All about fat in our body
An exhaustive guide from post-science
Ekaterina Ivannikova, Post-science
Why is obesity a medical diagnosis, how to lose weight, what is the yo–yo effect and why is cellulite normal? We tell you together with the endocrinologist, nutritionist Ekaterina Ivannikova.
Let's conduct a small thought experiment. You know that a young man at the age of 21 weighs 115 kilograms with a height of 188 centimeters. Can you decide on the basis of these data that he has problems with excess weight? In general, yes, because these indicators correspond to grade I obesity. And that's exactly how much Arnold Schwarzenegger, the winner of the Mr. Universe bodybuilding contest, weighed in 1968 in London. Of course, he didn't suffer from any obesity.
There is still an opinion that fat is bad. But in fact, fat is the main source of energy for our body. Adipose tissue is a kind of bank where everything you eat is stored in the form of special cells, adipocytes. In addition to energy, adipose tissue stores fat-soluble vitamins (A, E and D), participates in the synthesis of steroid hormones such as estrogens, and its deficiency leads to rapid aging. Adipose tissue is responsible for thermoregulation and performs the functions of shock absorption. If a person falls, fat acts as a pillow, so older people, who often live with a deficiency of adipose tissue, have a higher risk of fractures. And this fabric also protects us from temperature changes in the external environment.
There are general norms: it is considered that the optimal fat content for men is 15-25% of body weight, and for women – 15-30%. But medical experience and numerous studies show that there are no universal metrics and each case needs to be approached individually.
There is nothing wrong with fat itself, but its overabundance leads to obesity, which, in turn, entails the risk of cardiovascular diseases, cancer pathology and diabetes. To diagnose obesity in a particular person, it is important to know the amount of this fat, its quality and distribution in the body. In our article, we will tell you how to properly assess your own adipose tissue (no matter how it sounds), what types of obesity there are and what you need to do if you need to lose weight.
What is the norm
The easiest way to calculate the degree of obesity is to use the body mass index (BMI), when a person's weight (in kilograms) is divided by the square of height (in meters). The easiest way is to use the online calculator of the Moscow Medical Prevention Center. An indicator above 25 indicates that you are overweight, above 30 – second degree obesity, and above 40 – morbid obesity, which threatens human life.
Drawings: Ekaterina Zolotareva
But the formula itself is currently considered by doctors to be insufficiently correct – you could see this by the example of Arnold from the first paragraph. It does not differentiate adipose tissue from muscle mass, therefore, in addition to measuring BMI, you need to conduct bioimpedance, that is, an analysis of your body composition. It is necessary at least to estimate the amount of fat and muscle tissue in percentages and kilograms. Physical activity matters because, according to research, people with normal body weight but low activity have cardiovascular complications and die more often than overweight people who exercise regularly.
The reverse example is the term skinny fat, which has not yet been recognized in the scientific community. They designate outwardly thin people, but suffering from so-called sarcopenic obesity. As a rule, these people have a deficiency of muscle mass against the background of excess adipose tissue, the replacement of active tissues with fat occurs. In such situations, it is necessary to consult a doctor who will help with the selection of a training program and nutrition. Such a picture is typical for those who spend a lot of time at the computer, move little and do not observe a balanced diet.
Types of fat: one is white, the other is brown (and the most dangerous is visceral)
There are two main types of fat in the body. The first, brown, is located in the neck, shoulders and back. It performs the functions of thermogenesis, protects the walls of blood vessels and helps speed up metabolism. As a percentage, it is most common in newborn children, whom it protects from hypothermia. Adults have very little brown fat. If we take an average man who weighs about 75 kilograms, he will have no more than 500-700 grams of brown fat. However, even these small portions are now being very actively studied, since brown fat has an active ability to burn or reduce the amount of white fat.
The second is white fat, which we see in our abdomen, on our back and many other places. There is much more of it in the body than brown, the hypothetical man from the previous paragraph will have about 30 kilograms of white fat. This fat helped our ancestors to survive, but in modern times, when a person moves less intensively and consumes more refined carbohydrates and fats, the body accumulates white fat for the future.
There is also a third type of fat – beige. This is an intermediate stage between white and brown adipose tissue. It performs the function of thermogenesis.
The modern lifestyle leads to the fact that white fat begins to be deposited more often not only under the skin, but also around the internal organs. This is the so-called visceral fat, which is very dangerous. First of all, the liver suffers from it: it begins to increase in volume, which can negatively affect its function. It should also be noted a natural response from the state of the vascular wall, when excessive consumption of fatty foods triggers the process of atherosclerosis associated with a high risk of myocardial infarction. Visceral fat often leads to problems with reproductive or erectile function, and at the same time to diabetes mellitus, because the pancreas, in conditions of excessive accumulation of adipose tissue, does not cope with the tasks set and leads to insulin resistance, when insulin is present in the blood in increased amounts, but cannot perform its functions – to force the cells of the body to absorb glucose. This often causes the development of type 2 diabetes mellitus.
