Nutritional support of figure correction programs

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

In 1997, the World Health Organization (WHO) recognized obesity as a "global epidemic" and took the problem under control. This is surprising, because according to WHO experts estimates, the number of obese people in the world will exceed 300 million by the year 2005. Note that if we take as 100% the death rate of persons with normal body weight, then in case of obesity, only I degree, mortality reaches 178% with obesity of the second degree - 225%. It is disturbing to increase the number of obese people at a young age, a combination of this pathology with the metabolic syndrome: type II diabetes, arterial hypertension and coronary heart disease, dyslipidemia, microalbuminuria. However, there are also comforting research data. Thus, it is proved that the reduction of excess body weight by only 9 kg in women will lead to a reduction in the risk of diabetes by 30-40%, as well as to a 25% reduction in all causes of mortality from diseases.

Since the overwhelming majority of patients with obesity and overweight are turning first of all to the centers of figure correction, the activity of specialists in aesthetic medicine plays a huge role in the treatment and prevention of obesity. But here before cosmetologists and physiotherapists a very complex and responsible task arises. A person with excessive body weight often considers her to be only an "external", cosmetic problem of her appearance, absolutely without thinking about the real risk of the rapid emergence of a huge range of somatic and psychosomatic pathologies, to which obesity will result in a few years from the moment of its onset. Therefore, the main task of a specialist in aesthetic medicine is not only work with specific "problem areas", but also to identify the causes of obesity, create motivation for a healthy lifestyle and rational nutrition.

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The first steps to solving the problem of obesity

The first important step in solving the problem of obesity is a careful history:

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

The next step is mandatory anthropometric examination, biochemical blood test (serum glucose level and lipid spectrum, insulin level), ultrasound of the abdominal cavity. Most of the above data will allow a specialist to determine the type and type of obesity, and indicate the tactics of managing the patient. Also, it is necessary to remember the peculiarities of the structure of adipose tissue, the types of its distribution.

In the diagnosis and treatment of obesity, it is important to determine the percentage of fat in the body. At 25 years of age, in men, fat is approximately 14% of body weight, in women - 26%. With age, the amount of fat increases: in 40 years for men it is 22%, for women - 32%, for 55 years - 25 and 38%, respectively (the figures can vary widely). Several methods for determining the fat content in the body have been proposed, but in clinical practice, mainly caliperometry and bioimpedance analysis of body composition are used.

As mentioned above, the distribution of adipose tissue in the human body can be divided into several types, which depend on genetic factors, hormonal background and lifestyle. With the predominant deposition of fat in the subcutaneous adipose tissue of the abdomen, shoulders, around the abdominal cavity, in the omentum and mesentery, an abdominal (visceral) type of obesity. It is more common in men and is called android. Adipocytes have a large volume, in this adipocyte membrane there is a significant amount of beta-adrenergic receptors, sensitive to lipolytic effects. Therefore, we can safely say that this type of obesity responds to attempts at correction more effectively.

In this case, effective use in the course of correction of the figure lipolytic, lymphatic drainage techniques, deep heat, procedures aimed at improving skin tone. At the same time, the appointment of an adequate diet can effectively solve the problems of figure correction in patients who have expressed contraindications to the conduct of physiotherapy procedures. Therefore, having knowledge of diet correction and diets, an expert in aesthetic medicine can significantly expand the range of its clients.

With the predominant deposition of fat in the subcutaneous fat tissue of the thighs and buttocks, the gluteal-femoral (gluteo-fumoral) type of obesity is formed. It is characteristic of women and is called hypoid. The features of adipose tissue in this case are the following: prevalence on the adipocyte membrane of alpha-adrenergic receptors, sensitive to lipogenetic influences; adipocytes are smaller in size; fatty lobes are bounded by coarse fibrous strands; the number of fat cells can be increased.

There is a violation of microcirculation, tissue hypoxia and fibrosis. In order to eliminate the above-mentioned phenomena, the main method of correction of the figure is the appointment of defibrizing and lymphatic drainage techniques and only after this - the use of diet therapy. Against the background of dieting, it is important to continue the course of these procedures in conjunction with lipolytic procedures. Only with such an integrated approach is it possible to achieve a pronounced, stable result.

For many years there has been a discussion about the quantitative composition of adipose tissue. Adipocyte is a long-living cell, and their number in each organism is individual and relatively constant. In most cases, there is a hypertrophic type of obesity: the fat cell is sharply increased in size, and the number of cells does not change. Having selected the necessary lipolytic effects, you can achieve a quick and stable result. More often to the hypertrophic type is abdominal obesity. Obesity, which began in childhood, is genetically conditioned obesity, which is often accompanied by an increase in the number of fat cells. This option is less amenable to therapy, and weight loss, volume reduction occurs only as a result of a decrease in the size of adipocytes, rather than their number.

There is also a mixed hypertrophic-hyperplastic variant of obesity, more common in very complete people. What kind of patient can we classify as "very full"? We calculate the BMI using the formula BMI = body weight (kg) / height (m ² ). If this figure exceeds the figure of 40, then we are competent to diagnose morbid obesity, accompanied by a very high risk of concomitant diseases. It is these patients and should be classified as "very complete".

