Medical treatment of obesity: peculiarities of medical treatments, information, responsibility and relation to medical treatment of obesity of patients

The aim to evaluate medical appointments, as well as awareness, adherence and attitude of patients to medical treatment of obesity based on the results of a survey of patients with a prospective outpatient registry.

Materials and methods. Total 305 patients with obesity in the outpatient “PROFILE” register were surveyed, including self-assessment questions regarding their own body weight, prescription of obesity treatment by doctors, patients’ adherence to the implementation of these recommendations, propensity to self-medication and information about personal financial costs for the treatment of this disease. 42 (12 %) patients refused to participate in the survey. 213 people (69.8 %) who answered the questionnaire were diagnosed with obesity of the 1st degree, 63 (20.7 %) – obesity of the 2nd degree; obesity grade 3 was detected in 29 people (9.5 %). Waist circumference in women averaged 104.7 ± 12.9 cm, in men – 116.7 ± 9.6 cm – all patients had abdominal obesity. 263 (86.2 %) people had arterial hypertension, 117 (38.4 %) patients had coronary heart disease; type 2 diabetes mellitus was diagnosed in every fourth patient (85 (27.2 %) people); atrial fibrillation was diagnosed in 55 (18 %) patients; 48 (15.7 %) people had a history of myocardial infarction, 23 (7.5 %) patients had a stroke.

Results. According to the survey results, only one in four patients – 77 (25.2 %) – out of 305 patients who participated in the survey knew about the possibility of drug treatment of obesity. Mostly, patients received recommendations for non-drug treatment of obesity: 242 patients (79.3 %) were recommended to reduce caloric intake, 194 (63.6 %) – increased physical activity. Only 37 (12.1 %) patients with obesity were recommended for weight correction, significantly more often they were recommended and taken by patients with 2 and 3 degrees of obesity compared to patients with obesity of 1 degree (p <0.0001). At the time of the survey, none of the patients were taking drugs to treat obesity. Previous experience of drug weight loss had 42 (13.8 %) participants of the survey. Most patients (more than 70 %), in principle, are not ready to spend money on the fight against overweight, and drugs are considered an extra item of expenditure almost 90 % of obese patients. There is a significant relationship (p = 0.008) between the severity of the disease and patients’ spending on obesity treatment in the range of 1–5 thousand rubles per month: the higher the degree of obesity, the more patients agree to spend this amount on the treatment of the disease.

Conclusion. According to the results of the survey, medical treatment of obesity is prescribed by doctors rarely. Apparently, this is due to the extremely low awareness of patients about the possibilities of drug therapy in the treatment of overweight and obesity, the popularity of biologically active additives independently used by patients to reduce weight.

1. World Health Organization. Prevalence of obesity among adults, BMI ≥30, agestandardized. Estimates by WHO region. Available at: http://apps.who.int/gho/data/view.main.REGION2480A?lang=en.

2. Muromtseva G.A., Kontsevaya A.V., Konstantinov V.V. et al. The prevalence of non-infectious diseases risk factors in russian population in 2012–2013 years. The results of ECVD-RF. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention 2014;3(6): 4–11. (In Russ.) DOI: 10.15829/1728-8800-2014-6-4-11.

3. World Health Organization. 2018. Obesity and overweight. Available at: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight

4. Ng M., Fleming T., Robinson M. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384(9945):766–81. DOI: 10.1016/S0140-6736(14)60460-8.

5. Dedov I.I., Mel’nichenko G.A., Shestakova M.V. et al. Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults). Obesity and Metabolism 2018;15(1):53–70. (In Russ.) DOI: 10.14341/OMET2018153-70.

6. Lukina Y.V., Dmitrieva N.A., Zakharova A.V. et al. Adverse event of drug therapy (the first results of the study according to the PROFILE outpatient register). Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology 2016;12(3):306–13. (In Russ.) DOI: 10.20996/1819-6446-2016-12-3-306-313.

7. Lukina Yu.V., Dmitrieva N.A., Kutishenko N.P. et al. The relationship and interinfluence of aspects of therapy safety and compliance in patients with cardiovascular diseases(by the data from outpatient registry “PROFILE”). Kardiovaskulyarnaya terapiya i profilaktika = Сardiovascular therapy and prevention 2018;17(5):72–8. (In Russ.) DOI: 10.15829/1728-8800-2018-5-72-78.

8. Martsevich S.Yu., Lukina Yu.V., Kutishenko N.P. et al. Assessment of adherence to treatment and factors affecting it in patients with stable ischemic heart disease during therapy with nicorandil. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology 2017;13(6):776–86. (In Russ.) DOI: 10.20996/1819-6446-2017-13-6-776-786.

9. Zolnierec K.B., Dimatteo M.R. Physician communication and patient adherence to treatment a meta-analysis. Med Care 2009;47(8):826–34. DOI: 10.1097/MLR.0b013e31819a5acc.

10. Yanovski S.Z., Yanovski J.A. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014;311(1):74–86. DOI: 10.1001/jama.2013.281361.

11. Khalimov Y. Sh., Ulupova E.O. Tactics of obesity treatment (according to the survey of endocrinologists of St. Petersburg). In: Diabetes mellitus in the XXI century is a time of joint efforts. Abstracts of the VII Russian diabetes Congress. Moscow: UP Print, 2015. P. 260. (In Russ.)

12. Lobykina E.N. Organization of prevention and treatment of obesity and overweight of the adult population of a large industrial center. Mezhdunarodnyy endokrinologicheskiy zhurnal = International Journal of Endocrinology 2011;(7):11–8. (In Russ.)