DR. SHEIKH MANSOOR AND DR. VIKAS SHARMAIntervention of diet & eating habits: Weight loss diet through improved quality of nutrition exempted direct energy restriction with general recommendation of 1200 Kcal/day for women & 1500 Kcal/day for men. Additionally, low carbohydrate diets or low-fat diet may reduce weight 7.25 Kg or 7.27 Kg after one year respectively. Further, low glycemic index diets help to improve insulin resistance as well as triglyceride concentration, but it sometimes converts to unhealthy like high-fat snacks or food having a low glycemic index.Dietary approache to Stop Hypertension: Research supported by the US National Institute of health, was used to reduce the blood pressure without medication. This diet is also significantly used to control other risks of several disorders like stroke, cardiac disease, obesity, kidney stone and diabetes etc. DASH diet for obesity is designed to control belly fat especially, manage metabolic syndrome and other causing disease. DASH diet that focuses on using low fat/fat-free dairy products fruits, vegetables and whole grains such as nuts, beans low-fat meat, eggs etc., with low or negligible intake of refined grains & foods.Mediterranean diet: It mainly constitutes plant-based foods, healthy fats like olive oil instead of butter, herbs and spices. White meats are used two times in a week while red meats should be eaten in a month. Metabolic Syndrome Reduction in Navarra (RESMENA) diet is quite similar to the Mediterranean diet but it also includes anti-oxidant capacity and various meals/day.Macro-nutrients: Intake of high protein diet along with fat-free or low-fat consumption, foods belong to hypoglycemic index and avoidance of high carbohydrate diet. Low fat diet contains a low concentration of low-density lipoprotein and high-fat diet is composed of low concentration of triglycerides and high concentration lipoprotein of high density.Physical activity: Sedentary persons with obesity are advised with improved aerobic physical exercise such as brisk walk is advice for more than 150 minutes a week. Moderate exercises are significantly effective help to reduce risk of diabetes and cardiac disorder but independent of weight reduction obese adult. Regular physical exercise at least for 12 months along with dietary involvement leads to a reduction in weight. At least 1-1.5 hr/day regular physical exercise leads to maintain healthy body weight.Pharmacotherapies: Generally interference of various model of care in the behavioural way of living style such as intake of proper healthy food, low calorie, control of sedentary lifestyle and improve regular physical exercise etc. have developed only limited effect on obese persons.For efficient control of severe and complicated obesity, we need to consider pharmacotherapy, which include liraglutide agonist of glucagon-like peptide 1-receptor which issued to control glycemic effect in obese patients (3mg/day subcutaneously administer for 56 days). The medicinal therapies are recommended to moderate or high-risk obese patient i.e., BMI of more than 27 kg/m2 or 30kg/m2Surgical approach: Bariatric surgery can be a sword on two-edged facilitated approach for attaining long-term weight loss. It has significant efficacy and improvement of safety profile for treatment of complicated and severe obesity besides help to control other obesity-related disorders. On exposure to the gut, energy balance and metabolism of obese patients are majorly changed. Based on NICE guidelines, bariatric surgery is advised to the obese patients at BMI? 50kg/m2 while according to international diabetes federation, surgery is recommended to a patient with T2DM and the BMI > 40kg/m2. First bariatric procedure i.e. LAGB (Laparoscopic adjustable silicone gastric banding) was related to laparoscopic technique. LAGB is significantly applicable in clinical practice in Europeans & Australian areas. A bariatric procedure like sleeve gastrotomy, standard RYGBP (Roux-en-Y gastric bypass), laparoscopic gastric banding and BPD-DS (biliopancreatic diversion with duodenal switch) as well are applied in this technique. The major challenges of this surgery (in various countries) are the requirement of equitable access for obese patients as it is mainly availed in the private sector. Obesity-related complications like fatty- liver disease, high blood pressure and dyslipidemia etc. can be improved concerning weight loss. Among several studies, only one death was found to be reported during bariatric surgery via laparoscopic technique while a 6.7-24 per cent rate was recorded for re-operation through this technique (Roux-en-Y gastric bypass group) and a banded group of laparoscopy was 3.3-34 per cent. Lifelong precautions are required like replacement therapy and regular monitoring due to vitamins or mineral deficiencies. In these advanced techniques regain weight while remodelling of surgery can increases risk.
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