How to lose weight after 40 years

General rules

The age of forty for a man is a kind of “Rubicon”, a turning point in his life, which is often defined as a “ midlife crisis ”. At this age, a man rethinks his place in the socio-psychological space and physiological changes in his body. By this period of life, the vast majority of average men come with a physiological loss of muscle mass, a decrease in overall metabolism, androgen deficiency (reduced production of male sex hormones), including testosterone , which causes a change in emotional state, decreased sexual function (decreased libido/potency ).
In addition, an unhealthy lifestyle (physical inactivity/lack of physical activity, alcohol abuse, smoking, uncontrolled consumption of fatty foods, increased body weight, chaotic/disorderly eating, chronic fatigue due to career/work, sexual diseases) make this age dangerous. for men. Gradually, men develop abdominal fat deposits and develop metabolic syndrome : increased cholesterol , blood pressure , and impaired carbohydrate metabolism.

Of course, all these changes in the body are unpleasant and many men cannot come to terms with the fact that they are no longer the same as they were 10 years ago. This approach is dangerous and leads to prolonged depression , worsening functional disorders, and subsequently to the development of diseases. It is much more productive to realize that the aging of the body is a natural physiological process and an integral part of life (we have to, like the fruits of trees/the fruits of the earth, wither and fall off) and make some efforts to reduce the impact of risk factors on our health. Life doesn’t stop after 40, and it’s better to rely on constant care of your health. First of all, this is a change in a man’s lifestyle - increasing physical activity, giving up bad habits, reducing neuropsychic stress, correcting body weight/rational nutrition.

Thus, properly organized nutrition for a man after 40 years of age can significantly reduce the manifestations of existing physiological disorders and the risk of their development. A diet for a 40-year-old man does not provide for strict restrictions; rather, we are talking about organizing a rational, balanced diet for men with a body weight that corresponds to the physiological norm. Those whose weight exceeds the norm, first of all, need to correct their weight and then maintain it at the desired level.

For weight loss, a hypocaloric diet is prescribed with an energy deficit (relative to calorie expenditure) of 400-600 kcal/day, which allows you to lose weight without stress to the body within 500 g per week. A more accelerated rate of weight loss is not justified, since it is extremely difficult to achieve long-term weight stabilization and, moreover, the process is accompanied by a pronounced feeling of hunger, general weakness, decreased performance, headache , and mental discomfort. A low-calorie diet for a man after 40 years of age should be focused on 1800-2000 kcal per day.

It must be said right away that the so-called “women’s diets” - those based on buckwheat and kefir, fruits or vegetables, apples and low-fat cottage cheese and similar diets - are absolutely not suitable for men. The main requirement for weight loss diets for men at this age is the inclusion in the diet of a complete (at the physiological norm) quota of protein - at least 90-100 g/day (white fish, lean meat, egg whites, cottage cheese, low-fat fermented milk products).

Reduction of caloric intake is carried out by excluding from the diet foods containing saturated fats (fast food products, fatty meats, canned food, solid fats, smoked meats, fatty dairy products) and simple carbohydrates (sugar, sweets, baked goods, confectionery/bakery products). The diet of men at this age should contain as little as possible foods rich in cholesterol , and it is also necessary to avoid processed foods and fatty meats.

In addition to micronutrients, it is important to ensure in the diet a sufficient content of essential amino acids , vitamins /minerals, PUFAs (in particular, omega 3 ), the deficiency of which reduces the metabolic . Special attention should be given to fish and seafood. It is recommended to include in your diet at least 2 times a week fatty red fish, shrimp, crabs, mussels, squid, which contain not only complete amino acids and PUFAs, but are also rich in various microelements, including zinc, which is extremely important for production of male sex hormones.

The menu of a 40-year-old man must include a variety of vegetables; all types of cabbage, celery, tomatoes, carrots, pumpkin, and garden herbs (parsley, leeks, garlic, spinach) are especially useful. Pumpkin seeds are also a good source of zinc, which should be consumed regularly raw or dried. Healthy fruits include yellow and orange fruits, which contain lutein , which is also necessary in the synthesis of testosterone .

