Community Efforts | Overweight & Obesity

To reverse the obesity epidemic, community efforts should focus on supporting healthy eating and active living in a variety of settings. Learn about different efforts that can be used in early childhood care, hospitals, schools, and food service.

Early Care and Education

Improving the Early Care and Education (ECE) environment of child care and early education facilities may directly impact what children consume and how active they are, as well as help them develop a foundation of healthy habits for life.

Salad Bars to Schools

Salad Bars to Schoolsexternal icon is a unique public-private partnership to mobilize and engage stakeholders at the local, state and national level to promote and sponsor salad bars in schools. Helping children develop good eating habits early in life helps maximize academic performance during the school years and promotes wellness throughout their lives.

Healthy Food Environments

There are many different programs and policies that can contribute towards the creation of healthy community food environments. These include providing incentives for supermarkets or farmers markets to establish their businesses in underserved areas, placing nutrition and calorie content on restaurant and fast food menus, and implementing and supporting nutrition standards for childcare, schools, hospitals, and worksites.

Healthy Hospitals

Hospitals reach a large population of employees, patients and visitors and can have an impact on neighboring communities. This makes them an important setting for obesity prevention efforts.

Physical Activity Community Strategies

There are many different types of strategies to increase physical activity in the community. These strategies include point-of-decision prompts to encourage use of paths or trials, individually adapted health behavior change programs, enhanced school-based physical education, and large-scale media campaigns that deliver messages by television, radio, newspaper, and social media. They may also include efforts to increase the places where people can be active, such as opening school facilities to public use and creating walking trails. Some strategies may involve community design changes.

School Community

To reverse the obesity epidemic, schools should focus on supporting healthy eating and active living throughout the school day. Learn about different efforts that can be used in the school community

Schools Can:

Worksites

To reverse the obesity epidemic, workplace efforts should focus on supporting healthy eating and active living in their own workplace community. Learn about different efforts that can be used to create a healthy work environment.

How to Avoid the Obesity Epidemic – Healthy Living Center

As we continue to modernize our lifestyles — riding instead of walking, working in a cubicle instead of in a field, playing iPods instead of sports — more people are becoming overweight and, worse, obese. In fact, there are so many overweight and obese people that some public health officials now call it an epidemic, particularly because of the many resulting health problems.

Obesity: A Worldwide Problem

Around the world, more than one billion adults are overweight and about 300 million of them are obese. In the United States, 66 percent of all adults are overweight and, of those, 32 percent are obese.

Obesity levels in Japan and some African nations are below 5 percent, but they’re rising. Obesity rates in China overall are not high, but in some of that country’s larger cities, rates are up 20 percent.

Childhood obesity has reached epidemic proportions, too. The number of overweight children in the United States has doubled since 1980, and for teens, it’s tripled. And the problem with children is now a global issue as well.

Obesity: Why It’s Happening

Although your genes play a role in your body weight, there are other factors involved. In many places around the world, particularly the United States, we have plenty of nutrient-rich food to eat and easy access to fattening fast foods and sweets. Also, because of our modern lifestyles, we are not as active as we once were. The end result: We’re eating more calories than we can burn.

Being overweight or obese can cause a whole cascade of health problems, from heart disease and diabetes to stroke and even some types of cancer. These diseases can seriously impact a person’s quality of life and lead to premature death.

Obesity: How It Differs From Being Overweight

Obesity and overweight are terms used to describe a level of excess weight that’s considered unhealthy for your body size. One way to determine if you are overweight or obese is to figure out your body mass index (BMI), a calculation you make by dividing your weight in kilograms by the square of your height in meters (kg/m2). Don’t worry — you don’t have to do the math; you can find BMI calculators online.

Note that for adults:

• A BMI between 25 and 29.9 is considered overweight
• A BMI of 30 or higher is considered obese

When assessing teens and children, BMIs that are higher than normal weight ranges have other labels, such as “at risk of overweight” and “overweight.” Also, health professionals take into account the differences in body fat between boys and girls as well as changes in body fat at different ages.

Obesity: Finding a Solution

Getting our obesity and overweight epidemic under control will involve more than just telling everyone to go on a diet. The World Health Organization says it requires an integrated approach that includes:

• Promoting healthy eating habits and encouraging exercise
• Developing public policies that promote access to healthy, low-fat, high-fiber foods
• Training healthcare professionals so that they can effectively support people who need to lose weight and help others avoid gaining weight

Here’s what you can do to lose weight or avoid becoming overweight or obese:

• Eat more fruit, vegetables, nuts, and whole grains.
• Exercise, even moderately, for at least 30 minutes a day.
• Cut down your consumption of fatty and sugary foods.
• Use vegetable-based oils rather than animal-based fats.

