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Obesity of 1 degree according to microbial 10. Obesity

RCHD (Republican Center for Healthcare 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 obesity (E66.8), Extreme obesity accompanied by alveolar hypoventilation (E66.2), Unspecified obesity (E66.9), Obesity due to excess energy supply (E66.0)

Endocrinology

general information

Short description

Expert Council of the Republican State Enterprise on REM "Republican Center for Health Development"

Ministry of Health and Social Development of the Republic of Kazakhstan

Obesity- a chronic, recurrent disease characterized by excess fat deposition in the body.

Body mass index(BMI) (BMI) - a value that allows you to assess the degree of correspondence between a person's mass and his height and thereby assess whether the mass is insufficient, normal or overweight.

Body mass index is calculated using 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 more - 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-obesity;

BMI over 60 kg / m 2 - super-super fat.

Bariatric surgery(metabolic surgery, overweight surgery) is a branch of surgery that deals with the treatment of 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) surgeries 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 surgery 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;

Malabsorptive surgery- the 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: by restrictive surgery on the stomach and by reducing the absorption surface of the gastrointestinal tract.

I. INTRODUCTORY PART

Protocol name: Morbid obesity. Metabolic syndrome.

Protocol code:

ICD 10 code:

E66.0 Obesity due to excess energy supply;

E66.2 Extreme obesity accompanied by alveolar hypoventilation (Pickwick syndrome);

E66.8 Other forms of obesity Painful (morbid) obesity;

E66.9 Obesity, unspecified

Abbreviations used in the protocol:

HELL - blood pressure;

ALAT - alanine aminotransferase;

AsAT - aspartate aminotransferase;

APTT - activated partial thromboplastin time;

GDZ - hepato - duodenal zone;

GERD-gastroesophageal reflux disease;
HHOD - hernia esophageal opening diaphragm;

VC - vital capacity of the lungs;

ZhKB - bilious - stone disease;

Gastrointestinal tract - gastrointestinal tract;

BMI - body mass index;

CT - computed tomography;

LGP - laparoscopic gastric plication;

HDL - high density lipoproteins;

LDL - low density lipoproteins;

LPU - medical and preventive institutions;

INR - international normalized ratio;

MRI - magnetic resonance imaging;

MS, metabolic syndrome;

KLA - complete blood count;

OAM - general urine analysis;

OB - thighs

OT - waist size

PT - prothrombin time;

PHC - primary health care;

PLV% -% of excess weight loss;

RCT - randomized clinical trial;

DM 2 - type 2 diabetes mellitus;

TAG - triacylglyceride;

PE - pulmonary embolism;

LE is the level of evidence;

Ultrasound - ultrasound examination;

CSBH - Centers of Excellence in Bariatric Surgery;

ECG - electrocardiogram;

BMI - Body Mass Index;

EWL% - Exess Weight Loss.

IFSO - International Federation for the Surgery of Obesity and Metabolic Disorders;

MRSA - Methicillin-resistant Staphylococcus aureus (Resistant Staphylococcus aureus)

Date of protocol development: 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 analysis of the scientific literature, and the choice of the grade of recommendation (table 2), which in turn depends on the level of evidence. In 2010, a joint clinical guideline by the American Association of Clinical Endocrinologists, the Society of Bariatric and Metabolic Surgeons used a grading of evidence level similar to the Oxford system to assess the evidence base.

Table 1. Levels of Evidence

Level	Therapy / Prevention, Etiology / Risk
1a	Systematic Reviews (Meta-analyzes) of Randomized Clinical Trials (RCTs)
1b	Selected RCTs
1c	Series of all-or-none results
2a	Systematic reviews (with homogeneity) of Cohort Studies
2b	Selected 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 (both low-quality cohort and case-control studies)
5	Expert opinion without precise critical assessment, 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. Data from randomized controlled trials do not always rank as recommendation grade A if there are methodological gaps or inconsistencies between the published results of several studies. Also, the lack of high-level evidence does not preclude a Level A recommendation if there is a wealth of clinical experience and consensus. In addition, there may be exceptional situations in which confirmatory studies cannot be carried out, perhaps for ethical or other reasons, in which case precise advice is considered useful.

Note:

“Extrapolation” is when data are used in a situation where there may be clinically significant differences that are clearly and confidently described in the original studies.

Classification

Obesity classification

By 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 extensive symptoms of metabolic syndrome;

With severe eating disorders;

With nocturnal meal syndrome;

Seasonal affective fluctuations;

With a hyperphagic response to stress;

With Pickwick's syndrome;

With secondary polycystic ovary disease;

Sleep apnea;

With adolescent dyspituitarism.

2. Symptomatic (secondary) obesity(in 5% of cases):

With an established genetic defect:

As part of the known genetic syndromes with multiple organ damage;

Genetic defects of structures involved in the regulation of fat metabolism.

Cerebral:

... (adiposogenital dystrophy, Babinsky-Pekhkrantz-Frohlich syndrome)

Tumors of the brain, other cerebral structures;

Dissemination of systemic lesions, infectious diseases;

Hormone-inactive pituitary tumors, "empty" Turkish saddle syndrome, "pseudotumor" syndrome;

Against the background of mental illness.

Endocrine:

Hypothyroid;

Hypo-ovarian;

With diseases of the hypothalamic-pituitary system;

With diseases of the adrenal glands.

