sábado, 5 de marzo de 2016
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Obesity is one of the major public health problems at present, its origin is multifactorial and complex. In this article are reviewed comprehensively the aspects related to the importance of obesity as a problem of health, its pathophysiology as well as their determinants. On the other hand dealt with the successes and failures of different dietary regimens used in the treatment of this disease, the beneficial effects of very low-calorie diets and in particular the diet of Cambridge; not only in the reduction of body weight, but also on the improvement of the clinical pictures of other diseases related to the obesity, such as hypertension, type 2 diabetes mellitus and the Dyslipidemia, as well as the substantial decrease in the doses of drugs used in their control.
DeCS descriptors: Obesity/diet therapy; DIET reducing/methods; LOSS OF WEIGHT.
Obesity has become one of the major public health problems. It is a real disease whose origin is multifactorial and complex. It reflects a disorder of the regulation of appetite and energy metabolism (which involves factors pathophysiological and biochemical, genetic and hereditary factors and cultural environment-related psychosocial factors).
The obese has also 2 special features: the first is the intense effort that makes to stop the disease, the second is discrimination which can padecer.1 the general public and even some doctors often experienced are inclined to consider obesity as a problem of lack of will; He eats too much or is not enough physical activity. However, several million people in Europe are striving to lose weight using a diet and most of the times is to improve their appearance. Unfortunately the results are disappointing. The statistics support if the majority of candidates in the process of thinning lose an average of 10% of their body weight, returning to win the two-thirds in the next year and the third in the five years that follow.
All these facts demonstrate that isolated slimming methods are generally ineffective in the long run.
New perspectives
While the candidates most want to lose weight for aesthetic purposes, experts underline as more important improvement in obesity-related complications. In a more specific way, one can say that the objectives of the treatment of obesity have moved from simple weight loss isolated aesthetic goal, towards global management of a best or optimal health. This new concept includes weight loss, but is not limited to this. As a result, a program management for weight loss may be considered as effective if the patient responds favorably to one or more of the following strategies:
The prevention of fat.
The improvement of the associated complications.
The improvement of the General rules on health and hygiene of life.
The stable weight loss long term.
Achieve their goals is the joint of the patient and the health professional responsibility knowing that you whatever the value of the program, only the patient can put it into practice.
The prevention of fat
For the obese the first objective is to stop the fat, which is not insignificant in this disease that tends to get worse.
For the subject in overweight, the first objective is identical, prevent overweight turns into obesity.
To the subject of normal weight, you should know that with age, the natural tendency is to get fat.
Any program that allows you to keep the same weight for a decade can be considered as effective.
Improvement of the associated complications
For an obese 10 to 15% of the initial weight loss often leads a reduction of these complications. A modest weight loss, 5-10 kg in one year, can engender a 25% reduction in mortality risks.
This improvement is evidenced by the reduction at least one of the following complications:
High blood pressure.
Hyperlipidemia (LDL-cholesterol, triglycerides).
Pre-diabetes, diabetes (DNID).
Sleep apnea.
Arthritis of the joints that support the weight.
Depression.
The improvement of the health and hygiene of life rules
It is a set that includes:
Acquire the knowledge base on health and hygiene of life.
Engage in improving their eating habits by eating balanced at least 4 d on 7.
Regularly consult your doctor, especially if the purpose of the weight loss has not been reached.
Improve the self-love and their attitudes regarding their responsibility.
Long term stable thinning
The return to an 'ideal' body mass index was long considered by the medic profession
Is called a variety of diet which keeps proteins (protein-sparing modified fast: PSMF) a VLCD constituted of traditional foods of less than 600 kcal high protein calories (minimum: 1.5 g/kg of ideal weight).3
Is flame diet protein a VLCD with high content of protein and very low in glucidos.4
History: a quarter century of scientific studies
The use of protein-based diets is not new. Evans and Strang5, 6 published a series of works between 1929-1931, where he proclaimed that a diet low in calories of 400-600 kcal could be used safely in the treatment of obesity. Later the Simeons7 diet was used without limits by many doctors, along with injections of human chorionic gonadotropins (HGG). The diet contained around de600 kcal and consisted of meat or fish, vegetables, toasted bread, fruits. Such poor diets energy, certain natural foods still very poor from the energy point of view, still are used, for example in japon.8
Since 1970 research programs fairly extended on that kind of diet have been developed in several countries. The strongest defender of fasting with supplement-protein has been the Group Blackbun, 3 who gave the patients 100 g of casein/d with a mineral supplement. Weight loss achieved was not different from that observed in complete starvation. The concept is good and effective. By fate when it was developed commercially under the name of "liquid protein diets", the misinterpretation of requirements led to the disaster. Commercial preparations were based on hydrolysates, formed by leather of cow, collagen and gelatin, which is adicionaba them artificial flavouring and saccharin. Proteins included in such diets were from the nutritional point of view of low biological quality and did not contain a proper balance of essential amino acids; vitamins and minerals were not included. They followed several deaths, 10 of them showed that they were definitely linked to the diets of "liquid protein".9
Clinical reports and autopsies seems to be that the deaths may have been a result of the poor quality of the protein (absence of essential amino acids), a shortage of electrolytes (mainly potassium), or vitamins; or a combination of these effects. These "liquid-protein" diets were all retired almost 20 years ago. Since there was no similar products available.
