Файл: The number of people who at risk of serious health problems due to being overweight is increasing. What is the reason for the growth of overweight people in society? How can this problem be solved?.pdf

The greatest practical effectiveness in the treatment of obesity is achieved by observing nutrition protocols (diets) with a low content of easily digestible carbohydrates:

• LCHF (Low Carb, High Fat - low-carb high-fat nutrition system)
• The Paleolithic diet
• The ketogenic diet
• MMT diets (mitochondrial metabolic therapy by Dr. Joseph Mercola)
• Keto-carnivore diets

All these nutrition protocols lead to a decrease in the level of insulin in the blood, restoration of insulin resistance to normal levels, and to the transition of the body to the mode of burning its own fat reserves. Often this is accompanied by the restoration of many other parameters of the blood.

This is mainly a diet with a moderate amount of protein (from 1 to 1.5 grams of protein per 1 kilogram of muscle mass per day), an increased content of saturated fats (mainly animal fats, as well as olive and coconut oils, avocado), increased or moderate fiber content (leafy greens, cucumbers, celery, asparagus, etc.), vitamins and other biologically active components, limiting the use of easily digestible carbohydrates:

• Sugar;
• Candy;
• Pastry;
• Bakery and pasta;
• Grain;
• Fruits with high sugar content;
• Vegetables with high starch and sugar content (carrots, potatoes, tomatoes, etc.);
• Dairy products with high lactose content;
• Sugary or high-carbohydrate beverages (juices, carbonated beverages with added sugar, alcoholic beverages);
• Products of deep processing (contain hidden carbohydrates, TRANS fats).

The advantages of these power protocols are the following factors:

• Wide applicability for different ages and different diseases;
• Comfortable diet due to the absence of hunger;
• No surgical intervention.

At the same time, many of these nutrition protocols do not require limiting the caloric content of food, but on the contrary, recommend eating until satiety, so as not to feel hungry. However, the effectiveness of some of them in the treatment of obesity increases significantly when they are combined with various methods of fasting, which are carried by the body much easier than when eating mainly carbohydrate food.

The transition to any nutrition Protocol should be performed under the supervision of a qualified physician. Before switching to a new diet, blood tests should be done, as well as regular monitoring of the necessary parameters on the basis of laboratory tests. For example, due to the high iron content in meat, when choosing a keto-carnivore diet, it is important to take into account the markers of iron in the blood (iron ions in the blood, hemoglobin, ferritin, transferrin).

Bodily exercises

The process of treating obesity is 80% influenced by diet, and 20% influenced by exercise. Recommended types of training: HIIT (eng.) (Interval training), moderate cardio training 2-3 times a week for 20-30 minutes. If there are contraindications, be sure to consult a doctor.

Continued economic growth, the violent pace of industrialisation and urbanisation can minimise the need for activities that require physical effort. Our ancestors did not have to pay for performing physical labor and receiving loads. They were forced to do so by life itself. We, who live in cities, need to pay a considerable amount to visit a modern fitness center or pool, work out or undergo a session of medical procedures. Meanwhile, movement is essential for maintaining the normal structure and function of almost all organs and systems in our body. Its absence without good reasons will sooner or later lead to pathological changes in organs and tissues of the body, to General health problems and early aging.

Numerous epidemiological studies have shown that a sedentary lifestyle is most often associated with an increase in metabolic disorders, in particular, overweight and obesity. An interesting fact is that obesity is bi-directional in reducing physical activity, i.e. lack of exercise leads to weight gain, and it is more difficult for overweight people to initiate physical activity. Thus, the accumulation of excess weight worsens and leads to the formation of a kind of vicious circle. It is the increased energy consumption and reduced physical activity that is responsible for the observed jump in the prevalence of obesity at the present time. It is believed that nutrition has a greater share of risk, because through it we can more easily generate a positive balance of energy than compensate for it then through physical activity.

Psychotherapy

One of the most effective approaches in psychology to work with people who are obese is cognitive behavioural therapy, which most effectively affects the causes that induce a person to overeat. In addition, it makes it possible to adjust some aspects of the quality of life of patients, thereby improving their quality of life. Psychotherapeutic approach to the treatment of obesity is desirable to implement at different levels (family, school, society).

Behavioural therapy methods used in the treatment of obesity are aimed at developing self-control, changing attitudes to nutrition and related habits, the introduction of gradually increasing physical activity and the formation of reliable social support. In controlled trials, it was found that patients to whom these methods were applied were later less likely to gain the same body weight than those to whom other treatments were applied.

Canadian scientists have found that the development of obesity can affect negative relationships with parents. Conversely, a good relationship, in particular, with the father has a positive effect on maintaining a normal weight.

