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Modern drugs for the treatment of obesity. Comparison of modern anti-obesity drugs. Affecting carbohydrate metabolism

Before you start reading this article, it is worth clarifying one little-known nuance (or few people want to believe in it). To date, effective drugs for the treatment of obesity simply do not exist. It is impossible to take a few pills and lose weight today. You didn’t accumulate the fat deposits that you now have on your waist, hips and other places in one day, did you? Therefore, when using anti-obesity drugs, you need to understand that you will not lose a large amount of weight.

Also, it is worth noting that one should not think that anti-obesity drugs purchased on Internet sites and from unverified sellers can cause serious harm to human health.

Important!

Do not believe that anti-obesity drugs will relieve you of excess weight in a day, a week, or even a month. Fat deposits on your body have accumulated for more than one day, therefore, if it were so easy to get rid of them, then everyone around you would have been thin and slender for a long time.

Obesity drugs purchased from unverified manufacturers can cause irreparable harm to a person.

Obesity is curable!

If we talk about the means of official medicine, then the methods of treatment are:

• A diet based on healthy and proper nutrition;
• Constant physical activity, taking into account the initial body weight;
• In especially severe cases, only surgical intervention.

Conventional medicine recognizes the use of anti-obesity drugs solely as an adjunct to the above methods.

Is there a magic pill for obesity?

There is no magic pill for obesity. Of course, scientists around the world are still researching and looking for products that can burn fat in minutes. But, modern technology has not reached this point.

Dinitrophenol

If you are offered the use of dinitrophenol as a means of losing weight, then immediately say a categorical "no", despite the fact that this drug is really very effective.

In the case of constant intake of dinitrophenol, a person has a violation of cellular respiration. Irreversible disorders occur in the human body, ranging from an increase in temperature, pressure, and the occurrence of shortness of breath. In fact, the effect of the drug is based on the poisoning of the body, due to which, in fact, there is a rapid decomposition of body fat.

Effectively suppress appetite

Despite the fact that most anti-obesity drugs have a large number of side effects, the demand for them does not subside. Overweight people are ready to go to any lengths to get rid of these hated kilograms.

Now the most popular are anorectics - drugs that block a person's appetite and completely suppress energy costs. We list common remedies that promise to reduce a person’s appetite from the first pill:

• Sibutramine Meridia is a drug that interacts with the active substances of the brain. As a result, a satiety signal is sent from the brain to the stomach and the person naturally does not want to eat.
• Xenical- a tool that reduces or even suppresses the absorption of fat (however, as well as useful substances) from the food consumed by a person.
• Hormonal remedies that stop or significantly slow down the metabolism in internal organs and tissues. As a rule, these are hormones, growth hormone and thyroid gland.

Note!

The only more or less harmless drugs from the list above are Xenical and Meridia. All others have a number of severe side effects.

To get rid of obesity, you need to completely revise your previous diet and, at a minimum, resort to diet and exercise. Thus, you are guaranteed to be able to get rid of excess weight and do not harm your internal organs.

According to statistics, 40% of the world's population use anti-obesity pills to combat overweight and obesity. Significant excess body weight can be caused by various reasons:

• psychogenic overeating;
• genetic disorders and changes in internal organs;
• high content of simple fats and carbohydrates in food;
• lack of physical activity;
• diseases of the endocrine system;
• stress;
• the use of drugs that promote weight gain;
• age-related changes and slow metabolism;
• alcohol abuse.

Drugs and nutritional supplements are considered only as an addition to the main methods in complex therapy: diets, physical activity and surgical intervention. Physicians often use body mass index (BMI) to assess risks and understand the need for and effectiveness of drug therapy. You can find out the body mass index by calculating the ratio of a person’s height to his weight, that is, it is necessary to divide the weight in kilograms by the height in meters squared.

Example: a person's weight is 81 kg with a height of 1.58 m. BMI \u003d 81 / (1.58 * 1.58) \u003d 32.45.

Depending on the values ​​of the body mass index, there are several degrees of obesity:

• from 16 to 18 - indicates underweight;
• from 18 to 25 - normal body weight;
• from 25 to 30 - indicates overweight, the cause of which may be a tendency to overeat from an early or childhood age, high protein intake at one meal, physical inactivity;
• from 30 to 35 - indicates obesity of the first degree, most often the causes are endocrine diseases, hormonal disorders;
• from 35 to 40 - shows obesity of the second degree;
• from 40 and above - obesity of the third degree.

If the body mass index is more than thirty, experts strongly recommend contacting them for more accurate diagnosis and prescribing a course of treatment.

In clinics, an additional examination is carried out with a special device - a caliper. It is used to quickly and accurately measure the thickness of the skin-fat fold and the percentage of fat in the human body. It is indispensable in the control of weight loss. There are cases when body weight exceeds the norm, but a person cannot be considered obese in any way. This applies to professional athletes and sports enthusiasts: their proportion of muscle mass exceeds the usual figures.

After undergoing complex treatment, patients feel an improvement in their health, as weight, blood pressure normalize, and the overall balance of sugar and fat in the body returns to normal.

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Medications to treat obesity

Obesity drugs are drugs that can reduce or control weight indicators, they help change the basic processes in the human body, regulate weight by reducing appetite, accelerating metabolism or calorie absorption.

Side effects

Before using any drugs for obesity, you should consult a specialist. After a complete examination of the body, the doctor will select the necessary weight loss program individually. Side effects from taking drugs for obesity are mainly associated with a negative effect on the cardiovascular system and on the whole body as a whole. Preparations containing the active ingredient sibutramine can cause heart palpitations, high blood pressure, nausea, and vomiting. Medicines containing orlistat can cause headaches, depression, changes in the stool, which is accompanied by severe spasms and flatulence in the intestines. Preparations containing metformin can cause weakness and drowsiness, abdominal pain, and a metallic taste in the mouth.

