Nutritional support of figure correction programs

In recent years, the number of people turning to aesthetic medicine centers to solve problems of body correction has been progressively increasing. And most often, the primary cause of changes in body contours is such a pathology as obesity. A huge number of people around the world suffer from obesity. In developed countries, up to 30% of the population have obesity of varying degrees of severity. This figure increases to 40-60% in people over 40 years of age. The most critical situation is currently observed in the United States, where over 55% of the adult population is overweight.

In 1997, the World Health Organization (WHO) recognized obesity as a "global epidemic" and took control of the problem. This is surprising, since according to WHO experts, by 2005 the number of obese people in the world will exceed 300 million. It should be noted that if we take the mortality rate of people with normal body weight as 100%, then with obesity of only stage I the mortality rate reaches 178%, with obesity of stage II - 225%. The increase in the number of people with obesity at a young age, the combination of this pathology with metabolic syndrome (type II diabetes mellitus, arterial hypertension and ischemic heart disease, dyslipidemia, microalbuminuria) is alarming. However, there are also encouraging research data. Thus, it has been proven that reducing excess body weight by just 9 kg in women will lead to a 30-40% reduction in the risk of developing diabetes, as well as a 25% reduction in all causes of death from disease.

Since the vast majority of patients with obesity and excess body weight seek, first of all, body shaping centers, the activities of specialists in aesthetic medicine play a huge role in the treatment and prevention of obesity. But here, cosmetologists and physiotherapists face a very complex and responsible task. A person with excess body weight often considers it only an “external”, cosmetic problem of their appearance, without thinking at all about the real risk of the rapid emergence of a huge range of somatic and psychosomatic pathologies, which obesity will lead to within a few years from the moment of its occurrence. Consequently, the main task of a specialist in aesthetic medicine is not only to work with specific “problem areas”, but also to find out the causes of obesity, create motivation for a healthy lifestyle and rational nutrition.

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First steps to solving the problem of obesity

The first important step in addressing obesity is a thorough medical history:

• familial (identification of hereditary predisposition to obesity);
• social (lifestyle, diet, eating habits, profession, stress factors)

The next step is mandatory anthropometric examination, biochemical blood test (blood serum glucose level and lipid spectrum, insulin level), ultrasound of the abdominal cavity. Most of the above data will allow the specialist to determine the type and kind of obesity, to outline the tactics of patient management. It is also necessary to remember the features of the structure of adipose tissue, the types of its distribution.

Determining the percentage of body fat is important in diagnosing and treating obesity. At the age of 25, men have approximately 14% of their body weight in fat, and 26% in women. The amount of fat increases with age: at 40, men have 22%, women have 32%, and at 55, they are 25% and 38%, respectively (these figures may vary widely). Several methods have been proposed for determining body fat, but caliperometry and bioimpedance analysis of body composition are mainly used in clinical practice.

As stated above, the distribution of adipose tissue in the human body can be of several types, which depend on genetic factors, hormonal background and lifestyle. With predominant fat deposition in the subcutaneous fat tissue of the abdomen, shoulders, around the abdominal organs, in the omentum and mesentery, an abdominal (visceral) type of obesity is formed. It is more common in men and is called android. In this situation, adipose tissue has certain features - adipocytes have a large volume, a significant number of beta-adrenergic receptors sensitive to lipolytic effects are presented on the adipocyte membrane. Therefore, it can be safely stated that this type of obesity responds to attempts at correction more effectively.

In this case, the use of lipolytic, lymphatic drainage techniques, deep heat, and procedures aimed at improving skin tone in the course of body shaping is effective. At the same time, the prescription of an adequate diet allows for effective solutions to body shaping problems in patients with significant contraindications to physiotherapy procedures. Consequently, possessing knowledge of diet correction and diet prescription, an aesthetic medicine specialist can significantly expand the range of his clients.

