Cellulite is a problem that today, to a greater or lesser extent, about 80% of women around the world at any age. Since the main causes of cellulite formation are unhealthy diet, physical inactivity, stress, bad habits, etc., in order to eradicate this problem, it is necessary, on the one hand, to lead a healthy lifestyle, on the other hand, to provide proper care for your body, eliminating already the resulting signs of cellulite – “orange skin”, flabbiness, etc.
Anatomy and morphology of adipose tissue
What is called cellulite today and what it actually is are two different things. Strictly speaking, the use of the term “cellulite” in a context familiar to us is incorrect, since the ending ” it ” in medical vocabulary implies the presence of an inflammatory process (bronchitis, cystitis, peritonitis, etc.). That is, cellulite is an inflammation of the subcutaneous fat.
However, the phenomenon that we today habitually call cellulite does not indicate inflammation. These unaesthetic “bumps” and “depressions” are the result of mechanical deformation of the skin as a result of hypertrophy of superficial fat cells and an increase in lipodystrophy . But, since the term “cellulite” in relation to a similar condition of the subcutaneous fat layer, as they say, has taken root, we will operate on it.
Why don’t men get cellulite? In men, cellulite practically does not happen. This is due to the peculiarities of the architectonics of the structure of the male fat layer. It is assumed that the location of the connective tissue bridges prevents the protrusion (bulging) of the fat layer here (see diagram). In addition, the density of adipose tissue in men is significantly higher than in women, which provides a more consolidated state.
How is our adipose tissue formed? In order to correctly understand the pathogenesis of cellulite, it is necessary to have at least basic knowledge about the features of the structure and functioning of adipose tissue.
The embryology of adipose tissue has not been studied in as much detail as the embryology of other tissues of the human body. However, it is known that primitive adipose tissue is determined already in the fourth month of intrauterine life. Fat cell – adipocyte – is responsible for the synthesis and accumulation of fat. During the first year of life, adipocytes triple in size and continue to divide and grow until the age of five. After this age, fat cells do not divide and only increase in size. The final number of adipocytes of an adult is determined genetically and strictly individually, therefore the appearance of each of us depends only on the increase in size of a strictly fixed number of adipocytes .
The functioning of adipocytes is provided by biologically active substances – catecholamines, which stimulate lipolysis.
Lipolysis (release of energy from adipose tissue) is especially pronounced during fasting and stressful situations. As you know, stress – if, of course, it is not actively “seize” – inevitably leads to a strong weight loss.
Adipocytes possess two different chemical receptors (beta-1 and alpha-2) that are sensitive to epinephrine and norepinephrine, which are catecholamines. Beta-1 is responsible for lipolysis.
Alpha-2, by contrast, blocks lipolysis and is a direct antagonist of the beta-1 receptor. Alpha-2 receptors are most numerous and functionally active in areas of pronounced fat deposition: the outer surface of the hip joint, the inner surface of the knee joint. Perhaps this explains the resistance of body fat in these areas to different diets.
In addition, adipocytes in the deep layers of fat are more susceptible to carbohydrates and utilize them faster than the superficial layers. Thus, the fat cells in the deep layers grow faster than the superficial ones. From this it follows, in particular, that with liposuction, the effect can be obtained only after manipulations in the deep layers. This also explains why diets for cellulite do not improve the appearance of the skin.
The vast majority of human adipose tissue consists of white adipose tissue. The most important function of white adipose tissue is the accumulation and mobilization of lipids,
especially triglycerides and free fatty acids. In addition to white adipose tissue, there is also brown adipose tissue, which plays an important role in thermoregulation of newborns. Its function in adults is currently unknown.
What determines the distribution of fat? The distribution of body fat varies by gender, age, and race. Typically, women have a proportionally higher percentage of body fat by weight than men, as manifested by a thicker layer of subcutaneous fat. Typical for women is the deposition of fat in the upper third of the outer and inner thighs, buttocks, lower body. On the contrary, men tend to accumulate fat evenly throughout the body, which is manifested by an increase in the abdomen, thickening of the torso, neck, and nape.
The distribution of adipose tissue also depends on age. As already mentioned, newborns and children (up to five years of age) have significantly fewer adicytes than adults. On average, it is 20% of the total number of adiocytes in an adult. With age, there is a progressive increase in the amount of fat in the abdomen, both due to subcutaneous and visceral ( interintestinal ) fat. In contrast, on the lower extremities, the amount of subcutaneous fat decreases with age, but the volume of intermuscular and intramuscular fat increases.
The racial differences in fat storage areas are also evident.
Compared to other races, black people have a predominant deposition of fat in the buttocks, which is associated with the characteristic lumbar lordosis (a specific curvature of the spine anteriorly) characteristic of this race.
The distribution of adipose tissue also depends on the location. The subcutaneous fat of the anterior abdominal wall and the upper part of the lower extremities includes two layers – superficial and deep. The superficial fat layer consists of compact, dense “packages” of fat, enclosed in a well-organized fibrous membrane. The deep fat layer is made up of looser fat separated by a disordered network of fibrous septa.
Despite the fact that – as already mentioned – the number of adipocytes is a constant number, there are cases of pronounced, hyperplastic obesity, when the number of existing fat cells can no longer cope with the accumulation of adipose tissue. This is the very rare situation when the number of adipocytes begins to increase. The hyperplastic phase of obesity is turned on only when a person’s weight exceeds 100% of his ideal weight. Clinically, hyperplastic obesity does not respond to diet and physical stress, since the number of newly formed adipocytes is no longer subject to a decrease.