Classification of obesity by the course of the disease:

Stable;

Progressive;

Residual.

Classification of obesity by body mass index

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 by the type of adipose tissue deposition:

Abdominal (android, central) obesity;

Glute-femoral (gynoid) obesity;

Mixed obesity.
To determine the type of adipose tissue deposition, the ratio of OT to OB is used. Obesity is considered abdominal if women have OT / OB> 0.85, men -> 1.0.

Table 3 Waist circumference and 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, midway between the lower edge of the chest and the iliac crest along the mid-axillary line (not at the maximum size and not at the level of the navel), the circumference of the hips is in their widest region at the level of the greater trochanter.

Indicators of high risk of concomitant diseases (by waist circumference): in men> 102 cm, in women> 88 cm.

Diagnostics

II. METHODS, APPROACHES AND PROCEDURES OF DIAGNOSTICS AND TREATMENT

List of basic and additional diagnostic measures

Basic (mandatory) diagnostic examinations carried out at the outpatient level:

UAC deployed;

Biochemical blood test (urea, creatinine, total protein, ALT, ASAT, glucose, total bilirubin, HDL, LDL, cholesterol, thymol test, alkaline phosphatase);

Glycemic profile;

GDZ ultrasound;

Endocrinologist consultation;

Consultation with a hepatologist;

Consultation of a therapist.

Additional diagnostic examinations carried out on an outpatient basis:

Definition of VC;

CT scan of the brain;

Ultrasound thyroid gland.

The minimum list of examinations that must be carried out when referring to planned hospitalization:

Coagulogram (PT, fibrinogen, APTT, INR);

Biochemical blood test (urea, creatinine, total protein, ALT, ASAT, total bilirubin, HDL, LDL, cholesterol, thymol test, alkaline phosphatase);

Blood sugar;

Microreaction;

Determination of blood for viruses hepatitis B, C;

GDZ ultrasound;

Fluorography;

Consultation of a therapist to identify contraindications to surgical treatment;

Basic (mandatory) diagnostic examinations carried out at the inpatient level:

Coagulogram (PT, fibrinogen, APTT, INR);

Biochemical blood test (urea, creatinine, total protein, ALT, ASAT, total bilirubin);

Blood sugar;

Group and Rh - blood factor;

R - scopy (graphy) of the stomach with barium.

Additional diagnostic examinations carried out at the stationary level:

Abdominal ultrasound.

Diagnostic measures carried out at the stage of emergency emergency care: not carried out.

Diagnostic criteria

Complaints and anamnesis

Complaints:

Overweight;

Joint pain - pelvic, knee, ankle;

Shortness of breath when walking;

Palpitations when walking;

Increased blood pressure;

Chest pain;

Violation of the menstrual cycle in women of fertile age;

Infertility.

Anamnesis:

The presence of concomitant diseases (arterial hypertension, type 2 diabetes mellitus, arthropathy);

Familial predisposition to the development of obesity;

Sedentary lifestyle;

Violation of the diet;

Stress.

Physical examination:

Measurement of body weight;

Measurement of growth;

BMI calculation;

Measurement of the volume of the chest;

Measurement of the waist;

Measurement of the volume of the hips;

Measurement of YEL.

Laboratory research

Table 4... Diagnostic criteria for metabolic syndrome

Laboratory test criterion	Index
Elevated level 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 levels 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.
Increased 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 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 identify stones in the gallbladder to determine a possible simultaneous surgical treatment;

EFGDS - detection of GERD and / or HH.

Indications for consultation of narrow specialists:

Consultation of a therapist / cardiologist in order to clarify the general somatic condition;

Consultation of an endocrinologist in order to exclude obesity associated with endocrine diseases;

Consultation with a neuropathologist / neurosurgeon for patients with a history of traumatic brain injury, neuroendocrine diseases;

Consultation with a psychotherapist is indicated for patients with eating disorders (bouts of compulsive eating at separate intervals, lack of satiety, eating large amounts of food without feeling hungry, in a state of emotional discomfort, sleep disturbance with night meals in combination with morning anorexia);

Consultation with a geneticist if there are signs of genetic syndromes.

Differential diagnosis

Table No. 5 Differential diagnosis for morbid obesity

Obesity types	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); Physical inactivity, predisposing heredity to obesity; Adipose tissue constitution; Fat metabolism activity; The state of the hypothalamic centers of satiety and appetite; Dyshormonal conditions (pregnancy, childbirth, lactation, menopause) often predispose to the development of obesity.		BMI; FROM / ABOUT; Elevated levels of triacylglycerols; Increased cholesterol; Triglycerides in the blood; Increased plasma glucose.
Cerebral	Skull trauma; Neuroinfection; 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 (hypercortisolism, hypothyroidism, hypogonadism, insulinoma)	the upper type is characteristic of 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; Raising the level of 17KS, 170KS;. Decrease in the content of thyroid hormones (TK, T4, TSH); Decrease in the level of GTG, estrogens, progesterone, testosterone, inherent in hypogonadal obesity. These hormonal changes provide lipogenesis.
Medicinal	Formed when long-term intake drugs that increase appetite or activate liposynthesis	Even distribution of subcutaneous fat throughout the body	BMI; FROM / ABOUT; Elevated levels of triacylglycerols; Increased cholesterol Triglycerides in the blood Increased plasma glucose

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Treatment

Treatment goals:

Achieving the most persistent (at least 5 years) and gradual weight loss (no more than 0.5-1 kg per week).

