Endocrine aspects of obesity and cellulite development

Extensive epidemiological researches conducted to date mostly concern obesity. Cellulite as a medical problem began to draw researchers’ attention only recently so available data are rather contradictory.

It is well known that obesity presents a serious threat to health. WHO (World Health Organization) proclaimed this disease “an epidemic of the XXI century”. 250 millions of people in the world suffer from excess weight and obesity. In developed countries 25% of population have excess weight and 35% are obese. Epidemiological research data concerning cellulite are less accurate; various authors say its prevalence among women varies at 50-80%, in 80-100% of cases there is a combination of obesity and cellulite. According to our observations 93% of examined women have the combined pathology. The more is the extent of obesity, the more probable is the cellulite. At the same time many women who do not have excess weight and lead quite healthy way of life have all symptoms of this pathology. A natural question appears:

«Why?»

To answer it we should dwell on reasons that cause development of these diseases. We can find a lot of common factors in analysis of etiology of both obesity and cellulite. Among those factors there are some we cannot influence in any way, i.e. uncorrectable factors. These are hereditary and demographic properties (sex, age, ethnic origin). Researches show that a child may develop obesity in 30% of cases if there are no obese people in his family. With one obese parent the probability increase to 50%, in case of two obese parents in the family the child will be obese in 80% of cases.

There are no convincing data about hereditary transmission of cellulite; obviously it is possible to say about predisposition to its formation and inheriting of metabolic peculiarities. At the same time it should be remembered that a daughter of two obese parents would probably have both obesity and cellulite taking into account frequent combination of both problems. Age peaks of cellulite formation are well known; the process is aggravated with age. Ethnic origin primarily tells upon obesity prevalence and nature of fat deposition, hence on cellulite frequency. It is known that women of Arabic and Latin American origin typically have fat depositions in lower part of the body which is also typical for cellulite. None of the factors mentioned above is susceptible to our influence, they can only be taken into account at diagnosing. The following group of factors is correctable and therefore removable. We shall dwell on them in detail.

Unbalanced diet and hypodynamia are leading causes of both obesity and cellulite. Prevalence of products that contain saturated fat and easy of digestion carbohydrates inevitably leads to fat cells volume increase even if calorie content of dietary intake is normal. Increase of calorie content causes dramatic weight increase because of hypertrophy and hyperplasia of adipose tissue.

Sedentary life does not allow accumulated fat to burn and causes formation of the first vicious circle. It is characterized by positive energy balance and energy accumulation in the form of fat depositions. In addition, hypodynamia inevitably causes blood circulation worsening that is also one of the factors of cellulite formation. Blood circulation disturbance in lower part of the body promotes blood congestion and liquid accumulation in extracellular space which in turn influences collagen metabolism and promotes accretion of collagen fibers around fat lobules. This concludes the second vicious circle.

Other correctable factors are stress, various intoxications caused by drug intake, caffeine, nicotine, and alcohol abuse, etc. It is known that toxins affect metabolism of hormones and several mediators which in turn causes blood circulation disturbances and accumulation of toxic compounds in tissues (it is sometimes called “organism slagging”).

The last but not least are hormone factors that promote development of obesity and cellulite.

Researches conducted in recent years prove that adipose tissue is an endocrine organ that participates in metabolism of sex steroids. Adipocytes produce 14 types of biologically active compounds including leptin (affects hunger and satiation centers in hypothalamus and participates in regulation of its gonadotropic function), tumor necrosis factor, interleukin-6, angiotensin, and others.

The answer to the question “Why both men and women suffer from obesity but only women have cellulite?” is no secret. It is known that estrogens have tropism for adipose tissue and promote its accumulation. It is natural mechanism that serves for child bearing and breeding. Testosterone, on the contrary, has lipolytic action. It is necessary in adequate quantity for men to mobilize energy resources of abdominal adipose tissue for prolonged physical activity (for example to chase a mammoth long time ago).  However mammoth became extinct, day-to-day activities are made easier by large number of domestic appliances, high-caloric food is available at virtually any time of the day. Instead of hunger and fatigue other problems are brought to the forefront, namely hypodynamia and overeating. They in turn cause obesity epidemy. In the meantime female organism still accumulates fat in gluteal area with the help of estrogens and male organism produces sufficient quantity of testosterone. Dominating sex hormones determine the nature of connective tissue fibers in the structure of subcutaneous fat. By the way boys that were castrated before puberty not only suffer from obesity of feminizing type but also can have pronounced cellulite because of developed testosterone deficit. Men with hypogonadism have the same problem. Thus female sex hormones are responsible for the problem called “cellulite”. And this is a small price for the right to belong to the beautiful part of mankind.

Cellulite manifestations or worsening of its course most often happen during hormone reconstructions that a female organism experiences. “Critical periods” in woman’s life are well known. First of all it is puberty period when active estrogen production begins. Apparently speed of pubescence and/or sex hormones ration has critical importance and influences deposition of adipose tissue on thighs and breech. It is worth to notice that adolescents rarely have cellulite; usually it is associated with excess weight or is related to early beginning of intake of contraceptives.

Second period is pregnancy when the organism is reconstructed to bear the fetus. Accumulation of energy substrate in the form of adipose tissue looks absolutely natural. Problems with blood circulation and lymph outflow are frequently observed, especially in the lower part of the body, liquid can be accumulated in the organism.

And finally it is menopause when level of sex hormones decreases, basal metabolism slows and often microcirculation disturbances take place.

Researches conducted in Boston Medical Center have shown that 12% of respondents had first manifestations of cellulite during puberty, 20% - during pregnancy, 20% - during intake of hormone contraceptives and 25% - during menopause period.

