Rehabilitation in overweight and obesity as an integral part of pathogenetic therapy

Obesity is one of the most acute issues of medicine at the present stage due to the steady increase in morbidity, high risk of complications and comorbid conditions that entail significant financial costs. At the same time, many different etiopathogenetic factors are involved in the formation of obesity. The article presents a literature review concerning the main risk factors and etiologic aspects of the development of overweight and obesity in adults and children. The most relevant pathogenetic mechanisms are considered, including imbalance of adipokines (decrease in adiponectin level and increase in leptin content), formation of low activity chronic inflammation as a result of proinflammatory cytokines, changes in the features of neuroimmune-endocrine interactions, the impact of chronic stress on the human body, vitamin D deficiency, disorders of the “gut – brain” axis, quantitative and qualitative changes in the composition of intestinal microbiota. The main therapeutic approaches and surgical methods in the treatment of obesity are presented. The data available in the literature at the present stage on methods of rehabilitation of patients with obesity, as well as persons with excess body weight, indicating the need for a comprehensive approach and combination of lifestyle modification, physiotherapeutic methods, psychological counseling to achieve positive results are summarized.

1. Simonson M., Boirie Y., Guillet C. Protein, amino acids and obesity treatment. Rev. Endocr. Metab. Disord. 2020;21(3):341–353. doi: 10.1007/s11154-020-09574-5

2. Mkrtumyan A.M. Actual problems of obesity conservative treatment. Meditsinskiy sovet = Medical Council. 2010;(7-8):21–27. [In Russian]

3. Obradovic M., Sudar-Milovanovic E., Soskic S., Essack M., Arya S., Stewart A.J., Gojobori T., Isenovic E.R. Leptin and obesity: role and clinical implication. Front. Endocrinol. (Lausanne). 2021;12:585887. doi: 10.3389/fendo.2021.585887

4. Khadartsev A.A., Tokareva S.V., Konstantinova D.A. On the pathogenesis of obesity and the justification of its non-drug correction (literature review). Vestnik novykh meditsinskikh tekhnologiy = Journal of New Medical Technologies. 2020;14(5):100–107. [In Russian]. doi: 10.24411/2075-4094-2020-16749

5. GBD 2015 Obesity Collaborators; Afshin A., Forouzanfar M.H., Reitsma M.B., Sur P., Estep K., Lee A., Marczak L., Mokdad A.H., Moradi-Lakeh M., … Murray C.J.L. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 2017;377(1):13–27. doi: 10.1056/NEJMoa1614362

6. Caballero B. Humans against obesity: who will win? Adv. Nutr. 2019;10(suppl_1):S4–S9. doi: 10.1093/advances/nmy055

7. Ruyatkina L.A., Ruyatkin D.S. Obesity: the cross-roads of opinion, knowledge, and opportunity. Meditsinskiy sovet = Medical Council. 2020;(7):108–120. [In Russian]. doi: 10.21518/2079-701X-2020-7-108-120

8. Biddle S.J.H., Garcia Bengoechea E., Pedisic Z., Bennie J., Vergeer I., Wiesner G. Screen time, other sedentary behaviours, and obesity risk in adults: A review of reviews. Curr. Obes. Rep. 2017;6(2):134–147. doi: 10.1007/s13679-017-0256-9

9. Federal clinical guidelines (protocols) on the management of children with endocrine diseases. Eds. I.I. Dedov, V.A. Peterkova. Moscow: Praktika, 2014. 442 p.

10. Volkova N.I. Modern approaches to pathogenetic therapy of obesity. Ozhireniye i metabolism = Obesity and Metabolism. 2007;4(4):14–18. [In Russian]. doi: 10.14341/2071-8713-5000

11. Hall K.D., Kahan S. Maintenance of lost weight and long-term management of obesity. Med. Clin. North Am. 2018;102(1):183–197. doi: 10.1016/j.mcna.2017.08.012

12. Mamatov A.U., Polupanov A.G., Kakeev B.A., Ismarova G.S., Sabirova A.I. Sex and age factors associated with the development of obesity. The Scientific Heritage. 2021;(68-2):46–56. [In Russian]. doi: 10.24412/9215-0365-2021-68-2-46-56

13. Simanenkov V.I., Tikhonov S.V. Ilyashevich I.G., Ledovay A.V., Makiyenko V.V., Fedorova N.V. Epidemiology, social aspects and pathogenesis of obesity. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta imeni Il’yi Il’yicha Mechnikova = Newsletter of North-Western State Medical University named after I.I. Mechnikov. 2017;9(1):21–27. [In Russian].