So walk a little more, eat a little less — and do what you need to do to maintain a healthy BMI.

Learn more in the Everyday Health Healthy Living Center.

Treatment for Overweight & Obesity

In this section:

Common treatments for overweight and obesity include losing weight through healthy eating, being more physically active, and making other changes to your usual habits. Weight-management programs may help some people lose weight or keep from regaining lost weight. Some people who have obesity are unable to lose enough weight to improve their health or are unable to keep from regaining weight. In such cases, a doctor may consider adding other treatments, including weight-loss medicines, weight-loss devices, or bariatric surgery.

Experts recommend losing 5 to 10 percent of your body weight within the first 6 months of treatment. [10] If you weigh 200 pounds, this means losing as little as 10 pounds. Losing 5 to 10 percent of your weight may

Healthy eating plan and regular physical activity

Following a healthy eating plan with fewer calories is often the first step in trying to treat overweight and obesity.

People who are overweight or have obesity should also start regular physical activity when they begin their healthy eating plan. Being active may help you use calories. Regular physical activity may help you stay at a healthy weight.

Learn more about healthy eating and physical activity to lose or maintain weight.

When combined with healthy eating, regular physical activity will help you lose weight and stay at a healthy weight.

Changing your habits

Changing your eating and physical activity habits and lifestyle is difficult, but with a plan, effort, regular support, and patience, you may be able to lose weight and improve your health. The following tips may help you think about ways to lose weight, engage in regular physical activity, and improve health over the long-term.

• Be prepared for setbacks—they are normal. After a setback, like overeating at a family or workplace gathering, try to regroup and focus on getting back to your healthy eating plan as soon as you can. Try to eat only when you’re sitting at your dining room or kitchen table. At work, avoid areas where treats may be available. Track your progress using online food or physical activity trackers, such as the Body Weight Planner, that can help you keep track of the foods you eat, your physical activity, and your weight. These tools may help you stick with it and stay motivated.
• Set goals. Having specific goals can help you stay on track. Rather than “be more active,” set a goal to walk 15 to 30 minutes before work or at lunch on Monday and Friday. If you miss a walk on Monday, pick it up again Tuesday.
• Seek support. Ask for help or encouragement from your family, friends, or health care professionals. You can get support in person, through email or texting, or by talking on the phone. You can also join a support group. Specially trained health professionals can help you change your lifestyle.

Weight-management programs

Some people benefit from a formal weight-management program. In a weight-management program, trained weight-management specialists will design a broad plan just for you and help you carry out your plan. Plans include a lower-calorie diet, increased physical activity, and ways to help you change your habits and stick with them. You may work with the specialists on-site (that is, face-to-face) in individual or group sessions. The specialists may contact you regularly by telephone or internet to help support your plan. Devices such as smartphones, pedometers, and accelerometers may help you track how well you are sticking with your plan.

Some people may also benefit from online weight-management programs or commercial weight-loss programs.

Weight-loss medicines

When healthy eating and physical activity habits are not enough, your doctor may prescribe medicines to treat overweight and obesity.

You should try to stick with your healthy eating plan and continue getting regular physical activity while taking weight-loss medicines.

You may see ads for herbal remedies and dietary supplements that claim to help you lose weight. But many of these claims are not true. Some of these supplements can even have serious side effects. Talk with your doctor before taking any over-the-counter herbal remedies or dietary supplements for the purpose of trying to lose weight.

Weight-loss devices

Your doctor may consider weight-loss devices if you haven’t been able to lose weight or keep from gaining back any weight you lost with other treatments. Because weight-loss devices have only recently been approved, researchers do not have long-term data on their safety and effectiveness. Weight-loss devices include

• Electrical stimulation system. The electrical stimulation system uses a device a surgeon places in your abdomen with laparoscopic surgery. The device blocks nerve activity between your stomach and brain.
• Gastric balloon system. For the gastric balloon system, a doctor places one or two balloons in your stomach through a tube that goes in your mouth. Once the balloons are in your stomach, the surgeon fills them with salt water so they take up more space in your stomach and help you feel fuller.
• Gastric emptying system. A gastric emptying system uses a pump to drain part of the food from your stomach after a meal. The device includes a tube that goes from the inside of your stomach to the outside of your abdomen. About 20 to 30 minutes after eating, you use the pump to drain the food from your stomach through the tube into the toilet.

