Contemporary Approaches to Obesity

Obesity is one of the most common chronic diseases and is characterized by the excessive accumulation of fat in the body. Experts forecast that by the year of 2025 the number of obese people will exceed 300 million. Obesity is a disease with a high risk for health. Obesity is the second important risk factor for cardiovascular disease after smoking. Obesity, particularly the obesity with abdominal fat distribution, is often associated with hypertension, coronary disease, and diabetes mellitus. About 70% of patients with hypertension and 80% of patients with diabetes mellitus are overweight or obese. Hypercholesterolemia in young obese patients is detected two times more frequently than in people with normal weight. The frequency of cancer in obesity is also increased.
Body Mass Index (BMI) closely correlates with total body fat. Therefore, doctors use BMI to reveal the risks of diseases associated with obesity. To make calculations easy, it is good to use BMI calc specially created for these purposes. Statistics show that the risk of death increases dramatically with BMI greater than 30. However, among people over 65 years old and athletes BMI does not always reflect completely the body fat content.
Obesity is not only a fundamental medical issue, but also social and economic problem of modern society. This disease requires enormous direct and indirect financial investments. In developed countries these costs comprise about10% of all health care expenses.

Presently, the doctors use the classification of obesity on the etiological principle. From this standpoint obesity may be:

• Alimentary-constitutional
• Hypothalamic
• Endocrine
• Iatrogenic

Obesity may be also classified according to the type of fat distribution:

• Android (abdominal, central)
• Gynoid (gluteal-femoral)
• Mixed

Nature of the adipose tissue distribution may be determined by measuring the waist circumference. Studies have shown that high levels of fat in the abdominal region are associated with a high risk of diabetes and cardiovascular diseases. Gluteal-femoral obesity is characterized by the deposition of fat in the lower body. Gluteal-femoral obesity is more common for women and usually has a benign course. Mixed type of obesity is characterized by a relatively uniform distribution of adipose tissue. Depending on the phase of obesity development, doctors describe the dynamical stage with constant increase of body weight and static stage with weight stabilization.
The main causes of obesity development are genetic, demographic, socio-economic, psychological, metabolic and hormonal factors, usually acting in combination with each other. However, the determining factor is overeating, combined with the lack of exercise against the background of genetic predisposition. Pathophysiological mechanisms of obesity are complex. In general terms, obesity is the result of a long-standing positive energy balance resulting from the predominance of energy intake over its expenditure. This leads to the accumulation of body fat and weight gain. The clinical picture of the disease is determined by the severity, duration, type of obesity, as well as the presence of associated diseases. The main criterion of obesity is excessive fat in the body. Indirectly the fat content in the body can be determined by the thickness of the skin fold using calipers, absorption densitometry, and bioelectric analysis. Magnetic resonance imaging of the abdomen area helps calculate the amount of subcutaneous and visceral fat.