. The goal of therapy is to minimize the process of splitting and absorption of fat, activation of serotonin and adrenaline receptors, leptin and ghrelin (as appropriate) to speed up satiety, suppress appetite, increase thermoreduction. HMG-CoA reductase inhibitors or statins, fibrates, ACE inhibitors are used in treatment.
3. Bariatric surgery is used in the most severe cases of obesity in the absence of general contraindications for surgical intervention. Formation of a small stomach, bypass shunting of the organ, and resection of part of the intestine are possible.

Prognosis and Prevention

If you follow your doctor’s two main recommendations – diet and increased physical activity – it is quite realistic to cope with abdominal obesity. The prognosis is, of course, favorable, since there is no threat to life, except in very severe cases. However, patience and persistence are needed to accomplish the objectives. Prevention includes a dispensary examination, control over the amount of food intake, and regular exercise.

Obese people are recommended to limit high-carbohydrate and fatty foods in favor of vegetables, fruit, lean meat, and dairy products. Eating three hours before bedtime is not recommended, but walking, exercising in the morning, and going to the gym several times a week are encouraged.