Is a group of common metabolic syndrome. When the body is eating more calories than calories, excess calories in the form of fat stored in the body, the amount of more than the normal physiological requirement, and reached a certain value and the evolution of obesity. Normal male adult adipose tissue weight / body weight from 15% to 18%, women accounted for 20% ~ 25%. With the increase of age, body fat percentage increase. On obesity evaluation methods, including anthropometry, dual energy X-ray absorptiometry, ultrasound, CT, infrared induction method etc.. If there is no obvious cause that Simple obesity
The definite etiology is called. Secondary obesity
External to eating too much and too little activity. Calorie intake than calorie consumption, the increased fat synthesis is the material basis of obesity. Because the fat metabolism disorder caused by obesity.
1 genetic factors
The incidence of human simple obesity have a certain genetic background. One study suggests that one of the parents were obese, their children's obesity rate is about 50%; the parents are both obese, their children's obesity rate rose to 80%. Generally believed that human obesity is genetic, genetic susceptibility plays a role in its pathogenesis. The formation of obesity and life behavior, feeding behavior, habits, climate and social psychological factors interaction.
2 neuropsychological factors
There are two on the feeding behavior of nucleus related known human and animal hypothalamus. A pair of the contralateral ventral nucleus, also called satiety; another on the ventral lateral nucleus, also known as the hunger center. There is excitement when satiety satiety and Antifeedant, failure is appetite hunger; central excitement appetite, anorexia antifeedant failure. The interaction of the two regulation, restrict each other, in a state of dynamic balance under physiological conditions, the appetite regulation in the normal range and maintain a normal weight. The thalamic lesions occurred, whether inflammatory sequelae (such as meningitis, encephalitis, or after) trauma, tumors and other pathological changes, if the destruction of the ventromedial nucleus, ventral lateral nucleus function is relatively hyperthyroidism and insatiable gluttony, caused by obesity. On the contrary, when the ventrolateral damage function of the ventromedial nucleus relative hyperactivity and anorexia, weight loss caused by.
3 endocrine factors
Many hormones such as thyroxine, insulin, glucocorticoids can regulate food intake, so that these hormones may be involved in the pathogenesis of simple obesity. Obesity on insulin resistance caused by hyperinsulinemia, and hyperinsulinemia can make insulin receptor down regulation and increase insulin resistance, thus forming a vicious spiral. Insulin secretion, can stimulate feeding increased, while inhibiting lipolysis, thus causing the accumulation of fat in the body. Sex hormones may play a role in the pathogenesis of obesity.
Eating too much can through the small intestine to stimulate excessive gastric inhibitory polypeptide (GIP), GIP stimulates the release of insulin. In hypopituitarism, especially the decrease of growth hormone, gonadotropin and thyrotropin decrease caused by specific types of gonad and thyroid function under the condition of low obesity, fat mobilization may reduce the relative increase in the synthesis of. Clinical obesity in women, especially after menopause women or women or women are prone to oral contraceptives, suggesting that estrogen metabolism and fat synthesis. Adrenal cortical hyperfunction, cortisol secretion, promote gluconeogenesis, hyperglycemia, stimulate insulin secretion increased, so fat synthesis increased, while cortisol promote fat decomposition.
4 brown adipose tissue abnormalities
Brown adipose tissue is an adipose tissue discovered in recent years, and mainly distributed in the surrounding subcutaneous and visceral white adipose tissue corresponding to. Brown adipose tissue distribution is limited, only in the area around the shoulder, the back of the neck, axillary, mediastinal and renal tissue, its appearance is light brown, changes in cell volume is relatively small. White adipose tissue is an energy storage form, the body will be excess energy stored in the form of neutral fat, the body can be when the fat cells of the hydrolysis of neutral fat use. White fat cell volume with energy release and storage change. Brown adipose tissue in the functional organs of a heat, that is when the body when feeding or by cold stimulation, brown fat cells in the fat burning, to determine the body's energy metabolism. The above two kinds of circumstances are called feeding induced by heat and cold induced thermogenesis. Of course, the function of specific proteins are affected by many factors. Thus, the general regulation of brown adipose tissue of the heat producing organizations directly involved in the body heat, the distribution of excess body heat to the body, make the body energy metabolism balance.
