Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the developed world. Simple hepatic steatosis is mild, but the coexistence of steatohepatitis (NASH) and fibrosis increases the risk of hepatocellular carcinoma. Proper dietary and pharmacological treatment is essential for preventing NAFLD progression. The first-line treatment should include dietary intervention and increased physical activity. The diet should be based on the food pyramid, with a choice of products with low glycemic index, complex carbohydrates in the form of low-processed cereal products, vegetables, and protein-rich products. Usage of insulin-sensitizing substances, pro- and prebiotics, and vitamins should also be considered. Such a therapeutic process is intended to support both liver disease and obesity-related pathologies, including insulin resistance, diabetes, dyslipidemia, and blood hypertension. In the pharmacological treatment of NAFLD, apart from pioglitazone, there are new classes of antidiabetic drugs that are of value, such as glucagon-like peptide 1 analogs and sodium/glucose cotransporter 2 antagonists, while several other compounds that target different pathogenic pathways are currently being tested in clinical trials. Liver biopsies should only be considered when there is a lack of decline in liver enzymes after 6 months of the abovementioned treatment. Dietary intervention is recommended in all patients with NAFLD, while pharmacological treatment is recommended especially for those with NASH and showing significant fibrosis in a biopsy.

The Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons (Polish acronym: SCMiB TCHP) is a Polish specialist scientific society representing bariatric surgeons as well as specialists from other disciplines and professions cooperating with them during the provision of services in the field of bariatric and metabolic surgery, as well as the entire care process before and after surgery. The following standards constitute the minimum requirements set by the SCMiB TCHP for good practice of the basic process of bariatric care throughout its entire period, which ensure satisfactory safety and effectiveness of the obesity treatment and its metabolic complications.

IntroductionRecently, the incidence of obesity, especially extreme obesity, has significantly increased. It is connected with inappropriate lifestyle, including a high calorie diet, psychological and genetic factors, some medications, diseases or infectious factors. Nowadays, the consumption of food is not only to satisfy a physiological need, but also fulfils psychological needs. The most effective method of morbid obesity treatment is metabolic surgery. Moreover, food is considered to be a reward and method of coping with stress. In order to improve the efficiency of the surgical treatment, it seems significant to assess the effects of psychological factors on eating behaviours.AimTo evaluate the effects of stress on eating habits that increase the risk of extreme obesity.Material and methodsThe study included 50 subjects qualified for bariatric surgery. The authors’ own questionnaire and standardised PSS-10 questionnaire by Cohen, Kamarcki and Mermelstein adapted by Juczyński and Ogińska-Bulik were used.ResultsThese questionnaires indicated that patients felt a moderate levels of stress but with a tendency for high levels. The majority of respondents declared an increased appetite due to stress-causing factors. Reasons for snacking most frequently included negative emotions and feeling like eating something. Consumption of additional snacks was a way of coping with stress. Most frequently the subjects ate sweets and salty snacks, but also sandwiches, nuts, fruit and alcohol beverages.ConclusionsPsychological support may help morbidly obese people both to change nutritional habits and to cope with stress.

Cel pracyCelem badania była ocena nasilenia zachowań zdrowotnych i żywieniowych, dotyczących jedzenia emocjonalnego, nawykowego, stosowania restrykcji dietetycznych, określenie poczucia własnej skuteczności pacjentów z otyłością olbrzymią oraz sprawdzenie związków pomiędzy wskaźnikiem masy ciała BMI badanych pacjentów a ich zachowaniami żywieniowymi i poczuciem skuteczności.MetodaBadaniem objęto 37 chorych ze zdiagnozowaną otyłością II i III stopnia w wieku od 18-62 lat (M=39,94; SD=12,20). Wskaźnik masy ciała BMI badanych wynosił od 36 do 60kg/m2 (M=43,50; SD=5,36). Zastosowano narzędzia badawcze: Inwentarz Zachowań Żywieniowych (IZZ), Kwestionariusz Zachowań Związanych z Jedzeniem (KZZJ) i Skalę Uogólnionej Własnej Skuteczności (GSES).WynikiBadanie wykazało, że pacjenci z otyłością olbrzymią charakteryzowali się przeciętnym w przypadku mężczyzn (5 stenów) i niskim w przypadku kobiet (4 steny) nasileniem zachowań zdrowotnych. Badani przejawiali tendencję do nieprawidłowych zachowań żywieniowych, jedzenia emocjonalnego, nawykowego i stosowania restrykcji dietetycznych. Uogólnione poczucie własnej skuteczności GSES w badanej grupie było na poziomie od 4 do 10 stenów, a średnia na poziomie wysokim (7 stenów).WnioskiChorzy z otyłością olbrzymią powinni zostać objęci szeroko rozumianą edukacją w obszarze zdrowotnym, żywieniowym oraz psychologicznym.