Grade 2 obesity: in women, men and children

It is probably very difficult to find a person who would not know that lack of physical activity, reinforced by errors in nutrition, quite quickly corrects the figure in the direction of increasing body weight. If this situation persists for a long time, then in a few months we can already talk about obesity, when extra pounds are outwardly manifested in the form of noticeable fullness. And if with mild obesity fullness is perceived as some kind of nice constitutional feature, then obesity of the 2nd degree is already striking with obvious signs of excess weight, distorting the attractive forms for the eye.

But obesity is called that way because this pathology is associated with excessive accumulation of fatty tissue in the body, due to which weight increases and a person's appearance changes. The word "pathology" is used here for a reason. The whole point is that obesity, unlike slight fullness, is already a medical diagnosis, since it entails not only external changes, but also disruptions in the functioning of internal organs.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Epidemiology

As for obesity, the statistics are far from encouraging. Not so long ago, obesity was considered a "privilege" of developed countries. The United States of America occupied 1st place in the fat people rating, England and Greece - 2nd, Germany - 3rd, Russia - 4th, etc. In recent years, the situation has changed, and underdeveloped countries such as Qatar, the Cook Islands, Palau, Nauru, Kuwait, UAE have come to the fore, pushing the United States to 8th place (34% of the adult population of the country, according to statistics from 2014, are overweight and 27% suffer from obesity of varying degrees).

And the issue here is no longer about the standard of living, but about food preferences associated with the directions of economic development of countries (for example, selling quality goods abroad and consuming products with low nutritional value), national traditions, etc.

The figures that show that the number of obese patients is growing noticeably every year are also terrifying. Over the past 35 years, this figure has almost doubled. On average, about 13% of the entire adult population of the planet suffers from obesity, and about 40% will have it in the near future. And this is despite the fact that the average life expectancy of such people is shorter by about 10 years, and the incidence of diabetes and heart disease is significantly higher than in people with normal weight.

The World Health Organization forecast is even less comforting. In 2025, it is expected that 17 percent of the world's population will suffer from obesity, rather than 13 percent. Europe will be especially affected in this regard, with the following figures expected by 2030: about 89 percent of the male and 85 percent of the female population will be overweight.

The “childhood” obesity statistics are not much more attractive. In the US, a fifth of children and a quarter of teenagers are overweight. Over the past 16 years, the number of obese children has practically doubled and continues to grow rapidly.

Ukraine is somewhere in the middle of the world obesity rankings. According to the latest data, about 26% of women and 16% of men suffer from excess weight. Moreover, obesity of the 2nd degree is considered the most common among the adult population of the country and the planet as a whole.

[ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ]

Causes grade 2 obesity

So, we have found out that obesity is not just external fullness, but a disease that negatively affects the general well-being of a person and requires certain treatment. At the same time, in order to prescribe effective treatment, it is extremely important to know the reasons that led to the development of obesity, especially if we are talking not about the onset of the disease, but about stage 2 pathology.

I think that the question of what can lead to obesity of the 2nd degree worries not only doctors. Many people know about the influence of overeating and food rich in carbohydrates and fats on the growth of fat deposits. Recently, the media has been paying special attention to this issue. We are told about proper nutrition from the pages of the Internet, offering various ways to combat excess weight.

And there is nothing surprising about this. In our age of computer technology, physical labor is increasingly being replaced by intellectual labor, and people's work is being done by machines. But having freed ourselves from physical labor, which requires a lot of energy, we have not changed our diet, still giving preference to sweet, floury and fatty dishes, and in significant quantities. And where does the energy obtained from food go?

But if eating high-calorie foods and overeating must necessarily lead to weight gain, then a fair question arises: why can some eat hearty and large amounts without gaining weight, while others just need to relax on holidays, and this will immediately be reflected in their figure?

Yes, poor nutrition and its relationship with weight gain have their own individual manifestations in different people. Some people have a family history of being thin, and it is often very difficult for such a person to gain weight. And others have to fight excess weight all their lives, because everyone in their family is plump. This means that in order for poor nutrition to provoke weight gain, certain factors are also needed that contribute to the development of obesity under favorable conditions, which are overeating and a passion for high-calorie foods.

[ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ]

Risk factors

Risk factors for the development of obesity include:

• lack of physical activity,
• hereditary predisposition, which is sometimes also called a tendency to be overweight,
• some pathologies, hormonal disorders that can cause weight gain (endocrine diseases, complications after traumatic brain injury, consequences of intoxication and negative impact of infectious factors, etc.),
• stress (strangely enough, by eating sweets to relieve stress, even those who at first glance are not at all prone to being overweight often gain weight),
• use of psychotropic drugs,
• lack of sleep,
• situations when a person remains bedridden for a long time,
• some viruses (adrenovirus-36 is one of the causative agents of respiratory diseases and inflammatory eye diseases, capable of transforming adipose tissue stem cells directly into fat cells).

The causes of grade 2 obesity in children and adolescents can also be incorrect introduction of complementary foods in infancy, incorrect dosage of milk formulas, congenital deficiency of thyroid hormones, iodine deficiency in the body, and hereditary factors.

Obesity of the 2nd degree cannot occur on its own. This pathology is the result of an irresponsible attitude towards one's health, because it was preceded by slight obesity and obesity of the 1st degree, which also required corrective measures. In this regard, an indirect cause of the development of obesity of the 2nd degree can be considered a permissive attitude and failure to take the necessary preventive and treatment measures at the initial stage of the pathological process.

[ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ]

Pathogenesis

Factors predisposing to the development of the disease, including stage 2 obesity, can cause weight gain only if there is a provoking factor. That is why consuming a large number of calories with a lack of physical activity is considered the main cause of obesity. The energy itself, which is converted into fat, does not arise from air and water, which means that it enters the body with other products that are different in composition and caloric content.

Energy is necessary for the human body to carry out various life processes and perform work. Another question is, what is the balance of energy entering and expended by the body? If less energy is expended than is received with food, its surplus, of course, remains in the body in the form of fat, accumulating in fat cells (adipocytes) and causing their proliferation (hyperplasia). An increase in the amount of subcutaneous and internal fat leads to an increase in body weight and corresponding changes in its shape.

It would seem that harmless snacks while working at the computer would hardly affect the figure, but no, they stubbornly settle in the form of fat deposits on various parts of the body. And the reason is that for snacks, people most often choose flour and sweet products that provide quick saturation, rather than vegetables and fruits with modest calorie content.

Buns and pies are also preferred by students, which is the main reason for the development of obesity at a young age.

Weight gain is promoted not only by sweet, fatty and floury dishes, but also by spicy ones, richly seasoned with spices, causing an excessive appetite and leading to overeating. The same effect is observed when drinking alcohol and sweet carbonated drinks.

Our body is a complex system that controls all processes necessary for life. The following take part in the regulation of fat metabolism (accumulation and consumption of fats):

• the brain (in particular its cortex and subcortical areas),
• nervous system (both the sympathetic nervous system, which works under load, and the parasympathetic nervous system, which functions at rest, participate in this process),
• endocrine organs.

The pathogenesis of obesity is based on malfunctions in the cerebral cortex and the subcortical organ called the hypothalamus. They are responsible for regulating appetite and maintaining an optimal balance between supplied and expended energy. Pathologies of appetite regulation centers can be both congenital and acquired, including those that arose under the influence of inflammatory processes and brain injuries.

An important role in the pathogenesis of obesity as a metabolic pathology is also given to the endocrine glands (pituitary gland, adrenal glands, thyroid gland, islet apparatus of the pancreas, sex glands). Disruptions in the functioning of these organs can lead to excessive accumulation of fat, inhibition of its mobilization and oxidation in the liver. This happens with increased activity of the "pituitary gland - adrenal cortex - pancreas" system, decreased production of growth hormone in the anterior pituitary gland, insufficient production of thyroid hormones by the thyroid gland, decreased production of adrenaline, etc.

[ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ]

Symptoms grade 2 obesity

It is simply impossible not to notice a person with stage 2 obesity. After all, this is no longer a slight plumpness, which even decorates some people. In addition, extra pounds leave their mark on physical activity and work, not to mention well-being.