When using diets with calorie restriction of food consumed, as well as diets with a high content of carbohydrates, a person experiences a constant feeling of discomfort, often fails in the fight against obesity due to high levels of insulin in the blood, and may come to the conclusion that psychotherapeutic treatment does not work.

Medical treatment of obesity

Medicines, as a rule, allow to achieve only short-term improvement, but not persistent, long-term effect. If after the termination of the course of medical treatment, the patient has not changed his lifestyle and does not comply with dietary recommendations, then the body weight increases again. Perhaps this is due to the fact that overweight causes irreversible inflammatory processes in the hypothalamus, which disrupt the regulation of adipose tissue. Each drug is selected by the doctor individually:

• Phentermine (adipex-P, fastin, ionamine — amphetamine group) — acts as a neurotransmitter norepinephrine, reducing appetite. May cause nervousness, headache and insomnia;
• Orlistat (xenical) - an inhibitor of pancreatic lipase, approximately 30% reduces the absorption of fat, does not suppress hunger, but can cause incontinence of the chair;
• Metformin-affects the metabolism of carbohydrates, especially shown in obesity associated with diabetes.
• Sibutramine (meridia) is a serotonin and norepinephrine reuptake inhibitor. The drug acts on the centers of satiety and thermogenesis, which is located in the hypothalamus. The drug is contraindicated in patients with uncontrolled hypertension!
• Fluoxetine (prozac) is an antidepressant used by some specialists to suppress appetite, but there is no information about the long-term effects.
• Lorcaserin (belvik) is an agonist of 5-HT2C receptors, suppresses appetite.
• Bupropion (wellbutrin, ziban) is a reuptake inhibitor of norepinephrine and dopamine and suppresses the appetite.
• The combination of Ephedrine with Caffeine is a sympathomimetic, stimulates alpha-and beta-adrenergic receptors, stimulates the production of norepinephrine. It is widely used in Denmark for the treatment of obesity.
• Topiramate is an antiepileptic drug that reduces body weight through an unspecified mechanism.
• Naltrexone-an opioid receptor antagonist, suppresses cravings for delicious food.
• Liraglutide (victoza, saxenda) is an agonist of the HPP-1 receptor. Presumably, it enhances the action of leptin (saturation hormone) through the suppression of its soluble receptor.

Despite the large number of drugs to treat obesity, almost all of them have been banned by the U.S. food and drug administration because of serious side effects. Five of them are currently approved: orlistat, lorcaserin, phentermine-topiramate, bupropion-naltrexone and liraglutide.

Preparations of plant origin

Along with diet and drug therapy, herbal preparations in the form of tea or other medicines can be used, but it is necessary to know their composition well.

An example of the story of herbal treatment for obesity:

«I was advised different diets, but to comply with a strict diet lacked willpower. Several times I got to the hospital with different sores, the doctors told me that I need to lose weight, then there will be nothing to treat, because all my health problems are from obesity. I wanted to be healthy and take care of my children. I kept trying to regain my normal weight and with it my health. On the advice of friends decided to try, along with separate nutrition herbal tea. To make tea, you need to take 1 teaspoon of cornflower flowers and leaves of the three-leaf watch, 2 teaspoons of starflower grass, St. John's wort grass and oregano grass. All the herbs to chop and mix well. A teaspoon of the resulting collection pour a glass of boiling water (preferably in a thermos), insist 2-3 hours, and then strain. Infusion I take half a glass 2-3 times a day for 30 minutes before meals. I drink the drug courses for 2-3 weeks, then take a break for the same period. When the first time embarked on scales, even somebody-has lost 8 kg for 3 weeks.» - Zagorodny Olga.

Surgical treatment of morbid obesity

As it was found out on the basis of long-term studies, the maximum effect in the treatment of obesity is surgery (bariatric surgery). Only surgical treatment makes it possible to solve this problem completely. Currently, the world's most commonly used three types of surgery for obesity. These three operations have been selected by the long-term evolution of bariatric surgery as giving the maximum effect in terms of weight loss while minimising the level of side effects:

