Prevention of recurrence of obesity is a very urgent problem..

It is known that if preventive measures are not taken or carried out inadequately, weight gain after the end of treatment is observed in at least 90% of patients (Bray G. , 1998).

As a measure for the prevention of relapses, the authors propose modified unloading diets in one form or another, which may be softer than those used by them for weight loss, but built on the same principles..

Most often, this is a restriction of easily digestible carbohydrates - a lifelong rejection of sugary foods, pastries and other tasty things.. Often the prevention of obesity recurrence is based on counting calories by patients, a tedious procedure even for a professional nutritionist.. We do not rule out that with careful implementation of these principles it is possible to achieve stabilization of the result.. However, if it were possible in all cases, there would be no such depressing statistics of relapses..

Indeed, any method of prevention, as well as treatment, is only truly effective when it can be used by the majority of those to whom it would be useful..

Recently, the literature has increasingly focused on the role of low-fat diets in the prevention of relapses of obesity (Wing R. , Hill J. , 2001).

The theoretical substantiation of this is the facts already considered by us.. Namely, when the fat content of the daily diet is reduced to 25% of the total daily caloric intake and below, body weight ceases to increase regardless of the total amount of calories consumed (Lissner L. , Heitmann B. , 1995). In practice, this means 35-45 grams of fat per day..

After the end of the course of treatment, patients were advised to maintain a non-fat diet (reducing daily fat intake to 35-45 g per day, possibly a mixture of "

After 6 months, we were able to examine 44 patients who completed the treatment, 36 of whom received a combined program (Group 1), and 8 - a purely unloading regimen (Group 2).

The effect of maintaining the achieved result was evaluated according to the following scale (Table 14):.

Table 14. Classification of the effect of weight maintenance after the end of the course Good effect of weight maintenance Body weight either does not increase, or increases, but not more than 10% of the weight lost Satisfactory effect of weight maintenance Body weight after the end of treatment increases, but remains within 50% of the weight lost.

Table 15. The effect of maintaining the achieved result after the end of the course of diet therapy (in % of the total number of patients) Good Satisfactory Poor Group 1 (n\u003d36) 22 (61.1%) 8 (22.2%) 6 (16.7%) Group 2 (. This effect does not depend on the treatment regimen, but depends on the quality of adherence to the relapse prevention regimen..

So, when analyzing food diaries in the group with a good effect, fat consumption averaged 37.4±6.59 g per day, in the group with a satisfactory result - 59.6±8.68 g per day, in the group with relapse of obesity -. At the same time, the average fat intake in the group with relapsed obesity was significantly higher than in the group with a good effect (p\u003c0.05).

The effect of a low-fat diet as a measure to prevent recurrence of obesity has also been demonstrated in the works of other authors (Lissner L.. et al. , 1997; Saris W. , 1998). It seems to us that the use of Doctor-slim or similar mixtures can optimize adherence to the prophylactic regimen..

Firstly, as many of our patients noted, the use of this mixture before meals somewhat reduces appetite and makes the process of eating more controlled.. The use of Doctor-slim as a daily food product to replace milk in dairy dishes already in itself reduces the fat content of the daily diet..

Diet therapy for complicated obesity.

It is known from the literature that if obesity in patients is accompanied by arterial hypertension, dyslipidemia and/or diabetes mellitus, there is a very high probability that the control of these diseases will improve significantly with a decrease in excess weight (Lean M. et al. , 1990; Andersson I. , Rossner S. 1996; Straznicky N. et al. , 1999).

In some cases, we can even observe normalization of blood pressure, reverse development of echocardiographic signs of left ventricular hypertrophy, improvement in blood lipids and plasma atherogenicity, normal blood glucose and glycosylated hemoglobin levels (Wannamathee G. , Shaper A. , 1989; Lean M. , 1998; Foreyt J. , Poston W. , 1999; Howard B. , 1999).

A number of epidemiological studies have found that reducing excess weight reduces the likelihood of death from obesity-related diseases and increases life expectancy (Lean M. , 1998; Oster G. et al. , 1999).

It has also been established that in order to achieve better control of diseases associated with obesity, it is not at all necessary to strive for normal body weight, but it is enough to achieve a decrease in body weight by 5-10% from the original (Lean M. , 1998).

Many aspects of the treatment of complicated obesity are still far from final resolution..

There are three groups of questions that need to be investigated:.

• What are the predictors of the therapeutic effect that occurs in obese patients with arterial hypertension, dyslipidemia, coronary heart disease (CHD) and / or type 2 diabetes mellitus with successful reduction of overweight?

• What are the features of tactics for reducing overweight in complicated obesity?

• What are the features of the tactics of treating arterial hypertension, dyslipidemia, coronary artery disease and / or type 2 diabetes mellitus in patients with obesity?

Ginzburg M.

medbe. en.