Achievement of target values of metabolic indicators:

BP is 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 over 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(regime, diet, etc.):

Diet therapy;

Physical activity.

Drug treatment

Ampicillin / sulbactam (1.5 g, i.v.);

Amoxicillin / clavulanate (1.2 g, i.v.);

Cefazolin (2 g, i.v.);

Cefuroxime (1.5 g, i.v.).

From 1 to 3 days of the postoperative period - if the duration of the surgical intervention is more than 4 hours, if there are technical difficulties during the operation, especially when performing hemostasis, as well as if there is a risk of microbial contamination.

(depending on the results of microbiological research):

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;

With a moderate course of -1.5 g 4 r / day iv, the duration of treatment is 5-7 days;

In severe cases -3 g 4 r / day / in, the duration of treatment is up to 7-10 days.

Amoxicillin / clavulanate(calculation for amoxicillin):

In case of mild infection: 1 g IV, 3 times a day, the duration of treatment is up to 3-5 days;

Cefazolin:

In case of mild infection: 0.5-1 g IV, 3 times a day, the duration of treatment is up to 3-5 days;

In case of severe infection: 2 g IV, 3 times a day, duration of treatment 5-10 days.

Cefuroxime:

In case of mild infection: 0.75 g IV, 3 times a day, the duration of treatment is up to 3-5 days;

In case of severe infection: 1.5 g IV, 3 times a day, duration of treatment 5-10 days.

Metronidazole:

For mild infection: 500 mg IV, drip, 3 times a day, duration of treatment up to 5-7 days;

In case of severe infection: 1000 mg IV, 2-3 times a day, duration of treatment 5-10 days.

Vancomycin:

In case of allergy to betalactams, documented case of MRSA colonization: 7.5 mg / kg every 6 hours or 15 mg / kg every 12 hours IV. Duration of treatment is 7-10 days;

Ciprofloxacin 200 mg IV 2p / day, Duration of treatment - 5-7 days

Macrolides:

Azithromycin 500 mg once a day i.v. The course of treatment is no more than 5 days. After the end of intravenous administration, it is recommended to prescribe azithromycin orally at a dose of 250 mg until the full 7-day total course of treatment is completed.

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 degree of risk of developing a fungal infection.

Synthetic opioids:

Tramadol intravenously, intramuscularly, subcutaneously at 50-100mg up to 400mg per day, by mouth at 50mg up to 0.4g per day) no more often than every 4-6 hours.

Narcotic analgesics

List of main medicines(100% likely to be applied): not carried out.

List of additional medicines (less than 100% likely to be used): not available.

Antibacterial therapy carried out with the aim of:

Prevention of infectious complications:

Ampicillin / sulbactam (1.5 g, i.v.),

Amoxicillin / clavulanate (1.2 g, i.v.),

Cefazolin (2g, i.v.)

Cefuroxime (1.5 g, i.v.).

Terms of antibacterial prophylaxis:

Once (intraoperatively);

Treating infectious complications(depending on the results of microbiological research)

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;

With a moderate course of -1.5 g, 4 r / day iv, the duration of treatment is 5-7 days;

In severe cases -3 g, 4 r / day iv, the duration of treatment is up to 7-10 days.

Amoxicillin / clavulanate(calculation for amoxicillin):

In case of mild infection: 1 g, IV, 3 times a day, the duration of treatment is up to 3-5 days;

Cefazolin:

In case of mild infection: 0.5-1 g, IV, 3 times a day, the duration of treatment is up to 3-5 days;

In case of severe infection: 2 g, IV, 3 times a day, duration of treatment 5-10 days.

Cefuroxime:

For mild infection: 0.75 g, IV, 3 times a day, the duration of treatment is up to 3-5 days;

In case of severe infection: 1.5 g, IV, 3 times a day, duration of treatment 5-10 days.

Metronidazole:

In case of mild infection: 500 mg, IV, drip, 3 times a day, the duration of treatment is up to 5-7 days;

In case of severe infection: 1000 mg, IV, 2-3 times a day, duration of treatment 5-10 days.

Vancomycin: (for allergy to beta-lactams, 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 2p / day, Duration of treatment - 5-7 days

Macrolides:

Infusion - detoxification therapy: is carried out for the purpose of treatment of intoxication syndrome, prevention of infectious complications, in the provision of emergency medical care - with active bleeding.

Crystalloid solutions in a total volume of up to 1500-2000 ml:

Sodium chloride solution 0.9%;

A solution of sodium chloride 0.9% / sodium acetate;

A solution of sodium chloride 0.9% / potassium chloride / sodium bicarbonate;

A solution of sodium acetate trihydrate / sodium chloride 0.9% / potassium chloride;

Dextrose solution 5%.

Antimycotic therapy:

Fluconazole 50-400 mg once a day, depending on the degree of risk of developing a fungal infection.

Prevention of thromboembolic complications carried out within 3 days with low molecular weight heparins:

Dalteparin, 0.2 ml, 2500 IU, s / c;

Enoxaparin, 0.4 ml (4000 Anti-Ha MO), sc;

Nadroparin, 0.3 ml (9500 IU / ml 3000 Anti-Ha MO), sc;

Reviparin, 0.25 ml (1750 anti-Xa ME), sc;

Certoparin sodium 0.4 ml (3000 Anti-Xa MO), sc.

