Morbid obesity in clinical practice: current treatment concepts

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Abstract

The article discusses modern methods of treatment of morbid obesity and associated diseases. It is known that obesity leads to disability in people, including young people, due to the frequent development of severe comorbid diseases. According to current clinical guidelines, the main goals of treating obese patients are: weight loss, achieving good metabolic control, and improving the course of diseases associated with obesity. A small selection of drugs for the treatment of obesity, the need for strict adherence to indications and contraindications to their appointment, significantly limits the possibilities of drug therapy for morbid obesity. With morbid obesity, the effectiveness of conservative treatment is only 5–10%. Up to 60% of patients cannot maintain the result of weight loss within 5 years of observation. Long-term use of bariatric surgeries, the purpose of which was initially to reduce body weight in patients with morbid obesity, showed certain possibilities of surgery in compensating for a number of diseases associated with obesity. Therefore, at present, the concept of bariatric surgery is not only to reduce the patient’s weight, but also to achieve beneficial metabolic effects (normalization of glycemia, lipid metabolism). In this regard, modern bariatric interventions are united by the term “metabolic surgery”. It has been proven that compensation of non-insulin-dependent diabetes mellitus after bariatric interventions is observed in 42–95% of patients, depending on the type of surgery, duration of non-insulin-dependent diabetes mellitus and basal C-peptide level. As a result of many years of research, bariatric surgery has allowed for the first time to formulate the term “remission of non-insulin dependent diabetes mellitus”.

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About the authors

Kristina A. Anisimova

Рavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: anisimova-k-a@mail.ru

Surgeon of the Surgical Department No 2

Russian Federation, Saint Petersburg

Dmitrij I. Vasilevsky

Рavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: vasilevsky1969@gmail.com

MD, PhD, Dr. Sci. (Med.), Professor, Department of Faculty Surgery

Russian Federation, Saint Petersburg

Stanislav G. Balandov

Рavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: vesikaada@gmail.com

MD, PhD, Head, Surgical Department No. 2.

Russian Federation, Saint Petersburg

Zarina M. Khamid

Рavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: zarina.hamid@yandex.ru

Surgeon of the Surgical Department No. 2 of the Research Institute for Surgery and Emergency Medicine

Russian Federation, Saint Petersburg

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Copyright (c) 2020 Anisimova K.A., Vasilevsky D.I., Balandov S.G., Khamid Z.M.

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