Bariatric surgery

Bariatric surgery includes several types of operations that help you lose weight by making changes to your digestive system. Bariatric surgery may be an option if you have extreme obesity and haven’t been able to lose enough weight to improve your health or keep from gaining back the weight you lost with other treatments. Bariatric surgery also may be an option at lower levels of obesity if you have serious health problems, such as type 2 diabetes or sleep apnea, related to obesity. Bariatric surgery can improve many of the medical conditions linked to obesity, especially type 2 diabetes.

Special diets

Calorie-restricted diets

Your doctor may recommend a lower-calorie diet such as 1,200 to 1,500 calories a day for women and 1,500 to 1,800 calories a day for men. The calorie level depends on your body weight and physical activity level. A lower calorie diet with a variety of healthy foods will give you the nutrients you need to stay healthy.

Intermittent fasting

Intermittent fasting is another way of reducing food intake that is gaining attention as a strategy for weight loss and health benefits. Alternate-day fasting is one type of intermittent fasting that consists of a “fast day” (eating no calories to one-fourth of caloric needs) alternating with a “fed day,” or a day of unrestricted eating. Researchers have conducted only a few studies of intermittent fasting as a strategy for weight loss. They have no long-term data on the safety and effectiveness of intermittent fasting for long-term weight maintenance.

References

[10] Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation. 2014;129:S102–S138.

Innovative Solutions to Childhood Obesity

Among the most common questions people ask Chief of Epidemiology, Mercedes Carnethon is “What is the biggest threat to the nation?” Her succinct one-word reply is, “Obesity!” Notice, she did not say, smoking, dangerous driving, or mention any terminal illness which is also hazardous to the nation’s health. National statistics confirm the extent of this serious problem.

As Carnethon says “over one-third of all adults are obese, and another two-thirds are overweight, and are on the way to becoming obese. ” Obesity is also associated with comorbidities such as cardiovascular diseases and lung disease. Obesity contributes to depression and escalates the suffering from disabilities such as osteoarthritis.

For children and adolescents, the prevalence of obesity is 18.5% and affects approximately 13.7 million people. Taking a closer look at the statistics shows an 18.4% occurrence of obesity among 6 to 11-year-olds and 20.6% among 12 to 19-year-olds. These statistics tell us as children age, they are more likely to suffer from obesity.

Despite the increased spread of childhood obesity, there are exciting solutions on the horizon.

Empowering Youth to Overcome Obesity                                                         

In a first-of-its-kind study, researchers from Boston University of Public Health introduced youth-produced narratives. They asked a group of 9-12-year-olds from the Boys and Girls Club of Worchester to form a narrative of “why it was important for them to reduce their sugary-drink intake. ” Staff assisted participants in producing their own written, video, or audio narratives to promote increased water intake and a decrease in the consumption of sugary drinks.

Dr. Monica Wang and her colleagues also designed training activities such as “blind taste tests of favored water, a corner-store scavenger hunt, and role-play skits.” Researchers built these activities based on strategies for replacing sugary drinks with water.

After each week, participants went home and “taught their parents or guardians what they had learned, and shared their narratives.” At the end of the 6-week program, the organizers of the program arranged a Boys and Girls Club community event to demonstrate the results.

Results from the program showed that participants and their parents “consumed fewer sugary drinks and more water over 6 months than a demographically similar Boys and Girls Club (BGC)  in a nearby city.”

Dr. Monica Wang says this type of empowerment strategy works because it “recognizes the youth as experts of their own lives. ”  Most prevention programs concentrate on reducing childhood obesity by focusing on multiple dietary behaviors. However, Wang and her research team discovered that by focusing on only one dietary behavior, they were able to reduce the risk of childhood obesity.

Since the success of the program, “12 Boys and Girls Clubs have expressed their interest in the program for a future, larger-scale study.”

Preventing Obesity: Do Children Have an Objective Choice?

Often childhood and adult obesity are all about making an adjustment in diet. When diets are rich in nutrition, this minimizes the risk of obesity. Children face a barrage of advertising of fast foods and sugary drinks, influencing their choices. The question is: How often do you see an advertisement that promotes healthy food choices for children, if at all?

Research shows, children, and young adults between the ages of 8-18 spend more time in front of a television, computer, or mobile device screen “than any other activity in their lives except sleeping. ” Research has also found a significant relationship between increases in advertising of unhealthy foods and a rise in childhood obesity.