In order to relieve pain syndrome:

Non-steroidal anti-inflammatory drugs:

Ketoprofen, i.m., i.v., 100 mg / 2 ml up to 4 times a day;

Ketorolac orally, i / m, i / v, 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, 50-100 mg to 400 mg per day, by mouth, 50 mg to 0.4 g per day) no more than every 4-6 hours.

Narcotic analgesics with severe pain syndrome during the early postoperative period:

Trimeperidine, 1.0 ml of 1% or 2% solution in / m;

Morphine, 1.0 ml of 1% solution in / m.

Outpatient drug treatment:

Essential Medicines List: Not available.

Inpatient drug treatment

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-Ha MO).

List of additional medicines:

Ampicillin / sulbactam, powder for solution preparation for intravenous and intramuscular administration, 1.5 g;

Amoxicillin / clavulanate, powder for the preparation of an injection solution for intravenous administration, 1.2 g; 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 intravenous infusion;

Azithromycin, powder for the preparation of an injection solution for intravenous administration, 500 mg; table of 250 mg;

Ciprofloxacin, solution 200 mg, 100.0 ml for intravenous infusion;

Dalteparin, 0.2 ml disposable syringe, 2500 IU, sc;

Nadroparin, 0.3 ml disposable syringe (9500 IU / ml 3000 Anti-Xa MO), sc;

Reviparin, 0.25 ml disposable syringe (1750 anti-Xa ME), sc;

Certoparin sodium disposable syringe 0.4 ml (3000 Anti-Ha MO), sc;

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;

A solution of sodium acetate trihydrate / sodium chloride 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 75mg, 3.0 ml;

Tramadol 50 mg ampoule 1.0 ml

Trimeperidine, 1.0 ml of 1% or 2% solution;

Morphine, 1.0 ml of 1% solution;

Medical treatment provided at the stage of emergency emergency care: not carried out.

Other treatments

Endoscopic use of an intragastric balloon

Indications for the installation of an intragastric balloon:

BMI 30 kg / m2, when the methods of conservative therapy were not effective;

As a preoperative preparation for the main bariatric treatment of obesity, with extreme forms of obesity.

Contraindications to the installation of an intragastric balloon are:

Hernia of the diaphragmatic opening of the diaphragm and gastroesophageal reflux disease;

Erosion and ulcers of the esophagus, stomach and duodenum 12 in the acute stage;

Taking hormonal and anticoagulant drugs;

Alcohol and drug addiction;

Previously performed stomach surgeries;

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 outpatient treatment: not available.

Other types provided at the stationary level: not carried out.

Other types of treatment provided during the ambulance stage: not available.

Surgical intervention

Methods of surgical treatment of MO and MS(UD 1a):

Laparoscopic gastric banding;

Laparoscopic plication of the greater curvature of the stomach;

Laparoscopic longitudinal (sleeve, tubular, sleeve) resection of the stomach;

Laparoscopic Roux-en-Y gastric bypass;

Mini-gastric bypass (single-anastomotic gastric bypass, Ω-shaped gastric bypass);

Biliopancreatic shunting method (N. Scopinaro operation);

Biliopancreatic bypass surgery in the modification of Hess-Marceau (Biliopancreatic Diversion / Duodenal Switch).

Contraindications to surgical treatment for all techniques are as follows:

The patient's age is less than 20 years old / more than 70 years old;

Diseases of cardio-vascular system;

Mental illness;

Drug addiction, alcoholism;

The patient has an esophageal pathology such as severe esophagitis, esophageal varices;

The patient has portal hypertension;

The presence of cirrhosis of the liver;

Have a stomach or duodenal ulcer;

The presence of chronic pancreatitis;

Pregnancy;

Availability chronic infection in organism;

Continuous use of steroid hormonal drugs;

The presence of autoimmune diseases of the connective tissue.

Outpatient surgery: not performed.

Inpatient surgery

Laparoscopic gastric banding(UD 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 dilation;

Slip effect;

Difficulty setting the port to adjust the inner hole;

Discomfort from having a device;

Device migration;

Erosion formation;

Pressure ulcers 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 the methods of conservative therapy were ineffective and the patient still has associated psychological problems.

Specific indications:

When combined with MO with GERD and HH. (LEO 3).

Method of laparoscopic longitudinal (sleeve, tubular, sleeve) resection of the stomach(level 1b)

Indications for laparoscopic longitudinal gastric resection:

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:

Failure of the sutures on the stomach;

Development of peptic ulcers;

Bleeding;

Reflux is esophagitis.

Roux-en-route laparoscopic gastric bypass(LE 1a)

Indications for laparoscopic gastric bypass according to Roux:

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 anastomotic gastric bypass, Ω-shaped gastric bypass)(UD 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 mini-gastric bypass surgery:

BMI less than 30 kg / m2.

Complications:

Inconsistency of the seams of the anastomoses;

Outlet stenosis from a small part of the stomach;

Development of peptic ulcers;

Bleeding.

Metabolic complications:

Manifestations of calcium deficiency;

Manifestations of iron deficiency;

Vitamin deficiency manifestations.

