Awareness

The fight against obesity will be effective only when parents realize that their child really needs weight correction.

If the parents were able to admit that their child is not just a little chubby, but really obese, that's half the battle. It is also important to understand that the fight against excess weight is a long process that requires willpower and a focus on results.

Causes of obesity

Wrong nutrition. The most common reason overweight lies in the wrong diet. If a child consumes more calories than his body needs for development and growth, then the accumulation of extra pounds is inevitable. It is worth analyzing the child's diet: what, how often and under what circumstances does he eat? As a rule, extra calories are “hidden” in fast food, snacks, as well as in sweets and pastries so beloved by the child.

Genetics. Older generations can also be "guilty" of a child being overweight. A proven fact is given: if one of the parents is obese, then the degree of probability that the child will inherit the parent's addiction is 40%; if both - all 80%.

Hormones. There is a common belief that a frequent cause of overweight are disorders of the endocrine glands. In fact, diseases of the pancreas and adrenal glands can only in very rare cases provoke obesity, as well as reduced activity. thyroid gland. And if hormones are “not to blame” for being overweight, the chances of success increase.

Physical inactivity. But a really common overweight problem is a sedentary lifestyle, excessive love for TV and a sofa. And outdoor games in the yard of most modern children have been replaced in the form of computer toys. By the way, parents themselves often set an example of spending leisure time, and children only copy their model of behavior.

Society and psycho-emotional sphere

From about the age of five, the child begins to worry about their own body weight. Still - after all, he has already formed

ideas about beauty, and there is no escape from the opinions of others. After all, the socialization of the baby begins around this period of life. But it is he who is awarded the most offensive nicknames by his peers, it is the hardest for him to climb the hill and the girl Masha, who he likes so much, does not want to notice “this fat man” in any way.

From these big problems more little man not far from psycho-emotional disorders, the consequences of which are lifelong. An inferiority complex appears, against which a feeling of anxiety, aggressiveness, isolation develops, a desire appears to escape from this cruel world. Often this is how a complete child feels.

Anna Belinskaya, family psychologist, comments on the problem in this way: “Indeed, with such a problem as childhood obesity, parents most often turn to a psychologist at the stage of diagnosis by doctors. This is both bad and good at the same time. Bad - because the situation is already quite neglected, the child's psyche is traumatized, self-esteem is low. Good - because the parents themselves realized that they were faced with a problem, and turning to specialists for help indicates a serious intention to get rid of it.

Of course, in order to achieve a result, you need to change your lifestyle and nutrition system: instead of sweets in a vase - fruits; instead of a cafe - a skating rink, etc.

Do not forget about motivation by personal example! This is a really powerful and effective weapon! Make it a rule to visit the pool with the whole family and go skiing in the snowy winter. And be sure to reward for each achievement and let your child understand that you are proud of him.

First of all, you need to develop a program in which all family members will become participants. The treatment of obesity is a long process and the success of the enterprise largely depends on the behavior of adults. What should this program include?

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 disorders, 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 food intake as a means of avoiding reality and normalizing the emotional state, an addictive person “acquires” new problems in the form of alimentary-constitutional obesity, indicating spiritual distress. However, 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, more and more work has appeared, indicating that the satiety 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 proportion of obese people has 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, ischemic disease heart, 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 monitoring aimed at stable weight loss, reduction of comorbidities and mortality. Up to 75% of patients on a diet (especially a very low calorie diet - about 400-800 kcal / day) gain most of the weight lost 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.

