Exogenously constitutional. Alimentary constitutional obesity: causes, symptoms, treatment

Primary obesity, or alimentary, is a consequence of the fact that a person either abuses food or moves little. This also applies to that part of humanity who has a sedentary job. In these circumstances, the fat that enters the body, as well as carbohydrates, are not fully used. Instead, they are deposited in subcutaneous tissue located around the organs.

Second reason this disease there may be consequences of other diseases associated with the endocrine and central nervous system, as well as psychological disorders.

The formation of fat deposits in large quantities in human body and there is obesity. At present, this disease is considered an epidemic of a non-infectious nature. The diet of most people is far from balanced, and the food itself does not consist of healthy products. Their diet mainly consists of fats and carbohydrates.

Kinds

If we talk about alimentary obesity, then it should be noted that it is divided into three types, referring to the places where the following types are located:

1. Android. It is most commonly found in men. Here, fat accumulations are concentrated in the abdomen and armpits. This species also has a subtype - abdominal, which means that fat is located only under the epidermis of the abdomen and surrounds the internal organs.
2. Gynoid look. It belongs more female gender. Fats are deposited on the thighs and in the lower abdomen.
3. Mixed look. In this case body fat located on all parts of the body.

External causes

Alimentary obesity can occur under the influence of external and internal factors.
External causes include:

• Eating large amounts of food. Because of this, both adults and children are susceptible to the disease.
• Reflex to eat a lot. It is acquired over time. If a stressful situation arises, then for many people you need to eat something high-calorie to calm down. Some, having come home from work, relax, watch their favorite shows on TV and at the same time eat junk food.
• National tradition. In this case, some people not only change their lifestyle, but also their daily diet, which is not always good for the body.
• Sedentary lifestyle. A lot of people are not very active. After a hard day, people just want to lie down and sleep. In addition, in our time, many still have a sedentary job. Then the activity is reduced to almost zero.

Internal

The internal reasons are:

• Heredity. When someone in the family is prone to this disease, future generations will be at risk.
• The rate of fat metabolism, which depends on how adipose tissue is arranged.
• The active functioning of the centers located in the hypothalamus, which are responsible for the state of satiety or hunger.

These are the main causes of obesity.

Degrees

Experts have identified 4 degrees of the disease:

• the first stage - body fat is up to 39 percent of a person's normal weight;
• the second - up to 49 percent;
• third - overweight is 99 percent;
• the fourth is the most severe form, where the excess fat is more than one hundred percent.

We calculate the indicator

Excess weight is calculated without the help of specialists, independently. This is done like this:

1. Two indicators are taken - weight and height.
2. The growth rate is converted to meters. Multiply the resulting number by the same number.
3. The weight is divided by the resulting number.
4. The result is ready - it remains only to check whether it fits into the weight norms.

Set weights

Overweight has its own generally accepted norms. They differ according to the following indicators:

• if the calculated total is from 18.5 to 24.9, then this means that the weight is in order and does not threaten the state of health;
• when the result is from 25 to 29.9 - excess weight present; especially should be paid attention when the indicator is 27, as the risk of obesity increases;
• from 30 to 34.5 - you should start to worry, this is alimentary obesity of the first degree;
• with a result of 35 to 39.9, a second degree is observed, it already needs to be treated;
• above 40 - the third degree; in this case, it is difficult for people with their weight, and secondary diseases are also added to this;
• an indicator of more than 50 indicates the fourth degree of obesity, it is accompanied by many other serious abnormalities in the body.

At the slightest change in weight, you should not be shy to seek the advice of a doctor. He will be able to explain what nutritional obesity is and what its consequences may be.

Concomitant diseases

May contribute to the development of diseases in body systems such as:

• respiratory;
• cardiovascular;
• digestive;
• endocrine.

With a negative effect on the cardiovascular system, one can observe the occurrence and development of:

• atherosclerosis;
• hypertension;
• myocardial infarction;
• varicose veins.

Fat deposits, which are located in the abdomen, change the position of the diaphragm. And this, in turn, is fraught with a malfunction pulmonary system. The elasticity of the lungs is significantly reduced, as a result, the development of pulmonary insufficiency begins.

Approximately half of obese people have gastritis. In addition, various diseases of the liver, pancreas and gallbladder are actively developing.

In the fight against alimentary obesity, diets and sports are used. The diet should be developed by a specialist, taking into account the individualities of the body. In addition, you must adhere to the following recommendations:

• follow the rules of healthy eating;
• do not eat food in the evening and at night;
• in the intervals between meals, make snacks, always light, so as not to heavily burden the stomach;
• portions during meals should be small;
• observe the drinking regime;
• completely abandon harmful products;
• periodically cleanse the body using only safe methods.

Activity and sport

In the fight against obesity, physical activity is indispensable, so forget about a sedentary lifestyle. Exercises are also selected individually for each person. Therapeutic exercises help:

• much faster to reduce weight;
• strengthen muscles;
• improve the work of the cardiac system;
• reduce the risk of many diseases;
• cheer up.

Unlike alimentary, exogenous constitutional obesity differs not only in its distribution in the body, but also in the duration of development. The fight against him is also a little different. Drug treatment is not used, as it gives only a temporary effect.

In this case, the treatment takes place under the watchful supervision of a nutritionist. One of important recommendations in this method are:

• low-calorie diet;
• the minimum amount of carbohydrates and fats in the diet;
• compulsory consumption of fresh fruits and vegetables;
• constant intake of biological supplements and vitamins prescribed by the doctor.

Also, do not consume more than 5 grams of salt per day. It is useful to spend unloading days. Once a week will be enough. In addition, in the fight against obesity, proper mental attitude, since diets and physical activity radically change the habits and lifestyle of the patient.

Alimentary obesity (exogenous-constitutional) is a type of metabolic pathology in which hereditary factors do not play a role. significant role. External causes play a leading role in the development of this disease, but the influence of the initial state of the organism on the process should not be excluded.

All factors contributing to the development of alimentary obesity can be divided into external and internal. The external ones include regular overeating, the presence in the diet of a large amount of food rich in fats and simple carbohydrates (bakery, sweets, pasta, fatty meat dishes, etc.), improper eating habits (eating out of order, taking high-calorie and heavy meals at night) . Today, the problem of a sedentary lifestyle as one of the key links in the pathogenesis of obesity is particularly relevant. To internal factors include metabolic diseases (diabetes mellitus, etc.). A special group is hormonal imbalances with excessive or insufficient function of the gonads that occur during pregnancy and lactation, during menopause in women. In the anamnesis of almost every obese person, there are relatives who suffer to some extent from metabolic pathology, which indicates the invariable role of genetic predisposition to the disease.

According to UN estimates, the countries with the highest percentage of the population suffering from obesity include the United States (32.8%), Mexico (31.8%) and Syria (31.6%). Russia in this ranking occupies the 28th line, the level of the population with excess body weight is 24.9%.

Existing classification

1. Excess body weight is 10-29%.
2. Overweight - 30-49%.
3. Overweight - 50-99%.
4. The actual body weight of a person exceeds the norm by 100%.

Types of obesity according to the location of adipose tissue:

1. Android (male) obesity, sometimes called central obesity. This type is characterized by the deposition of fat masses in the abdomen, armpits, lower back and back.
2. Gynoid (female) obesity - fat deposits occur in the chest, buttocks and thighs, lower abdomen.
3. Mixed - relatively the same distribution of fat throughout the body.

The deposition of adipose tissue in the body is a genetically determined process that is controlled by sex hormones. With hormonal dysfunction in men or women, a redistribution of adipose tissue according to the type of the opposite sex can occur.

Particular attention should be paid to the process of obesity of internal organs. With a slight excess of body weight, its percentage is low, but the higher the degree of obesity, the more fat is distributed around the internal organs. It is possible to develop pathologies of fat metabolism, leading to inclusions of fat droplets between the functional cells of organs, which leads to the development of dystrophies of the latter (“tiger” heart, fatty degeneration of the liver, etc.). Any dystrophy is accompanied by a violation or insufficiency of the organ, which leads to the appearance of concomitant diseases.

Clinical picture

In addition to fat deposits, alimentary obesity is characterized by some secondary symptoms. These include shortness of breath and respiratory failure, palpitations during exercise, and excessive sweating. They arise due to an increase in the volume of circulating blood along with adipose tissue, but the heart copes with such a load with difficulty and with the inclusion of compensatory mechanisms. The lack of breathing may be partly due to the increased size of the internal organs and the greater omentum, which press on the diaphragm from below, thus compressing the lungs. Against the background of a constant excess of lipoproteins in the blood, atherosclerotic vascular lesions develop, which underlies the development of coronary heart disease. Excess adipose tissue can lead to the development of type 2 diabetes. Every fat person is a potential diabetic.

Stretch marks may appear on the skin (white or red stripes, similar to scars, occur when a person recovers quickly, but the elasticity of his skin does not allow him to accommodate a sharply increased amount of tissue). Excessive sweating creates favorable conditions for reproduction in the folds of pathogenic bacteria, which leads to pustular skin diseases. Constant excessive pressure on the spine can lead to its deformities and curvature.

Diagnosis of obesity

The international standard for diagnosing obesity is the body mass index. It is calculated by the formula: BMI = body weight (kg) / height² (m), (kg / m).

This indicator is very subjective, since it does not take into account the weight of a person's muscle mass. Based only on the body mass index, one can mistakenly calculate that an athlete with well-developed muscles is overweight.

During the inspection, the following indicators are determined:

1. Thickness skin fold on the stomach, at the angle of the scapula, shoulder (the norm is up to 1.5-2 cm).
2. Waist. For a man, this figure should be less than 101-102 cm, for a woman - less than 87-88 cm.
3. Type of constitution (hypersthenics are most prone to obesity - people with a strong, stocky physique).

Necessary treatment

In order to reduce or get rid of obesity, a complete reorganization of lifestyle is required. The nutritionist prescribes to such a patient strict diet with restriction of fats and carbohydrates, gradually reducing the calorie content of the daily diet. Alimentary obesity is by no means treated by fasting. Food is fractional, in small portions, up to 5-6 times a day. The patient is recommended moderate physical activity: walks in the fresh air, physiotherapy and physical education. At good health loads can be increased.

With excessive consumption of food, reduced physical activity, alimentary obesity develops (primary, constitutional - other names for the pathological process). This condition is characterized by incomplete processing and accumulation of fats in the body. excess fat envelops the internal organs and forms an excess subcutaneous fat layer. This type of disorders must be distinguished from the secondary accumulation of lipids, which occurs against the background of diseases of the nervous and endocrine systems, as well as psychogenic disorders.

The term "obesity" refers to increased accumulation of lipids in the body. An unbalanced diet leads to an increase in a large amount of adipose tissue, when high-calorie food dominates in the diet, and natural healthy food is not enough.

Causes and pathogenesis

Lipid metabolism is a complex mechanism. It involves the endocrine glands, nervous system, hypothalamus. Energy imbalance in the body is the main cause of obesity. With excessive appetite and insufficient energy expenditure, failures occur in the body. The metabolic rate lags behind the intake of energy-producing foods. Since lipids do not have time to be processed, adipose tissue accumulates.

Factors leading to alimentary-constitutional obesity are divided into endogenous (internal) and exogenous (external).

Internal factors include:

1. Heredity. The likelihood of developing the disease is high when a person has relatives burdened with an ailment.
2. Features of the anatomical structure of subcutaneous fat.
3. The rate of lipid metabolism.
4. Incorrect work of the centers of the hypothalamus responsible for hunger and satiety.
5. Hormonal imbalance associated with pregnancy, childbirth, breastfeeding, menopause, menopause.

Among the external factors of alimentary obesity are:

1. The availability of food, its excessive consumption by people of any age category.
2. Reflexes associated with the time of eating and the amount of food eaten. Some eat stress, others constantly have something to eat, others gorge themselves in the evening, sitting in front of the TV with a plate overflowing with tasty, but completely unhealthy food.
3. National tastes and food habits. People depend on certain stereotypes in nutrition. Their menu consists of a set of dishes that lead to overeating and obesity. They excessively consume fatty, salt, carbohydrates, sweets, alcohol, systematically eat before going to bed.
4. Factors that cause hypodynamia: sedentary work, being in static positions, an inactive lifestyle.

