The presented paper is a third revision of the clinical recommendations for the treatment of morbid obesity in adults. Morbid obesity is a condition with body mass index (BMI) 40 kg / m2 or a BMI 35 kg / m2 in the presence of serious complications associated with obesity. The recommendations provide data on the prevalence of obesity, its etiology and pathogenesis, as well as on associated complications. The necessary methods for laboratory and instrumental diagnosis of obesity are described in detail. In this revision of the recommendations, the staging of prescribing conservative and surgical methods for the treatment of obesity are determined. For the first time, a group of patients with obesity and type 2 diabetes mellitus is selected, in whom metabolic surgery allows a long-term improvement in the control of glycemia or remission of diabetes mellitus.

Резюме. Обследовано 70 пациентов с ожирением и сахарным диабетом 2 типа до и на протяжении 5 лет после билиопанкреатического шунтирования: через 3 месяца после операции у больных отмечено существенное улучшение состояния углеводного и липидного обмена, которое наряду со сниженной массой тела сохранялось на протяжении всего срока наблюдения. Status of carbohydrate and lipid metabolism in obese patients with type 2 diabetes mellitus after biliopancreatic diversion surgery ErshovaAbstract. We examined 70 patients with obesity and diabetes mellitus type 2 before and within 5 years after BPD: these patients showed a significant improvement in the status of carbohydrate and lipid metabolism within 3 months after surgery. This improvement has remained stable along with the reduced body weight during the whole observation period of up to 5 years.

Клинические рекомендации уже давно вошли в число рабочих инструментов современного врача, помогая ему быстро ориентироваться в наиболее эффективных доказанных методах лечения и профилактики различных заболеваний, а также адаптировать эти методы к конкретным задачам своих больных и добиваться максимальной персонализации лечения. Клинические рекомендации составляются профессиональными некоммерческими ассоциациями и одобряются научным советом МЗ РФ, при этом нередко одна рекомендация готовится двумя или даже тремя ассоциациями. Особенность предлагаемых вашему вниманию рекомендаций в том, что в профилактику и лечение ожирения вовлекаются не только эндокринологи, но и терапевты, кардиологи, гинекологи, гастроэнтерологи и врачи многих других специальностей. Мультидисциплинарная рабочая группа представляет этот проект в многопрофильном журнале с целью объединения усилий нескольких профессиональных ассоциаций, что связано с необходимостью уделить внимание не только самому ожирению, но и коморбидным состояниям. Мы надеемся на конструктивную критику и разностороннее обсуждение проблемы на страницах нашего журнала.

The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM. The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, etc.), chronic kidney disease (CKD) and the risk of developing hepatocellular cancer (HCC) were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid (UDCA) molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of UDCA to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.

Despite the developed methods of diet therapy in obesity and a variety of pharmacotherapy drugs for type 2 diabetes up to 60% of patients cannot maintain weight loss within 5 years of observation and more than 60% of patients with type 2 diabetes do not achieve adequate diabetes control. With morbid obesity the efficacy of conservative therapy is only 5-10%. Bariatric surgery has demonstrated a significant potential in compensation of obesity-related disorders, including type 2 diabetes.

The purpose of the article is to highlight the social aspects of stress as a syndrome of adaptation to the current situation in Russian society in order to justify the consideration of society as a factor contributing to the development and spread of overweight and obesity among the Russian population. The problem of the conditions and quality of everyday life of a significant part of the population of our country is raised, which are accompanied by an increased stress level of everyday life events. A modern Russian society, possessing an immanently inherent systemic quality - a stressful property, combined with the specificity of a hypodynamic lifestyle, is a powerful and systemically active factor that provokes the development and spread of obesity and overweight. The stress factors of modern society, generated by the disorder and non-complementarity of the work of social institutions, instability in the economic and political spheres are analyzed. Food family traditions, food paradigm, leisure activity of Russians are studied. The irrationality of the use of food by mankind is discussed. The proposed measures to combat and prevent obesity.

We examined 292 patients (mean age 37,5±9,1 years) with morbid obesity (initial BMI 47,3±7,0 kg/m2), from which 72 patients had type 2 diabetes, before and after biliopancreatic diversion in Hess-Marceau modification, conducted from 2003 to 2010. Along with a significant and steady weight loss, the most important advantage of surgery is its high efficiency in treatment of disturbances in carbohydrate and lipid metabolism in patients with morbid obesity and associated type 2 diabetes and severe atherogenic dyslipidemia.

Most researchers support the important role of incretins, particularly glucagon-like peptide-1 in improving metabolic control in patients with type 2 diabetes after bariatric operations, mostly involving shunting. A positive effect of bariatric surgery for type 2 diabetes is known from numerous publications on the results of surgical treatment of morbid obesity and in this review we try to analyze the mechanisms of this effect.