Лечение повторного набора массы тела у пациентов с ожирением после бариатрических операций
Ожирение является распространенной патологией, ассоциированной с нарушениями углеводного обмена и увеличением кардиоваскулярного риска. Наиболее эффективным методом лечения морбидного ожирения признана бариатрическая хирургия, приводящая к значительному снижению массы тела, улучшению контроля гликемии и коморбидных состояний. Несмотря на сравнительно высокую эффективность бариатрической хирургии по сравнению с традиционными методами лечения ожирения, наблюдаются случаи как неэффективного снижения массы тела, так и повторного набора массы тела. В связи со сравнительно недавним внедрением бариатрической хирургии в медицинскую практику, проспективные долгосрочные наблюдения за пациентами немногочисленны и нередко противоречивы. Опыт лечения повторного набора массы тела после бариатрических вмешательств ограничен и представлен в основном хирургическими методами коррекции выполненных ранее модификаций желудочно-кишечного тракта. Целью данного обзора является систематизация имеющихся данных по консервативному лечению повторного набора массы тела: особенностей диетического консультирования, подбора режима физической активности, а также опыта использования ряда лекарственных препаратов.Семикова Г.В., Волкова А.Р., Халимов Ю.Ш., Эргерт А.В., Тимощенко Е.А.
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Список литературы
1. Voorwinde V., Steenhuis I.H.M., Janssen I.M.C., et al. Definitions of long-term weight regain and their associations with clinical outcomes. Obes Surg. 2020;30(2):527–36.
2. Shukla A.P., He D. Current concepts in management of weight regain following bariatric surgery. Expert Rev Endocrinol Metab. 2018;13(2):67–76. Doi: 10.1080/17446651.2018.1447922.
3. Courcoulas A.P., King W.C., Belle S.H., et al. Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study. JAMA. Surg. 2018;153(5):427–34. Doi: 10.1001/jamasurg.2017.5025.
4. Keeney B.J., Fulton-Kehoe D., Wickizer T.M., et al. Clinically significant weight gain 1 year after occupational back injury. J Occup Environ Med. 2013;55(3):318–24.
5. Apovian C.M., Aronne L.J., Bessesen D.H., et al. Endocrine Society. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62.
6. Hansen D., Decroix L., Devos Y., et al. Towards optimized care after bariatric surgery by physical activity and exercise intervention: a review. Obes Surg. 2020;30(3):1118–25.
7. King W.C., Chen J.Y., Bond D.S., et al. Objective assessment of changes in physical activity and sedentary behavior: prethrough 3 years post-bariatric surgery. Obes. (Silver Spring). 2015;23(6):1143–50.
8. Paul L., van der Heiden C., Hoek H.W. Cognitive behavioral therapy and predictors of weight loss in bariatric surgery patients. Curr. Opin. Psychiatry. 2017;30(6):474–79.
9. Mechanick J.I., Apovian C., Brethauer S., et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists – executive summary. Endocr Pract. 2019;25(12):1346–59.
10. Zalesin K.C., Franklin B.A., Miller W.M., et al. Preventing weight regain after bariatric surgery: an overview of lifestyle and psychosocial modulators. Am. J. Lifestyle Med. 2010;4(2):113–20.
11. Carnero E.A., Dubis G.S., Hames K.C., et al. Randomized trial reveals that physical activity and energy expenditure are associated with weight and body composition after RYGB. Obes (Silver Spring). 2017;25(7):1206–16.
12. Leahy C.R., Luning A. Review of nutritional guidelines for patients undergoing bariatric surgery. AORN. J. 2015;102(2):153–60
13. Pizato N., Botelho P.B., Gonçalves V.S.S., et al. Effect of Grazing Behavior on Weight Regain Post-Bariatric Surgery: A Systematic Review. Nutrients. 2017;9(12):1322. Doi: 10.3390/nu9121322.
14. Magro D.O., Geloneze B., Delfini R., et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.
15. Rosenberger P.H., Henderson K.E., White M.A., et al. Physical activity in gastric bypass patients: associations with weight loss and psychosocial functioning at 12-month follow-up. Obes Surg. 2011;21:1564–69.
16. King W.C., Hsu J.Y., Belle S.H., et al. Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2). Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8:522–32.
17. Chaston T.B., Dixon J.B., O’Brien P.E. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007;31(5):743–50.
18. Istfan N.W., Lipartia M., Anderson W.A., et al. Approach to the Patient: Management of the Post-Bariatric Surgery Patient With Weight Regain. J Clin Endocrinol Metab. 2021;106(1):251–63. Doi: 10.1210/clinem/dgaa702.
19. Stanford F.C., Alfaris N., Gomez G., et al. The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: a multi-center study. Surg. Obes. Relat. Dis. 2017;13(3):491-500.