Forms

Depending on the location of adipose tissue, there are:

1. Android. Lipids accumulate in the abdomen. So adipose tissue grows mainly in men. This species has a subtype - visceral. With it, lipids accumulate in the subcutaneous layer of the abdomen and on the internal organs.
2. Gynoid. Adipose tissue overgrows the hips, lower abdomen. This pathology occurs more often in women.
3. Mixed. Adipose tissue is formed in excess throughout the body.

Up to 95% of overweight patients suffer from alimentary obesity.

Stages of the disease

Fat begins to be deposited when the body is not able to use up the energy received from food without a trace. Doctors distinguish 4 stages of the disease:

1. In the first degree, the amount of fat exceeds the norm by 10-30%.
2. In the second degree, the excess of lipids reaches 31-50%.
3. In the third degree, body fat exceeds 50% and can reach up to 99%.
4. At grade 4, the amount of fat reaches critical levels. They exceed the allowable rate by 100 percent or more.

Diagnostics

Obesity is defined in 3 ways:

1. Measure the thickness of the fold formed on the abdomen. An indicator of 1.5-2 cm is considered normal. In the case of constitutional exogenous obesity, this parameter exceeds 2 cm.
2. Measure the waist. The technique is used to determine the abdominal form of the disease. Values ​​that do not go beyond 88 cm for women and 102 cm for men are recognized as the norm.
3. Body mass index. Let's understand what BMI is. The criterion is calculated as follows: weight (kg) / height 2 (m). Consider an example: height - 167 (1.67), mass 97 kg. With these parameters, we get the following index: 97:1.67 2 = 34.78. After calculating the BMI, the degree of obesity is diagnosed in accordance with accepted standards.

To accurately determine the places of accumulation of fat, its amount and percentage, methods of hardware diagnostics help:

• CT scan;
• X-ray densitometry.

Symptoms

The main symptom of alimentary obesity is increased nutrition and overweight. Against its background, patients note: underdevelopment of muscles, a second chin, growth of the mammary glands, thighs in the form of riding breeches, hanging fat folds, umbilical or inguinal hernia.

Signs 1 and 2 stages

Obesity of the 1st degree, and even more so of the second, is accompanied by functional disorders in the body. With severe forms of the disease, patients suffer from:

• profuse sweating;
• weakness and drowsiness;
• shortness of breath;
• edema;
• constipation;
• joint pain.

Stage 3 and 4 symptoms

Comparing obesity of the 2nd degree with the 3rd and 4th stages, the development of more serious disorders in the body is noted. Patients with severe forms of the disease have:

• tachycardia;
• hypertension;
• respiratory failure;
• occurrence of cor pulmonale;
• liver pathology: cholecystitis, pancreatitis;
• joint pain (especially in the spine, ankles, knee joints);
• disturbed menstruation;
• excessive sweating leading to skin diseases (eczema, furunculosis, acne);
• stretch marks on the skin of the thighs, abdomen, shoulders;
• hyperpigmentation (occurs in places of increased friction, occurs in the neck and elbow joint);
• dysfunctions of the nervous and endocrine systems.

Treatment

With alimentary constitutional obesity, deposits are distributed over problem areas of the body. The disease progresses for a long time. It is not advisable to treat him with drugs. They do not bring a sustainable positive effect.

The impact of drugs such as Adiposin, Phenanine and Fepranone contributes to weight loss. However, the positive results are short-lived as the weight returns soon. Patients are treated with dietary nutrition, psychotherapy, therapeutic exercises.

Diet

Diet therapy is a key way to treat this disease. The diet for the patient is made by the doctor. In this case, the nutritionist relies on the generally accepted principles of healthy eating:

• low-calorie dishes are introduced into the menu (their energy value is calculated taking into account the IMC and the patient's well-being);
• significantly limit the consumption of fatty and carbohydrate foods;
• introduce dishes from raw vegetables and fruits into the diet;
• water is recommended to consume moderately up to 1.5 liters per day;
• regulate the amount of salt (4-5 g per day);
• spend fasting days: eat only fruits, vegetables or dairy products (1 time in 7 days);
• use multivitamins, useful nutritional supplements (BAA);
• adhere to fasting in the evening and at night;
• arrange light snacks between main meals;
• introduce fractional nutrition, eat in small portions;
• refuse harmful products;
• cleanse the body in a safe way;
• review and adjust eating habits.

You cannot practice diet therapy on your own. The nutrition plan is developed in collaboration with the doctor. The nutritionist selects methods for cleansing the body, products for everyday nutrition and fasting days, calculates the caloric content of food, and adjusts the diet if necessary.

Physical Education

Diet therapy is supported by selecting adequate physical activity. Motor activity is calculated individually, taking into account the condition and capabilities of the patient.

Systematic fat-burning sports contribute to rapid weight loss. Thanks to them, muscle tissue is strengthened, the work of the cardiovascular system is getting better, the likelihood of concomitant pathologies is reduced, and the mood is uplifted.

Psychological rehabilitation

Psychotherapists correct the behavior and eating habits of patients. Psycho-emotional background is restored faster when complex treatment, which includes:

• diet;
• physiotherapy procedures;
• physiotherapy;
• walks in the open air.

Conditions for such treatment have been created in many sanatoriums, health resorts and resorts. Motivation is essential to fight disease. It is especially relevant when the weight is not too critical. It is used to eliminate obesity of the 2nd degree and the first, when irreversible functional disorders have not yet occurred in the body.

Photos are used as motivation. Thanks to them, the patient:

• sets a goal, looking at himself in the photo, where he was absolutely healthy, he liked his own image;
• compares the changes that have occurred in the body during treatment.

When obesity is treated for a long time, excess weight goes away slowly. It is this approach that ensures that the previous body weight does not return. If the treatment course takes 1-3 years, the weight will stabilize. Patients rarely gain back the lost kilograms.

Effects

Obesity provokes the occurrence of diseases of the heart and blood vessels. It becomes an impetus for the appearance of pathologies of the respiratory system. Causes digestive upset.

If the cardiovascular system is involved in the pathological process, there is:

• atherosclerosis;
• varicose veins of the legs;
• hypertension;
• ischemia;
• stroke;
• myocardial infarction.

Subcutaneous fat, which has grown in the abdominal cavity, raises the diaphragmatic septum too high. As a result, the lungs lose their ability to function normally. They lose elasticity, shrink unnaturally. An obese patient develops respiratory failure.

The same factor in half of overweight patients leads to an upset of the gastrointestinal tract. They develop diseases of the liver (up to cirrhosis), biliary tract, gastritis and other ailments of the digestive system.

Endocrine organs do not remain aloof. They are also drawn into the pathological process. Against the background of obesity often develops diabetes mellitus. Obesity leads to joint diseases: arthritis, arthrosis, osteochondrosis.

Because of it, there are problems with the organs of the reproductive system. Fertility and libido decrease, menstruation is disturbed, women develop polycystic disease. The illness leads to cancer: malignant tumors affect the mammary glands, ovaries, uterus, prostate, large intestine.

People need to understand that alimentary obesity is a dangerous disease. It leads to serious complications. The risk group includes not only those who are prone to accumulation overweight. Simple preventive measures help to protect against the disease: rational nutrition, sports, positive emotions.

Graduate work

Psychological characteristics of people suffering from alimentary-constitutional obesity.

Introduction

Relevance: In most economically developed countries of the world, there is a clear trend towards an increase in the number of patients with eating behavior, accompanied by severe somatoendocrine disorders and causing persistent psychosocial maladjustment (Krylov V.I., 1995). Changing eating behavior is one of the types of pathological adaptation and underlies food addiction, which is a socially acceptable type of addictive behavior - condemned, but not dangerous to others. Using Excessive Eating as a Means of Escape and Normalization emotional state, an addictive person “acquires” new problems in the form of alimentary-constitutional obesity, indicating spiritual trouble. However, characteristic of clinical picture formation of alimentary-constitutional obesity, the relationship between disturbed eating behavior and the psychological characteristics of a person suffering from overweight remains poorly understood to date (Powers P. S. et al., 1988, 1992; Shapiro S., 1988).

Appetite regulation is a complex multicomponent mechanism, one of the most important links of which is the reciprocal interaction of the satiety center and the hunger center located in the hypothalamus (Brobeck, 1946; Bray, 1976; Gallaugher, 1981; Bray, 1982). In recent years, everything appears more works, indicating that the saturation signal triggers complex reactions of the hypothalamic-pituitary and limbic systems, some of which are associated with positive emotions. According to A.M. Wayne (1981), there is a close relationship between mental, emotional and vegetative processes that underlie the adaptation of the body to various stimuli of the external and internal environment. In a situation of developed family stereotypes of the cult of food with a lack of positive emotions a person can use food intake as a compensatory way to normalize the emotional background (Korosteleva I.S. et al., 1994). Overeating becomes a source of positive emotions, an adaptation option under adverse social conditions or mental distress (Knyazev Yu.A., Bushuev S.L., 1984; Gavrilov M.A., 1999; Rotov A.V., 2000).

Thus, the above determines the relevance of the study of the psychological factors underlying obesity and determines the following goals and objectives.

Purpose: To identify the psychological characteristics of obese people.

1. Conduct psychodiagnostics of people with alimentary-constitutional obesity and normal weight as a control group.

2. Determine the psychological factors associated with the formation of obesity in overweight people.

3. Determine the indications and formulate recommendations for providing psychological assistance (psychotherapy) for obesity.

Hypothesis: People with alimentary-constitutional obesity are characterized by certain psychological characteristics: hypochondria, anxiety, escape from reality.

Object: Psychological characteristics of people with alimentary-constitutional obesity.

Subject: Indications for psychotherapy of people with alimentary-constitutional obesity.

Organization, materials, research methods:

3. Psychodiagnostic methods of OHP (Karvasarsky B.D., Wasserman L.I. Iovlev B.V. 1999), MMPI (Minnesota Multiphasic Personality Inventory) modified by Berezin F.B. (Berezin F.B., Miroshnikov M.P., Rozhanets R.V. 1976)

4. Method for determining the Quetelet body mass index (degree of obesity). (Vardimiadi N.D., Mashkova L.G., 1988)

1. Obesity - concept, classification

In recent decades, overweight and obesity have become one of the most important problems for the inhabitants of most countries of the world.

According to the latest World Health Organization (WHO) estimates, more than a billion people on the planet are overweight. This problem is relevant even for countries in which a large part of the population is constantly starving. In industrialized countries, obesity is already a significant and serious aspect of public health. This problem has affected all segments of the population, regardless of social and professional affiliation, age, place of residence and gender. In Western European countries, for example, 10 to 20% of men and 20 to 25% of women are overweight or obese. In some regions of Eastern Europe, the share fat people reached 35%. In Russia, on average, 30% of people of working age are obese and 25% are overweight. Most obese people in the United States: in this country, overweight is registered in 60% of the population, and 27% are obese. According to experts, obesity is the cause of premature death of about three hundred thousand Americans a year. In Japan, representatives of the society for the study of obesity, who first prepared a special declaration, say that overweight and obesity in the Land of the Rising Sun are becoming a tsunami, threatening the health of the nation.

There is an increase in the incidence of obesity in children and adolescents everywhere. In this regard, WHO considers this disease as a pandemic affecting millions of people.

Obesity and all the problems associated with it are becoming an increasingly heavy economic burden on society. In the developed world, obesity treatment accounts for 8-10% of all annual healthcare costs.

A feature of obesity is that it is often combined with serious diseases that lead to a reduction in the life expectancy of patients:

type 2 diabetes mellitus.

arterial hypertension,

dyslipidemia,

atherosclerosis,

ischemic heart disease,

sleep apnea syndrome,

Some types of malignant neoplasms

reproductive dysfunction,

Diseases of the musculoskeletal system.

It's no secret that being overweight is one of the health indicators. Extra pounds significantly increase the risk of developing such serious diseases as arterial hypertension, type 2 diabetes, coronary heart disease, so it is very important to monitor your weight. The main sign of obesity is the accumulation of adipose tissue in the body: in men, more than 10-15%, in women, more than 20-25% of body weight.

