Treatment of obesity 2 degrees: diet, nutrition, medication, exercise

In the previous article, we talked about what obesity is, what are its types and types, how to diagnose obesity of the 2nd degree and the pathologies associated with it, i.e. Which became the cause or effect of obesity. Now, remembering the main points related to the disease itself and its diagnosis, let's try to figure out how to effectively deal with the problem of excess weight and prevent this in the future.

A little bit about obesity of 2 degrees

Let's remind at once that obesity is not just extra pounds and a magnificent figure. This is a disease with which you must actively fight, otherwise its consequences will affect many organs and systems of our body. Obesity of 2 or medium degree significantly increases the risk of concomitant diseases, which not only negatively affect the patient's well-being and affect his physical activity, including professional activity, but can also be life-threatening.

In itself, obesity means increasing the thickness and volume of subcutaneous and internal fat. When it comes to the large amount of fat that forms around the internal organs and squeezes them, breaking their structure and functionality (visceral obesity), one must understand that this pathology is especially dangerous for the patient's life and health, since it causes the greatest number of complications.

Distinguish between primary and secondary obesity. They differ in that, in the first case, excess eating and sedentary lifestyle become the cause of pathology, while secondary obesity is a symptom of other pathologies associated with disorders in the work of various parts of the brain (cortex, pituitary gland, hypothalamus), adrenals, endocrine bodies.

Primary obesity is also called alimentary or exogenous-constitutional. This is a fairly common type of obesity, and, according to statistics, the increase in the number of people with excess weight (and obesity in particular) is largely due to:

• inadequate nutrition (food saturated with fats and carbohydrates, salty and spicy dishes, alcoholic drinks and sweet soda, stimulating appetite),
• lack of physical activity (sedentary work, the weekend in front of the TV, computer games, replacing active outdoor activities, etc.).

Hypothalamic and endocrine obesity is already associated not so much with inaccuracies in nutrition, as with the pathologies of the corresponding organs. Although here the quality and nutritional value of the food you eat is not the least important.

By the arrangement of fatty obesity obesity is divided into several types:

• Hinoid - hips and buttocks,
• abdominal - abdomen,
• mixed - throughout the body,
• Cushingoid - all over the body except for the hands and feet,
• visceral - on internal organs.

To understand that a person has obesity of the 2nd degree on the following grounds:

• noticeable ugly fullness,
• the appearance of shortness of breath, not only under heavy loads, but also at rest,
• increased sweating,
• increased heart rate in motor activity,
• causeless weakness,
• the appearance of edema on the hands and feet in the summer.

To clarify the diagnosis will help measure the body mass index: BMI = m / h ². In this formula, m stands for weight, and h for human growth. If the BMI is more than 30, but less than 39.9, then the person has become obese from the lung to the average and it will take some time to live with the diagnosis of "obesity of the 2nd degree".

But to live is not to be reconciled. The second degree of obesity is not a verdict at all. The main thing is to patiently fulfill the appointments and recommendations of the doctor plus to be persistent in achieving your goal, which is a return to a normal, healthy life. So let's figure out how to deal with the problem of obesity and make sure that it never returned.

[1], [2]

Indications

The body mass index (BMI) above 30 does not yet mean that the patient should start taking medications to reduce weight. First, the therapy is carried out with the help of diet and exercise, and based on the results of such treatment the doctor decides on the advisability of drug therapy.

Indications for prescribing drugs are the following situations:

• non-pharmacological therapy for 90 days gave an insignificant decrease in body weight (less than 5%),
• several such treatment courses were conducted, but the result was negative or insufficient,
• excess weight threatens the development of complications due to the individual characteristics of the organism or there is a hereditary predisposition to the development of pathologies such as diabetes, heart and vascular disease.

[3], [4], [5], [6], [7], [8]

Contraindications

Contraindications to medical therapy are:

• children under 16 years of age,
• older age (65 years and over),
• pregnancy,
• lactation.