Adipose tissue with morbid obesity has the following features: the size of fat cells is very high - up to 300 μm ³ against 90 μm ³ normal; they closely adjoin each other, displacing other cells, and are separated by hardly noticeable connective fibers; fatty vacuoles occupy the whole cell. Trophy of the cell and tissue is broken. Adipose tissue accounts for 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 amounts.

Consequently, this obesity can be attributed to a mixed hypertrophic-hyperplastic variant with a uniform distribution of adipose tissue. Clinically proven explanations for the occurrence of such obesity are few. Most likely, against a background of genetically predetermined hyperplastic obesity, for a long time there are serious eating disorders in the direction of a significant excess of calories. The same option is possible for a constantly overeating person with a hypertrophic type of obesity.

It should be remembered that a person who has repeatedly tried to lose weight independently with the help of various "fashionable" diets, supplements and medicines without examination and accompaniment by a doctor, also easily falls into the "very complete" groups. A constant fluctuation of body weight disrupts the endocrine mechanisms, expressed periods of weight loss and an unbalanced exit from diets can lead to a compensatory increase in the cellular composition of adipose tissue.

Unfortunately, changes in the work of the endocrine system, the pathology of the musculoskeletal system, the cardiovascular system severely limit the possibility of using physical exertion in such patients, so the main role is assigned to the hardware methods and diet.

It is also necessary to remember the condition of the skin in such patients. Trophic disorders due to excess of subcutaneous fatty tissue and disturbed regulation of vascular tone lead to increased sweating, hyperpigmentation, inflammatory manifestations. The skin turgor is sharply reduced, pasty 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 the cases of the origin of this pathology, the primary cause is the excess, in comparison with the expenditure, the entry into the body of energy substrates. Providing the same energy is possible only through nutrition. In this situation, the axiom is the observance of an adequate calorie daily diet. It has been statistically proven that an excess of calories per day, equal to only 100 kcal, after 1 year will lead to an increase in weight by 5 kg. The proper value of the daily caloric intake is easily determined using tables that take into account gender, age, physical activity.

It is noteworthy that the norms are clearly calculated depending on sex, age and the coefficient of physical activity:

• CFA I - mental labor;
• CFA II - easy physical work;
• CFA III - physical activity of moderate severity;
• CFA IV - heavy physical labor;
• CFA V - especially hard physical labor.

The actual (and, most likely, excessive) calorie of the patient's daily diet should be determined by the method of keeping a diary. In the diary, the patient should indicate the composition, the amount of food eaten, the time taken to eat, and the cause of the meal. By the way, it 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 noted at the stage of the initial consultation.

One of the most important tasks of the cosmetologist is the patient's motivation to realize 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 correction.

Theories of rational nutrition

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

Basics of rational nutrition:

1. Correspondence of caloric content deprive needs in energy;
2. a certain ratio between the main food nutrients;
3. the conformity of the composition of food to the individual characteristics of the digestive system.

The diversity of the qualitative composition of the diet is necessary to provide the body with irreplaceable nutrients. Optimal methods of cooking can ensure the assimilation of nutrients and preserve their nutritional value. An obligatory element of rational nutrition is adherence to the diet, uniform distribution of its volume throughout the day, which is necessary to maintain a stable body weight.

In the daily diet of a healthy person, proteins should be 17%, fat - 13%, carbohydrates - 70%. At the same time, 55% of the daily calorific value is provided by carbohydrates, 30% by fats, and 15% by proteins.

Carbohydrates

Is the basis of any diet. Most of them (85%) should be represented by complex carbohydrates - vegetables, fruits, dark-colored cereals, bread and bread with bran, and only 15% - simple bread, high-quality flour roll, white rice, semolina, pasta, sweets confectionery.

Proteins are the main structural component of the human body. Of the total number of proteins, 2/3 should be animals - meat, fish, poultry, seafood, and 1/3 - vegetable - soybeans, legumes, mushrooms. Animal proteins are more valuable than plant in terms of their amino acid composition and must ensure the daily requirement of the organism for essential amino acids (not synthesized in the body).

In the food must necessarily be present ballast substances (cellulose, etc.) in an amount not less than 50 g per day. These substances provide a normal detoxification and excretory function of the body.

Of great importance is the maintenance of normal intestinal microflora. In a modern environmental situation, this is especially true. In the diet should be introduced dairy products, enriched bifido-, lactobacilli and other microorganisms, normalizing the composition of the intestinal microflora.

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

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

Since the 80s of the XX century, the most graphic illustration of a rational diet is the Pyramid of Healthy Nutrition.

Correspondence of one portion to a certain number of products

One portion	Number of products
Cereals	1 slice of bread, 30 g of finished porridge, 1.1 / 2 cups of ready-made macaroni
Vegetables	1 cup of fresh leafy vegetables, 1/2 cup of crushed raw or boiled vegetables, 100 ml of vegetable juice
Fruit	1 medium apple, banana, orange, 1/2 cup sliced canned fruit, 100 ml fruit juice
Dairy	1 cup of milk, kefir, yoghurt, 45 g of cottage cheese, 60 g of hard cheese
Meat	60-90 g of boiled meat, poultry, fish, 1/2 h; 1/3 cup nuts
Fatty and sweet foods	1 serving - the smaller, the better!

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