Adipose tissue is the most important participant of the endocrine system. For example, it is in adipose tissue that we can observe the aromatization of testosterone or its peculiar transition into estrogens. Therefore, overweight men have a risk of decreased sexual function and the development of hormone-dependent tumors.
Causes of obesity: food, activity and genes
There are a huge number of factors that lead to overweight and obesity. Most often they recall the development of the food industry, the cheapening of products, the high degree of their processing and availability. WHO also cites a decrease in physical activity caused by the sedentary nature of many activities, changes in modes of movement and increasing urbanization. All this leads to an energy imbalance when the body consumes more energy than it needs.
Is there a pill for weight loss?
No. But scientists have noticed that during training, skeletal muscles secrete the protein irisin. This regulatory peptide affects the differentiation of adipose tissue cells, as well as the activity of the protein that regulates the transition of white fat to brown. So the theory that physical activity helps to reduce the amount of white fat is confirmed. Now representatives of the pharmaceutical industry are studying how irisin is formed and acts, because it can potentially help people with overweight.
However, there are less common versions. According to one of them, microbiota plays an important role among the causes of obesity – a set of microorganisms that are in symbiosis with humans. The biomass of microbes inhabiting the human intestine is approximately 5% of the body weight. The number of genes of the intestinal microflora is 100-150 times higher than the human own genome, and there are more than 1000 different types of microorganisms in the intestine. It is a separate organ with many functions: formation of a protective barrier, participation in immune reactions, regulation of water-salt metabolism, maintenance of homeostasis (self-regulation), synthesis of vitamins, detoxification of xenobiotics, regulation of certain genes, implementation of digestive processes. Chronic lack of sleep, stress, insufficient or excessive physical activity negatively affect the intestinal microbiota, which increases the number of bacteria in it that cause the accumulation of fat in the body.
Another reason is a violation of fat metabolism. In classical medicine, it is most often understood as dyslipidemia, that is, problems with the level of cholesterol and other fats in the blood. If fats accumulate actively enough, and bad cholesterol has reached its critical values, this threatens cardiovascular catastrophes. From the point of view of dietetics, a violation of fat metabolism is associated with an unbalanced intake of fats into the body and their subsequent accumulation. There are also hereditary forms of dyslipidemia, and its owners may have a standard body weight. In addition to the hereditary factor, human eating habits and concomitant diseases play an important role.
Obesity may also have prerequisites that lie in the human genome. For example, the SLC30 gene helps to digest carbohydrates, and mutations in it determine a person's love for sweets. There are genes that determine the condition of muscle tissue and how the body burns fat in cardio training. However, the genetic component is no more than 25% of the factors that affect a person. The rest is determined by external factors, such as physical activity, diet or healthy sleep.
Types of obesity: apple, pear and the norm of 220 kilograms
There are three classifications of obesity: by anatomical phenotype (androidic and gynoid), by etiology (primary and secondary) and by the state of fat cells (hyperplastic and hypertrophic).
In case of obesity, according to the anatomical phenotype, attention is paid to the distribution of fat. The android type, also known as the abdominal or "apple", is characterized by the fact that a person's fat settles in the abdominal area. As a rule, it is associated with high risks of cardiovascular diseases and diabetes. On average, the android type begins when a man's waist exceeds the volume of 102 centimeters, for women this indicator is 88 centimeters. The gynoid type, also known as the femoral-gluteal or "pear", describes the accumulation of fat in the pelvic region and is associated with lower risks from the diseases described above.
In the classification by etiology, as the name implies, the origin of fat is important. Primary (it is also exogenous-constitutional or alimentary-constitutional) indicates a violation of eating behavior. Secondary obesity is less dependent on a person and develops due to external factors, taking medications and genetic defects, such as hypogonadism (this pathology is characterized by underdeveloped sexual organs).
According to the type of fat cells, obesity is divided into hyperplastic or hypertrophic. With hyperplastic, the number of adipocytes increases, and in this case it will not be possible to cope with the disease with the help of traditional or medicinal methods of treatment. Surgical intervention will be required. With hypertrophic obesity, the mass and size of adipocytes increases. This is often combined with an increased concentration of insulin and a decrease in glucose tolerance. In addition, obesity itself can be complicated by the development of atherosclerosis and diabetes at a young age.
There is such a thing as metabolically healthy obesity. For example, I was consulted by a patient who weighed 220 kilograms with a height of 185 centimeters, and by all indicators he was practically a healthy person. During the observation, he even managed to become a father. We attribute such cases to paradoxical obesity. There are not so many of them, but they still occur.