After 40 years of age, men have an increased risk of developing cardiovascular diseases. Accordingly, the diet should contain foods rich in calcium, potassium, magnesium, phosphorus, which are found in dairy products (cottage cheese, hard cheeses), vegetables (potatoes, legumes, cabbage, tomatoes, pumpkin), fruits (grapes, raisins, bananas, dried apricots), nuts and seeds. Seaweed and other seaweed are extremely beneficial and are recommended to be consumed 2-3 times a week. The presence in the diet of cold-pressed vegetable oils rich in vitamin E (olive, flaxseed, sunflower) is also important.

Separately, it is necessary to dwell on alcohol. It is necessary to minimize the consumption of beer, since the phytoestrogens are analogues of the female hormone - estrogen, which triggers the process of obesity in the male body (beer belly). The preferred alcohol for men is dry red wine and cognac, which are recommended to be consumed in small quantities.

It is also recommended to switch to more gentle methods of culinary processing of foods, in particular, boiling, baking, stewing, reducing the consumption of fried and smoked foods. These cooking methods will not only preserve the maximum amount of vitamins and microelements, but will also give the dish a new taste. If blood pressure and periodically increases, it is recommended to limit the consumption of salt and salty foods. At the same time, rock salt must be replaced with sea salt. It is equally important to consume at least 1.5-2. l/day of free liquid, mainly in the form of green tea, freshly prepared juices, herbal teas, still mineral waters, rosehip decoction. It is advisable to reduce coffee consumption. In the absence of contraindications, you can periodically practice fasting days (vegetable, kefir, fruit, cottage cheese), avoiding complete fasting.

How to lose weight after 40 years

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Why does losing weight become more difficult as you age? Previously, with sufficient motivation, you were always able to get rid of unwanted pounds. Even if you gained a couple of kilos on vacation, when you returned home you went on a diet, and it never let you down. But now you're 40 or 50 years old, and your favorite diet no longer works. You have to literally starve yourself to lose even a few hundred grams, although you know that most of the loss is just water and muscle. And as soon as you look at a piece of bread, the weight comes back. What's going on? Why is it so damn hard to lose weight after 40? There are many reasons for this, and it's not always about what you put on your plate (although that's important too!).

1. You are too nervous. Cortisol (the stress hormone) floods your blood with sugar to give your body enough energy to fight or flee. This extra sugar is absorbed by insulin and sent straight to fat cells for storage. In conditions of constant stress, a person can remain fat for the rest of his life!

ADVICE. Make sure you get enough rest and relaxation. Even if you just breathe deeply for 10 minutes every day, that's great!

1. You are not replenishing your strength. As people age, they have to do more and more things at the same time, and if you are physically exhausted, then you simply do not have the energy to think about healthy food. In this case, you are more likely to eat something that is easily accessible and guarantees a new burst of energy. As a rule, these are refined carbohydrates, sweet bars, processed foods and fast food.

ADVICE. Eat a good portion of protein for breakfast (like a protein shake) and take a protein-packed snack with you to work to ensure you have a healthy source of energy throughout the day.

1. The thyroid gland disrupts your metabolism. Low levels of the hormone thyroxine occur in many middle-aged people. This leads to a slowdown in metabolism and, as a result, increased fatigue and the body’s inability to burn calories obtained from carbohydrate foods.

On the subject: How to deal with bulimia ADVICE. Make an appointment with an endocrinologist and buy vitamin supplements to support the thyroid gland (vitamin A, zinc, iodine, tyrosine, selenium).

1. Unwanted guests have settled in your body. It's hard to believe, but the number of microorganisms that make up our intestinal microflora relates to the number of cells in our body as 10 to 1! We can say that our body is home to billions of tiny creatures such as bacteria, fungi, viruses and parasites. There are good and bad, but if you have too many bad neighbors in your body (this can be caused by frequent use of antibiotics, poor diet or infections), it can harm your efforts to lose excess weight.