Another harmful influence of advertising affects children as young as six who cannot tell the difference between “programming and advertising.” Research shows that advertising influences children’s product choices, which in turn influences the shopping decisions of their parents.

Two Solutions to Solve the Spread of Obesity

1. UCLA’s Health Sound Body Sound Mind

At one time Physical Education or P.E. was a key educational tool against inactivity at schools. Due to funding cuts, and pressure to perform on standardized tests, P.E. quickly lost its appeal. The current situation is not a pretty picture with a “median P.E. budget [of only] $1.50 per student a year, for a school of 500 students.”  As a repercussion, many children grow up without suitable equipment or a physical curriculum.

Thankfully, the Sound Body Sound Mind (SMSM) program is changing things. It currently serves 185,000 students a year. The program aims to “combine the body and mind to enjoy physical activity.” In the beginning, many students did not see themselves as having athletic ability, however by the end of the program, UCLA reported that confidence levels had improved together with performance levels on fitness tests.

2. Wearable Technology Created by a 9-year-old
   Andie Nugent is the inventor of Kazi, a nifty piece of wearable technology. Kazi is a Swahili word which means active. The purpose of this device is to enable parents and children to balance screen time with physical activity.

This unique innovation makes children earn their screen time with physical activity. The Kazi measures cardio activity, so kids need to do enough exercise to gain an access code. Once they have done a sufficient amount of physical activity, a piece of code appears on the device. To access video games, their favorite television programs they need to obtain a complete code. Then they type the code into their media device to gain access to the screen entertainment of their choice; more than one user at a time can use this technology, so it is ideal for families with quite a few children. Parents can also adjust the required level of activity needed to achieve a complete code.

Helping Children Take Charge of Making Healthy Choices

When a chief epidemiologist tells us that the biggest threat to our nation is obesity, we all need to take this seriously. Statistics show that childhood obesity is rapidly spreading. One of the problems children face in this modern-day is the amount of exposure to unhealthy food choices.

If given the choice of what kind of food they prefer, nutritious foods will not make it on a child’s top ten list! There are available solutions. Research shows that through creating their own narratives, young people are empowered to make positive choices and cut down on their sugary-drink intake.

Among the most innovative solutions is Kazi, a wearable technology that minimizes screen time and promotes physical activity. Technology such as this, by children for children, has enormous potential to engage kids and their parents alike to make better choices.

Community support part of solution to childhood obesity

Mark Mahoney
 |  Guest columnist

As we begin to enter the school year with some students studying from home it is important to maintain a focus on the health of our children.

We should not lose sight of the fact that about 1 in 5 (19%) children in the United States suffers from obesity. In Florida, one out of three children is overweight or obese. Certain groups of children are more affected than others. 

We are just ending a particular focus on children through National Childhood Obesity Awareness Month which provides an opportunity for all of us to learn more about this serious health condition. Although this major health problem has no simple solution, there are many ways communities can support children with their journey to good health.

Obesity in childhood poses immediate and future health risks including:

• Children with obesity are at higher risk for having other chronic health conditions and diseases, such as asthma, sleep apnea, bone and joint problems, and type 2 diabetes. They also have more risk factors for heart disease like high blood pressure and high cholesterol than their normal weight peers.
• Children with obesity can be bullied and teased more than their normal weight peers. They are also more likely to suffer from social isolation, depression, and lower self-esteem.
• Children with obesity are more likely to have obesity as adults. (65% of adults in Florida are at an unhealthy weight according to the Healthiest Weight Florida coalition)  This can lead to lifelong physical and mental health problems. Adult obesity is associated with a higher risk of type 2 diabetes, heart disease, and many types of cancers.

Many factors influence childhood obesity 

Impacts on childhood obesity can occur due to numerous factors including eating and physical activity behaviors, genetics, metabolism, family and home environment, and community and social factors. For some children and families, obesity may be influenced by the following: 

• too much time spent being inactive
• lack of sleep
• lack of places to go in the community to get physical activity
• easy access to inexpensive, high calorie foods and sugary beverages
• lack of access to affordable, healthier foods

Developing healthy eating habits

Parents, guardians, and teachers can help children maintain a healthy weight by helping them develop healthy eating habits and limiting calorie-rich temptations. You also want to help children be physically active, have reduced screen time, and get adequate sleep.

