Full text of the article:
Obesity
- this is not just excess weight, but a serious chronic disease that develops as a result of the influence of physiological and genetic factors, as well as under the influence of the environment. During the development of obesity, excess adipose tissue accumulates in the body, which is very difficult to get rid of. An obese person is forced to control his body weight throughout his life and keep it within acceptable limits.
Causes and consequences of obesity
A person can “earn” obesity on his own or “inherit it.” A common cause of obesity is regular overeating and low physical activity, i.e. burning insufficient energy when consuming high-calorie foods. Simply put, a person consumes too much and “spends” too little.
Obesity can also be caused by various malfunctions in the body. In particular, genetic and endocrine disorders can lead to obesity. True, this type of obesity is much less common than the first.
Obesity can cause a person not only moral discomfort and reduce his level of self-esteem, but also cause serious health problems, including the development of deadly diseases of the heart and gastrointestinal tract. Obese people are less productive and tire more quickly, and their life expectancy is shortened. Therefore, it is important that a person’s weight does not exceed the recommended norm and does not create additional stress on the body’s life support systems. Regular physical activity and a proper diet plan help you stay in shape. A therapist can help you form it.
Dietitian: about the work of a nutrition and weight loss specialist
Table of contents
- Who is a nutritionist?
- What does a nutritionist do?
- When to see a nutritionist
- How to prepare for your visit
- Consultation with a nutritionist
- Advantages of contacting MEDSI
Human health depends on many factors, and one of them is proper nutrition. This is worth following not only for models, artists, politicians and all those who speak in front of people. The fact is that poor nutrition, excess weight problems or anorexia entail many unpleasant consequences. These are, in particular:
- Diseases of the gastrointestinal tract
- gastritis, ulcers and much more - Cardiovascular
disorders – such as thrombosis or atherosclerosis - Joint diseases
– excess weight increases the load on the joints and spine - Biliary tract diseases
– excess fat in the abdominal area can cause the formation of gallstones - Metabolic disorders caused by endocrine diseases, including diabetes,
make it more difficult for the patient to lose weight, even if he wants it and makes considerable efforts
But such problems can be overcome. A nutritionist will help you with this.
Who is a nutritionist?
A dietitian is a specialist in the field of proper nutrition.
. It is a doctor, not a coach, teacher or psychologist. He treats obesity and gives recommendations regarding proper nutrition and a healthy lifestyle.
A nutritionist can be either an adult or a pediatrician. He knows how to effectively solve problems related to diet and weight. To do this, he uses advanced techniques and training with proven effectiveness. It is he who should be contacted if you want to get advice on adjusting your diet and preventing various diseases caused by poor nutrition, as well as learn how to lose weight or, conversely, gain weight. A consultation with a nutritionist will also be useful for those who are actively involved in sports and fitness or are recovering from an injury, surgery or serious illness.
What does a nutritionist do?
The main occupation of a nutritionist is the development of healthy nutrition plans
. Such regimens are needed not only for patients suffering from obesity, anorexia or gastrointestinal diseases. Healthy people are also interested in them, understanding that a balanced diet is the guarantee that they will not encounter many diseases in the future.
Many people believe that nutritionists work mainly with those who want to lose weight. But anorexia
also falls within their scope of competence. This eating disorder, which leads to painful weight loss, is quite common. In most cases, young girls suffer from it.
When to see a nutritionist
When should you consult a nutritionist? You should definitely contact a specialist if you have problems with weight.
. This applies to both its excess and deficiency. However, under no circumstances should you postpone your visit. Remember: the sooner you see a doctor, the easier it will be to solve your problems. And a consultation will definitely be needed before you decide to try to lose weight with a low-calorie diet.
Those who have already been diagnosed with:
- diabetes
- allergic conditions
- oncological diseases
- thyroid diseases
- diseases of the digestive and cardiovascular systems
In all of the above cases, weight fluctuations are possible, which negatively affect the general condition. At the same time, following a carefully selected and balanced diet can make life more comfortable
.
Parents must pay attention to the condition of their children. Weight problems don't just affect adults. If a child has a tendency towards obesity or anorexia (this is especially typical for teenage girls), he needs to consult a nutritionist. Type I diabetes mellitus and various chronic diseases, including diseases of the gastrointestinal tract, are also a reason to visit a specialist.
Frequent ARVI, sore throats and other similar diseases are associated with decreased immunity, which, in turn, is a consequence of poor nutrition. If you or your child often suffer from such diseases, you should consult a nutritionist. He will give recommendations for correcting nutrition. Following them will help solve the problem.
How to prepare for your visit
A person experiencing eating problems should keep a special diary. It's called a food diary.
