OBESITY: WHAT TO DO?
OBESITY: WHAT TO DO?
Obesity – a serious problem. And not just cosmetic. Being slim is pleasant, because it is beautiful (though there may be differing opinions), but it is important to normalize the weight not only for the sake of psychological comfort. The accumulation of excess fat in the body of itself can worsen your health: it can cause shortness of breath and palpitations, especially under load, fatigue and drowsiness, a tendency to pustular skin lesions, impaired sexual function. Imagine that a person with normal weight loaded 20 or even 40-kilograms bag, which he must bear all the time?
Excess fat – not just a heavy burden. The adipose tissue – an endocrine organ that produces various active substances. Our body is not designed for such chronic congestion, so people with obesity get sick more often and live less than people with normal body weight.
Obesity – a chronic disease characterized by excessive accumulation of adipose tissue in the body.
Doctors are interested in the treatment of obesity is not because they like thin patients more, but because the presence of obesity greatly increases the risk of severe pathologies: diabetes, cardiovascular disease, many forms of cancer joint diseases, gallstones, gout, disorders of the reproductive functions, etc. And if the disease has appeared, obesity exacerbates their course and worse prognosis.
For the diagnosis of deviations in body weight from the normal size, doctors use a index called body mass index (BMI).
It calculates this way:
body weight (in kg) divided by the rate of growth (in meters) squared.
BMI = body weight (kg) / height squared (m2)
In normal weight BMI = 18.5-24.9
BMI 25,0-29,9 corresponds to overweight;
BMI 30,0-34,9 – the 1st degree of obesity;
BMI 35,0-39,9 – the 2nd degree;
BMI over 40 – the 3rd, most severe, the degree of obesity.
Remember that BMI is not reliable for:
children with unfinished period of growth
persons over 65 years
sportsmen and those with a very developed muscles
There is much more approximate way to find your norm: subtract 100 from the meaning of your height in centimeters.
It may seem that to achieve ideal body weight is impossible to you, and therefore not worth trying. However, need to know that even the loss of 3-5 kg from the initial weight has a positive effect on your health and the risk of obesity-related diseases will be reduced significantly. So, it’s worth it.
Types of obesity
Despite the fact that excess body fat – it is always bad, not all types of obesity are the same. In some people fat deposition occurs mainly in the lower half of body (female type of obesity, or by type «pear»). Others have fat stored mostly in the abdomen (male-type obesity, or by type «apple»). To determine the type of obesity is possible by using the index of waist circumference and hip circumference (OT / OB). With obesity on the type of «apple» the value in women OT / ON > 0.85, in men – >1,0. To determine the type of obesity is important for us because the belonging to a type «apple» means a higher risk of developing cardiovascular disease.
It is known that the risk can be assessed by simple measurement of waist circumference. The «bad signal» will be the result of more than 80 cm for women and more than 94 cm in men.
Causes of obesity
Obesity develops when the flow of energy (calories) into the body is regularly exceeds its consumption. This is so-called alimentary obesity.
Of course, not everything so easy, and there are many factors that predispose to the development of obesity. Some of them (for example, genetic causes), we can not change, but many others (diet, physical activity) under our control. Many people mistakenly believe that heredity plays a major role in the development of obesity – – «My mother was the same, and nothing can be done». However, as a rule, children of plump parents become plump due to the «inheritance» of food habits. Precisely in family we are getting used to eat this way and not otherwise. But the eating habits and inclinations can be changed.
Endocrine obesity is only 5% of all cases. Typically, such patients have typical external signs that allow to suspect endocrine causes of obesity. In addition, obesity is rarely reaches a large extent. Therapeutist or endocrinologist, after examination of full-time should assign you the required examination – not only to eliminate the possible causes of obesity, but also to identify obesity-related diseases or conditions.
Here is a minimal examination, which is recommended to conduct in overweight: the measurement of height, weight, waist and thighs, the measurement of blood pressure, biochemical analysis of blood glucose, lipid profile, uric acid, from hormonal studies – TSH.
All the rest – at the discretion of the doctor if there are indications.
Sometimes you need to consult a psychiatrist or psychotherapist.
First of all, you need to understand that obesity is – a chronic disease, and treatment of it must also be a «chronic». Excess body fat accumulated in the body for years. To change this situation, you also have to change. To «sit on diet» and then get out of it will not work – you should forever change your eating habits and motor activity. And make it so that your new way of life gives you pleasure. Do not try to lose weight in one month to 15 kg, eating a yogurt or cucumbers. You will not still eat yogurt all rest of your life, and quickly dropped weight so quickly will return to you, and even more abundantly. Set a realistic goal – to lose weight by 3 kg over 1-2 months. Understand what you want to achieve and why you need it, and begin to move to this goal, once and forever changing your life.
