General principles for the prevention of obesity.

Taking into account the patterns of increase in overweight, we can distinguish the following groups of people whose probability of developing obesity significantly exceeds the average:.

• persons with at least one parent who is overweight;

• women during pregnancy and within 2-3 years after childbirth;

• athletes who have stopped training, persons retired from the army, persons, for whatever reason, who have reduced the amount of physical activity;

• patients who have undergone major operations or injuries and are forced to spend a long time on bed or limited motor mode;

• people who have given up smoking;

• people who have to take rauwolfia or ?-blockers for a long time;

• individuals with habitually high fat intake;

• middle-aged and elderly people.

As you can see, the majority of adults can be included in the risk group for obesity without much effort.. Therefore, we note once again that the prevention of obesity is very important and should be directed to the whole society..

Unfortunately, to date, none of the states, despite the high social significance of the obesity problem and the impressive amount of economic losses associated with this problem, can boast of having a serious nationwide obesity prevention program..

Most often, the case is limited to medical preventive work, and that, in turn, is limited to the wishes to lead a more active lifestyle and eat more rationally.. Sometimes advice of this kind reaches us from the media.. Moreover, as in the treatment of obesity, along with more or less serious advice, there are also tips, the scientific validity of which is very doubtful..

Moreover, from time to time in the media in one form or another there are also wishes that are directly opposite.. Namely, that overweight should not be treated, that a fat person is beautiful and healthy in his own way, that the body itself knows how much to eat and how much to weigh, and so on.. It is not difficult to imagine how overweight people, often already exhausted by numerous unsuccessful attempts to lose weight, perceive this kind of advice..

It is not superfluous to recall that the prevention of obesity, like the prevention of any other disease, should be based on an accurate knowledge of the causes and mechanisms of its development.. In this regard, the ideas that recommend intensive physical activity, low-calorie nutrition and extremely severe carbohydrate restriction as the basis of prevention should be considered outdated..

Firstly, only a few can observe them, and secondly, thanks to recent scientific achievements, other ways of prevention can be proposed that are more acceptable in terms of long-term and mass reproducibility and more effective (Katan M. 1998; Doucet E. et al, 1999).

This is a recently discovered phenomenon, the essence of which is the following. With a low proportion of fat in the diet, body weight remains stable even if the intake of other nutrients and, above all, carbohydrates is not limited (Katan M. 1998).

Such a diet with good reason could be defined as non-fat.. In preventive work, it is necessary to strive to limit fat intake as much as possible while maintaining a satisfactory quality of life..

In order to reduce fat intake, a person must at least approximately represent its amount in certain products.. It would be possible to offer people small tables on its content in the most popular products.

As for the motor regime, it is also found here that the probability of developing obesity is inversely proportional to the physical activity performed by a person.. The doctor in his work should strive to maintain the value of physical activity in a person, to arouse a desire to perform them..

However, there is still a lot of work to be done to determine the principles of dosing loads and determining the optimal training regimens and motor regimens to prevent the development of obesity in certain age groups..

The treatment of obesity in some family members can and should be accompanied by the prevention of overweight in other family members.. And this point general practitioners should take into account.

We believe that as awareness of the importance of the problem of obesity for health status, morbidity and life expectancy grows, attempts will be made in society to create a program aimed at preventing this disease..

General principles for the treatment of obesity.

If the treatment of obesity were a simple matter that did not require a certain attitude and tension from the patient, but from a doctor for control and constant correction of prescriptions, perhaps there would be no problem itself, and our patients, obeying such a natural desire to lose weight, would have lost weight long ago.

Despite the large number of proposed and such different ways to reduce excess weight, the only thing that really leads to a decrease in fat mass is an energy deficit, that is, the predominance of energy expenditure over its intake.. In this case, fat, as a form of stored energy, begins to be spent to cover the resulting deficit..

The simplest, most understandable, and most importantly, reproducible way to create an energy deficit is a hypocaloric diet.. Other proposed methods of treating obesity are physical activity, the use of tonic drugs and appetite suppressants, psychotherapy, reflexology, etc.. , without special fixation on dieting, are effective only in a small percentage of cases (less than 10-20%) and usually lead to small, unstable and difficult to control weight loss (less than 5-6% of the original). All of the above methods can only complement diet therapy, namely, either enhance its effect or improve treatment tolerance..

However, in the process of following a hypocaloric diet, a number of points arise that counteract the efforts of patients and are aimed at maintaining excess weight.. And in particular, the feeling of hunger is the first and perhaps the main obstacle to long-term adherence to hypocaloric diets, as well as slowing down all types of energy expenditure as a measure of the body's adaptation to hypocaloric diets..