To help children develop healthy eating habits:

• Provide plenty of vegetables, fruits, and whole-grain products.
• Include low-fat or non-fat milk or dairy products, including cheese and yogurt.
• Choose lean meats, poultry, fish, lentils, and beans for protein.
• Encourage your family to drink lots of water.
• Limit sugary drinks.
• Limit consumption of sugar and saturated fat.

Team approach to support healthy growth and prevent obesity in children

Many actors need to be involved in working in a complementary manner to address the issue of promoting the healthy growth of children and preventing obesity. These may include:

• parents and caregivers
• state and local health departments, businesses and community groups
• health care providers
• early care and education centers (including pre-school and day care centers)

The goal for children who are overweight is to reduce the rate of weight gain while allowing normal growth and development. Children should NOT be placed on a weight reduction diet without the consultation of a health care provider.

Remember that small changes every day can lead to longer-term success.

Additional Barriers

Obviously we should be cognizant of additional barriers impacting the ability to address this issue.  

Our society has a definite need to look at the many inequities that presently exist which include lack of educational opportunities (including education on nutrition and health topics),  limited income, lack of access to affordable healthier foods, difficulty in access to health care (i.e., health disparities, particularly with relation to minority population groups).

Finally, the issue of racial inequalities should not be discounted.

Resource information

Learn how obesity is measured in children by visiting 

https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html 

Mark A. Mahoney, Ph.D. has been a Registered Dietitian/Nutritionist for over 34 years and completed graduate studies in Nutrition & Public Health at Columbia University. He can be reached at [email protected].

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Food and Diet | Obesity Prevention Source

Beyond Willpower: Diet Quality and Quantity Matter

It’s no secret that the amount of calories people eat and drink has a direct impact on their weight: Consume the same number of calories that the body burns over time, and weight stays stable. Consume more than the body burns, weight goes up. Less, weight goes down. But what about the type of calories: Does it matter whether they come from specific nutrients-fat, protein, or carbohydrate? Specific foods-whole grains or potato chips? Specific diets-the Mediterranean diet or the “Twinkie” diet? And what about when or where people consume their calories: Does eating breakfast make it easier to control weight? Does eating at fast-food restaurants make it harder?

There’s ample research on foods and diet patterns that protect against heart disease, stroke, diabetes, and other chronic conditions. The good news is that many of the foods that help prevent disease also seem to help with weight control-foods like whole grains, vegetables, fruits, and nuts. And many of the foods that increase disease risk-chief among them, refined grains and sugary drinks-are also factors in weight gain.Conventional wisdom says that since a calorie is a calorie, regardless of its source, the best advice for weight control is simply to eat less and exercise more. Yet emerging research suggests that some foods and eating patterns may make it easier to keep calories in check, while others may make people more likely to overeat.

This article briefly reviews the research on dietary intake and weight control, highlighting diet strategies that also help prevent chronic disease.

Macronutrients and Weight: Do Carbs, Protein, or Fat Matter?

When people eat controlled diets in laboratory studies, the percentage of calories from fat, protein, and carbohydrate do not seem to matter for weight loss. In studies where people can freely choose what they eat, there may be some benefits to a higher protein, lower carbohydrate approach. For chronic disease prevention, though, the quality and food sources of these nutrients matters more than their relative quantity in the diet. And the latest research suggests that the same diet quality message applies for weight control.

Dietary Fat and Weight

Low-fat diets have long been touted as the key to a healthy weight and to good health. But the evidence just isn’t there: Over the past 30 years in the U.S., the percentage of calories from fat in people’s diets has gone down, but obesity rates have skyrocketed. (1,2) Carefully conducted clinical trials have found that following a low-fat diet does not make it any easier to lose weight than following a moderate- or high-fat diet. In fact, study volunteers who follow moderate- or high-fat diets lose just as much weight, and in some studies a bit more, as those who follow low-fat diets. (3,4) And when it comes to disease prevention, low-fat diets don’t appear to offer any special benefits. (5)

Part of the problem with low-fat diets is that they are often high in carbohydrate, especially from rapidly digested sources, such as white bread and white rice. And diets high in such foods increase the risk of weight gain, diabetes, and heart disease. (See Carbohydrates and Weight, below.)