The first signs of obesity are noticeable fullness (fat deposits can be distributed evenly or concentrated in certain places, most often in the waist, abdomen and hips) and shortness of breath.

The appearance of shortness of breath even with minor physical exertion indicates that excess fat, deposited in the subcutaneous layer and on the internal organs, complicates the work of the cardiovascular and respiratory systems, which allows us to consider obesity as a disease.

As for body weight, with obesity of the 2nd degree, there is an excess of the norm by 30-40%, which looks far from attractive.

Among other symptoms of stage 2 obesity, one can highlight the following manifestations:

• increased sweating,
• strong and rapid heartbeat, especially with minor or major exertion,
• general weakness despite the fact that a person leads a normal lifestyle, eats and sleeps normally,
• swelling of the extremities or just the fingers, especially in hot weather.

All these symptoms are not specific, including shortness of breath and weight gain, and may indicate various pathologies, although taken together they represent symptoms of moderate obesity. But to what extent this corresponds to reality can only be determined by a professional doctor using differential diagnostic methods.

It is possible to determine whether a person is obese or just plump by external signs, but certain difficulties arise with determining the degree of obesity. The thing is that each person is individual, has a unique appearance. This means that the ratio of weight and height is different for everyone. Moreover, it must be considered taking into account age and gender.

For example, 90 kilograms at a height of 180 cm will look ideal for a man, but a woman will seem large. The same 90 kg for a person with a height of 160 cm will indicate developing obesity, while a weight of 60 kg will be ideal. Again, for a teenage girl of 11-12 years old, even these 60 kg will seem excessive, not to mention boys, who ideally should have no more than 49 kg at a height of 158 cm.

So how do you know that your weight is almost half off the ideal? Scales and special tables come to the rescue, which can help you determine the ideal weight that corresponds to your age, height, and constitutional type.

In principle, the average ideal weight for women can be calculated using the formula: height (in centimeters) minus 100. This formula is best suited for middle-aged women (40-50 years). Young women should subtract 10 percent from the result, and older women, on the contrary, should add about 5-6%.

With men, teenagers and children the situation is more complicated, but there are various tables that help calculate the ideal weight for these categories of the population, taking into account age and constitutional characteristics.

Obesity in different population groups

Childhood obesity is a problem that modern doctors face almost every day. The positive aspects of intellectual and economic progress cannot be denied, but its impact on our future sometimes turns out to be negative when it comes to the incorrect use of the useful achievements of the human mind.

Thus, obesity of the 2nd degree in children aged 1-1.5 years most often develops due to the fault of parents who feed the baby with milk formulas without taking into account their nutritional value and impact on weight. The second reason for excess weight in infants is the incorrect introduction of complementary foods.

The onset of obesity in children under 12 months is considered to be an excess of body weight by more than 15%.

The next peak of obesity development is at the age of 10-15. Teenagers can sit for days with a bun or chips at the computer, preferring it to active games and sports. This leads to excess weight and other health problems.

Hormonal changes often remind you of themselves by increasing your appetite. If you give in to your irrepressible desire to eat something tasty and high-calorie during this period, the consequences will not take long to appear and will soon manifest themselves in the form of curvy shapes.

There is, of course, a certain percentage of children and adolescents whose obesity is associated with congenital or acquired thyroid dysfunction or hereditary predisposition. So, if both parents in a family are prone to obesity, the same problem in 80% of cases is also present in the child, if one of the parents – the probability of developing obesity fluctuates within 38-50%.

Stage 2 obesity in women is most often the result of banal overeating, passion for sweets and pastries, and low physical activity. The second cause of obesity in women is hormonal imbalances (increased appetite during menstruation, weakened control of satiety during menopause, etc.). And again, the genetic factor plays an important role. If there is a predisposition to obesity, weight control should be constant.

There is a special period in a woman's life when active weight gain is considered the norm rather than an abnormality. We are talking about the time during which a new life grows and develops inside the female body, which means that the expectant mother has to eat for two. And here it is already important what products a woman chooses to satisfy her hunger: vegetables and fruits or buns, sweets and heavy hearty dishes, which lead directly to the development of obesity of the 1st and then 2nd degree in pregnant women.

