La obesidad puede ser éxitosamente tratada mediante dietas muy bajas en calorías y ayunos intermitentes. presentamos aquí la evidencia científica:
Evidence that fasting can treat obesity. Changes in food cravings during low-calorie and very-low-calorie diets.
Obesity (Silver Spring). 2006 Jan;14(1):115-21
Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
OBJECTIVE: This study examined food cravings during a primarily food-based low-calorie diet (LCD) and a supplement-based very-LCD (VLCD). RESEARCH METHODS AND PROCEDURES: The Food Craving Inventory (FCI) was used to measure general cravings and cravings for specific types of foods (sweets, high fats, carbohydrates/starches, and fast food fats). The FCI was completed by participants in the LCD and VLCD programs at baseline and after 11 weeks of dieting. The VLCD group also completed the FCI at Week 6 and after 5 weeks of a refeeding phase, when their diet consisted primarily of solid food. RESULTS: From baseline to Week 12, craving decreases were greater for the VLCD group than for the LCD group on all measures. All craving measures decreased significantly for the VLCD group. The LCD group experienced a marginally significant decrease in sweet cravings. Within the VLCD group, all craving measures decreased significantly by Week 6 and did not change thereafter, including after resumption of solid food intake, and craving scores during all dieting points were lower than baseline. Changes in cravings were not related to weight loss.
DISCUSSION: Cravings did not increase during either diet; all changes represented decreases. Compared with a primarily food-based diet (LCD), a more restrictive supplement-based diet (VLCD) resulted in significantly larger decreases in food cravings that occurred by the end of the 5th week of supplement use and did not rebound with resumption of solid food intake. The results of this study suggest that food cravings diminish with calorie restriction.
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Treatment modalities of obesity: what fits whom?
Diabetes Care. 2008 Feb;31 Suppl 2:S269-77.
Hainer V, Toplak H, Mitrakou A. Institute of Endocrinology, Narodni 8, 116 94 Prague 1, Czech Republic.
The prevalence of obesity is increasing in both developed and developing countries, with rates reaching approximately 10-35% among adults in the Euro-American region. Obesity is associated with increased risks of cardiovascular diseases, type 2 diabetes, arthritis, and some type of cancers. Obesity significantly affects the quality of life and reduces the average life expectancy. The effective treatment of obesity should address both the medical and the social burden of this disease. Obesity needs to be treated within the health care system as any other complex disease, with empathy and without prejudice.
Both health care providers and patients should know that the obesity treatment is a lifelong task. They should also set realistic goals before starting the treatment, whereas keeping in mind that even a modest weight loss of 5-15% significantly reduces obesity-related health risks. Essential treatment of obesity includes low-calorie low-fat diets, increased physical activity, and strategies contributing to the modification of lifestyle. Anti-obesity drugs facilitate weight loss and contribute to further amelioration of obesity-related health risks. A short-term weight loss, up to 6 months, is usually achieved easily. However, the long-term weight management is often associated with a lack of compliance, failures, and a high dropout rate. Regular physical activity, cognitive behavioral modification of lifestyle, and administration of anti-obesity drugs improve weight loss maintenance. Bariatric surgery is an effective strategy to treat severely obese patients. Bariatric surgery leads to a substantial improvement of comorbidities as well as to a reduction in overall mortality by 25-50% during the long-term follow-up. Obesity treatment should be individually tailored and the following factors should be taken into account: sex, the degree of obesity, individual health risks, psychobehavioral and metabolic characteristics, and the outcome of previous weight loss attempts. In the future, an evaluation of hormonal and genetic determinants of weight loss could also contribute to a better choice of individual therapy for a particular obese patient. A multilevel obesity management network of mutually collaborating facilities should be established to provide individually tailored treatment. Centers of excellence in obesity management represented by multidisciplinary teams should provide comprehensive
programs for the treatment of obesity derived from evidence-based medicine.
Effect of a very low calorie diet on the diagnostic category of individuals with binge eating disorder. Indications for fasting
Obesity Int J Eat Disord 2002 Jan;31(1):49-56
Raymond NC, de Zwaan M, Mitchell JE, Ackard D, Thuras P.
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.
This study examined the factors associated with the diagnostic outcome of obese individuals with and without binge eating disorder (BED) 1 year after completing a very low calorie diet (VLCD) program. METHOD: Participants included 63 individuals with BED, 36 individuals with subthreshold BED, and 29 individuals with no binge eating symptoms. Diagnoses before and after VLCD were obtained using the Structured Clinical Interview for DSM-IV (SCID) interviews. The severity of psychiatric symptoms were assessed using various rating scales.
RESULTS: Fifty-six percent (n = 36) of the participants who met criteria for BED at baseline did not meet diagnostic criteria 1 year later. None of the baseline factors were statistically associated with outcome.
