ZH.D. KOBALAVA¹, T.V. NIKISHOVA², A.A. YAKUPOVA³, YU.YU. YAKIMOVA⁴

 ¹Peoples’ Friendship University of Russia, Moscow

²Kazan State Medical Academy — Branch of the FSBEIFPE RMACPE MOH of RF, Kazan

³Kazan State Medical University, Kazan

⁴Kazan (Volga Region) Federal University, Kazan

Contact details:

Nikishova T.V. — PhD (medicine), Associate Professor of the Department of Endocrinology

Address: 12 Mushtari St., Kazan, Russian Federation, 420012, tel.: +7-903-340-28-67, e-mail: ntv116@mail.ru

The article deals with a problem of improving the efficiency of therapy for exogenous-constitutional obesity, one of the most widespread chronic diseases with a high risk of developing many dangerous diseases and resulting in significant decrease in the quality of life. Modern paradigm of the treatment of exogenous-constitutional obesity — stage-by-stage approach, complexity and immediacy of the effect, in accordance with the disease mechanism, along with monitoring, relief and prevention of recurrence — is proved based on the review of Russian and foreign publications. The underlying mechanisms of exogenous-constitutional obesity origin and progression are discussed, as well as the methods of non-drug treatment (diet therapy, physiotherapy, psychotherapy, reflexotherapy), a limited role of pharmacotherapy, and a specific place of surgical correction. An important role of preventing the exogenous-constitutional obesity recurrence, the incidence of which is very high, is emphasized. The prime factors causing the development of recurrence, the principles of therapy and prevention are given.

Key words: exogenous-constitutional obesity, ghrelin, leptin, nutritional behavior, metabolic adaptation, obesity recurrence, stage therapy, hypocaloric diet, aerobic exercises.

 (For citation: Kobalava Zh.D., Nikishova T.V., Yakupova A.A., Yakimova Yu.Yu. Stage therapy for exogenous-constitutional obesity. Practical medicine. 2023. Vol. , № , P.)