During pregnancy, a weight gain of 8-12 kg (at the end of pregnancy) is considered normal. Exceeding the initial body weight by more than 12 kg often leads to certain health problems and problems with bearing the baby.

Obesity of the 2nd degree in men is observed a little less frequently than in women, because the male body is not as prone to accumulation as the female one. Nevertheless, the consumption of high-calorie food and a sedentary lifestyle make themselves known by the appearance of excess weight in this case too. And passion for alcoholic drinks, and especially beer, only aggravates the situation, because with strong drinks you also need a good snack.

Risk factors for the development of stage 2 obesity in men include the same poor heredity, exposure to stress, trauma and endocrine diseases.

Forms

Since obesity can be caused by various, unrelated reasons and requires different approaches to treatment, it is usually divided into the following types:

• primary obesity, which is associated with an unhealthy lifestyle and poor nutrition,
• secondary obesity, caused by pathologies in which the regulation of appetite and metabolism is disrupted.

Based on this division, the following types of obesity can be distinguished:

• exogenous-constitutional (aka alimentary or primary) obesity, which, depending on the stage and neglect of the process, can be of 1, 2, 3 and 4 degrees. The cause of the development of this type of pathology is the abuse of high-calorie food against the background of low physical activity. It is most often formed against the background of a hereditary predisposition to excess weight.

Alimentary obesity is characterized by frequent overeating, gradual weight gain, more or less even distribution of subcutaneous fat (in women, it is sometimes slightly more in the abdomen and hips), and the absence of endocrine disorders.

• Hypothalamic obesity is already associated with pathologies of the central nervous system, in which the hypothalamus is predominantly affected (tumors, injuries, exposure to infectious factors). It is characterized by:

• rapid weight gain,
• localization of fat deposits in the abdominal area (such deposits are sometimes called an apron), hips and buttocks,
• dry skin,
• the appearance of stretch marks,
• headaches and sleep disturbances indicating brain disease,
• vegetative disorders such as high blood pressure, hyperhidrosis, etc.

• Endocrine (morbid) obesity. It can be diagnosed against the background of some pathologies of the endocrine system (hypothyroidism, diabetes mellitus, etc.). The symptoms of such obesity include general symptoms and signs of the pathology that caused rapid weight gain, in the form of deterioration in health and hormonal disorders. Often, the patient exhibits signs of the opposite sex, for example, excessive hair growth on the body in women or female curves on a man's figure.

Hypothalamic and endocrine obesity of 1, 2, 3 and 4 degrees belong to the secondary type of weight pathology.

Classification by the location of fatty tissues implies the division of obesity into the following types:

• Gynoid obesity (female type) with localization of fat deposits in the buttocks and thighs.
• Abdominal obesity (male type) is the accumulation of fatty tissue in the abdomen.
• Mixed obesity with more or less uniform distribution of adipose tissue.
• Cushingoid obesity, associated with dysfunction of the pituitary gland and adrenal glands. In this case, fat deposits are localized throughout the body except for the arms and legs.
• Visceral obesity. The most dangerous type of obesity, in which fatty tissue entangles internal organs (heart, liver, etc.), and there may be no external signs of obesity.

[ 32 ], [ 33 ], [ 34 ], [ 35 ]

Complications and consequences

No disturbance in our body goes without consequences, including the accumulation of excess weight. If only it were all about psychological discomfort associated with teasing in childhood and condemnation from others in adulthood. In fact, the problem is much more complex, especially considering the fact that obesity of the 2nd degree is a significant excess of weight, which is a great burden on the body.

