Tactics of a general practitioner for comorbid pathology in an obese patient

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Introduction. In the last decade, scientists around the world have paid attention to comorbid patients, because The management tactics for such patients differ sharply from the treatment of other patients [1]. And one of the leading comorbid conditions is obesity due to the fact that it is a companion to a wide range of therapeutic diseases. The number of obese patients is steadily growing in Russia and around the world. According to the latest data, in the country as a whole, overweight is observed in 47.6% of men and 35.6% of women, obesity – in 19% and 27.6%, respectively. The Voronezh region is among the top ten Russian regions in terms of the number of people suffering from obesity. It has been proven that weight loss has a positive effect on the course of somatic pathology and clinical and laboratory parameters of patients. At the same time, the role of a sedentary lifestyle and eating disorders in the formation of obesity is often pointed out. The United States retains the leading position among countries with high incidence. The prevalence of this pathology among people of different ages, gender, social status and ethnicity is growing every year throughout the world, especially this trend is becoming obvious in the developed countries of Europe, Japan, North America and Australia. WHO and the European Congress on Obesity officially reported in 2022 that in the European Region, 59% of adults and almost one in three children (29% of boys and 27% of girls) live with overweight or obesity [2, 3]. Properly structured treatment, taking into account the correction of eating behavior and comorbid pathology, is the key to successful tactics in the practice of a general practitioner. At the same time, the patient’s eating behavior and nutritional status remains underestimated. Russian scientists have proven that long-term eating disorders (high-calorie foods with low nutritional value, excess amounts of animal protein and gluten, high ratio of Omega-6 to Omega-3, etc.) are an important factor in changing the patient’s condition [4, 5, 6, 7]. In clinical practice, eating disorders lead to obesity and overweight, which are associated with various somatic pathologies. Without changing the patient's nutritional status, all attempts to solve health problems do not produce sustainable positive results [7].
The purpose of the work was to study comorbid conditions in obesity and identify types of eating disorders in them in order to improve therapeutic tactics in the management of patients of this profile.
Materials and methods of research. The study included 65 patients aged 18-50 years with a body mass index (BMI) ≥ 30 kg/m2. Heredity for somatic diseases was studied. Body weight, height, waist and hip circumferences were measured. We assessed heart rate per minute at rest (HR), measured blood pressure (ABPM), ECG/24-hour monitoring, general and biochemical blood tests (glucose, HbA1C, ALT, AST, total bilirubin and fractions, ALP, GGT, total protein, CRP , urea, creatinine, lipid profile). Ultrasound of the abdominal organs and FEGDS were performed. The type of eating behavior was determined using the DEBQ questionnaire (identification of restrictive, emotional and external types of eating behavior). The obtained data were processed statically using the statistical analysis software package Statistica for Windows 7.0, and the parametric Student test was used to assess the average values of the studied clinical and laboratory parameters in the observation groups.

Research results. The average age of the patients was 36.2±1.1 years. Men made up 56%, women 44%. All patients were divided into 3 study groups depending on the degree of obesity. Obesity of 1st degree was registered in 39% of patients, 2nd degree was observed in 41% and the share of patients with 3rd degree of obesity accounted for 20%. In patients with grade 1, cardiovascular diseases were most often recorded - 78%, GERD - 62%, pathology of the urinary system 14%, sleep apnea 6%. In these patients, according to the DEBQ questionnaire, 77% of respondents had a restrictive type of eating disorder, emotional and external types in 13 and 10%, respectively. Thus, in this group, excessive restriction and dieting contributed to the loss of cognitive self-control and led to compulsive overeating. In patients with 2nd degree obesity, a study of the hemogram characteristics showed a weak tendency towards a higher hemoglobin level, which indirectly indicated an increase in blood viscosity and impaired microcirculation, contributing to the formation of interstitial hypoxia. Among the diseases, the most frequently recorded were type 2 diabetes mellitus (22%), cardiovascular pathology (69%), gastrointestinal tract pathology (GERD - 56% and NAFLD - 38%), pathology of the urinary system - 21% and reproductive systems - 15%. This confirms the data that overnutrition, hyperglycemia and prolonged increases in blood pressure lead to inhibition of the inhibitory ability of urine regarding crystallization of oxalate and calcium phosphate in the form of a decrease in daily excretion of citrates and contribute to the formation of urolithiasis. Moreover, this group was characterized to the same extent by restrictive and emotional types of eating disorders (38% each), and the external type accounted for only 24%. A completely different picture was recorded in patients with 3rd degree obesity: the amount of cardiovascular pathology increased to 97%, GERD - 69%, type 2 diabetes mellitus was in 32%, impaired reproductive function and NAFLD - 23% each, disorders of the musculoskeletal system. musculoskeletal system in 41%, sleep apnea – 3%. When studying the hemogram parameters of the observed group, a slight tendency towards an increase in the relative number of band neutrophils was noted, which indirectly reflects the pro-inflammatory potential of metabolic disorders, as evidenced by the observations of Russian scientists. In this group of patients, among eating behavior disorders, the emotiogenic type of disorders came to the fore (68%), the proportion of other forms was small - the external type was 20%, and the restrictive type was 12%. The predominance of the emotional type of eating disorder is evidence of an inadequate response of the body to stressful situations, a manifestation of maladjustment, i.e. this category of patients is characterized by a lack of strategies for effectively overcoming negative emotions.
Conclusion. In therapeutic patients, the most common diseases are cardiovascular diseases, carbohydrate metabolism disorders, gastrointestinal diseases and reproductive dysfunctions. When studying the types of eating disorders, it was revealed that obesity is always associated with eating disorders, and with degrees 2 and 3 obesity, the emotional type of disorders is reliably often recorded, demonstrating the imperfection of methods of psychological defense and poorly controlled emotionality. These grade 1 obese patients exhibited a restrictive pattern of eating disorder, demonstrating loss of cognitive self-control and binge eating. Accompanying medical psychologists and psychotherapists with patients with obesity will help improve treatment results and secure them for the long term.

About the authors

Yulia Sergeevna Ignatova

Voronezh State Medical University N.N. Burdenko

Email: media01@list.ru
ORCID iD: 0000-0002-8092-0477

6th year student of the Faculty of Medicine

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

Olga Alekseevna Panina

Voronezh State Medical University N.N. Burdenko

Email: olga.panina-2017@yandex.ru
ORCID iD: 0000-0002-7351-3638

Candidate of Medical Sciences, Assistant, Department of Nursing Organization

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

Natalia Mikhailovna Semynina

Voronezh State Medical University N.N. Burdenko

Author for correspondence.
Email: natala-sem@mail.ru
ORCID iD: 0000-0002-8763-0587

Candidate of Medical Sciences, Associate Professor,  Department of Organization of Nursing

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

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