STUDY - Technical - New Dacian's Medicine
Obesity
(3)
Translation Draft
To finish posts about obesity.
To finish posts about obesity.
And, for starters, there
would be more to discuss about the topography of adiposity.
The regional distribution of body fat plays an important role in the risk factors of obesity. To assess the distribution of body fat, the ratio of waist circumference to hip circumference is a valuable indicator for epidemiological studies. For a particular patient, however, this ratio is not as useful as waist circumference alone. A waist circumference above 100 cm in men and over 90 cm in women is associated with an increase in triglyceride levels and a decrease in HDL cholesterol levels. Quantitative estimation of the central distribution of adiposity can be obtained by nuclear magnetic resonance or computed tomography of the abdomen.
That's where the body weight cycle and intentional weight loss come in. Regaining body weight after a diet is common and refers to the cycle of body weight. Studies relating to the body weight cycle do not reveal any side effects. On the contrary, intentional weight loss reduces the risk of illness.
An intentional weight loss of 9 kg in one year in 28,000 women aged 40 to 64 years, who did not smoke and who had no other health problems, resulted in a 25% reduction in mortality from cardiovascular disease or cancer. In 15,069 women of the same age with coexisting health problems, any intentional weight loss resulted in a 10% decrease in cardiovascular disease, a 20% decrease in all causes of mortality, a 30-40% decrease in diabetes-related mortality and a 40-50% decrease in mortality from colon and breast cancers.
Treatment of obesity must be carried out with a clear understanding of the reality of this problem and its outcome. First obesity is a chronic condition whose prevalence is increasing. Secondly, etiology is usually unknown, making healing unlikely and therapeutic purposes paleative. Thirdly, both obesity and increased visceral fatness increase the risk of disease, even if the overall weight and fatness of the body are not greatly increased. Fourthly, obesity is a stigmatizing situation in which the overweight subject is frequently accused of being responsible for this situation. Fifth, the treatment of obesity by medication has a negative imprint of the "amphetamine halo".
The introduction of amphetamines in the treatment of obesity more than 50 years ago was quickly followed by their over-consumption, which led to a poor reputation for the use of such medicines. The various drugs of this class, called beta-phenethylamines, work through various mechanisms. Amphetamine releases norepinephrine and dopamine, while other drugs in the same class affect the mechanism of serotonin, norepinephrine or both, without influencing the mechanism of dopamine.
Sixth, recidivism, i.e. the return of excess weight, is common in obesity. Seventh, drugs and other treatments for obesity do not work when used constantly, when appetite suppressors are used discontinuously, patients regain weight according to the concept that drugs do not cure obesity, but only improve stint. The choice of treatments can be made on the basis of BMI, which is used to assess the risk associated with obesity and central fat distribution.
Medications that decrease appetite (and are approved in various states) include: a. noradrenergic agents (with benzamphetamine, fendimetrazine, diethylpropion, mazindol, phenrendic hydrochloride, phentermin resin and phenylpropanylamine) and serotonergic agents (with dexfenfluramine and phenfluramine). Factors complicating obesity are: age, sex, comorbid conditions such as diabetes mellitus, hypertension and hyperlipidemia, a family history of hypertension, diabetes mellitus or coronary artery disease. In young individuals under 40 years of age, especially in men who have these risk factors or a positive family history, treatment should be done as soon as possible.
Let's talk a little bit about behavior modification! Behavioral change principles provide support for most weight loss programs. The basic principles are those of operational conditioning and cognitive restructuring. Food behaviour is analysed at the level of his history, the act of eating and its consequences, asking the patient to register and monitor these activities.
The framework within which nutrition is carried out, the nutrition itself and the use of rewards designed to change misbehavior are all monitored. Attempts are made to change negative thinking with a positive one, such as: "I just ate this cake, I'm a person who was wrong/ I was wrong" with "I just ate this cake and now I have to exercise/ I'm going to do good", or to approach other positive ways to solve the problem.
Traits of change in behavior with a proven value in people who are successful in maintaining weight loss over a longer period of time include: 1. continuous monitoring of eating-related behavior, 2. adaptation to a low-lipid diet and 3. increase physical activity.
In terms of diet, it is possible that an increase in lipid intake is associated with an increased risk of developing obesity in patients with genetic susceptibility, and prudent people should adopt a low lipid diet (the question is how low in lipids is this diet?). Extrapolation of experimental data suggests that a diet with less than 25% lipids is a reasonable desire. For anyone on a weight loss diet, both the amount of foods ingested and the excessive amounts of lipid-rich foods are equally important.
Buffet or express meals are the easiest to achieve if alcohol consumption is going or eliminated, especially when alcohol tends to decrease the ability to maintain diet control. Increasing the frequency of meals is also a useful therapeutic tactic. Individuals who eat in the morning have a lower risk of developing obesity than individuals who do not eat breakfast. Ingestion of small and frequent meals with relatively high carbohydrate and fiber content is a way to decrease lipid intake and provides a continuous feeling of gastrointestinal satiety.
