Uzm. Dr. Ay\u015fe Seda Demirel, “\u00dclkemizde her 3 eri\u015fkinden biri obez, biri fazla kilolu ve sadece biri normal v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131nda. Obezitenin tedavisinde davran\u0131\u015f tedavisi (beslenme modeli), diyet, egzersiz, ila\u00e7 tedavisi, kombine tedavi ve cerrahi tedavi gibi \u00e7e\u015fitli tedavi y\u00f6ntemleri denenmektedir” dedi.<\/p>\n
\u0130stanbul Aile Hekimli\u011fi Derne\u011fi (\u0130STAHED) Bilim Komisyonu \u00dcyesi Uzm. Dr. Ay\u015fe Seda Demirel, Ramazan Bayram\u0131na yakla\u015ft\u0131\u011f\u0131m\u0131z bug\u00fcnlerde, toplumda gittik\u00e7e bozulan beslenme d\u00fczeni ve obezite salg\u0131n\u0131 ilgili a\u00e7\u0131klamalar yapt\u0131. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fcne g\u00f6re, 50 y\u0131l \u00f6ncesine kadar sadece geli\u015fmi\u015f \u00fclkelerde g\u00f6r\u00fclen ve sa\u011fl\u0131\u011fa verdi\u011fi zararlar pek de \u00f6nemsenmeyen obezitenin, bug\u00fcn son derece kronik hastal\u0131k olarak kabul edildi\u011fini belirtti. Obezite d\u00fcnya geneline yay\u0131lm\u0131\u015f b\u00fcy\u00fck bir sa\u011fl\u0131k sorunu oldu\u011funu ifade eden Demirel, “Ne yaz\u0131k ki, geli\u015fmekte olan ve az geli\u015fmi\u015f \u00fclkelerde de kilolu ve \u015fi\u015fman ki\u015fi say\u0131s\u0131n\u0131n sanki bula\u015f\u0131c\u0131 bir hastal\u0131k salg\u0131n\u0131 gibi h\u0131zla artt\u0131\u011f\u0131n\u0131 g\u00f6zlemliyoruz. Obezite tan\u0131s\u0131nda en s\u0131k kullan\u0131lan kriter v\u00fccut kitle indeksidir (VK\u0130). VKI eri\u015fkinlerde kilogram cinsinden a\u011f\u0131rl\u0131\u011f\u0131n metre cinsinden boyun karesine b\u00f6l\u00fcnmesiyle ortaya \u00e7\u0131kan rakamd\u0131r. VK\u0130\u2019si 18.5 – 25 aras\u0131nda olanlar normal, 25-30 aras\u0131 olanlar fazla kilolu, 30\u2019un \u00fczerinde olan ki\u015filer ise obez olarak de\u011ferlendirilmektedir. Asl\u0131nda bu kaba bir rakamd\u0131r ve v\u00fccuttaki ya\u011f miktar\u0131n\u0131 her zaman do\u011fru olarak yans\u0131tmayabilir. Yeti\u015fkin erkeklerde v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131n\u0131n y\u00fczde 15-18\u2019i, kad\u0131nlarda ise y\u00fczde 20-25\u2019ini ya\u011f dokusu olu\u015fturmaktad\u0131r. Bu oran\u0131n erkeklerde y\u00fczde 25, kad\u0131nlarda ise y\u00fczde 30\u2019un \u00fcst\u00fcne \u00e7\u0131kmas\u0131 obeziteyi olu\u015fturmaktad\u0131r. Anne ve babas\u0131 a\u015f\u0131r\u0131 kilolu \u00e7ocuklar\u0131n y\u00fczde 80\u2019inde, anne ve babas\u0131ndan birisi a\u015f\u0131r\u0131 kilolu olanlar\u0131n y\u00fczde 40\u2019\u0131nda, anne ve babas\u0131 normal kilolu olanlar\u0131n ise y\u00fczde 10\u2019unda eri\u015fkin d\u00f6neminde \u015fi\u015fmanlama riski vard\u0131r. Buna ek olarak baz\u0131 psikolojik rahats\u0131zl\u0131klar, stres ve depresyon da a\u015f\u0131r\u0131 at\u0131\u015ft\u0131rmaya ve \u015fi\u015fmanl\u0131\u011fa neden olur. Bu hastalar\u0131n bir k\u0131sm\u0131nda t\u0131kan\u0131rcas\u0131na yeme krizleri ve gece at\u0131\u015ft\u0131rmalar\u0131 daha fazlad\u0131r. Yine de sadece tart\u0131 a\u011f\u0131rl\u0131\u011f\u0131 fazla olan ki\u015filerin hepsinin \u015fi\u015fman olarak da kabul edilmeyece\u011fi; kas geli\u015fimi fazla olan ki\u015filerde de tart\u0131 a\u011f\u0131rl\u0131\u011f\u0131n\u0131n y\u00fcksek olarak saptanaca\u011f\u0131 da g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r” ifadelerinde bulundu.<\/p>\n
