Datum objave: 9/13/2010 Weight loss Obesity or fatness is defined as an unhealthy condition of the organism characterized by excessive bodily fat pileups. Due to the increased body weight, many clinical complications arise which reduce the quality of life, work ability and life expectancy of the patients. Obesity is the most common disease in the developed countries nowadays, dependent on a number of factors (socio-economical, cultural, genetic, psychological and physiological), which makes its treatment complex. To many people, obesity is still only an aesthetic problem because obesity “doesn’t hurt”, however, once the obesity caused complications appear, aesthetics becomes irrelevant. The main harmful consequences of obesity are the increased risk of: Type 2 diabetes Arterial hypertension cardiovascular diseases cerebrovascular diseases gastrointestinal diseases dyslipidemia (increased triglyceride level, reduced HDL cholesterol) degenerative joints disease feet deformation gynecological problems malign tumors hormonal imbalance psychological problems Excessive body mass and obesity definition For obesity and excessive body mass classification we usually use the Body Mass Index (BMI), which evaluates the fat percentage in the body. BMI calculation: BMI can be calculated by dividing the body mass (in kilograms) with the height (in meters) squared. Classification BMI (kg/m2) Low body mass <18.5 Normal body mass 18.5 – 24.9 Excessive body mass 25 – 29.9 First degree obesity 30 – 34.9 Second degree obesity 35 – 39.9 Third degree obesity >40 Body mass represents the balance of all the calories ingested into the organism in the form of food, and the energy spent on everyday activities. In order to achieve weight loss, the energy spent must be higher than the energy ingested. Therefore, weight loss can be achieved either by less calories ingested, or more energy spent. The most effective method is a combination of the two. Starvation or dieting on only one type of food is not healthy and therefore not recommended. Your goal should be a quick weight loss, but rather, gradual weight loss with permanent changes to the way of life and dietary preferences. The calorie intake must be reduced by 600 kcal and the diet should be regular and healthy. Breakfast skipping slows down the metabolism, and with a late breakfast, starvation occurs and we ingest a lot more food than needed. The extra calories are stored in reserves by our liver, and that is the lard. In the subcutaneous adipose tissue, many harmful substances are stored, and once degraded and suddenly absorbed into the bloodstream, the concentration of harmful substances increases. To alleviate such effect, large amounts of liquids are necessary, water for best effect, in order to flush and dissolve the toxins from the organism. The most difficult part of the weight loss process is maintenance. The general opinion is that a period of two to five years of healthy dieting must pass in order to consider weight loss a permanent achievement. Excessive body weight reduction and maintenance is based on the combination of the following: diet with 600 kcal less energy than required regular physical activity (cycling, speed walking) for at least half an hour a day lifestyle changes There is a wide variety of weight loss supplements on the market. Caution is recommended when choosing the right one because some of them may be ineffective and even harmful. That is why the pharmacy is the right place to get your lifestyle changes advice and supplements which will facilitate your intentions. It is very important to point out that there is no miracle substance, the only miracle is your own will power, determination and persistence which will make you the winner in your fight against obesity! Dietary supplements for weight loss Products which reduce hunger and create the sensation of satiety Various fiber and herb rich preparations should be used before meals with plenty of liquid. The fibers absorb the liquid, swell in the stomach and slow down digestion and provide a sensation of satiety. You should be careful about the amount of liquid because too much may cause flatulence and diarrhea. Indian Fig (Opuntia ficus indica, Cacteaceae) Psyllium (Plantago ovate, Plantaginaceae) Garcinia, (arcinia cambogia, Clusiaceae) – its effect is based on the presence of hydroxycitrates which is assumed to inhibit the enzyme ATP citrate lyase. It causes elevated glycogen levels and hunger prevention. It is also believed that this plant stimulates thermogenesis (fat tissue burning). There are indications of harmful effects of hydroxycitrate on the liver, so some manufacturers do not recommend it to diabetics, dementia patients and pregnant and breastfeeding women. Algae (Kelp, Spirulina, Fucus Algae) Fat absorption reduction agents Compounds of herbal origin (pectins and fibers) and of animal origin, connect to the fat and prevent digestion and bloodstream absorption. Apple (Malus domestica, Rosaceae) – is very rich in fat absorbing fiber, it lowers the insulin levels in the bloodstream and in that manner reduces hunger. The best option is fresh apples ingestion; however, there are other forms (tablets, flakes and effervescent tablets) and various types of apple cider. Indian Fig (Opuntia ficus indica, Cactacaeae) – other than creating a sensation of satiety, it contains significant quantities of fibers which connect to the fat and prevent absorption. Chitosan is a polysaccharide which is found in cellular membranes of mushroom and shells of some animals. Its activity is based on its fat connection abilities. It is assumed that it reduces fat absorption from the gastro-intestinal tract. Scientific examination failed to prove chitosan effectiveness, and yielded some serious side effects. Caution is recommended. Products which stimulate fat burning and energy release Chlorogenic acid – is the main ingredient of green coffee extract based preparations. It is believed to reduce glucose release into circulation which increases fat burning and fat tissue loss. The manufacturers claim that its effectiveness has been clinically proven, but no significant clinical studies have been found in the