Fighting obesity: expert advice
Ashot Mkrtumyan: "Patient education is extremely important in the fight against obesity"Irina Shirokova, Remedium.ru
– Ashot Musayelovich, there are many opinions about what is the main thing in the weight loss system.
And how do you feel about the most popular methods of getting rid of excess weight?– Indeed, disputes about how to lose weight properly are still ongoing, and they are not groundless.
You yourself know very well how many suggestions and recommendations have been made on this issue, how many different kinds of manuals have been issued. Some experts believe that the key to success is a separate diet, others advise sticking only to protein food. There is also a point of view according to which for weight loss it is necessary to limit the intake of carbohydrates or even exclude them from the diet, while increasing fat intake. An example is the so-called Kremlin diet, which is popular in our country (known in the world as the low-carb Atkins diet). Using any of these methods, of course, you can lose weight. But at what cost will this be achieved?
– Really, which one? Does the end not always justify the means?– Yes, I believe that the most important thing in solving the problem of excess weight is not to harm your health.
But the above-mentioned diets, alas, sin one-sidedness and lead either to a deficiency of protein or fat with all the ensuing consequences. For example, a complete rejection of fatty foods can lead to a deficiency of fat-soluble vitamins that cease to be absorbed in the body. We should not forget about the brain, which needs fatty acids and carbohydrates for normal operation. Therefore, a mixed diet is optimal if the physiological ratio of fats, carbohydrates and proteins is observed. Both American and our scientists have worked hard on this issue. By the way, in the 40s of the last century, it was our scientists who introduced the concept of a "physiological diet", in which the amount of proteins in the daily diet should be at least 15%, carbohydrates - from 50 to 60%, and fats – from 25 to 30%. Such a diet would be the most acceptable.
– And what, in your opinion, is the optimal recipe for weight loss?– In general, the best weight loss formula is a healthy lifestyle, which should be understood as dosed physical activity and mixed nutrition with calorie restriction.
I want to emphasize that limiting the caloric content of food does not imply the complete exclusion of any food product, because with food, in addition to vitamins, we also get trace elements. However, due to existing misconceptions, many people do not eat fats, but consume only vegetable oil, for some reason considering it dietary. In fact, it is more caloric than lard, which is not pure fat. Try to completely melt the lard – you will not succeed. Get a huge amount of flakes. Even butter has a fat content – a maximum of 82-83%. But vegetable fat is 100% fat at all. What really needs to be included in the diet is foods rich in fiber – primarily vegetables. This food does not melt in the mouth like fatty, on the contrary, it needs to be chewed for a long time.
– And what to do in cases when the patient is unable to adhere to the correct diet?– Indeed, it happens that compliance with the rules of a healthy lifestyle, which we recommend, turns out to be insufficient for "dropping" excess weight, or for some subjective or objective reasons, a person cannot curb his bad habits - eating "for company", constantly "snacking".
The latter, as a rule, occurs with violations in the regulatory systems of the body responsible for its appetite, especially often after infections. In these cases, weight correction is achieved with the help of medications, which, I note, are prescription all over the world. Drug therapy, which allows you to change habits, reduce energy intake in the difficult situation that we are facing in our country today (the epidemic nature of obesity), occupies not the last place in the system of combating excess weight.
– However, currently the range of medications for weight loss is extremely scarce. What do you think is the reason for this?– To answer this question, you need to delve into history.
For decades, amphetamine–type drugs have been used to combat excess weight - chemical stimulants that help reduce appetite. Yes, they are highly effective, but they cause chemical dependence. And patients who used these drugs could not refuse them later. Therefore, these funds were banned from use.
For some time, patients successfully reduced weight with the help of Isolipan (dexfenfluramine). This drug is fundamentally different from amphetamine anorexigenic drugs in the absence of addictive development, psychostimulating and hypertensive effects. However, after it turned out that this drug increases intrapulmonary pressure and can even cause disfigurement of the valve apparatus, it was withdrawn from the pharmaceutical market.