Exercise is not useful as a first choice of slimming strategy, but it is crucial in maintaining weight loss (demonstrated by numerous studies). Thus, in a group of patients who completed an initial 8-week program (during which the differences in weight loss with physical hours or not are insignificant), those who continued with the exercise continued with their exercise maintained their weight deficit, while those who did not do so regained weight. This clearly demonstrates the importance of physical activity for maintaining body weight control.
When using medicines to treat obesity, appetite-lowering medicines may be useful, but should be reserved for those with a BMI above 27-30 depending on the presence of morbid situations associated with obesity. Options for pharmacological treatment of obesity include the above-mentioned medicines that decrease appetite. These drugs increase extraneuronal norepinephrine by increasing its release (benzfetamine, fendimetrazine, phenfermin, masindol and diethylpropion) or by blocking its coupling as a result of inhibition of alpha1-adrenergic receptors (phenylpropanolamine) or by releasing serotonin and blocking its coupling of receptors (fenluramine).
Data from the first 34 weeks to week 210 from a placebo study versus a combination of phenfluramine and phentermin a large difference in weight loss under the effect of taking the drug. Patients receiving the combination of medicines decreased by more than 15% of their initial weight and maintained this decrease in the first year of the study. Those who were initially on placebo medication and were given a combination of medications also had a weight loss. In some patients the weight has not decreased, indicating that they do not respond to therapy.
The use of the combination of phenluramine-phenrenda is associated with the development of heart valvular diseases, and phenfluramine, alone or in combination with other anorexic agents can cause pulmonary hypertension. The possibility of neurotoxicity is not excluded. Consequently, the only justifiable medical recommendation of anorexic drugs is in the patient with marked obesity and associated with various other conditions, such as ischemic heart disease, diabetes mellitus, hypertension and/ or hyperlipidemia. The patient should be subject to actual risks and benefits (he should be monitored regularly by physical examination and, where appropriate, echocardiography).
For patients with a BMI over 35 who have an increased risk of diabetes or a family history of early myocardial infarction and for patients without these problems, but with a BMI above 40, the surgical approach to the gastrointestinal tract may be useful. Various surgeries such as gastric bypass, gastroplasty, vertical suture, terminolateral suture or biliopancreatic bypass have been performed. Data comparing the various procedures suggest that the largest long-term weight loss occurs in gastric bypass surgery, in which a small pocket formed in the upper portion of the stomach is attached by an anastomosis in Roux in Y de jejun. Mortality during the operation is between 0.1 and 0.5%. Weight gain and other problems are minimal in this intervention and in the vertical suture of the stomach, which are the two recommended procedures.
And with that, I'm done with obesity at the moment. Next time I'll tackle anorexia nervosa and bulimia nervosa.
The regional distribution of body fat plays an important role in the risk factors of obesity. To assess the distribution of body fat, the ratio of waist circumference to hip circumference is a valuable indicator for epidemiological studies. For a particular patient, however, this ratio is not as useful as waist circumference alone. A waist circumference above 100 cm in men and over 90 cm in women is associated with an increase in triglyceride levels and a decrease in HDL cholesterol levels. Quantitative estimation of the central distribution of adiposity can be obtained by nuclear magnetic resonance or computed tomography of the abdomen.
That's where the body weight cycle and intentional weight loss come in. Regaining body weight after a diet is common and refers to the cycle of body weight. Studies relating to the body weight cycle do not reveal any side effects. On the contrary, intentional weight loss reduces the risk of illness.
An intentional weight loss of 9 kg in one year in 28,000 women aged 40 to 64 years, who did not smoke and who had no other health problems, resulted in a 25% reduction in mortality from cardiovascular disease or cancer. In 15,069 women of the same age with coexisting health problems, any intentional weight loss resulted in a 10% decrease in cardiovascular disease, a 20% decrease in all causes of mortality, a 30-40% decrease in diabetes-related mortality and a 40-50% decrease in mortality from colon and breast cancers.
Treatment of obesity must be carried out with a clear understanding of the reality of this problem and its outcome. First obesity is a chronic condition whose prevalence is increasing. Secondly, etiology is usually unknown, making healing unlikely and therapeutic purposes paleative. Thirdly, both obesity and increased visceral fatness increase the risk of disease, even if the overall weight and fatness of the body are not greatly increased. Fourthly, obesity is a stigmatizing situation in which the overweight subject is frequently accused of being responsible for this situation. Fifth, the treatment of obesity by medication has a negative imprint of the "amphetamine halo".
The introduction of amphetamines in the treatment of obesity more than 50 years ago was quickly followed by their over-consumption, which led to a poor reputation for the use of such medicines. The various drugs of this class, called beta-phenethylamines, work through various mechanisms. Amphetamine releases norepinephrine and dopamine, while other drugs in the same class affect the mechanism of serotonin, norepinephrine or both, without influencing the mechanism of dopamine.
Sixth, recidivism, i.e. the return of excess weight, is common in obesity. Seventh, drugs and other treatments for obesity do not work when used constantly, when appetite suppressors are used discontinuously, patients regain weight according to the concept that drugs do not cure obesity, but only improve stint. The choice of treatments can be made on the basis of BMI, which is used to assess the risk associated with obesity and central fat distribution.