Obesity is:

accumulation of fat in the body, leading to an increase in excess body weight. Obesity is characterized by excessive deposition of fat in the body's fat depots.

the result of calorie intake from food that exceeds calorie expenditure, that is, the result of maintaining a positive energy balance for a long time.

chronic relapsing disease characterized by excessive accumulation of adipose tissue in the body.

chronic disease requiring long-term medical treatment and surveillance aimed at sustained weight loss, reduction in comorbidities and mortality. Up to 75% of patients who follow a diet (especially a very low-calorie diet - about 400-800 kcal / day) gain most from lost weight within 1 year.

Obesity classification:

I. Primary obesity. Alimentary-constitutional (exogenous-constitutional):

1. Constitutionally-hereditary;

2. With eating disorders (night eating syndrome, increased food intake for stress);

3. Mixed obesity.

II. secondary obesity.

1. With established genetic defects:

2. Cerebral obesity;

brain tumors;

trauma to the base of the skull and the consequences of surgical operations;

syndrome of an empty Turkish saddle;

skull trauma;

inflammatory diseases (encephalitis, etc.).

3. Endocrine obesity:

pituitary;

hypothyroid;

climacteric;

adrenal;

mixed.

4. Obesity on the background of mental illness and / or taking antipsychotics.

Stages of obesity:

a) progressive;

b) stable.

Types of obesity:

1. "Upper" type (abdominal), male

2. "Lower type" (femoral-gluteal), female

Fat can be located:

1. In subcutaneous fat (subcutaneous fat)

2. Around the internal organs ( visceral fat)

Abdominal subcutaneous fat + abdominal visceral fat = abdominal fat.

Deposition of adipose tissue in the abdominal region ( top type obesity, or central obesity) is more clearly associated with morbidity and mortality than the lower type of obesity or than the degree of obesity!

Numerous studies have shown that a large number of abdominal adipose tissue is associated with a high risk of developing dyslipidemia, diabetes mellitus, and cardiovascular disease. This relationship is not related to total body fat. For the same body mass index (BMI), abdominal obesity, or increased fat deposition in the abdomen, is associated with a higher risk of comorbidities than lower-type obesity.

Abdominal fat distribution increases the risk of mortality in men and women. Preliminary evidence also suggests an association between this type of fat deposition and sarcoma in women.

Recall that the simplest indicator of the distribution of adipose tissue is the OT / OB index (the ratio of waist to hips).

A high value of the ratio OT / OB means the predominant accumulation of adipose tissue in the abdominal region, i.e. in the upper body. Men and women are at risk if OT / OB is greater than or equal to 1.0 and 0.85, respectively.

For men OT/R 1.0

For women OT / OB 0.85.

Obesity related diseases and risk factors:

According to WHO, obesity of the first, second, initial degree of the third (BMI 35-37) is dangerous for human health. BMI over 38 is a threat to life.

Many obese individuals have impaired insulin function and carbohydrate metabolism, as well as the exchange of cholesterol and triglycerides. All of these comorbid conditions are risk factors for cardiovascular disease, and their severity increases with increasing BMI (see table).

Relative risk of diseases often associated with obesity:

For example, in obese individuals, the relative risk of type 2 diabetes mellitus triples compared with the risk in the general population. Similarly, obese individuals double or triple their risk of coronary heart disease.

Obesity is often accompanied by the development of:

▪ type 2 diabetes

▪ impaired glucose tolerance

▪ elevated level insulin and cholesterol

▪ arterial hypertension

Obesity is an independent risk factor for cardiovascular disease. Body weight is a better predictor of coronary heart disease than blood pressure, smoking, or high blood sugar. Moreover, obesity increases the risk of other forms of pathology, including certain types of cancer, diseases of the digestive system, respiratory organs and joints.

Obesity significantly impairs the quality of life. Many obese patients suffer from pain, limited mobility, low self-esteem, depression, emotional distress and other psychological problems due to prejudice, discrimination and exclusion in society.

2. Psychosocial aspects of obesity

At the present stage of studying the problem of obesity, most researchers recognize the fact that the leading etiological factors of the disease are hyperalimentation and hypokinesia. Based on these basic ideas about the causes of obesity, various models of the pathogenesis of the disease are proposed. However, the statement of hyperalimentation and hypokinesia, which is the starting point when considering the neuro-humoral-endocrine and energy mechanisms of the disease, does not allow one to get an adequate idea of ​​the clinic and etiopathogenesis of the disease, since the actual human factor of the disease falls out of the analysis, i.e. such mechanisms of the pathological process that are determined by the social essence of a person.

To most accurately understand the essence of the psychosocial factors of obesity, it is necessary to analyze eating behavior.

An analysis of eating behavior cannot be carried out without highlighting the main constitutive feature - nutritional needs. The approach to revealing the content of human behavior, based on the identification of needs as an inciting and guiding force, is traditional for Soviet psychology.

Nutritional need, according to most researchers, refers to the lowest, natural, biological, primary physiological needs, from which it follows that nutritional need is one of the leading needs of the body, which indicates a lack of plastic and energy substances necessary to perform vital functions. However, nutritional need, being typically biological in nature and serving as an object for the psychophysiological study of motivation in animals, in humans in the process of socialization, as it were, "humanizes" and ceases to be a need only for plastic and energy substances, it appears in a more complex form "socialized" needs. This circumstance was emphasized by K-Marx: "Hunger is hunger, but the hunger that is quenched by boiled meat eaten with a knife and fork is a different hunger than that in which raw meat is swallowed with the help of hands, nails and teeth." A.N. Leontiev reveals an important feature of needs, pointing out that "in the most needful state of the subject, an object that is able to satisfy the need is not rigidly recorded." Analysis of the eating behavior of obese patients, in to some extent, confirms this idea. Human eating behavior is psychologically polyfunctional. The polyfunctionality of eating behavior is especially clearly observed in patients with obesity, manifesting itself for all patients in the same way - hyperalimentation, but in essence it is different and depends on what needs the person satisfies, on its "personal meaning".

Eating behavior can be:

1. A means of maintaining energy and plastic homeostasis. This is the simplest form of eating behavior, when food serves only to meet the body's need for nutrients.

2. Means of relaxation, discharge of neuropsychic tension. In this form, eating behavior is found not only in humans, but also in animals. L.V. Waldman points out that cats in the depression-like stage of chronic stress show obsessive food motivation and food greed. Similar phenomena have been observed in humans.

3.G.I. Kositsky notes that during the war, during the bombing, some people experienced a pronounced feeling of hunger, and they ate the entire available supply of food. He draws attention to the fact that such manifestations occur in peacetime with strong neuropsychic stress, explaining them on the basis of the stress state formula he proposed: CH = C (In-En-Vn - Is-Es-Sun), where CH - the state of stress, C-goal, In, En, Vn - information, energy, time required to fulfill this goal, and Is, Es, Vs - the resources of these parameters available to the body, respectively. From this, he concludes that the body reduces the state of tension, increasing energy resources through excessive food intake. Among the patients examined by us, 45.5% noted a pronounced feeling of hunger during neuropsychic stress caused by a variety of reasons, and that eating at this moment had a calming effect on them. It should be noted that patients mainly consumed easily and quickly digestible carbohydrate foods.

4. By means of delectation (delectatio - lat. - pleasure, enjoyment), sensual, sensory pleasure, acting as an end in itself.

4. A means of communication, when eating behavior is associated with communication between people, a way out of loneliness.

5. A means of self-affirmation. Eating behavior in this case is aimed at increasing the self-esteem of the individual. This behavior is manifested in the choice and reception of exotic, most refined and expensive dishes, active visits to restaurants. It is closely related to an inadequate idea of ​​the prestige of food and the corresponding "solid" appearance.

6. Means of knowledge. The process of eating always includes a cognitive component. Taste, visual, olfactory analyzers evaluate the quality of food, its safety and usefulness for the body.

7. A means of maintaining a particular ritual or habit. At the same time, eating behavior is aimed at maintaining national, family traditions, rituals and habits. An example of such behavior is traditional holiday feasts, the habit of eating while reading, watching TV, listening to music.

obesity nutritional psychotherapy treatment

8. A means of compensation, replacement of unsatisfied needs of the individual (need for communication, achievement, parental needs, sexual needs, etc.).

9. Means of reward. Food, due to its taste, can serve as a reward for some actions that are positively evaluated by the social environment. This form of eating behavior is especially common in childhood.

10. A means of satisfying an aesthetic need. It is known that food, eating behavior of a person can be aimed at satisfying the aesthetic needs of a person. This is manifested both in the improvement of the taste of food through culinary processing, and in the process of eating through ritual, the use of beautiful tableware and cutlery.

11. Means of protection. R. Konechny and M. Bouhal indicate that excessive food intake, and after that the resulting change in appearance, can serve as a means of protection against unwanted marriage (marriage), an excuse for failure in sports and work.

Thus, human eating behavior is aimed not only at providing the body with plastic and energy substances, but also performs a wide variety of functions, and in an individual, these functions always manifest themselves in a complex way.

Eating behavior analysis opens the most important feature needs, the transformation of the subject of one need into the subject of another, masking the true motives of behavior. This transformation occurs under the influence of external factors, mediated by internal ones.

Psychosocial factors contributing to the occurrence of hyperalimentation. Clinical and psychological examination of obese patients made it possible to identify several types of psychosocial factors that contribute to the occurrence of hyperalimentation. It should be emphasized that the factors described in most cases do not act separately, but collectively.

1. Mental trauma. Psychological conflicts of personality, violations of inter - and (or) intrapersonal relationships contribute to excessive food intake. The influence of this factor was noted in 50% of the patients examined by us. The table presents data on psychotraumatic situations that contributed to the formation of hyperalimentation. As can be seen from the table, the largest percentage of psychotraumatic situations falls on the sphere of family and domestic relations, among which the leading role is dissatisfaction with family relations. An analysis of traumatic situations shows that they are found everywhere, and their influence is determined by the significant attitude of the patient's personality towards them. It is interesting to note that the same situations play an important role in the pathogenesis of neurosis, alcoholism, coronary heart disease, and hypertension. To answer the question why, in some cases, psychotraumatic situations that are significant for a person lead to the emergence of neurosis, alcoholism, coronary heart disease, hypertension, and in others to deformation of eating behavior and further development of obesity, today is not possible and requires additional research. It seems that the personality traits of the patients and the constitutional inferiority of the food center can be the decisive moments.

2. Socio-cultural norms and traditions. This factor often plays a significant role in the formation of the wrong attitude to food and overweight.

a) The idea of ​​a large body weight (fatness) and a good appetite as signs of health.

b) The idea of ​​a large body weight and certain eating behavior as a sign of solidity, social well-being, prestige.

c) National and cultural food traditions.

3. Wrong education. The formation of an inadequate idea of ​​food and the corresponding food stereotypes in a patient is closely related to upbringing in the family, but we separately single out this group of factors in order to pay special attention to the dependence of improper upbringing and hyperalimentation.

a) Upbringing by the type of "hyper-custody". Exaggerated concern for the health of the child, overfeeding him, too careful attitude towards him, limiting his physical activity can lead to the development of obesity in children. This factor is the leading cause of childhood obesity.

b) Education according to the type of "rejection". The undesirability of the child in the family, and as a result of this upbringing according to the type of "rejection" can, as well as excessive guardianship, lead to overfeeding of the child. It can be assumed that the mother's unconscious feeling of undesirability of the child, the lack of love for him is replaced by the implementation of socially regulated norms. In these cases, the mother, as it were, is removed from the child, formally performing her parental functions, guided by the principle: "The child must be well fed, shod, dressed no worse than other children." Among our patients, this factor was detected in 8%. They noted frequent conflicts with their parents, an authoritarian, harsh upbringing, a feeling of undesirability in the family against the background of an exaggerated concern for their health and clothing.

As can be seen from the foregoing, there is a significant number of psychosocial factors that affect the eating behavior of a person, which are a kind of trigger mechanisms for the development of obesity.

3. Genetic aspects of obesity

About the role hereditary factors the development of obesity was discussed as early as the 60s, when Pickwick's syndrome was first described in siblings. And although the so-called twin method did not give unambiguous results, later twin studies convincingly testify in favor of a significant role of hereditary predisposition to obesity.

