The biggest mistake made in obesity treatment is to aim for rapid weight loss. Gaining back the rapidly lost weight
and the resulting disappointments cause loss of motivation in the patient.
Therefore, realistic targets should be set at the beginning of the treatment (such as 5-10% weight loss in 6 months).
Even a 10% reduction in body weight significantly reduces risk factors. For example,
a 1 kg decrease in fat tissue provides a decrease of 2 mmHg in systolic blood pressure and 1 mmHg in diastolic blood pressure, which is as effective as an antihypertensive drug.
Maintaining weight depends on long-term behavioral change, balanced and healthy nutrition and increasing physical activity. For this purpose, the main point of treatment is to reduce energy intake and increase energy expenditure. Various treatment methods such as nutritional therapy, physical activity, behavioral therapy, drug therapy and surgical treatment are applied in the treatment of obesity.
How is Obesity Treatment Done?
In the fight against obesity; Various types of treatment methods are applied, such as diet (Medical Nutrition) treatment, physical activity (exercise), behavioral treatment
(nutrition model), drug treatment, combined treatment and surgical treatment.
Treatment goals are focused on 10% weight loss and the aim is to ensure long-term maintenance of weight loss. Maintaining weight depends on long-term behavioral changes, balanced and healthy nutrition and increasing physical activity. For this purpose, the main point of treatment is to reduce energy intake
and increase energy expenditure. The types of energy we spend during the day are as follows:
1- Basal metabolism,
2- Meal-dependent energy expenditure (thermic effect of foods)
3- Energy lost for physical activity.
Basal metabolism is 60-70% of daily energy, the thermic effect of food is 10%, physical exercise is 10-15% in sedentary people and 30-40% of total energy in active people.
Diet (Healthy nutrition) Treatment:
Although diet is a feasible, cheap and safe option, it should be personalized. diet therapy The aim of
is to reduce body fat stores by creating an energy deficit. Fat stores should be reduced in muscle and vital organs
without cell loss, and vitamin, mineral and electrolyte loss
should be prevented. In general, calorie restriction of 500-600 kcal/day causes a weight loss of 0.5 kg per week and 10% in 6 months. Many obese people skip meals
to limit their total energy intake during the day, but the hunger drive then creates more food intake and the thermogenic
effects of foods also decrease. Therefore, it is important to divide the daily calories into 20-25% for breakfast, 30-35% for lunch, and 30-35% for dinner and eat frequently and suppress the feeling of hunger.
Exercise:
Heart and lung tests must be performed before starting to exercise. Initially, 30-45
minutes/day should be encouraged for moderate physical activity 3-5 days a week. To spend 2,000 kcal
per week, it is necessary to walk briskly for approximately 7 hours (420 minutes) per week. In addition, the patient's age and additional diseases should be evaluated and exercise planning should be made individually. First of all, you start with walking for 10 minutes, 3 days a week. It is increased to 30-45 minutes at least 5 days a week.
Behavioral Treatment:
To increase physical activity and increase compliance in people who have difficulty complying with dietary recommendations
behavioral treatments are also used. is used. Behavior therapy increases a person's motivation. It is applied for 12-20 weeks in groups of 10-15 people, in 1-2 hour sessions per week, under the direction of the therapist
. Meetings once a week for 6 months, then 1-2 times a month can be extended for up to two years. However, behavior
treatment alone is not sufficient in the treatment of obesity. Behavioral strategies increase the weight loss achieved by diet and exercise by 10% of the baseline within 4 months to 1 year. It is recommended to apply it in combination with drug therapy or a very low calorie diet (VLCD).
Surgical Treatment:
In cases that fail despite lifestyle changes, diet, exercise and drug treatment. ; Surgical
methods are reliable and effective. Severe obesity has a BMI>40 kg/m2 and a BMI between 35-40 but is at high risk for obesity-related disease. These patients are candidates for surgical treatment. In obesity surgery, surgery is performed on the stomach and small intestine to reduce the amount of food consumed. Before surgery, patients should be informed about the risks and benefits, be examined by endocrinologists, relevant laboratory tests should be performed, should be evaluated psychiatrically and examined with a multidisciplinary approach.
Surgical methods used in the treatment of obesity are as follows: p>
Gastric resection
• Horizontal gastroplasty
• Vertical banded gastroplasty
• Gastric banding
Malabsorption methods
• Jejenoileal by pass
• Retrocolic loop by-pass
• Roux-en Y gastric by pass
Combinations
• Laparoscopic anti-obesity surgery
They can be listed as: • Biliopancreatic diversion
• Liposuction
• Lipectomy.
In the adjustable gastric band (also known as gastric band) method, a suitable band is placed around the upper part of the
stomach. The band is progressively compressed to create a small pouch. Needles are required for regular
application. It is technically easy, reversible and has no risk of malabsorption. Requires close
monitoring and regular band adjustment. Treatment
will fail if the patient consumes sweets and high-carbohydrate liquids.
Read: 0
