obesity

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synonym Obesity (Obesity) generally refers to obesity (disease name)

This entry is made by Compilation and application of scientific encyclopedia entries of "Science Popularization China" authentication.

Obesity is a group of common metabolic disorders. When the body eats more calories than it consumes, the excess calories are stored in the body in the form of fat, and the amount exceeds normal Physiological requirement When it reaches a certain value, it will become obesity. Normal male adults adipose tissue The weight accounts for 15%~18% of the body weight, and women account for 20%~25%. With age, Body fat The proportion increased accordingly. Assessment methods for obesity, including Anthropometry 、 Dual energy X-ray absorption method , ultrasound CT , infrared induction, etc. If there is no obvious cause Simple obesity Symptoms with clear causes are called Secondary obesity 。

TCM disease name

obesity

Foreign name

Obesity

Visiting department

Endocrinology Department, Nutrition Department

Common causes

Too much food, too little activity, fat metabolism disorder, heredity, etc

common symptom

Simple obesity increases slowly, and secondary obesity increases rapidly in a short time; Often combined with or aggravated hypertension, coronary heart disease, diabetes, hyperlipidemia, cholelithiasis, etc

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Xu Lingling | Deputy chief physician

Endocrine Department of Peking Union Medical College Hospital to examine

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essential information

TCM disease name: obesity
Foreign name: Obesity
Visiting department: Endocrinology Department, Nutrition Department

Common causes: Too much food, too little activity, fat metabolism disorder, heredity, etc
common symptom: Simple obesity increases slowly, and secondary obesity increases rapidly in a short time; Often combined with or aggravated hypertension, coronary heart disease, diabetes, hyperlipidemia, cholelithiasis, etc

pathogeny

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external cause with Overeating Too few activities. Caloric intake It is the material basis of obesity to consume more calories and increase fat synthesis. Endogenous fat Metabolic disorder And cause obesity.

1. Genetic factors

human beings Simple obesity The incidence of genetic background 。 Some studies believe that one of the parents is obese, and their children Obesity rate About 50%; Both parents are obese, and the obesity rate of their children has risen to 80%. Human obesity is generally considered to belong to Polygenic inheritance Heredity plays an easy role in its pathogenesis. The formation of obesity and life Behavior 、 Feeding behavior , hobbies, climate and society psychological factor Interaction.

2. Neuropsychiatric factors

Known to humans and a variety of animals hypothalamus There are two pairs of Nucleus nervi 。 One pair is ventro contralateral nucleus, also known as Satiety center ； The other pair is Ventrolateral nucleus , also known as hunger center. full Central excitation When they feel full, they refuse to eat, and when they are destroyed, their appetite increases greatly; When the hunger center is excited, appetite is strong, and when it is destroyed anorexia Refuse to eat. They regulate and restrict each other Physiological conditions It is in a state of dynamic balance, so that appetite can be adjusted within the normal range and maintain normal weight. When the hypothalamus changes, whether it is inflammatory sequela (e.g meningitis 、 encephalitis After), or trauma 、 tumour And others pathological change , if Ventromedial nucleus If it is destroyed, the ventrolateral nucleus is relatively hyperfunctional and gluttonous, causing obesity. On the contrary, when the ventrolateral nucleus is destroyed, the ventromedial nucleus is relatively hyperfunctional and anorexic, resulting in emaciation.

3. Endocrine factors

Many hormones such as thyroxine 、 insulin 、 Glucocorticoid Can adjust food intake, so it is speculated that these hormones may be involved in simple obesity Pathogenesis 。 Obese people insulin resistance Resulting in Hyperinsulinemia Hyperinsulinemia can insulin receptor Droop regulation And increase insulin resistance, thus forming a vicious circle. Increased insulin secretion can stimulate increased feeding and inhibit Lipolysis Therefore, it causes fat accumulation in the body. sex hormone It may play a role in the pathogenesis of simple obesity.

Eating too much can produce too much Gastrostatin （ GIP ）GIP stimulates islet beta cells to release insulin. In hypopituitarism, especially growth hormone Reduction, gonadotropism and Thyrotropin Gonad Hypothyroidism Special types of obesity may occur under the condition of Fat mobilization Reduction is related to the relative increase of synthesis. Clinically, obesity is mostly female, especially Menopause or Menopause Women or oral Female contraceptives It is easy to happen, prompt estrogen And fat Anabolism of Adrenocortical hyperfunction When, cortisol Increased secretion, promoting Gluconeogenesis The increase of blood sugar stimulates the increase of insulin secretion, thus increasing fat synthesis, while cortisol promotes fat decomposition.

four Brown adipose tissue abnormal

Brown adipose tissue It is a kind of adipose tissue that has been found in recent years White adipose tissue Correspondence. The distribution of brown adipose tissue is limited, only in the interscapular, neck and back armpit Ministry mediastinum And around the kidney, the tissue appearance is light brown, and the cell volume changes relatively small. White adipose tissue is a form of energy storage. The body uses excess energy Neutral fat The form is stored in the room. When the body needs energy, fat cells Use of hydrolysis of internal neutral fat. The volume of white adipocytes changed significantly with energy release and energy storage. Brown adipose tissue is a kind of Thermogenesis Organs, that is, when the body ingests or is stimulated by cold, the fat in brown fat cells burns, thus determining the energy metabolism Horizontal. The above two conditions are called feeding induced thermogenesis and cold induced thermogenesis respectively. Of course, the function of this special protein is affected by many factors. It can be seen that brown adipose tissue, a thermogenic tissue, is directly involved in the total regulation of internal heat, which dissipates excess heat in the body to the outside, and makes the energy metabolism of the body tend to balance.