ADVICE. Bring your gut flora into balance with fermented foods (sauerkraut, kefir, kombucha) and start taking quality probiotics.

1. You are eating food that is not good for you. If you have a reaction to certain foods, it can lead to a range of problems, from flatulence to headaches. However, this sensitivity can also disrupt your metabolism and hormonal levels, making weight loss more difficult.

ADVICE.
For 3-4 weeks, give up any food that can cause a negative reaction (wheat, dairy products, sugar, soy, corn). Then reintroduce such foods into your diet and monitor how you feel. Find out the causes of excess weight and ways to quickly lose weight

Sign up for a free initial appointment with a nutritionist!

1. You are approaching (or already there) menopause. After 35 years, the level of hormones in the female body begins to decline, and by the age of 45, hormones can behave extremely unpredictably. Fluctuating estrogen levels, high cortisol levels and low thyroxine levels often lead to weight gain.

ADVICE. See your doctor to get your hormone levels checked, and also include foods rich in phytoestrogens and omega acids in your diet (flax, chia, and hemp seeds, avocados, lentils, beans, fatty fish, walnuts, olive oil, and coconut oil).

1. You don't get enough sleep. Scientists have proven that lack of sleep increases the risk of obesity. It's a vicious circle: after a sleepless night, you wake up groggy and start eating junk food to restore energy, but as a result you feel even more tired and sleep even worse the next night. Moreover, it is known that lack of sleep increases the level of ghrelin - the hormone of hunger!

ADVICE. Go to bed earlier (the most productive time for sleep is before midnight), keep your bedroom dark (artificial light disrupts melatonin production), and an hour before bed, turn off all gadgets and do something calming.

1. You live in too toxic an environment. Our body has the ability to accumulate harmful chemicals that are present in the air, tap water, food and household chemicals. To prevent such substances from harming vital organs, the body turns them into fat cells. In other words, our body regards excess fat as a means of protection.

ADVICE. Eat organic food, filter tap water, avoid processed foods and, if possible, replace some household chemicals and cosmetics with eco-friendly products.

1. You spend too much time sitting. Our bodies are not designed to sit for long hours. This lifestyle not only disrupts blood circulation and the digestion process, but also increases the amount of insulin (the hormone responsible for fat storage).

ADVICE. Get up regularly and go for a short walk. Set an alarm on your cell phone to remind you to get out of your chair every hour. Try doing some tasks while standing (for example, talking on the phone or chatting on social networks). On the subject: What do hormones do?

1. You are not eating enough FAT. If you've been on a low-fat diet for a long time or haven't included enough healthy fats in your diet, you're more likely to eat more sugar. Low-fat products are often high in sugar and contain harmful flavoring additives. Healthy fats are needed for the proper production of hormones, to nourish brain cells and for the successful absorption of vitamins. Surprisingly, fat will not make you fat; on the contrary, it will help you remove your own fat reserves!

ADVICE. Avoid low-fat foods. Eat more oily fish, nuts, seeds, avocado, olive oil and coconut oil.

1. You are not eating enough PROTEIN. Every meal should contain something protein, otherwise carbohydrates will release sugar much faster, which will lead to excessive insulin production.

ADVICE. Place some protein on your plate every time you eat something carbohydrate. A good source of protein is dietary meat, commercial fish, eggs, nuts, seeds, beans, lentils, dairy products, quinoa, spirulina.

1. You are not eating well. A lack of fruits, vegetables, protein, healthy fats and fiber in your diet means that you are not getting enough vitamins and minerals that your body needs to function properly. This not only leads to hormonal imbalance, but also increases stress levels, which in turn causes the body to increase body fat.

ADVICE. Consult a professional nutritionist. He will help you develop an optimal nutrition program that will include all the necessary microelements.

1. You are taking too many pills. Regular use of painkillers, antibiotics, drugs to normalize digestion and low-quality nutritional supplements overloads the liver, increases the level of toxins in the body and disrupts the intestinal microflora. As a side effect, we also have an increase in body weight.

ADVICE. Take pills more seriously: any synthetic substances must be removed from the body. Visit your doctor to make sure you are taking only the right medications.