Contraindications for use

It is very important to consider the side effects of pills, the effects on the body in the presence of chronic diseases and the effect on the central nervous system. The use of anti-obesity pills has a number of contraindications: cardiovascular diseases such as hypertension and coronary heart disease, diseases of the thyroid gland, kidneys and liver. Obesity drugs are not recommended for the treatment of bulimia nervosa and obesity due to thyroid hormone deficiency, bile stasis in the liver and gallbladder. It is forbidden to take during pregnancy, breastfeeding, children.

Currently, there are no such anti-obesity pills that would be harmless and 100% effective.

No drugs will bring the desired result if there is no balanced combination of diet and exercise.

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With a balanced diet and systematic physical activity, you can not worry about your weight and refuse drug treatment.

Medicines for weight loss and correction can do this more or less effectively, but they will not replace comprehensive weight loss programs that last longer and help avoid side effects.

Excess adipose tissue is formed for various reasons, and an integrated approach is provided to normalize weight. In addition to following a dietary diet and maintaining an active lifestyle, doctors prescribe certain drugs that help reduce weight and help maintain it at a normal level. By taking an anti-obesity drug, the patient gradually loses extra pounds due to the effect on appetite, metabolism and calorie absorption. To avoid adverse reactions, you should refrain from self-medication.

With excessive body weight, it is often impossible to cope without the help of specialists, especially when it comes to the use of drugs for obesity. Their selection should be done by an endocrinologist, since any means that promote weight loss, if used improperly, can cause undesirable effects.

If you need to normalize weight, drugs will help:

• central action (anorectics and adrenomimetics);
• peripheral action;
• hormonal agents.

It is also possible to prescribe psychotropic drugs, diuretics and laxatives, the use of which must be monitored by the attending physician.

How do diet pills work?

Pills help to cope with excess weight, but without a complete correction of the nutritious diet and lifestyle changes against which extra pounds appeared, you should not count on long-term results. The recommendation is especially relevant at the end of the treatment course.

The use of anti-obesity pills leads to:

• appetite suppression by affecting the satiety center in the brain;
• acceleration of metabolism and increase in energy costs;
• blocking the processes of splitting fats and their absorption in the intestines.

If the pathology is caused by a hormonal imbalance, you will need to take appropriate medications. Laxatives are needed to get rid of constipation, which is often found in obesity, and diuretics remove excess fluid.

Medicines

Since the problem of excessive fullness does not lose its relevance, scientists do not stop working on the creation of new, more effective drugs. Many drugs for obesity with illiterate use provoke serious side effects. In addition, do not discount the presence of contraindications.

Pharmacology offers a choice of various groups of drugs with which body weight can be reduced to normal levels.

Drugs can be both cheap and effective. The only thing is that you can not carry out therapy without the knowledge of the doctor. To avoid consequences, it is necessary to treat obesity under the supervision of a specialist.

For weight loss

A representative of this group can be called any agent that reduces body weight. The difference between drugs for the treatment of obesity lies in how exactly they affect the processes occurring in the body. For example, some drugs help to suppress hunger, while others do not allow fats to be absorbed as before.

Also, do not forget about dietary supplements, which are not drugs, but with proper use, accelerate the loss of excess weight. Despite the fact that obesity pills, called dietary supplements, are sold without prescriptions, you should refrain from thoughtless use of funds.

To reduce appetite

Anorexigenic drugs (anorectics) suppress / reduce appetite. In another way, they are called drugs of central action. Thanks to them, there is a decrease in fat accumulation.

Often they are prescribed to patients with alimentary obesity, which develops against the background of various diseases and provokes malfunctions in the cardiovascular system. Also, with the help of anorectics, the fullness caused by hormonal disorders is eliminated.

The hypothalamus is responsible for appetite, since the satiety center is located in its medial zone, and the hunger center is located in the medial zone.

Anorectics block the desire to eat food, so even from a small portion a person manages to get enough and at the same time not gain extra pounds.

Depending on the mechanism of action of anorectics, there are:

• adrenaline-like (contribute to the activation of adrenaline-sensitive receptors and the emergence of a state of euphoria);
• serotonin-like (increase the amount of serotonin).

However, with the mentioned drugs, care must be taken, since they provoke many adverse reactions and seriously harm the body.

In pharmacies, drugs are dispensed by prescription. The list of anorectics is quite large, and among them there are well-known names: Mazindol, Fluoxetine, Fluvoxamine, Reduxin.

Accelerating metabolism

There is a direct relationship between metabolism and weight gain. And in order to reduce the amount of body fat, first of all, it is necessary to properly organize a nutritious diet and increase physical activity.

Also, for weight loss in obesity, drugs are prescribed that have a positive effect on metabolism. They are prescribed in cases where diet therapy and physical education are ineffective.

In the list of anti-obesity pills that eliminate the problem with a slow metabolism, there are Glucophage, Liraglutide, Lindax.

Fat and carbohydrate blockers

These are drugs that inhibit the action of gastrointestinal lipases that break down fats and carbohydrates. So the absorption of substances is reduced by at least 30%, which prevents the formation of adipose tissue. For those suffering from obesity, Xenical, Orlistat are most often prescribed.

However, the use of tablets often results in stool disorders, deterioration of the liver and pancreas.

What is the most effective medicine?

Obese patients always have questions about which drugs should be preferred. Therefore, it is worth mentioning the best remedies that are usually used against excessive fullness.

Orlistat

A good remedy with a peripheral mechanism of action. Tablets prevent the digestion and adsorption of fats, and also reduce cholesterol.

Mode of application:

• 1 tablet three times a day;
• before a meal or after it a maximum of an hour.

