The World Health Organization classifies obesity as "noncommunicable epidemics of the 21st century". According to current statistics, more than 50% of Europeans cannot get rid of the excessive weight for a long time, while more than 20% of Europeans suffer from obesity. In economically developed countries, the treatment costs for obesity and its complications make up 8-10% of the total annual healthcare costs.
The modern range of therapeutic options includes lifestyle modification programs, dietary recommendations and individual set of physical exercises, pharmacological support and bariatric surgery. In each case, the doctor selects the most sparing and most effective scheme for the patient, which guarantees a long-term result.
Obesity treatment goals
Excess body mass is primarily associated with aesthetic problems. As a rule, overweight people are less active in social terms, they are more likely to experience psychological disorders, up to depression. However, the main danger of obesity is associated with a high risk of somatic diseases:
- Cardiovascular diseases. The excessive adipose tissue leads to the increased levels of "harmful" cholesterol (low-density lipoproteins), coronary heart disease, arterial hypertension, heart attacks and strokes.
- Type 2 diabetes mellitus develops due to impaired tissue sensitivity to insulin as a result of excess body mass. Also, the pancreas depletes its hormonal reserve and cannot provide the obese patient with the required amount of insulin.
- Oncological diseases. Major studies show solid evidence of the association of overweight with colorectal cancer, esophageal, liver, pancreatic, endometrial and breast cancers.
- Joint pathologies. The increased load on the musculoskeletal system leads to premature joint degeneration and development of arthrosis.
- Reproductive dysfunction. The excess hormones of adipose tissue (leptin, adiponectin, resistin) affect adversely the quality of eggs and sperm.
Thus, the comprehensive obesity therapy pursues three goals:
- Reduction of the body mass by 5-7% per month until its normalization
- Patient's lifestyle modification for long-term consolidation of results
- Assessment of the patient’s general condition in dynamics and, if necessary, treatment of obesity complications
Selection of the best therapeutic tactics
As a more advanced treatment method, bariatric surgery attracts attention of patients promising quick results without any significant efforts. However, when choosing treatment tactics, the doctors always take into account the advantages and risks of both approaches.
Advantages and risks of bariatric surgery:
- The advantage is that weight loss can be achieved faster due to a sharp decrease in the volume of food (restrictive operations) or the intensity of nutrients absorption (malabsorption operations).
- The advantage is that the patient can directly regulate the amount of food eaten by changing the volume of the stomach (in case of gastric banding).
- The disadvantage is the surgical risks. Any operation potentially carries the risk of complications. These can be bleeding, infection, pain syndrome, functional disorders of the gastrointestinal tract.
- The disadvantage is a long period of hospitalization and rehabilitation. The patient should be under the supervision of doctors in a hospital for up to 5-7 days after surgery. This period is followed by the adaptation to a new diet and physical activity.
- The disadvantage is that the cost of treatment, especially in case of the endoscopic and minimally invasive interventions, can be quite high. As a rule, bariatric interventions are not covered by insurance.
Advantages and risks of conservative therapy:
- The advantage is a safe and physiological decrease in body mass not exceeding 5-7% of the current weight per month. The risks of conservative therapy are minimal, especially when compared to surgical treatment.
- The advantage is a more stable and long-term result. To maintain weight with any type of treatment, it is important to adjust the diet and build a good body with exercise. Surgery alone will not allow the patient to achieve the desired goal.
- The advantage is improved overall health. Along with weight loss, conservative therapy has a positive effect on the cardiovascular and nervous systems, all types of metabolism, as well as the patient’s mental state.
- The disadvantage is that the process of losing weight takes longer. This is undesirable in the treatment of obesity complications, such as hip arthrosis or diabetes mellitus decompensation.
- The disadvantage is that the patient usually requires a radical modification of his lifestyle. The patient should change his attitude to physical activity and eating habits.
In general, the conservative methods demonstrate the highest effectiveness and long-term result in obesity treatment. The doctors prefer a permanent or temporary bariatric surgery only if conservative methods fail to be effective.
Preliminary medical examination
The specialists from the leading world hospitals elaborate an individual obesity treatment program only after a comprehensive examination of the patient. This approach is most effective, since excess weight may be the result of hypothyroidism, adrenal pathology or other disorders. In this situation, the medical program necessarily includes treatment of the underlying disease.
The preliminary medical examination includes:
- Physical examination: body mass index calculation; abdominal, thigh and shoulder circumference measurement; blood pressure measurement.