With predominant fat deposition in the subcutaneous fat tissue of the thighs and buttocks, the gluteofemoral type of obesity is formed. It is typical for women and is called hypoid. The characteristics of adipose tissue in this case are as follows: prevalence of alpha-adrenoreceptors on the adipocyte membrane, sensitive to lipogenetic influences; adipocytes are smaller in size; fat lobules are limited by coarse fibrous strands; the number of fat cells may be increased.

There is a violation of microcirculation, tissue hypoxia and fibrosis. In order to eliminate the above phenomena, the main method of body correction is the appointment of defibrosing and lymphatic drainage techniques and only after that - the use of diet therapy. Against the background of diet, it is important to continue the course of these procedures in combination with lipolytic procedures. Only with such a comprehensive approach is it possible to achieve a pronounced, stable result.

The quantitative composition of adipose tissue has been the subject of debate for many years. An adipocyte is a long-lived cell, and their number in each organism is individual and relatively constant. In most cases, the hypertrophic type of obesity is encountered: the fat cell is sharply increased in size, and the number of cells does not change. By selecting the necessary lipolytic effects, you can achieve a quick and stable result. Abdominal obesity is more often classified as a hypertrophic type. Obesity that begins in childhood is genetically determined obesity, which is often accompanied by an increase in the number of fat cells. This option is less amenable to therapy, and weight loss and volume reduction occur only as a result of a decrease in the size of adipocytes, not their number.

There is also a mixed hypertrophic-hyperplastic variant of obesity, which is more common in very obese people. Which patient can we classify as "very obese"? We calculate BMI using the formula BMI = body weight (kg) / height (m ² ). If this indicator exceeds 40, then we are entitled to make a diagnosis of morbid obesity, accompanied by a very high risk of concomitant diseases. These are the patients who should be classified as "very obese".

Adipose tissue in morbid obesity has the following features: the size of the fat cells is very large - up to 300 µm3 ^versus 90 µm3 ^normally; they are closely adjacent to each other, displacing other cells, and are separated by barely noticeable connective fibers; fat vacuoles occupy the entire cell. Cell and tissue trophism is impaired. Adipose tissue makes up about 50% of the total body weight and accumulates not only in typical places, but also where it is usually absent or present in small quantities.

Consequently, such obesity can be classified as a mixed hypertrophic-hyperplastic variant with uniform distribution of adipose tissue. There are few clinically proven explanations for the occurrence of such obesity. Most likely, against the background of genetically predetermined obesity of the hyperplastic type, serious nutritional disorders occur over a long period of time in the direction of a significant excess of calories. The same variant is possible in a constantly overeating person with a hypertrophic type of obesity.

It should be remembered that a person who has repeatedly tried to lose weight on their own with the help of various "fashionable" diets, dietary supplements and medications without examination and supervision by a doctor, also easily falls into the "very obese" group. Constant fluctuations in body weight disrupt the work of endocrine mechanisms, pronounced periods of weight loss and unbalanced exit from diets can lead to a compensatory increase in the cellular composition of adipose tissue.

Unfortunately, changes in the functioning of the endocrine system, pathology of the musculoskeletal system, and the cardiovascular system sharply limit the possibility of using physical activity in such patients, so the main role is given to hardware methods and diet.

It is also necessary to remember the skin condition of such patients. Trophic disorders due to excess subcutaneous fat and vascular tone regulation disorders lead to increased sweating, hyperpigmentation, and inflammatory manifestations. Skin turgor is sharply reduced, pastosity is expressed, multiple striae are formed, which also requires adequate cosmeceutical treatment and the appointment of hardware methods for correcting these disorders.

It is known that in 98% of cases of this pathology, the root cause is an excess, compared to the expenditure, of energy substrates in the body. Energy supply is possible only through nutrition. In this situation, an adequate calorie intake of the daily diet is an axiom. It has been statistically proven that an excess of calories per day, equal to only 100 kcal, will lead to an increase in weight by 5 kg in 1 year. The required amount of daily calorie intake is easily determined using tables that take into account gender, age, and physical activity.