1. You have irregular bowel movements. The more often we suffer from constipation, the more our body accumulates toxins and, as a result, fat.

ADVICE. Make sure you eat enough fiber (whole grains, fruits, vegetables, legumes) and drink enough fluids.

1. You love Diet Coke, weight loss shakes, and other “no added sugar” drinks. Artificial sweeteners have been proven to make weight loss less effective!

ADVICE. Drink plain water or herbal teas (they come in so many different flavors that you're sure to find one you really like).

1. You eat on the run and chew food poorly. Busy people often eat something hastily at their desk or in the car. When you eat too quickly, you don't have time to chew your food well and it may remain undigested. If you are also under stress, your stomach begins to produce gastric juice and enzymes necessary for digestion more slowly. As a result, you don't get enough nutrients from food, and undigested food can disrupt the intestinal mucosa and slow down your weight loss process.

ADVICE. Be sure to take time to eat, even if you only have 10 minutes. Concentrate on your food (don't check your email while eating!) and chew every bite thoroughly. Appreciate and enjoy food.

1. You drink too much. Here we mean alcohol, lattes and energy drinks. Too much alcohol irritates your gut and encourages you to eat more (you can probably remember those times when you really wanted something sweet after a loud party). “What about a latte with skim milk?” - you ask. “It certainly won’t hurt my diet.” In fact, milk contains a lot of sugar, and caffeine stimulates insulin production. As for energy drinks, it’s better to forget about them altogether, because they consist exclusively of sugar and caffeine.

ADVICE. Reduce your alcohol consumption (for example, try to indulge yourself only on weekends). Replace the latte with an Americano (it doesn't contain milk) or herbal tea and don't buy energy drinks. Get into the habit of drinking green tea: it's proven to aid weight loss and provide a natural source of energy, but it contains much less caffeine.

1. You are not drinking enough water. Very few people drink enough fluids every day. But it is water that helps our body remove toxins, regulate stool and ensure optimal absorption of beneficial microelements necessary to normalize metabolism.

ADVICE. Try to drink 1-2 liters of filtered water daily. For taste, you can add a little cucumber or lemon to it.

1. You eat too many processed foods. Agree, after a busy day at work you really want to come home and cook yourself some dumplings. Unfortunately, such products will not allow you to lose weight. The fact is that such semi-finished products contain a large amount of vegetable oils, which during digestion turn into trans fats, which contribute to weight gain. In addition, the nutritional value of such dishes is much lower than that of home-cooked food.

ADVICE. Avoid processed foods and cook from scratch with wholesome ingredients as often as possible (it doesn't take long to make a steamed omelet or vegetable stew). You can also prepare a large quantity of a dish in advance, divide it into portions and freeze it so that you can quickly heat up a healthy dinner later.

1. You have no control over your sugar cravings. Can't resist a delicious muffin for breakfast? Or do you just need a candy bar to combat your afternoon sleepiness? It's not your fault: your body is sending you a signal that you lack energy. It may also be due to mood swings or the fact that the bacteria living in your body need food (their main diet is sugar).

ADVICE. If you're craving something sweet, eat some nuts, seeds, oatmeal cookies, fruits, vegetables or hummus. Another option is to make yourself a protein shake.

1. Your blood sugar levels have become imbalanced. When you eat foods containing refined carbohydrates (white bread, pasta, muffins, pastries, cookies), your blood sugar levels spike. However, after a couple of hours, on the contrary, it sharply decreases, and you again want to eat something carbohydrate to restore strength. These swings upset your blood sugar balance and cause your body to produce more insulin.

ADVICE. Instead of refined carbohydrates, choose healthy foods (whole grains, vegetables, proteins, healthy fats, complex carbohydrates) and your blood sugar levels will be optimal.

1. You're doing exercise wrong. Despite daily exercise and going to the gym, you still can’t get rid of excess weight? Firstly, exercise alone will not help you lose weight: to do this, you need to start eating right. And secondly, if you only do low-intensity cardio training, then your body gradually gets used to it, and its effectiveness decreases.