Against the background of the use of the drug, fecal incontinence may occur.

Sibutramine

Relate to anorexigenic drugs. It is usually prescribed when the body mass index is 27-30, while obesity is accompanied by the development of other diseases.

Sibutramine is prohibited for patients with:

• brain tumors;
• mental disorders;
• hepatic / renal disorders;
• malfunctions in the work of the heart;
• endocrine pathologies;
• anorexia/bulimia.

Sibutramine should not be combined with other anti-obesity drugs.

Rimonabant

Helps suppress appetite. It is recommended to take 1 tablet per day one hour before meals or after it 3 hours later. The duration of the course is one month.

In the list of contraindications:

• severe form of renal or hepatic pathologies;
• pregnancy;
• children's age up to 18 years;
• syndrome of glucose-galactose malabsorption.

Rimonabant is suitable for the treatment of advanced obesity.

Metformin

Taking the medicine leads to the normalization of glucose levels, the stabilization of fat metabolism and the reduction of cholesterol. In the presence of obesity during the first 10 days, Metformin should be taken 1-2 tablets per day. In the future, the maximum dosage can be 6 tablets per day.

Metformin is appropriate for type 2 diabetes mellitus, accompanied by the formation of overweight, if diet therapy has been ineffective.

Exenatide

This is a new drug for the treatment of patients with type 2 diabetes and obesity. Its benefit is to slow down the evacuation of food from the stomach and reduce appetite. Available as a solution for injection. Injections are made in the forearm, in the abdomen or thigh area.

Dosages:

• initially - 5 mcg twice a day before meals;
• a month later - 10 mcg 2 times a day.

Injections are contraindicated in patients with type 1 diabetes, renal failure, severe gastrointestinal diseases. Exenatide is also prohibited for pregnant, lactating and patients under the age of 18.

Senade

Laxative tablets that help relieve constipation. If defecation is normal, Senade is undesirable to use. The medicine is drunk before dinner, 1 tablet. If there is no effect, the dosage can be increased.

To avoid health problems, do not take the medicine for more than 1 week.

Pramlintid

It is used to suppress the feeling of hunger, as a result of which it is possible to reduce weight. Release form - injections. May cause nausea, vomiting, headaches, hypoglycemia.

Glukobay

Blocks carbohydrates and prevents complex sugars from being absorbed in the intestines. The daily dosage, which is 300 mg, is divided into 3 doses. If the desired results are not observed for 2-3 months, the dose of the drug is increased to 600 mg per day.

Glucobay is prohibited in chronic kidney disease and gastrointestinal disorders.

Isolipan

Thanks to a decrease in appetite, it helps to get rid of excess fat accumulations, while there is no risk of developing mental disorders and addiction to the medicine. The drug is used twice a day in a capsule for 3 months.

The use of dietary supplements

This group is represented, in particular, by supplements containing L-carnitine (amino acids), which are mainly produced in tablet form.

The benefits of the substance in obesity are:

• improvement of metabolic processes;
• burning excess fat reserves with subsequent release of energy;
• lowering cholesterol;
• reducing the feeling of fatigue;
• increase endurance - physical and mental.

Effective fat burners are great for those who make time for active training. For weight loss, dietary supplement Turboslim is recommended, which not only helps to reduce body weight, but also has a positive effect on the immune and nervous systems, and also normalizes the digestive tract.

Most dietary supplements contain natural ingredients and are available over-the-counter. Among them there are quite inexpensive options. However, you should be careful, because dietary supplements do not have a medicinal property, but are only an addition to the main course.

Homeopathy also comes to the aid of obese people. More than 200 drugs are known that can affect overweight.

With extra pounds usually take:

• Kurdlipid in granules (a homeopathic preparation that regulates lipid metabolism);
• Fucus Plus (anorectic, with the help of which it is possible to adjust the weight with obesity of 1-3 degrees).

Zlata gel is popular among women, the action of which is aimed at breaking down fat deposits and eliminating the manifestations of cellulite.

Side effects

Even the most effective drugs with illiterate use can provoke many adverse reactions. The consequences depend on the use of a particular drug, since each remedy acts on the body in its own way.

In general, patients experience palpitations, increased blood pressure, stool disorders, excessive anxiety, abdominal pain, severe allergic manifestations, nausea and vomiting, and tremors of the limbs.

When dietary restrictions and physical activity do not give the desired weight loss, the doctor prescribes drugs that can suppress hunger, slow down the absorption of fats and carbohydrates, and also speed up metabolic processes. Independent use of the mentioned means increases the risk of deterioration of health.

Medications

Since the beginning of the 1990s, when the “epidemic” of beauty finally reached Russia and our fellow citizens began to pay attention to their appearance, a large number of medicines came to the domestic market that could help them with this. Advertising promised that, with little effort, you can achieve truly magical results that will last "for the rest of your life." People believed and with great enthusiasm took medicines in beautiful packages.

Sometimes the results were really good, but they just didn’t last too long. However, some drugs were replaced by others - even more "effective", and the person again swallowed the pills, again hoping for a miracle. And for some, this goes on without end: hopes are replaced by disappointment and further in a circle. The reason for this is the desire inherent in a person to achieve results without making significant efforts. The proposed pills and pills are for so many the lifeline that can solve the problem of excess weight. This is where numerous companies that produce and distribute these "magic" drugs speculate.

After reading this paragraph, the reader will probably think that I am very skeptical about drugs used to reduce body weight. By no means! I myself very rarely use them in my treatment programs. You just need to know what place they occupy in the program, and the allowable time for using these medicines. So let's try to figure this problem out together.

