Ülekaalulise või rasvunud patsiendi käsitlus esmatasandil
Publication year: 2019
Overweight and obesity are an increasing health problem of the population all over the world, including in Estonia. According to the data of the Estonian adult population health behavior survey conducted in 2018, 40% of Estonian men and 26% of women are overweight, and 21% of men and 18% of women are obese (2). Based on the data of the 2014 nutrition survey of the Estonian population, obesity among children and young people is also common. According to the survey, approximately 7% of 2-5 year old boys and 6% of girls of the same age are overweight. Among children aged 6-9, approximately 32% of boys and 29% of girls are overweight and obese, among 10-13-year-olds, the corresponding figure is 37% for boys and 31% for girls, and for 14-17-year-olds, 28% for boys and 19% for girls. . (3) Based on the results of the European Childhood Obesity Surveillance Initiative (COSI) study, 2015/16 was sister 1.
The main causes of obesity are an unbalanced diet and lack of physical activity. Obesity is associated with several health risks and co-morbidities, while some diseases or their complications can be prevented or alleviated by reducing body weight.
Obesity also increases the economic burden on society:
treatment costs of obesity-related diseases and complications in the health system (direct costs) and absenteeism and premature mortality due to reduced work capacity (indirect costs). A study conducted in Estonia found that the costs related to overweight and obesity in Estonia totaled 45.5 million euros in 2015, which accounted for 3.7% of healthcare costs and 0.22% of gross domestic product (GDP) (direct costs related to 11 diseases were taken into account). (5) In Estonia, there is no unified approach to overweight patients and no coordinated services. The role of different specialists in the provision of services is not clear. It is a psychologically complex and delicate problem for the patient and the family, which is often not addressed and, therefore, effective interventions cannot be chosen or used to solve it. This is why the initiative of healthcare professionals is particularly important. Based on the results of the National Audit Office's 2016 audit "State activities in maintaining and treating children's health", the treatment of obese children is not consistent. Treating obese children and young people requires long-term and coordinated health care (service of a specialist, family doctor, family nurse, nurse or midwife, physiotherapist or psychologist), but only a very small part of the target group has received continuous treatment for several years, and the access to health care differs from region to region. The purpose of the treatment manual is to achieve better treatment results for overweight and obese children and adults through a harmonized approach at the primary level. The treatment guide provides recommendations for assessing the emotional state, eating disorders and eating behavior of these patients, factors affecting body weight and readiness for lifestyle change, lifestyle counseling interventions and methods, low-energy diets, and drug therapy. In addition, there are recommendations for coordinating the treatment of overweight children and adults. The treatment manual is the basis for the planning and implementation of further activities and the creation of new services. These activities are in the implementation plan of the treatment manual.
et|Ülekaalulisus ja rasvumine on järjest suurenev rahvastiku terviseprobleem kogu maailmas, ka Eestis. 2018. aastal läbi viidud Eesti täiskasvanud rahvastiku tervisekäitumise uuringu andmetel on 40% Eesti meestest ja 26% naistest ülekaalulised ning 21% meestest ja 18% naistest rasvunud (2). Eesti rahvastiku 2014. aasta toitumisuuringu andmetele tuginedes on laste ja noorte ülekaalulisus samuti levinud. Uuringu andmetel on ligikaudu 7% 2–5-aastastest poistest ning 6% samas vanuses tüdrukutest ülekaalulised. 6–9-aastaste laste seas on ülekaalulised ja rasvunud ligikaudu 32% poistest ja 29% tüdrukutest, 10–13-aastaste hulgas on vastav näitaja poistel 37% ja tüdrukutel 31% ning 14–17-aastaste seas poistel 28% ja tüdrukutel 19%. (3) Euroopa laste rasvumise seire (Childhood Obesity Surveillance Initiative, COSI) uuringu tulemuste põhjal oli 2015/16. õa 1. klassi õpilaste (7–8-aastased) seas poistest ülekaalulisi 17% ja rasvunuid 12%, tüdrukutest vastavalt 16% ja 8% (4).
Ülekaalulisuse peamised põhjused on tasakaalustamata toitumine ja vähene kehaline aktiivsus. Ülekaalulisus on seotud mitme terviseriski ja kaasuva haigusega, samas on võimalik osa haigusi või nende tüsistusi kehamassi vähendamise abil ennetada või leevendada.