5. Others

as environmental factor Etc.

clinical manifestation

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1. General performance

Simple obesity can be seen at any age. About 1/2 of adult obese people have a history of childhood obesity, generally showing a slow increase in weight (except for women after childbirth). If the weight increases rapidly in a short time, consider Secondary obesity 。 The fat distribution of men is mainly neck, trunk and head, while that of women is abdomen Lower abdomen , chest, breast and buttocks.

Obese people are characterized by short, round figure, narrow and wide face, double chin, thick and short neck, and backward leaning head pillow Department Skin fold Obvious thickening. Chest circle, Intercostal space Not obvious, double milk factor subcutaneous fat Thick and enlarged. When standing, the abdomen protrudes forward and is higher than the chest plane, Umbilical foramen Deep recesses. For those who are obviously obese for a short time, fine fragments can be seen on both sides of the lower abdomen, both thighs, the upper inner side of the upper arm, and the outer side of the buttocks Purple stripe Or white lines. Obese children External genitalia Buried in the subcutaneous fat of the perineum to make the penis appear small and short. The fingers and toes are thick and short, and the palms and fingers are thickened due to fat on the back of the hand Articular process The skin is sunken and the bone process is not obvious.

Light to moderate Primary Obesity may not have any conscious symptoms. People with severe obesity are more afraid of heat, and their activity ability is reduced. They may even have mild shortness of breath during activity, and snore during sleep. Available hypertension Disease, diabetes gout And other clinical manifestations.

2. Other performance

(1) Obesity and cardiovascular system Obesity complicated coronary heart disease The probability of hypertension is significantly higher than that of non obese people incidence rate Generally 5-10 times higher than non obese people, especially the waist Central obesity patients with thickness (male>90cm, female>85cm). Obesity can cause Cardiac hypertrophy , posterior wall and ventricular septum thickening, cardiac hypertrophy with Blood volume , Intracellular and Intercellular fluid Increase, ventricular end diastolic pressure Pulmonary artery pressure and Pulmonary capillary wedge pressure All increased, and some obese people Left ventricle Functional impairment and obese cardiomyopathy. The incidence of sudden death in obese patients is significantly higher, which may be related to myocardial hypertrophy Cardiac conduction system Of Fat infiltration Resulting Arrhythmia and Cardiac ischemia of Hypertension is very common in obese patients, and also focuses on nephropathy Main changes Risk factors , blood pressure will recover after weight loss.

(2) Obesity breathing Function change Obese patients vital capacity Lowering and pulmonary Compliance Descending can lead to multiple Pulmonary function Abnormality, such as obesity Hypoventilation Syndrome, clinically Lethargy , obesity, alveolar hypoventilation, often accompanied by obstructive sleep dyspnea 。 In severe cases, it may cause pulmonary heart syndrome. Because of the accumulation and thickening of adipose tissue in the abdominal cavity and chest wall, Diaphragm Increase and decrease vital capacity, pulmonary ventilation Poor, causing difficulty in breathing after activities, or even hypoxia Cyanosis 、 Hypercapnia , even appear Pulmonary hypertension cause heart failure , this kind of heart failure often Cardiotonic 、 diuretic Poor response. In addition, severe obesity can also cause Sleep asphyxia , sudden death is occasionally seen.

(3) The sugar of obesity Lipid metabolism Eating too much calories promotes triglyceride Synthesis and Catabolism , fat metabolism of obesity is more active, relatively Carbohydrate metabolism This metabolic change is involved in the formation of insulin resistance. The active fat metabolism of obesity is accompanied by metabolic disorder, which may occur Hypertriglyceridemia 、 Hypercholesterolemia and Low high-density lipoprotein cholesterol Etc. Disorder of glucose metabolism As Sugar tolerance And diabetes, especially Centrality Obese people. The incidence of diabetes more than doubled when the weight exceeded 20% of the normal range. When BMI >35 kg/m² The mortality rate was about 8 times of normal weight.

(4) Obesity and musculoskeletal diseases ① Arthritis: The most common is Osteoarthritis , caused by long-term load Articular cartilage The surface structure changes, Knee joint The most common lesions were ② Gout: about 10% of obese patients have hyperuricemia , gout is easy to occur. ③ osteoporosis : It was previously believed that osteoporosis was rare in obese people, but recent studies have found that adipocytes of obese people secrete a variety of adipocytokines and inflammatory factors, which may aggravate osteoporosis and fracture Occurrence of.