The deposition of fatty tissue in the abdominal region (upper type of 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 amount of abdominal adipose tissue is associated with a high risk of developing dyslipidemia, diabetes, 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 developing 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 function of insulin and carbohydrate metabolism, as well as cholesterol and triglyceride metabolism. 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:

Sharply increased (relative risk > 3)	Moderately elevated (relative risk 2-3)	Slightly elevated (relative risk 1-2)
Type 2 diabetes	Cardiac ischemia	Cancer (breast in postmenopausal women, endometrium, colon)
Gallbladder diseases	Arterial hypertension	Hormonal disorders of reproductive function
Hyperlipidemia	Osteoarthritis (knee)	polycystic ovary syndrome
insulin resistance	Hyperuricemia/gout	Infertility
Dyspnea	Lower back pain caused by obesity
sleep apnea syndrome	Increased anesthetic risk
Fetal pathology due to maternal 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 levels of 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." An analysis of the eating behavior of obese patients, to a certain 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 satisfy 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 are also encountered 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. Especially often this form of eating behavior occurs 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 performs a wide variety of functions, and in an individual, these functions are always manifested in a complex way.

The analysis of eating behavior reveals the most important feature of needs, the transformation of the object of one need into the object 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 dissatisfaction has a leading role. family relationships. 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. It is not possible today 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 it 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 in a patient and the corresponding food stereotypes is closely related to upbringing in the family, but we separately single out this group of factors in order to reverse Special attention on addiction wrong 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

The role of hereditary factors in the development of obesity was discussed as early as the 1960s, 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 rather 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 that determine the number of fat cells in the body are the level (quality) of nutrition and the genetically determined secretion of growth hormone - growth hormone (GH). 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 associated with a single 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), growth hormone (GH, growth hormone) - and peripheral endocrine glands - cortisol and norepinephrine (adrenal glands), thyroid hormones (thyroid iron), 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, of course, 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 the basal levels of pituitary, adrenal and thyroid hormones in patients with so-called "exogenous-constitutional" or "alimentary-constitutional" obesity are also usually 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 consistently occurring 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 obesity, much less often - with the gynoid (femoral-buttock) 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 particularly high-risk group that 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 are 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 associated menstrual irregularities.

So, in the vast majority of obese people, at least with an in-depth examination, numerous disorders 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 when using 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 for society as a whole and even for medical workers a rather frivolous attitude towards excess body weight is characteristic. 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 at different times of the day.

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 during the daytime and 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 not a physical, but a person’s psychological dependence on food. 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 a mental trauma, hence frequent failures in dieting, low effectiveness of therapy and a high relapse rate. Therefore, in such patients, psychological rehabilitation is necessary component 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.

In addition to the mental component, with obesity, significant changes are observed in the endocrine status of the body. 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, hypertension, 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 - breast, 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 of facial hair, 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. Available psychological disorders in most cases do not give the impression of being particularly important, but their presence raises the need 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 in 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 inclination to use a large number 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 can be broken by only dietary and drug treatment fails. 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 the common reactions is to ignore 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 style of behavior (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). Recently, this problem has been actively studied, and although a few studies have not established an association between obesity and mental disorders, most of the accumulated data indicate 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 clinically significant anxiety and depression is significantly higher than in the population: more than half of people with a body mass index (BMI) > 40 have at least one PD. Most studies are devoted to studying the relationship between obesity and one of the most common PD - depression. 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, loss of 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 eating disorders (EDS) 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 one’s ability to change something), closing the “vicious circle” with increased depression and anxiety. Characteristic features thinking and perception, common to both obesity and anxiety-depressive disorders, are rigidity, a tendency to "get stuck" in emotions, "black-and-white" thinking (on the principle of "all or nothing"), catastrophizing (expecting the worst of all options 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 disorders 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 obvious 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 of treating obesity

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 in physical activity and training in proper nutrition.

Obesity treatment methods.

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

▪ Non-drug treatments for obesity

▪ Medical methods obesity treatment

▪ Surgical treatments for obesity

Non-drug treatments for obesity 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 that are so advertised and promising super-fast weight loss either have not passed clinical trials or are 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;

increased 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 leading to the rejection of communications and free decisions is relevant.

