The method of treatment of obesity


(57) Abstract:

The invention relates to medicine, namely to therapy and endocrinology, and is intended for the treatment of obesity using a pulsed low-calorie diet with reduced fat content. The method involves conducting the diet by alternating days and days supply of conventional products. In the fasting days are powered using balkanology mix Doctor-slim and small amounts of vegetables and fruits and enter Italian 15 mg once in the afternoon. In nerasprodannye days patients adhere to recommendations to limit the intake of fat from food to 35-40 grams per day. The course of treatment is 12 weeks. The method leads to a decrease in average weight of 12 kg, decrease blood pressure, is well tolerated by patients, there has been no reduction in health and changes in lifestyle. table 2.

The invention relates to medicine, namely to diet therapy and pharmacotherapy for obesity.

Currently, for the treatment of obesity apply a low-calorie diet. Most often in domestic medicine is diet N 8 constructed on the following principles (C. A. Oleneva. Medical PI.175-1780):

limit daily calories by 20-25%;

sharp restriction of carbohydrates to 100-200 grams per day mainly due to the easily digestible carbohydrates. The exclusion from the diet of sugar, confectionery, sugary drinks, honey, sweet fruits and berries;

moderate restriction of fat in the diet on average 65-75 grams per day with a wish more than half of this amount is consumed in the form of vegetable fats;

physiologically normal amounts of protein (average of 70-90 g / day).

Limitation of free liquid to 1 - 1.2 liters per day;

to enhance the effect of using fasting days, usually with a frequency of 1 time per week.

Diet, as a rule, used in the monotone mode, i.e. this energy reduction and data principles of nutrition each day.

The purpose of the diet is as follows. With patients spend a long instruction on the principles of nutrition. Then he gets my hands on a manual, which describes the approximate range of products for the day and their number, as well as sample menus-keyboard for 7 days with a description of the number of products of food and time of meals.

This diet has a number of shortcomings that hinder its application and reduce effective and tasteless food with a large number of prohibitions, but also because of the sharp limits on the number of carbohydrates.

There are significant technical difficulties associated with the appointment of a diet. The diet should appoint an experienced dietitian who have professional knowledge on the composition of various foods, which owns the principles of replacement of one other products. Experience shows that General practitioners (physicians and endocrinologists) have about these issues the most common presentation. As a result, all patients without regard to their eating habits and characteristics of the proposed sample menu-layout taken from a nutritional Handbook.

The decrease in the proportion of carbohydrates in the diet, as recommended in the diet N 8, quickly leads to a reduction in the energetic cost due to the reduction in postprandial thermogenesis and metabolism of rest (main cancel), resulting in slowing the rate of body weight reduction or cessation of weight loss.

The diet does not lead to the formation of skills of a balanced diet, so after stopping treatment recurrence of excess weight observed with a frequency of 90-95%.

Despite the fact that the Russian public health this diet currently used as awn. Based on its own data on the use of diet N 8 patients with obesity, indicate that it is effective only in 70% of patients and 70% of them only during the first month of treatment. The average weight loss during the first month of treatment is 3 to 4.5 kg Next, in most cases, despite the continuation diet weight loss stops or patients discontinue treatment unable to withstand the harsh conditions monotonous diet.

Disadvantages of diet N 8 are, in our opinion, is that it does not take into account modern ideas about the mechanisms of development of overweight. According to modern concepts, the fat is deposited only in the case if the quantity of food prevails over the possibilities of the body by its oxidation (Flatt J-P. Importance of nutrient balance in body weight regulation. Diabbetes. Metab. Rev. 1988 Vol.6. P. 571-581). Increase the amount of fat in the diet does not increase its oxidation and is not accompanied by a compensatory decrease in the consumption of other nutrients (Schutz Y., Flatt J-P., Jeguier E. Failure of dietary fat intake to promote fat oxidation: a factor favoring the development of obesity. Am.J.Clin.Nutr.1989. Vol.50. P. 307-314). Reduction of fat in the diet does not lead to a compensatory increase in the consumption of other nutrients (protein and carbohydrate) and is accompanied by some reduction in the one-sided limit fat in the diet is not accompanied by increased appetite and feelings of hunger. It is established that a low-calorie diet with a sharp restriction of fat and moderate restriction of carbohydrates as effective as diet a reverse ratio of nutrients, but are transferred, it is much easier (Schlundt, D. G., Hill, J. O., Pope-Cordle, J. et al. Randomized evaluation of a low fat ad libitum carbohydrate diet for weight reduction. Int. J. Obes. 1993. Vol. 17. P. 623-629).