It would seem that a simple excess of fat, but it causes many unpleasant and even dangerous consequences and complications. Their list can be called more than impressive. So, obesity of the 2nd degree can lead to the development of:

• Diseases of the gastrointestinal tract, in particular pancreatitis. In this case, the disease is more severe, often with complications.
• Gallbladder diseases, in particular cholelithiasis. This applies more to women, since the process of stone formation in them is highly dependent on body weight. In men, such a dependence is observed much less often.
• Hemorrhoids, which is especially dangerous in the presence of constipation.
• Fatty hepatosis (in the case of visceral obesity) with impaired liver function.
• Hypertension. Increased blood pressure in obese patients is almost 3 times more common than in people with normal weight. In patients with stage 2 obesity, blood pressure will be 20-25 mm Hg higher than normal.
• Diabetes mellitus, developing according to type 2. As in the case of arterial hypertension, there is an almost threefold increase in the number of patients. Patients with abdominal obesity are most susceptible to diabetes.
• Heart ischemia (CHD) and myocardial infarction. The risk of developing pathology is again higher with abdominal or visceral obesity. With increasing body weight, the number of fatal outcomes also increases.
• Varicose veins and blood clots in the vessels.
• Pathologies of the respiratory system: difficulty breathing, development of hypoventilation syndrome, sleep apnea.
• Diseases of the musculoskeletal system, such as gout, osteoarthritis, flat feet, scoliosis (in children), etc. The development of such diseases is associated with too much stress on the joints and muscles of the legs and back.
• Problems in the sexual and reproductive sphere, including impotence and infertility.

Obesity of the 2nd degree is especially dangerous during pregnancy. In this case, there is a high risk of complications (about 75-80%) in the early stages, as well as anemia and respiratory diseases in the late stages of pregnancy.

In addition, shortness of breath in obesity is fraught with the fact that the fetus will experience a lack of oxygen while in the womb. Obesity is also dangerous due to the threat of miscarriage, weak labor, and the development of postpartum complications. It is not for nothing that such women are under special control of doctors.

Obesity of the 2nd degree not only brings certain psychological and physical discomfort, but also limits physical activity, which leads to further weight gain, development of subsequent stages of the disease and deterioration of health. That is why it is so important to stop the pathological process as early as possible, before you have to deal with its consequences.

[ 36 ], [ 37 ], [ 38 ]

Diagnostics grade 2 obesity

Despite the fact that excess weight in the vast majority of cases has pronounced external manifestations, a doctor cannot formulate an accurate diagnosis based only on a simple examination of the patient. Obesity diagnostics is a complex and multifaceted process that pursues several goals:

• establish the very fact of obesity, differentiating it from excess body weight,
• determine the degree of obesity (the diagnosis should be specific, for example, “obesity grade 2”),
• determine the type and kind of obesity,
• to establish the reasons that led to the pathological increase in weight indicators,
• identify other pathological changes in the body: congenital anomalies, consequences of injuries, diseases of internal organs, which can be both the cause and the consequence of complications,
• identifying an effective approach to treating obesity.

The beginning of diagnostic studies is considered to be the collection of anamnesis, measurements and external examination of the patient. Obesity of the 2nd degree is very difficult to confuse with ordinary mild obesity, unless of course it is its visceral type, when fat deposits are localized on internal organs, almost without changing the external forms of a person. And yet the line between obesity of the 2nd degree and pathology of the 1st or 3rd degree is quite thin, so anthropometric studies are simply impossible to do without.

[ 39 ], [ 40 ], [ 41 ], [ 42 ], [ 43 ], [ 44 ]

Anthropometric studies

The leading study that allows determining the degree of obesity is considered to be the calculation of the body mass index (BMI). The formula for calculating BMI was developed by the Belgian statistician A. Quetelet in the late 60s of the 18th century. Nevertheless, doctors successfully use it to this day.

To calculate using Adolphe Quetelet's formula, you only need the person's weight in kilograms and height in meters. According to the formula, BMI can be calculated by dividing the patient's weight by his or her height squared:

BMI = m/h ², where m is weight (in kg), h is height (in m).

A body mass index of 18.5-24.9 is considered normal. If the patient's weight and height, or rather their ratio, are such that the BMI is within 35-39.9, which happens with moderate obesity, the diagnosis will be unambiguous - stage 2 obesity, in which the probability of developing concomitant pathologies is quite high. This means that further comprehensive examination of the patient will be required to identify or prevent these same pathologies.

