Experience with the management of patients with extreme obesity – Part 1

Česká verzia

Authors: Adela Penesová ^1,2,3
Authors place of work: Ambulancia pre diabetológiu, poruchy látkovej premeny a výživy Adia-Mar s. r. o., Bratislava ¹; Ústav klinického a translačného výskumu, Biomedicínske centrum SAV, v. v. i., Bratislava ²; Katedra biologických a lekárskych vied, Fakulta telesnej výchovy a športu UK v Bratislave ³
Published in the journal: Diab Obez 2024; 24(48): 99-106
Category: Reviews

Summary

Management of obesity (OB) grade 3 (BMI ≥ 40 kg/m²), commonly referred to as extreme obesity (EO), requires a multidisciplinary approach. No child is born with extreme obesity but becomes so. Therefore, the development of obesity should be caught in the stadium of pre-obesity (overweight when the BMI is between 25–30 kg/m²), which is a key and decisive role of pediatricians and general practitioners in preventive examinations. The cause of extreme obesity is enormously high energy intake (overeating) and relatively minimal energy expenditure through physical activity. Genetic predisposition also plays its role, which affects not only metabolic pathways but also the preference for certain foods, energy intake, and physical (in)activity. Extreme obesity is related to factors such as gender (female), age, and ethnicity (Roma in Slovakia). This work aims to bring my own experiences with the management of patients with extreme obesity. During the initial interview, I tried to identify the key area why the patient reached this stage of obesity. In 50–70% of patients with extreme obesity, psychological factors are decisive, which are also the alpha-omega of success or failure of treatment. There is a link between psychological factors and the etiology of obesity. Stress and other negative emotions such as depression and anxiety might also lead to higher food intake. The term “emotional eating” is widely used to describe the tendency to eat in response to negative emotions without feeling hungry, with the foods chosen to be primarily high energy-dense and palatable. I also meet with the phenomenon of self-harm in those patients. Physical pain is a way for people to divert their attention from unpleasant or negative psychological feelings. Against these problems, food and pain are often used in the same way as drugs. Therefore, a key factor in the management of patients with extreme obesity is to properly motivate the patient and detect and manage psychogenic factors conducive to increased energy intake (overeating). The cooperation with psychologists and psychiatrists seems to be a key factor in the multidisciplinary management of a patient with extreme obesity.

Keywords:

ethnicity – extreme obesity – emotional eating

Zdroje

Sharma S, Batsis JA, Coutinho T. Normal-Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease. Mayo Clin Proc 2016; 91(3): 343–351. Dostupné z DOI: <https://doi: 10.1016/j.mayocp.2015.12.007>.

National Institute of Diabetes and Digestive and Kidney Diseases. Overweight and Obesity Statistics. Dostupné z WWW: <https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity>.

Kelly AS, Barlow SE, Rao G et al. [American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology]. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128(15): 1689–1712. Dostupné z DOI: <http://dx.doi.org/10.1161/CIR.0b013e3182a5cfb3>.

Ochoa-Moreno I, Taheem R, Woods-Townsend K et al. Projected health and economic effects of the increase in childhood obesity during the COVID-19 pandemic in England: The potential cost of inaction. PLoS One 2024; 19(1): e0296013. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0296013>.

UK Parliament. House of Commons Library. Obesity Statistics. Dostupné z WWW: <https://commonslibrary.parliament.uk/research-briefings/sn03336/>.

CDC. Chronic Diseases. Fast Facts: Health and Economic Costs of Chronic Conditions. Dostupné z WWW: <https://www.cdc.gov/chronicdisease/about/costs/index.htm>.

World Obesity. Economic impact of overweight and obesity set to reach 3.3% of global GDP by 2060. Dostupné z WWW: <https://www.worldobesity.org/news/economic-cost-of-overweight-and-obesity-set-to-reach-3.3-of-global-gdp-by-2060>.

Úrad verejného zdravotníctva SR. Svetový deň obezity 2021. Dostupné z WWW: <https://www.uvzsr.sk/web/uvz/svetovy-den-obezity-4-marec>.

Orechovská A. Manažment obezity v ambulancii všeobecného lekára. MPH práca. 2023.

Cleveland Clinic. Class III Obesity (Formerly Known as Morbid Obesity). Dostupné z WWW: <https://my.clevelandclinic.org/health/diseases/21989-class-iii-obesity-formerly-known-as-morbid-obesity>.