ADVICE. Add variety to your workout routine by adding strength, high-intensity, and stretching exercises. This will help you increase muscle mass and burn excess fat.

1. You are a dieter. Over the course of their lives, some people try dozens of different diets. At first, they lose weight easily, feel great, and decide to stop the diet. After this, all the lost weight comes back (and sometimes brings with it a couple of new kilograms). It's been known for a long time that this approach doesn't work, but every new diet looks so promising! In addition, we promise ourselves that next time we will be more disciplined. However, it’s not a matter of willpower at all: by depriving yourself of the necessary calories, healthy fats, proteins and microelements, you force your body to go into “survival mode”. As a result, cortisol levels rise, you begin to feel more and more cravings for forbidden foods, and your metabolism falls into disrepair.

ADVICE. Forget about advertised diets. Eat plenty of nutritious foods to give your body the resources and strength to work as it should. And the excess weight will gradually go away on its own. So, we found out why it becomes more and more difficult for us to lose weight as we age. But don't despair: try to follow the tips we gave above, and don't forget to monitor your hormone levels. Then you can return to your ideal weight and feel your best again!

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Test check yourself:

fact or fiction?

Eating more fruit can improve bone density.

Correct! Wrong!

Consuming foods with plenty of bioavailable calcium improves bone density. Fruits generally do not contain much calcium.

Excess protein accumulates in the muscles, causing them to increase.

Correct! Wrong!

Once the need for protein and energy has been met, excess amino acids are converted to acetyl-CoA, from which they are converted into fatty acids and stored in adipocytes. Therefore, excess protein will not be converted into muscle.

Calories consumed after 7 pm are automatically stored as fat, which contributes to weight gain.

Correct! Wrong!

Regardless of when you eat, excess calories are used in anabolic reactions, converted into fat or glycogen, and stored. If you eat fewer calories than you need, catabolic reactions will occur in the body more often and, accordingly, triglycerides will be broken down.

Test: myths about protein - fact or fiction?

Authorized Products

A diet for a 40-year-old man includes:

• Rye/whole grain bread, crispbread, oatmeal cookies.
• Various types of sea/river fish and seafood (shrimp, crabs, mussels, squid).
• Dietary meat of rabbit, domestic chicken, turkey, veal, beef.
• Fermented milk/dairy products with minimal fat content (cheese, cottage cheese, milk, kefir, acidophilus milk, fermented baked milk).
• Chicken/quail eggs in any form.
• A variety of vegetable crops (green peas, cucumber, bell peppers, spinach, garlic, asparagus, zucchini, celery, onions, green beans, all types of cabbage, lettuce, garden greens in raw, stewed and boiled form). Seaweed and other types of algae.
• Virgin vegetable oils (sunflower, flaxseed, olive), various seeds/nuts, dried fruits, bee products.
• Fruits/berries (oranges, avocados, cherries, pears, pineapples, kiwi, grapefruit, tangerines, nectarines, lemons, mangoes, feijoas, pomelo, plums, cherries, baked sweet and sour apples, raspberries, strawberries, black and red currants, grapes ).
• Herbal tea, freshly prepared juices, still mineral water, green tea, rosehip infusion.

Table of permitted products

Fully or partially limited products

A diet for a 40-year-old man excludes from the diet:

• Fatty meat and products made from it (smoked meats, ham, canned meat, sausages, bacon), semi-finished meat products, offal, fast food products.
• Canned fish.
• Pasta made from soft flours, white rice.
• Products that contain easily digestible carbohydrates (confectionery, candy, sugar, waffles, jam, condensed milk, semolina, ice cream, sweet drinks, jam).
• Solid fats (pork, lamb, beef fat), mayonnaise, high-fat dairy/fermented milk products (cheese, cream, sour cream, cottage cheese), waterfowl meat - duck, goose.
• Salt, preserves, and salty foods are limited.
• Strong coffee, sweet carbonated drinks, alcohol.