20. Boger BS, Queiroz NL, Noriega PEP, et al. Treatment with Antiobesity Drugs in Weight Regain After Bariatric Surgery: a Retrospective Cohort Study. Obes Surg. 2023;33(9):2941–44. Doi: 10.1007/s11695-023-06736-7
21. Zoss I., Piec G., Horber F.F. Impact of orlistat therapy on weight reduction in morbidly obese patients after implantation of the Swedish adjustable gastric band. Obes Surg. 2002;12(1):113–17. Doi: 10.1381/096089202321144685.
22. Dharmaratnam V.M., Lim E., Eng A., et al. Revisional Surgery or Pharmacotherapy for Insufficient Weight Loss and Weight Regain After Primary Bariatric Procedure: a Descriptive Study. Obes Surg. 2022;32(10):3298–304. Doi: 10.1007/s11695-022-06191-w.
23. Miras A.D., Pérez-Pevida B., Aldhwayan M., et al. Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial. Lancet Diab Endocrinol. 2019;7(7):549–59. Doi: 10.1016/S2213-8587(19)30157-3.
24. Wharton S., Kuk J.L., Luszczynski M., et al. Liraglutide 3.0 mg for the management of insufficient weight loss or excessive weight regain post-bariatric surgery
25. Suliman M., Buckley A., Al Tikriti A., et al. Routine clinical use of liraglutide 3 mg for the treatment of obesity: Outcomes in non-surgical and bariatric surgery patients. Diab Obes Metab. 2019;21(6):1498–501. Doi: 10.1111/dom.13672.
26. Horber F.F., Steffen R. Reversal of Long-Term Weight Regain After Roux-en-Y Gastric Bypass Using Liraglutide or Surgical Revision. A Prospective Study
27. Lautenbach A., Wernecke M, Huber T.B., et al. The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or Insufficient Weight Loss After Bariatric Surgery-a Retrospective Analysis. Obes Surg. 2022;32(10):3280–88. Doi: 10.1007/s11695-022-06211-9.
28. Jensen A.B., Renström F., Aczél S., et al. Efficacy of the Glucagon-Like Peptide-1 Receptor Agonists Liraglutide and Semaglutide for the Treatment of Weight Regain After Bariatric surgery: a Retrospective Observational Study. Obes Surg. 2023;33(4):1017–25. Doi: 10.1007/s11695-023-06484-8.
29. ClinicalTrials.gov. Semaglutide 2.4 mg in patients with poor weight-loss (BARI-STEP). Betheseda (MD: National Library of Medicine (US. Available at: https://clinicaltrials.gov/ct2/show/NCT05073835 NCT05073835).
30. Jastreboff A.M., Aronne L.J., Ahmad N.N., et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205–16. Doi: 10.1056/NEJMoa2206038.
31. Kashyap S.R., Kheniser K., Aminian A, et al. Double-blinded, randomized, and controlled study on the effects of canagliflozin after bariatric surgery: A pilot study. Obes Sci Pract. 2020;6(3):255–63. Doi: 10.1002/osp4.409.
32. Toth A.T., Gomez G., Shukla A.P., et al. Weight loss medications in young adults after bariatric surgery for weight regain or inadequate weight loss: a multi-center study. Child Basel Switz. 2018;5.
33. Treviño R.P., Piña Ch., Fuentes J.C., et al. Evaluation of Medicare’s Intensive Behavioral Therapy for Obesity: The BieneStar Experience. Am J Prev Med. 2018;54(4):497–502. Doi: 10.1016/j.amepre.2018.01.018.
34. Wadden T., Tsai A., Tronieri J. A Protocol to Deliver Intensive Behavioral Therapy (IBT) for Obesity in Primary Care Settings: The MODEL-IBT Program. Obesity (Silver Spring). 2019;27(10):1562–66. Doi: 10.1002/oby.22594.
Об авторах / Для корреспонденции
Автор для связи: Галина Владимировна Семикова, к.м.н., ассистент кафедры терапии факультетской с курсом эндокринологии, кардиологии с клиникой им. акад. Г.Ф. Ланга, Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова, Санкт-Петербург, Россия; Semikovagv@yandex.ru
ORCID / eLibrary SPIN:
Г.В. Семикова (G.V. Semikova), ORCID: https://orcid.org/0000-0003-0791-4705; eLibrary SPIN: 4534-0974
А.Р. Волкова (A.R. Volkova), ORCID: https://orcid.org/0000-0002-5189-9365; eLibrary SPIN: 4007-1288
Ю.Ш. Халимов (Yu.Sh. Khalimov), ORCID: https://orcid.org/0000-0002-7755-7275; eLibrary SPIN: 7315-6746