In this publication we will talk about obesity of the first degree in adults and children. Since today the most common is the first degree of obesity (exogenous-constitutional and alimentary), we will tell you how many kg. a person is gaining at this stage, what is the danger of painful fullness of the 1st degree during pregnancy, what diet will help in the fight against excess weight, and much more.
Obesity is a serious endocrinological disease, which is expressed by an increase in the volume of adipose tissue. The discrepancy between the intake of calories and their expenditure in the human body leads to excess body weight. Based on the severity of the development of fullness, four degrees of the disease are divided. To calculate the stage of pathology, there are certain tables that take into account BMI, gender, height, age.
Obesity of the first degree: how many kg (photo)
The mild form includes obesity of the first degree. There are several factors for the occurrence of this disease:
- hypodynamia;
- metabolism;
- increased likelihood of developing the disease;
- high calorie food;
- depression, stress.
The disease process of the 1st degree does not appear suddenly. Late seeking help on what to do with excess weight is more often due to the usual inexperience with the diagnosis.
The photo shows what the young body of a woman looks like in the first degree of the disease.
In order to find out how many kg you need to lose, you can use the reference tables. At stage 1 of the disease, the body mass index exceeds the established measure up to 29 percent. With obesity of this degree, patients begin to feel weakness and fatigue.
Accompanied by additional symptoms:
- Bad mood;
- emotional imbalance;
- inferiority complex;
- underestimation of one's personality.
Obesity should be treated 1 tbsp. immediately, because it leads to serious consequences: disruption of the thyroid gland, liver, pancreas. It also disrupts menstrual cycles and increases the risk of developing diabetes.
Exogenous-constitutional obesity of the 1st degree
Exogenous constitutional obesity of the 1st degree is often found in women who lead a sedentary lifestyle, eat excessively and tend to be overweight.
To determine the disease, you need to pay attention to the following signs that have appeared:
- dyspnea;
- lumbar pain;
- restlessness in knee and hip joints.
Housewives, office workers and fast food lovers are most often ill with this type. It is easy to cure, since it is not a hormonal disorder of the body. Exogenous-constitutional completeness requires an individual approach.
Among men, abdominal obesity is more common, where fat folds form in the abdominal cavity. With such a disease, it is recommended to visit a nutritionist and undergo a comprehensive examination by an endocrinologist.
Alimentary
Alimentary obesity of the 1st degree develops when energy costs do not have time to cope with the amount of food calories taken. There is a violation of the behavior of the organism as a whole, and not individual systems or organs. This is due to etiological reasons, which are divided into two factors.
For families that eat mostly fatty foods, alimentary primary obesity of the first stage is considered the norm. Treatment of alimentary disease is assigned to each individually.
The specialist considers everything:
- growth;
- Lifestyle;
- Kind of activity;
- nationality;
- age;
- predisposition.
The psychological assistance provided is important to the patient, because usually the cause of alimentary constitutional obesity is deep in the subconscious.
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Obesity during pregnancy
During pregnancy, the development of fatty tissue is naturally stimulated in order to protect the fetus from external factors.
Type 1 obesity in a pregnant woman increases the risk of developing serious complications:
- diabetes;
- increased blood pressure;
- increased risk of infection;
- the formation of thrombosis;
- sleep disorder;
- the duration of pregnancy increases;
- labor induction;
- the risk of birth complications;
- threatened miscarriage or stillbirth.
In the fight against weight pathology during pregnancy, the specialist advises to focus on maintaining a low body weight gain throughout the entire period of pregnancy. Such women are classified as a high risk group for the threat of losing a child and are always under the supervision of a doctor. Obesity of the 1st degree during pregnancy greatly affects the development of the fetus.
Diet for stage 1 obesity
For the treatment of pathology, a large number of diets are offered. Their main goal is to severely limit nutritional value in proportion to the stage of excess body weight.
The main goal of therapy is to increase the body's energy consumption due to strictly performed physical exercises. The combination of diet and active exercise gives effective results in losing weight.
When compiling the menu for the week, take into account:
- the introduction of products with proteins of animal and plant organisms;
- the presence of amino acids;
- exclusion from the diet of sugar;
- regulation of the intake of norms of bakery products and butter.
For patients, diets are developed in accordance with the type of disease. Take food should be fractional, at least six times a day.
The fight against excess weight in clinics
If you can’t lose excess weight on your own, then it’s time to seek help from a clinic. There, under the supervision of a specialist, an individual weight loss program is offered.
Clinic 1 for the fight against excess weight can offer effective weight loss. To do this, a doctor in a specialized center at the first appointment conducts diagnostics and draws up a personalized therapy program. Here you can get competent advice from real experts, listen to recommendations.
The procedures are expertly selected and include:
- SPA programs;
- manual therapy;
- trichology;
- therapeutic massages;
- physiotherapy;
- acupuncture;
- cleansing the body and other activities.
All the manipulations carried out will help not only to normalize body weight, but also to improve the body. Treatment in clinics under the supervision of a doctor is safe and comfortable.
Obesity 1 degree: ICD code 10
Diagnosis of excess fat accumulation in patients is of considerable importance, as the threat of exacerbations increases.
The disease has an ICD code 10 - E66 and there are two probabilities of development:
- Social factor: low standard of living;
- Risk Factor: Pregnancy, high fat diet, sedentary lifestyle.
For the treatment of pathology, it is recommended to increase physical activity, drug therapy helps. Surgical treatment is used already in the last stages of obesity. Only complex therapy together with diet and exercise can bring high efficiency. Treatment should be under the supervision of specialists.
Statistics say that a third of the world's population is obese and this is not the limit. The disease affects children and adolescents especially seriously. Therefore, scientists call the disease an epidemic of the 21st century.
RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2014
Other forms of obesity (E66.8), Extreme obesity accompanied by alveolar hypoventilation (E66.2), Obesity, unspecified (E66.9), Obesity due to excessive intake of energy resources (E66.0)
Endocrinology
general information
Short description
Expert Council of RSE on REM "Republican Center for Health Development"
Ministry of Health and Social Development of the Republic of Kazakhstan
Obesity- a chronic, relapsing disease characterized by excessive deposition of fat in the body.
Body mass index(BMI) (BMI) is a value that allows you to assess the degree of correspondence between a person’s weight and his height, and thereby assess whether the mass is insufficient, normal or overweight.
Body mass index is calculated by the formula:
I = --------------------
M is body weight in kilograms;
H - height in meters.
And it is measured in kg/m².
The body mass index was developed by the Belgian sociologist and statistician Adolphe Quetelet in 1869.
Up to 19 kg / m 2 - weight deficit;
19-24.9 kg / m 2 - normal weight;
25-29.9 kg / m 2 - overweight;
30 kg / m 2 and above - obesity.