The existence of familial forms of obesity is well known, in which the inheritance coefficient reaches 25%, which indicates a fairly high contribution of genetic factors to the development of this syndrome.

Yu.A. Knyazev and A.V. Kartelishev defined family forms as "constitutional-exogenous obesity". They hypothesized the existence of an adiposogenotype, which does not contradict the concept of multifactorial inheritance.

The risk of developing obesity in a person reaches 80% if both parents have it. The risk is 50% if only the mother is obese, about 40% if the father is obese, and about 7-9% if the parents are not obese.

Currently, the search for the obesity gene is underway, but apparently there are several such genes and they are localized on different chromosomes. There is evidence of the existence of a dominant obesity gene with weak expressivity. It is assumed that this gene is closely linked to the met oncogene on chromosome 7.

When discussing the genetic aspects of obesity, it is necessary to dwell on the existence of 2 main types of obesity - hypertrophic and hyperplastic (or hypercellular, multicellular). This division is based on a genetically determined and acquired number of adipocytes. The laying and increase in the number of these cells occur in the "critical period" of a child's life - from the 30th week of pregnancy until the end of the first year of postnatal life. The leading factors determining the number of fat cells in the body are the level (quality) of nutrition and the genetically determined secretion of growth hormone - growth hormone(STG). This was evidenced by an increase in the concentration (synthesis) of growth hormone in pregnant women with diabetes mellitus and the presence of the number of adipocytes in the fetus and newborn. Growth hormone is known to increase cell proliferation in various organs. And excessive nutrition of a pregnant woman and overfeeding of a child in the first months of life stimulate the reproduction of adipocytes and, therefore, contribute to the development of hyperplastic obesity. This form of obesity often develops in early childhood, has a more severe course and is difficult to treat. Resistance to therapy is associated with the irreversibility of the number, but not the size of adipocytes.

One of the methodological approaches to the study of the hereditary nature of diseases is the search for possible relationships between genetically determined signs - the so-called genetic markers - and pathology. Among genetic markers of considerable interest are human leukocyte antigens (HLA), the existence of which was proved in 1959. A relationship has been established between the antigens of the HLA system and the timing of the onset of the disease, on the one hand, also the nature clinical course and prognosis on the other. For example, work carried out in Western Siberia, revealed a high association of HLA, B8, A11, B22 with juvenile diabetes mellitus and arterial hypertension.

Obesity may be a manifestation of some pathological conditions linked by the same origin. In 1988 The hypothesis of the so-called "metabolic syndrome" (MS) or "X" syndrome was advanced, emphasizing that all signs are due to primary (probably genetically determined) tissue insulin resistance. The full picture of MS includes the presence of insulin resistance, overweight, predominant deposition of fat in the trunk, essential hypertension, characteristic changes in the blood lipid spectrum, and impaired glucose tolerance, increasing to overt diabetes mellitus. Due to the combination of all these signs, patients with MS have a high risk of developing atherosclerosis, arterial hypertension, coronary heart disease, strokes, type II diabetes mellitus, etc. The earliest manifestation of insulin resistance syndrome is abdominal (upper, visceral) obesity.

4. The role of the endocrine system in the etiopathogenesis of obesity

Speaking about the state of the endocrine system in obesity and its role in the genesis of the latter, it is extremely difficult to differentiate endocrine disorders that lead to weight gain from endocrine disorders that occur as a result of this increase.

A number of hormones are involved in the regulation of fat metabolism, both in the hypothalamic-pituitary region - corticolebyrin (CRF), adrenocorticotropic hormone (ACTH), somatotropic hormone (GH, growth hormone) - and peripheral endocrine glands- cortisol and norepinephrine (adrenal glands), thyroid hormones (thyroid gland), insulin (pancreas), androgens, estrogens and progesterone (sex glands, adrenal glands), not to mention the hormone of adipose tissue - leptin. Androgens and estrogens are modulators not only of the adiposogenic process in the body, but also of the regional distribution of fat depots; they also affect the level of leptin circulating in the blood.

Many endocrine diseases - Itsenko-Cushing's disease and Cushing's syndrome, hypothyroidism, type 2 diabetes mellitus - are accompanied by weight gain; at the same time, naturally, in laboratory tests, corresponding changes in the concentration of hormones are detected, which, in fact, determine the clinical and diagnostic picture of the disease.

However, the presence of only obesity as such in the absence of listed, well-defined endocrine diseases does not mean the absence of endocrine disorders in the body. For example, in obese individuals without hypothyroidism, blood levels of thyroid hormones are within the normal range. However, it is known that basal metabolic rate and thermogenesis, which are closely related to the action of thyroid hormones, are often reduced in obesity. This suggests a violation of the action of thyroid hormones on tissues, rather, not on everything (otherwise there would be a clinical picture of hypothyroidism), but, for example, on adipose tissue.

Although basal levels of pituitary, adrenal, and thyroid gland in patients with so-called "exogenous-constitutional" or "alimentary-constitutional" obesity, as a rule, they are also not changed; a detailed examination of a person often reveals more subtle hormonal abnormalities. So, the levels of somatotropic hormone - one of the most important fat-mobilizing factors - are within the normal range, but in most, if not all, obese individuals there is no increase in its concentration in response to specific stimulation (tests with insulin hypoglycemia, thyroliberin, levodopa, arginine and etc.). Therefore, it can be assumed that the level of lipolysis in adipose tissue under conditions of such a "latent" deficiency of growth hormone may decrease, and the accumulation of fat mass may increase. On the other hand, some authors consider impaired stimulated secretion of growth hormone secondary to obesity, since there is evidence that stimulated secretion of growth hormone is restored after weight loss.

Glucocorticoids (cortisol) suppress the anti-lipolytic effect of insulin on fat cells, especially those in the abdominal cavity, since the latter contain a large number of receptors for glucocorticoids. As a result, under the influence of cortisol, lipolysis and the flow of free fatty acids through the portal system to the liver increase; the described interaction may enhance hepatic insulin resistance.

In the process of developing abdominal obesity, there is an increase in the functional activity of the "corticoliberin - ACTH - adrenal glands" axis, with an increase in the production of cortisol. Increased secretion of corticoliberin can further lead to impaired secretion of growth hormone and gonadotropic hormones (LH and FSH), with the subsequent development of reproductive dysfunction. Over time, the functional activity of the hypothalamic-pituitary-adrenal axis is depleted, as a result of which, in individuals with already developed obesity, plasma glucocorticoid (cortisol) concentrations and their daily circadian rhythm remain within the normal range. However, the rate of decay of cortisol increases, and the rate of its production increases compensatory; sometimes, changes in cortisol secretion are detected in the dexamethasone test.

Perhaps the most pronounced and met with enviable constancy hormonal disorder in obese individuals is an increase in the concentration of insulin in the blood. Most often, it is detected in people with android (abdominal) and mixed types of obesity, much less often in gynoid (femoral-gluteal) type of fat deposition. Hyperinsulinemia develops most likely secondary to insulin resistance. However, high levels of insulin itself stimulate appetite, hyperphagia and weight gain, thus forming a "vicious circle". As already mentioned, hyperinsulinemia and insulin resistance can play the role of a link between obesity, on the one hand, and arterial hypertension, dyslipidemia, and atherosclerosis, on the other hand. This is why many obesity experts believe that overweight individuals with hyperinsulinemia are a special group. high risk, which primarily needs therapeutic and preventive measures.

The study of patients suffering from polycystic ovary syndrome and obesity attracted the attention of gynecologists and endocrinologists to the search for a possible relationship between insulin resistance, hyperinsulinemia and hyperandrogenism. Insulin resistance is found in polycystic ovary syndrome, even regardless of body weight. It is possible that insulin resistance and hyperisulinemia are a pathogenetic link common to polycystic ovary syndrome and obesity. Fluctuations in insulin levels under the influence of various medications relatively correlated with the concentration of testosterone in the blood. The pituitary gland contains receptors for insulin. Hyperinsulimism and hyperandrogenism can disrupt the secretion of gonadotropins, increasing the level of luteinizing hormone. On the other hand, the use of antiandrogens does not always improve insulin sensitivity. It is logical to assume that weight loss or the administration of drugs that reduce insulin resistance (eg, metformin) and, secondarily, hyperinsulinemia, can eliminate hyperandrogenism and its associated disorders. menstrual cycle.

So, in the vast majority of people with obesity, at least with an in-depth examination, numerous violations of hormonal secretion are detected, which do not fit into a clearly defined endocrine nosology, but, nevertheless, allow us to consider obesity - even "simple", or exogenous constitutional - as an endocrine disease. True, at the current level of knowledge, it is very difficult to clearly identify possible endocrine abnormalities in a particular patient, and it is almost impossible to influence them therapeutically in order to reduce body weight. Earlier in practice, attempts were made to treat obesity with thyroid hormones aimed at increasing basal metabolism and stimulating thermogenesis. They should be recognized as unreasonable and harmful, since weight loss could be achieved only with the use of very large doses of thyroid hormones, that is, in fact, by iatrogenic thyrotoxicosis, with all the ensuing adverse consequences, primarily for the cardiovascular system and bone fabrics.

5. Nutritional obesity - mechanisms of development

Many overweight people know that they are eating to relieve feelings of fear or grief. In the first year of a person's life, the relationship between mother and child is largely determined by food intake. Later, when the child already begins to eat independently, the mother or the person who has taken over the functions of the mother also prepares food and serves it on the table. Eating thus creates a largely unconscious fantasy of union with the mother. In this case, the mother may later be symbolically replaced by grocery stores, hotels or a home refrigerator. To be full means to be safe and not abandoned by the mother.

Alimentary obesity is a metabolic disease characterized by an increase in the volume of adipose tissue, a progressive course and a high tendency to relapse.

Speaking about alimentary (food) obesity, it must be remembered that this is a disease. This is important because society as a whole, and even medical professionals, tend to have a rather frivolous attitude towards being overweight. Meanwhile, the World Health Organization has recognized obesity as a new non-communicable epidemic, and the success of medicine in the fight against this epidemic seems to be more than modest.

Previously, it was believed that the basis of alimentary obesity is the excess of the energy value of food consumed over energy expenditure by the body. It is now firmly established that it is not only the amount of food consumed that matters, but also the imbalance of key nutrients, in particular, an increase in the proportion of fat in the diet.

Among all nutrients, fats have the highest energy value and are the most difficult to digest. In addition, the fate of alimentary fat in the human body is not the same in different time days.

So it is known that the main role in the assimilation of fat absorbed into the blood by body tissues is played by the hormone insulin. The intensity of secretion of this hormone during the day is not the same. Its maximum is at night, and its minimum is during the day. At the same time, the extraction of fat from adipose tissue is regulated by the sympathetic nervous system and mainly by adrenaline. The activity of the sympathetic nervous system is maximal in daytime days and is minimal at night. Thus, the food eaten during the day, to a very small extent, turns into fat and is deposited in adipose tissue. The main deposition of fat in the depot occurs at night. Therefore, all nutritionists are advised to limit the evening meal to 18 hours.

Speaking about the obesity clinic, one should start with changes in a person's eating behavior. Human food-procuring behavior is determined by the feeling of hunger. In this case, it is necessary to distinguish between the concepts of "hunger" and "appetite". The feeling of hunger is evidence of the body's need for nutrients and occurs when blood glucose levels decrease. And appetite is the desire to eat something, which is most determined by a person’s food and taste preferences, therefore, excess appetite is a manifestation of a person’s psychological dependence on food, not physical. Obesity is characterized by dissipation (i.e., splitting) of hunger and appetite. This is what dictates nightly raids on the refrigerator, unconscious gluttony during stress, dependence on sweet and fatty foods. Refusal of these "small joys" of life is perceived by patients as mental trauma hence frequent failures in dieting, low efficacy of therapy and high relapse rate. Therefore, in such patients, psychological rehabilitation is a necessary component of therapy, the purpose of which is to reduce the psychological dependence on food.