In addition, each of the means for weight reduction can have its own contraindications, which also need to be taken into account when proceeding to serious treatment of pathology.

[9], [10], [11], [12], [13]

The treatment protocol

Effective and safe drugs for fighting obesity is not so much. The bulk of what the Internet offers us in this regard, either does not have the properties described in the manufacturer's instructions, or can be effective, but cause some harm to health. Both are dangerous. The use of "dummies" makes a person disappointed in the treatment and dropping their hands, and dangerous drugs for health - to treat new pathologies caused by the reception of these miracle drugs.

Effective treatment is unlikely to be possible if the emotional-mental state of the patient leaves much to be desired, which is often observed when working with people who have significant excess weight. Therefore, often, along with other therapeutic measures, psychotherapy sessions are used.

Diet for obesity of 2 degrees

Since obesity is a consequence of improper eating behavior, then without its correction, no treatment will be effective. To put it differently, many dietitians agree that a diet for obesity of the 2nd degree is the main method of fighting the disease and is equated with medical procedures.

A universal diet, which would help everyone equally effectively lose weight, simply does not exist. Sometimes you have to try several diets, while you stop on the one that gives the greatest weight reduction. The choice of diet should be based on the characteristics of nutrition for obesity of the 2nd degree.

The main provisions that need to be based on the selection of an effective diet are the following requirements:

• Food should be simple, but with sufficient nutritional value. The patient's body should not suffer from a lack of vitamins, microelements, amino acids, etc.
• A large amount of fiber in foods and dishes will help clean the intestines and accelerate the process of weight loss.
• Low calorie foods, as a necessary condition for reducing body weight, is a single condition for all diets.
• In the patient's diet, there should be no sweet carbonated drinks (they are replaced with mineral water and natural compotes of fruits and berries), honey and sweets, ice cream, high-calorie desserts, fatty meat and fish varieties, sausages and smoked products, preserves, pickles, spices and sauces , alcoholic beverages.
• It is necessary to minimize the consumption of sugar and salt, butter and fats (giving preference to vegetable oils), dough products (especially puff, yeast and sand), fried and hearty dishes. Dairy products should be very low in fat, ideally - skim. Fruits - low in sugar. Bread is better to take gray or black and preferably with bran.
• Portions should be significantly less than usual, while the frequency of food intake should be increased to 6 times a day.
• Useful fresh vegetables and non-sweet fruits, rich in fiber, green leafy vegetables and root vegetables, rich in vitamins and trace elements, low-fat dairy products, green tea.
• Unloading days. They are mandatory for cleaning the body of harmful slags and toxins that prevent weight loss. On this day the patient should eat only certain dishes. The best option is considered to be apple and curd day (but the cottage cheese should be low-fat). You can also sit on vegetables for a day, with the exception of potatoes.

The daily ration should contain a lot less calories than before, and yet the figure should not be lower than 1200 kcal.

Here is an approximate diet menu for obesity of the 2nd degree, not forgetting that the multiplicity of meals increases and portions are reduced by half compared to the usual:

1 Breakfast:

• boiled meat, sauerkraut (not pickled!),
• Coffee (with milk, but without sugar, sweetener - xylitol).

2 Breakfast:

• skim cheese,
• green tea without sugar.

Dinner:

• borscht on vegetable broth without meat,
• boiled chicken meat, vegetables boiled or baked,
• compote of unsweetened fruits and berries.

Snack:

• a large apple (fresh or baked),

1 Dinner:

• boiled or baked potatoes,
• low-fat fish (boiled, baked or steamed)

2 dinner (light snack at night)

• A glass of kefirchik with zero percent of fat content.

Nutrition for obesity of the 2 nd degree, in spite of its low calorie content, should still be varied. Instead of borscht you can eat soup or vegetable stew instead of baked potatoes to make a casserole from carrots or salad from boiled beets and low-fat sour cream, etc.