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 hand, the social consequences of being overweight are 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 their diet 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 drugs are only auxiliary, since they give only a slight, short-term effect and have pronounced adverse effects. 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 bringing a large number of " folk wisdom and proverbs" as an argument.

"Proverbs and Folk Wisdom"

Better a full stomach than a full mouth of worries, an insatiable womb (grabbing hands), swallowing 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, but we are only talking about the loss of water, which is achieved due to the effect of dehydration. Obesity in less than 5% of cases is a symptom of an 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, primarily 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 "I could not eat it all, then the half-eaten 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 from which I took a bite 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 much as Johannes spoke vividly 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 because of his appearance he has not yet had a serious or long-term relationship. And then his thrift 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 served a substitutionary function: 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 at 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 regarding his concept of diligence and thrift and received positive feedback about it from his environment. 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, overweight (125 kg.), Attacks of high blood pressure began, her 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 from 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.

For studying psychological state patients, the Minnesota questionnaire test, usually abbreviated MMPI (Minnesota Multiphasic Personality Inventory) in the modification of Berezin F.B., was chosen as the main one: it can be used to judge the significance of personal characteristics, relevant mental state in the pathogenesis and formation of the clinical picture of the disease, 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 tool 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 a sense of threat are transferred from interpersonal relationships to 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 does not manifest itself on behavioral level, but canalized according to the psychosomatic variant with the formation of “conditional pleasantness”. If we rise on scale 1, we can assume 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 a 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 neurotic or psychosomatic disorders with clinically defined symptoms with a high degree of probability. 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. The combination of leading defense mechanisms and the degree of their intensity differ somewhat 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 do not have 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 abuse 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, the predominance of negative emotions over positive ones, 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 set 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, a decrease in social spontaneity and an increase in emotional lability were observed, 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 of varying severity. 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. Based on the results of working with the 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 about the psychological mechanisms in the formation of alimentary-constitutional obesity, we can conclude 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 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 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 a real assessment of the situation and the general picture of the world; 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 of 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 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 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 the provision of psychological assistance: Psychological assistance 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, different kinds psychotherapy: rational, suggestive (Ericksonian hypnosis), personality-oriented, gestalt therapy, emotional stress, self-regulation, neurolinguistic programming.

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Psychosomatic obesity in children most often develops as a result of bulimia (irrepressible food intake). Speaking of psychological aspects obesity, experts identify several reasons, and all of them are somehow related to the problems of education (excessive guardianship or, conversely, any lack of attention to the child). Overweight problems inevitably lead not only to poor health, but also to difficulties in the process of social adaptation.

Psychological aspects of the problem of obesity in children

Children who are overweight or obese are impulsive and addictive. They are dependent on their parents, they can hardly endure separation from them, and especially from their mother. The cause of obesity in children is constant overeating, preference for sweet and rich foods. The divorce or death of parents, leaving the parental home and other situations in which the object of love is lost provoke cravings for food. Often, when a second child is born in a family, the elder feels a lack of attention and love from the parents, so he starts eating more to comfort himself. With the help of food, such negative emotions as loneliness, anger, fear are drowned out. The last emotion is intensified for various external reasons (an upcoming exam, the expectation of unpleasant events), and therefore an even greater amount of food is required to suppress it.

Often the psychosomatic cause of obesity is excessive attachment to the mother, who plays a leading role in the family, and the father remains in the background. In such a family, the child grows up passive, he hardly adapts to society, he needs guardianship.

As a rule, the parents of a sick child do not show true attention to him. They do not try to find out his needs, do not notice them and try hard to feed him. They develop in the child the habit of overeating, lay in him the understanding that if he eats well, then he is good. They see their parental duty only in feeding the child, and do not contribute to his personal development.

Children need special attention and understanding of parents during the period of age crises (3, 5, 7, 12-15 years). At this time, there are significant changes in their psyche, which are associated with the development of personality, and parents need to accept them without creating prerequisites for mental trauma and psychosomatosis.

