Program Čigota je medicinski program namenjen za redukciju telesne težine. Koncepcija programa je zasnovana na: dobro izbalansiranoj dijeti, strogo određenoj i doziranoj fizičkoj aktivnosti i edukativnim predavanjima. Pacijent, životne dobi 27 godina, hospitalizovan u Specijalnoj bolnici Čigota u okviru Čigota programa. U 19. godini života počeo da dobija na težini, a unazad 2 godine se ugojio, oko 110 kg. Leči se od psihoze (shizophrenia). Do dana prijema u našu ustanovu nije hospitalno lečena gojaznost. Antropometrijske mere na dan prijema-BMI: 64,58 kg/m², telesne masti: 47.8% (110,8 kg), obim struka: 180cm. Objektivnim pregledom utvrđena gojaznost trećeg stepena, metabolički sindrom i hipertenzija prvog stepena. Pacijent je uz 24h medicinski nadzor podvrgnut dijetetskom režimu ishrane, doziranoj fizičkoj aktivnosti, fizikalnom tretmanu i svakodnevnoj psihološkoj obradi. U okviru tretmana gojaznosti došlo je do razvoja elektrolitnog disbalansa koji je protumačen kao diluciona hiponatremija sa hipokalijemijom, umerene simptomatologije i hroničnog razvoja i korigovan je tokom narednih sedam dana adekvatnom peroralnom suplementacijom kalijuma, natrijuma, magnezijuma i restrikcijom unosa tečnosti. Na kraju tretmana (160 dana) postignut je ukupan gubitak telesne mase od 105,8 kg, odnosno za 45,86% prvobitne težine. Postignuta je značajna redukcija telesnih masti za 68,8% prvobitnih vrednosti, redukcija obima struka za 61 cm, odnosno 33,8%. Uspostavljena nefarmakološka regulacija hipertenzije, regulacija glikemije i triglicerida, uspostavljen povoljan profil frakcija holesterola (HDL/LDL), značajno redukovana vrednost mokraćne kiseline u serumu. I nakon dve godine od započinjanja tretmana gojaznosti u našoj ustanovi pacijent je u kućnim uslovima nastavio trend gubitka telesne mase i postigao prelazak iz kategorije gojazan u kategoriju pre-1 Aleksandar Đenić, Specijalna bolnica za bolesti štitaste žlezde i bolesti metabolizma Zlatibor,

Obesity is one of the most significant independent risk factor for developing heart failure (HF) through direct and indirect mechanisms. Excessive secretion of aldosterone and activation of the renin-angiotensin system (RAAS) in obese patients leads to sodium retention and an increase in extracellular volume, which contributes to the development of heart failure and increased cardiovascular risk. Abdominal visceral obesity is associated not only with an increased risk for the development of heart failure with preserved ejection fraction (HFpEF), but also with a high risk for the development of diabetes mellitus and hypertension in both sexes, but more dominantly in women, with an increase in incidence with menopause. Multiple studies and meta-analyses have confirmed that obese patients with heart failure regardless of ejection fraction (HFpEF and HFrEF) have better survival compared to those of normal or underweight, a phenomenon known as the obesity paradox. The HF-ACTION trial showed that even small improvements in cardiorespiratory fitness could lead to significant improvements in cardiovascular outcomes, reducing the impact of the obesity paradox on the clinical outcome of heart failure. The ESC recommendations for heart failure advise weight loss in order to prevent cardiovascular disease in obese and overweight patients, and gradual weight loss should be considered in patients with heart failure and BMI > 35 kg/m2 , while in patients with heart failure and BMI<35 kg/m2 , weight loss is not recommended. The goal of bariatric procedures is to prevent or delay the onset of heart failure, not only by reducing body weight but also by reducing risk factors. The randomized DAPA-HF trial showed that the use of dapagliflozin proved to reduce the composite outcome of worsening heart failure or cardiovascular death in heart failure patients with BMI>30 kg/m2 and in HF patients with BMI<30 kg/m2 . The EMPEROR-preserved and DELIVER trials showed that therapy with SGLT2 inhibitors in patients with HFpEF and BMI>30kg/m2 reduces the risk of hospitalization and cardiovascular death. It is recommended that patients in the terminal stage of heart failure in the pre-transplantation period and placed on the list for heart transplantation achieve target values of BMI<30 kg/m2 in order to achieve a better clinical outcome and reduce mortality after transplantation.