Biliopancreatic bypass method (N. Scopinaro operation) .

BMI from 45 kg / m2;

Specific contraindications to the bilipancreatic bypass method:

BMI less than 40 kg / m2.

Biliopancreatic Diversion / Duodenal Switch(LE 1b):

Indications for the method of bilipancreatic shunting:

BMI from 45 kg / m2, with concomitant pathology of type 2 diabetes;

Specific contraindications to the bilipancreatic bypass method:

BMI less than 50 kg / m2.

Complications:

Uncontrolled weight loss;

Bleeding from the site of anastomoses;

Manifestations of metabolic disorders requiring substitution therapy.

Preventive measures (prevention of complications)

Bariatric surgeries in patients with excessive accumulation of adipose tissue have a high likelihood of complications and therefore require active preventive measures(UD 1a, 1b):

Complication type	Intraoperative prophylaxis	Postoperative prophylaxis
Inconsistency of sutures in the gastrointestinal tract, peritonitis	Peritonealization of mechanical staple suture by hand suture	Nasogastric tube
Bleeding from the seams of the gastrointestinal tract	Thorough hemostasis	Coagulation time control, drainage tube control
TELA	Passive by using the system: scd express thromboembolism prevention therapy system (COVIDIEN), elastic bandage and elastic stockings on the lower extremities	Passive and active prophylaxis using anticoagulants
ZhKB	Preventive cholecystectomy	-
Postoperative hernia	Closure of trocar wounds	-
Unacceptable weight loss Re-increase in body weight.	Choosing the most effective method	Regulating regimen and diet

Further maintenance ( postoperative management, dispensary events 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 stitching;

Appointment of parenteral nutrition in patients with a high risk of incompetence of sutures on the gastrointestinal tract and / or adherence to a liquid diet during the first week, semi-liquid during the second week;

Maintaining an appropriate blood glucose level; use of an insulin analogue, if indicated;

Vancomycin (Vancomycin) Dalteparin Dextrose Diclofenac (Diclofenac) Potassium chloride Ketoprofen (Ketoprofen) Ketorolac (Ketorolac) Clavulanic acid Metronidazole (Metronidazole) Morphine Nadroparin calcium Sodium acetate Sodium acetate trihydrate Sodium hydrocarbonate Sodium chloride Reviparin sodium Sulbactam Tramadol (Tramadol) Trimeperidine Fluconazole (Fluconazole) Certoparin sodium Cefazolin Cefuroxime Ciprofloxacin (Ciprofloxacin) Enoxaparin sodium

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, Ander-son 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 Pract. 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 Con-sultation. 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 THE PROTOCOL IMPLEMENTATION

List of protocol developers:

1. Ospanov Oral Bazarbaevich - 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 Respublikasynyk enbek sinirgen onertapkyshy.

2. Namayeva 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"

Declaration of lack of 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" in Astana.

Indication of the conditions for revision of the protocol: Revision of the protocol after 3 years and / or when new diagnostic / treatment methods with a higher level of evidence appear.

Appendix to the protocol

Conditions for the possibility of surgical treatment of obese patients:

Due to the presence of a high operational risk and the complexity of weight loss operations in conditions of excess fat, surgeons, equipment and hospitals are presented by the International Federation for the Surgery of Obesity and Metabolic Disorders - IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) requirements:

Requirements for the surgeon:

1. The presence of a certificate (certificate) issued in training centers accredited by IFSO or in national units - members of the world federation of societies for the treatment of obesity (IFSO);

2. Those who have good skills in performing endosurgical suturing of tissues (proof of passing the exam on a virtual simulator) and trained at work with suturing devices.

3. Able to perform an operative aid in case of complications both openly and laparoscopically;

4. Annually attending scientific conferences and congresses on bariatric issues, writing articles about their bariatric experience (mandatory IFSO requirements);

5. Additionally, it is required to undergo an educational cycle of advanced training 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 gastric resection according to B-2. and have experience of participating in assistants in at least 30 bariatric surgeries for each main type of surgery (gastric drain-resection and gastric bypass).

Equipment requirements:

Equipment necessary for obese patients, such as scales, height gauge, tables for operating rooms, instruments and supplies specially designed for obesity and for use in both laparoscopic and open surgery, laparoscopic video-endo-surgical systems (stands), wheelchairs, various other furniture items and mechanical lifts that can accommodate a stretcher for obese patients, as well as an equipped intensive care unit (Recovery room);

The medical trolley and the operating table must be designed for the maximum weight of the patient and must be multifunctional, and the operating table with the ability to change the position of the patient and accessories for fixing him in different positions;

Working laparoscopic instruments (trocars, clamps, etc.) and staplers should be of the 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.

Graduation of IFSO facilities where bariatric surgeries can be performed:

1. Primarily created bariatric medical organizations - where there are trained and certified medical personnel, equipped with special equipment and instruments (indicated above). In hospitals, cardiologists, pulmonologists, psychotherapists, nutritionists, anesthesiologists with experience in treating bariatric patients should be easily accessible for consultation. These hospitals cannot admit patients with super obesity during the first period (1-2 years) in their practice. In addition, during this period, one should be limited to simpler operations (LBZH, LHP, LRZH). After two years, these restrictions are lifted only if at least 50 operations have been performed);

2. Operating bariatric institutions - if bariatric surgeries are performed from 50 to 100 surgeries per year, or most of the performed more than 100 surgeries are only restrictive);

3. CSBH (excellence centers) if there are at least 100 bariatric surgeries per year, most of which are GSH and BPSH). Have at least one IFSO-certified bariatric surgeon, trained in other CSBCHs, with publications in leading international journals based on their own bariatric experience. Maintain a register of patients and their observation with coverage of at least 75% of operated patients. Such centers should provide educational and pedagogical work and accreditation for doctors and nurses.

