Therapeutic dietary standards for obesity

Obesity is essentially a metabolic disorder that is visually manifested by an excessive accumulation of adipose tissue. In other words, it is a leptin-affiliated pathology that progresses in its natural course, with dangerous complications and a high risk of relapse after a course of correction.

Being overweight is a serious medical and social problem. WHO says that in the EU and Russia more than half of the population is overweight, and 20 percent are diagnosed with varying degrees of true obesity.  In the United States, these rates are 60 and 30. The degree of obesity is diagnosed by BMI or the results of bioimpedance testing. Obesity is corrected with diets, including leptin diets.  You will learn about the basic principles of such diets in this article.

Contents:

1. Strategies for correcting excessive weight gain.
2. The principles of diet therapy for obesity.
3. Rules of diet development.
4. Indications for diet therapy for overweight.
5. Types of diets for obesity.
6. Food products.
7. Dietary supplements.

Strategies for correcting excessive weight gain

Obesity of any genesis is a trigger for coronary heart disease, hypertension, diabetes, liver, and musculoskeletal diseases. In more than 70% of cases, this pathology is the result of improper nutritional behavior, that is, it can be corrected by diet.

The central place in the strategy of treatment of obesity is given to the alimentary balancing of metabolic disorders and adequate provision of energy input of the body. In other words, the main link in the corrective chain is leptin with its ability to balance energy expenditure and caloric intake with food.

When selecting the optimal diet, the degree of nutritional status disorder is preliminarily determined on the basis of specific indicators of the results of clinical and instrumental, anthropometric, biochemical, metabolic, genetic and other techniques.  A comprehensive assessment of the detected disorders allows the effectiveness of the correction to be assessed.

The principles of diet therapy for obesity

Like any therapeutic tactic with its own strategy, nutritional therapy has a number of principles that help it achieve optimal results.

The basic principles look quite logical:

1. Therapeutic nutrition is selected taking into account the specific pathogenesis of excess weight gain, the clinic of the pathology, its stage, the nature of metabolic disorders, concomitant diseases.
2. The diet is based on controlling the energy value of the diet, the quantity and quality of incoming proteins, fats, carbohydrates, fiber, vitamins and minerals, correlating with the individual needs of patients.
3. At any stage, diet therapy is correlated with the severity of the course, complications, and comorbidities.
4. The personalization of the diet is done taking into account the patient’s energy requirements, nutritional status, metabolism, and hormonal background.
5. The optimal composition and energy value are guaranteed by the inclusion of dietary products and dietary supplements.
6. The discharge days with the inclusion of specialized foods is an important principle of therapeutic nutrition for obesity.

Rules of diet development

In order for the diet to work as effectively as possible, it is necessary to be guided by certain rules in its development. For example:

1. Restriction of calories by 25-40% of the generally accepted norm, taking into account the sex and age of the patient, the level of motor activity.
2. Optimal amount of carbohydrates: no more than half of the total caloric content of the diet, excluding refined substances in favor of sweeteners. Sugar substitutes are not used due to their sufficient energy value. Carbohydrates are distributed evenly between all meals.
3. Preference is given to products with a low glycemic index, its targeted reduction by enriching it with nutrients that minimize postprandial glycemia: protein, soluble dietary fiber and organic acids.
4. Maximum fiber through vegetables, fruits, cereals and dietary bread, other foods enriched with dietary fiber, and bran.
5. Control the quantity and quality of fat in the diet: up to 30 percent of total calories. It is important to exclude hidden fats from by-products, cheese, sausages, frankfurters, smoked meats, sweets and pastries, ice cream, cookies, nuts.
6. To prevent heart and vascular disease, the diet should be enriched with polyunsaturated omega-3 fatty acids from mackerel, capelin, halibut or vegetable oils, dietary supplements.
7. Control the protein content of the diet at least 15%, with equal proportions of plant and animal proteins.
8. Enriching the diet with vitamins and minerals through traditional fruits and berries and vegetables, as well as through vitamin-mineral complexes.
9. Limitation of salt in the diet correlates with the severity of hypertensive syndrome: in severe hypertension, salt is eliminated, in all other cases – the norm is 5 grams of salt per day (teaspoon).
10. Proper cooking: boiling, stewing, baking, steaming.
11. Drinking ration is calculated as 40 ml of pure water per 1 kg of weight. Although water is non-caloric, with its excess in the body begins pastosity tissues. Here, leptin also plays an important role: you should drink water only when you feel hunger or when the appetite centers are activated, because the thirst center is adjacent to the satiety center.
12. Observe the eating regime: do not eat on the go, at night. Eat in small portions and in small portions. Up to 90 percent of calories should be consumed before 6 p.m. After that, only kefir or other fermented dairy products should be consumed.

