(A) treatment

The two key components of the treatment is to reduce calorie intake and increase calorie consumption. Emphasis on behavior, diet, exercise-based comprehensive treatment, if necessary supplemented by drugs or surgery. Secondary causes of obesity should be targeted for treatment. A variety of complications and associated diseases should be given appropriate treatment.

1. Behavior Therapy

Through publicity and education to patients and their families to the dangers of obesity and its a proper understanding to complement treatment, adoption of a healthy lifestyle, changes in diet and exercise habits, consciously treating obesity long-term adherence is the first and most important step .

2. Controlling their diet and increasing physical activity

Mild obesity, control the total consumption, using low heat cards, low-fat diet, to avoid the intake of high carbohydrate foods, so that total calories a day less than the consumption, more manual labor and physical activity, such as can body weight per month 500 ~ 1000g to reduce and eventually reach the normal standard of weight, no need to use drug treatment.

Moderate or severe obesity must also strictly control the total calories, eating in female patients seek to restrict the volume of 5 ~ 6.3MJ (1200 ~ 1500kcal) / d, exceeding 6.3MJ / d who would be invalid. Men should be controlled within 6.3 ~ 7.6MJ (1500 ~ 1800kcal) / d, this standard is expected to lose weight one week, ~ 2 pounds. Should ensure that adequate food containing animal protein, essential amino acids (accounting for one third of the amount of total protein is more appropriate), protein intake per kilogram of body weight per day less than 1g. Fat intake should be strictly limited, and should limit sodium intake to avoid weight loss occurs Shuinazhuliu, and lower blood pressure and reduce the appetite and is also good. In addition, restrictions on sweets, beer, etc. as explained above. If the above diet for several weeks by the weight of those who still can not reduction, total daily calories can be reduced to 3.4 ~ 5MJ (800 ~ 1200kcal) / d, but the heat is too small, the patient susceptible to fatigue, weakness, chills, fatigue, mental Weidun etc., must be strictly observed. According to the research, the treatment of early dietary protein consumed more, resulting in faster weight loss and negative nitrogen balance, when the sustained low-heat card diet occurs when the protective reaction of nitrogen mass storage to remain, and gradually rebuilding nitrogen balance, so fat consumption increased rapidly, but the fat, heat production is about 10 times the protein, it is significantly less than the amount of fatty tissue disappears the amount of protein organization and protein synthesis more the opposite, anti-body weight can rise, which is the human body to limit calories after the adjustment process, so diet therapy is often the result is not significant, in this case, the wish to encourage the exercise therapy to increase the heat consumption.

3. Drug therapy

 Severe obese patients can be applied to drug weight, and then maintained. However, how to better the clinical application of such drugs have yet to be explored, medication side-effects and possible drug resistance, and therefore the drug of choice must be very careful treatment of the indications, according to the individual patient’s likely to be measured by the benefits and potential risks ( the advantages and disadvantages) in order to make a decision.

International Obesity Task Force in 2000 on the Asia-Pacific Obesity Prevention guidance: drug therapy only as a diet control and exercise adjunct to the treatment of obesity. In the following circumstances may consider drug treatment: â‘  a clear sense of hunger or appetite, hyperactivity lead to weight gain; â‘¡ existence of a relevant disease or risk factors, such as IGT, dyslipidemia, high blood pressure; â‘¢ the existence of obesity-related diseases, such as severe bone arthritis, sleep obstructive ventilatory, Yandeng reflux esophagitis. The following conditions should not use the weight-loss drugs: â‘  children; â‘¡ previously had a class of drug adverse reactions; â‘¢ pregnant women and nursing mothers; â‘£ are taking other selective serotonin reuptake inhibitors patients.

Clinical application is currently permitted only in weight-loss drug orlistat and sibutramine, but still a long-term follow-up and clinical evaluation.

Orlistat (orlistat) is a gastrointestinal lipase inhibitor. Reducing the absorption of dietary fat to 30%, to promote a negative energy balance so as to achieve weight loss. The recommended dose of 120mg, 3 times / d, meals medication. Gastrointestinal tract are not absorbed by the digestive system can be seen with mild side effects such as bloating, stool frequency will be increased and fat and so on.