• The longest history has gastric bypass (gastric bypass). It began to be used in the 60s of the twentieth century. This operation is to divide the stomach into two parts — small and large, which are not in contact with each other. To the "small stomach" the small intestine is sewn, so that the food moves along a short path. This operation has two components of action: the volume of the small stomach is about 50 ml., therefore, the patient can not consume food in the same volume, and reduced absorption of nutrients when food moves along the shortened path.
• Gastric banding. The operation consists in the imposition of a silicone ring (gastric bandage) on the border of the esophagus and stomach. The bandage creates an obstacle for the passage of food, thereby stimulating the reflexogenic zone of saturation. All modern bandages are adjustable, that is, their lumen can be controlled depending on the individual situation of the patient. In the modern form, the design of the bandage was proposed by the American surgeon of Ukrainian origin Lubomir Kuzmak.
• Sleeve gastroplasty (Sleeve gastrectomy). The operation is to remove part of the stomach and turn it into a thin long tube - "sleeve". The capacity of the stomach is reduced by about 10 times (up to 150-200 ml.). The mechanisms of action of sleeve gastroplasty in relation to weight loss include the creation of a restrictive effect for the passage of food due to a narrow "sleeve", enhanced activation of farnesoid X-receptors due to an increase in bile acids and a hypothetical mechanism for removing the ghrelin-producing zone (ghrelin — hunger hormone). Sleeve gastroplasty has been used as an independent bariatric surgery since 2004.

In addition to the three described standard operations, many other operations are proposed that are not used as often.

Currently, all bariatric operations are performed laparoscopically (i.e. without incision, through punctures) under the control of a miniature optical system.

It should be noted that operations related to plastic surgery, such as liposuction and abdominoplasty, are not intended to combat obesity, but are a way of surgical correction of local cosmetic defects. Although the amount of fat and body weight after liposuction may decrease slightly, but according to a recent study by British doctors, such an operation is useless for health. Apparently, the damage to health is not subcutaneous, but visceral fat, located in the omentum, as well as around the internal organs located in the abdominal cavity. Previously, there were isolated attempts to do liposuction for weight loss (the so-called megaliposuction with the removal of up to 10 kg of fat), but now it is left as an extremely harmful and dangerous procedure, inevitably giving a lot of severe complications and leading to rough cosmetic problems in the form of roughness of the body surface. Moreover, there is evidence that subcutaneous liposuction (for example, in the abdomen), leads to a compensatory increase in harmful visceral fat. Thus, bariatric surgery rather than plastic surgery is used to combat obesity.

Surgical treatment of obesity has strict indications, it is not intended for those who believe that they just have excess weight. It is believed that indications for surgical treatment of obesity occur at a BMI above 40. However, if the patient has problems such as type 2 diabetes, hypertension, varicose veins and problems with the joints of the legs, the indications arise already at a BMI of 35. In recent years, the international literature there are works that have studied the effectiveness of gastric banding in patients with a BMI of 30 and above. Moreover, in February 2011, the US licensing authority FDA decided to allow gastric banding starting at a BMI of 30. However, this permission applies only to one model of bandage-LapBand.

Also, a good method of treatment is to follow the daily routine and avoid stress. An integral part of a healthy lifestyle is the observance of the daily routine. This is especially true of sleep. It is recommended to go to bed no later than 22 hours. You need to sleep at least 8 hours a day. Sleep disorders have a negative impact on the activity of the body, in particular, can contribute to the development of obesity. Stress, depression also negatively affect human health. During experiences, people often begin to consume a lot of food, they have increased appetite, which leads to weight gain.

Society has not yet fully realised the need to create and implement programs to prevent obesity. Of course, such a program is a very expensive thing, but the problem of obesity also costs a lot of money. It should be seen as positive that society has begun to spend money on the creation of programs for the prevention of diseases such as hypertension, insulin-dependent diabetes and coronary heart disease. The pathogenesis of these diseases is very closely intertwined with the pathogenesis of obesity. Obesity is associated with the most common and costly diseases: insulin-dependent diabetes mellitus (insd), hypertension, coronary heart disease (CHD), a number of tumors. In humans obesity disrupts the activity of at least nine organ systems.

In countries where educational work on primary prevention is actively implemented and educational technologies are implemented during rehabilitation programs for patients in risk groups (Canada, UK, USA, Finland), the dynamics of reduction of cardiovascular morbidity, the frequency of myocardial infarction and mortality is clearly visible. The main components of rehabilitation programs are preventive training (healthy lifestyle training), physical training and psychological support.

The role of government is critical to achieving long-term positive changes in public health. Governments are primarily responsible for guiding and monitoring the initiation and development of the strategy, ensuring its implementation and monitoring the impact over the long term.

Governments need to ensure that information is correct and balanced, consider measures that provide balanced information to consumers so that they can easily make healthy choices, and ensure that appropriate health promotion and health education programmes are in place. In particular, information for consumers should be prepared taking into account literacy levels, communication barriers and local culture, and it should be understandable for all segments and groups of the population. In some countries, health promotion programmes have been designed to take into account considerations of this kind about diet and physical activity. Some governments have already made a legal commitment to ensure that factual information allows consumers to make well-informed decisions about issues that may affect their health.