. This will help you monitor your food intake and monitor your weight changes. Typically the diary states:
- What did you eat
- When did you eat it
- How much food did you eat (it is better to write down the number of calories)
- Why did you eat it: were you hungry or couldn’t resist, were stressed, etc.
Be sure to take this diary with you to your consultation. If you have already undergone any examinations and tests, bring their results. A nutritionist will need any information about your eating habits, as well as the dynamics of weight changes.
People with chronic diseases who are on constant therapy should not skip medications
, even if they go to a nutritionist. Think in advance about the questions you want to ask the specialist. For example:
- What is a healthy weight
for me - How can I eat healthy
if I have gastritis/peptic ulcer/diabetes? - What should you eat to get sick less often?
- How can I achieve the required indicators
?
What to do to gain the necessary weight or get rid of extra pounds
? - Is my excess weight causing my health problems
, or have my health problems caused me to be overweight now?
Consultation with a nutritionist
At the initial appointment, the specialist will review the data on the condition of your body, which is indicated in the medical record, and the results of tests taken previously.
At the appointment with the nutritionist:
- measures anthropometric data (height, weight, body mass index, waist and hip circumference)
- collects anamnesis, analyzes actual nutrition, eating habits, physical activity
- conducts bioimpedansometry - computer analysis of body composition
- selects the optimal calorie intake
- gives individual recommendations on nutrition and lifestyle
- prescribes necessary diagnostic tests
- recommends medications that normalize metabolic processes and correct hormonal levels
The number of follow-up visits to the dietitian will depend on how complex your case is. The fact is that each person’s body is individual, and there is no solution that suits absolutely everyone. It is necessary to collect as much data as possible about a particular patient in order to determine safe ways that will help him successfully achieve his goal.
If you are contacting an endocrinologist-nutritionist
, he can give a referral for a test to determine the level of thyroid hormones. This is explained by the fact that excess weight is often a consequence of improper functioning of this organ. Other specific examinations may also be needed: ultrasound of the abdominal organs, electrocardiography, assessment of insulin sensitivity, analysis of food intolerance, etc.
The doctor will carefully study the results of tests and examinations. Based on them, he will select an individual diet for the patient, taking into account the needs of his body, food preferences, general health and a number of other factors. He will give specific nutritional recommendations that you will need to follow.
Advantages of contacting MEDSI
The MEDSI clinic employs experienced, highly qualified nutritionists who are ready to help patients experiencing weight problems. They work with each patient individually, taking into account his eating habits and preferences, lifestyle, level of physical activity, general health and other factors. We have our own laboratory
, allowing you to quickly carry out the necessary tests and obtain results on the basis of which an accurate diagnosis can be made. Based on the results of examining the patient and analyzing his diet, an individual weight correction program is drawn up.
To make an appointment with a nutritionist, choose the method that is most convenient for you:
- Make an appointment on the website
- Leave your phone number and our manager will promptly contact you
- Call + 7 (495) 7-800-500
How to calculate body mass index
Body Mass Index (BMI)
is a “marker” that makes it possible to assess how much a person’s weight corresponds to his height, i.e. whether current body weight is normal or outside the minimum or maximum threshold values. BMI is calculated using a simple formula: body weight in kilograms must be divided by height in meters squared.
1.7 meters tall
weight
80 kilograms
, then the BMI will be
27.7
, this is an indicator
of excess body weight
.
The World Health Organization offers the following interpretation of BMI indicators:
Body mass index
- a conditional value, it does not take into account a person’s physique or the ratio of fat and muscle mass, so BMI is usually not calculated for professional athletes and pregnant women. However, if your body mass index does not fall within the “normal weight” range, then this is a reason to see a general practitioner. He may order additional tests to rule out the possibility of developing diseases that could contribute to weight gain.
The patient may also be classified as a “risk group”, or the so-called “overweight” group. They include people who cannot yet be diagnosed as obese, but excess body weight can trigger the development of serious concomitant diseases. Doctors usually recommend changing lifestyle and diet for such patients.
In recent years, there has been a progressive increase in the number of people with overweight and obesity (in the world - about 30% of adults; in Russia, according to various sources, from 30 to 54% of the population) [1-3]. According to forecasts, by 2025, 40-50% of the world's population will suffer from obesity. The World Health Organization has recognized obesity as an epidemic of the 21st century.
Currently, the effect of excess body weight on the occurrence and course of diseases of the gastrointestinal tract (GIT), including its upper sections, is being actively studied. The results of a number of studies demonstrate the association of an increased body mass index (BMI) with diseases such as gastroesophageal reflux disease (GERD), as well as with malignant neoplasms of the esophagus.