So, we have found out that with obesity of the 2nd degree, the BMI exceeds the norm by approximately 25-50%. And this is a considerable indicator, there is something to think about. But this data alone is not enough to understand the cause of weight gain and its consequences. To determine the type of obesity by the location of fat deposits, the doctor will have to measure the circumference of the chest, waist and hips (OG, OT, OB), and also measure the thickness of the fat fold on the abdomen using a special device - a caliper.

[ 45 ], [ 46 ], [ 47 ], [ 48 ], [ 49 ], [ 50 ]

Collection of anamnesis and external examination

Taking anamnesis when diagnosing stage 2 obesity is not a waste of time, because in this way you can accidentally establish the cause of the disease even without additional research. Since stage 2 obesity is visible to the naked eye, there is no point in starting diagnostics with measurements to determine whether a person is obese or not.

It is wiser to begin the appointment with an examination of the patient's lifestyle and health status. Obese patients often do not want to admit their problem, so communication with them must be conducted very delicately. Trust is the first step to successful treatment, which, mind you, can last for more than one year.

First, it is necessary to find out when the patient's weight problem arose, whether it was in childhood or in adulthood, whether the weight gain can be associated with hormonal surges in the body. Clarify the patient's food preferences, daily routine, level of physical activity, susceptibility to stress.

A study of the patient's health status will help clarify the cause of obesity: whether there were nervous and infectious diseases, whether enhanced therapeutic nutrition was prescribed, what injuries there were, including those after which long-term immobilization was carried out, what drugs were used for treatment. Attention is also paid to the type of puberty (premature or delayed puberty can also provoke obesity).

Overweight patients do not like to talk about food, but the doctor still needs to find out:

• what food and in what quantities the patient consumes,
• how often does he eat,
• evening menu and dinner time,
• Do night meals take place?
• how often does the patient participate in events with feasts.

In a conversation with the patient, it is necessary to find out the patient's relationship with his parents and family traditions regarding food intake and physical activity, whether there is a tendency towards obesity in relatives, whether there were conflict situations at work and at home, whether the patient tried to lose weight in the past, how many times and with what result.

An important role in stage 2 obesity is also given to the external examination of the patient. Some information about the health condition and hormonal status of the patient can be provided by examining the patient's skin: skin purity, color, type and intensity of hair, presence of stretch marks, edema, manifestations of hemorrhagic diathesis. Then the boundaries of the heart, liver and lungs are determined, which allows identifying such concomitant pathologies as cardiopulmonary insufficiency or obstructive bronchitis.

During the examination, the doctor determines the mobility of the joints of the lower extremities and spine, identifies whether there are varicose veins and whether there are signs of venous insufficiency.

[ 51 ], [ 52 ], [ 53 ], [ 54 ]

Laboratory research

During diagnostic procedures to determine the type and cause of stage 2 obesity, multiple tests are performed, which allow you to see the problem from the inside. It is clear that a general blood test is not enough, because it is more important to identify the consequences of obesity, such as anemia or leukocytosis.

More information is provided by a biochemical blood test, especially sugar levels (elevated levels indicate the development of diabetes) and cholesterol (determines the likelihood of developing atherosclerosis). Sometimes a more detailed study of such indicators as bilirubin, enzymes, transaminases, etc. is required.

An analysis of hormones produced by the thyroid gland, adrenal glands, pituitary gland, and sex glands will help determine the cause of obesity and the characteristics of the disease.

To determine problems with the kidneys, a general urine analysis and special tests may be prescribed.

To establish a hereditary predisposition to obesity, a molecular genetic study is carried out based on venous blood (or a piece of skin) of the patient and his relatives.

Instrumental diagnostics

Instrumental studies in the diagnosis of stage 2 obesity are used as auxiliary methods that help to clarify the patient's health condition and determine the impact of excess weight on the functioning of his internal organs. They are especially important if there is a visceral type of obesity, which is rightfully considered the most dangerous.