Sometimes the cause of obesity in children and adolescents is the desire of the mother to feed the child more. This need may be related to her negative experiences (fear of hunger, malnutrition in childhood). Then her main need arises - to feed, and everything else turns out to be unimportant for her.

Psychosomatics of obesity: psychological causes

The psychosomatics of obesity also manifests itself as a consequence of aggression. If the child is not able to express anger towards his parents or feel it towards them, then he directs it to himself, and in this case, food becomes self-punishment for him.

The development of the psychological problem of obesity is greatly facilitated by grandmothers who cannot ask the child about his personal experiences or do not want to listen to them, but instead feel sorry and try to treat him to sweets, feed another pie, etc. Sometimes they do this in spite of parents who see that the child is overweight, which is harmful to health, and food restrictions are necessary. It is not uncommon for parents to be unable or unwilling to spend time with their child. They do not show love and warmth towards him, but pay off with cakes and other high-calorie delicacies, in which the child finds consolation and a source of health problems.

The psychological cause of obesity may also be a family tradition of spending a lot of time socializing at the table with the accompanying overeating. In this case, overweight is detected in all family members whom food unites, and on other issues they may have different opinions, but they rarely enter into open conflicts.

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Over the past few years, various medical and public organizations on health issues were seriously concerned about the development of a real "epidemic" of obesity among children.

But overweight in a child not only contributes to the deterioration of health in childhood, but also leads to the development of quite serious problems in many social spheres of life when such children reach adulthood.

According to researchers, the factors that directly affect the appearance of overweight in a child are diverse: this is a genetic predisposition, and eating too high-calorie, but with a low nutritional value of food, and a minimum level of physical activity.

Consequences of childhood obesity

Overweight children often face the following social and emotional problems, which can have far-reaching consequences for their quality of life.

Bullying. An overweight or obese child is often subject to both psychological and physical abuse. A 2004 study published in the journal Pediatrics confirmed that such children are more “likely” to be the object of rumors and ridicule, receive an offensive nickname, or even suffer physically than their peers who are of normal weight.

Anxiety. Being overweight can also lead to increased anxiety in children. This statement is backed up by a 2010 study published in the French journal Obesity, which found that children faced with bullying from peers at school or from family members begin to position themselves as isolated from others, which leads to the development of social anxiety or the appearance of phobias. .

academic problems. The child's difficulties with social interaction with peers, combined with low self-esteem, can play a negative role in mastering school material and getting high marks. The issue of academic performance may take a backseat when a child struggles with growing anxiety, isolation from society, or other psychological problems.

“Such students are much less likely to enter higher education after graduation,” according to a 2007 study.

Depression. Dissatisfaction with oneself and a decrease in self-esteem often lead to the development of depression in a child, which is a serious mental illness that affects all aspects of a child's life. Such children are characterized by prolonged closed states without showing any emotions, stopping visiting thematic sections and giving up their favorite hobby, which can contribute to complete social isolation.

During adolescence, obese children are more likely to have problems with drugs and eating disorders, in which depression plays a key role.

Proper nutrition for obesity in children

Breakfast. Perhaps you think that best solution in this situation would be skipping breakfast to cut down on the baby's total calories!? However, according to reputable nutritionists, skipping one of the main meals, on the contrary, will contribute to weight gain than to its loss. Therefore, do not give your child a couple of fruits with you, such as bananas, so that he can enjoy them on the way to school.

Dinner. Good way help your child do right choice healthy food for lunch is to pack it yourself at home, instead of him buying it himself in the nearest store from school. For example, it could be a lean meat and low-fat cheese sandwich on whole grain bread, 0% fat cottage cheese, or yogurt. As a liquid, put a bottle of water in your schoolbag, which can be sweetened with a little lemon juice.

afternoon tea. It should not include foods high in fat and calories. The best option would be self-preparation of low-fat dairy or.