BMI greater than or equal to 25 - overweight;
BMI greater than or equal to 30 - obesity;
BMI greater than or equal to 35 - severe obesity;
BMI greater than or equal to 40 - morbid obesity;
BMI greater than or equal to 50 - super-obese (super-obese);
BMI over 60 kg / m 2 - super-super-obesity.
bariatric surgery(metabolic surgery, weight loss surgery) is a branch of surgery that treats overweight people and includes surgical weight loss by limiting the intake of nutrients and / or reducing their absorption in the gastrointestinal tract. Bariatric surgery does not include cosmetic (body contouring) surgery, and is aimed at improving health.
The bariatric effect is expressed in (Exess weight loss - EWL%) - the percentage of excess weight loss in kg of excess body weight.
Types of operations used in the treatment of obesity:
Restrictive surgery- the bariatric effect is achieved by reducing the volume of the stomach, in connection with which the quantitative food intake decreases with maximum and accelerated irritation of the bariatric receptors;
Malabsorption surgery- bariatric effect is achieved by reducing the absorption surface of the gastrointestinal tract.
Mixed type of operation- the bariatric effect is achieved in a combined way: restrictive surgery on the stomach and by reducing the absorption surface of the gastrointestinal tract.
I. INTRODUCTION
Protocol name: Morbid obesity. metabolic syndrome.
Protocol code:
ICD 10 code:
E66.0 Obesity due to excessive intake of energy resources;
E66.2 Extreme obesity accompanied by alveolar hypoventilation (Pickwick syndrome);
E66.8 Other forms of obesity Morbid (morbid) obesity;
E66.9 Obesity, unspecified
Abbreviations used in the protocol:
BP - blood pressure;
ALT - alanine aminotransferase;
ASAT - aspartate aminotransferase;
APTT - activated partial thromboplastin time;
GDZ - hepato-duodenal zone;
GERD-gastroesophageal reflux disease;
HH - hiatal hernia;
VC - vital capacity of the lungs;
ZHKB - cholelithiasis;
GIT - gastrointestinal tract;
BMI - body mass index;
CT - computed tomography;
LGP - laparoscopic gastroplication;
HDL - high density lipoproteins;
LDL - low density lipoproteins;
MPU - medical and preventive institutions;
INR - international normalized ratio;
MRI - magnetic resonance imaging;
MS - metabolic syndrome;
KLA - complete blood count;
OAM - urinalysis;
OB - volume of the hips
OT - waist size
PT - prothrombin time;
PHC - primary health care;
PLV% - % excess weight loss;
RCT - randomized clinical trial;
DM 2 - type 2 diabetes mellitus;
TAG - triacylglyceride;
PE - pulmonary embolism;
LE - level of evidence;
Ultrasound - ultrasound examination;
CSBH - Centers of Excellence in Bariatric Surgery;
ECG - electrocardiogram;
BMI -Body Mass Index (Body Mass Index);
EWL% - Exess Weight Loss.
IFSO - International Federation for the Surgery of Obesity and Metabolic Disorders (International Federation for the Surgery of Obesity and Metabolic Syndrome);
MRSA - Methicillin-resistant Staphylococcus aureus (Resistant Staphylococcus aureus)
Protocol development date: year 2014.
Protocol Users: surgeon, general practitioner, therapist, endocrinologist, cardiologist, gastroenterologist, hepatologist, neuropathologist.
This protocol uses the Oxford system of "evidence-based medicine", with levels of evidence (Table 1), which are determined by the analysis of scientific literature, and the choice of the degree of recommendation (Table 2), which in turn depends on the level of evidence. In 2010, in a joint clinical guideline developed by the American Association of Clinical Endocrinologists, the Society of Bariatric and Metabolic Surgeons, a gradation of the level of evidence similar to the Oxford system was used to assess the evidence base.
Table 1 Levels of evidence
|
Level |
Therapy / Prevention, Etiology / Risk |
| 1a | Systematic Reviews (Meta-analyses) of Randomized Clinical Trials (RCTs) |
| 1b | Selected RCTs |
| 1c | Series of “all-or-none results” cases |
| 2a | Systematic Reviews (with Homogeneity) of Cohort Studies |
| 2b | Individual cohort trials (including low-quality RCTs such as<80% follow-up) |
| 2c | Research reports. Environmental studies |
| 3a | Systematic reviews (with homogeneity) of case-control studies |
| 3b | Selected case-control studies |
| 4 | Case series (and low-quality cohorts and case-control studies) |
| 5 | Expert opinion without precise critical evaluation, or based on physiology and other principles |
It should be noted that in determining the grade of recommendation, there is no direct relationship between the level of evidence and the grade of recommendation. Evidence from randomized controlled trials does not always rank as grade A recommendations in case there are flaws in methodology or inconsistencies between published results from multiple studies. Also, the lack of high-level evidence does not exclude the possibility of making a grade A recommendation if there is rich clinical experience and consensus. In addition, there may be exceptional situations where confirmatory studies cannot be performed, perhaps for ethical or other reasons, in which case precise recommendations are considered useful.
Note:
"Extrapolation" is when data are used in a situation where there may be clinically significant differences than are unambiguously confidently described in the original studies.
Classification
obesity classification
According to etiology and pathogenesis:
1. primary obesity(alimentary-constitutional or exogenous-constitutional) (in 95% of cases):
Gynoid (lower type, gluteal-femoral);
Android (upper type, abdominal, visceral);
With individual components of the metabolic syndrome;
With advanced symptoms of metabolic syndrome;
With severe eating disorders;
With night eating syndrome;
With seasonal affective fluctuations;
With hyperphagic stress response;
With Pickwick's syndrome;
With secondary polycystic ovaries;
With sleep apnea syndrome;
With puberty-youthful dispituitarism.
2. Symptomatic (secondary) obesity(in 5% of cases):
With an established genetic defect:
As part of known genetic syndromes with multiple organ damage;
Genetic defects of the structures involved in the regulation of fat metabolism.
Cerebral:
. (adiposogenital dystrophy, Babinski-Pehkranz-Froelich syndrome)
Tumors of the brain, other cerebral structures;
Dissemination of systemic lesions, infectious diseases;
Hormonally inactive pituitary tumors, "empty" sella syndrome, "pseudotumor" syndrome;
Against the backdrop of mental illness.
Endocrine:
hypothyroid;
Hypoovarian;
In diseases of the hypothalamic-pituitary system;
In diseases of the adrenal glands.
Classification of obesity according to the course of the disease:
stable;
progressive;
Residual.
Classification of obesity by body mass index
Degrees of obesity by BMI:
Obesity I degree: BMI from 30 to 34.9 kg / m 2;
Obesity II degree: BMI from 35 to 39.9 kg / m 2;
Obesity III degree: BMI from 40 kg / m 2 and above.
