Savremeno lečenje gojaznosti - da li je dijeta dovoljna?
Ključne reči:
gojaznost, dijeta, lečenje gojaznosti, prevencija gojaznosti
Sažetak
Gojaznost je široko rasprostranjena i složena hronična bolest, koja pogađa pojedince, porodice i čitavo društvo. Gojaznost povećava rizik za obolevanje od više od 200 različitih bolesti, među kojima su dijabetes, kardiovaskularne i maligne bolesti. Osobe sa gojaznošću su veoma često izložene predrasudama, stigmatizaciji i diskriminaciji, što za njih može imati ozbiljne negativne posledice. Za lečenje gojaznosti su odobrene sledeće metode: 1. Unapređenje ishrane; 2. Fizička aktivnost; 3. Psihoterapija; 4. Farmakoterapija; i 5. Hirurško lečenje gojaznosti.
Nutritivne intervencije i medicinska nutritivna terapija su u osnovi lečenja gojaznosti. Mogu se primenjivati različite, pacijentu prilagođene nutritivne intervencije, pod uslovom da su bezbedne, nutritivno adekvatne, efikasne i da su pacijentu kulturološki i finansijski prihvatljive za dugoročnu primenu. Do danas nije dokazano da je neka posebna nutritivna intervencija najbolja za održavanje postignutog smanjenja težine, a dugoročni rezultati nutritivnih intervencija su na žalost ograničeni.
Fizička aktivnost, pshihoterapija, farmakoterapija i hirurško lečenje gojaznosti mogu značajno poboljšati rezultate lečenja, međutim, sveukupno lečenje gojazosti je složeno, skupo i najčešće sa ograničenim rezultatima. Smatra se da je primarna prevencija gojaznosti mnogo efikasnija i isplativija nego lečenje, te da prevencija gojaznosti i pratećih komorbiditeta treba da bude u fokusu svakog zdravstvenog sistema.
Reference
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2. Health service delivery framework for prevention and management of obesity. Geneva: World Health Organization; 2023.(https://iris.who.int/bitstream/handle/10665/367784/9789240073234-eng.pdf?sequence=1).
3. Milić N, Stanisavljević D, Krstić M, urednici. Istraživanje zdravlja stanovništva Srbije 2019. Beograd: Omnia Bgd;2021. (https://www.stat.gov.rs/sr-latn/publikacije/publication/?p=13005)
4. WHO European Regional Obesity Report 2022. Copenhagen: WHO Regional Office for Europe; 2022.(https://www.who.int/europe/publications/i/item/9789289057738).
5. De Lorenzo A, Gratteri S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease? J Transl Med. 2019 May 22;17(1):169. doi: 10.1186/s12967-019-1919-y.
6. Nadolsky K, Addison B, Agarwal M, Almandoz JP, Bird MD, DeGeeter, et al. American Association of Clinical Endocrinology Consensus Statement: Addressing Stigma and Bias in the Diagnosis and Management of Patients with Obesity/Adiposity-Based Chronic Disease and Assessing Bias and Stigmatization as Determinants of Disease Severity. Endocr Pract. 2023 Jun;29(6):417-427. doi: 10.1016/j.eprac.2023.03.272.
7. Spahlholz J, Baer N, König HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination - a systematic review and meta-analysis of observational studies. Obes Rev. 2016 Jan;17(1):43-55. doi: 10.1111/obr.12343.
8. Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. 2018;74(5):1030-42.doi: 10.1111/jan.13511.
9. Sharma AM, Campbell-Scherer DL. Redefining obesity: Beyond the numbers. Obesity. 2017;25(4):660-661. doi: 10.1002/oby.21801.
10. Rueda-Clausen CF, Poddar M, Lear SA, Poirier P, Sharma AM. Canadian Adult Obesity Clinical Practice Guidelines: Assessment of People Living with Obesity. (https://obesitycanada.ca/guidelines/assessment).
11. Radna grupa za izradu vodiča dobre kliničke prakse „Lečenje gojaznosti“. Šumarac M, Polovina S, urednici. Nacionalni vodič dobre kliničke prakse: lečenje gojaznosti. Ministarstvo zdravlja Republike Srbije, 2022.(https://www.zdravlje.gov.rs/view_file.php?file_id=2406&cache=sr).
12. Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H, et al. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019;12(1):40-66. doi: 10.1159/000496183.
13. Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020 Aug 4;192(31):E875-891. doi: 10.1503/cmaj.191707.
14. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H; Obesity Management Task Force of the European Association for the Study of Obesity. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8(6):402-424. doi: 10.1159/000442721.