14. Perez-Morales M.E., Bacardi-Gascon M., Jimenez-Cruz A. Childhood overweight and obesity prevention interventions among Нispanic children in the United States: systematic review. Nutr. Hosр. 2012; 27(5):1451–1421. doi: 10.3305/nh.2012.27.5.5973

15. Guzzardi M.A., Iozzo P., Salonen M.K., Kajantie E., Eriksson J.G. Maternal adiposity and infancy growth predict later telomere length: a longitudinal cohort study. Int. J. Obes. (Lond). 2016;40(7):1063–1069. doi: 10.1038/ijo.2016.58

16. Fretts A.M., Howard B.V., Siscovick D.S., Best L.G., Beresford S.A., Mete M., Eilat-Adar S., Sotoodehnia N., Zhao J. Processed meat, but not unprocessed red meat, is inversely associated with leukocyte telomere length in the strong heart family study. J. Nutr. 2016;146(10):2013–2018. doi: 10.3945/jn.116.234922

17. Kyle U.G., Pichard C. The Dutch Famine of 1944–1945: a pathophysiological model of long-term consequences of wasting disease. Curr. Opin. Clin. Nutr. Metab. Care. 2006;9(4):388–394. doi: 10.1097/01.mco.0000232898.74415.42

18. Castro H., Pomar C.A., Picó C., Sánchez J., Palou A. Cafeteria diet overfeeding in young male rats impairs the adaptive response to fed/fasted conditions and increases adiposity independent of body weight. Int. J. Obes. (Lond). 2015;39(3):430–437. doi: 10.1038/ijo.2014.125

19. Sipola-Leppänen M., Vääräsmäki M., Tikanmäki M., Matinolli H.M., Miettola S., Hovi P., Wehkalampi K., Ruokonen A., Sundvall J., Pouta A., … Kajantie E. Cardiometabolic risk factors in young adults who were born preterm. Am. J. Epidemiol. 2015; 181(11):861–873. doi: 10.1093/aje/kwu443

20. Campos D., Hernández-Torres J.J., Agil A., Comino M., López J.C., Macías V., Campoy C. Analysis of food advertising to children on Spanish television: probing exposure to television marketing. Arch. Med. Sci. 2016;12(4):799–807. doi: 10.5114/aoms.2016.60969

21. Suplotova L.A., Avdeeva V.A., Rozhinskaya L.Ya. To the question of the pathogenetic mechanisms of the influence of obesity on the level of vitamin D. Ozhireniye i metabolism = Obesity and Metabolism. 2021;18(2):169–174. [In Russian]. doi: 10.14341/omet12578

22. Gangloff A., Bergeron J., Lemieux I., Després J.P. Changes in circulating vitamin D levels with loss of adipose tissue. Curr. Opin. Clin. Nutr. Metab. Care. 2016;19(6):464–470. doi: 10.1097/MCO.0000000000000315

23. Karonova T.L., Mikheeva E.P., Krasilnikova E.I., Belyaeva O.D., Budanova M.V., Galkina O.V., Grineva E.N. Vitamin D deficiency is a risk factor for obesity and type 2 diabetes mellitus in reproductive age women. Arterial’naya gipertenziya = Arterial Hypertension. 2012;18(1):25–31. [In Russian]. doi: 10.18705/1607-419X-2012-18-1-25-31

24. Timasheva Ya.R., Balkhiyarova Zh.R., Kochetova O.V. Current state of the obesity research: genetic aspects, the role of microbiome, and susceptibility to COVID-19. Problemy endocrinologii = Problems of Endocrinology. 2021;67(4):20–35. [In Russian]. doi: 10.14341/probl12775

25. Pigeyre M., Yazdi F.T., Kaur Y., Meyre D. Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin. Sci. (Lond). 2016;130(12):543–986. doi: 10.1042/cs20160136