According to the US National Institutes of Health, up to 60% of obese individuals after successful weight loss through diet and exercise gained or exceeded their initial weight within the first year, and another 35% within the next five years. As you can see, persistent weight loss without recurrence of weight gain was achieved only in 5% of cases. There are many reasons for this, and the main one is that after receiving good results, a person relaxes and imperceptibly returns to his former way of life and habits.

But medications increase the effectiveness of treatment and allow better tolerance of therapy. In addition, they improve metabolic performance and strengthen patient adherence to treatment.

Treatment with pharmacological preparations should be used in the following cases:

1. All persons with a BMI of 30 kg / m 2 or more, if the body weight for the first three months of treatment using non-drug methods has decreased by less than 10% of the original.

2. Persons with a BMI of 27 kg / m 2 or more with abdominal obesity, with a predisposition to type 2 diabetes mellitus, cardiovascular diseases, in cases where, when using non-drug methods of treatment, body weight decreased by less than 7 in three months % of baseline.

3. If necessary, rapid weight loss.

Contraindications for pharmacotherapy are:

Childhood;

Pregnancy;

lactation period;

A history of indications of the development of side effects when using similar drugs;

Simultaneous use of several drugs with the same mechanism of action.

Treatment with the use of drugs is recognized as successful in cases where, within three months of their use, body weight is reduced by 5% or more. With a decrease in body weight of 10% or more, therapy is considered very successful. In addition, the treatment is considered successful if the patient has managed to maintain the achieved body weight or has gained no more than 3 kilograms in weight in the next 2 years.

All weight loss drugs are aimed at suppressing appetite or speeding up metabolism. The action of the former is based on a decrease in calorie intake, that is, the effect is similar to the effect of the use of low-calorie diets. The action of others enhances the metabolism of proteins, fats and carbohydrates and has the same effect as intense physical activity.

There are the following groups of drugs that are used in the treatment of obesity.

I. Central action

a) adrenergic drugs;

b) serotonergic drugs;

c) combined action.

II. Thermogenic

III.Peripheral action

a) biguanides;

b) inhibitors of gastrointestinal lipases;

c) increasing insulin sensitivity and reducing insulin resistance.

You can use drugs for weight loss only under the supervision of a doctor.

Most centrally acting drugs are aimed at reducing appetite. They were widely used in the 1960s and 1970s, but due to severe side effects, sometimes fatal, these drugs are now rarely used.

The ideal drug should directly affect only the hunger center in the hypothalamus, but at the same time not cause irritation of other brain structures. However, no such drug has yet been found.

The first drug to have anorexic effects was amphetamine. It affects carbohydrate and fat metabolism, and also suppresses appetite. Side effects of the drug are manifested in the form of palpitations, increased blood pressure, heart rhythm disturbances, headaches, sleep disturbances, mental agitation, gastrointestinal disorders, etc. In addition, long-term use of amphetamine develops addiction to it. Currently, this drug is banned for use in wide clinical practice.

True, sometimes drugs are used that are similar in structure and activity to amphetamine. For example, phentermine also reduces the feeling of hunger, but it is released only by prescription.

Mazindol (terenak, sanorex) also increases the activity of the satiety center and, accordingly, reduces the feeling of hunger. When using this drug, body weight decreases quite quickly, as well as the content of cholesterol and triglycerides in the blood serum, and indicators of carbohydrate metabolism improve. Mezindol has a moderately stimulating effect on the central nervous system. Usually treatment is carried out within two to three weeks. Contraindications to the use of the drug are thyrotoxicosis, glaucoma, severe atherosclerotic vascular disease, hypersensitivity to the drug.

Remember, drugs of this group can not be used for a long time!

Phenylpropanolamine belongs to the group of drugs with serotonin-like action. It is not addictive. Side effects also develop much less frequently, and they are not so pronounced. The drug enhances metabolic processes, which leads to increased energy consumption. In addition, it is also used to suppress the feeling of hunger. You can use it no longer than 2-3 months. Among the side effects, nausea, vomiting, increased blood pressure, arrhythmia and pain in the heart area are most often observed. Currently, this drug is practically not used.

Drugs of the second subgroup inhibit the consumption of carbohydrates without affecting the metabolism of fats and proteins, and also reduce appetite. In addition, they are not addictive. In the 1990s, the leading place in the medical treatment of obesity was occupied by fenfluramine (manifage) And dexfenfluramine (isolipane). With their use, the feeling of satiety increased, the amount of food consumed decreased and weight decreased. However, after a few years it was found that they give serious side effects: the first of them caused the development of pulmonary hypertension, and the second - valvular heart disease. Usually these complications developed after 6 months of treatment. Since 1997, drugs of this group have been banned for use in a number of countries or the period of their use is sharply limited.

A centrally acting drug is now widely used sibutramine (meridia). With its use, a feeling of rapid satiety develops. A person eats less, food addiction decreases. In addition, energy expenditure increases and the compensatory decrease in catabolism, which usually develops with a decrease in body weight, decreases. During treatment, you should consult a doctor. The duration of treatment usually does not exceed 1 year.

Side effects are mild - usually dry mouth, anorexia, insomnia, sweating, constipation. In addition, the drug is not recommended for use during pregnancy and lactation.

If in 3 months the body weight has decreased by less than 5%, the treatment is considered ineffective.

In recent years, drugs have appeared that have an antidepressant effect, against the background of which the body weight also decreases. This group includes fluxetin (Prozac), fluxamine, and sertraline (Zolofort). Weight loss in the treatment of these drugs is attributed to their side effects. Most likely, the loss of excess body weight is due to the fact that when using these drugs, the body temperature rises due to an increase in energy costs.

Often these drugs are prescribed for obese patients and at the same time suffering from depressive conditions. When using them, the number of bulimia attacks decreases - a condition in which the consumption of even a large amount of food does not cause a feeling of fullness, and the feeling of hunger persists constantly and does not depend on the amount of food eaten by a person. Usually drugs are well tolerated, but sometimes there may be sleep disorders (drowsiness or insomnia), headache, nausea, less often vomiting and diarrhea.