Obesity should be understood as a chronic metabolic disease, manifested by excessive development of adipose tissue, progressing in a natural course and having a certain range of complications. With this pathology, the content of adipose tissue in the body exceeds 10-15% of body weight in men and 20-25% in women. Most of the mass of an adipose tissue cell—an adipocyte—is fat in the form of triglycerides, consisting of glycerol and three fatty acid molecules [4]. Currently, adipose tissue is considered not just a type of connective tissue, but also an endocrine organ, since it is the site of synthesis of substances that have endocrine, paracrine and autocrine effects.
Obesity is primarily associated with metabolic syndrome (MS), which is characterized by an increase in visceral fat mass, a decrease in the sensitivity of peripheral tissues to insulin, and hyperinsulinemia [5, 6]. Data have been obtained indicating that MS is associated not only with diseases of the digestive system such as steatosis of the liver and pancreas, chronic pancreatitis, cholelithiasis, cholesterosis of the gallbladder, but also with GERD. Experts discuss the following hypotheses of their interaction: MS can be combined with gastrointestinal diseases; metabolic disorders can affect the functional state and morphology of the organs of the digestive system; The gastrointestinal tract directly takes part in the formation of dysmetabolic status [7].
A kind of vicious circle is formed: the digestive organs, contributing to the development of MS, themselves become target organs. There is a theory that it is food intake that triggers what is called “macronutrient-induced inflammation.” The secretory activity of adipocytes is stimulated and the concentrations of IL-6, C-reactive protein and other inflammatory mediators in the blood increase [8, 9]. According to other data, intense lipolysis occurs in visceral adipocytes during MS, which leads to the release of large amounts of free fatty acids, which prevent the binding of insulin to hepatocytes, causing the development of insulin resistance (IR). Under IR conditions, endothelial dysfunction occurs and the production of vasoactive mediators is disrupted, which causes vascular spasm [10]. Thus, the presence of MS is the basis of polymorbidity in gastroenterological practice and is characterized by systemic similar changes in the digestive organs, obviously caused, among other things, by microcirculatory disorders [11].
GERD is undoubtedly the most common pathology of the esophagus in the modern world. In Western populations, its prevalence varies from 20 to 30% with a tendency to further increase [12]. Predisposing factors, along with smoking, the use of drugs that reduce smooth muscle tone, and alcohol abuse, also include obesity [13]. This is proven by a number of studies, according to which overweight and obesity in patients with GERD are more common than in individuals in the general population, and more often in men than in women (43 and 34.9%, respectively) [14]. According to our own research, among 630 employees of internal affairs bodies who underwent a military medical commission in 2002-2009, GERD was diagnosed in 256 people (men, average age 43.8 ± 4.6 years), while overweight was detected in 64.5% of cases. According to endoscopy, reflux esophagitis was more common in obesity. Erosive forms were more common among individuals with a BMI>25 kg/m2 compared to non-erosive forms (72 and 62%, respectively). The effect of obesity on GERD is associated with a higher incidence of gastroesophageal reflux in obese individuals. In patients with GERD, an increased BMI is also associated with greater severity and frequency of symptoms typical for this pathology, primarily heartburn and regurgitation, especially in women. Thus, heartburn and regurgitation in obese GERD patients were detected in 10.2 and 22.1%, respectively, compared with 4.4 and 11.4% in GERD patients with normal BMI [15-17].
The main mechanisms of GERD formation in obesity are different. This includes impaired motility of the esophagus and slower gastric emptying. However, the main mechanism is the redistribution of visceral fat (abdominal obesity), which leads to increased intra-abdominal pressure, impaired esophageal motility and gastric emptying [18]. In addition, obese people are more likely to experience transient relaxation of the lower esophageal sphincter due to more frequent meals, especially fatty foods. With obesity, the so-called hypotensive lower esophageal sphincter is formed: as BMI increases, the pressure in it decreases [19]. According to 24-hour pH-metry, the number of refluxes increases in obesity, including those with pH <4, especially in the postprandial period [20]. Interesting data have been obtained that there is a direct correlation between an increase in the esophagogastric pressure gradient and waist size, that is, it is abdominal obesity that is associated with GERD, and not a simple increase in BMI.
Not only an increased BMI, but also an increase in body weight can cause an increase in the frequency and duration of gastroesophageal reflux. It has been shown that weight loss leads to improvement and significantly reduces the clinical and endoscopic manifestations of GERD [15, 21]. Many researchers note that the connection between obesity and GERD is expressed only in the white population, and is absent in blacks and Asians [15, 22]. The progression of GERD from catarrhal to erosive forms largely determines the presence of MS [23].
