Intensification of Weight Loss with the Ketogenic Diet during the Management of a Super Obese: Case Study

Abdalla Jamile Nobrega Zeraik,Gil Priscilla,Sajoux Ignacio,Corrêa Lívia Lugarinho,Guzman German,Freitas Silvia De,Coutinho Walmir

doi:10.23937/2378-3656/1410254

Abstract

Obesity is a chronic disease referred to as a world epidemic. Superobesus management is challenging and requires multidisciplinary follow-up. In this case report, the patient had an initial body mass index (BMI) of 110 kg/m² associated with comorbidities such as type 2 diabetes (T2DM). Initial clinical management was performed with changes in lifestyle, through hypocaloric and ketogenic diet, associated with several antiobesity drugs and the introduction of light physical activity. After a total loss of about 140 kg using only clinical measures, the patient's BMI still remained above 40 kg/m², with indication for bariatric surgery. Patient performed Roux-en-Y gastric bypass (RYGB) with greater safety due to previous important weight loss. After the surgery, the patient evolved to the reversion of type T2DM associated with a psychosocial and quality of life improvement.

Highlights

Obesity is a chronic metabolic disease characterized by a body mass index (BMI) equal to or greater than 30 kg/m2 and can be attributable to various causes
The patient had an initial body mass index (BMI) of 110 kg/m2 associated with comorbidities such as type 2 diabetes (T2DM)
Initial clinical management was performed with changes in lifestyle, through hypocaloric and ketogenic diet, associated with several antiobesity drugs and the introduction of light physical activity

Summary

Introduction

Obesity is a chronic metabolic disease characterized by a body mass index (BMI) equal to or greater than 30 kg/m2 and can be attributable to various causes. The ketosis phase is finalized by gradually adding carbohydrates to the diet during the Physiological Adaptation Phase, for a daily intake of up to 1200 kcal (LCD) During this stage the patient loses the remaining 20% of the weight. The final stage, the Maintenance Stage, consists of a balanced diet including protein, carbohydrates and fat, with a total calorie intake of between 1500 and 2000 kcal/day, the Figure 1 explains the program succinctly [3]. It was elected to perform a Roux-en-Y gastric bypass (RYGB), consisting of a mixed surgical technique which promotes weight loss through restriction and malabsorption [2], requiring a recommended minimum daily intake of 2 multivitamin and mineral complex capsules (which must contain folic acid, iron and thiamine), 1200-1500 mg of elemental calcium, 3000 IU of vitamin D (titrade to therapeutic levels of 25-hydroxyvitamin D > 30 ng/ml), vitamin B12 (as required to maintain levels within normal range), and 45-60 mg of total iron [5]. Five months after the bariatric surgery was performed, the patient had lost an additional 22 kg, for a final weight of 166 kg (Figure 3), with the possibility of performing cosmetic surgery to repair body contouring (Figure 4)

Findings

Discussion

Conclusion