The physiological basis of hunger is a decrease in blood sugar levels and a decrease in glycogen stores in the liver and muscles. Since a decrease in carbohydrate reserves is necessary to start the processes of fat oxidation (Kendysh, 1985), which, by the way, occurs when a hypocaloric diet is prescribed, the feeling of hunger should be recognized as an obligatory phenomenon observed during diet therapy (Schrauwen P. et al. , 1998).

Similar in sensations, but not in the mechanism of occurrence, a feeling of dissatisfaction with food. Indeed, almost all diets offered for the treatment of obesity contain restrictions or even prohibitions on a wide range of familiar foods - flour, sweets, salt, spices, liquids, etc.. , which turns such diets into bland and monotonous food.

The feeling of hunger and the feeling of dissatisfaction with the quality of food is a rather significant problem for the patient - they often lead to psycho-emotional stress, depression and encourage the patient to stop dieting ahead of time.. Because of the fear of imminent hunger, many patients refuse or delay treatment for overweight..

Many authors note that the feeling of hunger in the process of following a diet, reaching a maximum by the evening of the second or third day, then decreases and by the fifth or sixth day becomes stably minimal, in any case, significantly lower than in the initial period (Hakala P. et al. , 1999; Carmody T. et al, 1999; Rogers P. , 1999).

With this in mind, the doctor can orient his patients that they need to endure the existing discomforts only during the first three days..

As a way to counteract the feeling of dissatisfaction with food, it can be recommended to avoid excessive prohibitions and restrictions when building a nutrition program.. Prohibitions and restrictions should be avoided even if the patient himself insists on their introduction..

It is considered an established fact that in the course of following a hypocaloric diet, there is a decrease in all types of energy expenditure, including basal metabolism.. So, in particular, the main metabolism during the course of the diet is reduced, according to a number of authors, by 14-25% of the original (Fricken J. et al. , 1991; Schutz Y. 1995; Valtuena S. et al. , 1996).

A decrease in all types of metabolism and energy consumption during diet therapy should be considered as a measure of the body's adaptation to a hypocaloric diet.. Patients on a hypocaloric diet have deeper and longer sleep, a slight decrease in body temperature, a slowdown in the frequency and strength of heart contractions (Karklin A. et al. , 1994).

Reducing energy consumption during diet therapy slows down the rate of weight loss and, thus, creates known difficulties for the patient.. Physical activity can be considered as one of the ways to restore energy costs (Bryner R. et al. , 1999).

Indeed, as has been shown in a number of studies, the appointment of aerobic exercise in combination with diet therapy can prevent or, in any case, reduce the degree of this decline (Doucet E. et al. , 1999; Bryner R. et al. , 1999).

So, according to Bryner R. , et al, (1999), the use of daily exercise prevents a decrease in basal metabolic rate and a decrease in lean body mass in patients on a markedly low calorie diet (800 kcal/day). According to Schultz et al.. (1980), in order to prevent a decrease in basal metabolic rate, it is sufficient to perform daily moderate-intensity physical activity for 20 minutes.

A doctor, when treating a patient with obesity and prescribing diet therapy, should also take into account that errors in treatment tactics may cause undesirable side effects associated with a lack of certain food components and, in particular, protein, minerals, vitamins, w-3. et al. , 2001; Ricci T. et al. , 2001). These are the food factors that we call indispensable.. It is clear that a diet aimed at treating obesity should contain the physiological norm of these substances..

The treatment of obesity, like the treatment of any chronic disease, must be continuous.. After achieving weight loss, the efforts of the doctor and the patient should be aimed at maintaining the effect and preventing recurrence of the disease.. Indeed, obesity is a disease that is maximally capable of recurrence..

The chance of recurrence here is close to 100%.. In at least 90% of patients, initial body weight is restored within the first year after the end of diet therapy (Bray G. , Popkin B. 1998). In this regard, adherence to a diet that ensures the maintenance of the achieved weight is no less important than compliance with an unloading regime..

We already wrote above that as a non-fatty patient, a diet with a reduced fat content in food to about 35-45 grams per day can be offered.. Here we point out that the unloading diet itself can be an alternation of two dietary regimens - unloading and non-unloading, for example, a regular diet that does not contain any prohibitions, but with a reduced fat content and, due to this, non-fat.

And if the unloading regimen does contain a number of restrictions and requires a certain psycho-emotional stress from the patient, the non-unloading regimen does not require anything like that, it is easily observed and at the same time protects the patient from weight gain. Indeed, in the course of diet therapy, the patient's mood for treatment may change..

And if in some periods a person can relatively easily observe the unloading regime, then in other periods, under the influence of some circumstances of life and work, compliance with the unloading regime may turn out to be burdensome and even impossible.. During such periods, the patient could switch to non-unloading mode. At least we will avoid recurrence of obesity.

Ginzburg M.

medbe. en.