Obesity has long been not only a social problem - it is, first of all, a disease characterized by metabolic disorders in the body, and carries a certain risk to health. This is especially true for men whose excess weight causes adverse health effects to a much greater extent than in 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 backdrop of mental illness.
- hypothyroid (obesity caused by a pathological decrease in thyroid hormones of the thyroid gland );
- diseases of the hypothalamic-pituitary system;
- adrenal disease.
Iatrogenic obesity (due to medication).
Types of obesity by localization of adipose tissue
Android obesity (male type of obesity) is an accumulation of body fat in the upper body. This localization of fat is more typical for men and is manifested by fatty deposits on the face, axillary hollows, chest, stomach, and is characterized by an “apple” shape (Fig. 1).
Abdominal obesity is a form of android obesity and the most common form of obesity in men. It is manifested by the deposition of adipose tissue in the abdominal cavity or, as you can often hear, a "beer" belly. There are subcutaneous and visceral types of abdominal obesity in men. The latter form is the most dangerous, because fat is in close proximity to the abdominal organs and affects their performance.
Gynoid obesity (female type of obesity) is an 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 - characterized by a relatively uniform distribution of adipose tissue throughout the body.
Fig. 1 - Types of obesity: gynoid (female type), android (male type)
Causes of Obesity in Men
The most common causes of male obesity are:
- Binge eating;
- Hypodynamia - lack of exercise;
- Decreased levels of androgens in the blood, including age-related androgen deficiency ;
- Endocrine diseases;
- Nonendocrine pathologies (diseases of the intestines, pancreas, liver);
- Genetic factor.
What is the danger of obesity in men?
The most negative consequence of male obesity, which provokes further complications, is a decrease in testosterone levels. In adipose tissue, androgens are converted into estrogens, the female sex hormones, which are opposite in their properties. A clear relationship was established between the level of free testosterone and the number of visceral (intra-abdominal) fat in men. Thus, it can be argued that the harmless “beer” belly in men is a kind of factory for converting testosterone into estrogens, which in turn inhibit testosterone synthesis and provoke fat deposition. Based on all this, you can build the following logical chain with a vicious circle:
Adipose tissue → conversion of testosterone to estrogen → decrease in testosterone levels → increase in estrogen levels → deposition of adipose tissue.
In addition, the hormone leptin is produced in adipose tissue, which has an inhibitory effect both on the synthesis of testosterone in Leydig cells and on LH synthesis (see the role of LH in men ), thus forming a new closed chain:
Adipose tissue → leptin synthesis → decrease testosterone levels → adipose tissue deposition.
In addition, obesity can be accompanied and cause:
- insulin resistance (diabetes mellitus);
- diseases of the cardiovascular system;
- erectile dysfunction;
- violation of lipid metabolism;
- metabolic syndrome ;
- gall bladder disease;
- joint disease (arthritis, osteoarthrosis);
- drowning of the penis in adipose tissue.
Along with medical complications, obesity often provokes the development of psychological complexes. Low self-esteem, a decrease in the quality of life, depressive states and social problems can be the result of overweight.
Diagnosis and degree of obesity
One simple diagnostic method is measuring the width of the waist.
Another common method is to determine body mass index (BMI), the value of which indicates the degree of obesity (table. 1). Know the degree of obesity of the patient is necessary to select further treatment tactics.
Table 1 - Classification of obesity according to BMI, WHO (1997)
|BMI, kg / m2||Obesity||Risk of concomitant complications|
|18.5-25||Normal body weight||Missing|
|30-34.9||Obesity 1 degree||Tall|
|35-39.9||Obesity 2 degrees||Very tall|
|> 40||Grade 3 obesity (morbid)||Extremely tall|
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, concomitant diseases, diet and its calorie intake, 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 studies (total cholesterol, HDL, LDL, triglycerides, glucose, ALT, AST, uric acid);
- Instrumental examination (ultrasound, ECG, MRI / CT).
Treatment of obesity in men
The main treatment for obesity remains 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 restrict high-calorie foods (sugar, pastries, confectionery, sweets, fatty foods, fast food), and give preference to products of natural origin with a large number 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.
- Partial nutrition is recommended: 3 main and two additional meals;
- The last meal should be no earlier than 3-4 hours before sleep, medium or low calories;
- The drinking regimen should consist of at least 2 liters of plain water (see water balance in a man’s body ). Gradually abandon other types of liquids (juices, soda, coffee, tea) and switch only to water (see refusing coffee and tea - personal experience );
- Eat slowly, chewing food thoroughly;
- If hunger comes up, drink a glass of water and wait a couple of minutes - if hunger does not go away, eat something low-calorie, like an apple, if this still doesn’t help, then have a snack;
- Do not overdo meat products - eat them once a day. Arrange 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 weight loss - it can be long walks (for example, get 1-2 stops before yours and walk if you use public transport), exercise in the morning, jogging. If you feel constrained when practicing in public places, you can take care of buying or renting a cardio machine for the home .
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, excess weight provokes a decrease in sex hormones, one of the functions of which is to control body weight. On the other hand, low testosterone can cause excess weight to be deposited. What was the primary reason is not always important for the choice of treatment - in any case, a low level of androgens requires correction.
In men with obesity and a deficiency of sex hormones, the administration of testosterone along with lifestyle adjustments showed normalization of weight and an improvement in other health indicators, compared with a group of men who did not have androgen deficiency therapy.
The drugs are used for non-drug treatment failure for at least 3 months. Indicated for patients with a BMI of more than 30, or with a lower BMI, but concomitant diseases.
Drugs for the treatment of obesity:
- Orlistat (1 capsule with meals, no more than 3 times a day);
- Sibutramine (1 capsule in the morning);
- Selective serotonin reuptake inhibitors (fluoxetine, sertraline);
- Drugs that reduce plasma glucose (metformin, pramlintide, exenatide).
Medications and dosage are prescribed only by a doctor individually.
It is indicated for patients with morbid obesity (BMI> 40) with the ineffectiveness of conservative treatment methods.
The following operations are most effective today:
- Gastric bypass surgery;
- Bandaging the stomach;
- Sleeve gastroplasty.