Yo-yo Effect among Dieters and why Cellulite is Normal
A regular problem familiar to most dieters: even if it turned out to reduce body weight, then it quickly returns again. This is the so-called yo-yo effect. The reasons may be different – for example, micro- or macroelements have been significantly restricted. If due to the diet you lack B vitamins, upon returning to the usual diet, the body regards this as an opportunity to replenish its very reserves, and the rollback begins.
In 98% of cases, people who often lose weight and then gain again will not be able to lose weight on their own. Therefore, recently nutritionists have begun to evaluate the results of various diets more widely. It is important not only to lose weight, but also to keep it.
And just a few words about cellulite, which is regularly associated with obesity: in classical medicine, there is no such condition or medical diagnosis as cellulite. Initially, cellulite was called inflammation of subcutaneous adipose tissue, which requires the direct appointment of antibacterial therapy and consultation of a surgeon. What is now called cellulite is actually a gynoid deposit of fat – the very "pear". For the female body, such a distribution of adipose tissue is considered the norm, and cellulite appears extremely rarely in men.
How to lose weight: physical activity, diet and healthy sleep
Before you start reading this section, be sure to remember a few simple truths. Firstly, there is no one universal advice for weight loss. Secondly, obesity is a medical diagnosis, so do not make it yourself, it is better to consult a doctor. Thirdly, work on obesity, if the doctor has diagnosed it to you, should last at least 3-4 months so that you can evaluate the effectiveness of treatment.
So, if you are obese, start with an individual selection of exercises. It is impossible to cope with obesity without physical activity, but there is another extreme: very often people start running marathons, they sit in the gym all the time. This is fraught with a high risk of injury and an inadequate reaction of the heart to heavy loads. In addition, motivation suffers, because it seems that a person is engaged, but there is no effect: muscles train and increase in volume, fat does not become less, and weight increases.
The second step is the selection of diet therapy. Each person has their own needs for proteins, fats and carbohydrates, which depend on external (work, eating habits, stress level) and internal (genetics, changes in internal organs) factors. Someone may change liver function, someone suffers from kidney diseases. If we are talking about an eating disorder, it is mandatory to work with a psychologist.
If we talk about specific diets, the most studied of them is the Mediterranean. It is rich in vegetables, fish, a minimum amount of fatty and fried meat. Its observance, for example, reduces the likelihood of stroke, even if the first stroke has already occurred. The DASH diet (Dietary Approaches to Stop Hypertension), or "dietary approaches to stop hypertension", is quite promising from a scientific point of view. As the name implies, it was developed for people suffering from high blood pressure. However, as it turned out later, the diet is effective at weight loss, prevents the development of diabetes and cardiovascular diseases.
The third step is the selection of a diet. As for how many times a day to eat, there is only one answer: this mode is selected individually. For patients with type 2 diabetes mellitus, fractional nutrition is most often prescribed. And if a person does not have a violation of carbohydrate metabolism, snacking, on the contrary, is strictly prohibited.
Well, a small scattering of small tips. It is better to go to bed no later than 23 hours and get a good night's sleep, because scientists from The University of Glasgow found that the weight of people predisposed to fullness who do not sleep much is on average 2 kg more than those who sleep 7-9 hours. It is also advisable to take 10 thousand steps every day, because the risk of injury is lower with cardio exercises than with active sports. And at the same time, you can switch and get away from the refrigerator.
What is and what is not worth eating with obesity
There are many nutrition recommendations developed by experts and recognized as effective, for example, a Healthy Food Plate created by experts from the Harvard School of Public Health, or a culinary guide from the Ministry of Health of Canada. Their general principles are usually the same: it is necessary to balance the content of proteins, fats and carbohydrates in the diet, and at the same time increase the amount of water at the rate of 30 milliliters per kilogram of body weight. It is important to increase the number of sources of vegetable fiber, there are up to 400 grams of vegetables per day. However, it is worth making these changes only after consulting with a doctor, especially if there are chronic concomitant diseases.
It is necessary to limit the caloric content of your diet by reducing the sugars consumed, that is, to consume a minimum of sweet carbonated drinks and drink plain water or tea without additives. And when buying semi-finished products or sweets, carefully read the packaging: did the manufacturer add hidden sugars to the composition, such as hydrolyzed corn starch, agave nectar, barley malt or condensed cane juice? Roskachestvo has written detailed instructions on how to detect such additives.
In addition to sugar, it is very important to limit the consumption of trans fats, which are used in fast food, baked goods and fried products prepared industrially. A diet high in trans fats increases the risk of cardiovascular disease by 21% and mortality by 28%. However, manufacturers continue to actively use them due to their long shelf life. According to WHO recommendations, the total consumption of trans fats should not exceed 1% of the total calorie intake, that is, less than 2.2 grams per person per day with a diet of 2,000 calories.
About the author: Ekaterina Ivannikova – Candidate of Medical Sciences, endocrinologist, nutritionist, senior researcher at the Laboratory of Age-related Metabolic and Endocrine Disorders, RGNCC.
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