- Laboratory testing: complete blood count, blood glucose test and glucose tolerance test, lipid profile, biochemical profile with the determination of kidney and liver function, hormone blood test (TSH, free T4, LH, FSH, prolactin, estradiol, progesterone, cortisol).
- Imaging: ECG at rest and during exercise, abdominal ultrasound. If indicated, echocardiography, Doppler ultrasound of the blood vessels, CT/MRI scans of the joints.
If there are complaints of snoring and respiratory failure during sleep, the doctors carry out diagnostics of obstructive sleep apnea. A psychologist also works with patients. This helps to set the right goals and find motivation for active participation in the treatment process.
What is included in the conservative obesity treatment program?
The initial stage of the program is inpatient. This increases the patient’s commitment to therapy, makes it easier for him to switch to a healthy lifestyle and acquire the necessary skills (for example, following the diet and day regimen, changing the food basket, daily exercise).
Eating behavior correction
During a hospital stay, the patient switches to split meals and receives 5-6 meals per day. This mode makes it possible to get enough of a small volume of dishes, eliminates overeating and extra "snacks". When the patient has split meals, he does not feel any hunger or discomfort.
Once active training at the inpatient stage of treatment is completed, the patient can do the following things on his own:
- Assess the composition of the product, eliminate potentially hazardous food additives (preservatives, dyes, stabilizers, etc.)
- Calculate the daily calorie content of food
- Create a tasty and varied menu for a day and for a week
- Create a food basket and organize the purchase of products
- Cook several dishes for basic meals
- Organize proper nutrition in various life situations, namely in everyday life, during a trip, on vacation, during intense sports training
If necessary, when developing an individual diet, the doctors take into account the concomitant diseases, such as peptic ulcer, food intolerance or diabetes mellitus.
Advanced physical activity
Physical activity makes up 20% of the result in weight loss (the remaining 80% depend on the nutrition) along with 100% result is the improvement of aesthetic parameters of the body. The specialized European hospitals necessarily include several types of physical activity in the treatment program:
- Workouts to improve overall stamina for at least 2.5 hours a day – walking, swimming, cycling, aqua gymnastics
- Training for the formation of the muscular corset of the back (prevention of spinal pathology)
- Joint gymnastics, flexibility exercises (yoga, pilates)
- Outdoor games and sports
- Breathing exercises
In addition to practical training, the patient is offered theoretical classes on the biological and medical background of the physical activity. The patient also learns how to do special exercises to reduce volume of the stomach. This helps to control the amount of servings and not to overeat. Once inpatient treatment is completed, the patient will receive a set of exercises to perform at home.
Training of new everyday habits guarantees that after discharge from the hospital the patient will continue to work on weight loss and will do it with pleasure. A good helper in "restructuring" of the usual way of life is communication with a psychologist. Such classes provide an opportunity to:
- Understand the benefits of weight loss
- Set goals for the nearest future and long-term goals
- Appreciate the changes that occur with the body, and encourage yourself to continue working
- Work with stressful situations, level their impact on the process of losing weight
- Identify the causes that have led to the development of obesity in the past, and exclude them
If desired, patients can attend self-help groups to share their successes and difficulties with other people in a similar situation. Both diaries and photo diaries are encouraged, since these help the doctor and patient to track the weight loss process more objectively.
In some clinical cases, losing weight requires pharmaceutical support. Taking medications can be either temporary, at the initial stage of losing weight, or permanent, in the treatment of chronic diseases:
- Levothyroxine drugs for hypothyroidism (underactive thyroid, which is one of the common causes of obesity)
- Metformin drugs for insulin resistance (impaired tissue sensitivity to insulin, which stimulates the synthesis of adipose tissue)
- Specific inhibitors of gastric lipases (for example, Xenical, Orlistat), which hamper absorption of food fats
- Drugs that affect the center of hunger in the brain (for example, Cefamadar) and suppress appetite
- Glucagon-like peptide-1 analogues (for example, Victoza, Saxenda) that regulate the levels of hormones affecting body mass
The patients can also receive vitamin preparations and trace substances. According to the results of a number of clinical trials (for example, the CODING study on the use of selenium), replenishment of micronutrient deficiencies stimulates the process of losing weight and helps to maintain weight at the desired level in the future.
Selection of a specialist and development of a comprehensive treatment program
The high standards of work of the leading European hospitals allow them to treat not only the citizens of their countries, but also international patients. The European hospitals, in particular inpatient Obesity Centers in Germany, offer the structured treatment concept that combines work of nutritionists, psychologists, physiotherapists and specialists in the related fields.
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Author: Dr. Nadezhda Ivanisova