15. Brown J, Clarke C, Johnson Stoklossa C, Sievenpiper J. Canadian Adult Obesity Clinical Practice Guidelines: Medical Nutrition Therapy in Obesity Management. (https://obesitycanada.ca/guidelines/nutrition).
16. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GD, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014 Sep 3;312(9):923-933. doi: 10.1001/jama.2014.10397.
17. Daly P, Pace T, Berg J, Menon U, Szalacha LA. A mindful eating intervention: A theory-guided randomized anti-obesity feasibility study with adolescent Latino females. Complement Ther Med. 2016 Oct;28:22-28. doi: 10.1016/j.ctim.2016.07.006.
18. Warren JM, Smith N, Ashwell M. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutr Res Rev. 2017 Dec;30(2):272-283. doi: 10.1017/S0954422417000154.
19. Jakicic JM, Rogers RJ, Davis KK, Collins KA. Role of Physical Activity and Exercise in Treating Patients with Overweight and Obesity. Clin Chem. 2018 Jan;64(1):99-107. doi: 10.1373/clinchem.2017.272443.
20. Boulé NG, Prud’homme D. Canadian Adult Obesity Clinical Practice Guidelines: Physical Activity in Obesity Management. (https://obesitycanada.ca/guidelines/physicalactivity).
21. Petridou A, Siopi A, Mougios V. Exercise in the management of obesity. Metabolism. 2019 Mar;92:163-169. doi: 10.1016/j.metabol.2018.10.009.
22. Vallis TM, Macklin D, Russell-Mayhew S. Canadian Adult Obesity Clinical Practice Guidelines: Effective Psychological and Behavioural Interventions in Obesity Management. (https://obesitycanada.ca/guidelines/behavioural).
23. Jacob A, Moullec G, Lavoie K, Laurin C, Cowan T, Tisshaw C. Impact of cognitive-behavioral interventions on weight loss and psychological outcomes : A meta-analysis. Heal Psychol. 2018;37(5):417-432. doi: 10.1037/hea0000576.
24. Dalle Grave R, Sartirana M, Calugi S. Personalized cognitive-behavioural therapy for obesity (CBT-OB): theory, strategies and procedures. Biopsychosoc Med. 2020 Mar 9;14:5. doi: 10.1186/s13030-020-00177-9. doi: 10.1186/s13030-020-00177-9.
25. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011; Sep;12((9)):709-723. doi: 10.1111/j.1467-789X.2011.00892.x.
26. Chakhtoura M, Haber R, Ghezzawi M, Rhayem C, Tcheroyan R, Mantzoros CS. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. EClinicalMedicine. 2023 Mar 20;58:101882. doi: 10.1016/j.eclinm.2023.101882.
27. Pedersen SD, Manjoo P, Wharton S. Canadian Adult Obesity Clinical Practice Guidelines: Pharmacotherapy for Obesity Management. (https://obesitycanada.ca/guidelines/pharmacotherapy).
28. Moon S, Chung HS, Kim YJ. Efficacy and Safety of the New Appetite Suppressant, Liraglutide: A Meta-Analysis of Randomized Controlled Trials. Endocrinology and Metabolism. 2021;36(3):647-660. doi: 10.3803/EnM.2020.934.
29. Rubino D, Abrahamsson N, Davies M. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. doi: 10.1001/jama.2021.3224.
30. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: 10.1056/NEJMoa2206038.
31. Smith SR, Fujioka K, Gupta AK, Billes SK, Burns C, Kim D, Dunayevich E, Greenway FL. Combination therapy with naltrexone and bupropion for obesity reduces total and visceral adiposity. Diabetes Obes Metab. 2013 Sep;15(9):863-6. doi: 10.1111/dom.12095.
32. Langlois MF, Freedhoff Y, Morin MP. Canadian Adult Obesity Clinical Practice Guidelines: Commercial Products and Programs in Obesity Management. (https://obesitycanada.ca/guidelines/commercialproducts).
33. Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015 Oct 15;373(16):1531-1540. doi: 10.1056/NEJMsa1504267.
34. Biertho L, Hong D, Gagner M. Canadian Adult Obesity Clinical Practice Guidelines: Bariatric Surgery: Surgical Options and Outcomes. (https://obesitycanada.ca/guidelines/surgeryoptions).
35. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Review. JAMA. 2020 Sep 1;324(9):879-887. doi: 10.1001/jama.2020.12567.
36. Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring). 2020 Apr;28(4):O1-O58. doi: 10.1002/oby.22719.
37. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017 May;13(5):7277-41. doi: 10.1016/j.soard.2016.12.018.
38. Uredba o Nacionalnom programu za prevenciju gojaznosti kod dece i odraslih. "Sl. glasnik RS", br. 9/2018. (https://www.zdravlje.gov.rs/view_file.php?file_id=2040&cache=sr).
39. Flowers R, Blackshaw J, Van Dijk M, Reid L, WGLL Thematic Group on Healthy Weight (All Age), Public Health England. What Good Healthy Weight for all ages Looks Like. 2019.(https://www.adph.org.uk/wp-content/uploads/2019/07/What-Good-Healthy-Weight-Looks-Like.pdf).
40. Public Health England. Whole systems approach to obesity: A guide to support local approaches to promoting a healthy weight. 2019.(https://assets.publishing.service.gov.uk/media/5d396e7140f0b604de59fde9/Whole_systems_approach_to_obesity_guide.pdf).
2. Health service delivery framework for prevention and management of obesity. Geneva: World Health Organization; 2023.(https://iris.who.int/bitstream/handle/10665/367784/9789240073234-eng.pdf?sequence=1).
3. Milić N, Stanisavljević D, Krstić M, urednici. Istraživanje zdravlja stanovništva Srbije 2019. Beograd: Omnia Bgd;2021. (https://www.stat.gov.rs/sr-latn/publikacije/publication/?p=13005)
4. WHO European Regional Obesity Report 2022. Copenhagen: WHO Regional Office for Europe; 2022.(https://www.who.int/europe/publications/i/item/9789289057738).
5. De Lorenzo A, Gratteri S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease? J Transl Med. 2019 May 22;17(1):169. doi: 10.1186/s12967-019-1919-y.
6. Nadolsky K, Addison B, Agarwal M, Almandoz JP, Bird MD, DeGeeter, et al. American Association of Clinical Endocrinology Consensus Statement: Addressing Stigma and Bias in the Diagnosis and Management of Patients with Obesity/Adiposity-Based Chronic Disease and Assessing Bias and Stigmatization as Determinants of Disease Severity. Endocr Pract. 2023 Jun;29(6):417-427. doi: 10.1016/j.eprac.2023.03.272.
7. Spahlholz J, Baer N, König HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination - a systematic review and meta-analysis of observational studies. Obes Rev. 2016 Jan;17(1):43-55. doi: 10.1111/obr.12343.
8. Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. 2018;74(5):1030-42.doi: 10.1111/jan.13511.
9. Sharma AM, Campbell-Scherer DL. Redefining obesity: Beyond the numbers. Obesity. 2017;25(4):660-661. doi: 10.1002/oby.21801.
10. Rueda-Clausen CF, Poddar M, Lear SA, Poirier P, Sharma AM. Canadian Adult Obesity Clinical Practice Guidelines: Assessment of People Living with Obesity. (https://obesitycanada.ca/guidelines/assessment).
11. Radna grupa za izradu vodiča dobre kliničke prakse „Lečenje gojaznosti“. Šumarac M, Polovina S, urednici. Nacionalni vodič dobre kliničke prakse: lečenje gojaznosti. Ministarstvo zdravlja Republike Srbije, 2022.(https://www.zdravlje.gov.rs/view_file.php?file_id=2406&cache=sr).
12. Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H, et al. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019;12(1):40-66. doi: 10.1159/000496183.
13. Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020 Aug 4;192(31):E875-891. doi: 10.1503/cmaj.191707.
14. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H; Obesity Management Task Force of the European Association for the Study of Obesity. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8(6):402-424. doi: 10.1159/000442721.
15. Brown J, Clarke C, Johnson Stoklossa C, Sievenpiper J. Canadian Adult Obesity Clinical Practice Guidelines: Medical Nutrition Therapy in Obesity Management. (https://obesitycanada.ca/guidelines/nutrition).
16. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GD, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014 Sep 3;312(9):923-933. doi: 10.1001/jama.2014.10397.
17. Daly P, Pace T, Berg J, Menon U, Szalacha LA. A mindful eating intervention: A theory-guided randomized anti-obesity feasibility study with adolescent Latino females. Complement Ther Med. 2016 Oct;28:22-28. doi: 10.1016/j.ctim.2016.07.006.
18. Warren JM, Smith N, Ashwell M. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutr Res Rev. 2017 Dec;30(2):272-283. doi: 10.1017/S0954422417000154.
