Nutrition in Obesity

What is Obesity?

Obesity , popularly known as obesity, is a disease that occurs as a result of excessive fat accumulation in the body. The energy that obesity patients receive from daily food is more than the energy consumed. The biggest cause of obesity is a sedentary lifestyle and unhealthy eating habits. Obesity, which is a risky disease on its own, can cause cardiovascular diseases, respiratory system diseases, hormonal diseases, etc. It also causes many diseases. Especially heart diseases, fatty liver, sleep apnea, excessive hair growth, depression, diabetes, high cholesterol, high blood pressure, infertility, menstrual irregularity, some types of cancer are some of the diseases that are directly related to obesity.

Obesity is a disease that shortens human life and reduces the quality of life. It has become a very common disease in the world today. In our country, one third of the female population and 1% of the male population are obese. The first signs  of obesity are the  increase in fat mass in the body. Other symptoms of obesity are snoring, excessive sweating, sleep apnea, joint and back pain, and infection. To understand whether a person is obese, body mass index must be calculated. According to the World Health Organization, people with a body mass index of 30 and above are considered obese. Those with a body mass index of 40 and above are called morbid obesity, and those of 50 and above are called super-morbid obesity.

How should nutrition be in obesity?

Losing weight with a low-calorie and healthy diet is the most accurate method in the treatment of obesity. 45-65% of the daily energy needs of an obese person should be met from carbohydrates, 20-35% from fat and 10-35% from protein. Obese people need help from a specialist to lose weight. The eating habits of people with obesity symptoms should be as follows:

• The day should definitely start with breakfast.
• Small and frequent feeding should be made a habit. Thus, the metabolism works continuously and weight loss becomes easier.
• Snacks should be consumed. Meals should not be skipped.
• Food, tv, phone, chat etc. It should be consumed slowly, not accompanied by a calm environment.
• Every meal should have a variety of foods. In other words, a meal should include vegetables-fruits, bread-cereals, meat, eggs, legumes, milk and dairy products.
• At least 2-2.5 liters of water should be consumed per day.
• Physical activities should be done at least 3 days a week and at least 30 minutes a day.
• Portions should be reduced, there should be a limit to the foods to be consumed. Setting this limit is very important.
• Vegetable and fruit consumption should be increased.
• Consumption of whole grain foods and pulses should be increased.
• Consumption of high fiber foods should be given importance.
• Adequate protein should be taken. Processed meats, high-fat milk and dairy products should be avoided. It is necessary not to exceed the specified limit when consuming these products.
• Adequate amounts of healthy fats should be consumed.
• Dietary sugars and packaged food consumption should be reduced.

What are the conditions that cause obesity?

Conditions that cause obesity include:

• Excessive and wrong eating habits
• sedentary life
• Age, gender, education level, socio-cultural factors, income status
• Hormonal and metabolic factors
• genetic factors
• psychological problems
• Frequent very low energy diets
• Smoking and alcohol use habits
• Some drugs used
• Number and frequency of birth
• Malnutrition with breast milk

Malnutrition habits that cause obesity symptoms are as follows:

• Consuming more food than necessary and making a high-energy diet like a fast food diet a habit.
• Consuming food quickly, in large bites, with little chewing and without limits.
• Skipping meals or consuming constant snacks between meals.
• Being busy with other things while eating.
• Staying at the dinner table for a long time.
• Unlimited overeating  in situations such as boredom, stress, depression  .
• The habit of eating after waking up at night.
• Low amount of water consumed daily, turning to high-energy drinks instead of water.

Obesity Solutions by Age

Obesity prevention methods should be started in childhood. Because obesity in childhood and young adulthood is a basis for adult obesity. In order to be successful in the obesity  treatment  process, the Nutrition and Dietetics, Endocrine and Metabolic Diseases, Obesity Surgery and Psychiatry departments carry out a synchronized study and the most appropriate treatment method is determined for the patient.