Elma ve armut tipi obezite<\/p>\n
\u015ei\u015fmanl\u0131\u011f\u0131n kabaca elma ve armut tipi \u015fi\u015fmanl\u0131k olarak iki grupta de\u011ferlendirilebilece\u011fini kaydeden Demirel, “Elma tipi \u015fi\u015fmanl\u0131kta v\u00fccut ya\u011flar daha \u00e7ok orta b\u00f6lgede (kar\u0131n-bel) toplanmas\u0131 ile karakterizeyken, armut tipi \u015fi\u015fmanl\u0131kta v\u00fccuttaki fazla ya\u011flar\u0131n daha a\u015fa\u011f\u0131daki b\u00f6lgelerde depoland\u0131\u011f\u0131 (kal\u00e7a) ve v\u00fccuda daha yay\u0131lm\u0131\u015f olarak bulundu\u011funu g\u00f6zlenir. \u00d6zellikle bel \u00e7evresi geni\u015fli\u011fi olan ve v\u00fccut ya\u011flar\u0131 kar\u0131n b\u00f6lgesinde toplanan elma tipi \u015fi\u015fmanl\u0131\u011f\u0131 olanlar\u0131n Metabolik Sendrom ve kapsad\u0131\u011f\u0131 kronik hastal\u0131klar a\u00e7\u0131s\u0131ndan (diyabet, kardiyovask\u00fcler hastal\u0131klar, hipertansiyon, hiperlipidemi) daha b\u00fcy\u00fck tehdit alt\u0131nda oldu\u011fu unutulmamal\u0131d\u0131r. Obezitede \u00f6zellikle kar\u0131n ya\u011flar\u0131 artt\u0131k\u00e7a, bel \u00e7evresi geni\u015fledik\u00e7e, serbest ya\u011f asitlerinin karaci\u011fere ge\u00e7i\u015fi de artmaktad\u0131r ve bu da ins\u00fclin direncine yol a\u00e7maktad\u0131r. \u00dclkemizde her 3 eri\u015fkinden biri obez (\u015fi\u015fman), biri fazla kilolu ve sadece biri normal v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131nda. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc raporuna g\u00f6re T\u00fcrkiye n\u00fcfusunun y\u00fczde 33\u2019\u00fc obez. \u00c7ocuklar aras\u0131nda da obezite s\u0131kl\u0131\u011f\u0131, hiperlipidemi ve ins\u00fclin direnci gibi metabolik sorunlar\u0131n h\u0131zla artmas\u0131 \u00fclkemizin yar\u0131nki gen\u00e7leri i\u00e7in sa\u011fl\u0131kta tehlike \u00e7anlar\u0131n\u0131n \u00e7al\u0131nmas\u0131na neden oluyor” diye belirtti.<\/p>\n
Obezite tedavisi<\/p>\n
Obezitede \u00e7e\u015fitli tedavi y\u00f6ntemleri denendi\u011fini dile getiren Demirel, obez ki\u015filerin \u00e7o\u011funun h\u0131zl\u0131 ve kolayca zay\u0131flamay\u0131 istediklerine dikkat \u00e7ekti, bunun kolay olmad\u0131\u011f\u0131n\u0131 vurgulayan Demirel, “Bu y\u00fczden daha tedavi ba\u015flang\u0131c\u0131nda ger\u00e7ek\u00e7i hedefler belirlenmelidir. Ger\u00e7ek\u00e7i bir hedef olarak 6 ayda y\u00fczde 5-10 kilo kayb\u0131 ama\u00e7lanmal\u0131d\u0131r. V\u00fccut a\u011f\u0131rl\u0131\u011f\u0131ndaki y\u00fczde 10\u2019luk bir azalma bile obeziteyle ili\u015fkili risk fakt\u00f6rlerinin azalmas\u0131n\u0131 sa\u011flar. T\u0131bbi beslenme (diyet) tedavisinde diyet mutlaka ki\u015fiye \u00f6zg\u00fc ve enerji a\u00e7\u0131\u011f\u0131 olu\u015fturarak v\u00fccut ya\u011f depolar\u0131nda