19. Jakicic JM, Rogers RJ, Davis KK, Collins KA. Role of Physical Activity and Exercise in Treating Patients with Overweight and Obesity. Clin Chem. 2018 Jan;64(1):99-107. doi: 10.1373/clinchem.2017.272443.
20. Boulé NG, Prud’homme D. Canadian Adult Obesity Clinical Practice Guidelines: Physical Activity in Obesity Management. (https://obesitycanada.ca/guidelines/physicalactivity).
21. Petridou A, Siopi A, Mougios V. Exercise in the management of obesity. Metabolism. 2019 Mar;92:163-169. doi: 10.1016/j.metabol.2018.10.009.
22. Vallis TM, Macklin D, Russell-Mayhew S. Canadian Adult Obesity Clinical Practice Guidelines: Effective Psychological and Behavioural Interventions in Obesity Management. (https://obesitycanada.ca/guidelines/behavioural).
23. Jacob A, Moullec G, Lavoie K, Laurin C, Cowan T, Tisshaw C. Impact of cognitive-behavioral interventions on weight loss and psychological outcomes : A meta-analysis. Heal Psychol. 2018;37(5):417-432. doi: 10.1037/hea0000576.
24. Dalle Grave R, Sartirana M, Calugi S. Personalized cognitive-behavioural therapy for obesity (CBT-OB): theory, strategies and procedures. Biopsychosoc Med. 2020 Mar 9;14:5. doi: 10.1186/s13030-020-00177-9. doi: 10.1186/s13030-020-00177-9.
25. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011; Sep;12((9)):709-723. doi: 10.1111/j.1467-789X.2011.00892.x.
26. Chakhtoura M, Haber R, Ghezzawi M, Rhayem C, Tcheroyan R, Mantzoros CS. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. EClinicalMedicine. 2023 Mar 20;58:101882. doi: 10.1016/j.eclinm.2023.101882.
27. Pedersen SD, Manjoo P, Wharton S. Canadian Adult Obesity Clinical Practice Guidelines: Pharmacotherapy for Obesity Management. (https://obesitycanada.ca/guidelines/pharmacotherapy).
28. Moon S, Chung HS, Kim YJ. Efficacy and Safety of the New Appetite Suppressant, Liraglutide: A Meta-Analysis of Randomized Controlled Trials. Endocrinology and Metabolism. 2021;36(3):647-660. doi: 10.3803/EnM.2020.934.
29. Rubino D, Abrahamsson N, Davies M. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. doi: 10.1001/jama.2021.3224.
30. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: 10.1056/NEJMoa2206038.
31. Smith SR, Fujioka K, Gupta AK, Billes SK, Burns C, Kim D, Dunayevich E, Greenway FL. Combination therapy with naltrexone and bupropion for obesity reduces total and visceral adiposity. Diabetes Obes Metab. 2013 Sep;15(9):863-6. doi: 10.1111/dom.12095.
32. Langlois MF, Freedhoff Y, Morin MP. Canadian Adult Obesity Clinical Practice Guidelines: Commercial Products and Programs in Obesity Management. (https://obesitycanada.ca/guidelines/commercialproducts).
33. Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015 Oct 15;373(16):1531-1540. doi: 10.1056/NEJMsa1504267.
34. Biertho L, Hong D, Gagner M. Canadian Adult Obesity Clinical Practice Guidelines: Bariatric Surgery: Surgical Options and Outcomes. (https://obesitycanada.ca/guidelines/surgeryoptions).
35. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Review. JAMA. 2020 Sep 1;324(9):879-887. doi: 10.1001/jama.2020.12567.
36. Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring). 2020 Apr;28(4):O1-O58. doi: 10.1002/oby.22719.
37. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017 May;13(5):7277-41. doi: 10.1016/j.soard.2016.12.018.
38. Uredba o Nacionalnom programu za prevenciju gojaznosti kod dece i odraslih. "Sl. glasnik RS", br. 9/2018. (https://www.zdravlje.gov.rs/view_file.php?file_id=2040&cache=sr).
39. Flowers R, Blackshaw J, Van Dijk M, Reid L, WGLL Thematic Group on Healthy Weight (All Age), Public Health England. What Good Healthy Weight for all ages Looks Like. 2019.(https://www.adph.org.uk/wp-content/uploads/2019/07/What-Good-Healthy-Weight-Looks-Like.pdf).
40. Public Health England. Whole systems approach to obesity: A guide to support local approaches to promoting a healthy weight. 2019.(https://assets.publishing.service.gov.uk/media/5d396e7140f0b604de59fde9/Whole_systems_approach_to_obesity_guide.pdf).
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