You need to eat more unsweetened fruits and raw vegetables (if possible), include a small amount of cereals (oat, rice, buckwheat), fiber-rich, eggs, dairy products with low fat content in the diet.

The main thing for obesity of the 2 nd degree is the desire to lose weight. So, it is necessary to be reserved by patience, accustoming itself to eat gradually and only useful food.

[14], [15], [16], [17]

Physical activity for obesity of 2 degrees

By itself, a diet, no matter how effective it may be, is unlikely to produce a positive result if a patient with obesity of grade 2 does not give proper attention to physical activity. And in this situation a big role is played not only by special exercises, but also by ordinary daily walks, swimming, hiking, cycling and even active work at the dacha.

As for physical exercises for obesity of the 2nd degree, they can be selected independently. Still, it's not about correcting individual parts of the body, but about reducing the weight in general, which means that any exercise will be useful. But you can trust the case and a specialist who will pick up a set of exercises that will help to get rid of extra pounds as quickly as possible, and not allow pity for yourself to overpower common sense and the desire to be healthy.

In addition, with obesity of grade 2, as with any disease, it is better to select exercise therapy, given the patient's age and health status, since obesity of moderate and severe severity is often accompanied by the development of various diseases. Select an effective exercise, taking into account the characteristics of the body can only a doctor. In this case, you will have to deal 3 to 5 times a week and not less than half an hour a day.

Walking, water procedures, gymnastics elements are the best start to a day for people with excess weight. To support their action will help physical activity during the day and visits to gyms and fitness clubs, where an experienced instructor will also provide all possible help in the fight against excess weight.

For children with obesity, parents should be examples of physical activity. Only they can interest the child to actively move, organizing walks in the fresh air, hiking, active recreation by the water, attracting to mobile games and work.

Drug therapy for obesity

Drugs for obesity of grade 2 doctors appoint with reluctance and only in the event that diet and exercise do not give a visible positive result, and excess weight threatens the development of dangerous pathologies of health.

The drug treatment of obesity in some way is a trial and error method. In the world simply there are no equally effective for all patients drugs that help get rid of excess kilograms. And here is the task of a specialist to choose exactly the drugs that will give the best result.

There are 2 groups of drugs that help to effectively fight overweight:

• Anorectics are drugs that affect the human brain, in particular the saturation center located in the hypothalamus. They dull the feeling of hunger, reduce appetite, helping to better tolerate the restrictions in food, presumed by diet. In our country, drugs based on sibutramine are distributed: Reduxin, Lindax, Meridia, Slimia, Goldline, and less often prescribe ampredramone (Fepranon) and phenylpropanolamine (Dietrin) medications.
• Blockers of fats and carbohydrates. These drugs interfere with the absorption of fats and carbohydrates, responsible for weight gain, in the intestines. And although their effectiveness is proven even with normal nutrition, with obesity of 2 degrees they will give a decent result only in conjunction with diet and exercise. The most popular drugs are drugs based on orlistat: the eponymous drug "Orlistat", "Xenical", "Orsoten", "Listata", etc., as well as dietary supplements such as "Chitosan", "Reduxin-light", etc.

[18], [19], [20], [21], [22],

Effective drugs for obesity of 2 degrees

One of the most popular drugs from the group of anorectics used for obesity are capsules "Reduxin". They are prescribed in the event that the BMI exceeds 30 kg / m ², which is observed with obesity of the 2nd degree.

[23], [24], [25], [26]

Reduxin

It is considered a combined preparation, since its action is due not to one, but to two basic components - sibutramine and single-crystal cellulose. The first has an effect on the receptors responsible for satiety and appetite, and cellulose, due to its pronounced sorption and some detoxification properties, effectively cleanses the body, and the intestine in particular, from harmful microorganisms and their products, slags, toxins, allergens and other unnecessary substances, contributing to rapid weight loss.