For good health, the type of fat people eat is far more important that the amount (see box), and there’s some evidence that the same may be true for weight control. (6–9) In the Nurses’ Health Study, for example, which followed 42,000 middle-age and older women for eight years, increased consumption of unhealthy fats-trans fats, especially, but also saturated fats-was linked to weight gain, but increased consumption of healthy fats-monounsaturated and polyunsaturated fat-was not. (6)

Protein and Weight

Read more about healthy proteins on The Nutrition Source

Higher protein diets seem to have some advantages for weight loss, though more so in short-term trials; in longer term studies, high-protein diets seem to perform equally well as other types of diets. (3,4) High-protein diets tend to be low in carbohydrate and high in fat, so it is difficult to tease apart the benefits of eating lots of protein from those of eating more fat or less carbohydrate. But there are a few reasons why eating a higher percentage of calories from protein may help with weight control:

• More satiety: People tend to feel fuller, on fewer calories, after eating protein than they do after eating carbohydrate or fat. (10)
• Greater thermic effect: It takes more energy to metabolize and store protein than other macronutrients, and this may help people increase the energy they burn each day. (10,11)
• Improved body composition: Protein seems to help people hang on to lean muscle during weight loss, and this, too, can help boost the energy-burned side of the energy balance equation. (11)

Higher protein, lower carbohydrate diets improve blood lipid profiles and other metabolic markers, so they may help prevent heart disease and diabetes. (4,12,13) But some high-protein foods are healthier than others: High intakes of red meat and processed meat are associated with an increased risk of heart disease, diabetes, and colon cancer. (14–16)

Replacing red and processed meat with nuts, beans, fish, or poultry seems to lower the risk of heart disease and diabetes. (14,16) And this diet strategy may help with weight control, too, according to a recent study from the Harvard School of Public Health. Researchers tracked the diet and lifestyle habits of 120,000 men and women for up to 20 years, looking at how small changes contributed to weight gain over time. (9) People who ate more red and processed meat over the course of the study gained more weight-about a pound extra every four years. People who ate more nuts over the course of the study gained less weight-about a half pound less every four years.

Carbohydrates and Weight

Lower carbohydrate, higher protein diets may have some weight loss advantages in the short term. (3,4) Yet when it comes to preventing weight gain and chronic disease, carbohydrate quality is much more important than carbohydrate quantity.

Milled, refined grains and the foods made with them-white rice, white bread, white pasta, processed breakfast cereals, and the like-are rich in rapidly digested carbohydrate. So are potatoes and sugary drinks. The scientific term for this is that they have a high glycemic index and glycemic load. Such foods cause fast and furious increases in blood sugar and insulin that, in the short term, can cause hunger to spike and can lead to overeating-and over the long term, increase the risk of weight gain, diabetes, and heart disease. (17–19)

For example, in the diet and lifestyle change study, people who increased their consumption of French fries, potatoes and potato chips, sugary drinks, and refined grains gained more weight over time-an extra 3.4, 1.3, 1.0, and 0.6 pounds every four years, respectively. (9) People who decreased their intake of these foods gained less weight.

Specific Foods that Make It Easier or Harder to Control Weight

There’s growing evidence that specific food choices may help with weight control. The good news is that many of the foods that are beneficial for weight control also help prevent heart disease, diabetes, and other chronic diseases. Conversely, foods and drinks that contribute to weight gain—chief among them, refined grains and sugary drinks—also contribute to chronic disease.

Whole Grains, Fruits and Vegetables, and Weight

Whole grains-whole wheat, brown rice, barley, and the like, especially in their less-processed forms-are digested more slowly than refined grains. So they have a gentler effect on blood sugar and insulin, which may help keep hunger at bay. The same is true for most vegetables and fruits. These “slow carb” foods have bountiful benefits for disease prevention, and there’s also evidence that they can help prevent weight gain.

The weight control evidence is stronger for whole grains than it is for fruits and vegetables. (20–22) The most recent support comes from the Harvard School of Public Health diet and lifestyle change study: People who increased their intake of whole grains, whole fruits (not fruit juice), and vegetables over the course of the 20-year study gained less weight-0.4, 0.5, and 0.2 pounds less every four years, respectively. (9)

Of course, the calories from whole grains, whole fruits, and vegetables don’t disappear. What’s likely happening is that when people increase their intake of these foods, they cut back on calories from other foods. Fiber may be responsible for these foods’ weight control benefits, since fiber slows digestion, helping to curb hunger. Fruits and vegetables are also high in water, which may help people feel fuller on fewer calories.