Table of prohibited products

Obesity in men. How to help a patient: practical advice

12.01.2020

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During the urological Internet conference No. 6, endocrinologist, andrologist and weight loss specialist Elena Yurievna Gritskevich made a report on possible approaches to solving the problem of obesity.

According to the WHO definition, obesity is a chronic disease, heterogeneous in etiology and clinical manifestations, progressive in its natural course, characterized by excessive deposition of fat mass in the body and a relapsing nature

What is more accurate: BMI or waist circumference?

A tool for assessing the presence and severity of obesity is the body mass index (BMI) - the ratio of body weight in kilograms to the square of height in meters (kg/m2). According to WHO, a diagnosis of overweight or obesity is made in adults in the following cases:

• BMI greater than or equal to 25 – overweight;
• BMI greater than or equal to 30 – obesity;
• Waist circumference more than 94 cm.

However, it should be remembered that even with a BMI above normal, a patient can have a large percentage of muscle mass, and therefore not suffer from obesity. In some cases, focusing on waist circumference may be more reasonable.

If previously men lagged behind women in the prevalence of obesity, today its prevalence rates are almost equal between the sexes.

Patient examination algorithm

Individually, according to indications, a number of laboratory examination methods can be used in obese patients:

• performing a glucose tolerance test;
• lipid profile (total cholesterol, triglycerides, HDL, LDL);
• liver function indicators (bilirubin and its fractions, ALT, AST, alkaline phosphatase);
• determination of thyroid function (TSH, sT4);
• overnight dexamethasone test with one mg of dexamethasone if endogenous hypercortisolism is suspected;
• testosterone, prolactin, FSH, LH, estradiol, SHBG;
• C-peptide and insulin for suspected hyperinsulinemia (eg, insulinoma, nesidoblastosis, etc.).

Among the instrumental examination methods that can be used are:

• bioimpedansometry;
• Ultrasound of the abdominal organs and kidneys;
• Ultrasound of the thyroid gland;
• Ultrasound of the pelvic organs (scrotum);
• ECG;
• ECHO-KG;
• 24-hour blood pressure monitoring, ECG monitoring;
• radiography of the skull, sella turcica;
• polysomnography;
• MRI of the pituitary gland with contrast enhancement;
• MRI of the brain.

Which diet is better?

The basic principles of weight loss are a balanced diet, physical activity, normalization of carbohydrate, lipid and other types of metabolism if they are disturbed, if necessary, drug therapy, and in case of morbid obesity, bariatric surgery.

The most appropriate diet therapy for weight loss should be safe, effective and something that the patient can adhere to. Meals should include all major food groups. It is recommended to monitor the food eaten in the form of a food diary, which also records daily physical activity. Individual food preferences, eating behaviors and eating patterns must be taken into account, as well as cultural background, food traditions and availability, timing and financial concerns, food knowledge and culinary skills.

Low-calorie, fat-restricted diets lead to greater reductions in total and LDL cholesterol, while carbohydrate-restricted diets lead to greater reductions in serum triglycerides and increases in HDL cholesterol, as well as greater reductions in serum glucose HbA1c.

Separately, Elena Yuryevna mentioned the “Mediterranean” diet, which is not a specific diet, but rather a generalized term for several food options that are often found in Greece, Italy and Spain. The Mediterranean diet has the most consistent and robust scientific support for reducing the risk of atherosclerotic cardiovascular disease. There are a number of basic principles of such a diet:

• olive oil as the main source of fat;
• consumption of vegetables, legumes, whole grains, nuts and seeds;
• moderate consumption of red wine;
• moderate consumption of seafood, dairy products (cheese and yogurt), poultry and eggs;
• limiting the consumption of red meat, meat products and sweets.

You can also consider the DASH (Dietary Approach to Stop Hypertension) diet, developed by the US National Heart, Lung, and Blood Institute, mainly to correct high blood pressure. It prefers vegetables, fruits and whole grains, low-fat or low-fat dairy products , fish, poultry, lean meats, nuts, seeds and legumes, as well as fiber and minerals, particularly calcium, potassium and magnesium. Limit intake of sodium (1500–2300 mg per day), fat (no more than 27% of total daily calories), saturated fat (<6% of total daily calories), red and processed meats. Avoid sweet drinks and foods with added sugar.