Skinner AC, Ravanbakht SN, Skelton JA et al. Prevalence of Obesity and Severe Obesity in US Children, 1999–2016. Pediatrics 2018; 141(3): e20173459. Dostupné z DOI: <http://dx.doi.org/10.1542/peds.2017–3459>. Erratum in: Pediatrics 2018; 142(3): e20181916. Dostupné z DOI: <http://dx.doi.org/10.1542/peds.2018–1916>.

Olišarová V, Tóthová V, Bártlová S et al. Cultural Features Influencing Eating, Overweight, and Obesity in the Roma People of South Bohemia. Nutrients 2018; 10(7): 838. Dostupné z DOI: <http://dx.doi.org/10.3390/nu10070838>.

Vozarova de Courten B, de Courten M, Hanson RL et al. Higher prevalence of type 2 diabetes, metabolic syndrome and cardiovascular diseases in gypsies than in non-gypsies in Slovakia. Diabetes Res Clin Pract 2003; 62(2): 95–103. Dostupné z DOI: <http://dx.doi.org/10.1016/s0168–8227(03)00162–1>.

Dolinska S, Kudlackova M, Ginter E. The prevalence of female obesity in the world and in the Slovak Gypsy women. Bratisl Lek Listy 2007; 108(4–5): 207–211.

Fedacko J, Pella D, Jarcuska P et al. [HepaMeta Team]. Clinical and biochemical determinants of metabolic syndrome among Roma and non-Roma subjects in the eastern part of Slovakia. Cent Eur J Public Health 2014; 22(Suppl): S75-S80. Dostupné z DOI: <http://dx.doi.org/10.21101/cejph.a3905>.

Simko V, Ginter E. Short life expectancy and metabolic syndrome in Romanies (gypsies) in Slovakia. Cent Eur J Public Health 2010; 18(1): 16–8. Dostupné z DOI: <http://dx.doi.org/10.21101/cejph.b0011>.

Kocsis É , Feith HJ. A comparative study of the Hungarian-speaking Roma population living in the Carpathian Basin with regard to obesity during the COVID-19 pandemic. DHS 2024; 6(1): 1–10. Dostupné z DOI: <http://dx.doi.org/10.1556/2066.2022.00047>.

Macejova Z, Kristian P, Janicko M et al. The Roma Population Living in Segregated Settlements in Eastern Slovakia Has a Higher Prevalence of Metabolic Syndrome, Kidney Disease, Viral Hepatitis B and E, and Some Parasitic Diseases Compared to the Majority Population. Int J Environ Res Public Health 2020; 17(9): 3112. Dostupné z DOI: <http://dx.doi.org/10.3390/ijerph17093112>.

Sedova L, Tothova V, Novakova D et al. Qualification of Food Intake by the Roma Population in the Region of South Bohemia. Int J Environ Res Public Health 2018; 15(2): 386. Dostupné z DOI: <http://dx.doi.org/10.3390/ijerph15020386>.

Lazarevich I, Irigoyen Camacho ME, del Consuelo Velázquez-Alva M et al. Relationship among obesity, depression, and emotional eating in young adults. Appetite 2016; 107: 639–644. Dostupné z DOI: <http://dx.doi.org/10.1016/j.appet.2016.09.011>.

Annesi JJ, Johnson PH. Emotional eating: A treatment-worthy construct, or artifact of relations between mood and eating behaviors in younger and older women with obesity. Scand J Psychol 2021; 62(2): 193–202. Dostupné z DOI: <http://dx.doi.org/10.1111/sjop.12685>.

Dakanalis A, Mentzelou M, Papadopoulou SK et al. The Association of Emotional Eating with Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence. Nutrients 2023; 15(5): 1173. Dostupné z DOI: Dostupné z DOI: <http://dx.doi.org/10.3390/nu15051173>.

Shriver LH, Dollar JM, Calkins SD et al. Emotional Eating in Adolescence: Effects of Emotion Regulation, Weight Status and Negative Body Image. Nutrients 2020; 13(1): 79. Dostupné z DOI: <http://dx.doi.org/10.3390/nu13010079>.

Dakanalis A, Clerici M, Caslini M et al. Predictors of initiation and persistence of recurrent binge eating and inappropriate weight compensatory behaviors in college men. Int J Eat Disord 2016; 49(6): 581–590. Dostupné z DOI: <http://dx.doi.org/10.1002/eat.22535>.

