Obezite tedavisinde basit ve uygulanabilir bir tedavi modelinin etkinliğinin araştırılması
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Alınan enerjinin fazla olması ve fiziksel aktivitenin olmadığı yaşam tarzının birlikteliği fazla kilo oluşumuna, obeziteye ve bazı kronik hastalıklara sebep olmakla birlikte bireylerin yaşam kalitesini de düşürmektedir. Obezite tedavisinde günümüzde çeşitli yöntemler kullanılmakta olup birçoğu karışık ve sürdürülebilirlikleri zayıftır. Bu çalışmadaki amacımız ise bu yöntemlere ek olarak basit ve uygulanabilir bir program oluşturmak ve güncel başka bir program ile etkinliğini karşılaştırmaktır. Gereç ve Yöntem: Obezite polikliniğine başvuran hastalardan çalışmaya katılmayı kabul edenler ve kriterlere uyan hastalardan vaka ve kontrol grubu olmak üzere iki grup oluşturuldu. Kontrol grubuna obezite polikliniğinin normal işleyişi olan diyetisyen önerileri, egzersiz önerileri ve aylık kontrol programı uygulanırken vaka grubuna literatür desteği ile hazırlanan 5 maddelik bir program uygulandı. Bu 5 madde; Günde 2 öğün yemek yenecek ve öğün aralarında enerji içeren herhangi bir gıda veya içecek tüketilmeyecek. Her öğün maksimum bir servis tabağı büyüklüğünde olacak şekilde katı gıda tüketilecek ve en fazla 1 dilim ekmek yenilecek. Her bir lokma katı gıdayı en az 30 kez çiğneyecek şekilde yenilecek. Minimum egzersiz düzeni olarak haftada 3 gün en az 45'er dakika veya haftanın her günü en az 30'ar dakika tempolu yürüme veya muadili egzersiz yapılacak. Aylık olarak düzenli kontrollere gelinecek. Şeklinde olması istendi. Tüm hastaların sosyodemografik verilerine ek olarak boy, kilo, yağ oranı, bel çevresi, kalça çevresi, sistolik ve diastolik tansiyon değerleri, açlık kan şekeri, açlık insülini, HbA1c, Trigliserit, Total Kolesterol, HDL, LDL, ALT değerlerini içeren laboratuvar tahlilleri yapılıp veri seti oluşturuldu ve karşılaştırması yapıldı. Bulgular: Çalışmaya %78'i kadın, %22'si erkek 109 hasta dahil edildi. Katılımcıların %86,24'ü evli, %53,21'i ev hanımıydı. Vaka ve kontrol grubu büyük oranda benzerdi. Yalnızca gelir durumu ve hipertansiyon tanılı hasta sayısı iki grup arasında anlamlı farklıydı (sırasıyla p=0,038 ve p=0,042). Vaka grubundaki 4 vizitelik takibi bulunan hastalar(n=27) kendi içinde değerlendirildiğinde ortalama kiloları 98,62±23,02 kg'dan 93,55±21,88 kg'a düştüğü gözlendi. Kontrol grubundaki 4 vizitelik takibi bulunan hastalar(n=32) kendi içinde değerlendirildiğinde ise ortalama kiloları 89,09±15,55 kg'dan 85,51±16,16 kg'a düştüğü gözlendi. Vaka ve kontrol grubu 4 vizite sonrasında ilk ve son kiloları karşılaştırıldı vaka grubu ortalama 5,07±4,24kg, kontrol grubu ortalama 3,57±4,51kg verdiği görüldü. Vaka grubu ortalama kilosu %5'ten fazla azalırken, kontrol grubu ortalama kilo kaybı %5'in altında kaldı. Vaka grubunun daha fazla kilo vermesine rağmen iki grup arasında ortalama kilo kaybı açısından anlamlı fark bulunmadı (p=0,122). Vaka ve kontrol grubu kendi içinde incelendiğinde kilo (vaka p<0,001; kontrol p<0,001) ve açlık insülin seviyeleri (vaka p=0,001; kontrol p=0,016) anlamlı azaldığı görüldü. Vaka grubunun ilk ve son sistolik tansiyon (p=0,037), diastolik tansiyon (p=0,027), açlık kan şekeri (p=<0,001), HbA1c (p=0,015), ALT (p=0,001), değerlerinde anlamlı düşüş görülürken, kontrol grubunun bu değerlerinde anlamlı düşüş gözlenmedi. Her iki grupta da kendi içinde HDL değeri açısından anlamlı artış gözlendi (vaka p=0,026; kontrol p=<0,001) Vaka grubunda kolesterol, trigliserit, LDL, yağ oranı değerleri düştüğü görüldü. Buna karşılık kontrol grubunun kolesterol ve LDL değerlerinin ise arttığı gözlendi. Fakat bu değişiklikler istatistiksel olarak anlamlı değildi. Kontrol grubunda yağ oranı (p=0,030) ve trigliserit değerleri (p=0,007) anlamlı azaldı. Sonuç: Obezite tedavisinde kullanılabilecek basit ve uygulanabilir olduğunu düşündüğümüz bir programın, sık uygulanan bir programla karşılaştırıldığında kilo verme konusundaki başarısının yanında metabolik birçok parametrede olumlu değişikliklere yol açtığı ve önemli sağlık iyileştirmelerine yol açtığı görüldü. Bu anlamda obezite tedavisi ve yönetiminde farklı uygulamaların olması gerektiğini düşünmekteyiz.