Medications that decrease appetite (and are approved in various states) include: a. noradrenergic agents (with benzamphetamine, fendimetrazine, diethylpropion, mazindol, phenrendic hydrochloride, phentermin resin and phenylpropanylamine) and serotonergic agents (with dexfenfluramine and phenfluramine). Factors complicating obesity are: age, sex, comorbid conditions such as diabetes mellitus, hypertension and hyperlipidemia, a family history of hypertension, diabetes mellitus or coronary artery disease. In young individuals under 40 years of age, especially in men who have these risk factors or a positive family history, treatment should be done as soon as possible.
Let's talk a little bit about behavior modification! Behavioral change principles provide support for most weight loss programs. The basic principles are those of operational conditioning and cognitive restructuring. Food behaviour is analysed at the level of his history, the act of eating and its consequences, asking the patient to register and monitor these activities.
The framework within which nutrition is carried out, the nutrition itself and the use of rewards designed to change misbehavior are all monitored. Attempts are made to change negative thinking with a positive one, such as: "I just ate this cake, I'm a person who was wrong/ I was wrong" with "I just ate this cake and now I have to exercise/ I'm going to do good", or to approach other positive ways to solve the problem.
Traits of change in behavior with a proven value in people who are successful in maintaining weight loss over a longer period of time include: 1. continuous monitoring of eating-related behavior, 2. adaptation to a low-lipid diet and 3. increase physical activity.
In terms of diet, it is possible that an increase in lipid intake is associated with an increased risk of developing obesity in patients with genetic susceptibility, and prudent people should adopt a low lipid diet (the question is how low in lipids is this diet?). Extrapolation of experimental data suggests that a diet with less than 25% lipids is a reasonable desire. For anyone on a weight loss diet, both the amount of foods ingested and the excessive amounts of lipid-rich foods are equally important.
Buffet or express meals are the easiest to achieve if alcohol consumption is going or eliminated, especially when alcohol tends to decrease the ability to maintain diet control. Increasing the frequency of meals is also a useful therapeutic tactic. Individuals who eat in the morning have a lower risk of developing obesity than individuals who do not eat breakfast. Ingestion of small and frequent meals with relatively high carbohydrate and fiber content is a way to decrease lipid intake and provides a continuous feeling of gastrointestinal satiety.
Exercise is not useful as a first choice of slimming strategy, but it is crucial in maintaining weight loss (demonstrated by numerous studies). Thus, in a group of patients who completed an initial 8-week program (during which the differences in weight loss with physical hours or not are insignificant), those who continued with the exercise continued with their exercise maintained their weight deficit, while those who did not do so regained weight. This clearly demonstrates the importance of physical activity for maintaining body weight control.
When using medicines to treat obesity, appetite-lowering medicines may be useful, but should be reserved for those with a BMI above 27-30 depending on the presence of morbid situations associated with obesity. Options for pharmacological treatment of obesity include the above-mentioned medicines that decrease appetite. These drugs increase extraneuronal norepinephrine by increasing its release (benzfetamine, fendimetrazine, phenfermin, masindol and diethylpropion) or by blocking its coupling as a result of inhibition of alpha1-adrenergic receptors (phenylpropanolamine) or by releasing serotonin and blocking its coupling of receptors (fenluramine).
Data from the first 34 weeks to week 210 from a placebo study versus a combination of phenfluramine and phentermin a large difference in weight loss under the effect of taking the drug. Patients receiving the combination of medicines decreased by more than 15% of their initial weight and maintained this decrease in the first year of the study. Those who were initially on placebo medication and were given a combination of medications also had a weight loss. In some patients the weight has not decreased, indicating that they do not respond to therapy.
The use of the combination of phenluramine-phenrenda is associated with the development of heart valvular diseases, and phenfluramine, alone or in combination with other anorexic agents can cause pulmonary hypertension. The possibility of neurotoxicity is not excluded. Consequently, the only justifiable medical recommendation of anorexic drugs is in the patient with marked obesity and associated with various other conditions, such as ischemic heart disease, diabetes mellitus, hypertension and/ or hyperlipidemia. The patient should be subject to actual risks and benefits (he should be monitored regularly by physical examination and, where appropriate, echocardiography).
For patients with a BMI over 35 who have an increased risk of diabetes or a family history of early myocardial infarction and for patients without these problems, but with a BMI above 40, the surgical approach to the gastrointestinal tract may be useful. Various surgeries such as gastric bypass, gastroplasty, vertical suture, terminolateral suture or biliopancreatic bypass have been performed. Data comparing the various procedures suggest that the largest long-term weight loss occurs in gastric bypass surgery, in which a small pocket formed in the upper portion of the stomach is attached by an anastomosis in Roux in Y de jejun. Mortality during the operation is between 0.1 and 0.5%. Weight gain and other problems are minimal in this intervention and in the vertical suture of the stomach, which are the two recommended procedures.
And with that, I'm done with obesity at the moment. Next time I'll tackle anorexia nervosa and bulimia nervosa.
Understanding, love and
gratitude!
Dorin, Merticaru