The relationship not only between obesity and variants of GERD, but also the incidence of Barrett's esophagus and esophageal adenocarcinoma has been actively studied. It has now been shown that people with obesity and reflux symptoms have a higher risk of Barrett's esophagus (OR 34.4; 95% CI 6.3–188) compared with those with reflux only without obesity (OR 9.3 ; 95% CI 1.4—62.2) [24]. A recent study found that abdominal fat is a key factor linking obesity and Barrett's esophagus. It is waist circumference that is a risk factor for the latter, regardless of BMI. It should be noted that after a decrease in waist circumference, the correlation between BMI and the risk of Barrett's esophagus disappears. In addition to mechanical pressure, visceral fat (as opposed to subcutaneous fat) has a metabolic effect on the body and the adipocytokines it produces, including IL-6 and tumor necrosis factor α, may play a role in carcinogenesis [20]. With severe obesity, the risk of adenocarcinoma increases, according to various sources, by 3-7 times.
In contrast to GERD, the effect of obesity on the development of diseases of the stomach and duodenum has not been sufficiently studied. A number of researchers have identified only a borderline relationship between the symptoms of dyspepsia and obesity (OR 1.1) [25].
Most studies have not found a relationship between increased BMI and the incidence of chronic gastritis, gastric and duodenal ulcers [26]. There is only a correlation between the severity of the existing peptic ulcer and obesity and disorders of lipid and carbohydrate metabolism caused by IR [27]. It is believed that the intensification of lipid peroxidation processes, hypercoagulation and hyperlipidemia characteristic of MS, together with increased activity of the acid-peptic factor and a decrease in barrier function, lead to the formation of more severe erosive and ulcerative lesions of the upper gastrointestinal tract [11].
Recently, the relationship between the presence of Helicobacter pylori infection and obesity has been discussed. The data is not clear: according to some studies, there is rather an inverse relationship between obesity and the presence of Helicobacter pylori infection.
Taking into account the available data, we can conclude that the effect of excess body weight on the development of diseases of the gastrointestinal tract is mediated primarily through various mechanisms: metabolic, mechanical, inflammatory, toxic. Despite significant evidence supporting the important role of weight gain in the pathogenesis of GERD, further research is needed to better understand the mechanisms by which obesity leads to the development and progression of GERD.
How is a person's body composition analyzed?
Calculating body mass index is not the only and far from the most accurate way to diagnose obesity. There are special devices that can be used to perform bioimpedance measurements
, i.e. analyze body composition. This diagnostic method is based on human anthropometric data and the ability of different types of tissue to conduct electricity differently.
The point is that the device can additionally evaluate tissue, distinguish muscle tissue from fat, determine skeletal muscle mass and fluid mass in the body. Using this analysis, we can say exactly how true the hypothesis is that a person has “heavy bones.” Knowledge of body composition helps doctors assess the risks of developing various diseases.
Obesity symptoms
Obesity 1st degree
Moderate weight gain, which is easily corrected by diet and exercise.
Obesity 2 degrees
Excess body weight is manifested by pronounced fat deposits, sometimes in the form of skin folds.
Shortness of breath appears during physical activity, pain in the joints and lower back, headaches due to high blood pressure, etc. are possible.
It is at this stage of the disease that existing methods of conservative treatment of obesity (diet, exercise, medications) are most effective. If they are not applied, further progression of the disease becomes possible.
Obesity 3 degrees
Excess body weight is extremely pronounced and is manifested by significant fat deposits like “skin aprons” on the abdomen and thighs, accompanied by inflammatory changes in the skin.
Worries include shortness of breath at the slightest physical exertion and even at rest, swelling of the extremities, headaches, etc.
Efficiency is sharply reduced, patients often have difficulty caring for themselves at home.
At this stage of the disease, conservative treatment is ineffective and surgery is the treatment of choice.
Who diagnoses obesity
A person can monitor their body weight independently, including by periodically calculating their body mass index and comparing it with the threshold values established by WHO. However, only a doctor can make a diagnosis of obesity. Typically a therapist.
If there is a suspicion of the development of diseases caused by obesity, the general practitioner can write a referral to the patient for consultations with other doctors. This is necessary to clarify the diagnosis and prescribe treatment. Obesity can also be treated with drug therapy, but the decision to prescribe it can only be made by a doctor if there are necessary medical indications.
When to go to a nutritionist and how to choose a good one Instructions from Meduza
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In Russian dietetics there are many who do not know about the achievements of world science, do not comply with ethical rules, and thereby harm patients. We asked nutritionist Elena Motova to tell us when it is necessary to contact such a doctor and what to look for when looking for one.