Objective: The combination of excessive energy intake and a lifestyle without physical activity leads to overweight, obesity, some chronic diseases and reduces the quality of life of individuals. Various methods are used in the treatment of obesity today, but many of them are complex and poorly sustainable. Our aim in this study is to create a simple and applicable programme as an alternative to these methods and to compare its effectiveness with another current programme. Methods: Two groups, case and control groups, were formed from the patients who applied to the obesity outpatient clinic and who accepted to participate in the study and met the criteria. While dietician recommendations, exercise recommendations and monthly control programme, which are the normal functioning of the obesity outpatient clinic, were applied to the control group, a 5-point programme prepared with the support of the literature was applied to the case group. These 5 points are; 2 meals a day will be eaten and no food or drink containing energy will be consumed between meals. At each meal, solid food will be consumed with a maximum serving plate size and a maximum 1 slice of bread will be eaten. Each bite of solid food should be chewed at least 30 times. As a minimum exercise regime, brisk walking or equivalent exercise will be done for at least 45 minutes 3 days a week or at least 30 minutes each day of the week. Regular monthly check-ups will be made. It was requested to be in the form. In addition to the sociodemographic data of all patients, height, weight, fat ratio, waist circumference, hip circumference, systolic and diastolic blood pressure values, laboratory tests including fasting blood glucose, fasting insulin, HbA1c, Triglyceride, Total Cholesterol, HDL, LDL, ALT values were performed and a data set was created and compared. Results: The study included 109 patients, 78% female and 22% male. 86.24% of the participants were married and 53.21% were housewives. The case and control groups were largely similar. Only income status and the number of patients diagnosed with hypertension were significantly different between the two groups (p=0.038 and p=0.042, respectively). When the patients (n=27) with 4 visits in the case group were evaluated within themselves, it was observed that their mean weight decreased from 98.62±23.02 kg to 93.55±21.88 kg. When the patients (n=32) in the control group with 4 visits were evaluated within themselves, it was observed that their mean weight decreased from 89.09±15.55 kg to 85.51±16.16 kg. When the initial and final weights of the case and control groups were compared after 4 visits, the case group lost an average of 5.07±4.24kg and the control group lost an average of 3.57±4.51kg. While the average weight loss of the case group was more than 5%, the average weight loss of the control group was less than 5%. Although the case group lost more weight, there was no significant difference between the two groups in terms of mean weight loss (p=0.122). When the case and control groups were analysed within themselves, weight (case p<0.001; control p<0.001) and fasting insulin levels (case p=0.001; control p=0.016) decreased significantly. Significant decreases were observed in initial and final systolic blood pressure (p=0.037), diastolic blood pressure (p=0.027), fasting blood glucose (p=<0.001), HbA1c (p=0.015), ALT (p=0.001) in the case group, whereas no significant decrease was observed in the control group. A significant increase in HDL values was observed in both groups (case p=0.026; control p=<0.001) In the case group, cholesterol, triglyceride, LDL and fat ratio values decreased. On the other hand, cholesterol and LDL values of the control group increased. However, these changes were not statistically significant. In the control group, fat ratio (p=0.030) and triglyceride values (p=0.007) decreased significantly. Coclusions: We observed that a simple and feasible programme for the treatment of obesity led to positive changes in many metabolic parameters and significant health improvements in addition to its success in weight loss when compared with a frequently applied programme. In this sense, we think that there should be different applications in the treatment and management of obesity.