" Reduxin " - a serious drug that affects the brain. Assigning yourself to yourself is a big risk for your health, because like every other drug, Reduxin also has a lot of other contraindications to its use besides individual drug intolerance. This and multiple heart diseases, and circulatory disorders in the brain, and an excess of thyroid hormones, and severe renal or hepatic pathologies, and angle-closure glaucoma.

For men, this medication is not prescribed for prostate adenoma. It is forbidden to take a drug medication and with such a rare disease as pheochromocytoma.

Do not prescribe the drug to pregnant women and those who breastfeed. Contraindicated, he and patients who are not yet 18 years old, as well as the elderly at the age of 65 years and older.

Do not prescribe "Reduxin" and people who have a pathological dependence, both medicinal, and narcotic or alcoholic.

The drug intake should not be combined with other central medication, used for weight correction, with MAO inhibitors (at least 14 days after the end of therapy with them), medications affecting the psyche and the central nervous system, drugs to correct sleep disorders based on tryptophan.

Therapy "Reduxin" should be carried out under the supervision of a specialist doctor after a thorough examination of the patient. This is a necessary requirement, as the drug has several more contraindications associated with the cause of body weight gain. So the medicine is not prescribed if there are organic causes of obesity associated with internal pathologies, and not with banal overeating (the same hypothyroidism).

Inadvisable, and even dangerous, will be taking the drug in such severe food pathologies as anorexia nervosa or bulimia, with mental disorders, motor tics (Tourette's syndrome).

Method of application and dosage. The drug is recommended to apply 1 time per day (preferably in the morning) regardless of eating. Capsules swallow whole, squeezed with water in sufficient quantities.

In this case, the treatment should be started from the drug with a dosage of 10 mg (the optimal daily dose with good tolerability, which, if necessary, can be halved). Ideally, however, the physician, but not the patient himself, should be engaged in determining the necessary dose in treating obesity of grade 2.

The drug intake should be combined with diet and physical activity, as well as constant monitoring of body weight changes. If the weight of the patient decreased by less than 5% during a month of therapy, they switch to treatment with a drug with a higher dosage (15 mg).

Indicative is the three-month course of therapy "Reduxin", during which the patient's body weight should decrease by at least 5%. If this is not observed, it is more expedient to look for other methods of combating obesity.

It is recommended to cancel the drug if, after a good result is achieved, the reverse process is observed (weight gain of 3 or more kilograms).

The duration of the therapeutic course is determined by the doctor, based on the results and health status of the patient, but in any case should not exceed 2 years.

Reception of the drug may be accompanied by multiple side effects, which are often observed during the first month of treatment with "Reduxin" and are not dangerous or irreversible. It can feel dry mucous, pain in the head, drowsiness, itching on the skin. Some patients complain of nausea and lack of appetite, constipation, apathy or anxiety, numbness of the limbs, cramps, swelling. In the cores there is an increase in heart rate and an increase in heart rate and blood pressure. Increased risk of bleeding. Women complain of soreness with menstruation. Some people note the development of the flu-like syndrome.

All the undesirable symptoms should be reported to the doctor in charge. At the same time, it is necessary to measure pressure and heart rate regularly (once every 2 weeks). If the drug causes an increase in blood pressure, it must be discarded.

Since in our country only anitetic drugs based on sibutramine have been distributed, all of the above can be applied to Lindax, Goldline, Meridia, and others with a similar composition.

Another thing drugs that block the absorption of fats and carbohydrates, There is already a variety of both in the composition and in the mechanisms of action.

Here you can identify drugs that interfere with the absorption of fats, and blockers of carbohydrates. The first group includes preparations based on orlistat ("Orlistat", "Xenical", "Orsoten", etc.), as well as most dietary supplements (the same popular "Chitosan", bioadditive "Reduxin Light"). Among the drugs of the second group is the hypoglycemic drug "Glukobay" based on acobase, preparations based on metformin (Glucophage, Gliiformin, Siofor, etc.), hypolipidemic "Lipobay" with the active substance cerivastatin, enterosorbent, used for treatment of obesity of 2 degrees, even in children, "Polyphepan".

