Morbid obesity in adults: new treatments

Morbid obesity is a problem with overweight, which has passed to the last stages. At the same time, the weight indices are more than 100% higher than the norm acceptable for a person.

[1], [2], [3], [4], [5]

Epidemiology

Statistics show that obesity in severe form (morbid) is observed in 3-5% of adults in countries with a high level of economic development.

[6], [7], [8], [9], [10], [11], [12], [13], [14],

Causes of the morbid obesity

The causes of morbid obesity can be such factors:

• a variety of infections that disrupt the metabolic processes in the body;
• adrenal gland diseases;
• injuries and diseases of the pituitary gland;
• diseases of the gonads or thyroid gland.

It is usually quite difficult to separate the various causes of the morbid form of obesity, since in this case the problems affect to some extent all the glands responsible for internal secretion.

[15], [16], [17], [18], [19],

Pathogenesis

With this disease, the essence of the process of deposition of fat stores is that an imbalance is created between the energy supplied under the guise of eating into the body, as well as its further expenditure. There are also additional factors such as hormonal disruptions - which increase the process of fat deposition, but in general, the pathology development mechanism remains as described above.

[20], [21], [22], [23], [24], [25], [26], [27]

Symptoms of the morbid obesity

The main symptom of this disease is overweight, which can be determined with the help of BMI. To do this, you need to divide your weight (in kg) by your height in a square (in m). For example, with an increase of 1.70 m and a weight of 80 kg, BMI is calculated as follows: 80 / 1.70 ² = 27.68. The normal BMI in men is 20-25, and in women - 19-23.

Among the external symptoms of morbid obesity are the following:

• presence of the second chin;
• the appearance of fat folds on the sides and on the abdomen;
• legs in their shape resemble trousers "riding breeches";
• underdevelopment of the muscular system.

Later, when obesity begins to occur such signs:

• increased sweating;
• emotional instability (frequent feeling of nervousness or irritability);
• a constant feeling of drowsiness;
• the appearance of dyspnea;
• nausea and general weakness;
• limbs begin to swell;
• permanent constipation, and in addition, pain in the joints with the spine.

Against the background of morbid obesity, such diseases as ODA pathology, cardiovascular system, and liver are often developed. They are manifested in the form of increased blood pressure, pancreatitis and arthrosis of the joints.

Stages

Morbid obesity begins with the transition of the disease to the 3rd or 4th degree.

[28], [29], [30], [31], [32], [33]

Forms

There are several types of morbid obesity:

• Alimanno-constitutional. This type of obesity can develop due to such reasons: overeating from the earliest childhood, the acquired diet (due to national traditions), heredity, and hypodynamia. In addition, the development of obesity can be affected by disorders in the processes of fat metabolism and the state of the centers of the hypothalamus, which are responsible for appetite and satiety. The cause may be the structure of adipose tissue, but in addition hormonal failure (during menopause, pregnancy, or GV).
• Cerebral. It develops due to damage to the skull, brain tumor, neuroinfection or prolonged increase in intracranial pressure.
• Endocrine. It occurs as a result of a primary disease of the endocrine glands (with hypothyroidism, Cushing's syndrome, insulinoma or hypogonadism).
• Medicamentous. It develops because of prolonged use of drugs that increase appetite or activate liposynthesis.

[34], [35], [36]

Complications and consequences

Among the most common complications of the disease are violations such as type 2 diabetes mellitus, hypertension, nocturnal sleep apnea, and various pathologies of the spine and large joints.

[37], [38], [39], [40], [41]

Diagnostics of the morbid obesity

Patients with obesity are initially shown to see a doctor, during which the weight of the patient, as well as BMI, should be determined. In addition, a survey is conducted to find out the lifestyle of the patient: learn about the diet and diet, exercise it, exercise, etc. At the same time, background diseases (which the patient was ill and sick at the moment) are also identified - this is considered the main task of the doctor.

Analyzes

To make a diagnosis, you may need blood tests - on the level of sugar, lipoproteins, triglycerides, and cholesterol.

Instrumental diagnostics

In addition, instrumental diagnostic procedures are also carried out:

• Ultrasound;
• MRI, as well as CT;
• the NMR procedure;
• radiography;
• ECG together with echocardiography.

[42], [43], [44], [45], [46], [47], [48], [49]

Treatment of the morbid obesity

For the treatment of morbid obesity, it is necessary to follow a selected diet, exercise, and medication. It should be noted that the range of modern anti-obesity drugs is rather small, and all of them have contraindications and side effects.

