Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults)

Dedov, Ivan I.; Melnichenko, G. A.; Shestakova, Marina V.; Troshina, Ekaterina A.; Мазурина, Н. В.; Shestakova, Ekaterina A.; Yashkov, Yu I; Неймарк, А. Е.; Biryukova, E. V.; Бондаренко, И. З.; Bordan, Natalia S.; Dzgoeva, Fatima H.; Ершова, Е. В.; Комшилова, К А; Mkrtumyan, А. M.; Петунина, Н. А.; Романцова, Т. И.; Старостина, Е. Г.; Стронгин, Л Г; Суплотова, Л. А.; Fadeyev, Valentin V.

doi:10.14341/omet2018153-70

Cited by 120 publications

(68 citation statements)

References 121 publications

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“…Для лечения ожирения в России зарегистрированы препарат центрального действия сибутрамин, ингибитор кишечной липазы орлистат и синтетический аналог глюкагоноподобного пептида-1 лираглутид [5]. Согласно Национальным клиническим рекомендациям по лечению морбидного ожирения у взрослых лекарственная терапия должна быть назначена всем пациентам с ожирением (ИМТ ≥30 кг / м 2 ), а при наличии коморбидных состояний -и больным с ИМТ ≥27 кг / м 2 [5]. Полученные в нашем исследовании результаты подчеркивают крайне редкое назначение лекарственного лечения пациентам с ожирением в амбулаторной практике.…”

Section: Discussionunclassified

“…Применение лекарственных средств показано при неудачных попытках или неэффективности диетотерапии и других немедикаментозных методов лечения, при осложненных формах ожирения, т. е. наличии ассоциированных с ним заболеваний (сердечно-сосудистых заболеваний, сахарного диабета (СД) 2-го типа, выраженных факторов сердечно-сосудистого риска, болезней опорно-двигательного аппарата, дыхательной недостаточности и др.). В последнем случае (наличие заболеваний, связанных с ожирением) медикаментозная терапия может быть рекомендована уже при индексе массы тела (ИМТ) ≥27 кг / м 2 [5]. Медикаментозная терапия ожирения позволяет добиться хорошего результата у многих пациентов, резистентных к немедикаментозному лечению.…”

Section: Introductionunclassified

“…На сегодняшний день существует большое количество лекарственных препаратов, способствующих снижению массы тела. В России для лечения ожирения зарегистрированы и рекомендованы блокаторы всасывания жиров -орлистат; аноректики -сибутрамин; аналог глюкагоноподобного пептида-1 человека для подкожного введения -лираглутид, который применяется для лечения СД 2-го типа и ожирения [5].…”

Section: Introductionunclassified

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Medical treatment of obesity: peculiarities of medical treatments, information, responsibility and relation to medical treatment of obesity of patients

Лерман¹,

Лукина²,

Кутишенко³

et al. 2019

Klinicist

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The aim to evaluate medical appointments, as well as awareness, adherence and attitude of patients to medical treatment of obesity based on the results of a survey of patients with a prospective outpatient registry.Materials and methods. Total 305 patients with obesity in the outpatient “PROFILE” register were surveyed, including self-assessment questions regarding their own body weight, prescription of obesity treatment by doctors, patients’ adherence to the implementation of these recommendations, propensity to self-medication and information about personal financial costs for the treatment of this disease. 42 (12 %) patients refused to participate in the survey. 213 people (69.8 %) who answered the questionnaire were diagnosed with obesity of the 1st degree, 63 (20.7 %) – obesity of the 2nd degree; obesity grade 3 was detected in 29 people (9.5 %). Waist circumference in women averaged 104.7 ± 12.9 cm, in men – 116.7 ± 9.6 cm – all patients had abdominal obesity. 263 (86.2 %) people had arterial hypertension, 117 (38.4 %) patients had coronary heart disease; type 2 diabetes mellitus was diagnosed in every fourth patient (85 (27.2 %) people); atrial fibrillation was diagnosed in 55 (18 %) patients; 48 (15.7 %) people had a history of myocardial infarction, 23 (7.5 %) patients had a stroke.Results. According to the survey results, only one in four patients – 77 (25.2 %) – out of 305 patients who participated in the survey knew about the possibility of drug treatment of obesity. Mostly, patients received recommendations for non-drug treatment of obesity: 242 patients (79.3 %) were recommended to reduce caloric intake, 194 (63.6 %) – increased physical activity. Only 37 (12.1 %) patients with obesity were recommended for weight correction, significantly more often they were recommended and taken by patients with 2 and 3 degrees of obesity compared to patients with obesity of 1 degree (p <0.0001). At the time of the survey, none of the patients were taking drugs to treat obesity. Previous experience of drug weight loss had 42 (13.8 %) participants of the survey. Most patients (more than 70 %), in principle, are not ready to spend money on the fight against overweight, and drugs are considered an extra item of expenditure almost 90 % of obese patients. There is a significant relationship (p = 0.008) between the severity of the disease and patients’ spending on obesity treatment in the range of 1–5 thousand rubles per month: the higher the degree of obesity, the more patients agree to spend this amount on the treatment of the disease.Conclusion. According to the results of the survey, medical treatment of obesity is prescribed by doctors rarely. Apparently, this is due to the extremely low awareness of patients about the possibilities of drug therapy in the treatment of overweight and obesity, the popularity of biologically active additives independently used by patients to reduce weight.