Sibutramine (sibutramine, β-phenylethylamine) is the central nervous system effects of drugs. Inhibition of hypothalamic norepinephrine and serotonin re-uptake, reduce food intake, reducing body weight; also has a thermogenic effect may be related to an indirect central sympathetic efferent nerve stimulation, the activation of brown adipose tissue in the β3-adrenergic receptor, leading to which increased the glucose utilization. Dose of 10 ~ 30mg, 1 time / d, breakfast medication. The drug side effects include reduced appetite and constipation, dry mouth, insomnia, mild to moderate blood pressure and heart rate increased rapidly and so on, need to be monitored, with cardiovascular complications, caution, or not.

4. Surgical treatment of

 Jejunum and ileum short-circuit operation, short pancreas, bile duct surgery, gastric short-circuit operation, gastroplasty, vagotomy surgery and gastric balloon surgery, etc. to choose from. Surgery effective (mean weight loss “20%) rate of up to 95%, the mortality rate” 1%, many patients receive long-term efficacy, preoperative complications can be varying degrees of improvement or cure. However, surgery may be complicated by malabsorption, anemia, narrow pipe, there is a certain degree of danger, only for severe obesity, weight loss failures have serious complications, these complications may be improved through weight loss and those who. Patients with preoperative systemic want to make a full assessment of the situation, especially diabetes, hypertension and cardio-pulmonary functions, giving the corresponding monitoring and processing.

WHO to develop a healthy diet three main principles: all but diet, diarrhea is not, not weakness. And also pointed out that the weight loss per week should not exceed 0.5 ~ 1.0kg.

Chinese Medicine Conference set with obesity obesity in primary efficacy criteria:

An end of treatment, weight loss of 3kg or more effective, or fat percentage by 5% effective; 5kg weight loss or fat percentage dropped more than 5% of markedly; weight loss has reached within the framework of the standard weight or overweight, called the recent clinical recovery .

The end of treatment were not reached effectively null and void. Follow-up of more than 1 year to maintain the original effect of long-term effect.

Treatment calculated as follows: 3 months of a course of treatment, at intervals of 1 month may be discontinued for 1 week.

Weight-loss drug treatment plan is implemented: In the specialist guidance, press your doctor medication 1 to 3 months, this period known as the weight loss period. When the weight loss to pre-medication 90% ~ 95% (ie weight loss of 5% ~ 10%), the entered the maintenance phase, 1 ~ 2 months. Such as weight after weight loss can be stabilized at the level of observation may be discontinued. If the observation period of weight gain, rebound, medication should be restored.

Early weight-loss treatment, weight loss of the fast, followed by multi-access platform, period, not easy to drop, this point of the regulation with its own body weight. If persist and intensify efforts to lose weight, maintain a plateau, the scope for further weight loss. If you do not adhere to a healthy life behavior, even if weight loss can still occur following a rebound.

5. Frequently used Chinese medicine to lose weight

(1), Fang Feng Tong Sheng Wan: from wind, Nepeta, ephedra, mint, ginger, Forsythia, Platycodon grandiflorum, Chuanxiong, angelica, Atractylodes, Montenegro gardenia, rhubarb wine, Glauber’s salt, gypsum, Huang Ling, talcum, licorice, TGP composed of such drugs. Used for abdominal subcutaneous fat, plump, that is centered on umbilical swelling over obesity. Through sweating, urination, diarrhea role of excretion, divergence, but also has detoxifying, anti-inflammatory effect. Inhibit the metabolism of the side effects, especially constipation and high blood pressure for obese tendencies.

(2) fine rhubarb pieces: heat Lishi, Xiehuo purge, lipid-lowering diet. For obesity and constipation.

(3) 7 Xiaowan: from the ground and yellow, ebony, papaya, TGP, North Adenophora composed of such drugs. Usage of 2 pills / d, morning and evening each serving a pill, the fasting in order to get under the warm water. After treatment fatigue, palpitation, easy to hunger and other symptoms have different degrees of improvement and disappear. Indications simple obesity associated with edema.

(4) Consumer fat America: from Bupleurum Chinese and Western medicine such as the composition. Suppress the appetite, enhance physical fitness, Shugan Jieyu, Spleen Qi, remove turbidite, Lee water Shenshi, enhance metabolism, mild reduction of intestinal absorption of glucose and other functions. For the treatment of simple obesity, has significant efficacy. Clinical observation of the total effective rate was 85.57%.

