Why calculate body mass index (BMI)? By BMI, you can find out the degree of obesity, which is necessary for the selection of the correct therapy for excess weight. To obtain data, use the BMI = Weight / Height 2 formula, or use the online BMI calculator.

Your height: (cm)

Table 1 - Classification of obesity and the risk of complications by BMI, WHO (1997).

BMI, kg / m2 Degree of obesity Risk of associated complications
18.5 - 25 Normal body weight Missing
25 - 29.9 Overweight Elevated
30 - 34.9 Obesity grade 1 Tall
35 - 39.9 Obesity grade 2 Very tall
> 40 Obesity grade 3 (morbid) Extremely high

General principles

The tactics of treatment is to choose a program of non-drug, drug therapy, or one of the types of surgical treatment. At the same time, an individual approach is based on the body mass index (BMI), taking into account risk factors, that is, existing associated diseases and obesity complications. When overweight, you only need to maintain a lifestyle that prevents its increase. The program of non-drug therapy is recommended for:

  1. Overweight in combination with two or more risk factors.
  2. Overweight in combination with a waist size of more than 102 cm.
  3. Any degree of obesity.

The addition of medication drugs is necessary in cases of non-effectiveness of non-drug therapy, as well as if there are two or more risk factors for a BMI of 27 kg / m 2 or a waist of 102 cm. Surgical treatment, provided there is no mental illness or alcoholism, is prescribed in the following cases:

  1. Ineffectiveness of complex conservative therapy in people with a BMI greater than 40 kg / m 2 .
  2. Combination of BMI from 35 kg / m 2 with arterial hypertension, coronary heart disease, type 2 diabetes mellitus, a significant excess of blood lipids, sleep apnea syndrome, circulatory failure.
  3. The term obesity is more than 5 years.

Non-drug treatment

It consists in a specific diet of phased or rapid weight loss, measured physical activity and behavioral therapy.

Phased weight loss

It is used in most patients. In a phased weight reduction, the following are distinguished:

  1. Stage I - weight reduction by 10% for 1–6 months; six months from the start of the diet, the main metabolism begins to decline.
  2. Stage II - its essence is to stabilize over the next six months of the main exchange by keeping the weight at the reached level; excessively rapid weight loss can cause a significant reduction in basal metabolism and recurrence of obesity.
  3. Stage III - further weight loss.

For these purposes, a low-calorie diet with a daily cholesterol content in foods of no more than 300 mg is used. Its energy value is 1400 - 1600 kcal / day, of which falls to share:

  • proteins - up to 15%, 1/3 of which is the protein of soy products;
  • fat - up to 29%; of them polyunsaturated - 30 - 50%, and saturated fatty acids limit to 10% of the daily energy value of products; for the replacement of fats, fish of low-fat varieties are recommended mainly, poultry meat without skin, sometimes lean beef tenderloin is allowed to be consumed;
  • carbohydrates - an average of 55%; their source is mainly soluble dietary fiber of whole oats and barley, bran, legumes, bread, baked from grades of coarse flour, pasta, but only from wheat flour of solid varieties and in very limited quantities, unsweetened types of berries and fruits, vegetables; the total daily amount of carbohydrates to prevent the development of ketoacidosis must be at least 100 g

The diet is enriched with calcium salts by introducing low-fat cottage cheese into the diet, 0.5% kefir, milk with a low percentage of fat, and vitamins, potassium and magnesium are replenished by additional daily intake of vitamins with microelements. The daily intake of table salt is limited to 4.5 g (see salt intake standards for men ). Before meals, 3 times a day, it is recommended to drink green tea, which increases energy consumption by 80 kcal to maintain a constant body temperature and digestive processes.

Rapid weight loss

The technique is to reduce the weight by an average of 20% within 3 months by reducing the daily calorie to 800 kcal. This method is shown only with a BMI of 40 kg / m2 and above when combined with immunity to the correction of violations listed in the 2nd paragraph of indications for surgical treatment. It is applied for no longer than 4 months and is contraindicated for:

  • aged over 65;
  • diseases of the liver, kidneys, gallbladder;
  • bronchial asthma and type 1 diabetes;
  • the presence of a malignant tumor;
  • heart rhythm disorders;
  • carrying out rehabilitation therapy after circulatory disorders of the brain, acute myocardial infarction;
  • alcoholism and drug addiction.

Preventing the recurrence of obesity is carried out by taking sibutramine for about 2 to 3 months. In case of a depressive state, fluoxetine is prescribed instead.

Dosed physical exertion

The main one is walking. When BMI is less than 40 kg / m 2, training is carried out at a speed of 100 steps / min for 3–4 times in 1 week. Gradually, the duration of walking is increased up to 1 hour, speed - up to 160 steps / min with daily trainings. If the BMI is above 40 kg / m 2 , classes start from 10 minutes 3 times a week at a speed of 65 steps / min, after adaptation, exercises are held 35 to 45 minutes. every day or 4 times a week (minimum) at a speed of 100 steps / min.

Behavioral Psychological Therapy

Its goal is to develop motivation for losing weight, to teach the rules of eating and self-control through keeping a diary of the dynamics of weight, exercise and nutrition, as well as the fight against stress and depression, etc.

Drug treatment

Officially recommended are the first-line drugs sibutramine, which suppresses appetite and increases basal metabolism, orlistat, which inhibits pancreatic and stomach lipase, and phentermine (second-line drug). Long-term use of it can cause drug addiction, pulmonary hypertension, increased anxiety disorders. The advantages of first-line drugs are high efficacy in achieving weight loss and reducing the severity of obesity complications, in the absence of side effects such as the development of heart valve disease and pulmonary hypertension with prolonged (2 years) use. Orlistat is also the drug of choice for concomitant arterial hypertension. Any program for the treatment of obesity is developed by doctors of the appropriate profile and carried out under their dynamic control.


It is indicated in patients with morbid obesity (BMI> 40) with the ineffectiveness of conservative treatment methods.

Today the following operations are most effective:

  • Gastric bypass;
  • Gastric banding;
  • Sleeve gastroplasty.

Read more about surgical treatment of obesity.

See also:

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