Should start to worry about is that if your BMI exceeds 25 kg/m2. It is considered that overweight (BMI less than 29.9) and the absence of diseases associated with obesity, it is necessary to begin treatment with lifestyle modifications – it is possible that this will be enough. If there are varying degrees of severity of obesity, then a changit will make the treatment more effective. If obesity is reaching severe (BMI over 40 kg/m2, morbid obesity), the effectiveness of surgical treatments, and to change eating behaviors often need help of the therapist.
The logic here is simple: reduce your daily calories consumed food. Obesity has developed against a background of long-term revenue surplus of food. Hence, in order to lose weight, you will need to provide a long lack of calories (compared to the people of the same height and activity level, but with normal body weight). The habitual diet for you was excessive, so you must change it. The best way to control daily calorie is to approximate counting calories. In order to count calories, it will be convenient to use tables of calories.
СIt is considered that in order to determine the required daily calories to lose weight must be multiplied 20 calories (in obesity and grade 2-3 – 18-15 kcal, respectively) per kilogram of ideal (not actual!) of body weight. To «estimate» ideal body weight for you, you can with «Height – 110». However, to use less than 1100-1200 calories a day is not recommended. If your work involves heavy physical labor, your diet should be at least 1,500 calories a day.
You can go two ways:
1. A. The gradual reduction in habitual daily energy in the 500-600 calories each month. First, within a week or two is a food diary (which, how much and when I eat) and then calculated usual to you daily calories. Then, every month, this value is reduced by 500-600 calories until you reach 1,200-1,400 kcal per day.
2. ВB. You immediately limit yourself to the calculated amount of calories. However, if you are accustomed to the daily diet to 3000-3500 calories a day, limit yourself to immediately will be difficult.
If you reach the ideal body weight, the diet can be expanded up to normal for your height and activity level of calories, but take into account the calories still have.
There are some considerations that can navigate through the variety of products.
Food you should avoid – fats and sweets. The oil (vegetable and animal), mayonnaise, sour cream, fatty dairy products (fat content of foods is recommended to purchase no more than 2.5%), fatty cheeses, meats, sausages, sausages, pastries, butter and nuts. Instead of sugar is better to use sweetener.
Foods that need to limit (approximately – to reduce their content in your diet by half): cereals, pasta, potatoes, beans, fruits and berries, dairy products, lean meats and fish. You can eat unlimited vegetables, herbs, no-calorie drinks (mineral water, tea and coffee without sugar).
In order to facilitate the task of changing ration will be very useful food diary – that is, you write how much (approximately), when and why you eat during the day. Of course, keep a diary over the years is optional, but it is very help at first, lifestyle changes and sometimes – on the following steps when something goes wrong. Write down not only the composition and quantity of what you eat – indicate why you’re doing it. Often we try to solve some problems with eating – eating to calm down, or because we get bored. However, one more sandwich will not solve any problems but only create new ones.
Some useful tips
Change your lifestyle starting from the store
Buy the subcaloric foods. No need to buy what is bad for you. If you do not buy sausages or cheese, but fresh vegetables and herbs, then your family will benefit. Buy products with less fat. When selecting meat and fish products, try not to buy semi-finished products – salt and fat in them will be much more than in dishes prepared by you.
МMany people say that they «can not afford» to eat correctly. Нs not worth be cunning: limit the use of meat and sausages, and you will be able to afford a variety of seafood and fresh herbs. Cheese and sausage are not cheaper than fresh or frozen vegetables in the winter. And about the summer-autumn and say nothing. Do not buy foods for «rainy day», and you will not have to eat them quickly.
Observe some rules in cooking
Try to use the methods of cooking without adding fat: no frying but stewing, or baking in the oven. Do not try dish when cooking – call some of relatives if necessary.
Try to use less salt
Abundant salty food not only improves the appetite, but also increases the risk of developing hypertension.
Use small-diameter dishes and put small portions
Keep for you small plate or saucer – a dish for the second, and the bowl / cup – for the soup. It will be much easier to limit the amount of servings and eat it slowly and with pleasure.
Do not eat if you are not hungry – «for company» or having nothing to do
If you came to visit, it is better not to advertise your food restrictions. Select the dishes you allow yourself to eat, and stick to this course. Waiver of other dishes can be explained by a banal «I do not want».
Do not starve, eat often and little by little
Full fasting – no way out. his way you will not lose weight (you will get back everything you lost), but quite manage to hurt yourself. Also try to avoid the appearance of a strong sense of hunger – in the «ravenous appetite» is difficult to control the composition and amount of eaten. Eat frequently (4-5 times a day) and gradually. Try not to eat at night, let your dinner will end no later than 2-3 hours before bedtime. If between meals or before bedtime hungry comes, eat something reduced calorie – vegetable salad, or apple, or fat-free yogurt.
