Obesity - excess fat deposition in the body can be either independent multifactorial disease or syndrome, accompanying other diseases. The vast majority of people suffer form obesity, which doctors call "alimentary-constitutional", ie. E. obesity is associated with the violation of the diet.
Causes
The so-called "simple" obesity - multifactorial disease, in its most obvious reasons are:
- excessive caloric intake with a predominance of fat and carbohydrates;
- chaotic diet;
- insufficient with respect to the consumption of food of physical activity;
- education of children with rewarding sweets as a reward.
Set product standard, people 5-6 times a week consume essentially the same products, and systematic correction of eating behavior in this case, it gives good results. As a rule, it is not perceived by patients and a real calorie taken alcoholic products.
Manifestations and consequences of obesity
Obesity - the most powerful factor in the risk of developing type 2 diabetes, and 90% of patients with diabetes of this type suffer from it.
Dangerous, but inevitable companions of obesity are sleep apnea syndrome (a person ceases temporarily to make breathing movements) arthrosis, An increase in the incidence of colon cancer and gallbladder.
In women, obesity is accompanied by a high rate of anovulation (ovulation disorders), menstrual irregularities, infertility associated with impaired production of sex hormones hyperplasia and endometrial polyposis, High risk of cervical cancer of the endometrium, ovary, breast.
In obese patients often improved function of sweat and sebaceous glands, the skin is wet, greasy, with pustules, eczema. typical inguinal and umbilical hernia.
Diagnostics
For the diagnosis of obesity measured waist circumference ratio (OT) to the circumference of the thighs (OB). Abdominal obesity (obesity in the waist) are diagnosed in men when FROM / ON greater than 0.9, in women - more than 0.8.
Important and waist circumference, if it is more than 88 cm for women and 102 cm for men, we can talk about the pathological deposition of abdominal fat - the most unfavorable form of obesity.
Obesity is an integral part of the so-called "metabolic syndrome". It includes
- obesity,
- hyperinsulinemia,
- arterial hypertension,
- diabetes.
bariatrics
The basis of the modern approach to the treatment of obesity is the recognition of the chronic nature of obesity and, consequently, the need for long-term treatment. It is possible to lose weight by 18 kg for 40 days, as stated in advertising posters, but this approach is doomed to failure, ie. K. A decrease in leptin (a hormone involved in the regulation of hunger and satiety centers activity) because of a sharp weight loss will lead to a compensatory increase in food intake and weight gain retransmission.
- The first step in the treatment of obesity should be a correction of eating and physical activity. Being technically easy, this recommendation is very difficult.
- The second principle is the need for relatively safe treatments (no more dangerous than the disease).
- The third postulate - preventive treatment focus: better to lose 10 kg, and keep the new weight, which will reduce the risk of complications than to lose in the short term gain of 40 kg and 50, which will accelerate the fatal Exodus.
- The fourth aspect - can not be overlooked that the human body should act vitamins, essential amino acids, fatty acids, trace elements, ie. a. when they have any other nutritional deficiency problems, t. e. problems caused by malnutrition.
Recommendations of patients with obesity - not a harsh sentence, and the joint development of a reasonable correction of eating: Eat as much as you ate, but pay attention to your meal, enjoy a meal, but do not snack on a newspaper, and eat of the served table, small portions. Minimize the intake of fat (the transition to 0.5% milk, low-fat cheeses, sugar substitute aspartame or cyclamate, limit salt intake).
The program is discussed in view of gustatory habits. It recommended the inclusion of a large number of dietary fiber: not only do they reduce the absorption of fat, but also reduce the feeling of hunger. Most dietary fiber in fresh vegetables, fruits, whole grain bread.
therapeutic diets
Most fully all the conditions of correct and balanced diet takes into account diet, developed as early as 1937 Soviet nutritionist M. AND. Pevzner, now known as the "Table number 8" and actively used in spa treatment. By the way, many of the principles of nutrition, developed M. AND. Pevzner, borrowed from modern French nutritionist M. Montignac, in developing its supply system.
diet principles "Table number 8" is based on limiting the consumption of carbohydrates and salt. Under this system, the patient is assumed to consume per day:
- carbohydrates - 150 g;
- proteins - 90-110 g (60% of animals);
- fat - 80-85 g (30% vegetable)
- calories - 1700-1800 kcal;
- salts - 5.6 g;
- free liquid - 1-1.2 liters.
The patient is fed 5-6 times a day, which eliminates the possibility hungry and snacking on the "wrong" foods.
Physical activity, while the undoubted benefits, sometimes frustrating lack of patients with significant weight reduction the body, due to the redistribution of body fat content (decreases) and increase in muscle (increases). Despite a slight decrease in the total weight, there is an intensive decrease in visceral fat with active physical activities and insulin resistanceThat it is highly desirable to improve the quality of life and its duration.
Short-term load offer liver glycogen consumption, and long - fat reserves.
medication
The use of diuretics, thyroid hormone, "extracts" from the pituitary thing of the distant past. The main requirement for drugs used for the treatment of obesity - the drug must be previously studied in an experiment must be "open" formula, and its composition must also be known.
"Magic" range of herbs can not be considered as a real alternative, because in such kits may contain substances with narcotic or unexplored properties. Phytochemical does it devoid of chemical formulas, the binding properties of the receptors, and so forth. We need to know both the positive and negative properties of the drugs that we use in a patient, and the source of the information should not be handouts and multicenter studies.
The following options of drug therapy: effects on hunger and satiety centers, blocking absorption of dietary fat as a source of the greatest number of calories, increased lipolysis.
For prescription in our country registered dexfenfluramine. Duration of treatment is not more than 3 months. severe cardiac pathology, pulmonary hypertension, mitral and tricuspid valves must be excluded before drug administration. The drug regulates feeding behavior due to the influence on the serotonergic brain structure. Short duration of use is a drawback in treatment of chronic diseases.
Orlistat (Xenical) blocks the absorption of fat in the gut by competing with intestinal lipases. Lack of systemic effect minimizes the number of contraindications, the total length of its continuous use is regulated by the doctor. Use of the drug necessarily require fat dietary restrictions - a violation of this condition leads to steatorrhoea, steatorrhoea in continuous possible loss of fat-soluble vitamins. It is necessary to take seriously the rules of the drug, as only their observance ensures the safety and efficacy of treatment.
alternative treatment
Liposuction (local removal of fat) promoted cosmeticians and encouraged the patients as a solution of a cross-sectional cosmetic problems, but in a controlled study has shown that the weight lost as a result of liposuction is recovered in the absence of changes in lifestyle. Therefore, such a procedure is not of strategic importance with significant obesity.
