Obesity

Obesity is a disease. Like any illness, it should be treated, especially since doctors in their practice often meet with mixed pathology, when a patient with a BMI has a combination of two, three or more diseases. This may be MS (metabolic syndrome).Such a complex of metabolic disorders (BMI, hypercholesterolemia, hypertriglyceridemia, violation of carbohydrate tolerance, cholelithiasis, uric acid diathesis, gout and others in various variations) requires, on the background of the main principle of intervention (reducing the caloric intake of a fat man's diet)raka. In this case, especially the presence and degree of development of vascular pathology, especially hypertension, heart failure should be taken into account.

When building a diet, it is important to observe the principle of a balanced diet: to introduce into the diet products containing a sufficient number of essential components necessary for the normal functioning of the organism: essential amino acids, PUFA, vitamins and minerals.
The method of treatment of BMI and obesity starvation It is not suitable, since fasting for more than 3 days can disrupt metabolic processes in the body; on the other hand, it exerts a specific psychological effect on man, further enhancing the importance of food for him and stirring up appetite centers. Great problems also arise when you leave fasting: a person gains body weight even more than was before the diet.Fasting, as a method of treating obesity, is not currently applied due to the fact that the risk of complications is high (arrhythmias, mental disturbances, hypovitaminosis with polyneuritis, skin and hair lesions).

The use of biologically active additives with excessive body weight

It is recommended to start the reduced diet therapy in combination with the use of dietary supplements (BAA), which cause a sense of satiety, cleans the body, strengthen catabolic processes ("burn"), support the body's antioxidant and immune systems ("build") , suppressed under restrictions in the diet, and also have a positive effect on serum lipids.

Treatment is carried out in three stages. Each of them lasts a month.

The 1st stage is "cleansing": Activated carbon, polysorb*, guar, Questran; bran, cellulose - in the morning; purifying, diuretic and laxative teas - in the evening, etc.

The second stage is "burning": preparations containing chromium, zinc, hydroxyl ammonium acid, papaya and pineapple extracts, etc.

The third stage is "building": vitamins, eubiotics, microelements, polyunsaturated ω-3 fatty acids, phospholipids, bioflavonoids possessing immunomodulating antihypoxic, antioxidant properties.

Appointment of dietary supplements is due to two reasons: compensation for insufficient intake of nutrients due to diet reduction and their ability to regulate metabolism and increase body adaptation.

The basis of the principle of adequacy of phytotherapy - individualization of treatment, taking into account the specific features of the organism, the nature of the disease, its peculiarities, the presence of complications and associated pathological processes.

Selected medicinal plants are necessary for long-term individual treatment (and prevention) of a particular patient. Treatment with herbs can last 1-2 years with 1-2 months interruptions, but a mandatory condition is the replacement of some plants by others.

Use of medicines It is shown if diet therapy is ineffective and other methods of non-drug intervention are in place; with a body mass index of more than 30, without concomitant pathology and more than 27 if there are two or more risk factors and concomitant pathology: diabetes, arthritis, AH, and others.

In addition, drugs are used in secondary obesity, when there is pathology on the part of the endocrine system (treatment of the underlying pathology).

Medicines used in BMI are divided into the following groups:

■ anorexigens, which reduce appetite (most often antidepressants: fluoxetine and etc.);

■ hormonal, improving metabolism (levothyroxine sodium, stumel*, acarbose, glycazide, hexaestrol, estrogens);
■ fat absorption blockers, for example orlistat a lipase inhibitor;
■ vitamins, amino acids and minerals that help to balance the reduced diet (glycine, methionine);
■ symptomatic drugs (antihypertensive - indapamide, enalapril, captopril; diuretic - furosemide, spironolactone; laxative - senna extract *, bisacodyl etc.).

The main risk associated with currently available drugs that reduce appetite (anorectics) is primary pulmonary hypertension (PLG) and complications from the valves of the heart and the nervous system. The risk obviously does not change with an increase in BMI from 27 to 39 kg / m². Nevertheless, the risk of complications increases markedly with further increase in body weight, age and in the presence of a family history of metabolic disorders. In this regard, the indicator "benefit / risk", obviously, increases at certain stages of obesity.Therefore, anorectics on should be used when there is evidence of pulmonary hypertension or nighttime apnea.

Treatment with anorectics should be performed for 3 months and can be continued only with confirmed loss of body weight by 10%. The maximum duration of therapy is at the discretion of the attending physician. The combination of anorectics with a complete nutrition program seems to be optimal, these drugs are moderately effective in many patients on a limited diet used in clinics.

Antidepressants (fluoxetine and others) increase the serotonin content in the brain, thereby reducing appetite. The effectiveness of their appetite is low. Can be used for "night meal" syndromes.
Sibutramine Suppresses the reuptake of norepinephrine and serotonin. It is prescribed in a dose of 10-40 mg / day. In higher doses can cause an increase in blood pressure. Used since 1998.
Orlistat - inhibitor of pancreatic lipase. Reduces the absorption of fat by 30%. It is prescribed in a dose of 120 mg three times daily with meals. Systemically not absorbed, although the study is not definitive. Applied since 1997.

Note:At present, insufficiently long studies have been performed to determine the risk or benefit of pharmacological treatment of obesity. Although it can be stated that medication should not be used, or given to the patient to solve this problem independently, the most reasonable approach is probably somewhere in between. Undoubtedly, an increase in body weight is associated with increased rates of morbidity and mortality. It is also clear that the weight reduction achieved by many people with the help of a standard diet and exercise is not enough.
Read more on treating obesity here.

Authors:"School of health. Overweight and obesity" was developed by specialists of the State Research Center for Preventive Medicine under the auspices of the All-Russian Scientific Society of Cardiology. Eganian RA, Kalinina A.M. Ed. R.G. Oganov.