The process of eating is determined not only by internal reasons, but also by various kinds of social pressure. Children are often forced to leave an empty plate after eating. Later it turns into a habit. Some people have a guilty conscience if they throw away food they haven't eaten, especially in restaurants and cafes where leftover food cannot be known to be reused for human consumption. At the same time, some people recall the starving people in other countries, which were often already told in families when the child did not want to eat. Of course, one person in a starving country will not become more full if someone in Germany indulges in gluttony. It is also important that many parents express their love through the offering of food or sweets. With the help of sweets, they seek to comfort children when they are in a bad mood.

Except mental component, with obesity, significant changes are observed in the endocrine status of the organism. Not only the level of secretion of insulin, growth hormone, adrenaline and norepinephrine changes, but also the sensitivity of body tissues to these hormones. Characteristically, sensitivity to insulin decreases earlier in muscle cells than in fat cells, and to adrenaline - on the contrary. In this case, the so-called "metabolic syndrome" develops, which is manifested by an increased risk of developing various diseases. These diseases include: type II diabetes mellitus, hypertonic disease, atherosclerosis and its organ manifestations (in the vessels of the brain - dyscirculatory encephalopathy, stroke, in the coronary arteries of the heart - ischemic heart disease and its formidable complication - myocardial infarction, in the vessels of the extremities - obliterating atherosclerosis, gangrene of the extremities), increased risk of malignant neoplasms - mammary gland, colon, prostate, endometrium. Since adipose tissue plays an important role in the breakdown of female sex hormones - estrogens, its excessive development leads to a lack of these hormones in a woman's body, which leads to premature menopause, menstrual irregularities, development hairline on the face, complications during pregnancy and childbirth. The musculoskeletal system suffers with the development of osteochondrosis, osteoarthritis, curvature of the spine, and joint deformities.

In the development of obesity, in all likelihood, constitutional and social factors that contribute to overeating play a large role. The existing psychological disorders in most cases do not create the impression of being particularly important, but their presence makes it necessary to consider issues related to their impact on the course of obesity as a disease.

For example, obese people often have low self-esteem, many of them feel insecure in society, there may be sleep disturbances in the form of hypersomnia or severe insomnia, persistent asthenization, manifested in reduced performance, low mood, irritability, sensitivity, impaired adaptive abilities to various changes living conditions.

Psychopathologically, obese patients have depressive and anxiety-phobic disorders, which, in their opinion, are caused by a violation of socio-psychological adaptation. In all forms of obesity, to varying degrees, there are signs of damage to the nervous system and mental sphere. Undoubtedly, these changes in obesity are not accidental and differ quantitatively and qualitatively from those in diseases of the internal organs.

An analysis of the few data available in the literature on changes in the mental sphere in obesity shows that they can be divided into several groups.

First of all, these are psychological constitutional and personal characteristics that are related to psychogenic factors. Personally-structurally, they are determined by the desire to consume a large amount of food, due to which the development of the disease with the presence of biochemical, endocrine, metabolic disorders can be formed. The latter, in turn, can contribute to increased attraction as a psychogenic factor. Thus, a vicious circle is formed, which cannot be broken by dietary and drug treatment alone. There comes an improvement, clinically short-term, since one of the reasons is not eliminated - attraction and the dependence associated with it.

The second group of violations is secondary. They can be called personality-reactive changes, since they arise as a reaction of patients to their own somatic state, which changes their nature of social functioning. There are several types of these changes. One of frequent reactions is ignoring the problem. This can manifest itself in the form of the formation of personality-typological features of hyperactive fat people, the creation of their own subculture, the formation of a behavior style (the creation of their own style of clothing, works of art, clubs, etc.). These changes can be characterized as psychological agnosia or hypercompensation reactions.

Another type of secondary personality-reactive changes is the formation of depressive-neurotic disorders with painful experiences of a physical defect, reaching a neurotic depression at its peak.

Back in 1921, psychiatrist E. Kretschmer wrote that people with a picnic physique (abdominal obesity in the modern sense) often suffer from depression, stroke, atherosclerosis, and gout. In 1932 in persons with this symptom complex, a violation of carbohydrate metabolism, a decrease in insulin sensitivity, and autonomic dysfunction were detected. These works were the first to suggest a link between depression and a syndrome that was later called metabolic syndrome (MS). AT recent times this problem is actively studied, and although in a few studies of the association between obesity and mental disorders not established, most of the accumulated data indicates a clear predominance of psychopathology in certain groups of obese people. The highest frequency of mental disorders (PD) was found in some categories of obese people - women, patients with morbid obesity, and also (which is especially important) in those who actively seek medical attention for weight loss (BW). In the Dresden Health Study, obese women had the highest incidence of AR; Anxiety disorders ranked first, followed by affective disorders (depression) and PR of childhood.

In morbid obesity, the frequency of subclinical and clinical significant anxiety and depression are significantly higher than in the population: more than half of people with a body mass index (BMI) > 40 have at least one PR. Its prevalence during life in the population is about 17%, and in obese individuals - from 29 to 56%. General and abdominal obesity are not equally associated with psychopathological symptoms. In men, direct and indirect symptoms of depression and anxiety - depression scores - sleep disturbance, dyspepsia (the equivalent of irritable bowel syndrome, in the genesis of which anxiety and depression play a leading role), the use of anxiolytics, antidepressants, sleep disturbances - significantly correlate with the presence of abdominal obesity, those. with waist circumference (WC), but not with BMI. In women, anxiolytics and sleep disturbances are associated with BMI, while antidepressants and dyspepsia are associated with OT.

Thus, PD often precedes the development of obesity, especially in adolescents and young women with severe depression, but in a number of patients, on the contrary, depression develops after many years of obesity. This indicates the possibility of different pathogenetic variants of the association of obesity with PR.

Classical depression is accompanied by insomnia, decreased appetite and BW, while atypical, erased and somatized depressions often occur with drowsiness, increased appetite and BW increase. Both obesity and depression are often accompanied by ED - food excess syndrome (FES) and bulimia nervosa. Depressive disorder is present in anamnesis in 54% of obese patients with SPE and only in 14% of obese patients without SPE. Both in obesity, abdominal obesity and MS, and in depression, there is a high incidence of the same somatic diseases - arterial hypertension, coronary artery disease, stroke and type 2 diabetes. According to epidemiological data, obesity and depression (separately) are independent risk factors for the development of these diseases and increase the mortality associated with them.

Most obese people do not suffer from specific personality disorders (psychopathies), but they do have some personality traits. The most important of them is alexithymia, i.e. a reduced ability to recognize and name one's own feelings, combined with a limited ability to imagine. Alexithymia is present in about 8% of people with normal body weight and more than 25% of obese people, but usually only in those who have other psychopathological symptoms, such as anxiety or eating disorders. Individuals with alexithymia have a hypertrophied reaction to stress: against the general background of "inexpressiveness" of feelings, episodes of anger suddenly appear, often "unreasonable". Obese people who go to the doctor to reduce body weight, as well as women and people with morbid obesity, also have impulsiveness, unpredictability of behavior, passivity, dependence, irritability, vulnerability, infantilism, emotional instability, eccentricity, hysteria, anxiety-phobic and psychasthenic features. Impulsivity is reflected in the alternation of overeating and starvation, attempts to reduce BW and rejection of them. Failures with a decrease in body weight or in other areas of life exacerbate low self-esteem inherent in obese people, a sense of their own inadequacy, low self-efficacy (confidence in their ability to change something), closing the "vicious circle" with increased depression and anxiety. Characteristic features of thinking and perception, common to both obesity and depressive-anxiety disorders, are rigidity, a tendency to "get stuck" in emotions, "black-and-white" thinking (according to the "all or nothing" principle), catastrophizing (expecting the worst of all variants of events), a tendency to unreasonable generalizations ("I never succeed"), poor tolerance for uncertainty and expectation.

Thus, obesity is a psychosomatic disease, in the pathogenesis and clinical picture of which biological and psychological factors and symptoms are combined and interact. There are epidemiological and clinical associations between depressive and anxiety disorders, on the one hand, and obesity, MS, and associated somatic diseases, on the other. Although the majority of obese individuals in the population do not suffer from AE, some categories of patients have a clearly high prevalence of AE, which is accompanied by the development of obesity, including abdominal, and MS. In many cases, depression and anxiety precede the development of obesity, and the severity of mental symptoms is correlated with anthropometric and biochemical abnormalities characteristic of obesity. Depression, anxiety and obesity have a mutually negative effect on each other. The connection between obesity and PR is due to many factors, first of all, the commonality of some links in the central regulation of food intake and mood, i.e. serotonin - and noradrenergic neurotransmitter systems of the CNS, as well as the similarity of the functional state of the neuroendocrine system and psychological characteristics.

All of the above necessitates a holistic psychosomatic approach to the management of patients with obesity, which combines traditional medical programs for the correction of MT with psychotherapy aimed at eliminating the psychological problems that caused the development of obesity or that arose against its background. In this regard, the role of sibutramine as a drug of central action for the treatment of obesity, which through the serotonin and norepinephrine systems simultaneously affects both food intake and the psycho-emotional state of obese patients, is increasing. At the same time, the approach to treatment should also become more differentiated, since it is obvious that people with obesity and PR should be managed differently than those without PR. In the presence of clinically apparent depression or anxiety, it is advisable to start with the treatment of the relevant disorders and only then proceed to the actual BW correction program, otherwise the probability of a positive result is low. With less pronounced or erased symptoms of depression, the advantage in the treatment of a patient with obesity can be given to sibutramine, if possible in combination with psychotherapy or its elements.

6. Modern methods obesity treatment

Leading experts in the field of weight loss recommend a comprehensive approach to the treatment of obesity.

Current anti-obesity programs include:

examination of the state of human health; for the possible identification of the cause of overweight;

development of an individual program for gradual but stable weight loss;

treatment of concomitant diseases;

prevention of weight gain and maintaining it at the achieved level.

Before starting treatment, it is necessary to determine the goals of obesity therapy:

1. Weight loss (at a rate of no more than 7% per month); many authors suggest measuring the rate of weight loss in kilograms, but I think this is not correct, since weight loss is 0.5-1 kg. per week is not the same for a person with an initial BMI of 63 (160 kg.) or a BMI of 29 (62 kg.).

2. Maintaining the body weight reached at the new level and preventing re-gain of weight after losing weight;

3. Reducing the severity of risk factors / comorbidities.

Obesity - chronic illness which should be treated for life.

If you have a body mass index (BMI) > 30 kg/m2 or a BMI > 27 kg/m2 but in combination with:

▪ abdominal obesity (ratio of waist circumference to hip circumference [RT/RT] in men >1.0; in women > 0.85);

▪ hereditary predisposition to type 2 diabetes, arterial hypertension;

▪ risk factors (increased levels of cholesterol, triglycerides, etc.);

▪ concomitant diseases (type 2 diabetes mellitus, arterial hypertension);

then treatment should be started immediately!

Before you start treating obesity, the first thing you need to do is change your lifestyle. No advertised drugs will give the desired effect without a gradual increase physical activity and nutrition education.

Obesity treatment methods.

Modern methods of treating obesity are divided into three main groups:

▪ Non-drug treatments for obesity

▪ Medical treatments for obesity

▪ Surgical treatments for obesity

To non-drug methods obesity treatments include:

▪ Rational hypocaloric nutrition;

▪ Increasing physical activity.

psychotherapy.

Medical methods of treatment:

Before taking any drug, you need to consult with your doctor! After all, the vast majority of drugs, so many advertised and promising super-fast weight loss or have not passed clinical trials or simply harmful to health (a large number of side effects, faster and more significant weight gain after the end of use, the appearance of drug dependence, etc.).

Modern requirements for an ideal drug for the treatment of obesity:

▪ must have a known mechanism of action;

▪ must significantly reduce body weight;

▪should have a positive effect on diseases associated with obesity (diabetes mellitus, arterial hypertension, etc.);

▪ must be well tolerated;

▪ should not cause dependence (addiction);

▪ must be effective and safe for long-term use;

Groups of drugs for the treatment of obesity:

1. The first group of drugs - anorectics, appetite suppressants (not used for long-term treatment of obesity!):

Side effects:

increased nervous excitability, insomnia, euphoria, sweating

diarrhea (diarrhea), nausea;

promotion blood pressure, heart rate

the risk of developing drug dependence.

