Obesity has long been not only a social problem - it is, first of all, a disease characterized by impaired metabolic processes in the body, and carrying a certain risk to health. This is especially true for men whose overweight causes adverse health effects to a much greater degree than women.
Types of Obesity by Origin
1. Primary (alimentary-constitutional) - due to improper lifestyle (overeating, lack of physical activity).
2. Secondary (symptomatic) - due to various disorders in the body. There are 3 types of secondary obesity.
- brain tumors;
- infectious diseases;
- against the background of mental illness.
- hypothyroid (obesity is caused by a pathological decrease in thyroid hormones of the thyroid gland );
- diseases of the hypothalamic-pituitary system;
- adrenal gland diseases.
Iatrogenic obesity (due to medication).
Types of obesity by localization of adipose tissue
Android obesity (male type of obesity) - the accumulation of fat deposits in the upper body. This localization of fat is more typical for men and is manifested by fat deposits on the face, axillary areas, chest, abdomen, and is characterized by the "apple" form (Fig. 1).
Abdominal obesity is a form of android obesity and the most common form of obesity in men. Manifested by the deposition of fatty tissue in the abdominal cavity or, as often can be heard, "beer" belly. There are subcutaneous and visceral type of abdominal obesity in men. The latter form is the most dangerous, since fat is located in the immediate vicinity of the abdominal organs and affects their performance.
Ginoid obesity (female type of obesity) - accumulation of fat deposits in the thighs, buttocks, lower abdomen, which gives the body a pear-shaped shape (Fig. 1). The manifestation of this type of obesity in men indicates endocrine diseases ( hypogonadism , hyperestrogenemia, etc.).
Mixed obesity - is characterized by a relatively uniform distribution of adipose tissue throughout the body.
Fig. 1 - Types of obesity: ginoid (female type), android (male type)
Causes of obesity in men
The most common causes of male obesity are:
- Binge eating;
- Hypodynamia - lack of exercise;
- Reducing the level of androgens in the blood, including age-related androgen deficiency ;
- Endocrine diseases;
- Not endocrine pathologies (intestinal, pancreas, liver diseases);
- Genetic factor.
What is dangerous obesity in men?
The most negative consequence of male obesity, provoking further complications, is a decrease in testosterone levels. In adipose tissue, androgens are converted into estrogens opposite to them in their properties - female sex hormones. A clear link was established between the level of free testosterone and the amount of visceral (intra-abdominal) fat in men. Thus, it can be argued that the innocent male stomach is a kind of factory for the conversion of testosterone into estrogens, which in turn inhibit the synthesis of testosterone and provoke fat deposition. Based on all this, you can build the following logical chain with a closed circle:
Adipose tissue → the conversion of testosterone to estrogen → a decrease in testosterone → an increase in the level of estrogen → the deposition of adipose tissue.
In addition, the hormone leptin is produced in adipose tissue, which has an inhibitory effect on both testosterone synthesis in Leydig cells and LH synthesis (see on the role of LH in men ), thus forming a new closed chain:
Adipose tissue → leptin synthesis → decrease in testosterone → adipose tissue deposition.
In addition, obesity can be accompanied and cause:
- insulin resistance (diabetes);
- diseases of the cardiovascular system;
- erectile dysfunction;
- lipid metabolism;
- metabolic syndrome ;
- gallbladder disease;
- joint disease (arthritis, osteoarthritis);
- drowning of the penis in adipose tissue.
Along with medical complications, obesity often provokes the development of psychological complexes. Low self-esteem, reduced quality of life, depressive states and social problems can be the result of being overweight.
Diagnosis and obesity
One of the simplest diagnostic methods is to measure the waist width.
Another common method is the determination of body mass index (BMI), the value of which indicates the degree of obesity (Table 1). To know the degree of obesity of the patient is necessary to select further tactics of treatment.
Table 1 - Classification of obesity by BMI, WHO (1997)
|BMI, kg / m2||Degree of obesity||Risk of associated complications|
|18.5-25||Normal body weight||Missing|
|30-34.9||Obesity grade 1||Tall|
|35-39.9||Obesity grade 2||Very tall|
|> 40||Obesity grade 3 (morbid)||Extremely high|
Further studies are aimed at eliminating secondary forms of obesity and identifying diseases associated with obesity and include:
- Anamnesis (identification of the duration of obesity, associated diseases, diet and its caloric content, medication, patient complaints);
- Physical examination (measurement of blood pressure, assessment of the state of the respiratory system, determination of the size of the liver, the presence of gynecomastia );
- Laboratory tests (total cholesterol, HDL, LDL, triglycerides, glucose, ALT, AST, uric acid);
- Instrumental examination (ultrasound, ECG, MRI / CT).
Male obesity treatment
The main method of treating obesity is lifestyle correction. Therapy is aimed at gradually reducing the daily caloric intake and increasing calorie expenditure through physical activity.
In the diet it is necessary to gradually eliminate or severely limit high-calorie foods (sugar, pastries, confectionery, sweets, fatty foods, fast food), and give preference to products of natural origin with a large amount of fiber, vitamins and minerals (vegetables, fruits, cereals, nuts, greens).
- Lose weight slowly. The optimal weight loss rate is 0.5-1 kg per week.
- Recommended split meals: 3 main and two additional meals;
- The last meal should be no earlier than 3-4 hours before the sleep of medium or low calorie content;
- Drinking regime should consist of at least 2 liters of plain water (see water balance in the body of a man ). Gradually abandon other types of liquids (juices, sparkling water, coffee, tea) and switch only to water (see rejection of coffee and tea - personal experience );
- Eat slowly, chewing food thoroughly;
- If you feel hungry, drink a glass of water and wait a couple of minutes - if the feeling of hunger has not passed, eat something low-calorie, such as an apple, if that did not help, then have a snack;
- Do not overdo it with meat products - eat them once a day. Have vegetarian days 3-4 times a week.
However, it is necessary to increase daily physical activity. It is not necessary to take drastic measures at the initial stage of dropping weights - these can be long walks (for example, go 1-2 stops before yours and walk on foot if using public transport), morning exercises, jogging. If you feel constraints when working in public places, you can take care of buying or renting a cardio trainer for the house .
Hormone Therapy for Obesity
The situation when the main recommendations for weight loss do not give a significant effect may be associated with a lack of androgens in the blood of a man.
As mentioned earlier, overweight provokes a decrease in sex hormones, one of the functions of which is to control body weight. On the other hand, low testosterone levels can cause weight loss. What was the primary reason is not always important for the choice of treatment - in any case, a low level of androgen requires correction.
In men with obesity and deficiency of sex hormones, the prescription of testosterone drugs, along with the adjustment of lifestyle, showed normalization of weight and improvement of other health indicators, compared with the group of men who did not receive therapy for androgen deficiency.
Drugs are used for the ineffectiveness of non-pharmacological treatment for at least 3 months. Shown in patients with a BMI of more than 30, or with a smaller BMI, but concomitant diseases.
Preparations for the treatment of obesity:
- Orlistat (1 capsule with meals, not more than 3 times per day);
- Sibutramine (1 capsule in the morning);
- Selective serotonin reuptake inhibitors (fluoxetine, sertraline);
- Drugs that reduce the level of glucose in the blood plasma (metformin, pramlintide, exenatide).
Drugs and dosage are prescribed only by a doctor individually.
It is indicated in patients with morbid obesity (BMI> 40) with the ineffectiveness of conservative treatment.
Today the following operations are most effective:
- Gastric bypass;
- Gastric banding;
- Sleeve gastroplasty.