Attached files

Attention!

Self-medication can cause irreparable harm to your health.
The information posted on the MedElement website and in the mobile applications "MedElement", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Guide" cannot and should not replace an in-person consultation with a doctor. Be sure to contact medical institutions if you have any medical conditions or symptoms that bother you.
The choice of medicines and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
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The main treatments for overweight and obesity:
These include adherence to a diet with a high content of fiber, vitamins and other biologically active components (cereals and whole grains, vegetables, fruits, nuts, herbs and) and limiting the use of easily digestible carbohydrates (sugar, sweets, baked goods, baked goods and pasta made from flour higher grades), as well as exercise.
The general approach to drug treatment for obesity is to test all known drugs for the treatment of obesity. For this purpose, drugs are used for the treatment of obesity.
If the result of drug treatment is insignificant or not, then it is necessary to stop such treatment. It is possible to consider the issue of the expediency of surgical treatment.

Diet therapy for obesity.

Diet therapy.

This is the main method of obesity correction.
However, the diet must be selected by a specialist, and thoughtless fasting and improper diets often increase obesity. The reason is that a strict diet (a sharp reduction in calorie intake) can help you lose weight quickly, but after stopping the diet, your appetite increases, the digestibility of food improves, and you gain more weight than before the diet. If an obese patient tries to lose weight again with a rigid diet, each time losing weight becomes more difficult, and weight gain becomes easier, and the weight gained increases each time. Therefore, diets focused on fast results (to lose as much weight as possible in a short time) are harmful and dangerous practices. In addition, many weight loss products contain diuretics and laxatives, which results in water loss rather than fat loss. Loss of water is useless for fighting obesity, unhealthy, and weight is restored after stopping the diet.
Moreover, according to a study by American psychologist Tracy Mann and her colleagues, diets are generally useless as a means of fighting obesity.
However, it should be noted that without adequate control of food calories and taking into account the adequacy of the amount of incoming calories to physical activity, successful treatment of obesity is impossible. For successful weight loss, the WHO recommends calculating the usual calorie content of food, and then monthly reducing the calorie content by 500 kcal until the figure reaches 300-500 kcal below the adequate energy requirement. For people who are not engaged in active physical labor, this value is 1,500-2,000 kcal.

Obesity drug treatment.

All drugs have an effect only during the period of administration and do not have a prolonged effect. If, after stopping the course of treatment, the patient has not changed his lifestyle and does not follow dietary recommendations, then the body weight increases again. Each drug is selected individually by the doctor:
Phentermine (adipex-P, fastin, ionamine - an amphetamine group) - acts as a neurotransmitter norepinephrine, reducing appetite. May cause nervousness, headache, and insomnia;
Orlistat (Xenical) is a pancreatic lipase inhibitor that reduces fat absorption by about 30%, does not suppress hunger, but can cause stool incontinence;
Sibutramine (Meridia) is a serotonin and norepinephrine reuptake inhibitor. The drug acts on the centers of saturation and thermogenesis located in the hypothalamus. The drug is contraindicated in patients with uncontrolled arterial hypertension!
Fluoxetine (Prozac) is an antidepressant used by some professionals to suppress appetite, but there is no information on long-term effects.

Herbal preparations:.

Along with diet and drug therapy, drugs can be used vegetable origin in the form of teas or other medicines, however, it is necessary to know their composition well.
Surgery morbid obesity.
Long-term studies have shown that surgery (bariatric surgery) is most effective in treating obesity. Only surgical treatment makes it possible to solve this problem completely. Currently, there are mainly two types of obesity surgery used in the world. One method is Roux-en-Y gastric bypass; another - banding - placing a silicone band in the upper third of the stomach, which leads to a change in the shape of the stomach (it takes the form hourglass). In the USA and Canada, Roux-en-Y gastric bypass is used (90% of all operations). It makes it possible to get rid of 70-80% of excess weight. In Europe and Australia, regulated gastric banding is dominant (90% of all operations), which makes it possible to get rid of 50-60% of excess weight. Restrictive surgical methods for the treatment of obesity implement the way of limiting food intake into the stomach cavity. The second group of operations is united by the fact that as a result of their use, the absorption of nutrients is reduced, which also leads to a gradual weight loss.
Currently, all bariatric surgeries are performed laparoscopically (that is, without incision, through punctures) under the control of a miniature optical system.
In case of ineffectiveness of diet therapy and drug treatment of obesity, the issue of surgical treatment is considered. Liposuction, as an operation in which fat cells are sucked out, is currently not used to combat obesity, but only for the cosmetic correction of small local fat deposits. Although the amount of fat and body weight can be reduced after liposuction, according to a recent study by British doctors, such an operation is useless for health. Apparently, the damage to health is caused not by the subcutaneous fat, but by the visceral fat located in the omentum, as well as around the internal organs located in the abdominal cavity. Previously, there were isolated attempts to do liposuction for weight loss (the so-called megaliposuction with the removal of up to 10 kg of fat), but now it is left as an extremely harmful and dangerous procedure, which inevitably gives many serious complications and leads to gross cosmetic problems in the form of uneven body surface ...