Dakanalis A; Clerici M, Bartoli F et al. Risk and maintenance factors for young women’s DSM-5 eating disorders. Arch Women Ment Health 2017; 20(6): 721–731. Dostupné z DOI: <http://dx.doi.org/10.1007/s00737–017–0761–6>.

Rahme C, Obeid S Sacre H et al. Emotional eating among Lebanese adults: Scale validation, prevalence and correlates. Eat Weight Disord 2021; 26(4): 1069–1078. Dostupné z DOI: <http://dx.doi.org/10.1007/s40519–020–01001–7>.

Godet A, Fortier A; Bannier E et al. Interactions between emotions and eating behaviors: Main issues, neuroimaging contributions, and innovative preventive or corrective strategies. Rev Endocr Metab Disord 2022; 23(4): 807–831. Dostupné z DOI: <http://dx.doi.org/10.1007/s11154–021–09700-x>.

Nogueira-de-Almeida CA, de Almeida CCJN, Pereira NI et al. Obesity as a Presentation of Munchausen Syndrome by Proxy. J Trop Pediatr 2018; 64(1): 78–81. Dostupné z DOI: <http://dx.doi.org/10.1093/tropej/fmx027>.

Carr-Gregg M. Psychické problémy v dospívaní. Portál: Praha 2012. ISBN 978–80–262–0062–8.

Krieglerová M. Záměrné sebepoškozování v dětství a adolescenci. Grada: Praha 2008. ISBN 978–80–247–2333–4.

Gratz KL. Risk Factors for and Functions of Deliberate Self-Harm: An Empirical and Conceptual Review. Clinical Psychology Science and Practice 2023; 10(2): 192–205. Dostupné z DOI: <https://doi.org/10.1093/clipsy.bpg022>.

Thomas TA, Tilk K, Klassen K et al. Self-Harm Before and Six Months After Obesity Surgery. Obes Surg 2024; 34(10): 3579–3591. Dostupné z DOI: <http://dx.doi.org/10.1007/s11695–024–07439–3>.

Darbor KE, Lench HC, Carter-Sowell AR. Do People Eat the Pain Away? The Effects of Acute Physical Pain on Subsequent Consumption of Sweet-Tasting Food. PLoS One 2016; 11(11): e0166931. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0166931>.

Faith MS, Butryn M, Wadden TA et al. Evidence for prospective associations among depression and obesity in population-based studies. Obes Rev 2011; 12(5): e438–453. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1467–789X.2010.00843.x>.

Luppino FS, de Wit LM, Bouvy PF et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67(3): 220–229. Dostupné z DOI: <http://dx.doi.org/10.1001/archgenpsychiatry.2010.2>.

Blasco BV, García-Jiménez J, Bodoano I et al. Obesity and Depression: Its Prevalence and Influence as a Prognostic Factor: A Systematic Review. Psychiatry Investig 2020; 17(8): 715–724. Dostupné z DOI: <http://dx.doi.org/10.30773/pi.2020.0099>.

37. Magkos F, Fraterrigo G, Yoshino J et al. Effects of Moderate and Subsequent Progressive Weight Loss on Metabolic Function and Adipose Tissue Biology in Humans with Obesity. Cell Metab 2016; 23(4): 591–601. Dostupné z DOI: <https://doi.org/10.1016/j.cmet.2016.02.005>.

38. Garvey WT, Mechanick JI, Brett EM et al. [Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines]. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract 2016; 22(7): 842–884. Dostupné z DOI: <https://doi:10.4158/EP161356.ESGL>.

39. Gregg EW, Jakicic JM, Blackburn G et al. [Look AHEAD Research Group]. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016; 4(11): 913–921. Dostupné z DOI: <https://doi: 10.1016/S2213–8587(16)30162–0>.

40. Lean ME, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018; 391(10120): 541–551. Dostupné z DOI: <https://doi: 10.1016/S0140–6736(17)33102–1>.

Fábryová Ľ (ed) et al. Klinická obezitológia. Facta Medica 2023. ISBN 9788088056164.

Fábryová Ľ. Zhodnotenie súčasnej situácie a možností v manažmente obezity na Slovensku. Diab Obez 2023; 23(45): 22–28.