Maintaining weight after a course of diet in most cases can be achieved by limiting the daily intake of fat to 35-40 g, even if the carbohydrate is not limited to (Schutz Y., Tremblay, A., Weinsir R. L., Nelson K. M. Role of fat oxidation in the long term stabilization of body weight in obese women. Am. J. Clin.Nutr. 1992. Vol. 55. P. 670-674).

Some of the above comments taken into account in the so-called expressed a low-calorie diet, which in the last ten years was widely used in Western countries (M. A. Kirschner et al. stage eight-year experience with a very-low-calorie formula diet for control of major obesity. Int. J. Obes. 1988. vol. 12 p. 69-80., Henry R. R. , Gumbiner B. Benefits and limitations of very-low-calorie diet therapy in obese NIDDM.//Diabetes Care. 1991, 14, N 9. - P. 802-823.). The diet is characterized by daily calorie 500-800 kcal. The diet of patients is usually performed using a nutrient mixture consisting of or mainly of protein, or from protein and carbohydrates in different ratios (for example, a mixture of Optifast-70, produced by Sandoz Nutrition USA, day preparations drugs dietary fiber and polyunsaturated fatty acids. This diet is effective in virtually 100% of cases. Weight reduction when its use is achieved even in patients on strict bed rest. The rate of weight loss varies significantly and ranges from 1.5 to 2 kg per week, although in some cases can reach 3 to 3.5 kg per week. Use this diet in the outpatient setting.

The disadvantages of the diet with pronounced low in calories include the following (Henry R. R., Gumbiner B. Benefits and limitation of very-low-calorie diet therary in obese NIDDM.// Diabetes Care. 1991, 14, N 9. - P. 802-823.):

poor tolerance due to monotonous, repetitive and low-power;

adaptation of the organism to reduce caloric intake, reduced energy expenditure and as a result - a slowdown in weight loss or termination of losing weight;

when applying diet described complications and the most dangerous of them - ventricular tachycardia with heart failure;

the diet does not lead to the formation of skills of a balanced diet, so after stopping treatment recurrence of excess weight observed with a frequency close to 100%.

To improve portability diameter ulatory). In the last 10 - 15 years in the practice of the treatment of obesity there is a new diet regulator - Italian (dexfenfluramine) - production "Servier France (M. M. Ginsburg, G. S. Catupecu. Italian (dexfenfluramine) and its place in the treatment of obesity. Problems of endocrinology. 1996., so 42, N 3. - S. 38-390. This drug is specifically reduces the intake of carbohydrates and fat, not significantly affecting the consumption of proteins. On a background of reception of a preparation it is observed decreasing daily caloric intake by 20-40% (Wurtman J., Wurtman R. , Mark S et al D-fenfluramine selectively suppresses carbohydrate snacking by obse subjects. //Int. J. Eating.Dis.-1985. - Vol. 4, N 1. - P. 88-99.).

According pharmacodynamic studies, the drug is rapidly absorbed from the gastrointestinal tract. The maximum concentration in blood is reached after 3-4 hours after ingestion. The half-life of Italiana is 18 hours (Caccia, S., Conforti I., Duchier j et al. Pharmacokinetics of fenfluramine and norfenfluramine in volunteers given d - and dl-fenfluramine for 15 days.// Eur.J. Pharm.- 1985. Vol. 29, N 3. - P. 221-224).

So far, all clinical studies were performed with a dose of Italiana 15 mg twice a day, morning and evening. However, in these doses not less than 20% of cases, there are side effects, the most frequent of which are fatigue, drowsiness, dryness of the tx2">

According to the method of implementation and the obtained results the prototype of the proposed method of treatment should determine pronounced low-calorie diet with nourishing compounds and drugs that reduce the need for patients in the diet, such as Italiana.