One of the peripheral drugs is orlistat (xenical). Its action is limited to the gastrointestinal tract. When using orlistat, about 30% of the ingested fat in the gastrointestinal tract is not broken down and absorbed, which leads to an energy deficit and contributes to weight loss. In addition, the amount of fatty acids in the intestinal lumen decreases, due to which cholesterol is absorbed worse.

If the drug is taken long enough, the mass of visceral-abdominal fat decreases, the sensitivity of peripheral tissues to insulin improves, and hyperinsulinemia decreases. The drug has no effect on the central nervous system. About 97% of the drug is excreted with feces, and 83% is unchanged. Orlistat is not prescribed for pregnant women.

The recommended dose is 1 capsule containing 120 mg of the active substance with each meal (no later than 1 hour after a meal). If the food does not contain fat, then the drug can be skipped. At the same time, you should follow a diet that contains no more than 30% fat.

Side effects from the gastrointestinal tract are observed in 40% of patients. The most common are abdominal pain, flatulence, frequent defecation, changes in the nature of feces (oily discharge from the rectum). In practice, I have never had to prescribe Xenical in weight loss programs, as I recommend a low-fat diet.

In some cases, this drug can be used in the "on demand" mode as "banquet" tablets, that is, it can be taken before you have eaten a lot of fat, or during such a meal.

Sibutramine and orlistat are currently the safest and best studied drugs used in the treatment of obesity. But besides them, in a number of clinical conditions, some other drugs are also used that have the ability to more or less influence overweight.

These include, in particular, acarbose (glucobay), a drug used in the treatment of type 2 diabetes. The basis of its action is the ability to slow down the absorption of carbohydrates in the intestine and reduce the elevated level of postprandial (period after eating) glycemia. With prolonged use, the drug allows you to slightly, but significantly reduce body weight. Treatment should begin with small doses with a gradual increase in accordance with the doctor's prescription. Acarbose should be used in patients with metabolic syndrome with impaired carbohydrate metabolism and increased blood glucose levels in the postprandial period. In some cases, side effects such as dyspepsia and flatulence can be observed.

Another group of drugs that are advisable to use in abdominal obesity or a combination of diabetes mellitus with overweight are biguanides. They are able to reduce appetite and stimulate lipolysis. The most commonly prescribed biguanide metformin (siofor, glucophage). The course of treatment is 2-4 weeks and, if necessary, can be repeated after 1-2 months. Metformin is a unique drug that can increase the sensitivity of insulin receptors, that is, reduce insulin resistance. Thanks to its action, the absorption of carbohydrates and fats in the intestine slows down, and the metabolism of glucose in the body normalizes. When treated with metformin, excess body weight decreases and the lipid spectrum of blood serum normalizes.

Enterosorbents (polyphepan) able to reduce the energy value of food intake due to a longer duration of satiety and a decrease in intestinal absorption of nutrients. In addition, there is a correction of lipid metabolism. But the initial weight after the termination of treatment with polyphepan is restored quite quickly. During treatment, side effects may occur in the form of an imbalance of minerals and trace elements in the body, as well as vitamins, which requires the use of mineral supplements and multivitamins for correction. In some cases, it is also necessary to carry out the prevention of dysbacteriosis. Enterosorbents in the treatment of obesity are rarely used because of their low efficiency.

So, drugs for the treatment of obesity exist. Sibutramine and orlistat have gained general acceptance mainly due to their safety. However, their effectiveness in the difficult task of weight loss is no greater than the effectiveness of other treatments. But still, the inclusion of drugs in comprehensive weight loss programs can in some cases significantly improve treatment outcomes.

However, once again it must be emphasized that the decision to use drugs for weight loss should be made only in conjunction with a doctor and under his supervision.

Mesotherapy

The second direction of the use of medicines in aesthetic medicine is mesotherapy. Mesotherapy is a method of treatment in which microdoses of drugs are administered intradermally or subcutaneously. This method was first proposed by the French specialist Michel Pistor in 1952 and was used primarily in rheumatology, dentistry, sports medicine, and then in aesthetic medicine. In Russia, in the last decade, there has been a real boom in mesotherapy techniques specifically in aesthetics. Given the high cost of the procedure, it began to be offered not only in medical centers, but even in beauty salons that specialize primarily in hairdressing and do not have a medical license. But we should not forget that the effectiveness and, above all, the safety of the method depends to a large extent on the qualifications of the doctor and the quality of the drugs administered.

The action of mesotherapy is based on the characteristics of the drugs used. The drug after injection into the epidermis does not immediately enter the bloodstream, but is absorbed slowly, thereby prolonging the action of the active substance that is part of it.

In mesotherapy, two types of preparations are used - allopathic (medicines) and homeopathic. They are introduced, as a rule, as part of cocktails either with a syringe or with the help of special devices - injectors. The procedure should be carried out only by a specially trained doctor, since, depending on the tasks, the administered drugs must be selected individually. In addition, only a doctor can determine where, in what quantity and sequence, to what depth and in what mode the cocktails composed by him from various medicines should be administered. It must be remembered that the more drugs are included in the cocktail, the more likely it is to get side effects, especially allergic manifestations. Usually, various combinations of cocktails include vascular drugs, painkillers, anti-inflammatory, lipolytic and trophic-improving drugs.

Mesotherapy in modern aesthetics is, first of all, the treatment of cellulite, scars, age-related changes and other skin diseases, as well as contouring. As for obesity, in this case we can only talk about local fat deposits, for which mesoliposuction, or the technique of introducing special and individual for each case hypoosmolar cocktails into fatty tissue. Due to their action, adipocytes are destroyed, the osmotic pressure in which increases sharply under the action of cocktails, which is the reason for the rupture of cell membranes.