The figures that Russian authors have received agree with this: cellulite was diagnosed during periods of hormone reconstruction at 61.1% of respondents. 25.8% of them had cellulite during puberty, 26% - after labor, and 9% - during menopause period.

In general, when speaking about influence of sex hormones on cellulite formation we need to notice complex nature of their action. Cellulite starts from local hypertrophy of fat cells. Skin and subcutaneous fat are generally sensitive to action of female sex hormones due to special receptors that are present on cellular membranes.

Estrogens inhibit secretory activity of sebaceous glands, increase hyaluronic acid content in derma (which in turn leads to increase of water content in tissues) and promote stabilization of collagen fibers. Estrogen content increase causes inhibition of glycolysis and lipolysis (estrogens decrease sensitivity of adypocite beta-adrenergic receptors) and accumulation of metabolites in subcutaneous fat which combines with lymph congestion, derma blood supply worsening, and hypoxia. Estrogens stimulate lipogenesis ferments activity and provoke further adypocites hypertrophy. Together with fibrosclerosis this leads to formation of micro- and macronodes during cellulite.

Progesterone has natriuretic action because of its interaction with renal aldosterone receptors. If progesterone production increases and it blocks aldosterone receptors, aldosterone production increases as a compensation, which in turn leads to liquid accumulation. Estrogens that promote salts retention also make their contribution. Thus any disbalance of estrogen-progesterone ratio causes adipose tissue and liquid accumulation in the organism.

Renin-aldosterone system has profound effect on regulation of water-salt metabolism that plays an important part in cellulite formation. Main effect of aldosterone is stimulation of sodium reabsorption in kidneys. Increase of sodium concentration in blood stimulates production of vasopressin hormone that promotes water resorption. Renin as a component of this system has regulatory effect on aldosterone synthesis. Disbalance of these hormones causes increase of extracellular fluid volume. Glucocorticoids also affect water-salt metabolism although to a lesser extent: liquid retention is observed in the organism if cortisol content changes.

As we can see, sex hormones are not the only ones that affect the skin and subcutaneous fat condition. In recent years increasing attention is brought to growth hormone or somatotropin. This hormone affects each cell of human organism including adypocites directly or indirectly, via insulin-like growth factors. As one of main effects of this hormone is catabolism intensification, it can be assumed that it applies also to main proteins of dermal skin layer, collagen and elastin. However no researches were conducted concerning influence of growth hormone on cellulite development. Somatotropin effect on adipose tissue studied in several works concerned fat depositions in abdominal area.

People of very elderly age were observed and most of them were males.

Thyroid hormones affect basal metabolism and metabolic activity of cells including adipose tissue cells, increasing lipolysis. Insufficient amount of these hormones leads to increase of cholesterol and other lipids concentration in blood plasma and weight increase. Many effects of thyroid hormones can be mediated by their interaction with other hormones, e.g. catecholamines.  Decrease of functional activity of thyroid gland is accompanied with liquid retention that manifests itself through edematization of face, arms, and lower extremities. In recent years clinicians pay attention to increase of latent hypothyroidism. This disease has minimal symptoms on early stages, primarily slight weight increase and tissue edematization. This must be remembered because in this case cellulite treatment without hormone replacement therapy would be ineffective.

It is often mentioned in the literature that stress is one of cellulite development factors. Similar information is contained in works on obesity. Realization of any stress influence occurs through activation of hypothalamo-pituitary area and alteration of subtle interactions between various hormones that inevitably affect metabolic processes including those in subcutaneous fat. Adrenalin, noradrenalin and other catecholamines that are produces at stress also affect adipose tissue directly through α- and β-adrenergic receptors of adypocites and by increase of vascular tone of subcutaneous fat. Most women have more α-adrenergic receptors in adypocites of thighs and breech than in fat cells in other parts of the body, and there are approximately 6 α-adrenergic receptors per 1 β-adrenergic receptor (lipolysis is carried out through these receptors). Their prolonged stimulation with catecholamines determines prevalence of lipogenesis over lipolysis. Furthermore, on body weight increase due to adipose tissue increase 6/7 of all deposited fat will be on thighs and breech and only 1/7 will be on the upper part of the body.

Thus importance of examination of hormone aspects of cellulite and obesity development is indubitable. However although their influence on obesity formation is studied quite well, subtle mechanisms of hormone changes and their role in cellulite are still not known completely.

Apparently presence of these factors has to be taken into account in practical work. First of all attention should be paid to sex hormones level because any disbalance, even without menstrual cycle disturbances, tells on cellulite course.

We have already mentioned that hormone aspects of cellulites are correctable factors. We want to emphasize that solution of these problems belongs to the competence of endocrinologists and gynecologists-endocrinologists. However specialists in esthetic medicine have to know that simple recommendations to increase physical activity, rationalize dietary pattern, quit bad habits, strange though it may seem, are quite important in terms of their possible influence on hormone status. Recent studies have shown that regular physical activity increases growth hormone production, normalizes testosterone level and estrogen-progesterone ratio.

We would like to separately mention the possibility of hormone preparations use for cellulite treatment. Prescription of any hormone preparation happens strictly according to indications and with consideration of all contraindications and possible side effects that can manifest themselves in the future. Special examination must be done prior to beginning of hormone therapy. Cellulite is absent in the indications of any hormone preparations, therefore a doctor has no right to prescribe hormones for its correction. At the same time there are enough methods of fighting with this enemy of womankind.

It should be remembered when starting cellulite treatment that there are factors of its development that a specialist can successfully influence, there are effective methods of such influence, and there is the golden rule of medicine – «don’t harm».