Indications for diet therapy for overweight

Obesity in a variety of variants with comorbidities is the main indication for diet therapy. Moreover, a diet with moderate energy restriction is developed, mainly at the expense of fats and carbohydrates. Simple sugars are removed from the diet, animal fats and table salt are minimized (3 to 5 g/day).

The diet must include iodine-containing products: seafood, sea fish, sea cabbage, vegetable fats, dietary fibers in the form of raw vegetables, fruit, and bran. The drinking ration is limited to 49 liters of pure water per 1 kg of weight. Food is steamed or boiled, without salt. The frequency of meals 4-5 times a day.

Chemical composition: 

Proteins – up to 80 g, and 50/50: vegetable and animal;

Total fats – up to 70 g, including vegetable – 25 g;

Total carbohydrates – up to 150 g;

Dietary fiber – 25 g.

Energy value – 1350-1550 kcal.

Types of diets for obesity

In addition to the standard diet therapy for obesity, special diets are used:

1. Unloading: apple, kefir, dairy, cottage cheese, juice, rice and compote, fish, meat, vegetables. During the discharge diet is recommended voluminous food, but with low calories and energy density. Food is distributed evenly over 4-5 meals, the patient should not feel hunger, so as not to overeat on the remaining days, so the optimal for unloading leptin diet with its rhythm of meals and the intervals between these meals.
2. On contrast days from the diet are excluded bread, all sweets, table salt.
3. Therapeutic fasting – used only inpatiently and for a short period in cases of pronounced obesity.

Food products

Individually designed diet for obesity involves the inclusion of specialized foods and supplements in the standard therapeutic diet in accordance with the medical indications for their use.

The list of foods is quite long:

• with modified proteins;
• with the exclusion of mono- and disaccharides;
• with the use of sweeteners;
• low glycemic index;
• low-fat;
• with minimum cholesterol;
• low in saturated fats;
• high omega-3 content;
• with maximum dietary fiber: soluble and insoluble;
• low energy content;
• high in antioxidants;
• high in chromium, iodine, zinc;
• with a minimum of sodium.

Diet therapy for extra pounds uses foods with a therapeutic effect, designed to replace one of the meals. These specialized foods are low-calorie, because they are prepared with exclusion of light carbohydrates, fat of animal origin, with a sufficient amount of protein, including vegetable, with a high concentration of fiber. They usually contain all the necessary vitamins in balanced doses.

In addition, therapeutic nutrition for obesity, along with traditional products, uses protein mixtures, concentrates which are used as a component of ready meals. As a rule, natural sources of protein contain a lot of calories, and protein mixtures minimize the caloric content of dishes, preserving the physiological norm of protein.

Protein blends are recommended for breakfast by introducing them to vegetable dishes, porridges, because they induce a feeling of satiety for the entire first half of the day. In other words, they affect the production of leptin by the fatty tissue and ghrelin by the gastric mucosa.

Enteral nutrition mixtures are often used as special products for patients with extra pounds: not only standard, but also semi-elemental, metabolic, and modular. They are used only when prescribed by a doctor for a few days.  The choice of special products is based on laboratory tests that diagnose the severity of the pathology. The complete replacement of the daily diet with specialized products once can be used as a discharge.

Dietary supplements

In the complex diet therapy for obesity it is reasonable to use dietary supplements – concentrates of biological substances of natural or close to natural origin. Especially effective are such inclusions in combination with probiotics.

Dietary supplements that are used in the treatment of obesity are divided into groups:

• those that minimize appetite;
• those that create a feeling of fullness;
• stimulating the mobilization of lipids from depots and increasing thermogenesis;
• reducing absorption of fat in the digestive tube;
• that help to balance the metabolism;
• having diuretic action;
• loosening agents.

The last two types of supplements can be used as symptomatic agents in the diet therapy of obesity for two weeks, no more with repetition after a couple of months.