The purpose of the invention is the improvement of tolerability and efficacy of treatment, the simplification of the procedures for the appointment and playback diet patients, reducing the frequency of relapse of obesity, as well as reducing the frequency of side effects associated with pronounced low-calorie diet and using Italiana.

The essence of the proposed method of treatment is in the pulse mode of diet, that is, in the alternation of days, spent in the mode of pronounced low-calorie diet, which is prescribed diet control Italian and the food is carried out using nutrient mixture "Doctor-slim", and days when the patients are allowed to use any products with recommendations to limit consumption of fat and fat-containing products.

The method is as follows.

Prior to the first day of treatment, patients are examined. Collected comprehensive anamnisis about the causes of overweight and Tinker about feeding habits, identified relationships to the different products, the presence of food allergies.

Next, patients are given detailed instructions about diet. Explain its principles and mechanisms of action. In addition to making recommendations on nutrition patients receive General advice on maintaining a more active lifestyle.

On the first day of treatment nutrition patients are a mixture of "Doctor-slim", which was developed by the authors of the proposed method and consists of soy and dairy proteins, carbohydrates (lactose, sucrose), vitamins and minerals, as well as small amounts of milk fat (TU 9223-40996156-97). The composition of the mixture "Doctor-slim" is shown in table 1.

On the day that patients receive 100 g of the dry mixture, which was dissolved in 1 liter of water with a temperature of 32-40oC. Next, the resulting solution is brought to boiling, cooled at room temperature and stored in the refrigerator. In addition to the specified power supply patients receive per day vegetables (except potatoes) in the amount of 400-500 g in raw or cooked form, but without added oils and sugars, and fruit (except bananas) in the amount of 200, 15-16 hours fasting day patients received Italian at a dose of 15 mg.

The next day, sick of eating sobstwennu more familiar quantities, secondly, to limit consumption of fatty and fat-containing products to the level of 35-40 g per day. Patients were advised to limit consumption of animal fats and less hard - plant. For better control of fat in the diet, patients receive the products in table 2, which shows the fat content in the most frequently used products.

Time of last food intake in fasting days and days of normal power supply is not limited. The amount of fluid and salt is limited only if the patient has comorbidities cardiovascular system or kidneys. In this case, the fluid intake and salt corresponded to the recommended tables N 7 and 10 (Handbook of nutrition. /Ed. by M. A. Samsonov and A. A. Pokrovsky. M.:Medicine, 1992).

This diet is observed by the patients to reach the desired weight, then the number of days of discharge gradually reduced to two times per week for two weeks and then once a week during the month. Further patients adhere to the principles of nutrition, developed in nerasprodannye days, i.e. eat mostly low-fat foods.

On the body mass Index (ratio of body weight, expressed in kilograms by the square of height in meters) was 35,0 of 0.7. In 9 patients had blood pressure (BP) at rest above 140/90 mm RT.article.

The initial level of energy consumption, measured using diaries power (the Chemical composition of food. Reference tables of contents of basic nutrients and energy value of food and culinary products. /Ed. by I. M. Skurikhina and C. A. Shaternikova. M: Light and food industry, 1984), was 2400 - 2800 kcal (2656 114 kcal/day). Consumption of fat - 123 13 g/day, and more than half of this amount was accounted for by animal fats (58,7 3,26%).

Patients were examined weekly. In the course of inspections recorded the weight, arterial pressure was measured, analyzed the food diary. Patients have repeated briefings, during specified principles pulsed diet.

During the diet, food consumption was 560 - 600 (578 23,3) calories a day of fasting and 1800 - 2000 (1876 102,4) kcal in nerasprodanny day. The consumption of fat in nerasprodannye days also decreased to 35 - 42 g (37,7 to 3.56) , we Note that this decrease daily calories chileno equal to the reduction in the consumption of fat. That is, in nerasprodannye days patients are not reduced change your usual daily routine and occupation, maintained satisfactory performance. There have been no refusals of treatment and premature termination. Patients quickly got used to navigate the fat content in various foods and used the provided table only during the first two weeks. Many patients, has repeatedly using different low-calorie diet, found his proposed diet regime much easier in terms of portability and performance.

