Weight reduction program with continuous psychological support in obese patients

Abstract

Obesity has been recently one of the important public health problems, with the increasing tendency of Body Mass Index (BMI) in the world.1 The prevalence of obesity or overweight has been twice of that of 1980 and about one third of population in the world is supposed to be obese or overweight.2 The cause of the obesity has been multi-factorials, and the prevention of the obesity includes environmental interventions and various lifestyle changes. For the medical management of obesity and overweight, there was a standard guideline. It was the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and The Obesity Society (AHA/ACC/TOS) in 2013, and it showed various available evidence to medical practice.3 It has been often found that obese people had succeeded weight reduction, but could not maintain the weight easily. From previous reports, the important factors have been the correlations among lifestyle, dietary and psychosocial situations.4 Then, further research would be expected concerning the behavioral and clinical characteristics of maintaining satisfactory weight reduction. On the other hand, there was an ‘adult disease’ a few decades ago in Japan. After that, it was changed to ‘life style related disease’ because their geneses are probably due to inadequate lifestyle situation.5 It was proposed by Dr. Shigeaki Hinohara who was the President Emeritus of St. Luke International Hospital in Tokyo associated with the philosophy ‘Hinohara-ism’.6 Consecutively, the medical term ‘metabolic syndrome’ has been prevalent including obesity, diabetes mellitus, hypertension and hyperlipidemia. There is a possibility that hyperuricemia and gout has been also added as another factors in the future.7 As to the treatment of metabolic syndrome, the basic therapy would be the control of the body weight. Consequently, the weight reduction should be tried at first for the treatment of metabolic syndrome and obesity prior to starting various medicine.8 The actual method for weight reduction includes both diet therapy and exercise therapy. For diet therapy, there was a standard method, which was calorie restriction (CR). After that, low carbohydrate diet (LCD) has been introduced in Western countries. In succession, authors and colleagues had started LCD in Japan9 and developed LCD through medical practice, medical society, workshop and textbooks.10 We have proposed three patterns of LCD meal including super-LCD, standard-LCD and petite-LCD, which can be applied in various clinical situation.11 Among our clinical research, we have treated lots of patients with obesity in weight reduction program. During the program, they were given medical, nutritional and psychological supports by medical staffs including registered dietitian nutritionists (RDNs). Their managements and advises were based on several medical and psychological supports.12 The detail of the program was described and discussed in this report.