Don't expect a miracle
You shouldn’t expect miracles from a nutritionist: his task is to help you change your eating behavior over the long term, which will require motivation and some work on your part. This is a marathon, not a 100-meter race.
Let's take for example a situation where you need to lose weight for medical reasons.
Gradual, stable weight gain over several years means that a person regularly overeats. This can happen for various reasons, and the nutritionist’s task is to identify the factors that lead to overeating, and also track with the patient in what situations this happens. Restructuring nutrition and eating habits requires time and some direction, consistent, gradual changes, new skills, so that all this is not abandoned and forgotten after the first failure. For example, after an episode of overeating.
You need to understand very clearly that weight can be reduced in absolutely any way if you create a situation for at least a few months in which more calories are spent than consumed. After such a diet ends and the person returns to normal eating behavior, the weight also gradually returns. Simple solutions do not work where problems have been building up for years and decades. In addition, changing eating behavior requires a variety of resources, from time and money to social approval. This makes it quite a challenge. Miracles, alas, do not happen here.
At the same time, there is a widespread idea that there is no need for complex work with eating behavior. Allegedly, it is enough to give the patient an average statistical menu balanced according to the KBZHU and everything will work out on its own. Soviet number tables were set up similarly: they simply listed what you could and couldn’t eat.
In reality, the limitations and narrowness of the ready-made menu do not allow one to make independent decisions about the choice of food and nutrition, to understand the logic of constructing a diet and the distribution of food groups, to pick up signals of hunger and satiety, to feel free in social situations when a person eats at a party or in a cafe with friends. That is, this approach does not take into account individual characteristics and does not allow achieving flexible, but at the same time conscious eating behavior.
Think again about whether you really need to see a nutritionist
Low or high weight, dissatisfaction with your body, excessive concern about weight or proper nutrition, severe dietary restrictions or, on the contrary, a diet mainly from highly processed foods, chaotic and unbalanced nutrition, chronic overeating, anxiety and fears about food can be a reason independently consult a nutritionist.
Ideally, other doctors should refer you to a nutritionist. If you have complaints related to your physical condition, including weight gain, it is better to start with a competent therapist. If complaints are related to the functioning of the gastrointestinal tract, then contact a gastroenterologist. If you have problems with eating behavior, then contact a clinical psychologist, psychotherapist or psychiatrist who deals with eating disorders (ED; we are talking about anorexia nervosa, bulimia and some other disorders). A nutritionist rarely works alone with a patient - usually together with other specialists, and this is completely justified.
When there is reason to suspect eating disorder
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When there is reason to suspect eating disorder
My loved one eats too much. Or he doesn't eat at all. In general, he clearly has problems with food. How to help? Instructions for "Medusa"
9 months ago
Patients (and sometimes even people with medical education) are often confident that any diseases can be cured with some special dietary restrictions. Unfortunately, it is not. For the vast majority of chronic diseases, a complete, adequate, varied diet and drug therapy are recommended. Folk, naturopathic and other proprietary “exclusion diets” do not cure anything.
At the same time, a nutritionist can really help if there are any chronic diseases and conditions. For example, gout, urolithiasis, prediabetes, type 2 diabetes mellitus, obesity, metabolic syndrome, arterial hypertension, atherosclerosis, celiac disease, irritable bowel syndrome, nutritional deficiencies in various diseases, eating disorders, etc.
Like the prescription of medications, the exclusion of foods and food groups from the diet should be carried out according to indications and be justified. If a person has celiac disease, they are prescribed a gluten-free diet for the rest of their life. And he will need a lot of time and effort for training, food selection, and nutrition control.
Try to find a good nutritionist through other doctors
The best way to find a good nutritionist is to ask other qualified doctors you trust. Or you can look for a nutritionist in a general medical clinic that adheres to the principles of evidence-based medicine.
Unfortunately, asking friends is not the best option: the patient can rarely evaluate the professional qualities of the doctor. If we are talking about short-term results, then rapid weight loss in various non-physiological ways does not mean that this effect is permanent, usually on the contrary.
I myself run a professional blog (this is inevitable if you write books), but I would not advise looking for a doctor, including a nutritionist, based on TV or social networks. Yes, problems with the quality of medical care in our country and a general crisis of confidence in specialists stimulate the creation of medical blogs. But many of the doctors to whom I refer patients do not blog. Not all bloggers who call themselves adherents of evidence-based medicine (and blast charlatans and obscurantists on social networks because this attracts maximum traffic) know and apply international clinical recommendations for the diagnosis and treatment of diseases in their practice.
In my opinion, Peter Attia gave good instructions on choosing a general practitioner. A nutritionist absolutely must be able to motivate and support the patient, have good theoretical and clinical training, and constantly update his knowledge.