Xenical

It is one of the most often prescribed drugs that limit the absorption of fats. Its action is based on blocking the production of the digestive enzyme lipase, responsible for the assimilation of edible fats (their digestion and absorption in the digestive tract). Thus, fats are eliminated from the body in virtually unchanged form.

Xenical is not absorbed into the blood, but acts directly in the gastrointestinal tract.

Contraindications to the use of the drug are: cholestasis (or stagnation of bile, deficiency of its admission into the 12-colon), syndrome of chronic malabsorption, when nutrients and vitamins from food are digested in insufficient quantities, and, of course, individual intolerance of the drug. With epilepsy, it is possible to increase the frequency of convulsive seizures.

Method of application and dosage. Take the drug is recommended during meals or not later than an hour after it. A single dose of the drug is 120 mg of orlistat (1 capsule). The frequency of reception depends on the number of meals a day, because the drug must be taken with each main meal. It is recommended that eating foods containing a significant amount of fats, proteins and carbohydrates be limited to 3 times a day. In this case, the drug is limited to 3 capsules per day.

If the patient for some reason does not eat in the allotted time, taking the drug at this time is considered optional. The same can be said about the intake of low-calorie food with a minimum content of fat and carbohydrates.

It makes no sense to consume more than 3 capsules a day, since such treatment does not give the best results.

The drug is used with great care for the treatment of obesity of grade 2 in children under 12 and patients with impaired liver and kidney function.

Despite a small number of contraindications, the drug, however, has a significant number of side effects. Most often observed: bloating, changes in the type of stool (oily stool) and stool frequency (more frequent urges for defecation, stool incontinence), unpleasant sensations (pain of varying intensity, feeling of heaviness) in the abdomen, headaches. Women complain of malfunctions in the menstrual cycle.

Less common are non-specific symptoms such as respiratory and urinary tract infections, inflammation of the mucous gums, impaired teeth integrity, fatigue and anxiety. Often allergic reactions of varying severity (rash, mucous throat swelling, bronchospasm, anaphylactic reactions). In rare cases, the development of pathologies such as pancreatitis, hepatitis, diverticulitis, nephropathy.

Reduxin Light

Bioadditive to combat excess weight on the basis of conjugated linoleic acid and vitamin E. It also blocks the absorption of fats, which results in effective weight loss and effective dietary therapy and sufficient physical activity.

Despite the fact that this drug is not a full-fledged medicine, it has its own contraindications for use. These are chronic cardiac pathologies, pregnancy and lactation periods, age under 18 years, hypersensitivity to the components of dietary supplements.

Like "Xenical", "Reduxin Light" is recommended to take with each main meal in the amount of 1 or 2 capsules. The maximum daily dose is 6 capsules.

The therapeutic course is from 1 to 2 months. At the same time, such courses should be held at least 3 times a year with an interval between courses of not less than 1 month.

Side effects of the drug in the instructions to it are not described. Nevertheless, there is confirmed information indicating a link between dietary supplements and the development of such pathologies as diabetes, cholelithiasis and urolithiasis, hypervitaminosis.

Glucobay

A drug that blocks the absorption of carbohydrates. Acarbose in the drug blocks the production in the pancreas of alpha-glucosidase, responsible for the splitting of sugar into glucose and fructose. This leads to the fact that complex sugars lose the ability to be absorbed into the intestines and get into the blood. Such an effect is effective both in diabetes mellitus and for the treatment of excess weight, in particular obesity of the 2nd degree.

Take Glucobay in a daily dosage of 300 mg. Multiplicity of intake 3 times a day. It is better to take the tablet immediately before eating whole or chewing with food.

If the effect is insufficient after 1-2 months of therapy, the dosage can be increased to 600 mg per day.

