NUTRITION AND DIET
OBESITY
HOW CAN WE DEFINE OBESITY?
According to World health organisation, obesity is a complex disaease defined as abnormal or excessive fat accumulation that presents a risk to health.
HOW CAN WE CLASSIFY OBESITY?
There are various methods for assessing your body fat like body composition analysis with specialized devices, antropometric measurements (waist circumferences, hip circumferences, skinfold measurements etc.)
But you can easily classify yourself with body mass index (BMI) by using your weight and height. BMI is calculated as your weight (in kilograms) divided by the square of your height (in metres) or BMI = kg/m2.
WHAT ARE THE METHODS TO TREAT OBESITY?
Two main methods are using to treat obesity according to your condition. İt should be notted that treatment should be personalized according to your health conditions.
One of them is healty life style and healty nutrition to lose weight. You can change your life style and wrong habits that cause obesity quitted in addition to your excessive fat mass with right health care team including a dietitian.
The second one is now getting attention last decades called as bariatric surgery. İt seems easy to lose weight but it should be remembered that it is a surgery that have many risks. Besides a disciplined diet programme should be followed both in pre and post operation period and this could be forcible for patient. Weight loss surgery is usually only recommended for people with a BMI of at least 40, or 35 if you have a weight-related health condition, such as type 2 diabetes or high blood pressure. You should be adviced a professional health care team for this method.
CURRENT DIET PRACTİCES TO HANDLE OBESITY
There are many diffent interventions to lose weight but it should be noted that your diet programme should be personalized like fingerprint and it shouldn’t be practised without a health care team.
Table 1: Dietary interventions for weight loss
For the treatment of obesity, the current National Institute for Health and Care Excellence (NICE) guidelines recommend.
- A dietary approach with lower energy intake than expenditure is recommended.
- A deficit of 600 kcal/day (via LCD or LFD) is recommended for sustainable weight loss, together with expert support and intensive follow-up.
- Consider LCD at 800–1600 kcal/day but ensure it is nutritionally complete.
- Diets of 200–800 kcal/day are not recommended unless there is a clinical need for rapid weight loss.
Ruban, A., Stoenchev, K., Ashrafian, H., & Teare, J. (2019). Current treatments for obesity. Clinical Medicine, 19(3), 205.
WEIGHT REDUCTION/WIİGHT LOSS PROGRAMMES
WHAT IS THE BEST WEIGHT REDUCTION/WEIGHT LOSS PROGRAMME FOR OWERWEIGHT/OBESITY?
You can find many different diet programmes on internet but the best way to lose your fat mass should be personalized acoording to your health and life sytle conditions. Standart diet programmes couldn’t be sustainable for long time so you can easly gain your fat mass again.
You can see that weight lose depens on many factors seen on the figüre below (2).
Dayan, P. H., Sforzo, G., Boisseau, N., Pereira-Lancha, L. O., & Lancha Jr, A. H. (2019). A new clinical perspective: Treating obesity with nutritional coaching versus energy-restricted diets. Nutrition, 60, 147-151.
WHERE SHOULD I BEGIN?
First of all you shoul have your routine blood tests that helps to analysis your medikal conditions. Before beginning a weight reduction/weight loss programme you should check the markers below:
- Fasting Plasma Glucose
- Fasting Insulin
- Liver Function Tests (ALT, AST)
- Urea, Creatinine, Uric acid
- Blood Lipid Profile (HDL cholesterol, LDL cholesterol, Total cholesterol)
- Thyroid Function Tests (T3, T4, TSH)
- Vitamin D level
- Vitamin B12 level
- Blood Profile for anemia (hemoglobin, hematocrit, ferritine)
**If you have a different disease you could check another markers and ask your doctor if any special notes to be observed while starting the programme.
HOW MUCH WEIGHT SHOULD I LOSE IN A MONTH?
There isn’t a standart weight reduction because of indvidual differences like age, gender, weight and body composition, chronic diseases, physical activity levels. But it could be said that with a light physcal activity level 2-4 kg could be your goal after starting a weight reduction/weight loss programme for a month.
IS IT ENOUGH TO WATCH YOUR WEIGHT TO UNDERSTAND YOUR SUCCES ABOUT WEIGHT REDUCTION/WEIGHT LOSS PROGRAMME?
You may not watch a regular weight loss because of your body profile. You can be slimmer at the same weight; which pointed that your lean body mass increased whereas your fat mass decreased. Waist, hip and upper arm circumferences can be indicators to watch your succes according to body weight.
INSULIN RESISTANCE
WHAT IS INSULIN?
Insulin is a hormone made by the pancreas that helps glucose (comes from the food you eat) in your blood enter cells in your muscle, fat, and liver, where it’s used for energy. The liver also makes glucose in times of need, such as when you’re fasting. When blood glucose, levels rise after you eat, your pancreas releases insulin into the blood. Insulin then lowers blood glucose to keep it in the normal range. Insulin is a key player in developing type 2 diabetes.
WHAT IS INSULIN RESISTANCE?
The cells in your pancreas sense the increase of your blood sugar after meals and release insulin into your blood. Insulin then travels around your bloodstream, telling your cells to pick up sugar from your blood. This process results in reduced blood sugar levels. However, cells sometimes stop responding to insulin correctly because of unhealty life sytle habits like low physşical activity or overeating. This is called insulin resistance. Over time, your cells may become increasingly resistant to insulin, resulting in a rise in both insulin and blood sugar levels. Eventually, your pancreas may become damaged, leading to decreased insulin production. After blood sugar levels exceed a certain threshold, you may be diagnosed with type 2 diabetes.
HOW CAN WE DYSNOGSIS INSULIN RESISTANCE?
You can't tell that you have insulin resistance by how you feel. You'll need to get a blood test that checks your blood sugar levels. HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) tells you and your doctor how much insulin your pancreas needs to make to control your blood sugar levels. A HOMA-IR value of 2.5 is taken as an indicator of insulin resistance in adults.
HOMA-IR = { fasting insulin (µIU/mL)*fasting glucose (mmol/L) } /22.5
HOMA-IR = { fasting insulin (mU/L)*fasting glucose (mg/dL) } /405
WHAT IS THE TREATMENT OF INSULIN RESISTANCE?
You can often completely reverse this condition by changing your lifestyle in the following ways:
Eating a healthy diet and losing excess weight: You can easily handle insülin resistance with losing your excessive weight. healty diet recommendations given by a nutritionist can be useful to defeat IR. But it should be noted that your clinical conditions must be checked by a doctor.
Physical activity: Getting regular amounts of moderate-intensity physical activity helps increase glucose energy usage and improve muscle insulin sensitivity. İntense, time of physical activity should be carefully planned to your conditions.
Medications: Your doctor may give you some medications according to your clinical conditions to increase the sensitiveness of your organs to insülin. İt may also helps you to lose weight.