Learn about nutritionist education
In reality, social networks are full of “nutritionists” who have taken various online courses. These people do not bear any responsibility for their recommendations and do not have the right to prescribe examination, much less treatment (diet therapy is also treatment). There are also many people offering treatment for eating disorders through social networks. And it's really scary.
A real nutritionist is a doctor and only a doctor. That is, you need to obtain a higher medical education in the specialty “pediatrics” or “general medicine” (six years), then study for another two years in clinical residency, where theoretical training is combined with work as a doctor under the guidance of senior colleagues. The residency can be directly in dietetics, or maybe in another specialty, but then after it you will need to undergo professional retraining in dietetics (again, full-time and on the basis of a medical school) with a certification exam and obtaining a specialist certificate - a nutritionist. That is, training takes at least eight years.
But even this may not be completely enough to feel like a competent specialist. In many ways, Russian guidelines and textbooks do not correspond to international medical consensus and are based on outdated or incorrect ideas about diet therapy. But to understand this, you need to learn English, read textbooks in it, take a variety of professional courses, subscribe to the authoritative medical knowledge base UpToDate, communicate and exchange experiences with foreign colleagues. Like any other doctor, a nutritionist needs to study and read professional literature every day, otherwise he will degrade.
Do not go to a nutritionist if you have medical problems
Nutritionists in Russia are trained online in 256 hours at a humanitarian university. Any person can take such courses, and they give the right to “carry out professional activities in the field of nutritionology.” There are also shorter options - everyone is trained in 30 academic hours. Therefore, you should not contact a nutritionist if you want to do more than just “improve your diet,” but you have medical problems (from obesity to gout).
The problem with the multitude of courses and programs that produce various kinds of non-medical nutrition specialists does not exist only in our country. Here, for example, is the story of Canadian holistic nutritionist Denby Royal about what she was taught in these courses. On the website of the National Health Service of Great Britain they write that the name of the profession “nutritionist”, unlike “dietitian”, is not regulated by law, so anyone can call themselves that.
To find a nutritionist with the appropriate qualifications (at least a bachelor's degree, professional accreditation), in the UK it is recommended to contact official professional organizations. They specifically emphasize that a nutritionist is not a medical specialty. The legal areas of activity and the boundaries of the professional competencies of a nutritionist are clearly defined.
Look out for warning signs
It would be ideal if Russia had a code of ethics and guidelines for good clinical practice that must be adhered to if you are part of an organized professional community. In this case, this community itself would ensure that the nutritionist adheres to the rules and standards. The problem is that in Russia there is no such code. Meanwhile, even when maintaining a professional blog, a doctor must also comply with medical ethics.
According to various national and international codes of ethics, a nutritionist should not:
- make non-existent diagnoses (leaky gut syndrome, chronic candidiasis, hormonal imbalance, insulin resistance, asymptomatic heavy metal intoxication along with parasitosis);
- recommend high-impact weight loss programs, very low-calorie diets and fasting. A reasonable rate of weight loss for medical reasons is half a kilogram per week. Moreover, weight loss goals for each patient should be individualized;
- sell proprietary weight loss programs;
- guarantee weight loss;
- post “before” and “after” photographs of patients on your social networks and websites;
- engage in body shaming and stigmatize people with non-standard parameters;
- conduct marathons and any other mass weight loss programs;
People who are dissatisfied with their body, weight and shape are more likely than the general population to have eating disorders. And any projects aimed at losing weight can significantly worsen their condition in the long term. A dietitian should be trained in diagnosing and treating eating disorders. Massive weight loss programs may miss such patients. At the same time, some group methods of working with patients are quite applicable in medicine and dietetics (let’s remember schools for patients with type 2 diabetes).
- offer its “cosmetic correction” to people of normal weight.
- advertise medicines;
- advise taking nutritional supplements;
- directly or indirectly participate in their sale;
- advertise highly processed products;
- on a blog, give recommendations to a specific person. A nutritionist is not a professional clairvoyant who, based on a photograph and two or three sentences, can form an informed opinion about a person’s state of health and offer treatment;
- give unscientific advice like “bananas in the form of smoothies increase blood sugar and lead to diabetes”, “drink clean water at the rate of 30 ml/kg”, “just stop overeating”.