Surgical treatment.

Obesity surgery has strict indications, it is not intended for those who think they just have excess weight... It is believed that indications for surgical treatment of obesity arise with a BMI above 40. However, if the patient has problems such as type 2 diabetes mellitus, hypertension, varicose veins and problems with the joints of the legs, indications arise already at a BMI of 35. Recently, works have appeared in the international literature that have studied the effectiveness of gastric banding in patients with a BMI of 30 and above.

Obesity is a condition in which excess body fat accumulates in the human body. A person is admitted to have this disease if his weight exceeds the maximum allowable for his height by at least 20 percent.

Causes of occurrence

Obesity occurs when energy value the food entering the body exceeds the needs of the body. The predisposition to obesity can be inherited both as a result of established eating habits and due to the fault of a genetic factor. In rare cases, obesity can be a symptom of a hormonal disorder such as hypothyroidism. Certain drugs, especially, can also lead to obesity.

Risk factors

The risk of developing the disease increases with age. Women suffer more often. Sometimes the predisposition to obesity is inherited. The main risk factors are intemperance in food and a sedentary lifestyle.

Complications

Obesity can be the cause various problems with health, since because of it the organs and joints of the human body experience additional stress. For example, shortness of breath, back pain, hip and knee pain are among the most common problems. Obesity increases the risk of developing some common, potentially life-threatening diseases such as arteritis, stroke, and high blood pressure.

Diagnostics

If you develop obesity, you should consult a doctor. To exclude concomitant diseases, the patient will be taken a blood test for sugar (to exclude diabetes mellitus) and cholesterol. Additionally, blood tests may be taken to detect other hormonal disorders. At the appointment, most likely, the patient's weight and height will be measured, and an individual diet will be developed. In addition, exercise of a certain intensity will be recommended.

Non-drug methods treatment

Obesity is most commonly treated with a weight-loss diet and increased exercise. Usually, the daily calorie intake is reduced by 500-1000 from the number recommended for people of the same height, gender and age as the patient. The individual diet is designed in such a way as to ensure a slow, gentle weight loss. The diet can be tailored by a doctor or nutritionist, although in addition the patient can join a self-help group. To lose weight, it is imperative to exercise regularly. physical exercise moderate intensity.

Pharmacotherapy

Appetite suppressants can be effective. regulates appetite by acting on neurotransmitters in the brain. In addition, medications, such as those that weaken the ability of the digestive tract to absorb nutrients, may be helpful. In rare cases, obesity is treated with surgery. For example, the stomach can be stapled together to reduce its size.

In this publication, we will talk about first degree obesity in adults and children. Since today the most common is precisely 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 obesity of the 1st degree during pregnancy, which 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 mismatch 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 obesity, 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 is obesity of the first degree. There are several factors for the appearance of this disease:

hypodynamia;
metabolism;
increased likelihood of developing the disease;
high-calorie food;
depression, stress.

The process of grade 1 disease does not appear suddenly. Late seeking help, what to do with excess weight, is often explained by the usual inexperience with the diagnosis.

The photo shows what a young woman's body looks like in the first degree of the disease.

In order to find out how much 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 by up to 29 percent. With obesity of this degree, patients begin to feel weakness and rapid fatigability.

Additional symptoms are accompanied:

Bad mood;
emotional imbalance;
inferiority complex;
underestimation of one's personality.

Obesity should be treated with 1 tbsp. immediately, because it leads to serious consequences: disruption of the thyroid gland, liver, pancreas. And also violated menstrual cycles and the risk of developing diabetes is increasing.

Exogenous constitutional obesity of the 1st degree

Exogenously constitutional grade 1 obesity is common in sedentary women who are overnourished and overweight.

To determine the disease, you need to pay attention to the following signs that have appeared:

dyspnea;
lumbar pain;
anxiety in the knee and hip joints.

This type is most often affected by housewives, office workers and fast food lovers. It is easy to treat as it is not a hormonal disorder in the body. Exogenous-constitutional completeness requires an individual approach.

Among men, abdominal obesity is more common, where fatty folds form in the abdominal cavity. With such a disease, it is recommended to visit a nutritionist and be comprehensively examined 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 of individual systems or organs. This is due to etiological reasons, which are divided into two factors.

For families who eat mainly fatty foods, alimentary primary obesity of the first stage is considered the norm. Treatment of alimentary disease is assigned to each individual.

The specialist takes into account everything:

height;
Lifestyle;
Kind of activity;
nationality;
age;
predisposition.

The provided psychological assistance is important for the patient, because usually the cause of alimentary constitutional obesity is deep in the subconscious.

Be sure to read the review-story about, as it has helped many people recover from arthrosis and arthritis. Next, we posted information on Mangosteen syrup, because Mangosteen for weight loss is very popular today.

Also read about the methods used at home).

Obesity in pregnancy

During pregnancy, the development of fatty tissue is naturally stimulated in order to protect the fetus from external factors.