Classification of obesity according to the type of deposition of adipose tissue:
Abdominal (android, central) obesity;
Gluteal-femoral (gynoid) obesity;
mixed obesity.
To determine the type of deposition of adipose tissue, the ratio of OT and OB is used. Obesity is considered abdominal if women have OT/OB > 0.85, men - > 1.0.
Table #3 Waist circumference and the risk of complications of obesity
An increase in waist circumference is a sign of an increased risk of complications, even with normal BMI values.
Waist circumference is measured in a standing position, in the middle of the distance between the lower edge of the chest and the iliac crest along the mid-axillary line (not according to the maximum size and not at the level of the navel), hip circumference - in their widest area at the level of the greater trochanter.
Indicators of high risk of comorbidities (in terms of waist circumference): in men > 102 cm, in women > 88 cm.
Diagnostics
II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT
List of basic and additional diagnostic measures
The main (mandatory) diagnostic examinations carried out at the outpatient level:
UAC deployed;
Biochemical blood test (urea, creatinine, total protein, ALT, AST, glucose, total bilirubin, HDL, LDL, cholesterol, thymol test, alkaline phosphatase);
Glycemic profile;
GDZ ultrasound;
Endocrinologist consultation;
Hepatologist consultation;
Therapist's consultation.
Additional diagnostic examinations performed at the outpatient level:
Definition of VC;
CT scan of the brain;
Ultrasound of the thyroid gland.
The minimum list of examinations that must be carried out when referring to planned hospitalization:
Coagulogram (PV, fibrinogen, APTT, INR);
Biochemical blood test (urea, creatinine, total protein, ALT, AST, total bilirubin, HDL, LDL, cholesterol, thymol test, alkaline phosphatase);
blood sugar;
Microreaction;
Determination of blood for hepatitis B, C viruses;
GDZ ultrasound;
Fluorography;
Consultation of a therapist to identify contraindications to surgical treatment;
The main (mandatory) diagnostic examinations carried out at the hospital level:
Coagulogram (PV, fibrinogen, APTT, INR);
Biochemical blood test (urea, creatinine, total protein, AlAT, AsAT, total bilirubin);
blood sugar;
Group and Rh - blood factor;
R - scan (graph) of the stomach with barium.
Additional diagnostic examinations carried out at the hospital level:
Abdominal ultrasound.
Diagnostic measures taken at the stage of emergency emergency care: not carried out.
Diagnostic criteria
Complaints and anamnesis
Complaints:
Overweight;
Pain in the joints - pelvic, knee, ankle;
Shortness of breath when walking;
Palpitation when walking;
Increased blood pressure;
Pain in the chest;
Violation of the menstrual cycle in women of childbearing age;
Infertility.
Anamnesis:
The presence of concomitant diseases (arterial hypertension, type 2 diabetes mellitus, arthropathy);
Family predisposition to the development of obesity;
Sedentary lifestyle;
Violation of the diet;
Stress.
Physical examination:
Measurement of body weight;
Height measurement;
Calculation of BMI;
Measurement of chest volume;
Waist measurement;
Measuring the volume of the hips;
Measurement of VC.
Laboratory research
Table No. 4. Criteria for diagnosing metabolic syndrome
|
Criteria for laboratory tests |
Indicator |
| Elevated levels of triacylglycerols (esters of glycerol and higher fatty acids—TAGs) or LDL fractions (beta-lipoproteins) | greater than or equal to 1.7 mmol/l or specific treatment for these lipid disorders. |
|
Reduced cholesterol Decreased high-density lipoprotein (HDL) |
less than 1.03 mmol/l in men; less than 1.29 mmol/l in women; or specific treatment for these lipid disorders. |
| Elevated plasma glucose |
Fasting plasma glucose greater than or equal to 5.6 mmol/L or previously diagnosed type 2 diabetes mellitus; If fasting plasma glucose is less than 5.6 mmol/l, a glucose tolerance test is recommended, although this is not required to confirm the presence of the metabolic syndrome itself. |
Instrumental research:
Ultrasound of the liver - to detect dystrophic changes in the liver in the form of fatty hepatosis;
Ultrasound of the liver - to detect stones in the gallbladder to determine possible simultaneous surgical treatment;
EFGDS - detection of GERD and / or HH.
Indications for consultation of narrow specialists:
Consultation with a general practitioner/cardiologist to clarify the general somatic condition;
Consultation with an endocrinologist to exclude obesity associated with endocrine diseases;
Consultation of a neuropathologist/neurosurgeon for patients with a history of traumatic brain injury, neuroendocrine diseases;
Consultation of a psychotherapist is indicated for patients with eating disorders (attacks of compulsive eating at certain intervals of time, lack of a feeling of satiety, taking large amounts of food without feeling hungry, in a state of emotional discomfort, sleep disturbance with night meals in combination with morning anorexia);
Consultation of a geneticist in the presence of signs of genetic syndromes.
Differential Diagnosis
Table No. 5 Differential diagnosis for morbid obesity
|
Types of obesity |
Etiology | Clinical manifestations | Diagnostics |
| Alimentary - constitutional |
Availability of food and overeating from early childhood; Reflexes related to time and amount of food; Assimilated types of nutrition (national traditions); Hypodynamia, predisposing heredity to obesity; The constitution of adipose tissue; The activity of fat metabolism; The state of the hypothalamic centers of satiety and appetite; Dishormonal conditions (pregnancy, childbirth, lactation, menopause) are often predisposing to the development of obesity. |
BMI; FROM/OB; Elevated levels of triacylglycerols; Increase in cholesterol; triglycerides in the blood; Elevated plasma glucose. |
|
| Cerebral |
Skull injuries; neuroinfections; brain tumors; Prolonged increase in intracranial pressure. |
even distribution of subcutaneous fat throughout the body |
CT scan of the brain; MRI of the brain. |
| Endocrine | . primary pathology of the endocrine glands (hypercorticism, hypothyroidism, hypogonadism, insulinoma) | the upper type is typical for hypothalamic obesity of the type of Itsenko-Cushing's disease with adrenal obesity and in fact with Itsenko-Cushing's disease; |
Increase in the content of ACTH, cortisol; Increasing the level of 17KS, 170KS;. Decrease in the content of thyroid hormones (TK, T4, TSH); Decreased levels of HTG, estrogen, progesterone, testosterone, inherent in hypogonadal obesity. These hormonal changes provide lipogenesis. |
| Medicinal |
Formed at long-term use of drugs that increase appetite or activate liposynthesis |
Uniform distribution of subcutaneous fat throughout the body |
BMI; FROM/OB; Elevated levels of triacylglycerols; Increase in cholesterol Triglycerides in the blood Elevated plasma glucose |
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Treatment
Treatment goals:
Achieving the most stable (at least 5 years) and gradual weight loss (no more than 0.5-1 kg per week).
