Article 92: Weight Loss Strategies for Obesity Combined with Kidney Disease and Constipation

Diet planning is often difficult for obese individuals with kidney disease, as it requires ensuring adequate calorie intake while restricting protein and fat. Patients often develop hypertension due to obesity, which, if not properly controlled, ultimately affects their kidneys. When kidney function is impaired, patients typically have poor appetite and eat small amounts; therefore, malnutrition must be prevented during weight loss, as it could be life-threatening.

However, because obesity can lead to uncontrollable blood pressure and increase the burden on the kidneys, patients still need to lose weight under the supervision of a doctor. In terms of diet, the key issue is limiting protein intake. A high-protein diet may worsen the kidneys' hyperfiltration state, leading to further damage to kidney function, and also increase the production and retention of nitrogenous metabolic products in the body. In this case, a low-protein diet can reduce kidney damage.

However, low-protein doesn't mean a predominantly vegetarian diet or eliminating meat. It means limiting total protein intake while reducing plant-based protein and increasing the proportion of animal protein. The recommended daily protein intake is 0.6–0.8 grams per kilogram of body weight. While restricting protein, it's crucial to ensure sufficient total energy intake to meet the energy needs of bodily functions. Foods high in calories but low in protein, such as pumpkin, potatoes, sweet potatoes, yams, taro, and lotus root starch, can replace some of the staple foods like rice and noodles. Vegetables and fruits don't need strict restrictions. However, it's still important to appropriately limit fat intake to avoid further weight gain due to excessive calorie expenditure.

To treat constipation in people with simple obesity, one must start with weight loss, and laxatives should not be abused.

(1) High-fiber foods are the best for weight loss, as they are the most effective for weight loss. High-fiber foods are also the most effective at stimulating intestinal peristalsis, maintaining stool moisture, and preventing constipation. Furthermore, fiber is the best food for creating a feeling of fullness, and bowel regularity is one of the methods for weight loss. Therefore, for obese individuals with constipation, eating high-fiber foods is a win-win situation, achieving both weight loss and bowel regularity. It has been reported that men who consume 50 grams of fiber daily experience noticeable weight loss and regular bowel regularity within a week. Therefore, whether or not an obese person has constipation, they should eat more fiber-rich foods, such as various fresh vegetables and fruits, especially leafy green vegetables, pumpkin, winter melon, cucumber, and konjac. A low-fat, low-sugar, low-calorie, high-fiber diet should be adopted.

(2) Physical exercise and physical activity are considered to be another effective way to lose weight. They can also treat the weakening of heart and lung function, muscle relaxation and weakness, and drowsiness (the more you sleep, the fatter you get) caused by obesity. Similarly, physical exercise can improve the tension of defecation muscles such as abdominal muscles, diaphragm, levator ani muscle and intestinal smooth muscle, which is also an effective way to prevent and treat constipation. For example, abdominal muscle exercises, sit-ups, squatting exercises, jogging, swimming, etc. can both lose weight and exercise defecation muscles, which are suitable for preventing and treating obesity and constipation.

The World Health Organization has classified obesity as a disease. Since obesity is a chronic condition, like other chronic diseases such as diabetes and hypertension, it requires long-term treatment. Ideal treatment for obesity should include education on knowledge and behavior, a balanced diet, and increased physical activity to boost calorie expenditure. However, only about 5% of people achieve and maintain their target weight through non-pharmacological methods. Therefore, while drug therapy is not the first-line treatment for obesity, it plays a crucial role.

Some weight-loss drugs, slimming teas, and slimming foods have a slimming effect, and their principle is mostly to stimulate the central nervous system, reduce food intake, and suppress appetite to achieve the desired result. Improper use can lead to liver damage, endocrine disorders, and other consequences. Hormonal drugs promote metabolism and protein breakdown, increasing energy expenditure to achieve weight loss, while laxatives increase excretion, forcibly removing normal body fluids rather than excess fat, often causing dehydration. Furthermore, some have significant side effects or poor results, accompanied by reactions such as loose skin, and the lost fat tends to rebound quickly. For optimal weight loss results, medication must be combined with diet and exercise.

The causes of obesity are complex and vary from person to person. Medications for obesity can only target specific symptoms; there is no magic bullet. Every medication has both effects and side effects. Therefore, medication can only be an adjunct to weight loss; relying solely on medication for weight loss is impossible.

The United States recommends that people use weight-loss drugs if their body mass index (BMI) is >30, or >27 with one or more complications. In Japan, weight-loss drugs are used for obese patients whose obesity is >70% or whose BMI is >35, for whom diet and exercise are ineffective. The World Health Organization believes that drug intervention for pre-obese individuals with a BMI of 27-30 has significant benefits in preventing complications and improving psychological stress. In China, the indications for weight-loss drugs are considered to be: ① For those who have achieved initial results with strict dietary control but cannot continue, medication can be added to help them maintain weight control. ② For patients who are not suitable for dietary control, such as those with peptic ulcers or mental disorders, medication can be used as a temporary measure. ③ For those who relapse after dietary control. ④ For those who have failed dietary restriction therapy.

Different weight-loss drugs work on different principles. Some are lipase inhibitors, reducing the body's absorption of fat from food; others increase basal metabolism, increasing energy expenditure; and still others suppress the appetite center, reducing hunger. While morbidly obese individuals can take weight-loss drugs, they should not become overly reliant on them. Because weight-loss drugs have certain side effects, they are not suitable for obese children.