Medications

Drug therapy consists of drugs with peripheral, as well as central effects. Selection of the drug occurs for each patient individually - to take into account possible contraindications and effectiveness.

Medication Orlistat has a peripheral effect. It blocks intestinal lipases, thereby contributing to a decrease in fat absorption. As a result, the body begins to lack energy, thereby reducing body weight. In addition, due to the decrease in the number of FFA and monoglycerides in the intestinal lumen, the absorption of cholesterol and its solubility are weakened, thereby reducing hypercholesterolemia. The advantage of the medication is that it is allowed to prescribe to patients of any age group, because it acts only in the gut, without affecting other systems with organs. Among the side effects are an oily consistence of discharge from the anus, gas separation with a small amount of discharge, and in addition urgent urges to empty the bowels, more acts of defecation, incontinence, and steatorrhea. In some cases, pain in the gut (similar to colic) is possible - this is the reason for the withdrawal of the medication.

Sibutramine has a central effect - it is an inhibitor of OZSiN. The drug is contraindicated to take with MAOI, as well as with intolerance of components of drugs, bulimia or anorexia. In addition, if you have a history of sick diseases of the cardiovascular system (such as CHF or IHD, circulatory problems, heart disease, tachycardia, as well as arrhythmia and hypertension in severe form), disorders in the work of the kidney or liver, thyrotoxicosis, prostate adenoma or glaucoma. But it is Sibutramine is the most effective drug against morbid obesity (when combined with other methods of therapy). The appointment of an adequate dose (from 10 mg per day with a gradual increase to 15-20 mg (this is individually, depending on the patient's feelings)) and the correct intake of drugs (1-2 tablets in the morning (10: 00-11: 00 hours), regardless of food) will allow you to get the desired result. Weight decreases naturally, because the patient begins to eat less. Due to the fact that Sibutramine is a central drug, and it has some contraindications, it is recommended that it be prescribed only to patients entering the young age category and not having serious accompanying pathologies.

Meridia is a drug with a central effect - treatment with it is carried out only under the supervision of a therapist who will take into account all possible contraindications and limitations.

Xenical weakens the process of absorption of fat in the intestines, thereby inhibiting the absorption of food that enters the body with food (up to 30%). Because of this, it should be borne in mind that the likely side effect of taking the drug will be diarrhea (in some cases quite pronounced).

Vitamins

In morbid obesity, patients often have a deficiency in the body of vitamin D.

Physiotherapeutic treatment

Of the existing methods of physiotherapy for morbid obesity, the following are used:

• bitemporal inductothermy;
• mineral water;
• hydro-, and also balneotherapy (in this case, the effect is carried out by neurohumoral mechanisms that cause a reflex influence on the body);
• hydroxyperthermia;
• bathing procedures of several types: dry-air (in the sauna), and in addition infrared (often using the short-wave region of the UFI - about 780-1400 nm) and steam;
• treatment with mud.

Alternative treatment and herbal treatment

Among the methods of alternative treatment of morbid obesity:

• use a decoction of marigold, birch leaves, thyme, and poplar - add it to the bath with water, which you then take (about 20 minutes);
• prepare a herb collection that includes such ingredients - birch leaves, blackberries, and mother-and-stepmother. A mixture of these ingredients (1 tablespoon) should be added to boiling water (1 glass) and infused for 1 hour. Drink tincture should be in the morning or before dinner (fresh).

Point massage in morbid obesity

Acupressure or acupressure is one of the traditional methods of Chinese medicine. On the body, there are several points that affect weight loss - they can be stimulated by pressing with your fingertips. These bioactive points are located in different areas of the body. Correctly found point due to the pressure in the massage will slightly hurt, and this is normal. But if the pain is too strong, you need to immediately stop pressing on it.

The first point: obesity in people often begins due to regular overeating, so you should stimulate the point that is responsible for the saturation center. It is located next to the ear. To determine the location of the point, move up / down with the lower jaw and track with your finger the exact area of movement (where the jaw movement will be felt and the desired point is located). On this place you need to press and hold for 2-3 minutes. Do this massage before eating.