Such as environmental factors.
obesity Clinical manifestation 1 general performance
Obesity can be found in any age, about 1/2 of adult obesity with juvenile obesity. A general body weight increased slowly (except for women after childbirth), weight increased rapidly within a short period of time, should be considered secondary to obesity. Male fat distribution around neck and trunk and head, while women in the abdomen, lower abdomen, buttocks and chest breast.
The characteristics of the obese body appearance is short, rounded face, narrow width, double chin, stubby neck, head back occipital skin fold thickening. Chest circle, intercostal space is not significant, breasts due to subcutaneous fat thickness. When standing above the chest abdomen protruding navel Shenao plane. Short time obvious obesity in the abdomen, thighs and upper arm on both sides of the upper part of the inner and outer hip visible fine lines or purple white stripes. Children obesity genitalia buried in perineal subcutaneous fat which looked small and short penis. Finger and toe thick and short, because the back fat thickness of the metacarpophalangeal joint prominent skin sag, bone protrusion is not obvious.
Mild to moderate primary obesity without any symptoms, severe obesity is much more afraid of the heat, activity decreased, even when the activity has mild shortness of breath, sleep snoring. May have hypertension, diabetes, gout and other clinical manifestations.
2 other features
(1) obesity and cardiovascular system
Risk of obesity in patients with coronary heart disease and hypertension was significantly higher than that in non obese patients, the incidence rate of 5 ~ 10 times in non obese, especially girth (male >90cm, female >85cm) in patients with central obesity. Obesity can cause cardiac hypertrophy, posterior wall and interventricular septal thickening, cardiac hypertrophy and blood volume, intracellular and intercellular fluid increased, ventricular diastolic pressure and pulmonary artery pressure and pulmonary capillary wedge pressure was increased, some obese people have left ventricular dysfunction and obesity cardiomyopathy. Obese patients significantly increased the incidence of sudden death, and myocardial hypertrophy, cardiac conduction system of fatty infiltration caused by arrhythmia and cardiac ischemia related. Hypertension is very common in obese patients, the main risk is also increase the heart, kidney disease, blood pressure will be restored after weight loss.
(2) the change of obesity and respiratory function
The vital capacity in obese patients decreased and lung compliance decreased, can lead to a variety of lung function abnormalities, such as obesity hypoventilation syndrome, clinical characterized by lethargy, obesity, alveolar hypoventilation, often accompanied by obstructive sleep apnea. Severe cases can cause pulmonary heart syndrome due to abdominal adipose tissue accumulation and chest wall thickening, diaphragmatic muscle decreased lung capacity, pulmonary ventilation, breathing difficulties caused by activities, severe cases can lead to hypoxia, cyanosis, hypercapnia, and even lead to heart failure, pulmonary hypertension, heart failure, cardiac diuretic on this often poor response. In addition, severe obesity can cause sleep apnea, occasionally sudden death.
(3) obesity, glucose and lipid metabolism
Eating too many calories and promote the catabolism of triglyceride synthesis and lipid metabolism in obesity is more active, the relative glucose metabolism is inhibited, the metabolic changes in insulin resistance formation. At the same time, active lipid metabolism disorder of obesity with metabolic, hypertriglyceridemia, will appear high cholesterol and high density lipoprotein cholesterol. Sugar metabolism disorder of abnormal glucose tolerance and diabetes, especially central obesity. More than a normal weight range of 20%, the incidence of diabetes increased by more than 1 times. When BMI>35kg/m, the mortality rate is about 8 times of normal weight.
(4) obesity and musculoskeletal lesions
The arthritis is the most common osteoarthritis, the long-term weight-bearing articular cartilage surface caused by the structural changes, the most common diseases of knee joint. The gout: about 10% of obese patients with hyperuricemia, prone to gout. Osteoporosis: previous view that obesity osteoporosis is rare, but recent studies have found that obese fat cells secrete various adipokines and inflammatory factors may aggravate obesity, osteoporosis and fractures.
