Classification of obesity according to the severity of excess body weight.

Obesity should include situations where excess fat mass is 15% higher than the ideal weight or 10% higher than the maximum allowable body weight, according to the online publication for girls and women from 14 to 35 years old Pannochka. net Less excess weight is defined as overweight and is considered as a predisease (Shurygin D. et al., 1980).

There is the following classification according to the degree of obesity:.

Table 4. Classification of obesity according to the severity of excess weight (Shurygin D. et al., 1980) Degree of obesity % overweight 1 10-30 2 30-50 3 50-100 4 100 In Western literature, excess weight is more often assessed by body mass index or by Kettle index. It is determined by dividing body weight in kilograms by height in meters squared..

The Kettle index quite reliably characterizes excess body weight in adult men and women with height within the average values \u200b\u200b(150-185 cm). With normal body weight, the Kettle index is less than 25.0. If it is more than 25.0, but less than 27.0 - this is overweight, but not yet obese, if more than 27.0 - this is obesity.

Moreover, if the Quetelet index is less than 28.5, they speak of mild obesity, if it is less than 35.0, then this is moderate obesity, if the Quetelet index is less than 40.0, this is severe obesity, and finally, if it is more than 40.0, this is.

We point out that the determination of the presence of obesity only according to the height and weight of the patient's body is always somewhat arbitrary, since these values \u200b\u200bdo not accurately reflect the fat mass and its relation to the norm..

It is especially difficult to navigate by height and body weight in childhood. Since in this age group the muscle mass is relatively less than in adults. Similar problems arise in determining the severity of obesity in the elderly..

There is also a relative decrease in muscle mass in this age group.. It would be possible to determine the severity of obesity in both children and the elderly by directly determining their fat mass and its relation to body weight.. However, unfortunately, so far there are no simple, reliable and affordable methods for determining the mass of fat in the body..

Etiopathogenetic classification of obesity.

According to this classification, obesity is divided into primary and secondary forms..

Secondary or symptomatic obesity includes endocrine-metabolic obesity (obesity in Cushing's syndrome, hypothyroidism, acromegaly and insuloma), as well as cerebral obesity associated with diseases and brain damage.. A distinctive feature of secondary forms of obesity is a decrease in body weight with successful treatment of the underlying disease (Shurygin D.. et al., 1980).

Primary obesity, which accounts for 90-95% of all cases of the disease, is in turn divided into alimentary-constitutional and neuroendocrine (hypothalamic) forms..

It should be noted that there are no absolutely reliable and clear criteria for a differentiated diagnosis of these forms.. The guidelines on this issue indicate that alimentary-constitutional obesity is a benign, slowly progressive form, which rarely leads to the development of complications..

Fat deposition is usually proportional and gender-appropriate. Neuro-endocrine - on the contrary, it progresses rapidly, often has complications (arterial hypertension, dyslipidemia, diabetes mellitus), symptoms of hypothalamic dysfunction can be observed - headaches, sleep disturbances, vegetative disorders, etc.. , fat deposition is disproportionate (pronounced abdominal by the type of Cushing's syndrome or gluteofemoral by the type of Barraquer-Siemens syndrome).

It should be noted that in Western medicine there is no division of obesity into alimentary and hypothalamic. As for domestic medicine, not all authors support such a division (Tereshchenko I. , 1991).

Indeed, with any obesity, periods of rapid weight gain can be observed, which are replaced by long periods of stabilization.. The presence or absence of complications is rather determined by the degree of obesity, the form of distribution of fat, age and duration of the disease..

The form of fat distribution (abdominal or gluteofemoral), as established in recent studies, is determined by genetic and endocrine mechanisms (Ginzburg M. , Kozupitsa G. 1996 Hashimoto N. , Saito Y. , 2000), but not hypothalamic dysfunction.

And the hypothalamic dysfunction itself (hypothalamic syndrome) can develop for the second time against the background of existing obesity.. In other words, when analyzing specific cases of the disease, it can be quite difficult to identify undoubtedly neuroendocrine forms, the development of which is associated with primary hypothalamic dysfunction..

Classification of obesity based on fat distribution.

In recent years, there has been a tendency to subdivide obesity based on the distribution of fat into abdominal, when the bulk of fat is located in the abdominal cavity, on the anterior abdominal wall, trunk, neck and face (male or android type of obesity) and gluteofemoral with predominant fat deposition on the buttocks and thighs.. , Kozupitsa G. 1996 Hashimoto N. , Saito Y. , 2000).

This division is due to the fact that with abdominal obesity, complications are observed much more often than with gluteofemoral obesity..

The simplest and most reliable criterion for the division of obesity on the basis of fat distribution is the ratio of waist and hip sizes.. With a predominant glutenofemoral distribution of fat in women, this ratio is less than 0.81, respectively, with an abdominal - more than 0.81.

In men, the subdivision boundary for abdominal and gluteofemoral obesity is 1.0. Quite accurately, the situation with abdominal fat accumulation is also characterized by the size of the waist circumference.. At the same time, it is desirable that the waist circumference of a man be less than 94 cm, and for a woman less than 80 cm (Lean M. , 1998).

Depending on how far the indicators of fat distribution in a given patient differ in one direction or another from the indicated values, one could speak of a pronounced abdominal, abdominal, mixed, gluteofemoral and pronounced gluteofemoral distribution of fat.. However, to date no agreed criteria have been developed for such a unit..

Classification of obesity according to the direction of the process.

Depending on whether the body weight is increasing at the moment, remains stable or decreases, it is justified to divide obesity into progressive, stable or regressing.. However, until now there are no exact criteria for how many kilograms and for what period should be gained or lost in order for this obesity to be classified as progressive or regressing..

We believe that body weight fluctuations of the order of 2-3 kg per year can be attributed to stable obesity, but if body weight increases by 5 kg per year or more, then such a case has every reason to test for progressive obesity.

Classification of obesity depending on the presence or absence of complications.

Depending on the presence or absence of complications, obesity can be divided into complicated or uncomplicated.. Recall that hypertension, atherosclerosis and coronary heart disease, as well as non-insulin-dependent diabetes mellitus, can be considered as typical and most frequent complications of obesity..

Exemplary wording of the diagnosis.

In view of the above, the following approximate formulations of the diagnosis can be proposed:.

Obesity, primary, second degree (BMI \u003d. ), with mixed fat distribution, uncomplicated, stable course.

Obesity, primary, third degree (BMI \u003d. ), with abdominal fat distribution, stable course. metabolic syndrome. Moderate arterial hypertension.

Ginzburg M.

medbe. en.