It is noteworthy that the standards are clearly calculated depending on gender, age and physical activity level:

• CFA I - mental work;
• CFA II - light physical labor;
• CFA III - moderate physical activity;
• CFA IV - heavy physical labor;
• CFA V - particularly heavy physical labor.

The actual (and most likely excessive) caloric content of the patient's daily diet should be determined by keeping a food diary. In the diary, the patient should indicate the composition, amount of food eaten, time of eating, and the reason for eating. By the way, this is not always a feeling of hunger. Very often there are such motivations as "for the company", "to try something new", "attractive appearance", etc. This should be paid attention to at the stage of the initial consultation.

One of the most important tasks of a cosmetologist is to motivate the patient to understand and adhere to the principles of rational nutrition, which is the key to maintaining the stability of the results obtained during the course of hardware body correction.

Theories of rational nutrition

Rational nutrition involves a balanced combination of proteins, fats, carbohydrates of food, necessary for normal functioning of the body. The term "rational" means "reasonable" (from the Latin ratio - reason).

Basics of rational nutrition:

1. compliance of caloric content with energy needs;
2. a certain ratio between the main food nutrients;
3. compliance of food composition with individual characteristics of the digestive system.

Diversity of the qualitative composition of the diet is necessary to provide the body with essential nutrients. Optimal methods of cooking food allow for the absorption of nutrients and the preservation of their nutritional value. An obligatory element of rational nutrition is compliance with the food intake regimen, even distribution of its volume during the day, which is necessary to maintain a stable body weight.

In the daily diet of a healthy person, proteins should make up 17%, fats - 13%, carbohydrates - 70%. At the same time, 55% of the daily caloric content is provided by carbohydrates, 30% - by fats, 15% - by proteins.

Carbohydrates

- is the basis of any diet. Most of them (85%) should be represented by complex carbohydrates - vegetables, fruits, dark cereals, bread and buns with bran, and only 15% - simple - bread, buns made from premium flour, white rice, semolina, pasta, sweets, confectionery.

Proteins are the main structural component of the human body. Of the total amount of proteins, 2/3 should be animal - meat, fish, poultry, seafood, and 1/3 - plant - soy, legumes, mushrooms. Animal proteins are more complete than plant proteins in amino acid composition and should provide the body's daily need for essential (not synthesized in the body) amino acids.

The food must contain ballast substances (fiber, etc.) in an amount of at least 50 g per day. These substances ensure normal detoxification and excretion functions of the body.

Maintaining normal intestinal microflora is of great importance. In the current environmental conditions, this is especially important. Fermented milk products enriched with bifido-, lactobacilli and other microorganisms that normalize the composition of intestinal microflora should be included in the diet.

Fats in the diet should consist of 2/3 of vegetable fats, containing a significant amount of unsaturated fatty acids and phospholipids; 1/3 of the dietary fats should be animal fats.

Fruits are essential in the diet of a healthy person (1-2 fruits per day), as the most important sources of organic acids, vitamins, and microelements.

Since the 1980s, the most visual illustration of rational nutrition has been the “Healthy Eating Pyramid”.

Correspondence of one serving to a certain amount of products

One serving	Number of products
Cereals	1 slice of bread, 30 g of ready-made porridge, 1.1/2 cups of ready-made pasta
Vegetables	1 cup fresh leafy vegetables, 1/2 cup chopped raw or cooked vegetables, 100 ml vegetable juice
Fruits	1 medium apple, banana, orange, 1/2 cup chopped canned fruit, 100 ml fruit juice
Dairy products	1 cup of milk, kefir, yogurt, 45 g of cottage cheese, 60 g of hard cheese
Meat	60-90 g boiled meat, poultry, fish, 1/2 tsp; 1/3 cup nuts
Fatty and sweet foods	1 serving - the less the better!

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