azalma sa\u011flayacak bir diyet planlanmal\u0131d\u0131r. Kas kayb\u0131 olmadan ya\u011f depolar\u0131nda azalma sa\u011flanmal\u0131, vitamin ve mineral kayb\u0131na kar\u015f\u0131 dikkatli olunmal\u0131d\u0131r. Pek \u00e7ok defa g\u00fcnde 500-600 kalori k\u0131s\u0131tlamas\u0131 yap\u0131ld\u0131\u011f\u0131nda haftada 0.5 kilogram ve 6 ayda y\u00fczde 10 kadar bir zay\u0131flama ortaya \u00e7\u0131kar. G\u00fcn i\u00e7erisinde al\u0131nan toplam enerji al\u0131m\u0131 k\u0131s\u0131tlamak i\u00e7in bir\u00e7ok obez \u00f6\u011f\u00fcn atlamakta, ancak a\u00e7l\u0131k d\u00fcrt\u00fcs\u00fc daha sonra daha fazla yedirmekte ve g\u0131dalar\u0131n ya\u011f yak\u0131c\u0131 \u00f6zellikleri de b\u00f6ylece azalmaktad\u0131r. G\u00fcnl\u00fck kalorinin b\u00f6l\u00fcnerek kahvalt\u0131da y\u00fczde 20-25, \u00f6\u011fle yeme\u011finde y\u00fczde 30-35, ak\u015fam yeme\u011finde y\u00fczde 30-35 oranlar\u0131nda s\u0131k yemek yenilmesi \u00e7ok daha uygundur ve a\u00e7l\u0131k hissinin de b\u00f6ylece bask\u0131lanm\u0131\u015f olacakt\u0131r” dedi.<\/p>\n
Egzersiz tedavisi<\/p>\n
Fiziksel egzersiz \u00f6ncesinde mutlaka kalp ve solunum kontrollerinin yap\u0131lmas\u0131 gerekti\u011fine de\u011finen Demirel, ba\u015flang\u0131\u00e7ta g\u00fcnde 30-45 dakika, haftada 3-5 g\u00fcn orta derecede fiziksel aktivite i\u00e7in te\u015fvik edilmesi gerekti\u011fini s\u00f6yledi. Haftada 2 bin kalori harcamak i\u00e7in yakla\u015f\u0131k haftada 7 saat ritmik ve tempolu y\u00fcr\u00fcy\u00fc\u015f yapmak gerekti\u011fini an\u0131msatan Demirel, “Fiziksel aktivite s\u0131ras\u0131nda yaralanmalardan ka\u00e7\u0131nmak da \u00f6nemli. A\u015f\u0131r\u0131 obez bir ki\u015finin kendine zarar vermemesi i\u00e7in basit egzersizlerle fizik aktiviteye ba\u015flamas\u0131 ve dereceli olarak art\u0131r\u0131lmas\u0131 \u00f6nerilir. Yeni bir fiziksel aktivite rejimine ba\u015flamadan \u00f6nce mutlaka kontrollerin yap\u0131lmas\u0131 gerekir; ki\u015finin ya\u015f\u0131, e\u015flik eden kronik hastal\u0131klar \u00f6nceden de\u011ferlendirilmelidir. G\u00fcnl\u00fck ya\u015famda y\u00fcr\u00fcme mesafesindeki yerler i\u00e7in ta\u015f\u0131t kullan\u0131lmamas\u0131, otob\u00fcsten bir durak \u00f6nce inilmesi, asans\u00f6r yerine merdiven kullan\u0131lmas\u0131, araban\u0131n m\u00fcmk\u00fcn oldu\u011funca uzak yerlere park edilmesi yararl\u0131 olabilir. Obezlerin \u00e7o\u011fu egzersize emniyetli oldu\u011fu i\u00e7in y\u00fcr\u00fcme ile ba\u015flar. Haftada 3 g\u00fcn 10 dk. y\u00fcr\u00fcy\u00fc\u015f ile ba\u015flan\u0131r. Haftada en az 5 g\u00fcn 30-45 dakikaya art\u0131r\u0131l\u0131r. Y\u00fczme de yaralanmadan yap\u0131labilecek en iyi egzersizlerdendir” ifadelerini kulland\u0131.<\/p>\n
Davran\u0131\u015f de\u011fi\u015fikli\u011fi tedavisi<\/p>\n