The Paleolithic diet is based on the diet believed to have existed during the Paleolithic period (lasting 3.4 million years and ending 6000–2000 BC). It recommends fresh vegetables, fruits and root vegetables, grassy lean red meats, fish and seafood, eggs, nuts and seeds, and healthy oils (olive, walnut, flaxseed, macadamia, avocado and coconut). Avoid grains, legumes including peanuts, dairy products, potatoes, processed foods, refined sugar, refined oils and salt.

Optimal physical activity – how many times a week?

Physical activity is another extremely important measure in the fight against obesity. It refers to any work performed by skeletal muscles that results in energy expenditure in excess of the level characteristic of the resting state. The intensity and type of load depend on the patient, in particular, the presence of complications, and are selected individually. Moreover, any physical activity is better than no physical activity.

Dynamic (aerobic) training, performed at least 150 minutes (2.5 hours) per week of moderate activity or 75 minutes (1.25 hours) of vigorous activity, provides most of the health benefits, moderate weight loss and prevention of its increase. In the mode of 300 minutes (5 hours) per week with moderate aerobic activity or 150 minutes (2.5 hours) with intense aerobic activity, more sustainable weight loss is observed and weight regain after weight loss is prevented. If resistive (anaerobic) strength training is selected, a preliminary assessment of body composition (bioimpedance measurement) is carried out. During the training process, appropriate weight lifting techniques are used, various weights, resistance bands, etc. are used. During the recovery period, short-term muscle pain can be expected.

Medical weight correction

When managing patients with obesity, it is critical to avoid stigmatizing them while encouraging, motivating and supporting their choice to partner with their healthcare provider during treatment. From the point of view of behavioral therapy, eating disorders are divided into several types: external (I eat when I see food), emotional (I eat when I experience emotional discomfort) and restrictive (alternating strict diets with refusal of treatment). Cognitive behavioral therapy builds motivation and sets realistic goals, while patient awareness and family involvement are also important.

Several types of drugs can be used in the drug therapy of obesity:

• centrally acting drugs to accelerate saturation (sibutramine);
• drugs that affect the body's ability to absorb certain nutrients from food (orlistat);
• analogues of human glucagon-like peptide - 1 (liraglutide).

Sibutramine is a reuptake inhibitor of serotonin and norepinephrine, and, to a lesser extent, dopamine at central nervous system synapses. It accelerates the feeling of fullness, reducing the amount of food consumed, and increases the body's energy expenditure, which together leads to a negative energy balance. The drug, however, has a number of side effects: nausea, loss of appetite, constipation, dry mouth, changes in taste, headache, agitation and sweating. Contraindications include uncontrolled arterial hypertension, coronary heart disease, decompensated heart failure, heart rhythm disturbances, cerebrovascular diseases (stroke, transient cerebrovascular accident), severe liver and kidney damage. When taking the drug, blood pressure control is necessary in all patients. The drug is discontinued if the heart rate increases by more than 10 beats per minute, or the blood pressure increases by more than 10 mmHg. Art., and also if it exceeds 140/90 mm Hg. Art. with previously compensated hypertension, if shortness of breath, chest pain or joint swelling progresses. Sibutramine is also not prescribed within 14 days after taking monoamoxidase inhibitors and drugs that act on the central nervous system, including antidepressants.

Liraglutide is a glucagon-like peptide-1 receptor agonist and is an injectable drug. At low doses (1.8 mg per day) it is indicated to lower blood sugar levels in patients with type 2 diabetes. At a dose of 3 mg per day, it is approved for the treatment of obesity. Some patients may lose 5–10% of body weight, especially at higher doses of the drug. Side effects include nausea, hypoglycemia, diarrhea, constipation, vomiting, headache, decreased appetite, dyspepsia, dizziness, abdominal pain and increased lipase. Contraindicated in patients with a family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2. It is recommended to discontinue therapy if pancreatitis, gallbladder disease, or suicidal behavior or thoughts are suspected. May contribute to hypoglycemia, especially in patients with diabetes mellitus receiving insulin or sulfonylureas. It can also slow down gastric emptying, which may affect the absorption of concomitantly administered oral medications.

