The All-Russian Patients’ Union insists that obesity must be recognized as a socially significant disease.
Photo: Ivan VISLOV
PROBLEMS WITH BODY WEIGHT – EVERY SECOND HAS PROBLEMS
Rosstat recently published a collection of new data on the extent of obesity among Russians. Judging by the document, every year an average of 400 thousand people receive this diagnosis. And recently, the number of overweight people (obesity is diagnosed with a body mass index ≥ 30, see “KP Help” below) is also growing by about 10% per year. This is according to the most modest official data.
— The magnitude of the problem is very serious. In fact, today we do not even fully understand the real figures,” shrugs Yuri Zhulev, co-chairman of the All-Russian Union of Patients (VSP). — According to the Federal Research Center for Nutrition and Biotechnology, 62% of the adult population of Russia and 10% of children in our country are overweight, including obese.
Furthermore, it is necessary to understand that, although there is still no medical diagnosis, excess weight is already a direct path to it, the expert emphasizes. Just as prediabetes precedes diabetes, polyps in the intestines can turn into cancer.
“So far we see that the problem is constantly growing,” Zhulev continues. — If in the year 2000 there were 325 million overweight and obese people in the world, in 2020 there will already be 650 million and, according to forecasts, in 2030 the figure will increase to 1.1 billion.
The All-Russian Patients’ Union insists that obesity must be recognized as a socially significant disease. Then the State will have the obligation to create a complete support system for overweight people. VSP specialists, together with other relevant experts, have drawn up a detailed “roadmap” – what and how needs to be changed in our country so that citizens become slimmer and healthier.
Changes for the better are already taking place, notes Yuri Zhulev. Thus, in 2022 a new standard of medical care for adults with obesity was adopted.
“It provides for a multidisciplinary approach, that is, the participation of doctors of different profiles in the treatment,” says the co-president of the VSP. “And also a whole series of tests, instrumental examinations and other types of medical care. All of them must be included in the compulsory health insurance, that is, provided free of charge under the policy.” But in practice everything is still not so simple.
Yuri Zhulev, co-chairman of the All-Russian Union of Patients (VSP).
Photo: Alexander ShPAKOVSKY
LOSING WEIGHT UNDER COMPLIANCE: WHAT IS REQUIRED?
“Today, medical care within the framework of compulsory health insurance is provided specifically for obesity, that is, an existing disease,” explains Yuri Zhulev. “However, we are trying to ensure that any excess weight gives the right to consult a doctor. After all, it is a serious risk factor, just like high cholesterol or glucose.
In any case, it is worth starting by visiting a therapist, explains the All-Russian Union of Patients. If obesity is suspected, the doctor should issue a referral for an initial appointment with an endocrinologist. The standard also establishes that, if necessary, consultations with a cardiologist, psychiatrist and surgeon are prescribed. In addition to an appointment with a nutritionist.
The list of instrumental tests and studies for obese patients provided in the document is simply impressive. Checking the level of thyroid hormones, various sex hormones, cortisol (“stress hormone”), vitamin D, various microelements and much more. Examinations include ultrasound, gastroscopy, ECG, and even duplex scanning of the leg veins.
“In fact, various types of medical care for obesity still do not “fit” into compulsory medical insurance,” says Yuri Zhulev. — So, there are problems with free access to nutritionists, these specialists are very few in relation to the number of patients. Bariatric surgery (that is, to reduce the stomach or change its configuration) is performed under compulsory health insurance if the patient has already been diagnosed with diabetes or other extremely serious complications. While doctors admit that there are compelling medical indications for this type of operation in obesity and in other cases. However, the quota for bariatric surgery under compulsory health insurance is now only 600 operations per year for all of Russia.
BUILD AND NOT RUIN: HOW TO ACT IN PRACTICE
Thus, in real life, the availability within the framework of compulsory medical insurance of the entire range of medical care specified in the standard of obesity treatment is still in doubt, as recognized by the All-Russian Union of Patients.
How to behave in practice taking this into account? Experts give the following advice:
1. If your body mass index is ≥ 30, see your GP if you are obese. To be convincing, you can carry with you a printed protocol for the diagnosis and treatment of this disease, approved in 2022 (Order of the Ministry of Health of the Russian Federation of May 25, 2022 N 352n), it can be easily found on the Internet ( https://base.garant.ru/404907659/ #block_1000).
2. The therapist issues referrals to specialist doctors: endocrinologist, cardiologist, etc. (watch up). To provide psychological assistance, a consultation with a psychiatrist is provided.
In real life, the availability within the framework of compulsory health insurance of the entire range of medical care specified in the obesity treatment standard is still in doubt.
Photo: RASYUK Tatyana Vitalevna
! If you have difficulties in accessing such doctors, in addition to obtaining referrals for tests and examinations, you can contact the health insurance company that issued your compulsory health insurance policy. Even call your insurer’s call center immediately; You will find contacts on the Internet with the company name. Ask to be connected with an insurance representative (this is the name of a specialist who is a patient assistant under compulsory health insurance) for advice on obtaining medical care for obesity.
3. Another option is a visit to the health center/office. They work in all regions of the country and also accept patients under the compulsory medical insurance policy (contacts and addresses will appear again through an Internet search). In such centers, a series of examinations are carried out, including those for excess weight that has not yet turned into obesity. There is also the possibility of obtaining a free consultation with a nutritionist and a physiotherapist.
BY THE WAY
Medications and fitness: on your own
Standard treatment for obesity includes various weight loss medications. Including a drug from the same class as the sensational “weight loss injections.”
— Today, not a single drug is included in the list of benefits for obese patients. Therefore, they cannot be offered for free or at a discount,” explains Yuri Zhulev. “We are in favor of immersing them in a preferential program.
Gym or pool subscriptions are unlikely to be discounted, experts say. But there are many opportunities to practice physical activity without money: doing exercises at home, on the playground sports field or just walking briskly, suggests the VSP co-president.
TO THE POINT
What more is needed to combat obesity?
The All-Russian Union of Patients in its “roadmap” mentions the following measures:
— education, information campaigns to promote the principles of a healthy diet and lifestyle in general;
— introduction of special labeling of products containing substances that increase the risk of obesity (excess sugar, saturated fats, etc.);
— increase the alertness of doctors about obesity and excess weight as a way to achieve it (by analogy with the alert against cancer);
— as well as a number of other measures.
* Excess weight – body mass index (BMI) 25 – 29.9
* Obesity – BMI ≥ 30.
* How to calculate BMI: take your height in meters and square it. Then divide your body weight in kg by the resulting figure.
Is it possible to lose weight with fractional meals?
Is it true that it is necessary to eat frequently and in small portions, 5-6 times a day, and chew each piece for as long as possible? Let’s talk about everything in order.