Health services, especially primary health care, but also other services (such as social services) can play an important role in preventing obesity. Regular study of basic eating and physical activity habits, combined with simple life-long counseling, can reach a significant portion of the population and prove to be a cost-effective exercise. Identifying specific groups at high risk and identifying measures to meet their needs, including possible pharmacological measures, are important components. Key factors for the implementation of these measures are: the training of health workers, the availability of appropriate guidance and possible incentives.

The issue of global consideration of nutrition and physical activity was also raised in the who/world economic forum report at the joint event "Prevention of noncommunicable diseases in the workplace through diet and physical activity».

Who offers several different methods to set priorities for obesity prevention. All of these approaches have the following common steps:

• Problem identification and needs analysis.
• Identification of possible solutions.
• Assessment and prioritisation of possible solutions.
• Strategy formulation.

When setting priorities, it is important to understand that no single intervention will be able to prevent obesity. The determinants of obesity are complex and diverse, so the solutions must be multifaceted. Depending on the area, region or country, some measures or specific policy options will be more important, relevant and feasible than others. It is therefore essential that decisions on policy options and priorities be taken at the local level. Potential areas of work should be carefully analysed, taking into account factors specific to the locality, region or country. For example, historical, political, cultural, social and economic factors or constraints, existing and available resources, and existing policies and systems need to be taken into account. It is also recognised that prevention and policy implementation are often haphazard, on a case-by-case basis.

The government of the Russian Federation expressed its agreement with the provisions of the who global strategy on nutrition and physical activity and health, recognising its timeliness and relevance.

The national project "health" was launched in Russia on January 1, 2006. As part of the project in 2012, the III all-Russian competition of projects on healthy lifestyle "Healthy Russia"was held. Analysis of the projects showed that most of them were devoted more to tobacco control, rather than aimed at the formation of a healthy diet and physical activity. Also, some of the projects paid attention to the fight against the consequences of obesity, such as cardiovascular diseases and their complications.

In the national project "Health", unfortunately, there is no program to combat obesity and sedentary lifestyles. This is probably due to the fact that in our country obesity is considered as a concomitant disease. For example: "obesity and coronary heart disease", "obesity and hypertension, " obesity and breast cancer", "obesity and metabolic syndrome", "obesity and diabetes", etc. Therefore, there is no accurate statistics of obesity.

It is long overdue to consider obesity as an independent disease. It is the root cause of many diseases and affects many people. It is believed that obesity is a personal problem of a person. No disease is self-medicated on the scale of obesity. For many, excess weight is just something that spoils the figure. Trying to lose weight, people sit on diets, and after a while again gain extra pounds.

The rapidly increasing prevalence of obesity in the Russian Federation requires immediate action, an effective strategy and innovative solutions, the adaptation of existing experience in other countries to the conditions of our country. The prevalence of overweight in the age of 20 + of both sexes according to who data for 2008 in the Russian Federation is 57.8 %.

The Ministry of health and social development of the Russian Federation in the framework of implementation of paragraph 21 of the Order of the Prime Minister of the Russian Federation V. V. Putin dated March 27, 2012 № VP-P12-1763 to organise effective prevention of morbidity and mortality associated with excess body weight, developed the "Provision of medical care to adult population to reduce excess body weight".

The guidelines contain a description of the organisation of medical care for overweight and obese people in primary health care institutions (PHC).

The health of the nation is the highest social value, the basis of national wealth and security of Russia. However, Russians do not tend to take care of their health, think of it as their own resource and capital. This factor is largely key to the dynamics of mortality and morbidity in our country.

Therefore, preventive medicine and the whole society face a difficult task aimed at creating such conditions when it will be beneficial for a person to observe a healthy lifestyle and maintain health for many years.

The creation of so-called “health Schools” in the primary health care system contributes to the solution of this problem. "School of health” is a special form of work with patients. Training programs for "health Schools" are based on active learning and strengthening the patient's ability to plan and develop their own lifelong learning, patient collaboration with each other, and health care provider-patient partnership in health management. Training in these programmes should be part of the consistent training of health workers and can be incorporated into the basic medical education of doctors, nurses and other health workers. Training in the "school" should increase the level of knowledge and practical skills of patients in risk management, contribute to improving the quality of life, preservation and restoration of working capacity. The role of the patient in the treatment of chronic disease can not be limited to passive submission to medical appointments. He should be an active, responsible participant in the therapeutic process, and help him in this can be a medical professional who fully owns the medical knowledge, skills of the organiser, psychologist and teacher.