Dinner. One of the most simple ways To make dinner healthier for your child and your entire family is to cook your own meals at home using only natural ingredients. Instead of instantly replacing your baby's high-calorie foods with salads or, do it gradually, instilling healthy eating habits in the family. Try to cook meat dishes on chicken or ground beef using a grill, add more spices to it, for example, parsley, pepper, garlic.

Snacks. As paradoxical as it sounds, using snacks between main meals will help yours, but only if he chooses healthy foods for this. Make sure that these are nutritious meals that are low in sugar and fat. For example, baked wholegrain crackers are a good alternative to chips, and a fresh vegetable salad based on natural yogurt will fill you up well until the next meal.

Exercise program for adolescents with obesity

Reducing your daily calorie intake isn't the only way to help your child lose weight. It is equally important to interest and accustom him to regular physical training.

Parents should choose exercises that are appropriate for the child's current level of preparation. This will allow you to gradually bring it to more difficult and intense loads. Practice for 30 to 60 minutes every day of the week if possible.

Warm up

Start with a workout consisting of moderate-intensity cardiovascular exercises (jumping, walking in place, walking sideways left and right), static and dynamic stretches (alternating leg lunges, pulling shoulders back) and power movements (lifting shoulders, squats, push-ups) . This stage is very important for obese children, allowing the muscles to warm up properly, which will help prevent injury and increase muscle strength and flexibility. The warm-up should last from 5 to 10 minutes.

Aerobic exercise

The three main elements of fitness include endurance, strength and flexibility. Endurance develops in children who regularly take part in aerobic activity. For example, it can be walking, running or cycling, each of which can be done both in your own home (if available) and in the fresh air.

Dancing is another good activity for kids. Always start slowly and gradually pick up the pace. In fact, it's a way to show your child that exercise can be fun too. Go rollerblading or go to the park. Think of walking routes that run through hilly terrain, which will affect the development of endurance.

Jumping forces the muscles of the whole body to work and burns a large number of calories in a short period of time. Of course, due to overweight, a child may have difficulty with the duration of the jumps. It's not scary, start jumping even for 5 seconds, but gradually increase the duration of the approach.

Strength exercises

This type of training is carried out on a day free from aerobic exercise (previous paragraph). Strength training helps increase muscle mass. The thing is that the muscle cell burns several times more calories than fat, so this will allow the child to adjust his weight faster.

Before starting any strength exercise, children should learn the correct technique for its implementation. Try the following load variations: push-ups, lunges, crunches, dumbbell curls, quad crawls, and side raises. Each exercise consists of 10 - 15 repetitions.

Flexibility exercises

Equally important in addition to aerobic and strength training are exercises that develop flexibility. Stretching with the body helps improve baby's mobility by making muscles and joints move through their full range. Completed at the end of each lesson.

Pulling to the feet with the tips of the fingers, pulling the shoulders back, tilting in different directions - these are simple exercises things your child can do to improve body flexibility. But remember that the stretch itself should not reach the point of discomfort. Hold each stretch for 10 to 30 seconds.

Warning: Before starting any for an overweight child, his parents should consult a pediatrician.

Talking to children about being overweight can be a sensitive topic for them, regardless of age. Therefore, the desire to avoid this dialogue can be very tempting, even if you are sincerely worried about the physical and emotional health of your baby.

Although this topic may be uncomfortable for you, the sooner you decide to discuss it, the sooner you can help your child take action to correct the situation. Ignoring the problem by itself will not solve it, as a result, your child will grow older, and it will become much harder to achieve a positive result later, although it is possible.

Also consider that obese children, without help, are more likely to be overweight as adults, making them more vulnerable to dreaded diseases such as type 2 diabetes, stroke and heart attack.

1. Become your child's ally.

Always try to be honest with children about their weight if they ask you to. If your child is concerned about their weight, tell them that you want to help and you will work together to achieve the result.