(5) obesity endocrine system changes
the growth hormone: obesity growth hormone release is reduced, especially for the stimulation of growth hormone releasing factor is not sensitive. The pituitary adrenal axis: Obesity adrenocortical hormone secretion is increased, but the peak normal secretion rhythm, increased adrenocorticotropic hormone (ACTH) concentration was slightly increased. The hypothalamic pituitary gonadal axis: obesity is associated with hypogonadism, pituitary gonadotropin decreased testosterone response to gonadotropin decreased. Obese men, the serum total testosterone (T) levels decreased, but mild to moderate obesity, free testosterone (FT) is normal, may be due to the sex hormone binding globulin (SHBG) decreased. While severe obesity also decreased FT. In addition, adipose tissue can promote the conversion of androgens to estrogens, so there will be some obese male breast development, obese girls, early menstruation. Adult obese women often have menstrual disorders, anovular menstruation or amenorrhea, high incidence of polycystic ovary syndrome. The hypothalamic pituitary thyroid axis: obesity on thyroid thyroid stimulating hormone (TSH) reduced the response of the pituitary gland, thyrotropin releasing hormone (TRH) response is reduced.
The two major aspects of treatment is to reduce calorie intake and increase energy consumption. Comprehensive therapy in behavior, diet and exercise the necessary medical or surgical treatment. Secondary obesity should be treated for the cause. The complications associated with disease should be given appropriate treatment.
1 behavioral therapy
Through publicity and education so that patients and their families to have a correct understanding of obesity and its harmfulness, and cooperate with the treatment, healthy lifestyle, diet and exercise habits change. Consciously adhere to long-term treatment of obesity is the first and most important measures.
2 control diet and increased physical activity
Mild obesity, eating amount, using low calorie, low fat diet, avoid intake of high sugar and high fat food, the total daily calorie consumption below. More physical labor and physical exercise, such as to reduce 500 ~ 1000g weight per month and gradually reached the normal standard weight, need not be treated with drugs.
Moderate obesity is more to strictly control the total calories, female patients required to limit food intake in 5 ~ 6.3MJ (1200 ~ 1500kcal) of /d, such as more than 6.3MJ/d, is invalid. Men should be controlled at 6.3 ~ 7.6MJ (1500 ~ 1800kcal) /d, this standard is expected to lose 1 to 2 pounds a week. To ensure food containing animal protein amount of essential amino acids (the total protein content of 1/3 is more appropriate), daily intake of protein per kilogram of body weight of not less than 1G. Fat intake should be strictly limited, and should limit sodium intake, retention of water and sodium to avoid weight loss, and also good for reducing blood pressure and reduce appetite. In addition, sweet beer limited. As it reduces the number of weeks is still not over weight control diet, the total daily calorie reduction to 3.4 ~ 5MJ (800 ~ 1200kcal) /d, but the heat is too small, with sensitive fatigue weakness, fatigue, chills spirits, must be closely observed. According to the study, diet therapy early protein consumption more, so that the body weight decreased rapidly and negative nitrogen balance, when continuous low calorie diet, have protective nitrogen retention response, gradually rebuilding nitrogen balance, and fat consumption increased gradually. But the fat heat produced about 10 times the protein, the fat tissue was significantly less than the amount of tissue protein disappeared, while protein synthesis instead of more, can make the counter weight recovery, this is the adjustment process of human body after the calorie restricted. Therefore diet treatment is often the result is not significant, in this case, should encourage exercise therapy in order to increase the calorie consumption.
About the activity or amount of exercise should be formulated on the principle of It differs from man to man. take a step-by-step approach.
3 drug treatment
For patients with severe obesity drugs can be used to reduce weight, and then continue to maintain. But how to better clinical application of these drugs remains to be explored. Medication may have side effects of drugs and drug resistance, and drug choice indications must be very careful, according to the individual patient measure may get the benefits and potential risk decision.
4 surgical treatment
Jejunoileum short-circuit operation, bile duct pancreatic surgery, gastric bypass surgery, short gastroplasty, vagotomy and stomach capsule, available. Effective operation (refers to the weight loss rate of up to 95% >20%), the mortality rate of <1%. Many patients can obtain long-term curative effect, preoperative complications can be greatly improved or cured. But the operation may be associated with malabsorption, anemia, narrow, there is some risk, only for severe obesity, weight loss failure and serious complications, but these complications may be reduced and improved by weight. To make a full estimate of the general condition of the patient before surgery, especially for diabetes, hypertension and heart and lung function, given the corresponding monitoring and treatment.