Experience with the management of patients with extreme obesity – Part 1

Czech version

Authors: Adela Penesová ^1,2,3
Authors‘ workplace: Ambulancia pre diabetológiu, poruchy látkovej premeny a výživy Adia-Mar s. r. o., Bratislava ¹; Ústav klinického a translačného výskumu, Biomedicínske centrum SAV, v. v. i., Bratislava ²; Katedra biologických a lekárskych vied, Fakulta telesnej výchovy a športu UK v Bratislave ³
Published in: Diab Obez 2024; 24(48): 99-106
Category: Reviews

Overview

Management of obesity (OB) grade 3 (BMI ≥ 40 kg/m²), commonly referred to as extreme obesity (EO), requires a multidisciplinary approach. No child is born with extreme obesity but becomes so. Therefore, the development of obesity should be caught in the stadium of pre-obesity (overweight when the BMI is between 25–30 kg/m²), which is a key and decisive role of pediatricians and general practitioners in preventive examinations. The cause of extreme obesity is enormously high energy intake (overeating) and relatively minimal energy expenditure through physical activity. Genetic predisposition also plays its role, which affects not only metabolic pathways but also the preference for certain foods, energy intake, and physical (in)activity. Extreme obesity is related to factors such as gender (female), age, and ethnicity (Roma in Slovakia). This work aims to bring my own experiences with the management of patients with extreme obesity. During the initial interview, I tried to identify the key area why the patient reached this stage of obesity. In 50–70% of patients with extreme obesity, psychological factors are decisive, which are also the alpha-omega of success or failure of treatment. There is a link between psychological factors and the etiology of obesity. Stress and other negative emotions such as depression and anxiety might also lead to higher food intake. The term “emotional eating” is widely used to describe the tendency to eat in response to negative emotions without feeling hungry, with the foods chosen to be primarily high energy-dense and palatable. I also meet with the phenomenon of self-harm in those patients. Physical pain is a way for people to divert their attention from unpleasant or negative psychological feelings. Against these problems, food and pain are often used in the same way as drugs. Therefore, a key factor in the management of patients with extreme obesity is to properly motivate the patient and detect and manage psychogenic factors conducive to increased energy intake (overeating). The cooperation with psychologists and psychiatrists seems to be a key factor in the multidisciplinary management of a patient with extreme obesity.

Keywords:

ethnicity – extreme obesity – emotional eating

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