In the treatment of cellulite, drugs are used that simultaneously affect several factors that lead to the appearance of cellulite. But the main attention is paid to the normalization of microcirculation. The duration of cellulite treatment using mesotherapeutic techniques depends on the severity of the process, but, as a rule, it is at least 10-12 procedures with an interval between them of 5 to 10 days.

Mesotherapy has no age restrictions and is usually well tolerated. However, in some cases, there are traces of injections, small hematomas, hyperemia and pain at the injection sites. However, all this usually passes quickly enough. When preparing cocktails, it must be remembered that many of the drugs used in the treatment of cellulite and local fat deposits have a choleretic effect, so they are contraindicated in patients with cholelithiasis. In this regard, patients should remember that the appointment of mesotherapeutic procedures is done only by a doctor!

Thus, mesotherapy is an important component in a comprehensive program for the treatment of local fat deposits and body modeling, as well as getting rid of a number of other pathological processes within the framework of aesthetic medicine.

dietary supplements

In recent years, the use of various methods for reducing excess body weight has become very popular. biologically active additives - dietary supplements. Every year, new dietary supplements appear on the world and domestic markets in large quantities, and manufacturers promise gullible buyers just miracles, and nothing more. In practice, most often the expected results cannot be obtained. Why is this happening? Yes, the thing is that dietary supplements are not drugs in the full sense of the word. None of the supplements have passed a real clinical trial. Yes, and they are called "FOOD ADDITIVES", that is, they contain components that a person lacks in the food they eat. Vitamins, trace elements and a number of other components.

However, manufacturers also include medicinal components in dietary supplements, for example caffeine. In some cases, in the composition of dietary supplements, plant components can be found in doses exceeding those in the official medicinal products in which they are included. It is clear that these are just the tricks of manufacturers, since dietary supplements are easier and cheaper to register than a drug. Therefore, you need to be very careful when choosing dietary supplements. And yet they are actively used, and not only by those who are losing weight, but also, for example, by athletes and people in many professions where quick rehabilitation is required after hard physical or mental labor.

There is no point in analyzing specific dietary supplements, since many of them are one-day products and do not stay on the market for a long time. It would be more correct to get acquainted with the main components included in dietary supplements, and the mechanisms of their action. According to the mechanisms of action, all components of dietary supplements are divided into several groups.

The first group - Dietary supplements that reduce appetite. They give a feeling of fullness or reduce the feeling of hunger. Although their negative effect on the nervous system has not been proven, one should still be careful when taking them for a long time, since, by acting on hunger centers, they can potentially have an effect on brain structures close to these centers.

The components of dietary supplements that reduce appetite and thereby reduce the need for food include seasonings from horcinia cambogia.

Gives a feeling of fullness dietary fiber, fructose, galactomannan, etc.

The second group of dietary supplements reinforces in a different way processes of fat breakdown in cells. They are also called "fat burners". They include forskolin, caffeine, tannin, adrenaline, some glycosides, vitamins and trace elements and a number of other components.

The third group of dietary supplements is aimed at body cleansing. They can bind lipids in the gastrointestinal tract to form complexes inaccessible to attack by digestive enzymes. (chitosan), increase the excretion of water from the body (plant substances with a mild diuretic effect), sharply accelerate the passage of food mass in the intestines and thereby limit the intake of nutrients in the body in full (dietary fiber at a dose of more than 25–30 g per day, stimulants of the motility of the gastrointestinal tract).

There are dietary supplements with original mechanisms of action. For example, citric acid hydroxide inhibits the synthesis of fatty acids from carbohydrates; L-carnitine- stimulates the transfer of fatty acids into the mitochondria of cells, where they are broken down; organic forms of chromium- improve the transport of glucose into muscle tissue through the action on insulin receptors, where it is used for energy production.

Once again I want to emphasize that dietary supplements work only with properly selected nutrition and physical activity. An example is L-carnitine, which becomes an active drug only during active physical exertion or in physiotherapy programs, and at rest does not bring any effect at all.

Another danger of dietary supplements is the fact that, having bought into unfair advertising, patients begin to eat even more, hoping for a burning effect of these funds. As a result, body weight does not decrease, but rather increases. If a person does not know about such effects of dietary supplements, then such a nuisance occurs in 80-90% of cases.

And yet, what components of dietary supplements are currently the most effective? According to American experts, the best results in the process of reducing body weight can be obtained using the following components:

Dietary supplements should be considered only as an additional tool that serves as an excellent addition to a rational diet and adequate physical activity.

1) 5-HTP (5-hydroxy-1-tryptophan). 5-HTP is a naturally occurring amino acid that is converted into serotonin with great efficiency in the human body. By increasing serotonin levels, 5-HTP significantly reduces the desire to consume foods containing carbohydrates. What's more, with 5-HTP, satiety is achieved much faster, resulting in faster weight loss.

2) Bitter orange extract. Bitter or green orange (Citrus aurantium) extract is obtained from unripe fruit and standardized on the basis of synephrine. Synephrine is a compound, an agonist of the activity of the sympathetic nervous system, which enhances the processes of thermogenesis. Thus, bitter orange extract accelerates the burning of fat and calories without affecting the heart rate, respiratory rate, and does not increase blood pressure. In addition, bitter orange extract contains octopamine, a biogenetic substance belonging to the amine class, which selectively induces fat cells to release stored fat by burning it.

3) Branching chain amino acids (BCAs). Three branching chain amino acids - L-leucine, L-isoleucine and L-valine - produce approximately 35% of the total free amino acids in muscle. By serving as a source of energy in muscle tissues, as well as protecting muscle components from breakdown, VCAs are effective in promoting calorie and fat burning even when the muscles are at rest. VCAs also reduce fatigue, allowing you to extend the time of exercise or any other activity, thereby helping to burn more calories.

