At the heart of obesity is a violation of the balance of energy intake and expenditure towards the predominance of the first. It is manifested by excessive deposition of fat in the body, an increase in body weight, a violation of the metabolism and function of a number of systems and organs.
Obesity is observed in 10 – 15% of children, occurs in all periods of childhood, and especially at an older age. More often, children living in cities are sick, and girls are more likely than boys. A CONNECTION has been established between the development of obesity in children and the security of the family, the profession of parents. In recent years, there has been an increase in the prevalence of obesity in children of the first year of life, which is explained by the increasing birth rate of children with a larger body weight.
Etiology of Obesity
There are primary (spontaneous) and secondary (symptomatic) obesity. Primary development is promoted primarily by excess consumption of foods rich in carbohydrates and fats, as well as frequent intoxication due to infectious diseases, birth injuries, asphyxiation during childbirth, toxicosis of pregnancy, and insufficient physical activity of children. Among the many causes of obesity in children’s practice, the incorrect upbringing of children with the development of a habit of plentiful food is of particular importance. This habit of overeating is gradually and firmly entrenched and can persist throughout the course of a subsequent life. Often, obesity develops in patients during convalescence and after recovery from acute infectious diseases, when children receive a diet with high energy value. Hereditary-family matterspredisposition (Yu. A Knyazev and others). It was found that obesity developed in 80% of children during puberty in those families where parents were obese, and only 10% of children – if no one was obese in the family. Observations of identical twins may indicate a genetic predisposition to obesity. In the presence of obesity in one of them, it also developed in the second twin, who was in different conditions of education.
Secondary obesity develops with adiposogenital dystrophy, hypothyroidism, hypogonadism , Itsenko- Cushing’s disease , hyperinsulinism , injuries and brain tumors, inflammatory processes in the hypothalamus, etc.
Pathogenesis of obesity
Of great importance in the pathogenesis of obesity is the state of the system for regulating the correspondence of energy intake with food and its consumption. Under physiological conditions, adipose tissue is subcutaneous, distributed in the mesentery, omentum, retroperitoneal space, etc. Coordinated processes of its construction ( lipogenesis ) and cleavage ( lipolysis ), which are adapted to the needs of a healthy body and contribute to this, can contribute to this distribution of fat. from the conditions of its existence. For example, under the influence of a changed ambient temperature or an increase in motor functions during games or sports, energy consumption increases, and the need for the amount of food eaten changes accordingly. This coordination between energy intake and food and its consumption is ensured by appetite, in the regulation of which the hypothalamic centers — ventromedial (saturation centers) and ventrolateral (appetite centers) yalrams — play a large role.
It is suggested that in the pathogenesis of primary obesity , changes in the functions of the centers of appetite that occur under the influence of the above etiological factors play a role. In addition, great importance is also attached to the weakening of the regulation of metabolism, including fat, of the coronas of the brain.
In all cases of primary obesity, regardless of the cause, there is an imbalance between the intensity of lipogenesis and lipolysis . With the accumulation of body fat, the processes of lipogenesis more often prevail over the processes of lipolysis . However, excessive fat deposition is also possible in other cases: with an increase in lipogenesis and a decrease in lipolysis below the usual level or with a simultaneous increase in lipogenesis and lipolysis , but with a relative predominance of the former.
In the pathogenesis of secondary obesity, significant importance is attached to impaired function of certain endocrine glands. In conditions of reduced production of cortico -, thyro -, somatotropin , thyroxine and triiodothyronine , glucagon, adrenaline and norepinephrine, lipolysis processes are reduced , as a result of which the fat depot is not used enough as an energy source. Obesity may also be due to a deficiency of sex hormones. At the same time, there is a violation of glucose metabolism, increased production of glycocorticoids , leading to increased glycogen deposits in the liver with subsequent inhibition of lipolysis .
Massive deposits of fat adversely affect the functional state of a number of systems and organs, and therefore there are many clinical manifestations of this disease.