Achievement of target values of metabolic parameters:
BP less than or equal to 130/85 mm Hg. Art.;
Fasting glycemia less than or equal to 5.6 mmol/l;
Triglycerides less than or equal to 1.7 mmol/L;
HDL more than 1.03 mmol/l in men and more than 1.29 mmol/l in women;
Total cholesterol is less than or equal to 5.2 mmol/l.
Treatment tactics
Non-drug treatment(mode, diet, etc.):
Diet therapy;
Physical activity.
Medical treatment
Ampicillin/sulbactam (1.5 g, IV);
Amoxicillin/clavulanate (1.2 g, IV);
Cefazolin (2 g, i.v.);
Cefuroxime (1.5 g, IV).
From 1-3 days of the postoperative period - with a duration of surgical intervention of more than 4 hours, if there are technical difficulties during the operation, especially when performing hemostasis, as well as at the risk of microbial contamination.
(depending on the results of the microbiological examination):
Ampicillin/sulbactam:
With a mild course of infection - 1.5 g 2 r / day IV, the duration of treatment is up to 3-5 days;
In moderate course -1.5 g 4 r / day in / in, the duration of treatment is 5-7 days;
In severe cases -3 g 4 r / day in / in, the duration of treatment is up to 7-10 days.
Amoxicillin/clavulanate(calculation for amoxicillin):
With a mild infection: 1 g IV, 3 times a day, the duration of treatment is up to 3-5 days;
Cefazolin:
With a mild infection: 0.5-1 g IV, 3 times a day, the duration of treatment is up to 3-5 days;
In severe infection: 2 g IV, 3 times a day, the duration of treatment is 5-10 days.
Cefuroxime:
With a mild infection: 0.75 g IV, 3 times a day, the duration of treatment is up to 3-5 days;
In severe infection: 1.5 g IV, 3 times a day, the duration of treatment is 5-10 days.
Metronidazole:
With a mild infection: 500 mg IV, drip, 3 times a day, the duration of treatment is up to 5-7 days;
In severe infection: 1000 mg IV, 2-3 times a day, the duration of treatment is 5-10 days.
Vancomycin:
For beta-lactam allergy, documented case of MRSA colonization: 7.5 mg/kg every 6 hours or 15 mg/kg every 12 hours IV. Duration of treatment - 7-10 days;
Ciprofloxacin 200 mg IV 2 times a day, Duration of treatment - 5-7 days
Macrolides:
Azithromycin 500 mg once a day IV. The course of treatment - no more than 5 days. After the end of the intravenous administration, it is recommended to prescribe azithromycin orally at a dose of 250 mg until the completion of the 7-day general course of treatment.
Crystalloid solutions in a total volume of up to 1500-2000 ml.
Sodium chloride/sodium acetate solution;
Sodium chloride/potassium chloride/sodium bicarbonate solution;
Sodium acetate trihydrate/sodium chloride/potassium chloride solution;
Dextrose solution 5%.
Antimycotic therapy:
Fluconazole 50-400 mg once a day, depending on the risk of developing a fungal infection.
:
Synthetic opioids:
Tramadol in / in, in / m, s / c at 50-100 mg to 400 mg per day, orally at 50 mg to 0.4 g per day) no more than every 4-6 hours.
Narcotic analgesics
List of essential medicines (having 100% probability of use): not carried out.
List of additional medicines (less than 100% probability of use): not carried out.
Antibacterial therapy is carried out with the aim of:
Prevention of infectious complications:
Ampicillin / sulbactam (1.5g, IV),
Amoxicillin / clavulanate (1.2g, IV),
Cefazolin (2g, IV)
Cefuroxime (1.5g, IV).
Terms of antibacterial prophylaxis:
One time (intraoperatively);
From 1-3 days of the postoperative period - with a duration of surgical intervention of more than 4 hours, if there are technical difficulties during the operation, especially when performing hemostasis, as well as at the risk of microbial contamination.
Treatment of infectious complications(depending on the results of the microbiological examination)
Ampicillin/sulbactam:
With a mild course of infection -1.5 g, 2 r / day in / in, the duration of treatment is up to 3-5 days;
With a moderate course -1.5 g, 4 r / day in / in, the duration of treatment is 5-7 days;
In severe cases -3 g, 4 r / day in / in, the duration of treatment is up to 7-10 days.
Amoxicillin/clavulanate(calculation for amoxicillin):
With a mild infection: 1 g, IV, 3 times a day, the duration of treatment is up to 3-5 days;
Cefazolin:
With a mild infection: 0.5-1 g, intravenously, 3 times a day, the duration of treatment is up to 3-5 days;
In severe infection: 2 g, iv, 3 times a day, duration of treatment 5-10 days.
Cefuroxime:
With a mild infection: 0.75 g, intravenously, 3 times a day, the duration of treatment is up to 3-5 days;
In severe infection: 1.5 g, iv, 3 times a day, duration of treatment 5-10 days.
Metronidazole:
With a mild infection: 500 mg, intravenously, drip, 3 times a day, the duration of treatment is up to 5-7 days;
In severe infection: 1000 mg, iv, 2-3 times a day, the duration of treatment is 5-10 days.
Vancomycin: (for beta-lactam allergy, documented case of MRSA colonization).
7.5 mg/kg every 6 hours or 15 mg/kg every 12 hours IV. Duration of treatment - 7-10 days
Ciprofloxacin 200 mg IV 2 times a day, Duration of treatment - 5-7 days
Macrolides:
Azithromycin 500 mg once a day IV. The course of treatment is no more than 5 days. After the end of the intravenous administration, it is recommended to prescribe azithromycin orally at a dose of 250 mg until the completion of the 7-day general course of treatment.
Infusion - detoxification therapy: carried out for the purpose of treating intoxication syndrome, preventing infectious complications, in the provision of emergency medical care - with active bleeding.
Crystalloid solutions in a total volume up to 1500-2000 ml:
Sodium chloride solution 0.9%;
Sodium chloride solution 0.9%/sodium acetate;
Sodium chloride solution 0.9% / potassium chloride / sodium bicarbonate;
Sodium acetate trihydrate/sodium chloride solution 0.9%/potassium chloride;
Dextrose solution 5%.
Antimycotic therapy:
Fluconazole 50-400 mg once a day, depending on the risk of developing a fungal infection.
Prevention of thromboembolic complications carried out for 3 days with low molecular weight heparins:
Dalteparin, 0.2 ml, 2500 IU, s.c.;
Enoxaparin, 0.4 ml (4000 Anti-Xa MO), s.c.;
Nadroparin, 0.3 ml (9500 IU / ml 3000 Anti-Xa MO), s / c;
Reviparin, 0.25 ml (1750 anti-Xa ME), s.c.;
Certoparin sodium 0.4 ml (3000 Anti-Xa MO), s.c.