(5) Obese endocrine system Change ① Growth hormone: the release of growth hormone in obese people is reduced, especially for stimulation Growth hormone releasing factor Not sensitive. ② Pituitary gland- adrenal gland Axis: obese Adrenocortical hormone The secretion is increased, and the secretion rhythm is normal, but the peak value is increased, Adrenocorticotropic hormone （ ACTH ）The concentration also increased slightly. ③ Hypothalamus pituitary gonad axis Obese people are often accompanied by hypogonadism and hypophysis Gonadotropin Decrease, testosterone Reduced response to gonadotropins. The level of total testosterone (T) in the blood of obese men is reduced, but the free testosterone (FT) in mild to moderate obese men is normal, which may be due to Sex hormone binding globulin (SHBG). The FT of severely obese people can also be reduced. In addition, adipose tissue can promote androgen Transforming to estrogen, so obese men will appear breast Growth, obese girls, Menarche advance. Adult female obese people often have Menstrual disorder ， Anovulatory menstruation , even amenorrhoea ， Polycystic ovary syndrome High incidence rate. ④ Hypothalamus pituitary thyroid axis: the thyroid of obese people Thyrotropin (TSH) Reactivity Decreased, pituitary on Thyrotropin releasing hormone The reactivity of (TRH) was also reduced.

treatment

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The two main links of treatment are to reduce caloric intake and increase caloric consumption. Emphasis on behavior, diet and exercise combined treatment , supplemented with drugs or surgical treatment 。 Secondary obesity should be treated according to the etiology. various complication And concomitant diseases should be treated accordingly.

1. Behavior therapy

Through publicity and education, the patients and their families can learn about obesity and harmfulness Have correct understanding, so as to cooperate with treatment, adopt a healthy lifestyle, change diet and Exercise habits 。 Conscious long-term adherence is the first and most important measure for obesity treatment.

2. Diet control and increase physical activity

Mildly obese people, control the total amount of food intake, and adopt Low fever Card Low fat diet Avoid high sugar intake lipid Food, so that the daily total calories are less than Consumption 。 Multiplication physical labor And physical exercise, if the weight can be reduced by 500~1000g per month, it will gradually reach normal Standard weight , you do not need to use drugs.

For obesity above moderate level, the total calories must be strictly controlled. Female patients are required to limit their food intake to 5~6.3MJ (1200~1500kcal)/d. If it exceeds 6.3MJ/d, it will be invalid. The male should be controlled at 6.3~7.6 MJ (1500~1800 kcal)/d, which is expected to lose 1~2 pounds per week. Appropriate amount of food should be guaranteed essential amino acid Of Animal protein (% Total protein One third of the amount is appropriate), protein The daily intake shall not be less than 1g per kilogram of body weight. Fat intake should be strictly limited, and sodium intake should be limited to avoid weight loss Retention of water and sodium It is also good for reducing blood pressure and appetite. Additional restrictions sweet food 、 Beer Etc. If the weight can not be reduced after several weeks of diet control, the daily total calories can be reduced to 3.4~5MJ (800~1200kcal)/d. However, if the calories are too small, the patients are prone to fatigue, weakness, chilliness, fatigue, mental depression, etc., which must be closely observed. According to research, protein consumption is high in the early stage of diet treatment, resulting in rapid weight loss Negative nitrogen balance , when continuously low Hot card When eating, protective nitrogen retention reaction occurs and nitrogen balance is gradually rebuilt, so fat consumption gradually increases. But fat produces about 10 times more calories than protein, so adipose tissue The amount of lost protein is obviously less than the amount of protein tissue, and when the protein is conversely synthesized more, the weight can be recovered, which is the regulation process of the human body after limiting the calorie. Therefore, diet treatment often has no significant effect. In this case, it is advisable to encourage exercise therapy To increase heat consumption.

About activity or Amount of exercise The formulation of should vary from person to person, and in principle take a step-by-step approach.

three medication

For severely obese patients, drugs can be used to reduce weight and then continue to maintain it. However, how to better use these drugs in clinical practice remains to be explored. Medication may cause side effects and Drug resistance , so we choose medication Indications You must be very careful and make a decision based on the individual situation of the patient to measure the possible benefits and potential risks.

four Surgery treatment

Short circuit surgery of jejunum and ileum bile duct Pancreatic short circuit surgery, gastric short circuit surgery, gastroplasty Vagus neurotomy And gastric balloon surgery, etc. The effective rate of operation (weight loss>20%) can reach 95%, mortality <1%。 Many patients can obtain long-term curative effect, and preoperative complications can be improved or cured to varying degrees. But the operation may be complicated Malabsorption 、 anemia , narrow pipeline, etc., with certain danger, only for Severe obesity Failure to lose weight has serious complications, which may be improved through weight loss. Before operation, the patient's general condition should be Sufficient estimate , especially diabetes 、 hypertension and Cardiopulmonary function And give corresponding monitoring and treatment.

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