Objective: The combination of excessive energy intake and a lifestyle without physical activity leads to overweight, obesity, some chronic diseases and reduces the quality of life of individuals. Various methods are used in the treatment of obesity today, but many of them are complex and poorly sustainable. Our aim in this study is to create a simple and applicable programme as an alternative to these methods and to compare its effectiveness with another current programme. Methods: Two groups, case and control groups, were formed from the patients who applied to the obesity outpatient clinic and who accepted to participate in the study and met the criteria. While dietician recommendations, exercise recommendations and monthly control programme, which are the normal functioning of the obesity outpatient clinic, were applied to the control group, a 5-point programme prepared with the support of the literature was applied to the case group. These 5 points are; 2 meals a day will be eaten and no food or drink containing energy will be consumed between meals. At each meal, solid food will be consumed with a maximum serving plate size and a maximum 1 slice of bread will be eaten. Each bite of solid food should be chewed at least 30 times. As a minimum exercise regime, brisk walking or equivalent exercise will be done for at least 45 minutes 3 days a week or at least 30 minutes each day of the week. Regular monthly check-ups will be made. It was requested to be in the form. In addition to the sociodemographic data of all patients, height, weight, fat ratio, waist circumference, hip circumference, systolic and diastolic blood pressure values, laboratory tests including fasting blood glucose, fasting insulin, HbA1c, Triglyceride, Total Cholesterol, HDL, LDL, ALT values were performed and a data set was created and compared. Results: The study included 109 patients, 78% female and 22% male. 86.24% of the participants were married and 53.21% were housewives. The case and control groups were largely similar. Only income status and the number of patients diagnosed with hypertension were significantly different between the two groups (p=0.038 and p=0.042, respectively). When the patients (n=27) with 4 visits in the case group were evaluated within themselves, it was observed that their mean weight decreased from 98.62±23.02 kg to 93.55±21.88 kg. When the patients (n=32) in the control group with 4 visits were evaluated within themselves, it was observed that their mean weight decreased from 89.09±15.55 kg to 85.51±16.16 kg. When the initial and final weights of the case and control groups were compared after 4 visits, the case group lost an average of 5.07±4.24kg and the control group lost an average of 3.57±4.51kg. While the average weight loss of the case group was more than 5%, the average weight loss of the control group was less than 5%. Although the case group lost more weight, there was no significant difference between the two groups in terms of mean weight loss (p=0.122). When the case and control groups were analysed within themselves, weight (case p<0.001; control p<0.001) and fasting insulin levels (case p=0.001; control p=0.016) decreased significantly. Significant decreases were observed in initial and final systolic blood pressure (p=0.037), diastolic blood pressure (p=0.027), fasting blood glucose (p=<0.001), HbA1c (p=0.015), ALT (p=0.001) in the case group, whereas no significant decrease was observed in the control group. A significant increase in HDL values was observed in both groups (case p=0.026; control p=<0.001) In the case group, cholesterol, triglyceride, LDL and fat ratio values decreased. On the other hand, cholesterol and LDL values of the control group increased. However, these changes were not statistically significant. In the control group, fat ratio (p=0.030) and triglyceride values (p=0.007) decreased significantly. Coclusions: We observed that a simple and feasible programme for the treatment of obesity led to positive changes in many metabolic parameters and significant health improvements in addition to its success in weight loss when compared with a frequently applied programme. In this sense, we think that there should be different applications in the treatment and management of obesity.
Açıklama
Anahtar Kelimeler
Aile Hekimliği, Family Medicine