REFERENCES

1. Obesity and Overweight, 2021. World Health Organization: web site, available at: https://www.who.int/ru/news-room/fact-sheets/detail/obesity-and-overweight (accessed on: 20.05.2023).
2. Hales C.M., Carroll M.D., Fryar C.D., Ogden C.L. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, No. 360. Hyattsville, MD: National Center for Health Statistics, 2020, available at: https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf (accessed on: 29.05.2023).
3. WHO European Regional Obesity Report, 2022. World Health Organization: web site, available at: https://apps.who.int/iris/bitstream/handle/10665/353747/9789289057738-eng.pdf (accessed on: 20.07.2023).
4. Balanova Yu.A., Shal’nova S.A., Deev A.D. et al. Obesity in the Russian population — prevalence and associations with risk factors for chronic non-infectious diseases. Rossiyskiy kardiologicheskiy zhurnal, 2018, no. 4, pp. 123–130 (in Russ.).
5. Logvinova O.V., Poydasheva A.G., Bakulin I.S. et al. Modern ideas about the pathogenesis of obesity and new approaches to its correction. Ozhirenie i metabolizm, 2018, no. 15 (2), pp. 11–16 (in Russ.).
6. Kerr N.R., Booth F.W. Contributions of physical inactivity and sedentary behavior to metabolic and endocrine diseases. Trends Endocrinol Metab, 2022, vol. 33 (12), pp. 817–827.
7. Schwartz M.W., Seeley R.J., Zeltser L.M. et al. Obesity Pathogenesis: An Endocrine Society Scientific Statement. Endocrine reviews, 2017, vol. 38 (4), pp. 267–296.
8. Timper K., Brüning J.C. Hypothalamic circuits regulating appetite and energy homeostasis: pathways to obesity. Dis Model Mech, 2017, vol. 10 (6), pp. 679–689.
9. Klok M.D., Jakobsdottir S., Drent M.L. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev, 2007, vol. 8 (1), pp. 21–34.
10. Couce M.E., Cottam D., Esplen J. et al. Potential role of hypothalamic ghrelin in the pathogenesis of human obesity. J Endocrinol Invest, 2006, vol. 29 (7), pp. 599–605.
11. Obradovic M., Sudar-Milovanovic E., Soskic S. et al. Leptin and Obesity: Role and Clinical Implication. Front Endocrinol (Lausanne), 2021, vol. 12. DOI: 10.3389/fendo.2021.585887
12. Chumakova G.A., Ott A.V., Veselovskaya N.G. et al. Pathogenetic mechanisms of leptin resistance. RKZh, 2015, no. 4 (120), pp. 107–110 (in Russ.).
13. Tomiyama A.J. Stress and Obesity. Annu Rev Psychol, 2019, vol. 4 (70), pp. 703–718. DOI: 10.1146/annurev-psych-010418-102936
14. Vasyukova O.V., Okorokov P.L., Kas’yanova Yu.V. et al. Human energy metabolism: how we can personalize obesity therapy. Problemy Endokrinologii, 2021, vol. 67 (5), pp. 4–10 (in Russ.).
15. Kheniser K., Saxon D.R., Kashyap S.R. Long-Term Weight Loss Strategies for Obesity. J Clin Endocrinol Metab, 2021, vol. 106 (7), pp. 1854–1866.
16. Yumuk V., Tsigos C., Fried M. et al. European Guidelines for Obesity Management in Adults. Obes Facts, 2015, vol. 8 (6), pp. 402–424.
17. Drapkina O.M., Lopatin Yu.M., Petrov V.I. et al. Diagnostika, lechenie, profilaktika ozhireniya i assotsiirovannykh s nim zabolevaniy (natsional’nye klinicheskie rekomendatsii) [Diagnosis, treatment, prevention of obesity and associated diseases (national clinical recommendations)]. Saint Petersburg, 2017. 164 p.
18. Razina A.O., Runenko S.D., Achkasov E.E. The role of physical rehabilitation in the complex treatment of obesity and correction of excess body weight. Mediko-sotsial’naya ekspertiza i reabilitatsiya, 2016, vol. 19, no. 1, pp. 46–53 (in Russ.).
19. Bokov R.O. Regulation of mitochondrial biogenesis in human skeletal muscles during aerobic physical exercise and hypokinesia. Fiziologiya cheloveka, 2022, vol. 48, no. 3, pp. 33–43 (in Russ.).
20. Oppert J.M., Bellicha A., Ciangura C. Physical activity in management of persons with obesity. Eur J Intern Med, 2021, vol. 93, pp. 8–12. DOI: 10.1016/j.ejim.2021.04.028
21. Sharafetdinov Kh.Kh. Obesity as a global challenge of the 21st century: therapeutic nutrition, prevention and therapy. Voprosy pitaniya, 2020, vol. 89, no. 4, pp. 161–171 (in Russ.).