As a result, today the safety of the drugs used, implying in-depth clinical studies, is at the forefront of the drug solution to the problem of excess weight. Hence the smallness of the assortment, which in our country is represented by only two drugs – Meridia (sibutramine) and Xenical (orlistat).
– What are the features and differences of these drugs?– Meridia affects the main cause of weight gain – overeating, normalizing the feeling of satiety.
Without causing a decrease in appetite, it promotes an earlier onset of a feeling of satiety. Xenical has a different mechanism of action: by blocking lipase activity during meals, it prevents the breakdown of fats.
– Do you see any reserves for expanding the range of such drugs?– There are such reserves.
In the foreseeable future, a new drug will enter the market – Rimonaban, which acts on opioid centers and thus can simultaneously influence eating behavior, providing a feeling of satiety with a decrease in food intake, and smoking cessation. But this tool still needs to be repeatedly tested for complete safety. Rimonaban has already passed clinical trials, including in Russia. In addition, genetic engineering is actively developing today. And we assume the appearance of drugs that will be able to correct the broken genetic code. As of today, these funds do not yet have a name and are undergoing the 1st or 2nd phase of testing.
– Dietary supplements for weight loss are in high demand among consumers. How do you feel about this group of pharmacy assortment?– Indeed, dietary supplements are used by a huge number of people.
The trouble is that in many dietary supplements, the necessary effect is achieved due to a prohibited medicinal substance. A striking example is dietary supplements with a high content of caffeine. No, in no case do I want to criticize all dietary supplements indiscriminately, because they are necessary for a person as sources of trace elements, a soluble form of fiber and other useful compounds. However, patients should have a clear idea of what exactly they are using and for what.
– Medications for weight loss, unlike dietary supplements, belong to the prescription segment. But in our country, this problem is treated by a doctor only in extreme cases. From your point of view, what needs to be done here for a thoughtful consumer approach?– First of all, it is necessary to optimize patient education.
This should happen through the organization of "obesity schools", where behavioral change, psychotherapeutic aspects of the problem, the role of overweight in the development of severe ailments will be discussed. For example, many patients do not know that obesity is the cause of colon cancer in 40% of cases, breast cancer in 25%, and type II diabetes mellitus in almost 100%, which is caused by carbohydrate metabolism disorders. Pharmaceutical companies should also pay as much attention as possible to patient education. It is necessary to inform the consumer in an accessible form that it is necessary to carry out overweight therapy with the help of proven and safe medicines, that it is necessary to consult with doctors, listen to the advice of nutritionists, that when choosing a means to reduce weight, it is possible to wait for a long and sustained effect only from drugs that eliminate the cause of the disease. I note that an important role in such education is assigned to pharmacists.
In general, patient support is very important. And the initiative that was announced here today by Abbott is the development and maintenance of an open website http://www.vesu.net /, where patients will be able to learn more about different ways of weight loss, will be able to compare them and understand modern approaches to therapy, is commendable.
– Ashot Musayelovich, the main consumer of drugs for weight loss in Russia, as you know, are women. And the male audience is completely indifferent to this problem?– Attracting the attention of men to the problems of obesity is a very serious problem for us.
After all, many men underestimate the severity of this disorder, often not even suspecting of its side complications. So, when overweight, the synthesis of testosterone, the main sex hormone, is limited. Because of this, in overweight men, sexual desire decreases, and a violation of endothelial function can lead to impotence at all. In addition, obesity causes sleep apnea, snoring, sweating, and the musculoskeletal system suffers. With the help of publications in various publications, we are trying to convey this information to a male audience, to draw its attention to the problem, but there is a long and serious work to be done here.
– Let's hope that it will bear fruit. Thank you for the interview and wish you scientific success!Portal "Eternal youth" www.vechnayamolodost.ru