Nuts and Weight

Read more about nuts on The Nutrition Source

Nuts pack a lot of calories into a small package and are high in fat, so they were once considered taboo for dieters. As it turns out, studies find that eating nuts does not lead to weight gain and may instead help with weight control, perhaps because nuts are rich in protein and fiber, both of which may help people feel fuller and less hungry. (9,23–25) People who regularly eat nuts are less likely to have heart attacks or die from heart disease than those who rarely eat them, which is another reason to include nuts in a healthy diet. (19)

Dairy and Weight

The U.S. dairy industry has aggressively promoted the weight-loss benefits of milk and other dairy products, based largely on findings from short-term studies it has funded. (26,27) But a recent review of nearly 50 randomized trials finds little evidence that high dairy or calcium intakes help with weight loss. (28) Similarly, most long-term follow-up studies have not found that dairy or calcium protect against weight gain, (29–32) and one study in adolescents found high milk intakes to be associated with increased body mass index. (33)

One exception is the recent dietary and lifestyle change study from the Harvard School of Public Health, which found that people who increased their yogurt intake gained less weight; increases in milk and cheese intake, however, did not appear to promote weight loss or gain. (9) It’s possible that the beneficial bacteria in yogurt may influence weight control, but more research is needed.

Sugar-Sweetened Beverages and Weight

There’s convincing evidence that sugary drinks increase the risk of weight gain, obesity, and diabetes: (34–36) A systematic review and meta-analysis of 88 studies found “clear associations of soft drink intake with increased caloric intake and body weight.” (34) In children and adolescents, a more recent meta analysis estimates that for every additional 12-ounce serving of sugary beverage consumed each day, body mass index increases by 0. 08 units. (35) Another meta analysis finds that adults who regularly drink sugared beverages have a 26 percent higher risk of developing type 2 diabetes than people who rarely drink sugared beverages. (36) Emerging evidence also suggests that high sugary beverage intake increases the risk of heart disease. (37)

Like refined grains and potatoes, sugary beverages are high in rapidly-digested carbohydrate. (See Carbohydrates and Weight, above.) Research suggests that when that carbohydrate is delivered in liquid form, rather than solid form, it is not as satiating, and people don’t eat less to compensate for the extra calories. (38)

These findings on sugary drinks are alarming, given that children and adults are drinking ever-larger quantities of them: In the U.S., sugared beverages made up about 4 percent of daily calorie intake in the 1970s, but by 2001, represented about 9 percent of calories. (36) The most recent data find that on any given day, half of Americans consume some type of sugared beverage, 25 percent consume at least 200 calories from sugared drinks, and 5 percent of consume at least 567 calories-the equivalent of four cans of sugary soda. (39)

The good news is that studies in children and adults have also shown that cutting back on sugary drinks can lead to weight loss. (40,41) Sugary drinks have become an important target for obesity prevention efforts, prompting discussions of policy initiatives such as taxing soda. (42)

Fruit Juice and Weight

Read more on The Nutrition Source about the amount of sugar in soda, fruit juice, sports drinks, and energy drinks, and download the How Sweet Is It? guide to healthier beverages

It’s important to note that fruit juices are not a better option for weight control than sugar-sweetened beverages. Ounce for ounce, fruit juices-even those that are 100 percent fruit juice, with no added sugar- are as high in sugar and calories as sugary sodas. So it’s no surprise that a recent Harvard School of Public Health study, which tracked the diet and lifestyle habits of 120,000 men and women for up to 20 years, found that people who increased their intake of fruit juice gained more weight over time than people who did not. (9) Pediatricians and public health advocates recommend that children and adults limit fruit juice to just a small glass a day, if they consume it at all.

Alcohol and Weight

Read more about alcohol on The Nutrition Source

Even though most alcoholic beverages have more calories per ounce than sugar-sweetened beverages, there’s no clear-cut evidence that moderate drinking contributes to weight gain. While the recent diet and lifestyle change study found that people who increased their alcohol intake gained more weight over time, the findings varied by type of alcohol. (9) In most previous prospective studies, there was no difference in weight gain over time between light-to-moderate drinkers and nondrinkers, or the light-to-moderate drinkers gained less weight than nondrinkers. (43–47)

Diet Patterns, Portion Size, and Weight

People don’t eat nutrients or foods in isolation. They eat meals that fall into an overall eating pattern, and researchers have begun exploring whether particular diet or meal patterns help with weight control or contribute to weight gain. Portion sizes have also increased dramatically over the past three decades, as has consumption of fast food-U.S. children, for example, consume a greater percentage of calories from fast food than they do from school food (48)-and these trends are also thought to be contributors to the obesity epidemic.