literature to substantiate this claim. L-carnitine is produced from amino acids and methionine. It enables the use of fat for energy production and muscle activity. Its name comes from the fact that it was first discovered in meat. In normal circumstances, the human body produces sufficient amounts of it. There are indications that it increases durability therefore it is recommended half an hour prior to training. Daily dosage should not exceed 400mg. CLA – conjugated linoleic acid is a biological active matter which participates in fats metabolism, stimulates the transformation of fats into energy. CLA, according to some claims, reduces the amount of fat stored after meals and stimulates fat degradation in fat cells. It also stimulates fats metabolism and reduces the total number of fatty cells. The majorities of studies so far have been conducted on animals and prove that CLA does in fact reduce fats, increase metabolism and reduce energy intake. However, no evidence of effectiveness in obesity treatment has been found. A dosage of over 3gr is recommended. Citrus aurantium, Rutaceae – bitter orange – it contains synephrine, a compound similar to ephedrine but of slightly less intensity. It stimulates the energy release from the fats. Some side effects are possible (blood pressure increase, insomnia and headache) therefore, strict caution is recommended in its use. Caffeine (Coffeae Arabica, Rubiaceae- coffee) (Paullinia cupana, Sapindaceae – guarana) (Ilex paraguariensis, Aquifoliaceae – mate) Caffeine stimulates fat release from fatty cells and includes it in energy production. Caffeine increases durability because it spares on carbohydrates and proteins as energy sources so it is frequently used by athletes. Certainly, the negative effects of caffeine should be taken into consideration, primarily its negative effect on the cardiovascular system and blood pressure and rhythm effect. Green tea (Camelia sinensis, Theaceae) also contains caffeine which is why it releases heat and helps with fat burning which is one of the duties of the catechin polyphenol content. Detoxification agents Those are the agents which stimulate liquid excretion and with it the dissolved waste material which helps kidney and liver function. Liver function is affected by: nettle, artichoke and dandelion and kidneys by parsley, distaff and birch. While using these plants, it is necessary to drink plenty of water and take good care of electrolyte balance. It is important to notice that these agents stimulate liquid excretion and not fatty tissue reduction, so their obesity treatment application is only partially justified. Metabolism boosters Chromium picolinate – acts on sugar usability by increasing insulin activity. Active insulin, as opposed to the inactive one, stimulates fat degradation. Herbal teas During the weight loss process, various combinations of herbs are commonly used. The herbs used for those purposes are usually laxatives and diuretics (Urticae folium, Sennae folium, Betulae folium, Frangulae cortex). They, in fact, stimulate waste material excretion by increasing urination and bowel movement stimulation, and have no effect on calorie absorption from the food. Therefore, extreme caution is necessary in their use, because excessive use may cause diarrhea, electrolyte imbalance due to increased urination, and all that, with no weight loss effect whatsoever. Homeopathic preparations Homeopathic preparations can be bought in pharmacies which help regulate body weight. Medicines to help weight loss Orlistat Acts in combination with a low-calorie diet with less fat content and helps reduce body weight. It doesn’t affect the appetite; it acts in the digestive system, preventing fat absorption. Since undigested fats cannot be absorbed, they are excreted from the body. This medicine is only active in the stomach and intestines and doesn’t have any systematic effect. Orlistat can be used by person over the age of 18 with a BMI of 28 kg/m2 or more. Orlistat may reduce fat soluble vitamin absorption (vitamin A, D, E, K). This is why multivitamin supplements are recommended in combination with Orlistat use. This medicine is not recommended to pregnant and breastfeeding women who are already on medication. Seek medical counseling from your doctor of pharmacist before use. Basic weight reduction process guidelines (recommendations from the Obesity Prevention Association) Follow the advice on proper diet and physical activity daily, with individual adjustments. Continually keep track of your program. Make a note of all the food ingested, time, quantity and sensations during and after the meal. Note any difficulties or revelations on your habits and needs. Do not attempt to lose weight “over night” or think that someone else can solve your problems. The weight loss process should be gradual and well defined, and results are achieved over longer time periods. Introduce your entourage with your program and ask them for help and support. If possible, join a weight loss group. For all the problems that appear unsolvable, seek professional help. Keep your health in mind; let it be you ultimate goal. Do not allow physical appearance to set limitations for you. You are a person of your own, your physical appearance is a part of your personality, and is conditioned by a number of factors, some of which cannot be changed. Be aware of the bad habits you have adopted and decide whether you are ready to substitute them with new ones. Make sure you give it time and patience. Allow yourself to deviate from your goal and slack on prescribed activities. However, always keep in mind that only persistence and patience can yield permanent results. By adopting new positive habits, you make changes to your life which will affect your health and your waist. Everything should be gradual. Nothing is impossible if you decide with “I will and I can”. Share your problems with a pharmacist, he will support your decision to lose weight and change your life habits. Key to this process is will and persistence, and the pharmacist will direct you onto a healthy and safe way of achieving your goals of weight loss and general health and life quality improvement.