How is the degree determined?
The main reference point is the body mass index: weight in kilograms divided by the square of height in meters. But BMI does not reflect the distribution of fat, so it is supplemented by measuring waist circumference.
- ИМТ 25–29,9 — избыточная масса тела.
- ИМТ 30–34,9 — ожирение I степени.
- ИМТ 35–39,9 — ожирение II степени.
- ИМТ 40 и выше — ожирение III степени (морбидное).
Окружность талии больше 94 см у мужчин и 80 см у женщин указывает на абдоминальное ожирение — накопление висцерального жира вокруг внутренних органов. Именно он, а не подкожный жир, связан с диабетом и сердечно-сосудистыми рисками. Поэтому человек с нормальным ИМТ, но большим животом тоже в группе риска.
Why is it dangerous?
- Type 2 diabetes mellitus and insulin resistance
- Arterial hypertension and heart disease
- Fatty liver disease up to cirrhosis
- Obstructive sleep apnea syndrome
- Arthrosis of the knee and hip joints
- Gallstone disease
- Reproductive disorders in men and women
- Increased risk of certain cancers
Survey
- Измерение веса, роста, окружности талии, расчёт ИМТ.
- Глюкоза крови и гликированный гемоглобин — выявление диабета и предиабета.
- Липидный профиль: общий холестерин, ЛПНП, ЛПВП.
- Печёночные ферменты и УЗИ печени — оценка жировой diseases печени.
- ТТГ — исключение гипотиреоза как причины набора веса.
- При планировании операции — гастроскопия, ЭКГ, консультации специалистов.
Conservative treatment
- A diet with a moderate calorie deficit that a person can maintain for years, not 3 weeks
- Sufficient protein to maintain muscle mass while losing weight
- Regular activity: a combination of walking and strength training
- Sleep 7–8 hours: lack of sleep increases appetite through hormonal mechanisms
- Working with eating behavior during overeating due to stress
- Drug therapy as prescribed by an endocrinologist if indicated
A realistic target is a reduction of 5-10% of initial weight over 6 months and then maintaining it. It is retention, not the speed of weight loss, that determines success.
When surgery is discussed
Bariatric surgery is considered when conservative options have been exhausted and obesity is already affecting health. Generally accepted guidelines are a BMI of 40 and above, or a BMI of 35 or more in the presence of complications: type 2 diabetes, severe hypertension, sleep apnea, severe arthrosis.
- Longitudinal (sleeve) gastrectomy, Sleeve Gastrectomy, is the most common laparoscopic operation: a large part of the stomach is removed, a narrow “sleeve” is formed. The portion size decreases and the production of the hunger hormone ghrelin decreases.
- The operation is performed laparoscopically, through punctures.
- Lifelong nutritional correction and taking vitamins and microelements under the supervision of a doctor are mandatory.
- Before surgery, an examination and assessment of eating behavior is carried out.
Бариатрия — не замена изменению образа жизни, а инструмент, который делает это изменение выполнимым. Без соблюдения рекомендаций вес может вернуться и после операции.
