Obesity: Three Crucial Steps to Fight Disease
In May 2013 the guidelines of the Australian Society of Endocrinology on obesity in adults and children were published. This is a very relevant subject, since the population there is made up of 60% of overweight adults. In an earlier text we discussed the initial approach of a physician to an overweight or obese patient. The diagnosis can be easily made at home, with a well-adjusted scale and a measuring tape. The first step can be taken with careful planning and terrain recognition. Make no mistake, it's an epic battle for your life that's being planned. We just do not see the bullet coming in.
After planning comes execution. The guideline bases treatment on three pillars: reduced energy intake (calories), increased spending through physical activity, and behavioral reorganization. The first two are easy to understand. But how?
Reducing calorie intake should be done in a sustainable way. Reduction - not elimination - of harmful foods should be encouraged. The ideal is to create a deficit of about 2500kjoules or 600 calories per day. Tables of energy use and calories in food can be found easily on the internet. But beware: aggressive diets will not stick, and the most likely is that the person has bouts of hunger and overeating in food. In selected patients (BMI greater than 30 or greater than 27 in people with diseases associated with obesity) or who have not been able to reduce weight with other attempts may benefit from an extremely hypocaloric diet. Ideally this should be done with the support of a nutritionist. These diets are based on suppressing meals at strategic times, replacing carbohydrates with protein or salad, copious oral hydration and increased fiber intake, which increases satiety.
If you decide to take any more aggressive intervention, his doctor, who probably recommended a multiprofessional approach.
Physical activity also can not be unsustainable. The ideal is the prescription of 300 minutes of moderate activity or 150 minutes of intense physical exercises per week, distributed throughout the week. The limits of each patient should be respected, such as patients with joint pain who benefit more from activities in the water or without impact. Here are some tips to get you started:
- Extremely unconditioned patients may need rehabilitation, with or without accompaniment
- We can change elevators by stairs, try short walks and recreational games
- Join groups of people already doing physical training or with someone who has an emotional bond, such as playing with children and grandchildren, can be an encouragement.
- Avoid activities that do not match the monthly budget - if it is short, we will not enroll in an expensive gym, we can opt for a outdoor trekking or recreational football with friends
- Avoid periods of sitting or lying down. When you're on the phone, walk. If possible, stay longer
- Have realistic and achievable goals. Do not try to sign up for the Ironman Triathlon based on a one-month walk. No need to hurry to start over.
Reorganization of behavior
Third step is to accept the changes and prevent recurrences. First, do not get discouraged, it is normal some weight gain in the exchange of fat for muscle mass resulting from physical activity. Avoid situations where food abuse is likely. Avoid alcohol. Hold the beer with your friends for a while, until you accept the idea that you should not eat a greasy dish. Try to identify the emotional triggers that lead to food abuse. And when possible, avoid them, or understand the effect they have on you. This will allow us to identify what is hunger and what is substitution of another need. Identify and document your progress. Nobody works for free. You need to stick to something that you are gaining, or losing. Be it weight, be it waist, or BMI.
More aggressive interventions may be needed, such as use of oral medications and bariatric surgery. Avoid medications given by friends, such as thermogenics, appetite regulators, and especially hormones. Hormones deregulate their endogenous, physiological cycle. There's always a rebound. Thermogenics, which deserve a special chapter, cause arrhythmias, strokes, and are often contaminated with hormones and diuretics. Appetite regulators have come in and out of the market faster than the lay media can track. Some have caused problems in heart valves, forcing the patient to operate the heart. So if you decide to do something more aggressive, you should consult your doctor, who would probably recommend a multiprofessional approach.
If you need one more reason to stay away from cigarettes, consider the finding presented at The Endocrine Society's 94th Annual Meeting in the United States. According to the study, secondhand smoke may be linked to increased risks of developing type 2 diabetes and obesity. For the analysis, the authors used data from more than 6,300 adults who had participated in the US National Health and Nutrition Examination Survey (NHANES) between 2001 and 2006.
The term BIRADS is an acronym for Breast Imaging Reporting and Data System , that is, it is an international systematization for mammary evaluation, interpretation of the examination and making reports of breast imaging specifically for the breast. This classification should be applied in the mammography, mammographic and nuclear magnetic resonance reports of the breasts and assures greater reliability to the examination.