Complications of obesity

Metabolic and endocrine disorders

A central role in the development of metabolic complications is played by insulin resistance and hyperinsulinemia. They form a vicious circle, exacerbating the accumulation of adipose tissue and leading to a number of systemic failures:

• Carbohydrate metabolism: from impaired fasting glycemia and impaired glucose tolerance to the development of type 2 diabetes mellitus.
• Lipid metabolism: various forms of dyslipidemia (isolated hypercholesterolemia, hypertriglyceridemia, or mixed variants).
• Endothelial dysfunction: a pathological condition of the inner lining of blood vessels, closely associated with insulin resistance.
• Ovarian pathologies: hyperinsulinemia has a bidirectional relationship with the development of hyperandrogenism and polycystic ovary syndrome (PCOS).

Somatic and autonomic disorders

Excess body weight and the accumulation of visceral fat mechanically and functionally affect the work of internal organs:

• Respiratory system: respiratory failure develops, with the main pathogenetic factor being the high standing of the diaphragm, which limits lung excursion.
• Cardiovascular system: formation of vegetative-vascular dystonia and arterial hypertension (AH).
• Gastrointestinal tract: impairment of evacuation function, manifested by a tendency to constipation and irritable bowel syndrome.
• Musculoskeletal system: joint and bone pathologies due to excessive mechanical load. Obesity is also a risk factor for gout and rheumatoid arthritis.

Organ-specific lesions (morphology)

The morphological basis of obesity is adipocyte hypertrophy (triglyceride accumulation) and their hyperplasia. An increase in the volume of adipose tissue is observed in subcutaneous depots, the omentum, mesentery, and retroperitoneal space.

Visceral obesity is accompanied by chronic low-grade inflammation of adipose tissue (macrophage infiltration), which aggravates insulin resistance.

Pathologies of target organs:

1. Liver: non-alcoholic fatty liver disease (from fatty hepatosis/steatosis to progressive steatohepatitis). In combination with diabetes mellitus and arterial hypertension, it increases the risk of hepatocellular carcinoma.
2. Heart: fatty infiltration of the epicardium and myocardial stroma ("fatty heart"). In severe cases, fatty degeneration, atrophy, and thinning of cardiomyocytes occur, which in severe cases threatens rupture of the myocardial wall.
3. Pancreas: fatty infiltration of the parenchyma.

Features in children and adolescents

Obesity in childhood has an unfavorable prognosis: it takes a chronic course, causes early disability, and increases mortality.

• Sexual development: girls show early appearance of secondary sexual characteristics, menstrual irregularities, and ovarian dysfunction (disorder of neuroendocrine-vegetative regulation). In boys, the rate of development of sexual organs and secondary characteristics can be either accelerated or delayed.
• CNS and psychoemotional sphere: limited motor activity in obese children negatively affects the development of higher nervous activity (HNA), and psychological problems also form against the background of excess weight.

Class and exam questions

What else to study on this topic

• Pathogenesis of metabolic syndrome
• The relationship between 21-hydroxylase deficiency and metabolic complications
• Mechanisms of endothelial dysfunction in obesity
• Classification of obesity: hypertrophic, hyperplastic, and mixed

Other topics in the "Additional Topics" section

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