22. Ametov A.S. Ozhirenie. Sovremennyy vzglyad na patogenez i terapiyu: uchebnoe posobie [Obesity. Modern view of pathogenesis and therapy: a textbook]. Moscow: GEOTAR-Media, 2019. Vol. 1. 384 p.
23. Cheskin L.J., Poddar K.H. Obesity management. Modern Nutrition in Health and Disease.11th ed. Lippincott Williams and Wilkins; Wolters Kluwer, 2014. P. 786–799.
24. Troshina E.A., Ershova E.V. Pharmacotherapy of obesity: what’s new? Problemy endokrinologii, 2018, vol. 64, no. 4, pp. 270–276 (in Russ.).
25. Hall K.D., Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. The Medical Clinics of North America, 2018, vol. 102 (1), pp. 183–197.
26. Nudel Y., Sanchez V.M. Surgical management of obesity. Metabolism, 2019, vol. 92, pp. 206–216. DOI: 10.1016/j.metabol.2018.12.002
27. Arterburn D.E., Courcoulas A.P. Bariatric surgery for obesity and metabolic conditions in adults. BMJ, 2014, vol. 27, pp. 349–396. DOI: 10.1136/bmj.g3961
28. Logan J.M., Broughton G. Plastic surgery: understanding abdominoplasty and liposuction. AORN J, 2008, vol. 88 (4), pp. 587–600. DOI: 10.1016/j.aorn.2008.07.018
29. Perdomo C., Cohen R., Sumithran P. et al. Contemporary medical, device, and surgical therapies for obesity in adults. Lancet, 2023, vol. 1 (401), pp. 1116–1130. DOI: 10.1016/S0140-6736(22)02403-5
30. Dedov I.I., Mokrysheva N.G., Mel’nichenko G.A. et al. Obesity: clinical recommendations. Consilium Medicum, 2021, vol. 23, no. 4, pp. 311–325 (in Russ.).
31. Drapkina O.M., Samorodskaya I.V., Starinskaya M.A. et al. Ozhirenie: otsenka i taktika vedeniya patsientov: kollektivnaya monografiya [Obesity: assessment and tactics of patient management: collective monograph]. Moscow: FGBU NMITsTPM MZ RF; OOO “Silitseya-Poligraf”, 2021. P. 174.
32. Preparation and use of Food-based Dietary Guidelines: Report of a Joint FAO/WHO Consultation. Geneva: WHO and FAO; 1996. World Health Organization: web site, available at: https://www.who.int/publications/i/item/9241208805 (accessed on: 20.03.2023).
33. Greenway F. Physiological adaptations to weight loss and factors favoring weight regain. Int J. Obes, 2015, vol. 39, pp. 1188–1196. DOI: 10.1038/ijo.2015.59
34. Blomain E.S., Dirhan D.A., Valentino M.A. et al. Mechanisms of Weight Regain following Weight Loss. ISRN Obes, 2013. DOI: 10.1155/2013/210524
35. Noria S.F., Shelby R.D., Atkins K.D. et al. Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment. Curr Diab Rep, 2023, vol. 23 (3), pp. 31–42. DOI: 10.1007/s11892-023-01498-z
36. Sumithran P., Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Science (London), 2013, vol. 124 (4), pp. 231–241.
37. Semlitsch T., Stigler F.L., Jeitler K. Management of overweight and obesity in primary care-A systematic overview of international evidence-based guidelines. Obes Rev, 2019, vol. 20 (9), pp. 1218–1230. DOI: 10.1111/obr.12889
38. Engel’gardt G.N., Sharafetdinov Kh.Kh., Plotnikova O.A. et al. Correction of nutritional status disorders in patients with nutrition-dependent diseases. Poliklinika, 2017, no. 3, pp. 44–47 (in Russ.).
39. Bray G.A., Frühbeck G., Ryan D.H. et al. Management of obesity. Lancet, 2016, vol. 87 (10031), pp. 1947–1956.
40. Toledo P.R., Lotufo-Neto F., Verdeli H. et al. Interpersonal psychotherapy for treatment of obesity: A systematic review and meta-analysis. J Affect Disord, 2023, vol. 1 (320), pp. 319–329. DOI: 10.1016/j.jad.2022.09.070
41. Zhang R-Q., Tan J., Li F-Y. et al. Acupuncture for the treatment of obesity in adults: a systematic review and meta-analysis. Postgrad Med J, 2017, vol. 93 (1106), pp. 743–751. DOI: 10.1136/postgradmedj-2017-134969
42. Martins C., Gower B.A., Hill J.O. et al. Metabolic adaptation is not a major barrier to weight loss maintenance. The American Journal of Clinical Nutrition, 2020, vol. 112 (3), pp. 558–565. DOI: 10.1093/ajcn/nqaa086