Is Obesity Treated And How?

Obesity is not just a cosmetic problem, but a chronic and debilitating disease that poses serious health risks. That is why strategies to address this current problem are constantly being sought worldwide.

The choice of treatment approach depends on the degree of obesity. The most convenient and easy indicator for its classification is the body mass index, which is calculated according to weight in kilograms and height [BMI = body weight (kg) / height (m2)]. Thus, in the first degree obesity BMI is between 30 - 34.9 kg / m2, second degree: 35 - 39.9 kg / m2, and third degree is observed in BMI over 40 kg / m2.

Always the first step in therapy, at all stages of obesity, is a change in lifestyle. It includes three components: diet, physical activity and behavioral change.

Diet

The main recommendations for a diet for obesity are:

• Reduction of high-calorie foods and beverages;
• Reducing portion sizes;
• Skipping snacks;
• Mandatory breakfast and avoidance of night meals;
• Reduction of cases of uncontrolled eating and eating episodes;

To date, there is no convincing evidence that diets with restriction of certain food groups (fats, carbohydrates, proteins) have a better effect than a balanced calorie restriction. Hypocaloric regimens aim to consume about 25 kcal / kg body weight. This achieves an energy deficit of about 600 kcal / day, which implies a loss of 0.5 kg / week. 

Physical activity

It has a more moderate effect on weight loss, but is extremely helpful in the redistribution of adipose tissue and to maintain the achieved weight. Moderate physical activity (brisk walking, dancing, water aerobics) for at least 150 minutes a week (spread over at least 3 days) or 75 minutes of high-intensity activity (running, swimming, fast cycling) is recommended. Anaerobic training (such as weight lifting) increases muscle mass and should also be practiced 3 times a week.

Behavioral change

It aims to help a person change their thinking and understanding of obesity and its consequences. To achieve this, the help of a doctor or psychologist is often needed, as a number of psychological problems can contribute to excessive food consumption.

People with a BMI> 30 kg / m2 are indicated for the medical treatment of obesity. Pharmacotherapy does not reverse the change in lifestyle, but complements it. It is important to know that in the absence of a response to treatment after 3 months, it should be discontinued and replaced with other medications or therapeutic approaches. Treatment is considered effective in weight reduction by ≥ 5% of baseline. So far, only three obesity preparations have been approved in Europe: 

• Orlistat (Xenical) - it suppresses the absorption of fat in the gastrointestinal tract, which, unfortunately, leads to one of its most common and unpleasant side effects - steatorrhea ("oily" diarrhea). 
• Liraglutide (Saxenda) is a glucagon-like peptide -1 (GLP-1) receptor agonist that is given as an injection once a day, subcutaneously. It was originally registered for the treatment of type 2 diabetes, but due to its appetite-lowering effect, it has also been used successfully in obesity.
• Naltrexone / Bupropion (Maisimba) - Naltrexone is an opioid antagonist used to treat patients with drug or alcohol dependence, and bupropion is a medicine used to treat depression. It has been found that the effect of this preparation is on the hypothalamus and leads to a decrease in energy intake and an increase in energy expenditure. Common side effects are nausea, vomiting, headache, dizziness.

For patients with a BMI> 40 kg / m2, surgical treatment is most effective . With the help of metabolic surgery, a permanent weight reduction, improvement of the accompanying complications and quality of life are achieved. 

The biggest challenge in treating obesity is maintaining weight. Many people who have started diets to lose weight quickly regain their original body weight ( "yo-yo" effect ). Among the main reasons are the setting of unrealistic goals and low motivation. It is important to remember that obesity is a chronic disease and takes a long time to treat. Even 5-10% weight loss has a huge effect on human health and well-being.