Contraindications to the use of the drug are chronic pathology of the gastrointestinal tract with impaired absorption of nutrients, pathology leading to flatulence, kidney failure, pregnancy and lactation periods, age younger than 18 years, hypersensitivity to the drug.

Among the side effects can be identified: bloating and abdominal pain, stiffening of the stool, nausea, impaired intestinal permeability, occasionally swelling, allergic reactions in the form of rashes on the skin.

They help in curing many pathologies, including obesity of the 2nd degree, and preparations called enterosorbents, which bind and remove harmful substances and toxins from the intestine, contributing to rapid weight loss.

Polyphepane

A drug from the genus of intestinal sorbents, effective in the violation of lipid metabolism, including obesity. It is available in the form of powder, tablets or granules for internal use.

The main contraindication to the use of a sorbent is hypersensitivity to the drug. Nevertheless, it is undesirable to use in case of an exacerbation of stomach ulcers and duodenal ulcers, with intestinal atony and gastritis, taking place against a background of low acidity of gastric juice.

Take the drug is recommended for an hour and a half before eating. The powder is diluted in ½ cup of water, the tablets are simply washed down with water. The daily dose is 12-16 tablets (for adults) or 8-10 tablets (for children).

The daily dose for the drug in powder and granules is calculated based on the ratio: 0.5-1 grams per kilogram of weight per day. The daily dose is divided into 3-4 doses.

Duration of treatment can vary from 3 to 14 days at the doctor's discretion.

Reception of the drug in rare cases can be accompanied by constipation and allergic reactions.

Other methods of treatment of obesity 2 degrees

Drug therapy for obesity will not be successful if it is not supported by adherence to a special low-calorie diet and maintaining a physical form. But even in this case, the fight against excess weight will continue for more than one day.

Treatment of obesity of the 2nd degree is a long process and requires the patient's will power and positive attitude. Often patients who do not see the result in the next couple of months, drop their hands and fall into depression. To avoid such situations, it is advisable to supplement the therapy of obesity with sessions of psychological help and the appointment of antidepressants.

In psychotherapeutic classes and hypnosis sessions, patients are taught not only to critically treat their problem, but also to develop proper eating habits, self-control during meals, the ability to resist their desires and surroundings during feasts, the ability to deal with stress without resorting to food and t .

Good results are also shown by the physiotherapeutic treatment of obesity, which, according to experts, stands at the 2nd place of honor among the other methods of treating obesity 1, 2 and 3 degrees. The goal of physiotherapy is to correct the endocrine system, normalize the metabolism, stimulate the body's internal forces to fight with pathology.

We have already mentioned the benefits of exercise therapy as one of the methods of physiotherapy. It is worth noting and such a moment as veloergometric tests, which are necessary because the reserve forces of the body are declining with an increase in the degree of obesity.

A great addition to the physical therapy, helping to increase the tone and relieve fatigue, is massage. A good effect is provided by sweating procedures (in the absence of cardiovascular pathologies). Examples of such procedures are light, steam and mud baths, wet wraps, paraffin applications, hot procedures (for example, a sauna, a sauna).

Principal in this regard is the holding of hydro- and balneotherapy procedures. For example, contrast baths with a course of 15-18 procedures, conducted daily, sulfide, carbon dioxide, radon, sea, iodide-bromine baths. A wide distribution for obesity of the 2nd degree was received by various souls: Charcot's douche (from 10 to 16 procedures with a water temperature of 30-35 degrees and a spray pressure of 1.5 to 3 atmospheres, the duration of the procedure is 3-7 minutes), underwater shower massage, fan shower and so on.