For pain relief:
Non-steroidal anti-inflammatory drugs:
Ketoprofen, IM, IV, 100 mg/2 ml up to 4 times a day;
Ketorolac inside, in / m, in / in 10-30 mg up to 4 times a day;
Diclofenac, 75-150 mg per day IM up to 3 times a day.
Synthetic opioids:
Tramadol, i.v., i.m., s.c. 50-100mg up to 400mg per day, orally 50mg up to 0.4g per day) no more than every 4-6 hours.
Narcotic analgesics with severe pain during the early postoperative period:
Trimeperidine, 1.0 ml of 1% or 2% solution i / m;
Morphine, 1.0 ml of 1% i.m. solution.
Medical treatment provided on an outpatient basis:
List of essential medicines: not carried out.
Medical treatment provided at the inpatient level
List of essential medicines:
Cefazolin, powder for the preparation of an injection solution for intravenous administration 500 and 1000 mg;
Ketoprofen, ampoules 100 mg / 2 ml;
Enoxaparin, 0.4 ml disposable syringe (4000 Anti-Xa MO).
List of additional medicines:
Ampicillin / sulbactam, powder for solution for intravenous and intramuscular injection 1.5 g;
Amoxicillin / clavulanate, powder for the preparation of an injection solution for intravenous administration 1.2g; 600mg;
Cefuroxime, powder for the preparation of an injection solution for intravenous administration 750 mg and 1500 mg;
Metronidazole, solution 500 mg, 100.0 ml for IV infusion;
Azithromycin, powder for the preparation of an injection solution for intravenous administration 500 mg; tablet 250 mg;
Ciprofloxacin, solution 200 mg, 100.0 ml for IV infusion;
Dalteparin, disposable syringe 0.2 ml, 2500 IU, s.c.;
Nadroparin, disposable syringe 0.3 ml (9500 IU / ml 3000 Anti-Xa MO), s / c;
Reviparin, disposable syringe 0.25 ml (1750 anti-Xa ME), s.c.;
Certoparin sodium disposable syringe 0.4 ml (3000 Anti-Xa MO), s / c;
Sodium chloride solution 0.9%, 400.0 ml;
Solution, sodium chloride 0.9%/sodium acetate 400.0 ml;
Solution, sodium chloride 0.9% / potassium chloride / sodium bicarbonate 400.0 ml;
Sodium acetate trihydrate / sodium chloride solution 0.9% / potassium chloride, 400.0 ml;
Dextrose solution 5%, 400.0 ml;
Fluconazole, 50 or 150 mg capsules;
Ketorolac tab. 10 mg each, 30 mg/ml solution 1.0 ml;
Diclofenac 75 mg, 3.0 ml;
Tramadol, ampoule, 50 mg 1.0 ml
Trimeperidine, 1.0 ml of 1% or 2% solution;
Morphine, 1.0 ml of 1% solution;
Drug treatment provided at the stage of emergency emergency care: not carried out.
Other treatments
Endoscopic application of an intragastric balloon
Indications for the installation of an intragastric balloon:
BMI 30 kg/m2, when conservative therapy methods were not effective;
As a preoperative preparation for the main bariatric treatment of obesity, in extreme forms of obesity.
Contraindications to the installation of an intragastric balloon are:
Diaphragmatic hernia and gastroesophageal reflux disease;
Erosions and ulcers of the esophagus, stomach and duodenum in the acute stage;
Taking hormonal and anticoagulant drugs;
Alcohol and drug addiction;
Previously performed operations on the stomach;
Mental disorders;
Pregnancy.
The percentage of excess weight loss is approximately 10.9%, and the decrease in BMI is most often in the range from 2 to 6 kg/m2 (LE: 1b).
Other types of treatment provided at the outpatient level: not available.
Other types provided at the stationary level: not carried out.
Other types of treatment provided at the stage of emergency emergency care: not available.
Surgical intervention
Methods of surgical treatment of MO and MS(LE 1a):
Laparoscopic gastric banding;
Laparoscopic plication of the greater curvature of the stomach;
Laparoscopic longitudinal (sleeve, tubular, sleeve) resection of the stomach;
Roux-en-Y laparoscopic gastric bypass;
Minigastric bypass (single-anastomous gastric bypass, Ω-shaped gastric bypass);
Method of biliopancreatic shunting (N.Scopinaro operation);
Biliopancreatic shunting in the Hess-Marceau modification (Biliopancreatic Diversion/Duodenal Switch).
Contraindications to surgical treatment for all methods are as follows:
The patient's age is less than 20 years / more than 70 years;
Diseases of the cardiovascular system;
mental illness;
Drug addiction, alcoholism;
The patient has esophageal pathology such as severe esophagitis, esophageal varices;
The patient has portal hypertension;
The presence of cirrhosis of the liver;
The presence of a stomach or duodenal ulcer;
The presence of chronic pancreatitis;
Presence of pregnancy;
The presence of a chronic infection in the body;
Continuous use of steroid hormones;
The presence of autoimmune diseases of the connective tissue.
Surgical intervention provided on an outpatient basis: not performed.
Surgical intervention provided in a hospital setting
Laparoscopic gastric banding(LE 2b)
Indications for gastric banding:
BMI of 30 kg/m2 or more, when the methods of conservative therapy were not effective and the patient still has associated psychological problems.
Specific complications:
Dysphagia;
Esophageal dilatation;
The effect of "slip";
Difficulties in adjusting the port to regulate the inner hole;
Discomfort from having a device;
Device migration;
Erosion formation;
Bedsores of the stomach wall.
Laparoscopic plication of the greater curvature of the stomach(LE 2b) :
Indications for laparoscopic plication of the greater curvature of the stomach:
BMI of 30 kg/m2 or more, when conservative therapy methods have not been effective and the patient has associated psychological problems.
Specific indications:
When MO is combined with GERD and HH. (LE 3) .
The method of laparoscopic longitudinal (sleeve, tubular, sleeve) resection of the stomach(level 1b)
Indications for laparoscopic longitudinal resection of the stomach:
BMI 35 kg/m2 or more;
BMI 45 - 50 kg/m2, as the first stage of treatment, in the future to prepare for biliopancreatic bypass surgery.
Complications:
Inconsistency of seams on the stomach;
Development of peptic ulcers;
Bleeding;
Reflux - esophagitis.
Roux-en-Y Laparoscopic Gastric Bypass Method(LE 1a)
Indications for laparoscopic Roux-en-Y gastric bypass:
BMI from 40 kg/m2.
Specific contraindications for Roux-en-Y gastric bypass:
BMI less than 30 kg/m2.