(5) weight loss Ling: from Astragalus, Atractylodes, Poria, Pinellia, dried tangerine peel, etc. composed of 18 Chinese herbal medicines, there is Spleen Qi, phlegm dampness, improve Shenpi, fatigue, lower blood pressure and the role of fat consumption. For the treatment of simple obesity deficiency type, the body heavy, fatigue weakness, abdominal distension over the whole lower extremity pitting edema a significant effect. Clinical total effective rate was above 80%.

6. Acupuncture weight loss of the study confirmed: Acupuncture can reduce the level of basic activities in the stomach and postprandial delayed gastric emptying. Acupuncture can reduce the peripheral 5 – HT levels, but also enhance the patient hypothalamus – pituitary – adrenal cortex and sympathetic – adrenal medulla function of the system to promote the body’s fat metabolism, heat production increased consumption of fat accumulation. Common Acupuncture Prescription:

(A) takes liangqiu, Kung-sun points: one for each pin hole, alternate use, reducing method, resulting in a strong sense of the needles, the electro-acupuncture instrument were followed 20min. After the needles at the time of the needle points on the skin type with the grain of wheat within the needle, piercing the skin along the 1cm or so, leaving pin 3 days, 10 times as a course of treatment, three courses used in conjunction.

(2) Syndrome Shi Pin: Obesity is a wet resistance spleen deficiency who get inside the customs, water, day-shu, Guan Yuan, Hong Leong reinforcing-reducing, Sanyinjiao, column missing by reinforcing method; obesity is a strong stomach the spleen is weak, hot and humid intrinsic who take song pool, Zhigou four full, Sanyinjiao reinforcing-reducing, in chambers, abdominal knot with reducing method; obesity disorders are either red, with veins and those who do not, take Zhi Gou, Ping fill in islet Ping Xie, Guan Yuan, with veins, sea of blood, too river with reinforcing method. Shi pin 1 the next day, leaving needle 30min, 15 times as a course of treatment.

(Three) Body Acupuncture and Auricular Acupuncture: Body Points selected Tianshu, air sea, three feet, the weight-loss points, 1 / d, every 30min, as needle-points, after a modest weight loss Massage 10min, 12 times as a course of treatment. Ear choose God door, hunger point, spleen, each binaural acupoints asked the patients daily at press 4 ~ 5 times, each time 10min, 12 days for a course of treatment.

7. Auricular Acupuncture Weight Loss

(1) Ear Pressure Bead: ear to take the main points: endocrine, subcortical, spleen, with points to take mouth, adrenal gland, stomach, lung. Take 2000 Gauss, the magnetic beads 2mm diameter, placed on the size of 4mm × 4mm tape, and then fixed on the ear on the check, each time selecting points 4 to 5, press 3 to 4 times a day, every 10min, 10 times for a course of treatment.

(2) Mount acupuncture and ear: ear to take hunger point, the door god, stomach, endocrine main points. Sleepiness are to God Menga excited; appetite, hyperactivity, thirst, thirsty, plus those who want to drink spots; stubborn constipation increasing gut; with hypertension increases blood pressure groove. Mount the door beam penetrating needle acupoints returned liangqiu thoroughly thigh off the next day one times, 10 times as a course of treatment.

8. Slimming massage along meridians acupuncture to enable patients to supine position, patients who follow the lung, stomach, spleen and kidney meridians Traveling manipulate point House, the Cloud Gate, mentioned the stomach or stomach, abdominal knot, government homes, Zhongwan, Air sea, Guan Yuan and other points, then change to prone position, massage Bladder Meridian, point Pishu, stomach Yu, Shenshu and other points, there are complications, plus the corresponding meridian points. The next day massage therapy one time a day, 30min, 3 times per week, 4 weeks for a course of treatment.

(B) the prognosis

Obesity and its complications has become a serious social problem. In particular, visceral obesity is often associated with diabetes, hypertension, ischemic heart disease, hyperlipidemia, sleep apnea syndrome, and so on. Therefore, proper treatment of obesity should be actively and reduce complications.