Do not eat in front of TV or reading a book
You can get carried away so that you will not notice you they were filled or not, and will continue to eat «automatically». Beware of chips, nuts and popcorn.
Limit your alcohol use
Alcohol drinks are very high in calories and also increase the appetite.
Serve the table, try to cook beautiful meals and eat them slowly and with pleasure
УPleasure can deliver not only food but also the situation of your lunch or dinner. Try to pay attention to serving and aesthetic qualities of dishes.
To use the subcaloric snack foods
It is better to eat an apple or an orange, salad, or low-fat yogurt than a chocolate bar or a cheese sandwich.
Do not despair if there was a failure
Let’s say you ate the night of fried potatoes. This is not a reason to give up, and the reason to arrange a more physical activity – to stay at a health club, or go on an extraordinary trip. And, of course, try to avoid such failures in the future.
Sometimes a person is unable to change their dietary habits. When expressed eating disorders therapist’s intervention is required. Such disturbances may be a sign of mental suffering.
In order to increase consumption of energy, and to ensure the prevention of many diseases and just feel better, would require regular physical activity. Preferably, the so-called aerobic exercise – fast walking, jogging, swimming, biking, outdoor games (football, tennis, etc.), aerobics.
The main rule – these loads should bring you pleasure, be regular and fairly frequent (3-4 times per week). You do not need to ride a bike, if you can not stand. You can and should choose to accept such employment, which will be pleasing to you. If you are not accustomed to physical exercise, then increase their duration and intensity should be gradual. The easiest option – fast walking. You can start with a ten-minute walk at a fast pace and gradually bring them up to 40-60 minutes 3-4 times a week.
If you already have chronic diseases, it does not cancel the exercise, however, need to agree on their type and duration of the attending physician.
In diseases of heart and blood vessels, or if you’re not used to the load, it is recommended to start with light loads, focusing on heart rate, that is on pulse.
You should begin with these loads, in which the heart rate does not exceed 50-60% of maximum. After some time (3-4 weeks) with good endurance can increase the intensity of the load – so that the heart rate at the height of the load was increased to 60-70% of maximum.
If a serious illness you do not have, you can gradually move on moderate load, reaching 70-80% of maximum heart rate.
The maximum heart rate for you can be roughly calculated by the formula: «220-age in years».
That is, if you are 45 years old, the maximum heart rate for you is (220-45) = 175 beats per minute. So, you need to start with the load under which your heart rate will increase to 90-105 beats per minute.
Medications that reduce body weight
It is believed that drug therapy should be initiated in case of non-drug methods for 3-4 months is not enough for patients with a BMI of 30-35 kg/m2, or in patients with overweight and associated factors of cardiovascular risk. In a BMI over 35 kg/m2 the lifestyle change can be immediately added with drug therapy.
There are two (!) Medicinal products registered in our country as a treatment for obesity. This is orlistat (Xenical) and sibutramine (Meridia). Everything else is either Badami (ie, the effect is unknown, the doctor can not prescribe these medicines), or should not be used for the treatment of obesity.
Xenical prevents the absorption of fats in the small intestine. From this side-effect of this drug – liquid oily stools (especially in violation of the diet). This drug has no systemic side effects.
Meridia has a dual mechanism of action (slightly reduces appetite and increases energy consumption) but also has more serious side effects. To take this drug is possible only after consulting your doctor.
It is widely advertised on radio and TV supplements are not predictable on the composition, efficacy and side effects. Use them – then expose yourself unnecessary risk. Repeated enemas pace yourself for the «detoxification» is not needed. Our intestines are not need of «cleaning», the liver – even more so. Enema is not an assistant to weight loss.
In severe obesity (BMI over 40 kg/m2) to achieve the effect by changing lifestyle and the use of drugs is much more complicated. Such patients should pass surgical treatment (a decrease of gastric bypass surgery on the abdominal cavity). Unfortunately, the surgical treatment of obesity is very little used in our country yet.
Treatment of obesity – a difficult but doable task
ПFirst, define for yourself the long-term and short-term goals. That is why you lose weight (why you need it), and what result you want to get at each stage. It is important to set realistic goals (for example, this month I want to lose weight by 3-4 kg) and ensure their implementation. If your efforts will be permanent, you will be rewarded.
It is important to remember that in the initial phase is usually followed by the successes of the «plateau», when the weight is not decreasing as fast or quite a long time remained the same. You can even gain a few pounds back – nothing wrong with that, and it should not be cause for termination of the effort. Think how difficult it was to begin. Good luck!!
Author: Anna Shvedova, an endocrinologist