Metabolic Complications:
Hypoproteinemia;
Anemia;
Manifestations of deficiency of fat-soluble vitamins (A, D, E, K).
Mini-gastric bypass (single-anastomous gastric bypass, Ω-shaped gastric bypass)(LE 1a) [:
Indications for laparoscopic mini gastric bypass surgery:
BMI from 35 kg/m2, with concomitant pathology of type 2 diabetes;
BMI from 40 kg/m2.
Specific contraindications for minigastric bypass:
BMI less than 30 kg/m2.
Complications:
Inconsistency of the sutures of the anastomoses;
Stenosis of the outlet section from a small part of the stomach;
Development of peptic ulcers;
Bleeding.
Metabolic Complications:
Manifestations of calcium deficiency;
Manifestations of iron deficiency;
Manifestations of vitamin deficiency.
Method of biliopancreatic shunting (N.Scopinaro operation) .
BMI from 45 kg/m2;
Specific contraindications to the bilipancreatic shunt method:
BMI less than 40 kg/m2.
Biliopancreatic shunting in the Hess-Marceau modification (Biliopancreatic Diversion/Duodenal Switch)(LE 1b) :
Indications for the bilipancreatic shunt method:
BMI from 45 kg/m2, with concomitant pathology of type 2 diabetes;
Specific contraindications to the bilipancreatic shunt method:
BMI less than 50 kg/m2.
Complications:
uncontrolled weight loss;
Bleeding from the site of anastomoses;
Manifestations of basal metabolic disorders requiring replacement therapy.
Preventive measures (prevention of complications)
Bariatric surgery in patients with excessive accumulation of adipose tissue has a high likelihood of complications, and therefore requires active preventive measures (LE: 1a, 1b):
|
Type of complication |
Intraoperative prophylaxis | Postoperative prophylaxis |
| Lack of stitches in the gastrointestinal tract, peritonitis | Peritonization of a mechanical staple suture with a manual suture | Nasogastric tube |
| Bleeding from gastrointestinal sutures | Careful hemostasis | Coagulation time control, drainage tube control |
| TELA | Passive by using the system: scd express thromboembolism prevention system (COVIDIEN), elastic bandage and elastic stockings on the lower limbs | Passive and active prophylaxis use of anticoagulants |
| cholelithiasis | Preventive cholecystectomy | - |
| Postoperative hernia | Closure of trocar wounds | - |
|
Unacceptable weight loss; Re-increase in body weight. |
Choosing the most effective method | Regulation of regimen and diet |
Further management ( postoperative management, dispensary activities indicating the frequency of visits to PHC doctors and narrow specialists, primary rehabilitation carried out at the hospital level)
In the early postoperative period:
Monitoring of surgical complications, including leakage or bleeding from the anastomosis and other areas of organ stapling;
Prescribing parenteral nutrition in patients at high risk of suture failure on the gastrointestinal tract and / or following a liquid diet during the first week, a semi-liquid diet during the second week;
Maintain appropriate blood glucose levels; use of an insulin analog, if indicated;
Hospitalization
- 1. Oxford sed Medicine - Levels of Evidence (March 2009). 2. Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support . Endocr Practice. 2008 Jul-Aug;14(Suppl 1):1-83. 3. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995. 4. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization, 2000. 5. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia: Melbourne, 2000. 6. James WPT, Chen C, Inoue S. Appropriate Asian body mass indices? Obesity Review, 2002; 3:139. 7. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet, 2004; 157-163. 8. Lee WJ, Chong K, Chen CY, et al. Diabetes remission and insulin secretion after gastric bypass in patients with body mass index
Information
III. ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION
List of protocol developers:
1. Ospanov Oral Bazarbayevich - Doctor of Medical Sciences, Professor, Head of the Department of Endosurgery of the Faculty of Continuous Professional Development and Additional Education of JSC "Astana Medical University". Astana, President of the Republican Public Association "Society of Bariatric and Metabolic Surgeons of Kazakhstan". Kazakhstan Respublikasynyn enbek sinirgen önertapkyshy.
2. Namaeva Karlygash Abdimalikovna - Assistant of the Department of Endosurgery of the Faculty of Continuous Professional Development and Additional Education of JSC "Astana Medical University"
3. Akhmadyar Nurzhamal Sadyrovna - Doctor of Medical Sciences, Senior Clinical Pharmacologist of JSC "National Scientific Medical Center for Motherhood and Childhood"
Indication of no conflict of interest: no conflict of interest.
Reviewers:
Tashev Ibragim Akzholovich - Doctor of Medical Sciences, Professor, Head of the Surgical Department of JSC "National Scientific Medical Center", Astana.
Indication of the conditions for revising the protocol: Review protocol after 3 years and/or when new diagnostic/treatment methods become available with a higher level of evidence.
Annex to the protocol
Conditions for the possibility of surgical treatment of patients with obesity:
Due to the high operational risk and complexity of weight loss operations in conditions of excess fat, the International Federation for the Surgery of Obesity and Metabolic Disorders presents the following to surgeons, equipment and medical institutions: requirements:
Surgeon requirements:
1. The presence of a certificate (certificate) issued in training centers accredited by the IFSO or in national divisions - members of the World Federation of Societies for the Treatment of Obesity (IFSO);
2. Have good skills in performing endosurgical tissue stapling (confirming document for passing the exam on a virtual simulator) and trained in working with stapling devices.
3. Able to perform surgical intervention for complications both openly and laparoscopically;
4. Annually attending scientific conferences and congresses on bariatric issues, writing articles about their bariatric experience (IFSO mandatory requirement);
5. In addition, it is required to pass an advanced training cycle for teachers - members of the Republican Public Association "Society of Bariatric and Metabolic Surgeons of Kazakhstan", lasting at least 216 hours, and it is necessary to have experience in performing standard laparoscopic resection of the stomach according to B-2. and have experience in assisting at least 30 bariatric surgeries for each major type of surgery (gastric drain-resection and gastric bypass).
Equipment requirements:
Equipment necessary for obese patients, such as scales, stadiometer, tables for operating rooms, instruments and consumables specially designed for obesity and for use in both laparoscopic and open surgery, laparoscopic video endo-surgical complexes (racks), wheelchairs, various other pieces of furniture and mechanical lifts that can accommodate a stretcher for obese patients, as well as an equipped intensive care room (Recovery room);
The medical gurney and the operating table should be designed for the maximum weight of the patient and should be multifunctional, and the operating table should be able to change the position of the patient and accessories for fixing him in various positions;
Working laparoscopic instruments (trocars, clamps, etc.) and staplers should be of maximum length (elongated);
For the prevention of thromboembolic complications, means of intraoperative and postoperative compression of the veins of the lower extremities should be used.