Characteristics of some drugs:

2. The second group - drugs that reduce the absorption of nutrients into the body:

act locally, in the lumen of the gastrointestinal tract

inhibit the enzyme lipase, due to which food fats are broken down and absorbed into the blood;

reduce the absorption of fats, which creates an energy deficit and contributes to weight loss;

prevent the absorption of about 30% of the ingested fats (triglycerides) of food;

help control the amount of fat in food;

do not affect the central, cardiovascular systems;

do not form addictions and addictions;

safe for long-term use.

Surgery.

Liposuction is a surgical (cosmetic) method for the treatment of obesity, based on the removal of excess fatty tissue from under the skin.

7. Psychology and psychotherapy in the treatment of alimentary obesity

The ability of people to form dependence is the main feature that characterizes their social essence. Addiction provides support, orientation, and empathy; without this ability, ties are weakened, promiscuity is possible, and independence is hardly feasible. The complete rejection of dependence in all cases indicates psychiatric disorders. At the same time, a more or less acutely ongoing process is relevant, leading to the rejection of communications and free decisions.

Excess food intake is closely associated with an irresistible craving, a morbid passion, as in alcoholism. An alcoholic also "heals" an unpleasant state of mind and avoids building social relationships with alcohol, just like an overweight person does it with food. Similar to alcoholism, self-help groups for overweight people have worked well because they combine group dynamics with the patient's intelligent self. As a result, it then becomes easier to eat less. Treatment of excessive food intake (hyperphagia) is further complicated by the fact that lovers of a lot of food cannot completely refuse food, in contrast to alcoholism, in which a complete refusal of alcohol is quite possible. Controlled eating corresponds to controlled drinking in alcoholism, which is notoriously so difficult to achieve that most therapeutic schools reject controlled drinking as a goal of treatment. On the other side, social consequences excess weight is not as significant as the social consequences of excessive alcohol consumption. Serious social pressure in this regard is still experienced primarily by women, which, in turn, may force them to overrestrict themselves in food or resort to artificial vomiting after eating. Like excessive drinking in alcoholism, excessive eating in obesity, which is self-destructive to the body, can sometimes be self-punishing. As with alcoholism, shame often plays a large role in obesity. Obese people eat in secret, just as alcoholics secretly drink, not only out of fear that they might be prevented from eating, but also because they are ashamed to overeat. They are also ashamed of their fullness, which, however, cannot be hidden. Therefore, they often prefer solitude.

The main problem in the treatment of obesity is the failure of purely pharmacological approaches traditional for modern medicine. Despite the large number of studies on the pharmacotherapy of obesity, all currently available medications are only auxiliary, since they give only a slight, short-term effect and have pronounced adverse side effects. This applies to both centrally acting anorectics and lipase blockers of the gastrointestinal tract. The same applies to surgical methods of treatment.

Most of the causes of a psychological nature stretches, as a rule, from childhood. Parents force their children to eat everything, while citing a large number of "folk wisdom and proverbs" as an argument.

"Proverbs and Folk Wisdom"

It is better full stomach than a full mouth of worries, an insatiable womb (raking hands), swallow resentment; take care of; food and drink connect the body with the soul (cf .: the stomach is stronger - it is easier on the heart); love passes through the stomach (cf .: the way to a man's heart leads through the stomach) ....

In this way, habits are formed, which in NLP are called programs. That is, each person is programmed from childhood to a certain set of behavioral stereotypes, these habits - programs, are formed as follows, if they praise their performance, then the habit will be fixed in character. Therefore, when a child is praised by the mother that he finished the meal (if you love your mother, finish it!). A stereotype is formed, finished food - there is love for mom. He is praised for having "respected the combine operator" who grew this bread, or the baker who baked it. A stereotype is formed - to eat up to the end, a manifestation of respect for society. Habits are fixed and go to an unconscious level. A person in the future, knowing a lot of diets, will sit down and eat everything.

Aspects of self-help: the development of obesity in terms of positive psychotherapy.

With rapid weight loss, the fat layer never disappears, and we are talking only about the loss of water, which is achieved due to the effect of dehydration. Obesity in less than 5% of cases is a symptom organic disease(Cushing's disease, hyperinsulinism, pituitary adenoma, etc.). It is in obesity, which is gladly presented as a consequence of organic disorders ("glands do not work"; "be a good utilizer of food"), mental and psychosocial factors play a decisive role. In addition to prescribing a controlled diet or fasting course, ask what is causing the person to eat more than is necessary. In addition to the experience from early childhood that food is more than just a supply of nutrients (e.g., attention to the mother, "sleeping" needs, reducing the feeling of displeasure), there are also concepts that we adopt in the process of parenting ("You should eat well to become big and strong", "it is better to burst than to leave anything to a rich owner" - thrift!). These are those that reflect our attitude to food, our eating behavior. The principle "Eating and drinking fasten the soul to the body" gives special meaning to the process of eating. Communication, attention, security and reliability are obtained according to the principle "Love goes through the stomach." Within the framework of the five-step positive psychotherapy, with the help of a positive approach and meaningful analysis (awareness of food concepts), the foundations of the full meaning of therapy are laid. Obesity is understood as a positive attitude towards the Self, as an actualization of sensations, first of all, taste, the aesthetics of dishes, as a generosity and breadth of nature in relation to nutrition, as a commitment to established traditions in nutrition ("Those who are fat are beautiful"). Practical guidelines for the self-help aspect at the end of this chapter.

Therapeutic aspect: a five-step process of positive psychotherapy for obesity

Stage 1: observation/distancing.

Description of the case: "Better belly from food than a hump from work!"

A 44-year-old technician, who, with a height of 1m 78 cm, weighed 125 kg, came to me for a consultation on the advice of his family doctor, who was participating in the Psychotherapy Week in Bad Nauheimer. As is usually the case in such cases, no metabolic disorder was found in him. On the one hand, he complained only of being overweight, he had been treated for diabetes for six months and there were already signs of hypertension. On the other hand, it seemed that he fatally accepted his excess fullness as his fate. He came to the psychotherapist only at the urgent request of his family doctor, who for a long time had the opportunity to observe how all diets and sanatorium treatment courses failed unsuccessfully. It seemed that the patient felt superfluous in the psychotherapy session, looked at the situation of the reception room with interest and carefully tried to ignore me. The beginning of treatment was very difficult. The patient said nothing but general information: about his marital status, professional activities and remarks that he is already accustomed to slander about his figure and therefore "he has no more complexes." When we started talking about his concepts, we got this dialogue:

Therapist: "What did your parents especially value? Food, school success, family time together, or did everyone have their own freedoms and preferences?"

Johannes: “Of course, they paid attention to school, but eating together was especially important for them. My mother was an excellent cook. of my favorite foods"

Johanies interrupted his story as if it pained him to talk about his family's eating habits. Therapist: "What was the motto in your house?"

Johannes: "Everything was very simple with us: food and drink fasten the soul to the body. I remember well how if I did not want to eat, I had to hear:" EVERYTHING that is served on the table must be eaten. "If I somehow could not eat it all, then the uneaten food was warmed up for me again in the evening. If I did not want to eat, then I was told: there is nothing else. Every piece of bread that I bit off must be eaten by me without a trace. (Johannes smiled absently.) And we were also a storm of innkeepers. How we ate! We further had a proverb on this occasion: "It is better to burst than to leave something to a rich owner." In this I succeed even today When we have a feast at work, there is nothing left. I eat everything. My colleagues scoff: “Better a belly from eating than a hump from work.” (Johannes smiles contentedly. Large drops of sweat have appeared on his reddened forehead.)

A positive interpretation - "You treat yourself and your feelings well, first of all, the taste, the aesthetics of the dishes. You are generous with food" - laid the foundation for changing his point of view. Thus, we could easily move on to discussing ingrained eating habits.

We describe this case also in Positive Family Therapy to clarify the meaning of the concepts.

Stage 2: Inventory

Concepts of respect for food were drawn from the patient's childhood. We come to an experience that was meaningful to Johannes. When he was nine years old, his father died. It was war time, soon the post-war time came. Food was scarce and Johannes' mother constantly complained: "What are we going to do now that our breadwinner is dead?"

The role of the father was focused in his function as a provider of livelihood, and this concept was deposited in the mind of Johanies. Thus, food has acquired a symbolic character. She became for Johannes a symbol of the trust and security that he associated with his father. The thought of the death of the breadwinner and the subconscious conclusion that he himself would have to die of starvation led Johannes to the need to make sure again and again that there was still enough food. That's why he ate as much as he could and with every bite he acquired a steady sense of security. In doing so, he acted in accordance with family traditions of respect for food. Even today, he told us, his grandmother made sure he ate enough. When he returned home in the morning after working the night shift, he could not go to bed without eating. This was monitored by his grandmother, who could even wake him up, discovering that he had not eaten properly.

However, this need was also related to a well-known concept: he needed large earnings to be sure that he would always have enough food. In this regard, Johannes recalled stories about prisoners of war who, even years later, after being released, could not sleep without a piece of bread under their pillow. They simply could not cope with their memory of the famine they experienced many years ago.

Stage 3: Situational support.

So far, the emphasis has been on the observation and inventory stage. Johannes thus gained access to his problems. As vividly Johannes talked about his food and excesses, so little did he seem to care about contact with other people. He was strongly impressed by the remark that contacts are part of the nature of man, and that he has an inherent need to communicate to the same extent as there is a need. But this did not prompt him to talk on this topic. His one-sidedness reminded me of a story about shared duties. It is not about guilt, idealization, negative qualities and one-sidedness. The only thing this parable can say to the patient is that in order to judge something, you need to see it in its entirety!

I told this story to Johannes. He used her as an excuse to talk about how he would like to have a girlfriend, but due to his appearance, he has not yet had a serious or long-term relationship. And then his frugality again helped him turn need into virtue: "A wife would cost me a pretty penny!", but unlike how he said before, Johannes said this ironically, no longer taking what was said seriously. As a counter-concept, I told him about the importance of contacts in the East, about how wide family ties can be, how contacts help to strengthen a person's sense of security and self-respect. Moving in the direction of differentiation, Johannes was able to see that his frugality and overeating functioned as a substitute: At the beginning of his relationship with his late father, then social contacts with other people.

Degree 4: Verbalization

At this stage, Johannes was able, first hesitantly and cautiously, then with curiosity, and finally, vigorously and persistently, to try the proposal to change his point of view. In parallel with this, his thrift was worked out.

Step 5: Expansion of the value system.

Stage 5 had already been laid, and Johannes no longer needed help with this. After he consciously changed his behavior in relation to his concept of diligence and frugality and received positive feedback about it feedback from your surroundings. It became not difficult for him to invite other people. At the same time, he had a stable relationship with one woman. Actually psychotherapeutic treatment took place in 15 sessions. During the last 7 meetings, the patient began to follow a diet at home ( proper nutrition), which this time was a success. Six months after the treatment, Johannes visited me again, he was calm and unperturbed, but it was a different calmness, he was unrecognizable. He lost 24 kg, now went in for sports and planned a big trip, which he wanted to connect with his sports hobby. His blood pressure returned to normal, and his diabetes no longer needed treatment. Losing weight so unloaded his fat metabolism that insulin production from his pancreas increased again. All this became possible not only due to the manifestation of willpower, but due to a change in his life principles and the expansion of his concept.

In the development of obesity, in all likelihood, constitutional and social factors that contribute to overeating play a large role. The existing psychological disorders in most cases do not create the impression of being particularly important, but their presence makes it necessary to consider issues related to their impact on the course of obesity as a disease. (Learning and Teaching Therapy, Jay Haley; The Guilford Press? New York, 1996. Translated by Yu.I. Kuzina.)

One of the most famous American psychotherapists of our time, K. Madanes, considers obesity the result of an unsatisfied (or not completely satisfied) desire to be loved. Family members so compete for attention and care. The struggle for care and attention often leads to the fact that a person harms himself or seeks punishment. Often there is excessive exactingness and criticism, complaints of pain and emptiness. Interaction between family members ranges from excessive interference to complete indifference to the needs of the other. In this case, family therapy is quite effective.

I had the opportunity to attend family counseling for a family in which a woman was overweight. Counseling was carried out by a psychotherapist Golovina I.A. Then I led this family for 3 months, which allowed me to observe the changes taking place.