Orlistat is a gastrointestinal lipase inhibitor that impairs the absorption of fat from food. Low doses are approved without a prescription. Some patients may lose about 5% of their body weight while taking it. Side effects include oily discharge with gas from the rectum, especially after fatty foods, which, however, can help with constipation. In addition, the drug can promote the formation of stones in the gall bladder and kidneys, and also cause malabsorption of fat-soluble vitamins (A, D, E, K). It is necessary to take a daily multivitamin against this background. Contraindications are chronic malabsorption syndrome and cholestasis. Rare cases of severe liver damage and pancreatitis have been reported. Interacts with cyclosporine, hormonal contraceptives, anticonvulsants, thyroid hormones and warfarin.

Heavy artillery

Surgical treatment is recommended for morbid obesity and ineffectiveness of previously carried out conservative measures in patients 18–60 years old.

It is carried out for BMI > 40 kg/m2 - regardless of the presence of concomitant diseases, as well as for BMI > 35 kg/m2 and the presence of severe diseases, the course of which can be influenced by reducing body weight.

A number of techniques can be used in bariatric surgery. In particular, Roux-en-Y gastric bypass provides significant improvements in metabolic disorders, but is associated with an increased risk of malabsorption complications. Promotes weight loss up to 65–75%. Has benefits for high BMI, GERD, type 2 diabetes.

Laparoscopic adjustable banding is the least invasive method and has a 25% to 40% risk of bandage cuff migration at 5 years. Provides weight reduction of 30–50%. Used for obesity without severe metabolic disorders.

Longitudinal (sleeve) gastrectomy improves metabolic diseases without disturbing the small intestinal anatomy. Micronutrient deficiencies may occur infrequently. After it, a weight loss of 50–70% is observed.

Biliopancreatic bypass provides maximum weight loss and elimination of metabolic diseases. Associated with an increased risk of deficiency of vitamins and microelements. This is the most technically complex method, providing weight reduction of up to 70–80%.

In addition, Elena Yuryevna mentioned the American BAROnova system with a silicone device TransPyloricShuttle. The intragastric system is small in size - 80–90% smaller than a balloon. It changes the passage of gastric contents by slowing gastric emptying. The effectiveness of the system was confirmed by the results of the randomized, double-blind, placebo-controlled study ENDObesity II, which involved 302 patients from nine US research centers. Approximately 67% of patients lost 5 percent or more of their body weight, and 40% lost 10% or more of their weight, compared with 14% of patients in the placebo group. Sharp fluctuations in blood pressure and other cardio-metabolic risk factors, as well as a decrease in quality of life were not observed with this treatment. Side effects included gastrointestinal events such as abdominal pain, nausea, vomiting and dyspepsia, as expected with an intragastric device designed to treat obesity through delayed gastric emptying.

Another relatively new technique is embolization of the left gastric artery. The results of the first such operations for weight loss in humans were presented in 2013. Previously, this technique was used to stop gastric bleeding. The researchers found that embolization of the left gastric artery led to a decrease in the production of the hormone ghrelin, which is involved in the regulation of hunger and satiety, which explains the decrease in body weight. The average weight loss in patients was 8–9% in the first 2–6 months after surgery and 16% in 2 years. After losing weight, the operated patients maintained it for at least a year, without any complications. The operation is performed using a microcatheter; spheres of Tris-acrylic molecules bound to gelatin molecules are used as embolization material.

In general, the choice between taking measures to change the patient’s lifestyle, as Elena Yuryevna emphasized, depends on many factors, the main ones of which are the patient’s gender, BMI, waist circumference and the presence of comorbid pathologies.

The material was prepared by V.A. Shaderkina Video of the performance can be viewed on Uro.T

The article was published in the journal “Urology Digest” No. 6-2019

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