26. Logvinova O.V., Poydasheva A.G., Bakulin I.S., Lagoda O.V., Kremneva E.I., Troshina E.A., Mazurina N.V., Suponeva N.A., Tanashyan M.M., Dedov I.I., Piradov M.A. Modern concepts of the pathogenesis of obesityandnewapproachestoitscorrection. Ozhireniyei metabolism = Obesity and Metabolism. 2018;15(2):11–16. [In Russian]. doi: 10.14341/omet9491

27. Vadde R., Gupta M.K., Nagaraju G.P. Is adipose tissue an immunological organ? Crit. Rev. Immunol. 2019;39(6):481–490. doi: 10.1615/CritRevImmunol.2020033457

28. Scherbakov V.I., Skosyreva G.A., Ryabichenko T.I., Obukhova O.O. Cytokines and regulation of glucose and lipid metabolism in the obesity. Ozhireniye i metabolism = Obesity and Metabolism. 2022;19(3):317–323. [In Russian]. doi: 10.14341/omet12863

29. Shi J., Fan J., Su Q., Yang Z. Cytokines and abnormal glucose and lipid metabolism. Front. Endocrinol. (Lausanne). 2019;10:703. doi: 10.3389/fendo.2019.00703

30. Paltsev M.A., Kvetnoy I.M., Ilnitski A.N., Proshchayev K.I., Kvetnaia T.V., Sovenko G.N., Bessarabov V.I. The obesity: the molecular mechanisms and the optimization of target therapy. Molekulyarnaya meditsina = Molecular Medicine. 2013;(2):3–12. [In Russian].

31. Fedorin M.M., Livzan M.A., Gaus O.V. Associations of Leptin and Adiponectin in Irritable Bowel Syndrome Patients with Overweight and Obesity. Effektivnaya farmakoterapiya = Effective Pharmacotherapy. 2023;19(8):34–41. [In Russian]. doi: 10.33978/2307-3586-2023-19-8-34-41

32. Shestopalov A.V., Ganenko L.A., Grigoryeva T.V., Laikov A.V., Vasilyev I.Yu., Kolesnikova I.M., Naboka Yu.L., Volkova N.I., Rumiantsev S.A. Adipokines and myokines as indicators of obese phenotypes and theirassociation with the gut microbiomediversity indices. Vestnik Rossiyskogo gosudarstvennogo meditsinskogo universiteta = Bulletin of the Russian State Medical University. 2023;(1):49–58. [In Russian]. doi: 10.24075/vrgmu.2023.004

33. Shevchenko E.A., Potemina T.E., Uspensky A.N. Role of adiponektin and leptin in the development of metabolic syndrome and related obesity and type II diabetes mellitus. Vestnik meditsinskogo instituta «REAVIZ» = Bulletin of the Medical Institute “REAVIZ”. 2022;12(1):29–37. [In Russian]. doi: 10.20340/vmi-rvz.2022.1.CLIN.3

34. Geagea A.G., Mallat S., Matar C.F., Zerbe R., Filfili1 E., Francis M., Haidar H., Jurjus A. Adiponectin and inflammation in health and disease: an update. Open Medicine Journal. 2018;5:20–32. doi: 10.2174/1874220301805010020

35. Perez-Perez A., Toro A., Vilarino-Garcia T., Maymó J., Guadix P., Dueñas J.L., Fernández-Sánchez M., Varone C., Sánchez-Margalet V. Leptin action in normal and pathological pregnancies. J. Cell. Mol. Med. 2018;22(2):716–727. doi: 10.1111/jcmm.13369

36. Mazurina N.V., Leskova I.V., Troshina E.A., Logvinova O.V., Adamskaya L.V., Krasnikovsky V.Ya. Obesity and stress: endocrineand social aspects of the problem in the modern Russian society. Ozhireniye i metabolism = Obesity and Metabolism. 2019;16(4):18–24. [In Russian]. doi: 10.14341/omet9975

37. Bliss E.S., Whiteside E. The gut-brain axis, the human gut microbiota and their integration in the development of obesity. Front. Physiol. 2018;(9):900. doi: 10.3389/fphys.2018.00900

38. Kornienko E.A., Netrebenko O.K. Obesity and intestinal microbiota: a modern concept of the relationship. Pediatriya. Zhurnal imeni Georgiya Nestorovicha Speranskogo = Pediatrics. Journal named after Georgy Nestorovich Speransky. 2012;91(2):110–112. [In Russian].