4) cactus extracts. Extracts of two types of cactus can reduce appetite. The cacti species Caralluma fimbriata and Hoodia gordonii contain glycosides that have an appetite suppressing effect at the level of the hunger center in the hypothalamus. In this case, fewer calories are consumed and the process of losing excess body weight is accelerated.

5) Caffeine. Stimulates the sympathetic nervous system and enhances the physiological processes of thermal formation in the body, which occur when burning fat and calories. Caffeine works in three different ways: it allows fat cells to more quickly release their fat stores for burning; increases the basic metabolism, which affects the strengthening of the process of burning calories; reduces appetite by stimulating the production of cyclic adenosine monophosphate in the stomach.

6) Chromium. Trivalent chromium is a vital mineral for humans. It is essential for regulating insulin levels in the body. Chromium also stimulates hormonal activity. It regulates blood sugar levels and thus helps control appetite, as well as burn glucose that is in the bloodstream for energy production, and not to be stored as fat.

7) conjugated linoleic acid. This fatty acid is obtained from linoleic and linolenic acids. It is mainly found in the meat and milk of ruminants. Conjugated linoleic acid delays the absorption of fat into fat cells, reduces their size, which helps prevent muscle loss during the diet.

8) Green tea extract. Green tea (Camellia sinensis) is made from tea leaves that are picked green to protect against fermentation. The active component of green tea is a group of polyphenols, especially catechin and epigallocatechin. Epigallocatechin speeds up metabolism and enhances the process of burning stored fats in fat cells throughout the body. This component also prevents the formation of fat cells.

9) Hydroxycitric acids (HCC). These acids are unique fruit acids derived from thymirinda or horcinia. HCC interferes with the development of appetite and also significantly reduces the metabolic conversion of carbohydrates into stored fats.

10) Soluble fibres. Examples include carbohydrates such as beta-glucan and chitosan, which are incredibly effective for weight loss. These fibers literally stop the absorption of dietary fats. They also provide a feeling of fullness, so that the appetite is satisfied much faster.

Thus, we have additional assistants that can play a significant role in the fight against overweight, but you need to be very careful in the selection of special medicines and dietary supplements. And in this case, one should bypass distributors of dietary supplements from marketing networks, and consult only with specialists. But, unfortunately, there are really few of them even among doctors. So you should measure many times before you start using these products yourself.

In society, the concept of being overweight is rather relative. Someone likes donuts, and now plus size models are conquering the catwalks. Someone is gaining 60 kg - and immediately begins to actively lose weight, considering himself fat.

In medicine, everything is much more precise and definite. There are quantitative parameters that indicate the presence of such a disease as obesity. Moreover, it is delimited from just excess weight. According to WHO, there are 3 degrees of this pathology, and the last one is the most dangerous.

The essence of the disease

According to medical data, grade 3 obesity is a metabolic pathology when the BMI (body mass index) exceeds 40 points.

The disease is difficult to classify according to other criteria. For example, it cannot be attributed either to or to the genoid (gluteal-femoral) type. Adipose tissue in the body accumulates so much that it is distributed throughout the body, and not in any separate part of it.

The main feature of this stage is the high risk of not only dangerous concomitant diseases, but also death. It is characterized in 90% of cases by limited movement, social isolation and serious psychological and physiological problems. And the treatment is very, very difficult.

Causes

The main reason for grade 3 obesity is a neglected state and stages when it is much easier to reverse everything. The lack of willpower and the necessary treatment leads to such a deplorable result.

Other factors help a person in this - external (lifestyle) and internal (state of the body):

• uncontrolled use of easily digestible carbohydrates - sweets, pastries, soda, fast foods;
• heredity;
• unhealthy eating habits: eat not on schedule, but when you want, “jamming” not only problems, but often just a bad mood;
• lack of motor activity;
• calorie intake is many times greater than consumption;
• serious diseases of the gastrointestinal tract, liver, heart;
• a state of constant stress and chronic fatigue;
• severe congenital diseases.

As a rule, all these reasons do not arise out of nowhere. They have been present in a person's life for a long period of time - if it came to 3 degrees of obesity. This is when excess weight is just beginning to appear, you can be in search of a provoking factor, make mistakes, undergo examinations. And by this stage, a person usually already knows what exactly in his life served as the starting point of the pathological condition.

Clinical picture

If obesity of the 1st degree can be easily confused with ordinary overweight (especially if it is), then the pathology of the last stage is visible to the naked eye. Here are just a few of its signs:

• impossibility of motor activity (it is difficult to bend down, turn around, walk an extra distance;
• dyspnea;
• pathological weight gain;
• increased sweating even at rest;
• the BMI indicator exceeds the norm several times;
• psychological problems: the formation of internal complexes due to appearance, which in most cases leads to isolation from society;
• the work of most internal organs is disrupted - certain diseases are constantly manifested;
• blurred contours of the body, which begins to resemble a jelly-like ball.

To calculate BMI and determine the degree of obesity, the formula is used:

I \u003d m (weight) / h 2 (height)

Weight is in kilograms, height is in meters. If it turned out more than 40, a diagnosis is made - obesity of the 3rd degree.

If this disappointing diagnosis was made, you need to immediately begin to act. The first step is seeking medical help. In 90% of cases, a person is determined for inpatient treatment. If you have to deal with pathology at home, doctors describe in detail behavioral therapy for such patients. Here are their recommendations:

• go swimming, and under the supervision of a coach or doctor, with the obligatory fixation of pressure and pulse;
• move as much as possible;
• giving up alcohol and smoking;
• in the morning, do feasible exercises for charging: start with the simplest, and then gradually complicate them, the first classes can be 5 minutes, but each time they need to be extended in time;
• the rooms in which such patients are located should be well ventilated;
• undergo a course of treatment for stressful conditions, if possible, visit a psychologist and various trainings on motivation and self-improvement;
• sleep 7-8 hours.