A wide variety of physiotherapeutic procedures contribute to an effective weight loss in obesity. Unfortunately, not all of them are available in medical institutions, therefore, for obesity of the 2 nd degree, patients are often referred to specialized sanatoriums equipped with various equipment for carrying out various physiotherapeutic procedures. For example, for climate therapy (aerial, helio, thalassotherapy), hyperbaric oxygenation, oxygen foam intake. In parallel with this, the reception of mineral water, reducing the resorption of edible fats ("Essentuki" 4 or 20, "Narzan", "Borjomi", etc.).

Alternative treatment of obesity 2 degrees

Medicamentous treatment of any disease is fraught with the development of various side effects, which are often more dangerous than the disease itself. Therefore, many patients are looking for an alternative to such treatment in prescriptions of alternative medicine. And there is something in this, especially if it concerns the treatment of obesity of the second degree, which in itself is not as dangerous to health as anorexic drugs used to reduce appetite.

But you can reduce your appetite with alternative medicines. Perfectly reduces the appetite of the broth from the corn stigmas. To prepare the medicinal composition take 10 g of raw materials and pour a glass of boiling water, then boil for half an hour and leave to cool. The filtered broth is taken 4 times a day before meals at 3 tbsp. Spoons.

It helps to fight excess weight and oats broth (whole grain, not cereal). For its preparation 2 tbsp. Spoons of grain in the evening cook until ready in a liter of water. Leave to insist until morning, then filter and drink half a glass three times a day.

To combat excess weight, ginger tea with honey is also effective , which is better prepared on the basis of natural green tea, adding to it an infusion of ginger root.

Another delicious and healthy drink - chamomile tea with lemon (1 cup of tea takes half a lemon).

Help to fight weight and fasting days on fruit and vegetable juices, and lemon juice for weight loss is effective .

Herbal treatment in many cases can perfectly replace the medical treatment of obesity of the 2nd degree. Effective are chamomile, lemon balm, malva, senna, nettle and other herbs.

[27], [28], [29], [30], [31]

Homeopathy for obesity

One of the relatively safe methods of treating obesity of the 2nd degree is homeopathy. And here we already find a wide range of drugs that help fight both the underlying disease and its consequences.

With alimentary obesity against the background of overeating and consumption of high-calorie foods, Nux vomica preparations, Ignacia, Acidum phosphoricum and Anacardium will be effective.

If there are disorders of fat metabolism, the homeopathic doctor may prescribe such drugs as Tui, Pulsatilla, Fucus or Graphitis.

In addition to the main homeopathic preparations, drainage funds are prescribed, which help to strengthen the action of the former and speed up the result. These drugs include Likopodium, Taraksakum, Solidiga, Cardus Marianus.

Treatment with homeopathic remedies also takes into account accompanying diseases. Thus, in case of cardiac pathologies, Arnica or Lachezis may be prescribed, in gastrointestinal diseases - Calcium carbonicum, in diseases of the respiratory system - Ipecacuana or Kalium iodate, etc.

Good feedback from doctors and patients and about specific drugs such as Grace (5 granules 3 times a day half an hour before meals) and Dietol Compositum (8 granules 5 times a day half an hour before meals or an hour after eating) . But these medications should also be prescribed by a homeopath doctor, which takes into account not only the existing diseases, but also the characteristics of the patient's body.

Conclusion

Surgical treatment of obesity of the 2 nd degree is shown only when other methods of therapy proved to be ineffective, and excess weight threatens with complications, as, for example, in type 2 diabetes, hypertension, varicose veins. At the same time, the BMI is in the range of 33-35 kg / m ².

Bariatric surgery in this case resorts to such operations as gastric bypass and adjustable gastric banding, carried out laparoscopically, without incisions. Physicians are resorting less often to popular once-liposuction, because it gives a temporary effect and is not always safe for health.

But in any case it is easier to prevent the disease than to treat it later, which is a long and difficult process in the case of obesity. And measures to prevent obesity are fairly simple: proper nutrition plus physical activity to compensate for energy that enters the body along with calories, which then settles in the form of fat deposits, if it is not used up.

[32], [33], [34], [35], [36]