39. Menshchikova V.Е., Kartseva Т.V., Eliseeva D.V., Ryabichenko Т.I., Obukhova О.О., Zalavina S.V. Pathology of the gastrointestinal tract in overweight and obese children. Sibirskij Nauchnyj Medicinskij Zhurnal = Siberian Scientific Medical Journal. 2024;44(2):28–38. [In Russian]. doi: 10.18699/SSMJ20240203

40. Volkova N.I., Ganenko L.A., Golovin S.N. The role of gut microbiota in the development of obesity and its metabolic profile (Part II). Meditsinskiy vestnik Severnogo Kavkaza = Medical News of the North Caucasus. 2019;14(2):391–396. [In Russian]. doi: 10.14300/mnnc.2019.14098

41. Million M., Lagier J.C., Yahav D., Paul M. Gut bacterial microbiota and obesity. Clin. Microbiol. Infect. 2013;19(4):305–313. doi: 10.1111/1469-0691.12172

42. Samoilova J.G., Oleynik O.A., Sagan E.V., Vorozhtsova I.N., Filippova T.A., Denisov N.S., Dyakov D.A. Composition and metabolic activity of the gut microbiota in obese children and adolescents. Sibirskiy zhurnal klinicheskoy i eksperimental’noy meditsiny = Siberian Journal of Clinical and Experimental Medicine. 2020;35(3):38–46. [In Russian]. doi: 10.29001/2073-8552-2020-35-3-38-46

43. Evdokimova N.V., Shogiradze L.D., Pokhlebkina A.A., Petrenko Yu.V., Mikhnina E.A., Novikova V.P., Bezhenar V.F. Small gut intestine microbiota in adolescent girls with obesity. Eksperimental’naya i klinicheskaya gastroenterologiya = Experimental and Clinical Gastroenterology. 2023;(7):34–41. [In Russian]. doi: 10.31146/1682-8658-ecg-215-7-34-41

44. Peterkova V.A., Bezlepkina O.B., Bolotova N.V., Bogova E.A., Vasyukova O.V., Girsh Ya.V., Kiyaev A.V., Kostrova I.B., Malievskiy O.A., Mikhailova E.G., … Khramova E.B. Clinical guidelines «Obesity in children». Problemy endocrinologii = Problems of Endocrinology. 2021;67(5):67–83. [In Russian]. doi: 10.14341/probl12802

45. Dedov I.I., Mokrysheva N.G., Mel’nichenko G.A., Troshina E.A., Mazurina N.V., Ershova E.V., Komshilova K.A., Andreeva E.N., Antsiferov M.B., Biriukova E.V., … Yashkov Iu.I. Obesity. Clinical guidelines. Consilium Medicum. 2021;23(4):311–325. [In Russian]. doi: 10.26442/20751753.2021.4.200832

46. Chao A.M., Quigley K.M., Wadden T.A. Dietary interventions for obesity: clinical and mechanistic findings. J. Clin. Invest. 2021;131(1):e140065. doi: 10.1172/JCI140065

47. Kim B.Y., Choi D.H., Jung C.H., Kang S.K., Mok J.O., Kim C.H. Obesity and physical activity. J. Obes. Metab. Syndr. 2017;26(1):15–22. doi: 10.7570/jomes.2017.26.1.15

48. Berge J., Hjelmesaeth J., Hertel J.K., Gjevestad E., Småstuen M.C., Johnson L.K., Martins C., Andersen E., Helgerud J., Storen O. Effect of aerobic exercise intensityon energy expenditure and weight loss in severe obesity – A randomized controlled trial. Obesity (Silver Spring). 2021;29(2):359–369. doi: 10.1002/oby.23078

49. Stepanenko N.P., Kondrat’eva E.I., Svetlik O.B., Dostovalova O.V., Alajtseva S.V. Method of rehabilitation of children and adolescents suffering obesity. Patent 2440086 RF; published 20.01.2012. [In Russian].