Wife Elena 28 years old, higher education, suffers from overweight (125 kg.), attacks of high blood pressure began, his legs began to hurt. At the time of filing a complaint about bouts of compulsive eating in the evenings.

Before marriage and the birth of children, she had no problems with weight. The family has two children aged 3 and 4. Elena sleeps with her youngest child, her husband sleeps alone.

Not only Elena is interested in weight loss, but even to a greater extent her husband E. Alexei.

A family consultation was held, which was also attended by E. Anna Sergeevna's mother, who was also worried about her daughter's overweight. In her words, she, taking care of her daughter, always scolded her for being overweight and for eating a lot. A.S. herself has no excess weight.

In the course of family counseling, a program of recommendations was drawn up, which the spouses undertook to implement.

Program:

1. No one else keeps track of how much and how often E eats.

2. Spouses need to sleep together

3. If in the evening E. does not have an attack of compulsive eating, her husband gives E. a half-hour massage.

4. If E. takes 1 kg in a week. weight, mother E. takes the children to her place for the weekend, and E. and her husband spend 1 day off together. (Spend at the discretion of E .: cinema, walk ...)

5. If E. loses 4 kg in a month. then, at the end of the month, they spend 2 days off together (preferably outside the city)

6. If E. does not have a single attack of compulsive eating in a month, then the husband in the form of a "Bonus" gives E. a significant gift for her.

This program was developed together with the whole family and all family members agreed to follow these points.

A month later, E. lost 6 kg. weight, but during the first two months the bouts of compulsive eating continued. The frequency of attacks decreased. By the end of the 3rd month, the attacks stopped and by this time E. had already lost 15 kg.

Conclusion.

Recently, more and more attention is paid to the problem of overweight. The significance of the problem of obesity is determined by the disability of young people and a decrease in overall life expectancy due to the frequent development of severe concomitant diseases.

In the process of studying the literature on this topic, I came to the conclusion that Obesity is a multifactorial heterogeneous disease. The development factors of which can be:

1. genetic;

2. secondary obesity (as a result of damage to the endocrine system);

2. demographic (age, gender, ethnicity);

3. socio-economic (education, profession, social status);

4. psychological (nutrition, physical activity, alcohol, stress).

One of the most interesting questions in science is that in a person there is more biologically predisposed or socially determined. Did not bypass this question and this topic.

Population studies conducted in a number of countries have shown that the number of people with excessive body weight is 25-30%. Of the total number of these cases, 95% is primary obesity. And only 5% suffer from secondary obesity, which is a consequence of damage to the endocrine system, the current organic process in the central nervous system (tumor, trauma, neuroinfection) or genetic predisposition. [EAT. Bunina, T.G. Voznesenskaya, I.S. Korosteleva 2001] Thus, we can conclude that importance in the development of obesity are psychological factors. Excessive food intake leading to obesity in this case is:

A means of relaxation, discharge of neuropsychic stress

· A means of delectation (delectatio - lat. - pleasure, enjoyment), sensual, sensory pleasure, acting as an end in itself.

· A means of communication, when eating behavior is associated with communication between people, a way out of loneliness.

A means of self-assertion. Eating behavior in this case is aimed at increasing the self-esteem of the individual.

a means of knowledge. The process of eating always includes a cognitive component. Taste, visual, olfactory analyzers evaluate the quality of food, its safety and usefulness for the body.

A means of maintaining a particular ritual or habit. At the same time, eating behavior is aimed at maintaining national, family traditions, rituals and habits.

· Means of compensation, substitution of unsatisfied needs of the individual.

· Means of reward. Food, due to its taste, can serve as a reward for some actions that are positively evaluated by the social environment. Especially often this form of eating behavior occurs in childhood.

· Means of protection. R. Konechny and M. Bouhal indicate that excessive food intake, and after that the resulting change in appearance, can serve as a means of protection against unwanted marriage (marriage), an excuse for failure in sports and work.

The result of a lack of love and attention from loved ones.

· A means of avoiding social contacts.I. p. t.

Thus, it can be concluded that there are a huge number of psychological factors underlying obesity. In the literature studied by me, more attention is paid to the presence of these factors and the mechanism of their influence and ways to eliminate these mechanisms are practically not described.

Study.

Organization, materials, research methods.

1. A group of subjects with a BMI over 29 (10 women, age from 22 to 45, education from secondary special to higher education, working, who applied for psychotherapeutic help to reduce weight)

2. Control group of subjects with BMI less than 25 (10 women, age from 22 to 45, education from secondary special to higher, working, not suffering from overweight)

3. Psychodiagnostic methods OHP, MMPI modified by Berezin F. B.

4. Method for determining the Ketle body mass index (degree of obesity).

To diagnose obesity and determine its degree, the body mass index (BMI, body weight in kg / height in m2) is used, which is not only a diagnostic criterion for obesity, but also an indicator of the relative risk of developing diseases associated with it. However, according to the recommendations of the WHO International Obesity Group of 1997, BMI indicators are not for children with an incomplete growth period, people over 65 years of age, athletes, for people with very developed muscles and pregnant women. BMI from 19 to 25 is recognized as the norm. Anything less than 19 is considered dystrophy, as for BMI from 25 to 27, this is overweight. A BMI that is more than 27 is already recognized as obese, so depending on body weight, obesity is distinguished:

1st degree (increase in weight compared to the “ideal” by more than 29%) BMI 27-29.5.

2nd degree (overweight is 30-49%) BMI 29.5-35;

3rd degree (overweight is 50-99%) BMI 35-40;

4th degree (excess body weight is 100% or more) BMI over 40.

Previously, a conversation was held on the subject of concomitant somatic or mental illnesses. Based on anamnestic data and conclusions, women with various types eating disorders that led to the formation of alimentary-constitutional obesity, and who wanted to reduce body weight. The study did not include patients with secondary obesity, which occurs as a syndrome that develops in the pathology of the endocrine glands, with diseases of the central nervous system, patients with mental illness.

To study the psychological state of patients, the Minnesota questionnaire test was chosen as the main one, usually abbreviated MMPI (Minnesota Multiphasic Personality Inventory) in the modification of Berezin F. B.: it can be used to judge the significance of personal characteristics, the current mental state in pathogenesis and the formation of a clinical picture diseases, to study the characteristics of the mental sphere and psychosomatic relationships. This test was taken as the basis of the so-called psychological profile of the examined persons, since the quantitative assessment of the severity of mental changes, the possibility of statistical processing, the absolute comparability of data obtained by different researchers, allows us to consider the use of this psychodiagnostic technique as a means that significantly increases the reliability of studies that involve the study of large populations to assess the effectiveness of mental adaptation, changes in mental state in various conditions (L.N. Sobchik, 1990; F.B. Berezin, 1994).

Results.

As a result of our study, the following results were obtained. For obese women, an eating disorder by the type of hyperalimentation, as a rule, is combined with neurotic symptoms, an increase in the profile on scales 4, 2, 1 and, to a lesser extent, 5 and 7 is typical (Fig. 1). This group is characterized by a tendency to increase search activity in a stressful situation. In this group of patients, the anxiety displacement mechanism does not bear the imprint of a clear connection between psychosomatic disorders and psychogenic factors. They are characterized by a mixed type of response: the achievement motivation is combined with the motivation to avoid failure, the propensity to be active is combined with the propensity to block activities under stress. Increased self-esteem, the desire for dominance is combined with self-doubt, excessive self-criticism. On the one hand, there is an "external" compensation of some traits by others, on the other hand, there is an increase in internal tension, since both behavioral and neurotic ways of responding are blocked. The internal conflict is canalized, as a rule, according to the psychosomatic variant, or it is manifested by neurasthenic symptoms rich in somatic complaints.

MMPI PROFILE OF FOOD ADDICTION PATIENTS. (Fig.1.)

Obese people are prone to health complaints, they have increased attention to their own somatic processes. There is "listening" to your body; all difficulties and sense of threat are transferred from interpersonal relationships on internal processes; low emotional control, irritability, exactingness, anxiety, rigidity; there is a high probability of responding to psychotraumatic situations with an exacerbation of diseases of internal organs. In turn, complaints about health, a demonstration of one's physical ill-being allows one to interpret life's difficulties, as well as the inability to meet the expectations of others, inconsistency with one's own level of claims from a socially acceptable point of view. These reactions can be carried out, firstly, due to the affective presentation of existing disorders (the presence of severe obesity), which makes it possible to rationally explain the difficulty, and, secondly, due to the occurrence of non-psychotic pathopsychological symptoms (complaints of fatigue, irritability, inability to concentrate) . Complaints about the state of health can be used as a means of satisfying selfish tendencies.

Depending on the degree of obesity, there is some dynamics of MMPI scales. First of all, there is an increase in the rise on a scale of 1, which is most pronounced in patients with 3 tbsp. and 4 st. obesity, which indicates a greater degree of their concern about the somatic state, an increase in hypochondriacal tendencies and somatic complaints (which may well be associated with an objective deterioration in the somatic state due to an increase in body weight). There is also a slight rise on scale 2, indicating an increase in anxiety (it makes no sense to talk about obvious depressive tendencies in this case, except for stage 4, when, simultaneously with the rise on scale 2, there is a decrease in the profile on scale 9, indicating the appearance of depressive symptoms, manifested by anhedonic tendencies (a subjective feeling of lack of pleasure from previously interesting activities, an increase in passivity.) A decrease in social spontaneity, as a reaction to overweight, is also expressed in a decrease in the profile on a scale of 4 (more clearly manifested in the differences between 1 and 4 tbsp.) Also, in the direction from grade 1 to grade 4, there is an increase in scale 3, more pronounced in the transition from grade 1 to grade 2 and from grade 3 to grade 4, which indicates the activation of additional repression mechanisms, when the repressed anxiety manifests itself not on behavioral level, but canalized according to the psychosomatic variant with the formation of “conditional pleasantness”. If we rise on scale 1, it can be assumed that in this way there is a kind of “adaptation” to excess weight, as well as its use in order to put pressure on others, or to “justify” one’s inability to meet “socially approved” standards, not only in bodily sphere, but also in the sphere of behavior. The initial rise in the profile on a scale of 8 is associated, presumably, not with personal characteristics characteristic of schizoid personality, but with some autism, as a reaction to being overweight. As adaptation progresses (transition to grade 2), there is a decrease in the profile on this scale.

The inability to independently resolve crisis situations often leads mentally healthy individuals to partial mental maladjustment, which manifests itself in subclinical forms with polymorphic mild symptoms, which in turn, under the influence of social stress factors, can lead to a high degree the likelihood of leading to neurotic or psychosomatic disorders with clinically defined symptoms of anxiety, depression, asthenia, etc. (Aleksandrovsky Yu.A., 1992). In general, I noted that people with food addiction are dominated by mechanisms such as denial, regression, compensation. Substitution, reactive formation, intellectualization, projection and repression are less pronounced. combination of leading defense mechanisms and the degree of their tension are somewhat different in different groups of patients.

Also, to identify psychological characteristics, I used the Questionnaire of Neurotic Disorders. The data using this method showed that people suffering from alimentary obesity show high scores on such scales as hypochondria, neurotic "overcontrol" of behavior (Fig. 2), while people without excess weight have no hypochondria, they show high scores on the scale affective instability. (fig.3)

Average indicators of the results of the OHP of the group of subjects with alimentary obesity. personality scales. (fig.2)

Average indicators of the results of the OHP of the group of subjects without alimentary obesity. personality scales. (fig.3)

As for the special scales, OHP, the following data were obtained, in people with alimentary obesity, indicators on the abuse scale turned out to be high medicines and paranoid mood (Fig. 4.), people who are not obese and have a BMI less than 25 also showed high rates on the paranoid mood scale, and smoking was detected in half.

