As a rule, during diet therapy, even if all food restrictions prescribed by the doctor are observed, the rate of weight loss slows down over time..

A trend is known (Table 11) - during the first three months of diet therapy, the average result of weight loss in each subsequent month is less than in the previous one..

This happens for a number of reasons, objective and subjective..

Indeed, as has been demonstrated in a number of studies, in the course of a hypocaloric diet, there is a gradual reduction in all types of metabolism and energy expenditure (Karklin A. et al. , 1994). That is, in a trend, the body tends to level the energy deficit, which naturally leads to a decrease in the consumption of excess body fat..

It must also be borne in mind that if a hypocaloric diet is followed, the patient “gets tired” of its prohibitions and restrictions.. This is manifested in an increase in episodes of deviation from prescribed recommendations.. Naturally, a violation of the diet therapy regimen leads to an increase in caloric intake and, again, to a decrease in energy deficiency..

Slowdown, and sometimes complete cessation of weight loss during diet therapy is very painful for the psycho-emotional sphere of the patient and often leads to premature termination of treatment.. Until now, to overcome this kind of stops, the method of tightening the diet (Sjostrom L. et al. , 1998). We explored another possibility.

When there was a stop in the course of observing the combined diet regimen, patients were recommended to observe a non-unloading diet for two weeks, and then return to the combined program again..

We used this technique in 21 patients (5 men and 16 women). Patients who continued to follow the regimen prescribed by the combined program served as controls.. Table 13 shows the dynamics of weight loss in these patients Table 13. Dynamics of weight loss in patients after a two-week non-unloading regimen Group Duration of treatment (weeks) 0 2 4 Experiment (n\u003d21) 88.7+4.82 87.8+4.56 87.2+4.58* Control (n. We point out, however, that this weight loss can not be caused in all patients.. So, according to our data, out of 21 patients taken in the experiment, weight loss was observed only in 16 patients (76.2%), while in the rest, body weight remained practically unchanged..

We emphasize that despite the importance of this problem, we have not found in the literature a single study directly devoted to the tactics of overcoming weight loss stops during diet therapy.. In the same cases when the researchers came across this, the only thing they applied was a tightening of the diet regimen..

We do not mind that in this way it is possible to re-induce weight loss. However, we are convinced that this is a dead end path.. For after a while, even if the patient finds the strength to comply with a more stringent treatment regimen, his body, obeying the tendency to reduce energy consumption, will nullify this newly acquired deficit..

Much more promising is the way of alternating modes of unloading and non-unloading.

Indeed, in the course of compliance with the non-unloading regimen, we believe that patients can recover both energy consumption and the mood for more careful dieting.. And apparently due to this, more than half of the patients after such a rest in the next 4 weeks manage to achieve weight loss..

In this regard, I would like to make one more recommendation.. We have already said that since obesity is a chronic disease, the tactics of its treatment (diet therapy) should correspond to the tactics of treating other chronic diseases..

Namely: the treatment should be continuous, but consist of two modes - unloading and non-unloading.. The first of which should contribute to weight loss, and the second to prevent its re-accumulation.

The alternation of these regimens should be determined by the patient independently or in consultation with the doctor.. The non-unloading regimen should be prescribed to the patient even in the case when, despite careful observance of the unloading regimen, weight loss is not observed..

Ginzburg M.

medbe. en.