DISCUSSION: Although the main hypothesis was not supported, absence of a BED diagnosis at 12-month follow-up after a VLCD diet appears to be associated with less weight gain at 1-year follow-up regardless of baseline diagnosis.
Very-low-calorie diets and sustained weight loss. (A review)
Obes Res 2001 Nov;9 Suppl 4:295S-301S
Saris WH.
Nutrition and Toxicology Research Institue Maastricht, Maastricht University, The Netherlands.
To review of the literature on the topic of very-low-calorie diets (VLCDs) and the long-term weight-maintenance success in the treatment of obesity.
RESEARCH METHODS AND PROCEDURES: A literature search of the following keywords: VLCD, long-term weight maintenance, and dietary treatment of obesity. RESULTS: VLCDs and low-calorie diets with an average intake between 400 and 800 kcal do not differ in body weight loss. Nine randomized control trials, including VLCD treatment with long-term weight maintenance, show a large variation in the initial weight loss regain percentage, which ranged from -7% to 122% at the 1-year follow-up to 26% to 121% at the 5-year follow-up. There is evidence that a greater initial weight loss using VLCDs with an active follow-up weight-maintenance program, including behavior therapy, nutritional education and exercise, improves weight maintenance.
CONCLUSIONS: VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long-term weight-maintenance success.
Treatment of extreme obesity with a very low calorie diet.
Med Pregl 2001 Nov-Dec;54(11-12):534-8
Ivkovic-Lazar T.
Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Institut za interne bolesti, Klinicki centar, Novi Sad.
This paper presents the results of treatment of very obese persons with a very-low-calorie diet (VLCD).
MATERIAL AND METHODS: A group of 28 extremely obese subjects, average age 32 years, was treated in the course of one month by the following regime: 3-4 l of mineral water with "Enemon" pulv. 3 x 1 and vitamin substitution and allopurinol 300 mg/day
RESULTS: In addition to a statistically significant (p < 0.5) loss of body mass, significant changes were observed in regard to decrease of atherogenic lipid profile (cholesterol, triglycerides, LDL-cholesterol, apoprotein B), as well as lowered level of hyperinsulinism which, though, was not statistically significant. The degree of protein catabolism did not reach statistical significance, and the results were also more favourable with respect to potential changes in electrolytes, as well as with respect to the degree of hyperuricemia in regard to subjects being under the regime of total starvation.
DISCUSSION AND CONCLUSIONS: VLCD represents an extremely efficient and safe therapeutic procedure which, apart from body mass loss, is characterized by favourable changes in metabolism of lipids and a decrease in hyperinsulinism, which eventually results in reduction of the risk from early and accelerated atherosclerosis.
Treatment of diabetes in patients with severe obesity.
Biomed Pharmacother 2000 Mar;54(2):74-9
Scheen AJ.
Department of Medicine, CHU Sart Tilman (B35), Liege 1, Belgium.
Besides genetic predisposition, obesity is the most important risk factor for the development of diabetes mellitus, and weight reduction has been shown to markedly improve blood glucose control in obese subjects with type 2 diabetes. Therapeutic strategies for the obese diabetic patient include: 1) promoting weight loss through lifestyle modifications (hypocaloric
diet and exercise) and anti-obesity drugs (orlistat, sibutramine, etc.); 2) improving blood glucose control, essentially through the reduction of insulin resistance (metformin, eventually thiazolidinediones) or insulin need (alpha-glucosidase inhibitors) and, at a later stage, the correction of defective insulin secretion (sulphonylureas, repaglinide) or low circulating insulin levels (exogenous insulin); and 3) treating common associated risk factors, such as arterial hypertension and dyslipidaemias, to improve cardiovascular prognosis. When morbid obesity is present, both restoring a good glycemic control and correcting associated risk factors can only be obtained through marked and sustained weight loss. This primary objective justifies more aggressive weight reduction programmes, including very low-calorie diets and bariatric surgery, but only within a multidisciplinary approach and in well-selected patients .
VLCD a safe and simple treatment of obesity (A review).
Lakartidningen 2000 Sep 6;97(36):3876-9
Rossner S, Torgerson JS.
Article in Swedish Huddinge Universitetssjukhus.
This review summarizes Swedish experience with VLCD (Very Low Calorie Diets). VLCD-treatment is a safe and relatively simple way to induce weight reduction in obese patients. The rapid and profound initial weight loss reduces cardiovascular risk factors and relieves obesity-associated symptoms. Weight loss on the order of 20-25 kg is common after 12-16 weeks of treatment. The long-term results, about 10% weight reduction after two years, are similar to what can be expected with pharmacological treatment. VLCD's should be incorporated into long-term treatment programs including diet, physical exercise and lifestyle modification. A team of nurses and/or dieticians can, to a large extent, manage a VLCD-program, restricting the need for involvement of the physician.
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