During the treatment  , it is very important for the individual to be determined, not to exceed the determined limit and to participate. Obesity treatment is a mandatory, long and continuous process. With obesity treatment, it is aimed to prevent advanced obesity diseases, to gain adequate and balanced nutrition habits and to increase the quality of life. The first step in treatment is to set a realistic weight loss goal. With treatment, approximately 10% weight loss is expected in the first 6 months, and this weight loss provides the treatment of diseases caused by obesity. 5 different methods used in the treatment process of adults with obesity symptoms are as follows:

Diet Therapy

The first step in the treatment of obesity is diet therapy. With diet therapy, the body weight and height ratio is tried to be reduced to the required level. Each  dietary treatment  should be individualized. The applied diet program should be compatible with adequate and balanced nutrition. With the diet program, it is tried to give the person the right nutrition habit and make it a lifestyle. After the person reaches the desired weight with the diet program, the diet program should be arranged to maintain weight and weight gain should be prevented.

Exercise Therapy

With exercise therapy, it is aimed to reduce the fat tissue by increasing the physical activities of the person. When diet  and exercise therapy are applied together, it prevents the weakening of muscle mass. In addition, when diet and exercise are carried out together, weight gain is prevented.

It is recommended that an adult person exercise for at least 30 minutes each day.  It is imperative that people who show signs of obesity have  physical activities every day. The energy expended with exercise varies according to the weight of the person and the intensity of activity. When applying an exercise program in obese people, it is tried to create maximum efficiency and minimum risk of injury. It is important that the exercise program, which will be created by the specialist, is personal, applicable and suitable for the daily life of the person.

Behavior Change Treatment

With behavior modification therapy, it is aimed to provide a positive gain in behaviors related to eating and  physical activity that cause weight gain. Afterwards, it is aimed to make positive behaviors a way of life. The steps of behavior change treatment are:

1. self-observation,
2. stimulus control,
3. Developing alternative behavior
4. reinforcement, self-reward,
5. cognitive restructuring,
6. Social support.

Pharmacological Treatment

Drugs to be used in the treatment of obesity are not suitable for obese and morbidly obese people. Pharmacological  treatment method can be applied to super morbid obese people. The drugs used in the treatment must be used with the advice of a doctor and under the supervision of a doctor. In addition to pharmacology treatment, diet and exercise therapy should be carried out together, and the patient should attend the controls regularly.

Surgical treatment

There are two basic approaches in bariatric surgery. With bariatric surgery, which is the first approach, it is aimed to reduce the energy taken from food and nutrient absorption in the gastrointestinal tract. The treatment methods applied in bariatric  surgery are bypass, sleeve gastrectomy, gastric banding and gastric balloon.

In the second approach, reconstructive surgery, it is the process of removing fat tissues from various parts of the body. This treatment method is  an aesthetic  operation and if the person does not fulfill the requirements of the treatment, fat accumulation may occur again in the body.

The 5 methods of obesity treatment mentioned above are treatments that can be applied in adults at almost any age. However, in order for these treatments to be applied, all tests must be done and other diseases must be determined. There are surgical  treatments that cannot be applied according to age  .

In the treatment of obesity in children, diet therapy, exercise therapy and partially surgical treatment can be applied. The application of surgical treatments in children is not a preferred method in the world, but it is applied in severe cases.

In obese children, the factors  causing obesity  are investigated first and if there are diseases accompanying obesity, they are diagnosed. A nutrition and exercise program is then created for the child. However, in the diet and exercise programs created, excessive calorie restriction is avoided in children who continue to grow according to age, unlike adults.

Accompanying the age-appropriate  diet therapy with parents increases the success to be achieved. For exercise therapy, activity plans should be made in which parents can accompany their children. The child’s doctor checks should be followed regularly by the parents. In addition to all these, precautions should be taken according to age. Children’s activities during the day should be controlled by their parents, and their TV watching habits should be regulated.

What Should Obesity Patients Not Eat?

The rapidly increasing  number of obesity  patients in Turkey and in the world is a warning that we should pay attention to what we eat. Foods that obesity patients should not consume are:

• Fatty fried foods, foods containing saturated fat, and meat products cooked in oil should not be consumed.
• Simple sugar consumption should be avoided.
• Fast food and ready packaged products should not be consumed.
• Acidic, carbonated, ready-to-use beverages containing high sugar should not be consumed.
• Ready-made desserts (especially syrupy and pastry desserts) should not be consumed.
• Fatty milk and dairy products should not be consumed.
• Snacks should be avoided.
• Alcohol, cigarettes and oil-containing sauces should not be consumed.