It is important to appreciate that in the current very low calorie diets (Cambridge diet) all these factors have been corrected or rectified. Therefore modern diets of this type have no similarity to "protein-liquid" commercial diets. On the other hand in many studies have not been demonstrated none of electrocardiographic changes found with "protein-liquid" diet.
Coupled with additional metabolic studies under the supervision of Dr. McLean Baird in West Middlesex Hospital, subsequently created an obesity clinic for non-hospitalized patients, dependent of the Faculty of medicine at Addenbrookes Hospital, Cambridge. But next to these studies in the West Meddlesex Hospital in London and Cambridge, the diet was very studied by physicians in many other centres in Great Britain, Europe and the USA, during the first half of the Decade of the 1980s. Some of these studies were concerned with aspects as important as extensive clinical experience of the use of the diet. Others were geared towards more intensive patient groups research. These studies have included, among others, the effects of diet on the ECG, electrolytes, blood pressure and plasma lipid levels. Several were concerned about the use of diet in patients with other disorders, particularly those with diabetes.
In December 1987, the Department of health of the United Kingdom issued the report of the Working Group on diets very low in calories of the Committee aspects doctors of policy of Alimentos.10 within the recommendations in this report were (paragraph 9.3.1): "preparations for very low-calorie diets shall provide a minimum of 400 kcal per day for women and 500 kcal for men and women high (173 cm in height). Also they shall provide respectively 40 and 50 g per day of the appropriate proteins."
In the United States, the National Task Force formed to report on the prevention and treatment of obesity examined the VLCD and published his findings in 1993. Their findings supported this type of dietary therapy and said: "the current VLCD generally safe when used under medical supervision appropriate, in moderately and severely obese individuals (IM body mass index
This also implies an unstable cardiovascular system with the same regulations applied to myocardial infarction.
Pregnancy and breastfeeding
The requirements of the body's proteins, minerals and vitamins are increased during pregnancy and breastfeeding. On the other hand, any interference with normal living is now considered undesirable. Therefore, dieting during pregnancy contraindicated. The VLCD can, however, be used as a nutritional supplement for this. If deemed essential during lactation, 4 envelopes of the VLCD can be taken; each envelope must be reconstituted with 6 ounces of milk skim instead of water. This will provide almost 70 g of protein a day, just by enzyme of the RDA recommendations of the United Kingdom for women who are breastfeeding, together with the RDA for vitamins and minerals in a caloric intake of almost 800 kcal.
Children
The Council of the author of this work is that the diet should not be used for weight loss before the age of 12, but should also be used with caution in the following 2-3 years, if there is a rapid growth. The diet contains adequate amounts of protein, but does not cover the additional needs of the growths. If it is essential that a diet is used in early adolescence, this must be modified as recommended to women who are breastfeeding, but only under strict medical supervision. Diet can, however, be used as a nutrional supplement for children of all ages if required.
The weight loss phase
During the first 24 h with the diet, takes place the depletion of glycogen storage, this leads to a loss of 3 to 4 times the weight of the water that is normally associated with glycogen stores. The contents of the digestive tract absorbs and is used, alternately it is excreted, as a result of water that is released from glycogen stores, there is a marked diuresis. All of these factors lead to a net loss of fluid from the body, despite the advice to drink lots of fluids. Consequently, almost all experiences weight loss initial cheering to maintain the diet.
It is important to appreciate that any effective diet is accompanied by an initial depletion of glycogen, associated with the Elimination of liquids or diuresis and an initial loss of weight in the first few days. This is the reason of the diet published in women's magazines are effective in the first week. However, the effect is more due to the loss of glycogen and water, not fat. The following days can be very uncomfortable for that is to diet. At this stage some present hunger (ketosis still has not happened) and also weight loss is often low in the next few days. Also at this stage, it is possible that fluid intake is not maintained high level required, so side effects may appear. The third day of the diet is considered the worst day.
Once this phase is complete, the typical reaction is a weight loss that averages around 1.4 to 1.8 kg per week, although this varies form marked from one person to another and from one week to another in the same person. In the studies only 1.0 kg weight loss found per week in those that his weight was regularly controlled during the diet. However, when there are people who do not progress in their weight loss in general is, in the author's experience, to be not complying with the diet.
To reach the desired weight, it is usual that weight lowering speed is slower. This is probably partly a phenomenon natural due to a lower metabolism and in part by the fact that many people supplement food intake to a greater or lesser degree in this phase, for the hassle of keeping a diet.
The normalization phase
The change in diet "single source" to the introduction of another type of food is a critical period and requires careful monitoring.
There are advantages if possible, carry the weight during the stage of loss 1-2 kg below "acceptable weight", and explain the reasons for doing this to the person making the diet. Effecting change of phase from the phase of maintenance of weight loss it will diminish the degree of initial weight gain and it will slow it, but physiology is such that an increase of 1 to 2 kg cannot be avoided. This occurs automatically when the glycogen reserves are restored. However, the person who makes the diet will be really excited if the weight in any case does not increase above the acceptable weight when the change has been completed. This is the first stage of the rehabilitation.
During the stage of change the continuous use of the diet is of supreme importance. Once without the diet as the sole source of food, the person who does it should continue ingeriendola 3 times a day and suplementarla.
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