Then propose and discuss with him some options for your future joint actions. For example, learn the secrets of cooking to learn more about healthy ways to cook your favorite dishes. Go grocery shopping together and pick a new fruit or vegetable to use in your recipe.

Buy pedometers for all family members and set a goal for everyone to walk a certain number of steps per day. By involving your child in the decision-making process for his situation, you help him take responsibility for his health and build self-confidence.

2. Be a good role model.

When it comes to children and obesity, what you do is always more important than what you say. Parents for children are the first example to follow! This is confirmed by a study in which 70% of children answered that the most important factor for them is the actions of their parents.

Children build their relationship to food on the principle of their own parents, therefore, if they like to eat junk food in fast food restaurants, then the child will develop with the same habits, which later will be very difficult to eradicate.

3. Start by setting healthy habits right now.

Remember - it's never too late to join the canons of a healthy diet! Maybe you didn't always lead the right lifestyle in the past, but today start all over again. Improving your own life will help inspire your child to do the same.

Carry out all the fundamental changes in a few small steps. Gradually cleanse your home of all unwanted food. Take a look in your fridge and toss out anything high in saturated fats and sugars. Don't let yourself buy junk food. Stock up on options like low-fat yogurt, fresh fruit, raw vegetables, crackers (whole grains), lean cottage cheese, and peanut butter.

4. Don't criticize your child's weight.

Criticizing kids about their weight is one of the worst things adults can do!

5. Talk to your children about issues that may affect their weight.

Being overweight can be a symptom of a child's deeper problem, so parents need to be aware of how your child behaves in school and in society. The same loneliness for many children is the root cause of the onset of weight gain.

Therefore, parents need to interest and agitate their baby to participate in various activities. Going to the school disco or volunteering will help him become more active and meet many people who share his interests.

A child may also overeat in response to unresolved issues in their family, such as parental contention or financial problems.

6. Do not force children to completely refuse their favorite foods.

Creating a healthy approach to nutrition is a much more effective solution than the principle of food restriction. But this does not mean at all that your child can never eat a cake on his birthday or other holiday.

It is better to teach him to enjoy his favorite treat, and not to eat them instantly. Talk about how even sweets can be part of a healthy diet if they are consumed in a reasonable amount.

7. Try to eat together as a family.

There is evidence that in families where adults eat together with children, the problem of childhood obesity is practically non-existent. This is due to the fact that at the common table the child absorbs food more measuredly, which makes him feel full earlier and stop eating.

8. Don't force kids to follow a strict workout plan.

Parents who encourage physical activity in the family as a natural part of life and do not make it a duty, children quickly cope with the problem of obesity. Instead of forcing your child, come up with a better cross-country walk together.

9. Make sure your child is getting enough sleep.

More and more researchers are now concluding that lack of sleep is closely linked to the problem of weight gain and other medical conditions. So always make sure your child gets enough sleep each night.

Of course, individual needs vary, but general recommendations are as follows:

• ages 1-3: 13 to 14 hours of sleep

• 3 - 5 years: 11 to 12 hours

• 5 - 12 years old: 9 to 10 hours

• 12 - 18 years: at least 8.5 hours a day

To help your child get the right amount of sleep at night, ask them to turn off their computer, cell phone, or TV at least two hours before bed. Artificial light from electrical appliances stimulates the brain and makes it difficult to fall asleep.

Also, remember that the more time your child spends watching TV or using a computer, the less time they spend on positive family interactions or physical activity.

10. Let your child know that you love him in any way.

Remember that you will achieve your long-term goals faster if your child feels how much you love him.

Graduate work

Psychological characteristics of people suffering from alimentary-constitutional obesity.

Content

• Introduction
• 6. Modern methods of treating obesity
• 7. Psychology and psychotherapy in the treatment of alimentary obesity
• Conclusion
• List of used literature

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 disorders, 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 food intake as a means of avoiding reality and normalizing the emotional state, an addictive person “acquires” new problems in the form of alimentary-constitutional obesity, indicating spiritual distress. However, 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, more and more work has appeared, indicating that the satiety 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:

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 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)

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 from 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.