Gradation of IFSO facilities where bariatric surgery can be performed:
1. Initially created bariatric medical organizations - where there are trained and certified medical personnel, equipment with special equipment and tools (listed above). Cardiologists, pulmonologists, psychotherapists, nutritionists, anesthesiologists with experience in treating bariatric patients should be easily available for consultations in health facilities. These medical institutions cannot accept patients with superobesity during the first period (1-2 years) in their practice. In addition, during this period, simpler operations (LBZH, LGP, LRZh) should be limited. After two years, these restrictions are removed only if at least 50 operations are performed);
2. Operating bariatric institutions - if bariatric operations are performed from 50 to 100 operations per year, or most of those performed more than 100 - only restrictive);
3. TsSBH (excellence centers) if there are at least 100 bariatric surgeries per year, most of which are GSh and BPSh). Have at least one bariatric surgeon certified in the IFSO unit, trained in other CSSCs, having publications in leading international journals based on their own bariatric experience. Maintain a register of patients and their observation covering at least 75% of those operated on. In such centers, educational and pedagogical work and accreditation for doctors and paramedical personnel should be carried out.
Attached files
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The article discusses obesity of the 2nd degree. We talk about the causes of its appearance, symptoms, diagnosis and treatment methods,. You will find out what drugs treat this disease, whether they take the army with such a diagnosis, the possible consequences and nutritional characteristics for women, men and adolescents.
Obesity 2 (medium) degree (ICD code 10 - E66) is a serious disease resulting from overweight and after the first stage of obesity. It occurs as a result of maintaining an incorrect and sedentary lifestyle, due to various diseases, taking certain medications and ignoring treatment.
This pathology is an increase in the thickness and volume of internal and subcutaneous fat. A large amount of fat that forms around the internal organs and compresses them causes a violation of their structure and work (visceral obesity), which entails a dangerous condition for human life and health, as it subsequently leads to the development of various complications.
Adults and the elderly, as well as adolescents and children, are equally susceptible to this condition. You can learn more about childhood obesity from this.
The main indicator characterizing this condition is BMI in the range of 35-39.9 kg/m2. The calculation of body mass index is carried out according to the formula:
I = m / h2
Where weight in kg is divided by height squared (height is measured in meters).
How to Calculate Body Mass Index In young women, stage 2 obesity results from overeating and a sedentary lifestyle. After 35 years, a slow metabolism can provoke such a condition. But, as a rule, the main reason is a hormonal failure. The disease develops according to the gynoid type, the figure is in the form of a pear.
In men, this pathology is less often diagnosed due to the fact that the body of a man does not have such a tendency to hoarding as a woman's. The main factors in gaining excess body weight are the use of fatty foods, physical inactivity, as well as excessive passion for alcoholic products, especially beer. The disease develops according to the abdominal type, in which the figure is an apple.
In children under 1.5 years of age, obesity develops due to hereditary factors or through the fault of the parents. The main reasons are over-indulgence in milk formulas and improper introduction of complementary foods. One of the most dangerous stages is puberty, during which the body reacts inadequately to the changing hormonal background. Pathology develops in a mixed type.
Types of obesity
Experts distinguish between primary and secondary forms of obesity. Primary obesity (alimentary, exogenous-constitutional) occurs as a result of a sedentary lifestyle and overeating. Secondary obesity (endocrine, hypothalamic) is caused by disturbances in the functioning of various parts of the brain, adrenal glands and endocrine organs.
Primary obesity is the most common form of pathology. According to statistics, the appearance of excess and overweight is associated with:
- malnutrition - consumption of large amounts of alcohol, carbonated drinks, sweet, spicy and salty foods, as well as dishes with a lot of fats and carbohydrates;
- low physical activity - ignoring sports, sedentary work, spending the weekend at the TV and computer.
Secondary obesity is associated with malfunctioning of the endocrine system and hypothalamus. But the quality of nutrition also plays an important role in the appearance of excess weight, so it will not be superfluous to adhere to the principles.
Causes
The main reason for the development of stage 2 obesity is the neglect of the first stage of the disease.
Provoking external and internal factors include:
- hormonal disorders;
- diseases of the endocrine system;
- various viruses and infections;
- iodine deficiency;
- consequences of poisoning;
- complications after TBI;
- little physical activity;
- chronic lack of sleep;
- the use of psychotropic drugs;
- frequent stress and nervous tension;
- unbalanced diet;
- lack of thyroid hormones;
- genetic predisposition to be overweight.
Poor diet causes obesity If the cause of the disease is rare physical activity, stress and improper diet, then it will be quite simple to deal with this problem. It is much more difficult to deal with pathology if it is caused by various diseases. To begin with, you will have to undergo a course of treatment, but therapy is not always effective.
signs
Signs of obesity of the second degree are:
- the occurrence of shortness of breath at rest;
- deterioration of well-being;
- visible ugly fullness;
- body mass index over 35;
- decrease in working capacity, physical activity;
- weakness for no reason;
- the formation of puffiness on the arms and legs in the summer;
- increase in heart rate during physical activity;
- increased sweating.
Each of these signs cannot indicate the presence of obesity of the second stage. But together they make up the clinical picture of pathology. The final diagnosis can only be established by a specialist based on an examination.
According to the location of body fat, pathology is divided into 5 types:
- gynoid - buttocks and thighs;
- abdominal - stomach;
- mixed - the whole body;
- cushingoid - the whole body, except for the limbs;
- visceral - internal organs.
Photo obesity 2 degrees
Photo obesity 2 degrees in women 
Photo obesity stage 2 in men 
Photo of obesity of the second type in children Treatment
Therapy of the second stage of obesity involves taking certain medications and surgery. The statement that taking pills will allow you to lose up to 20 kg per month is just an opinion, since doctors themselves doubt the effectiveness of such drugs. However, without these drugs, the process of losing weight will be longer.
What pills help to lose weight correctly with obesity of the second stage? These are anorectics and blockers of fats and carbohydrates, let's look at each of them in more detail.
Anorectics
This group of drugs has a direct effect on the human brain, namely, on the saturation center in the hypothalamus. Contribute to dulling hunger and make it easier to endure food restrictions.
In the Russian Federation, it is allowed to take sibutramine tablets, which are prohibited in some countries:
- Reduxin;
- Lindax;
- Meridia;
- Goldline;
- Slimia.
Drugs containing amfepramone (Fepranone) or phenylpropanolamine (Dietrin) may also be prescribed.
Fat and carbohydrate blockers
Such drugs prevent the absorption of fats and carbohydrates in the intestines, provoking weight gain. In combination with diet and sports activities for obesity of the second stage, such drugs show a decent result.
Most often prescribed drugs containing orlistat as the main active ingredient:
- Listat;
- Orsoten;
- Glucobay.
At the same time, various dietary supplements, for example, Chitosan, show the worst result.