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Section: Discussionunclassified

Section: Introductionunclassified

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Medical treatment of obesity: peculiarities of medical treatments, information, responsibility and relation to medical treatment of obesity of patients

Лерман¹,

Лукина²,

Кутишенко³

et al. 2019

Klinicist

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show abstract

“…С учетом важности проблемы в России разработаны национальные клинические рекомендации по лечению морбидного ожирения у взрослых, где хирургическому лечению данной проблемы отводится важная роль [3].…”

Section: обоснованиеunclassified

The treatment of the metabolic syndrome with stapleless one-anastomotic gastric bypass: a randomized clinical trial compared to stapler method

et al. 2019

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BACKGROUND: The authors have developed an original method of laparoscopic gastric bypass significantly reducing financial costs when conducting this surgical treatment of obesity. In the presented article for the first time describes the evaluation of the effectiveness of the proposed to introduce a new type of staplerless gastric bypass compared to the standard stapler method. AIMS: to evaluate the effectiveness of the authors method of laparoscopic gastric bypass for the treatment of metabolic syndrome with obesity. MATERIALS AND METHODS: This prospective, randomized controlled trial presents the results of surgical treatment of 80 patients with metabolic syndrome. Patients were randomized into two groups of 40 people. In the first group, the authors method of laparoscopic mini-gastric bypass with a band-separated pouch was implemented, and in the second group, the standard laparoscopic mini-gastric bypass with a standard (stapler-separated) gastric pouch was used. Procedures were performed in the period from 2015 to 2016 with an average follow up period of 3 years. The postoperative change of weight loss and the changes of the main manifestations of the metabolic syndrome, as well as the change in the cardiovascular risk index in the comparison groups were assessed. RESULTS: In both groups there were no significant differences by sex and age. In the first group there were 39 women and 1 man, and in the second group 36 women and 4 men aged 36.758.6 years and 40.4711.0 years, respectively (p=0.097). Three years after surgery, all 80 patients were examined using analysis of variance. At the same time, it was revealed that the change in body mass index after operations, which was 14.025.05 kg/m2 in the first group, and 12.385.7 kg/m2 (p=0.170) in the second group, was found equally good bariatric effect of two compared methods of gastric bypass. The main indicators of blood pressure, as well as laboratory data reflecting the state of carbohydrate and fat metabolism, statistically significantly decreased in both groups to normal values, which suggests a pronounced metabolic effect of both gastric bypass methods. It was established that cardiovascular risk in the first group decreased from 5.40.9 to 2.90.4 (p0.001), and in the second group from 5.11.1 to 3.10.32 (p0.001). CONCLUSIONS: The results of the use of various types of laparoscopic gastric bypass in the surgical treatment of metabolic syndrome after three years indicate a significant reduction in body weight, normalization of carbohydrate and fat metabolism. In a comparative aspect, the authors and standard gastric bypass techniques equally positively affect the elimination of the main manifestations of the metabolic syndrome, but the proposed authors method has insignificant advantages in terms of weight loss.

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“…Всем пациентам, перенесшим бариатрическую операцию, для предупреждения развития микронутритивных дефицитов, рекомендуется прием поливитаминных комплексов, которые включают в себя витамины, макро-(кальций, фосфор и др.) и микроэлементы: железо, цинк, селен и медь [6,15,[30][31][32][33].…”

Section: витаминно-минеральная поддержка после различных типов бариатunclassified

Unsolved issues related to multivitamin and multimineral support for patients following bariatric surgery

2019

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In the review article the authors discuss unsolved issues regarding vitamin and mineral support of patients undergoing bariatric/metabolic operations. Many patients refer for the surgery already having deficiencies of macro- and micronutrients and need preoperative preparation for improving of vitamin-mineral status. Vitamin-mineral support is indicated after each bariatric operation, however the volume of nutritive support and the choice and doses of vitamins and minerals can be varied depending on type of surgery. Hypoabsorptive procedures such as duodenal switch or SADI-S (Single anastomosis duodenoileal bypass with sleeve gastrectomy) usually demand more significant protein, calcium and iron supplementations together with administration of multivitamin complexes containing fat-soluble vitamins. Existing standard vitamin-mineral complexes may not contain necessary doses of iron, calcium, fat-soluble and other vitamins as well as some microelements like cooper, zink, selenium etc. Thus, sufficient vitamin-mineral support may need up to 10 tablets or pills daily depending on kind of surgery. That can influence on patients compliance, lead to refusal of supplementations and thus to undesirable metabolic consequences after surgery. The authors have concluded about necessity of working out of cost-effective domestic series of vitamin-mineral combinations with high bio-availability specially adapted to every class of bariatric/metabolic operation. To authors opinion this can lead to better patients compliance and can prevent undesirable side effects after metabolic surgery.

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Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults)

Cited by 120 publications

References 121 publications

Medical treatment of obesity: peculiarities of medical treatments, information, responsibility and relation to medical treatment of obesity of patients

Medical treatment of obesity: peculiarities of medical treatments, information, responsibility and relation to medical treatment of obesity of patients

The treatment of the metabolic syndrome with stapleless one-anastomotic gastric bypass: a randomized clinical trial compared to stapler method

Unsolved issues related to multivitamin and multimineral support for patients following bariatric surgery

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