Obesity type 1 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 term of pregnancy increases;
induction of labor;
the risk of birth complications;
threatened miscarriage or stillbirth.

In the fight against weight pathology during pregnancy, the specialist advises to concentrate on maintaining a low weight gain during the entire period of pregnancy. Such women are considered to be at high risk of losing a child and are always under the supervision of a doctor. Grade 1 obesity during pregnancy strongly affects the development of the fetus.

Diet for obesity stage 1

For the treatment of pathology, a large number of diets are offered. Their main goal is to severely restrict nutritional value in proportion to the stage of excess body weight.

The main goal of therapy is to increase the body's energy consumption through rigorously performed physical exercises. The combination of diet and exercise yields effective weight loss results.

When drawing up a menu for a week, the following are taken into account:

introduction of products with proteins of animals and plant organisms;
the presence of amino acids;
elimination of sugar from the diet;
regulation of the intake of the norm of bakery products and butter.

For patients, diets are developed in accordance with the type of disease. Food should be taken fractionally, at least six times a day.

Fighting obesity in clinics

If you can't lose weight on your own, then it's time to seek help from the 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 to effectively lose weight. To do this, a doctor in a specialized center at the first visit conducts diagnostics and draws up a personalized therapy program. Here you can get competent advice from real specialists, listen to recommendations.

The procedures are competently 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 normalize body weight, but also 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 a code according to ICD 10 - E66 and distinguishes between two probabilities of development:

Social factor: low standard of living;
Risk Factor: Pregnancy, high fat diet, immobile 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 along with diet and exercise can bring high efficiency. Treatment should be supervised by specialists.

Statistics claim that a third of the world's population is obese and this is not the limit. The disease of children and adolescents is especially severely affected. Therefore, scientists call the disease an epidemic of the 21st century.

Currently, the terms "obesity in children" and "overweight" are equally often used in pediatrics, and the term "overweight" is more preferable.

Obesity (lat.adipositas, alimentary obesity) - a chronic eating disorder characterized by excessive accumulation of adipose tissue in the body.

ICD-10 codes

E65-E68. Obesity and other types of excess nutrition.
E66. Obesity.
E66.0. Obesity due to excess intake of energy resources.
E66.8. Other forms of obesity.
E66.9. Unspecified obesity.
E68. The consequences of excess nutrition.

Epidemiology of childhood obesity

In economically developed countries, including Russia, 16% of children are already obese and 31% are at risk of developing this pathology, which occurs in girls more often than in boys.

According to the WHO Regional Office for Europe (2007), the prevalence of obesity has tripled over the past twenty years, reaching epidemic proportions. According to epidemiological studies, in the presence of obesity in the father, the probability of its development in children is 50%, in the presence of this pathology in the mother - 60%, and in the presence of both parents - 80%.

The reasons for the obesity epidemic are considered to be a change in the composition of the diet (an increase in the consumption of energy-rich foods), dietary habits (eating in fast foods, the frequent use of ready-made breakfast cereals), insufficient consumption of fruits and vegetables, and a sharp decrease in physical activity.

What causes obesity in children?

In the vast majority of children, obesity is not associated with hereditary or endocrine diseases, although the role of hereditary predisposition to obesity is considered to be established. The genetically determined characteristics of metabolism and the structure of adipose tissue are of leading importance in the formation of a positive energy balance:

an increased number of adipocytes and their accelerated differentiation from fibroblasts;
congenital increased activity of lipogenesis enzymes and decreased lipolysis;
increasing the intensity of fat formation from glucose;
reduced formation of leptin in adipocytes or a defect in receptors for it.

Obesity pathogenesis

One of the main pathogenetic mechanisms of the development of obesity in children is an energy imbalance: the energy consumption exceeds the energy consumption. It has now been established that the pathogenesis of obesity is based not only on energy, but also on an imbalance of nutrients. Obesity in children progresses if the body is unable to provide oxidation of incoming fat.

Obesity in children: types

Obesity in children does not currently have a generally accepted classification. In adults, the diagnosis of obesity is based on the calculation of BMI [the ratio of body weight (in kilograms) to a person's height (in meters) squared]. BMI can overestimate the obesity of trained athletes or muscular children, nevertheless, calculating BMI is the most reliable and reliable method for determining overweight. Other methods for assessing obesity are also used, but they are either very expensive (ultrasound, CT, MRI, X-ray absorptiometry), or require special equipment (caliper), or are poorly reproduced (measurement of waist and hips), or do not have standards for childhood ( bioelectrical impedance analysis).

How to recognize obesity in children?

Obesity in children is not accompanied by specific changes in results general analysis blood and urinalysis. A biochemical blood test detects:

increased levels of cholesterol, triglycerides, low density lipoproteins, free fatty acids;
a decrease in the content of high density lipoproteins;
acidosis;
hyperinsulinemic type of the glycemic curve.

Obesity screening

Systematic (once a quarter) monitoring of mass-growth indicators with the definition of BMI, as well as blood pressure.

Obesity treatment in children

Obesity in children should be treated with the following goals - achieving an energy balance between energy consumption and energy expenditure. The criterion for the effectiveness of the treatment of obesity in children is a decrease in body weight. A prerequisite for diet therapy in all age groups is the calculation of nutrition for proteins, fats, carbohydrates, as well as calories, comparing the actual and recommended intake.