Pathomorphology of Obesity
In primary obesity, increased fat deposition is found in the skin, subcutaneous base, pericardial plates, myocardium, pancreas, mesentery, omentum, perinephric space and other areas. The liver is enlarged due to fatty infiltration and congestion. Histologically , an increase in the average size and number of fat cells containing predominantly griglycerides is detected.
Obesity classification
Constitutional exogenous obesity is considered the main form of primary obesity, and in its origin a genetic factor is preferred. The concept of exogenous obesity includes absolute and relative overeating (with hypokinesia). A simple form of obesity is characterized by an increase in body weight, a uniform distribution of fat, satisfactory well-being. Functional disorders on the part of the autonomic nervous and cardiovascular systems in this form are rare, weakly expressed and unstable. This initial phase of obesity is in most cases treatable by diet. As obesity progresses, fatigue, irritability, thirst, dizziness, increased skin pigmentation and other symptoms appear – a transitional form. Further development of the disease, the emergence of many persistent symptoms and signs of secondary hypothalamic syndrome is considered as a complicated form of obesity. Secondary forms of obesity are those that accompany the primary pathological processes in various organs, they are divided into cerebral (with brain damage), hypothalamic (with damage to the nerve structures of the hypothalamus) and endocrine (with impaired endocrine glands). The development of mixed forms of the disease is based on primary and secondary causative factors. Rare forms of obesity include diseases caused by gross chromosomal defects.
Clinic of Obesity
The clinic of primary obesity is determined by its form. In a simple form, children complain of weakness, fatigue, sometimes thirst and excessive sweating. In some cases, increased irritability is noted, night fear or enuresis occurs . In the future, as the process progresses (transitional form), headache, dizziness, shortness of breath during physical exertion, abdominal pain, nausea, vomiting appear, children lag behind in school. There is an excess of body weight with an even distribution of fat. Somewhat later, in some primary school children, an abdominal body type is formed. Subsequently (complicated form), folliculitis and increased pigmentation of skin folds develop, its cyanotic hue on the buttocks and hips due to the expansion of small vessels and stagnation of venous blood, as well as bright red and purple stretch bands ( striae ) on the chest, abdomen, and hips. There are paresthesias, changes in skin temperature, chilliness of the limbs. Sometimes there is hair loss due to insufficient nutrition of the hair sacs and violation of the neuro-endocrine regulation of trophic processes (A.I. Kliorin , 1978). With II degree of obesity, increased deposition of subcutaneous fat on the body occurs, with III degree in girls, fat deposition is noted more on the limbs, in boys – on the body. By puberty, fat deposition in girls predominates in the pelvic area, in boys – on the trunk. Due to poor ventilation of the lungs and a decrease in immunological reactivity, a tendency to atelectasis, diseases of the respiratory system often occurs. The cardiovascular system is often affected. Fatigue occurs, shortness of breath, pain in the heart, often – bradycardia, increased blood pressure. Due to damage to the muscles of the heart, muffled tones, systolic murmur are noted, quite often – a violation of the function of automatism and conduction of the heart: arrhythmias, sinus bradycardia, less often – extrasysgolia , changes in the atrioventricular and inside ventricular conduction. As obesity develops in most patients, acid-forming increases and the evacuation function of the stomach slows down, which leads to the development of dyspeptic syndrome. Often there is an increase in the liver with a violation of its functions, an increase in the exocrine activity of the pancreas and a disorder of water-electrolyte metabolism due to hypersecretion of the hormones regulating it. Some patients have a tendency to develop chronic tonsillitis, cholecystitis, cholangitis, gallstone disease, and inflammatory processes of the urinary system. There is a slowdown in sexual development. Children are drowsy, they are often worried about headaches, sometimes weakening of memory quickly progresses, neuralgia, neuritis and other signs of damage to the nervous system occur. In children with obesity more often than in healthy children, allergy manifestations and signs of low immunological reactivity are recorded. In blood tests, there is an increased content of hemoglobin and red blood cells, which is associated with an adaptive reaction to hypoxia, often hypercholesterolemia , an increase in the level of B-lipoproteins and free fatty acids. In the urine, protein and single red blood cells are sometimes found, resulting from congestion in the kidneys. The clinic of secondary obesity is determined by the form of the primary disease.