The second point: sometimes obesity develops due to a weakened digestive system. To have a positive effect on the digestive tract, you should massage the E-36 point, which is located about 4 fingers down from the patella (next to the outer side of the tibia). To find it, you need to put a palm on your knee. Her index finger, which will be on the outer surface of the leg, will be in the area of the point - there is a small depression. Press on it should be about 15-30 seconds. It is important to clarify that these points need to be stimulated on both legs (to avoid imbalance in the body). Pregnant exposure to this point is contraindicated.

Third point: it is also called the point number 9 of the meridian of the pancreas with the spleen. It is located very close to the point E-36 - from it you need to move your fingers closer to the inner side of the leg and rise slightly higher, to the knee, to the point with a small depression. Stimulation of this place promotes regulation of water exchange processes, which will be especially useful for those who have problems with excretion of water from the body.

Fourth point: is the point of the meridian of the large intestine and is located next to the elbow - on the inner surface of its fold. In order to find this place, you need to move your finger along the fold in the direction of the inner surface of the joint until the moment you feel a depression. When performing a massage, it is recommended to keep your hand close to your torso. You should massage the left hand first, and then the right one.

Surgery

There are also methods of surgical treatment of morbid obesity. The method is quite radical, it allows you to get rid of obesity right away. Today, there are several different methods of conducting the operation - both irreversible and reversible. Among the first - such a procedure as gastric bypass surgery. In addition to her, there are other ways - a stomach bandage, sleeve gastroplasty, and in addition, liposuction of the abdomen.

It should be noted that the operation is not allowed to be performed if the patient is a drug addict or toxicomaniac or abusers of alcoholic beverages.

Nutrition and diet for morbid obesity

The main principle of low-calorie diet is the need to create such a diet, in which a person can be saturated with low-calorie food, which, moreover, will be useful for the body. The number of calories that a person needs per day is about 1600. At the same time, the diet should not contain a lot of liquid, sugar and salt, as well as flour products (bread too).

The menu with this diet should look something like this:

• For breakfast, a small portion of fat-free cottage cheese and 1 apple;
• For lunch, soup made on meat broth, in which there may be some meat, and in addition canned green peas and unsweetened apple mousse;
• For dinner, a carrot and a decoction of rose hips;
• As a late dinner you can drink kefir (1 glass).

It is allowed to increase the number of meals to satisfy the feeling of hunger. But this will slightly reduce the amount of food eaten. In this case, you should adhere to such a diet:

• The first part of the breakfast (early) is the egg fried in sunflower oil, as well as a simple salad without any refueling and coffee;
• The second part of the breakfast (late) is a little boiled cauliflower;
• At lunch you can eat a plate of green cabbage soup, as well as 2 apples;
• At an early dinner you are allowed to eat cottage cheese and drink it with a rose hip;
• For a late supper, drink kefir (1 glass).

With such a low-calorie diet, it is necessary to arrange so-called "unloading days". It should happen once a week. On such days it is recommended to eat as follows:

• Milk day - drink kefir or milk after every 2 hours;
• Vegetable day - for a day to eat about 1 kg of the same type of vegetables (necessarily raw) - such as carrots, cabbage, tomatoes, etc .;
• Curd day - use cottage cheese (0,5 kg), along with coffee and sour cream (alternating with a decoction of rose hips);
• Apple day - there are fresh apples (in the amount of 1-1.5 kg), approximately the same portions throughout the day;
• Meat day - within a day it is allowed to eat a little boiled meat (about 300 g), filling it with a side dish of vegetables, and also to drink tea from dog rose and coffee.

Prevention

Among the preventive methods against obesity are the following:

• observe a balanced, as well as useful for the body diet;
• remove from the diet harmful food - such as sandwiches, chips, soda water, etc .;
• to lead a mobile way of life, to go in for sports;
• control your own weight.

[50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60]

Forecast

Morbid obesity often has a very unfavorable prognosis. In general, obese patients die earlier than people with normal weight. Among the main causes of death are possible bleeding in the brain, heart failure, complications of Liver Cancer, myocardial infarction, croupiform pneumonia and other infections, and in addition, surgical intervention, etc.,

In the absence of treatment, the disease progresses, and the severity of complications and the risk of their development increase in proportion to the increase in the amount of fat stores, their distribution along the body, and also the absolute muscle mass. After weight loss, the majority of patients return to the weight they had before treatment for the next 5 years, so it can be concluded that obesity requires a lifelong control program, as with any other chronic pathologies.

[61], [62], [63], [64], [65], [66], [67]