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 proportion of obese people has 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 monitoring aimed at stable weight loss, reduction of comorbidities and mortality. Up to 75% of patients on a diet (especially a very low calorie diet - about 400-800 kcal / day) gain most of the weight lost 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 internal organs (visceral fat)

Abdominal subcutaneous fat + abdominal visceral fat = abdominal fat.

The deposition of fatty tissue in the abdominal region (upper type of 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 amount of abdominal adipose tissue is associated with a high risk of developing dyslipidemia, diabetes, 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 developing 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 function of insulin and carbohydrate metabolism, as well as cholesterol and triglyceride metabolism. 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:

Sharply increased (relative risk > 3)	Moderately elevated (relative risk 2-3)	Slightly elevated (relative risk 1-2)
Type 2 diabetes	Cardiac ischemia	Cancer (breast in postmenopausal women, endometrium, colon)
Gallbladder diseases	Arterial hypertension	Hormonal disorders of reproductive function
Hyperlipidemia	Osteoarthritis (knee)	polycystic ovary syndrome
insulin resistance	Hyperuricemia/gout	Infertility
		Lower back pain caused by obesity
sleep apnea syndrome		Increased anesthetic risk
		Fetal pathology due to maternal 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 levels of 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 for performing 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." An analysis of the eating behavior of obese patients, to a certain 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 of the individual it satisfies, on its "personal meaning".

Eating behavior can be:

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.

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.

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 are also encountered 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.

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.

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, the 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.

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. An example of such behavior is traditional holiday feasts, the habit of eating while reading, watching TV, listening to music.

obesity nutritional psychotherapy treatment

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. Especially often this form of eating behavior occurs 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.

The analysis of eating behavior reveals the most important feature of needs, the transformation of the object of one need into the object 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. It is not possible today 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 it is not possible and requires additional research. It seems that the characteristics of the personality 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 are a significant number of psychosocial factors that affect a person's eating behavior, which are a kind of trigger mechanisms for the development of obesity.

3. Genetic aspects of obesity

The role of hereditary factors in the development of obesity was discussed as early as the 1960s, 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 rather 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 that determine the number of fat cells in the body are the level (quality) of nutrition and the genetically determined secretion of growth hormone - growth hormone (GH). 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, and the nature of the 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 associated with a single 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), growth hormone (GH, growth hormone) - and peripheral endocrine glands - cortisol and norepinephrine (adrenal glands), thyroid hormones (thyroid iron), 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, of course, 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 the basal levels of pituitary, adrenal and thyroid hormones in patients with so-called "exogenous-constitutional" or "alimentary-constitutional" obesity are also usually 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 consistently occurring 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 the 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 particularly high-risk group that 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 are 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 associated menstrual irregularities.

So, in the vast majority of obese people, at least with an in-depth examination, numerous disorders 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 when using 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 at different times of the day.

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 during the daytime and 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 not a physical, but a person’s psychological dependence on food. 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 a mental trauma, hence frequent failures in dieting, low effectiveness of therapy and a 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.

In addition to the mental component, with obesity, significant changes are observed in the endocrine status of the body. 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, hypertension, 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 - breast, 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 of facial hair, 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 in 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 the common reactions is to ignore 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 style of behavior (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). Recently, this problem has been actively studied, and although a few studies have not established an association between obesity and mental disorders, most of the accumulated data indicate 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 clinically significant anxiety and depression is significantly higher than in the population: more than half of people with a body mass index (BMI) > 40 have at least one PD. Most studies are devoted to studying the relationship between obesity and one of the most common PD - depression. 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, loss of 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 eating disorders (EDS) 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 one’s 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 (on the principle of "all or nothing"), 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 disorders 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.

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