Only a doctor can answer all questions about obesity of the 3rd degree. Self-medication is not only impossible, but also life-threatening.

Obesity 3 degrees - how many kg?

Any doctor will tell you that this question is incorrect. This disease is not determined by the number of kilograms. 120 kg with high growth can produce a BMI of less than 40. And in bodybuilders, the bulk can be muscle, not fat, despite their large weight category.

Where to start treatment?

Definitely - with a visit to the doctor and the consistent implementation of all his recommendations.

Is it possible to conceive a child?

The chances of this happening are very small because the visceral fat at this stage is tightly wrapped around the reproductive organs. Even if conception occurs, the pregnancy will be very difficult, and it will be almost impossible to complete it. This pathology causes cardiac arrest, hypertensive crisis, respiratory spasms and other conditions that are life-threatening for women and children.

Is this obesity different for women and men?

According to statistics, women are diagnosed with this disease more often than men. They constantly experience hormonal surges (during puberty, pregnancy, lactation, menopause, menopause), which become the causes of pathology. In addition, the fair sex is more emotional, prone to feelings and stress. This forces them to increase portions, eating each new problem.

What to do if a child has been diagnosed?

Rely on the competence of doctors and do everything they say: conduct a course of treatment, and you need to start with psychological help. Obesity of the 3rd degree in children is, first of all, problems with peers who do not accept such people in their circles. Against the background of internal complexes, a feeling of constant anxiety, self-doubt, phobias and low self-esteem develops. The result - problems with learning, conscious isolation from society, immersion in oneself up to autism.

Nutrition

A necessary part of any treatment for this disease is low-calorie. Most often, such patients are recommended the Pevzner table No. 8.

Features of clinical nutrition must be strictly observed:

• 5-6 meals a day at the same time;
• drink 1.5 liters of water per day;
• exclusion from the diet of harmful foods, the list of which is probably known to everyone: fatty, sweet, flour, smoked, salty, mayonnaise, chips, soda, fast food, etc .;
• the menu is balanced: you cannot completely refuse carbohydrates and fats, but their amount should be reduced, but there should be enough fiber and protein;
• for breakfast - carbohydrates (cereals, pasta), for lunch and dinner - protein (meat, fish, eggs, cottage cheese);
• once a week - ;
• recommended drinks: green tea without sugar, freshly squeezed fruit and vegetable juices;
• the daily calorie intake is no more than 1,500, but this is the maximum upper bar, which, if possible, should be lowered to a minimum;
• fruits and vegetables are a must.

As with other degrees of obesity, with the third, you just need to organize proper nutrition.

Sample menu for 1 day for a strict diet

Sample menu for 1 day for a sparing diet

Treatment

Comprehensive treatment of pathology includes not only diet and behavioral therapy. We have to resort to drastic measures.

Medications

First, the doctor prescribes medication. As a rule, these are drugs such as:

• Adiposine;
• Bupropion, Zyban, Wellbutrin;
• Hormonal agents;
• Liraglutide, Victoza, Saxenda;
• Lorcaserin, Belwick;
• Naltrexone;
• , Orlistat;
• Pramlintid, Simlin;
• Rimonabant, Acomplia;
• Sibutramine-containing drugs:,;
• Topiramate; Fastin;
• Fepranon, Regenon, Desopimon, Mirapont;
• , Prozac;
• Exenatide Byeta.

These drugs for obesity of the 3rd degree effectively block the feeling of hunger, give a false feeling of satiety, affecting the centers of the brain. Some reduce the absorption of fats in the intestines. But most of them are ineffective at this stage of obesity. In addition, they are fraught with various side effects.

Secondly, the doctor may allow treatment with folk remedies, but no one will say whether they will be of any use in such a neglected condition.

Usually assigned:

• decoctions and infusions of birch buds, chamomile, immortelle, St. John's wort, cleansing the intestines;
• laxatives - dried apricots, tansy, fennel, prunes;
• reducing appetite - kelp, wormwood, motherwort, nettle;
• fat-burning - mess, rosehip, green tea, ginger, guarana.

The effectiveness of alternative methods of treatment for obesity of the 3rd degree is subjected to great doubts by physicians.

Surgical intervention

Another way to fight obesity is to agree to stomach surgery. It can be:

• bandaging;
• reduction of the volume of the stomach with the help of a special balloon;
• shunting (including biliopancreatic).

Biliopancreatic shunting and bandaging for grade 3 obesity

How exactly to treat this pathology in such a neglected state, only doctors can tell after examinations and studies. Therapy is complicated by numerous concomitant diseases, which also require separate treatment.

Complications

This disease contributes to the development of very serious pathological conditions, which often end in death.

The most common complications include:

• apnea;
• atherosclerosis;
• infertility;
• hypertension;
• hormonal imbalance;
• impotence;
• oncology;
• kidney failure;
• problems with the gastrointestinal tract;
• risk of sudden death;
• self-isolation, prolonged depression up to a suicidal state;
• diabetes.

Grade 3 obese people should not perceive their body and lifestyle as something normal. But often this is what happens, they resign themselves to the state of affairs to which they are accustomed. They find it hard to tear themselves away from their favorite couch and pizza burgers that are delivered directly to their homes. The result is complete immobilization, social isolation and death, and long before old age.

Therefore, the first point of treatment for this pathology should be psychological assistance to the patient. He must realize the depth of the problem, find motivation for himself and begin to act. Without the patient himself, medicine is powerless in this case.