The diagnosis of primary obesity is established based on the available factor of overeating, eating foods rich in carbohydrates and fats, hypokinesia, a hereditary predisposition to obesity, indicators of the absolute amount of fat and the characteristic clinical symptoms of the disease.
Differential diagnosis of obesity
The differential diagnosis of primary obesity is carried out with various forms of secondary, developing with adiposogenital dystrophy, Itsenko- Cushing’s disease , hypothyroidism, etc. Currently, about 50 syndromes are known in which obesity is noted (Bardet- Beadle syndrome , Prader -Willy syndrome , etc. )
The prognosis for early detection and the right treatment tactics is favorable. Complications – bronchitis, pneumonia, cholecystitis, cholelithiasis and kidney stones, diabetes mellitus, etc.
Obesity treatment
Treatment for primary obesity should be comprehensive. The most important component of treatment is diet therapy, based on reducing the energy value of food and achieving a negative energy balance. Only in such cases is it possible to achieve a reduction in excess fat stores. At the same time, diet treatment should be carried out carefully so that the physical and mental development of the child is not disturbed, sufficient saturation is ensured. Food should be tasty, varied and not contain hot spices. These requirements are met by a diet with reduced energy value – 942 – 2512 kJ (225 – 600 kcal), less than the daily norm.
Patients with obesity of the III – IV degree should be treated in a hospital. In practice, a diet of approximately 1/3 of the energy value of a child’s food of a given age is prescribed . After a three-week treatment in a hospital, diet therapy continues on an outpatient basis, followed by a gradual increase in energy value to 1/2 – 2/3 of the daily requirement. For children of preschool age and school, the daily energy value of food should be respectively 4187 – 6280 kJ (1000 – 1500 kcal); of these, 30% should be covered by animal proteins, 25% by fat and 45% by carbohydrates. Such a distribution of the main food components makes it possible to noticeably reduce the amount of carbohydrates in the diet, somewhat limit animal fats, make the diet rich in proteins and ensure, over time, a negative nitrogen balance.
It is important to properly distribute the energy value of food throughout the day. Enhanced nutrition after 18 hours is most dangerous for children who are threatened by obesity, since from this time the processes of lipolysis are weakened . With five meals, the energy value of breakfast should be 20% (the first – 10 – 15%), lunch – 30 – 35, afternoon tea – 10 – 15, dinner – 20%; four times: breakfast – 25%, lunch – 35 – 40, afternoon tea – 10 – 15, dinner – 25%. Currently developed options for diets with reduced energy value, taking into account the degree of obesity. They propose to introduce protein in the form of lean meats (veal, beef), fish, cottage cheese, low-fat varieties of cheese, eggs, lean sausages, carbohydrates – in the form of brown bread, potatoes, unsweetened fruits; fats – mainly in the form of vegetable oil. It is recommended to avoid sweets and products from fine flour (white bread, cookies, cakes, muffins, vermicelli, etc.). Mandatory introduction of vitamins of mineral salts in the form of raw vegetables, abundant drinking of unsweetened liquids, salt – without restriction (if there is no arterial hypertension). In cases of hypercholesterolemia , cholesterol-rich foods are excluded. Hunger treatment is not recommended by most authors. Short-term treatment with hunger is allowed only in older children with high obesity in the absence of effectiveness of treatment with other methods. In this case, the child should have a desire to lose weight. In recent years, weight loss during obesity has been achieved using special food preparations – products in the form of a powder made on the basis of lean milk, in which proteins, fats, carbohydrates, salts, vitamins and trace elements are balanced. The drug of this group “ Redukab (GDR) is easy to prepare (given in the form of drinks) and is biologically complete. The energy value of one package of the drug – 4144 kJ (990 kcal), contains 70 g of protein, 18 i fat and 130 g of carbohydrates. However, these drugs are uniform in taste, and children therefore sometimes refuse them. The disadvantage is that they lead to constipation due to the small formation of toxins. Treatment of children with mild obesity can be carried out on an outpatient basis under the systematic supervision of a doctor. Positive results of diet therapy are achieved with strict adherence to the diet and daily routine, the normal amount of one feeding and the daily amount of food, slow food, the correct distribution of the energy value of food during the day, regular medical and parental control and self-control, timely correction of food and the gradual transfer of a sick child from one diet to another, taking into account the age and degree of obesity. In addition to dietary treatment, physical exercises are used, as they increase the main metabolism and enhance lipolysis processes . They are prescribed in a dosage and strictly individually. Fat-soluble vitamin preparations, especially retinol and ergocalciferol, are recommended . In order to mobilize fat from the depot and burn it, adiposin is prescribed (20 to 40 units 2 times a day intramuscularly for 10 to 20 days). It is not recommended to introduce drugs that suppress appetite ( fepranone , mefolin , etc.), as they have side effects (agitation, euphoria). Available reports on the synthesis of new effective anorexigenic drugs that do not cause negative side effects make this treatment method promising and encouraging. In secondary obesity – treatment of the underlying disease.
Obesity Prevention
In order to prevent obesity in children, a wide sanitary-educational work of health workers among parents and children on the importance of maintaining a normal body weight and the harm of excess is necessary. When raising children, the development of a proper diet with the elimination of cerebral eating is of great importance . It is very important to popularize outdoor games, sports and to fight a sedentary lifestyle. Prevention of exacerbations of obesity also involves the systematic adherence to a rational diet.
Lipoma
Refers to benign tumors of adipose tissue located in the subcutaneous fat.
Etiology and pathogenesis of lipoma
Not found out.
Clinic Lipoma
On the neck, upper limbs, hips, buttocks, abdomen in the dermis or subcutaneous tissue, spontaneously or after trauma , single or multiple tumor-like formations appear asymmetrically located, delimited, of elastic consistency. Reach large and rarely cause pain.
Differential diagnosis of lipoma
Atheroma. After suppurative processes on the skin (acne, boil, carbuncle, etc.), single or multiple, painless, pea-to-apple-sized, delimited, tumor-like formations of soft or dense consistency, slightly protruding above the skin level, are formed. They are located on skin areas rich in sebaceous glands (scalp, face, back, scrotum, etc.). Slowly increase in size and often become infected. Fibroma. More often in women on the upper and lower extremities or other areas there are painless, dark brown, single or multiple, round (clearly shaped or disc-shaped), dense, tumor-like formations up to 3-5 mm or more in diameter. They rise slightly and slowly develop.