Average indicators of the results of the OHP of the group of subjects with alimentary obesity. Special scales (Fig. 4)

Average indicators of the results of the OHP of the group of subjects without alimentary obesity. Special scales (Fig. 5)

In the process of experimental psychological research, we compiled a generalized psychological portrait of a person with food addiction. Analysis of the test results revealed the characteristic personality traits of a patient with impaired eating behavior, which led to the development of obesity of varying severity: isolation, distrust, restraint, increased anxiety, dominance negative emotions over positive, sensitivity, the desire for dominance, combined with self-doubt and excessive self-criticism, a tendency to easy frustrations, a high level of claims with a setting to achieve high goals, hypersocial attitudes, a tendency to “get stuck” on emotionally significant experiences (“affective rigidity ”). For such patients, on the one hand, there was an "external" compensation of some traits by others, on the other hand, there was an increase in internal tension, since the behavioral and neurotic ways of responding were blocked, and the internal conflict was often canalized along the psychosomatic variant, while all difficulties were tolerated. from interpersonal relationships to internal processes.

As the degree of obesity increased, there was an increase in hypochondriacal tendencies, which was most pronounced in patients with 3 and 4 degrees of obesity, indicating their concern about their somatic state. Patients with grade 4 obesity were characterized by obvious depressive symptoms, manifested by anhedonic tendencies (a subjective feeling of lack of pleasure from previously interesting activities, an increase in passivity). With an increase in body weight, there was a decrease in social spontaneity and an increase in emotional lability, more pronounced when moving from one degree to another (from stage 1 to stage 2 and from stage 3 to stage 4), which indicated the inclusion of additional repression mechanisms when the repressed anxiety manifested itself not at the behavioral level, but was channeled along the psychosomatic variant with the formation of “conditional pleasantness”. Analysis of the generalized psychological profile of the MMPI test made it possible to identify signs of mental maladjustment associated with the insufficient effectiveness of existing defense mechanisms.

Thus, generalizing the psychological characteristics of a person with food addiction, we can talk about a person who, in a situation of increased emotional stress, uses hyperalimentation as a compensatory source of positive emotions. A change in eating behavior is one of the types of pathological adaptation, and food addiction in general is a mechanism for escaping reality, manifested by a combination of eating disorders of the type of hyperalimentation with mental disorders of a neurotic and personal level, leading to the development of overweight or obesity. varying degrees expressiveness. An experimental psychological study reveals the “parallelism and coherence” of mental and somatic manifestations and reveals an increase in psychopathological disorders with an increase in the degree of obesity, and the degree of alimentary-constitutional obesity, in turn, reflects the degree of spiritual distress. Therefore, in the process of psychotherapy of food addiction, it is necessary to identify and correct those personality traits that contributed to the formation of hyperalimentation as a form of response to psycho-emotional stress, as well as the formation of more adequate mechanisms for mental adaptation and more constructive behavior in the microsocium, more frequent use of adaptive variants of coinciding behavior for through the use of personal and environmental resources.

Conclusion

Alimentary-constitutional obesity is a classic psychosomatic disease. The cause of its occurrence is a violation of eating behavior, equated to mental disorders of the borderline level (Stunkard A. J. et al., 1980, 1986, 1990). Changing eating behavior is one of the types of psychological adaptation, a socially acceptable type of addictive behavior that is condemned, but not dangerous to others, unlike other forms.

In this paper, the psychosocial characteristics of overweight people were considered. As a result of the study, I can conclude that the hypothesis that obese people are united by the presence of certain psychological characteristics has been confirmed.

The purpose of this work was to identify the characteristics of the psychological sphere of obese people.

The main research methods were the psychodiagnostic methods OHP and MMPI (Minnesota Multiphasic Personality Inventory) modified by Berezin F.B. As a result of work with scientific literature and my research, we can conclude. The personal-psychological sphere of the subjects is characterized by reduced resistance to stressful situations. A mixed type of reaction is inherent in them: the achievement motivation was combined with the motivation to avoid failure, the propensity to be active was combined with the propensity to block activity under stress. An increased sense of superiority, the desire for dominance was accompanied by a state of self-doubt, excessive self-criticism. On the one hand, there was an "external" compensation of some traits by others, on the other hand, there was an increase in internal tension, since both behavioral and neurotic ways of responding were blocked. Speaking of psychological mechanisms in the formation of alimentary-constitutional obesity, it can be concluded that a person with obesity, in a situation of increased emotional stress, uses hyperalimentation as a compensatory source of positive emotions. A change in eating behavior is one of the types of pathological adaptation, and food addiction as a whole is a mechanism for escaping reality, manifested by a combination of eating disorders of the type of hyperalimentation with mental disorders of a neurotic and personal level, leading to the development of overweight or obesity of varying severity.

1. A comparative psychodiagnostics of people with alimentary-constitutional obesity and people with normal weight as a control group was carried out.

1.1 People with obesity are characterized by the following psychological features: alexithymia; painful resentment; suspicion; the tendency to react to the influence of emotion without comprehending the situation; inadequacy of emotional reaction to social contacts; internal tension; difficulty in realistically assessing the situation and big picture peace; depressive tendencies; increased irritability and anxiety; increased sensitivity, rigidity; violation of interpersonal relationships; tendency to isolation, closeness; the desire to lay blame on others for the violation of interpersonal relationships and life's difficulties; passivity; dependence on others; hypochondriacal state with constantly depressed mood.

These tendencies manifested themselves in 8 people (80% of the subjects suffering from excess weight.)

1.2 When comparing the results of psychodiagnostics of obese people and people with normal weight, it was found that people who are not overweight have high scores on 9.0 MMPI scales and, unlike overweight people, low scores on 1.2 scales, people with normal weight is more characterized by such personal characteristics as independence; sociability; tendency to group; demonstrative forms of behavior, emotional brightness are combined with the desire for self-realization; high activity; self-confidence; enthusiasm, artistic temperament; low level anxiety; feeling of importance; hyperthymic background; initiative; high self-esteem is maintained, while only 20% of obese people have some of these characteristics.

2. A person with obesity, in a situation of increased emotional stress, uses hyperalimentation as a compensatory source of positive emotions. A change in eating behavior is one of the types of pathological adaptation, and food addiction as a whole is a mechanism for escaping reality, manifested by a combination of eating disorders of the type of hyperalimentation with mental disorders of a neurotic and personal level, leading to the development of overweight or obesity of varying severity.

3. An indication for psychotherapy in people with alimentary-constitutional obesity is neurotic symptoms: a tendency to respond to the influence of emotions without comprehending the situation, inadequate emotional response to social contacts, internal tension, a hypochondriacal state with a constantly depressed mood, depressive tendencies. Recommendations for providing psychological assistance: Psychological help should be aimed at: normalization of intrapersonal well-being and the ability to optimally and adequately respond to exogenous psycho-emotional stress; set yourself up to believe in success and develop self-confidence; consistency in actions aimed at achieving results; development of motivation for healthy eating; clear formulation and formation of a weight loss program; rapid or gradual change in eating habits (stereotypes); the formation of psychological protection in a situation of food temptation or emotional stress.

In the process of complex psychotherapeutic treatment, various types of psychotherapy are used: rational, suggestive (Ericksonian hypnosis), personality-oriented, gestalt therapy, emotional stress, self-regulation, neurolinguistic programming.

List of used literature

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Primary, or alimentary obesity, is a consequence of excessive food intake, as well as low physical activity. At the same time, the fat entering the body or the carbohydrates processed into it are not used in full, they are deposited "in reserve" around the internal organs and in the subcutaneous tissue. Secondary - develops as a result of diseases of the central nervous system, endocrine system and mental disorders.

Obesity is called increased formation and deposition of fat in the human body. This disease is a kind of non-infectious epidemic of the modern world. The nutrition of residents of megacities is unbalanced and contains few healthy foods. Most often, carbohydrates and fats predominate in the diet, while natural products are contained in insufficient quantities.

Types of primary obesity

Any obesity, including primary, can be divided into three types according to the place in which fat accumulates predominantly:

1. Android (male type) - the deposition of fat in the abdomen, armpits, which is more common in men. A subtype of this type of disease is the abdominal type, in which fat accumulation is localized only in the area (under the skin of the abdomen and around the internal organs).
2. Gynoid (female type) - characterized by the accumulation of fat in the thighs and lower abdomen, in most cases observed in women.
3. Mixed - fat is evenly distributed throughout the body.

Factors contributing to the development of the disease

All etiological factors that cause alimentary-constitutional obesity can be divided into: endogenous (internal) and exogenous (external).

Endogenous causes of the development of the disease:

• Genetic predisposition - if there are people in the family suffering from this disease, then the risk of developing it in future generations is increased
• The structure of adipose tissue, the rate of fat metabolism
• The activity of the functioning of the centers of hunger and satiety in the hypothalamus
• Changes in the hormonal background, which can be caused by the period of pregnancy, childbirth and lactation, menopausal syndrome.

To endogenous factors disease development include:

• Obesity of alimentary-constitutional genesis can be caused by excessive food intake at any age, including childhood
• Reflexes tied to the time and amount of food - some people in stressful situations calm down only during meals, others relax after a day's work on the couch in front of the TV with a plate full of favorite, but not always healthy foods
• National traditions, based on which people learn a certain type, as well as a diet
• A sedentary lifestyle that is common throughout the world, leading to physical inactivity.

Degrees of obesity, methods of its diagnosis

With a tendency to develop obesity, the body, which receives more energy from food than it expends, begins to accumulate it in the form of body fat. Depending on the amount of excess adipose tissue, experts distinguish four degrees of the disease:

• 1st degree - excess adipose tissue in the body can be 10-29% of normal body weight
• Obesity of the 2nd degree is characterized by the amount of adipose tissue exceeding 30-49%
• The 3rd degree can be called a state when excess amount body fat is 50-99%
• Grade 4 is an excess of adipose tissue of 100% or more.

Methods for diagnosing the disease

The simplest method of determination is to measure the thickness of the fold on the abdomen, the norm is from one and a half to two centimeters. Constitutional-exogenous obesity is diagnosed when the thickness of the fold exceeds two centimeters. Diagnosis of the abdominal form consists in measuring the patient's waist (boundary normal figures for women are 87-88 cm, for men 101-102 cm).

The recognized criterion for determining the degree of obesity is the body mass index (BMI). What it is? This is a quantitative ratio, determined by the formula: BMI \u003d body weight (kg) / person's height (m), squared. For example, with a height of 168 cm (1.68) and a weight of 98 kg, the BMI will be 98 / 1.68 * 1.68 = 34.72, the degree of illness of a person with such parameters can be determined from the table below.

The impact of the disease on the organs and systems of the body

An obese person may develop diseases of the cardiovascular, digestive, and respiratory systems over time. From the side of the cardiovascular system develop the following diseases: atherosclerosis, varicose veins of the lower extremities, hypertension, myocardial infarction.

Due to excess fat deposits in the abdominal cavity, a high position of the diaphragm develops, which leads to disruption of the functioning of the lungs, a decrease in their elasticity, and the possible development of respiratory failure. For the same reason, in almost 50% of patients with overweight there are various disorders of the gastrointestinal tract (gastritis, diseases of the liver, gallbladder, pancreas). The endocrine system also suffers.

Clinical manifestations, main methods of treatment

Exogenous-constitutional obesity is characterized by a long period of development and a uniform distribution of body fat throughout the body. Exogenous obesity has its own peculiarity of therapy - drug treatment, which is traditional in modern medicine, does not bring a long-term positive effect. All drugs give a bright, but short-term effect.

The main method of treating the disease is diet therapy. A nutritionist should develop an individual diet, but there are certain principles that are fundamental, these include:

• The diet should be low-calorie (the calorie content of the diet is determined by the doctor, focusing on BMI and the patient's condition)
• The daily diet includes a minimum amount of fats and carbohydrates.
• Be sure to include raw vegetables and fruits in the menu
• Restriction of salt (up to 4-5 g) and water (up to 1.5 l)
• Mandatory fasting day once a week (fruit, vegetable, sour-milk fasting days are popular)
• The patient is prescribed vitamins, dietary supplements.

How to treat obesity is described in the video:

Correct mental attitude

What is psychological rehabilitation is a change in behavioral and eating habits of a person. Treatment in a sanatorium, where physical activity is combined with diet, physiotherapy and clean air, is a good example of psychological impact.

In the treatment of disease initial stages development is important motivation. For proper motivation, you can use your photo, in which the patient is completely healthy and likes himself. Treatment of obesity should take a long time (from 1 to 3 years), the weight that goes away slowly rarely comes back.