The most informative methods of instrumental diagnostics in this situation are considered to be:

• Computer and magnetic resonance imaging (CT and MRI). They help to assess with great accuracy the thickness of subcutaneous and the volume of visceral (internal) fat, as well as to identify some pathologies of internal organs.
• Ultrasound examination (US). Also helps to determine the thickness of subcutaneous fat, plus records changes in the structure of internal organs, which are a dangerous consequence of obesity of the 2nd degree.
• Densitometry. The absorption of X-ray energy by different tissues occurs differently. This is the basis of the above-mentioned method, which allows you to determine the volume of fat reserves. With its help, you can also identify such a dangerous bone disease as osteoporosis, which is not such a rare complication of obesity.
• Impedancemetry. Another specific method for determining the amount of adipose tissue with the highest bioelectrical resistance.

A pure X-ray examination for obesity is only performed if there is a suspicion of pathologies of the digestive organs.

Differential diagnosis

External examination of the patient, collection of anamnesis, calculation of BMI, laboratory and instrumental studies give the endocrinologist a lot of ground for reflection. After all, he needs not only to determine the degree and classification of obesity, but also to identify concomitant pathologies, in which stage 2 obesity can be only one of the symptoms. And if with primary (alimentary) obesity everything is more or less clear, then secondary obesity requires a more complete study.

The goal of differential diagnostics is precisely these pathologies that have caused secondary obesity, without the treatment of which the fight against excess weight will not be successful.

So, obesity can be one of the symptoms of the following pathological conditions:

• Intracranial tumors.
• Tuberculous meningitis.
• Laurence-Moon-Biedl-Bardet syndrome, which is a hereditary pathology with multiple symptoms.
• Gelineau syndrome in women, which is characterized by increased appetite and short-term comatose states.
• Babinski-Frohlich disease in boys. Accompanied by obesity or type 1 diabetes, growth and developmental disorders of the genitals.
• Morgagni-Stewart-Morel syndrome. It is characterized by high weight, the appearance of masculine features and thickening of the internal plate of the frontal bone in women after 40 years of age.
• Itsenko-Cushing syndrome. Obesity (usually visceral) is observed against the background of increased hair growth on the body, hypertension, osteoporosis, etc.
• Stein-Leventhal syndrome. Symptoms: large amounts of adipose tissue, dysmenorrhea, uterine developmental disorders and, as a result, infertility, headaches and abdominal pain, the appearance of male features (the chest is quite developed).
• Martin-Albright syndrome. Diagnosed in childhood and accompanied by mental retardation.
• A secreting insulinoma characterized by hunger intolerance, mental disorders and elevated insulin levels.
• Sheehan's syndrome. Symptoms: excess weight, lack of lactation and menstruation after childbirth.
• De Toni syndrome, in which obesity is combined with physical and mental retardation, kidney disease, diabetes, and osteoporosis.
• Diabetes mellitus. Obesity against the background of high blood sugar.

And every year the list of such pathologies leading to secondary obesity of the 2nd degree becomes longer. This means that statistics will record an increase in obesity not only due to overeating and low physical activity, but also due to health pathologies affecting a person’s weight.

Treatment grade 2 obesity

Obesity is a disease that has not one, but several treatment options: multiple diets, various sets of physical exercises (LFK), physiotherapy procedures, massage, drug therapy, hypnosis and psychotherapy, surgical treatment. All these methods of combating excess weight are applicable to stage 2 obesity, but in each specific case, an individual set of measures is prescribed.

Yes, it is a complex, not individual measures. Many people know how difficult it is to get rid of even a couple of extra kilos, and here we are talking about dozens. It is unlikely that you will be able to remove such a quantity of fat with just a diet, perhaps in a few years. And the effectiveness of various diets is always supported by physical activity.

Let's not sin against the truth, but diets and an active lifestyle in combination with sports activities do not always give the necessary result for obesity of the 2nd degree. Sometimes weight loss is so slow that you have to resort to the help of medications and proven dietary supplements.

Forecast

The prognosis for stage 2 obesity is generally positive. Everything depends on the patient's desire and aspiration to return to normal forms. It is worth noting that stage 2 obesity is not a contraindication to work and military service, and there this problem can be solved by daily exercise and normalizing the diet.

[ 55 ], [ 56 ], [ 57 ]