The relevance of the chosen topic of the dissertation research is related to the
development of the obesity pandemic in the world and in Ukraine. According to the
STEPS study, in 2019, 59% of adult patients were overweight and 24.8% were obese,
and these indicators are predicted to increase in the near future. The aim of the
dissertation was to optimize the provision of primary medical care to obese patients of
working age by using a patient-oriented approach.
The study of the state of providing primary medical care to obese patients in
Ukraine and abroad showed that modern guidelines and recommendations do not
sufficiently take into account when choosing a patient-oriented approach to the
treatment of obesity, its pathogenetic interrelationships with the processes of sleep/vigor
disturbance, eating behavior, psycho-emotional condition due to a decrease in the
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functioning of the serotonergic system, especially in patients with circadian rhythm
disorders and a variable type of work.
The use of a set of questionnaires (Dutch Eating Behavior Questionnaire (DEBQ),
Hospital Anxiety and Depression Scale (HADS), Epworth Sleepiness Scale (ESS),
Pittsburgh Sleep Quality Index (PSQI), 36-Item Short Form Health Survey (SF-36 ),
IPAQ (International Physical Activity Questionnaire), FINDRISC) to improve the study
of etiopathogenetic factors of obesity and provide assistance to patients with obesity of
the I and II degrees, which will briefly and quickly additionally help to determine the
patient's condition in order to choose a patient-oriented approach to therapy. Using the
calculated ABSI index best diagnoses the abdominal type of obesity and additionally
makes it possible to assess the presence of risks of disease and mortality.
During the clinical evaluation of the research group of patients of the main working
age with obesity of the I and II degrees, it was found that 100% of them had obesity of
the abdominal type, in contrast to practically healthy individuals, the following were
observed: elevated blood pressure levels (p<0.001), the presence of clinically
pronounced anxiety and depression (p<0.001), eating disorders (p<0.001), sleep quality
disorders (p<0.001), the presence of excessive daytime sleepiness according to the
Epworth scale (p<0.001), 50.67% of patients had shift work disorder. Taking into
account the identified features, the patients of the research group (BMI=30.0-39.9
kg/m2
) were divided into 2 subgroups, patients with a daily work schedule (without
circadian rhythm disturbances) were included in I-ІІ, and patients with shift (night) type
of work schedule. A detailed analysis of the indicators of both subgroups showed that
in patients of the II subgroup with shift work disorder there was an increased level of
drowsiness (p<0.05), a decrease in the quality of sleep (p<0.05) and the level of physical
activity (p<0.05).
In order to optimize the treatment of patients of the 1st subgroup, it is proposed to
use the method of motivational counseling according to the step-by-step “5As” system,
supplemented by the “5Rs
” system, with a patient-oriented approach, which included
lifestyle modification and long-term support of the doctor and monitoring of compliance
with recommendations on lifestyle, sleep hygiene, physical activity and diet (2 times a
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week for 6 months) (diet therapy, physical activity, sleep hygiene). Armodafinil in a
dose of 150 mg per day in the morning was added to the patients of the II subgroup in
addition to this technique, as a drug for the treatment of shift work disorder in
accordance with the recommendations of the American Academy of Sleep. The
indicators were evaluated at 3 control points - after 1, 3, 6 months of observation. During
6 months of treatment in the I subgroup, it was possible to achieve the target reduction
in the percentage of body weight loss by 5.51±0.2%, which was accompanied by a
significant decrease in the level of anxiety and depression (р<0.01), improvement in
eating behavior (р<0.05 ), increasing the level of physical activity to the recommended
level (p<0.001), achieving target blood pressure levels (p<0.01), reducing the risk of
diabetes in the next 10 years (p<0.001) and improving the quality of life (p<0.001) . In
the II subgroup, more pronounced positive changes were observed over 6 months - a