After 12 weeks of diet, consisting of 3 days per week, there is a decrease in body weight at 8 - 14 kg (12,2 2,72 kg).

All 9 patients with baseline elevated blood pressure were observed decline, and 7 to normal values.

Over the next 6 weeks the number of days of discharge gradually decreased first to two and then to once a week. During this time in 18 patients continued weight loss at an average of 1.8 0,34 kg In 5 patients the level of weight remained stable.

Over the next 12 weeks the patients were kept power mode corresponding to neraskrytym days. While 20 patients were observed maintaining the achieved weight, 1 patient was observed danielos to explore the power structure of 3 months after the end of therapy. It was found that the consumption of fat they remained at the level of 35 - 45 grams per day. With more than half of this amount was accounted for by vegetable fats.

The authors did not observe any side effects that could be associated with therapy and the use of Italiana.

Clinical example.

Patient K. 41 years, height 168 cm, weight 89,6 kg, blood pressure - 150 and 100 mm RT.article The diagnosis of alimentary-constitutional obesity of 2 degrees. Arterial hypertension. The patient was prescribed a course of treatment consisting of pulsed low-calorie diet with the use of a day three days on and 4 nerasprodannyh days a week. In fasting days feeding was carried out using a mixture of Doctor-slim" with the addition of the above quantities of vegetables and fruits. In the second half of the day the patient received Italian at a dose of 15 mg. In accordance with the recommendations of the doctor patient daily celebrated morning hygienic gymnastics for 12 minutes. Other physical activity during treatment did not differ from the original.

After the first month of treatment, the weight of the patient declined to 83,8 kg Blood pressure dropped to a value less than 140 and 90 is the capacity and physical activity.

After 12 weeks of treatment, the body weight of the patient decreased to 74.9 kg, blood pressure remained normal. Further, within 6 weeks, when the frequency of days of discharge was gradually reduced, the weight of the patient declined to 72.5 kg Blood pressure remained lower than 140 and 90 mm RT.article Correlating the weight of the patient with the figures, accepted in Russia for the definition of overweight, it can be concluded that at the end of a course of diet the patient obesity disappeared.

The patient was examined by three months after the end of treatment. Body weight was 73.3 kg, blood pressure is 130 and 80 mm RT.article The patient was noted that adherence to diet with less fat entered her persistent habit and executed automatically.

Thus, the inventive method of treating obesity - pulse of a low-calorie diet with selectively reduced fat content in the diet is effective in reducing weight in patients with arterial hypertension has a hypotensive effect. This method is well tolerated, does not require complicated daily estimates of daily calories, simple in purpose and execution patients, allows without loss of clinical the century

The method of treatment of obesity, including diet and dietary control Italiana, characterized in that the diet is carried out in a pulsed mode by alternating every other day fasting and nerasprodannyh days with the provision of one extra nerazrushaushsego days a week so one week was three unloading and four nerasprodannyh day, with a total duration of treatment for 12 weeks, with food in a day of fasting is carried out using nutrient mixture "Doctor-slim" with 100 g of the dry mixture of the following composition:

Protein - 42,0 g

Fat 2.1 g

Carbohydrates - 42,0 g

Calcium - 1.3 grams

Phosphorus - 1.0 g

Magnesium - 100.0 mg

Zinc - 4,6 mg

Ascorbic acid - 11.0 mg

Thiamine - 0.4 mg

Riboflavin 1.5 mg

Nicotinic acid - 0.9 mg

Pantothenic acid - 3.4 mg

Vitamin B60.4 mg

Folic acid - 53,0 mcg

Vitamin B12- 4.5 g

Vitamin A - 2400 IU

Vitamin D - 400 IU

and having energy value per 100 g of dry mix 363 kcal, which take in the amount of 100 g of the dry mixture, dissolved in 1 l of warm water throughout the day, as well as vegetables, except potatoes, in the amount of 400 - 500 g cheese or IAS is Lovina fasting day, while in nerasprodanny day the patient eats normal food without increasing the consumption of starchy and sugary foods more than usual quantities and reducing daily fat intake to 35 - 40,


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