“Kendi kendini g\u00f6zlemleme, yemek yeme uyaran\u0131n\u0131n fark\u0131na varmak ve onun yerine alternatif bir davran\u0131\u015f geli\u015ftirmek obezlerin davran\u0131\u015f de\u011fi\u015fikli\u011fi geli\u015ftirmelerinde \u00e7ok \u00f6nemlidir” diyen Demirel, bu de\u011fi\u015fimin ger\u00e7ekle\u015fti\u011fi zamanlarda peki\u015ftirme, kendi kendini \u00f6d\u00fcllendirme ve b\u00f6ylece de bili\u015fsel yeniden yap\u0131land\u0131rmay\u0131 sa\u011flamak gerekiti\u011fini aktard\u0131. Demirel, “Sosyal destek al\u0131nmas\u0131 da s\u00fcrece yard\u0131m edecektir. Farmakolojik tedavide obezite tedavisinde kullan\u0131lacak ila\u00e7lar hafif ve orta derecede a\u011f\u0131rl\u0131k fazlal\u0131\u011f\u0131 olan bireyler i\u00e7in uygun de\u011fildir. Kullan\u0131lan ila\u00e7lar\u0131n, sa\u011fl\u0131k y\u00f6n\u00fcnden g\u00fcvenirlili\u011finin saptanm\u0131\u015f olmas\u0131, obeziteye neden olan etiyolojiye uygun bir etki g\u00f6stermesi, k\u0131sa ve uzun d\u00f6nemde \u00f6nemli yan etkisinin olmamas\u0131 ve ba\u011f\u0131ml\u0131l\u0131k yapmamas\u0131 ve bu t\u00fcr ila\u00e7lar\u0131n mutlaka hekim tavsiyesi ve kontrol\u00fcnde kullan\u0131lmas\u0131 gereklili\u011fi b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r. Obezite tedavisinin ba\u015far\u0131l\u0131 olmas\u0131 i\u00e7in hastan\u0131n ila\u00e7 tedavisinin yan\u0131 s\u0131ra t\u0131bbi beslenme tedavisi ve egzersiz tedavisini s\u00fcrd\u00fcrmesi ve d\u00fczenli olarak kontrollere gelmesi gerekmektedir. Son se\u00e7enek olarak cerrahi y\u00f6ntemler de d\u00fc\u015f\u00fcn\u00fclebilir” mesaj\u0131n\u0131 verdi.<\/p>\n","protected":false},"excerpt":{"rendered":"
UZM. DR. AY\u015eE SEDA DEM\u0130REL, “\u00dcLKEM\u0130ZDE HER 3 ER\u0130\u015eK\u0130NDEN B\u0130R\u0130 OBEZ, B\u0130R\u0130 FAZLA K\u0130LOLU VE SADECE B\u0130R\u0130 NORMAL V\u00dcCUT A\u011eIRLI\u011eINDA. OBEZ\u0130TEN\u0130N TEDAV\u0130S\u0130NDE DAVRANI\u015e TEDAV\u0130S\u0130 (BESLENME MODEL\u0130), D\u0130YET, EGZERS\u0130Z, \u0130LA\u00c7 TEDAV\u0130S\u0130, KOMB\u0130NE TEDAV\u0130 VE CERRAH\u0130 TEDAV\u0130 G\u0130B\u0130 \u00c7E\u015e\u0130TL\u0130 TEDAV\u0130 Y\u00d6NTEMLER\u0130 DENENMEKTED\u0130R” DED\u0130.<\/p>\n","protected":false},"author":1,"featured_media":164898,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[22148,3163,32177,73,2310,2383,39224],"class_list":["post-164897","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","tag-obez","tag-biri","tag-demirel","tag-her","tag-kisiden","tag-turkiyede","tag-uzm-dr"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/www.tvturk.com\/wp-content\/uploads\/2019\/06\/uzmdr-demirel-turkiyede-her-3-kisiden-biri-obez_2e41ee7.jpg?fit=1000%2C896","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/paKIfm-GTD","_links":{"self":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts\/164897","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/comments?post=164897"}],"version-history":[{"count":0,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts\/164897\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/media\/164898"}],"wp:attachment":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/media?parent=164897"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/categories?post=164897"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/tags?post=164897"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}