If obesity is in an advanced stage, therapy is not limited to taking pills, but surgery is also necessary. In the event that other methods of weight loss have not yielded any results, and obesity threatens with serious complications, including death, specialists prescribe bariatrics (gastric bypass, or bandaging). Liposuction is not advisable, as the procedure gives only a temporary effect.
It is acceptable to use traditional medicine (diuretic and fat-burning herbs). But only after the permission of the attending physician.
Contraindications
Drug therapy for type 2 obesity is prohibited in the following situations:
- age up to 16 and over 65 years;
- breast-feeding;
- pregnancy.
In addition, each drug has its own list of contraindications, which must first be studied.
Nutrition (diet) for type 2 obesity Diet
Since a common cause of obesity is an unbalanced diet, therapy without dietary correction will be ineffective. Many experts are inclined to believe that diet therapy is the main method of dealing with type 2 obesity, therefore it is referred to as therapeutic measures.
There is no universal diet that would help all overweight people cope with their problem. In some cases, you have to sit on several diets to find one that would be effective in a particular case. It can be noted that it is definitely not suitable for obesity, as it belongs to the category of hard and involves the use of alcohol.
When choosing a suitable diet, you should adhere to certain requirements:
- Meals should be simple, while having sufficient nutritional value. In the body of losing weight, vitamins, trace elements and important amino acids must be supplied without fail.
- Eating a lot of fiber helps cleanse the intestines, so that excess weight will quickly go away.
- An important condition for all dishes is their low calorie content. In this case, we recommend that you try .
- For the duration of the diet, carbonated drinks should be completely excluded from the diet, replacing them with mineral water, natural berry-fruit compotes. Also banned are honey, smoked meats, sausages, sweets, pickles, flour products, alcohol, hot spices and sauces, ice cream. It is necessary to minimize the consumption of granulated sugar and salt, oils and fats. Bread can only be eaten black and gray, mostly bran.
- Allowed the use of dairy products, but with a minimum fat content, best of all - fat-free. Fruits can also be eaten, but they must contain a minimum amount of sugar, no grapes and bananas!
- During weight loss, you should reduce the volume of servings, eat fractionally (6 times a day).
- It is useful to include unsweetened fruits, fresh vegetables and herbs in the diet. You can eat apples, but only green ones.
- Be sure to arrange at least once a week a fasting day. It helps cleanse the body of harmful substances that prevent excess weight from going away. At this time, you can only eat certain foods, such as apples or cottage cheese (preferably low fat). It is permissible to eat only vegetables on a fasting day, except for potatoes.
- The importance of drinking regimen has long been proven in weight loss. You need to drink at least 2 liters of pure water per day if there are no problems with swelling. The principle is based on the drinking regime. Also useful to know.
The calorie content of the daily diet should be lower than before losing weight. But at the same time, the figure should not be less than 1200 kcal.
Below is a sample menu for obesity of the second stage. Remember, portions should be reduced, and the multiplicity of their intake increased.
Menu:
- first breakfast - unsweetened coffee with milk, boiled meat, sauerkraut;
- second breakfast - unsweetened green tea, fat-free cottage cheese;
- lunch - unsweetened fruit and berry compote, borscht cooked in vegetable broth without meat, boiled chicken meat, baked vegetables;
- afternoon snack - green apple;
- first dinner - baked potatoes, boiled low-fat fish;
- the second dinner (before going to bed) - a glass of fat-free yogurt.
Nutrition for type 2 obesity should be varied and low-calorie. If desired, borsch can be replaced with vegetable stew or soup, baked potatoes - with boiled beet salad and low-fat sour cream or baked carrots.
The most important thing in stage 2 obesity is the desire to lose weight and become healthier. So, you will need to be patient in order to achieve your goal.
Exercise for type 2 obesity Physical activity
Excess weight will not go away on its own if you only follow a diet, and the rest of the time you sit on the couch or at the computer. Movement is life, so behavioral therapy plays a huge role in losing weight.
If you want to get rid of excess weight, you will have to change your lifestyle. For this:
- Try to move more. If you're at home, put on some upbeat music and start cleaning. Walk up the stairs, forget what an elevator is, take walks in the fresh air.
- Practice all the methods of complex therapy for obesity.
- Be less nervous and worry. Rejoice in life!
- Find the motivation to lose weight and do everything to achieve what you want.
- Give up bad habits, forget about alcohol and high-calorie foods.
- If you have mental health problems, take a course of antidepressants.
- Exercise regularly. Exercise in the morning, go to the pool in the afternoon, go for a bike ride in the evenings. All these activities underlie exercise therapy (physiotherapy exercises), which can be prescribed by a specialist.
- Get enough sleep. Sleep at least 8 hours a day.
- Strictly follow all the recommendations of your doctor.
Stick to these rules, as well as follow the recommended diet therapy, and in a short time you will be able to achieve amazing results.
Obesity and the army
Many parents and guys are interested in the question of whether they take into the army with a second degree of obesity. We have already described above how to calculate the body mass index, now we will consider by what criteria a specialist identifies whether an overweight guy is fit for service.
- Category "A" - full suitability for military service.
- Category "B" - suitability for military service with some restrictions. When passing a medical examination, the presence of minor pathologies, for example, slightly impaired vision, is confirmed.
- Category "B" - assignment of the status of limited fit. This category exempts from military service in peacetime, but in martial law, the conscript is enlisted in the 2nd turn.
- Category "G" - assignment of the status of "temporarily unusable". It means that the conscript has some pathologies that can be treated, for example, fractures or obesity. In such a case, a delay of six months is granted, which can be extended in the future if necessary.
- Category "D" - complete exemption from military service due to unsuitability.
Based on this, it should be noted that a conscript with stage 2 obesity can be drafted into the army only after weight correction and the necessary therapy.
Complications
Due to the fact that visceral fat puts pressure on most internal organs, their functioning is disrupted and slowed down.
In the absence of therapy and control by specialists, obesity of the second stage becomes the cause of such diseases:
- diseases of the gastrointestinal tract - pancreatitis with complications;
- gallbladder disease (more common in women);
- haemorrhoids;
- hypertension;
- type 2 diabetes;
- fatty hepatosis;
- cardiac ischemia;
- myocardial infarction;
- ailments of the musculoskeletal system;
- labored breathing;
- impotence, infertility.
If you ignore the treatment, then pregnancy may not occur. Such a diagnosis during pregnancy is dangerous, since in this case the risk of developing various complications in the early stages of pregnancy, anemia and respiratory ailments in the later stages increases.
Obesity of the 2nd degree is not a death sentence and is not as dangerous as the last stage of the disease. But at the same time, it carries more serious consequences than the initial stage of obesity. Therefore, it is important to seek help from specialists, and not wait for the problem to go away on its own.
Video: Three tests for obesity