How to understand that advice is unscientific
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Work on your eating behavior with a nutritionist
Let’s take for example a situation where a person was diagnosed with type 2 diabetes. In this case, one of the most important parts of treatment is medical nutrition therapy. A nutritionist, based on a person’s tastes and preferences, creates an individual nutrition plan that allows for the best possible control of the disease (in particular, blood glucose levels and lipid metabolism). At the same time, the patient is trained to solve specific problems in:
- counting and distribution of carbohydrates
- diet
- calorie intake
- prevention of overeating
- diversity and awareness in nutrition
The nutritionist gradually gives a lot of specific practical advice on preparing food, choosing foods, and expanding your diet. General advice (“eat more fish”) is completely useless if a person has no idea what kind of fish to buy and what to do with it. And how much is it - more.
If necessary, the nutritionist adjusts other aspects of lifestyle. Therefore, clinical guidelines recommend, for example, for type 2 diabetes, a series of three to six consultations with a dietitian lasting from 45 to 90 minutes. Ideally, the series of meetings should begin immediately and be completed within six months. This is a minimum; the need for further consultations is determined individually.
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A nutritionist may refer you to other specialists or recommend undergoing additional instrumental and laboratory tests (usually not very many, it should not be all the hormones or vitamins in the laboratory’s price list or a food intolerance test for all products with IgG4). The doctor must explain why he prescribes this.
You can and should expect detailed questioning about heredity, lifestyle characteristics, nutrition and eating behavior. The doctor will measure various anthropometric parameters (with the patient's permission, without comment) and calculate the body mass index. A dietitian may use a variety of questionnaires, including screening for eating disorders, anxiety disorders, and depressive disorders. It may offer examination of food labels and tools for calculating CBJU.
It is absolutely normal when a nutritionist gives tasks (including written ones) that help track hunger and satiety signals and form more conscious eating behavior. He will also suggest keeping a food diary, highlighting some important parameters for treatment. This is a good method for diagnosing eating problems, so you can start keeping a food diary in a form convenient for you when getting ready for your appointment.
It is important that your plate of food is outside the categories of morality and ethics. Patients are often embarrassed to talk about their diet and are afraid of being judged. Talking about eating habits, body image, and weight feels difficult, painful, and too intimate. But the doctor should always be on your side.
We don't give up because you are with us
"Medusa", I'm with you
Elena Motova , nutritionist, author of the book “Food for Joy. Notes from a nutritionist" and a blog about evidence-based medicine
Who treats the consequences of obesity?
Obesity
is a complex disease that can contribute to the development of other diseases. Therefore, a patient diagnosed with obesity may need consultation or assistance from other specialists.
Endocrinologist
will help identify the endocrine causes of obesity. To do this, the patient will need to undergo a test to determine the level of glucose and a number of hormones in the blood plasma, an oral glucose tolerance test and other recommended tests. If a doctor discovers an endocrine disease in a patient, he will prescribe the necessary drug treatment.
Excess weight in women can cause problems with pregnancy and the development of polycystic ovary syndrome. This should be determined by an obstetrician-gynecologist.
during the inspection. PCOS can be treated with medication or surgery. For effective treatment, it is necessary to take measures to normalize the patient’s weight. Recommendations for weight loss are given by your doctor.
Excess weight also affects the cardiovascular system. Obese people are at risk of developing hypertension, atherosclerosis, coronary heart disease and other dangerous diseases. For diagnosis and treatment, the general practitioner refers the patient to a cardiologist
.
If a general practitioner suspects that an obese patient has problems with the gastrointestinal tract, he will refer the patient to a doctor
-
gastroenterologist
. The hypothesis can be confirmed or refuted during the diagnostic process.
An obese man may experience decreased sexual function. A urologist will help solve this problem
. He will prescribe treatment based on the diagnostic results, but to restore sexual function the patient will have to work on normalizing his weight.
Sometimes excess weight can be a consequence of psychosomatic disorders. A neurologist helps to detect and eliminate the cause of these disorders.
or
a psychiatrist
. The general practitioner also refers the patient to him for an appointment. To treat depression, the patient may be prescribed antidepressants.
Excess weight can cause disturbances in static movement, a person can develop osteochondrosis, joint deformation occurs, and pain in the limbs occurs. An orthopedic traumatologist helps solve these problems.
.
In some cases, a patient diagnosed with obesity needs to visit several doctors at once in order to formulate a set of treatment measures. This will include recommendations on physical activity, dietary adjustments and the use of multi-target drugs. A number of medical institutions provide group classes to combat excess weight for obese patients.
Department of Obesity and Metabolic Pathology
! WE REDUCE THE RISKS OF OVERWEIGHT
At the Federal State Budgetary Institution “National Medical Research Center for Endocrinology” of the Russian Ministry of Health, we not only lose weight, but also maintain the results!
Excess weight is not only and not so much an aesthetic problem as a medical one. Yesterday you “couldn’t fit” into your favorite clothes, and after some time shortness of breath appeared... If you understand that excess weight is becoming dangerous for your health, then come to us, at the Endocrinology Research Center. Using modern diagnostic methods, our Center’s specialists will find the causes of excess weight, ways to get rid of it, and will help you smoothly change your lifestyle and improve your health.
Our Center has developed several special treatment and diagnostic programs for those who want to lose weight and maintain the results achieved for a long time. These programs were created jointly by various specialists - endocrinologists and cardiologists, gynecologists and andrologists, nutritionists and psychologists and are addressed to a wide range of patients: women and men, young and old, dreaming of motherhood and fatherhood, to those who have tried more than one promising diet, “miracle” nutritional supplements and courses of treatment, or is at the very beginning of this path.
The Federal State Budgetary Institution "National Medical Research Center of Endocrinology" of the Ministry of Health of Russia uses the most modern methods of examining patients:
- assessment of hormonal status to determine the endocrine causes of obesity (diseases of the thyroid gland, adrenal glands, rare diseases of the pancreas);
- complete laboratory and instrumental examination to assess the severity of complications of obesity;
- indirect calorimetry (determination of basal metabolism);
- bioimpedansometry (diagnosis of body composition);
- calculation of daily calorie intake followed by consultation with a nutritionist;
- development of exercises for weight loss with the participation of a physical therapy doctor;
- in the presence of type 2 diabetes mellitus, cardiovascular diseases and other complications of obesity, they are diagnosed and treated
SCHOOL FOR OBESITY PATIENTS Since 1998, the department has operated a School for Obese Patients.
Within 2 days, training in proper nutrition is provided and an individual program is drawn up for weight loss and treatment of concomitant diseases.
The program includes:
— group training in the principles and skills of rational nutrition with the development of an individual diet taking into account identified metabolic disorders
— support from an endocrinologist
Surgery for Obesity and Metabolic Disorders Our Center has created a unit for the surgery of obesity and metabolic disorders. Surgical treatment of obesity allows the patient to return to normal life and reduce the risk of developing serious complications, diabetes, heart and lung diseases. In our Center, patients with severe forms of obesity can be offered both educational programs to reduce excess body weight, dietary therapy methods, and modern endoscopic and surgical treatment methods:
• installation of an intragastric balloon;
• longitudinal (sleeve) gastrectomy;
• gastric bypass.
Surgery is used in cases where conservative treatment is ineffective. These operations vary in degree of risk and complexity. Thanks to the capabilities of modern surgery, many patients have lost excess weight and experienced a fundamentally different quality of life. Bariatric surgery is not only a surgical treatment for obesity, but also a highly effective treatment for type 2 diabetes. We have operations in our arsenal that, in some cases, can relieve patients from the need to take glucose-lowering drugs and insulin in the postoperative period or significantly reduce their doses, as well as improve the quality of life. There are strict general indications for performing an operation, so in our work we use only a personalized approach, always striving to find the correct and individual solution to the problem.
How to eat if you are obese
To treat and prevent obesity, doctors recommend switching to a healthy diet. This will be useful for everyone, even people with normal weight.
Doctors and nutritionists recommend taking food in small portions, but more often. It would be optimal to eat 4-5 times a day, avoiding overeating. The diet should be balanced and varied; you should definitely try to eat fresh fruits and vegetables all year round, and not just in season. It will be useful to switch to whole grain products. It is better to replace fatty meat with poultry; in rare cases, eating lean meat is allowed, but you will have to forget about meat and sausage products. You can consume milk and dairy products, but preference should be given to low-fat ones. Vegetable oils will be useful, but in moderation. The same goes for fish, nuts and legumes; it is recommended to include them in your diet at least 1-2 times a week. It is better to cook by steaming, avoiding frying.
Food should be chewed thoroughly and sufficient time should be given to eating. The last meal should be light; it is better to limit yourself to a glass of kefir or fruit. You should not eat immediately before bed; this will force the body to work again and will not give it the opportunity to prepare for rest. You need to leave at least a couple of hours for “unloading” before going to bed.
Physical activity if you are overweight
Physical activity is one of the methods to combat excess weight. According to WHO recommendations, people who want to lose excess weight need to move more. Physical activity should be regular, a total of at least 2.5 hours per week
. But not only the volume of training is important, but also the energy balance. Golden rule: “You need to spend more than you receive.” Simple math. Food provides a person with the energy that he must spend so as not to gain a couple more extra pounds. Aerobic types of physical activity are considered the most useful: swimming, dancing, Nordic walking, etc.
The load recommended for the patient must be determined by the doctor. It will largely depend on the condition of the body and the presence of concomitant diseases. Therefore, before choosing a physical activity regimen, you need to consult with your doctor.