Dietary Patterns and Weight

So-called “prudent” dietary patterns-diets that feature whole grains, vegetables, and fruits-seem to protect against weight gain, whereas “Western-style” dietary patterns-with more red meat or processed meat, sugared drinks, sweets, refined carbohydrates, or potatoes-have been linked to obesity. (49–52) The Western-style dietary pattern is also linked to increased risk of heart disease, diabetes, and other chronic conditions.

Following a Mediterranean-style diet, well-documented to protect against chronic disease, (53) appears to be promising for weight control, too. The traditional Mediterranean-style diet is higher in fat (about 40 percent of calories) than the typical American diet (34 percent of calories (54)), but most of the fat comes from olive oil and other plant sources. The diet is also rich in fruits, vegetables, nuts, beans, and fish. A 2008 systematic review found that in most (but not all) studies, people who followed a Mediterranean-style diet had lower rates of obesity or more weight loss. (55) There is no single “Mediterranean” diet, however, and studies often use different definitions, so more research is needed.

Breakfast, Meal Frequency, Snacking, and Weight

There is some evidence that skipping breakfast increases the risk of weight gain and obesity, though the evidence is stronger in children, especially teens, than it is in adults. (56) Meal frequency and snacking have increased over the past 30 years in the U.S. (57)-on average, children get 27 percent of their daily calories from snacks, primarily from desserts and sugary drinks, and increasingly from salty snacks and candy. But there have been conflicting findings on the relationship between meal frequency, snacking, and weight control, and more research is needed. (56)

Portion Sizes and Weight

Since the 1970s, portion sizes have increased both for food eaten at home and for food eaten away from home, in adults and children. (58,59) Short-term studies clearly demonstrate that when people are served larger portions, they eat more. One study, for example, gave moviegoers containers of stale popcorn in either large or medium-sized buckets; people reported that they did not like the taste of the popcorn-and even so, those who received large containers ate about 30 percent more popcorn than those who received medium-sized containers. (60) Another study showed that people given larger beverages tended to drink significantly more, but did not decrease their subsequent food consumption . (67) An additional study provided evidence that when provided with larger portion sizes, people tended to eat more, with no decrease in later food intake. (68) There is an intuitive appeal to the idea that portion sizes increase obesity, but long-term prospective studies would help to strengthen this hypothesis.

Fast Food and Weight

Fast food is known for its large portions, low prices, high palatability, and high sugar content, and there’s evidence from studies in teens and adults that frequent fast-food consumption contributes to overeating and weight gain. (61–66) The CARDIA study, for example, followed 3,000 young adults for 13 years. People who had higher fast-food-intake levels at the start of the study weighed an average of about 13 pounds more than people who had the lowest fast-food-intake levels. They also had larger waist circumferences and greater increases in triglycercides, and double the odds of developing metabolic syndrome. (62) More research is needed to tease apart the effect of eating fast food itself from the effect of the neighborhood people live in, or other individual traits that may make people more likely to eat fast food.

The Bottom Line: Healthy Diet Can Prevent Weight Gain

and Chronic Disease

Weight gain in adulthood is often gradual, about a pound a year (9)-too slow of a gain for most people to notice, but one that can add up, over time, to a weighty personal and public health problem. There’s increasing evidence that the same healthful food choices and diet patterns that help prevent heart disease, diabetes, and other chronic conditions may also help to prevent weight gain:

• Choose minimally processed, whole foods-whole grains, vegetables, fruits, nuts, healthful sources of protein (fish, poultry, beans), and plant oils.
• Limit sugared beverages, refined grains, potatoes, red and processed meats, and other highly processed foods, such as fast food.

Though the contribution of any one diet change to weight control may be small, together, the changes could add up to a considerable effect, over time and across the whole society. (9) Since people’s food choices are shaped by their surroundings, it’s imperative for governments to promote policy and environmental changes that make healthy foods more accessible and decrease the availability and marketing of unhealthful foods.

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50. Newby PK, Muller D, Hallfrisch J, Andres R, Tucker KL. Food patterns measured by factor analysis and anthropometric changes in adults. Am J Clin Nutr. 2004;80:504-13.

51. Schulz M, Nothlings U, Hoffmann K, Bergmann MM, Boeing H. Identification of a food pattern characterized by high-fiber and low-fat food choices associated with low prospective weight change in the EPIC-Potsdam cohort. J Nutr. 2005;135:1183-9.

52. Newby PK, Muller D, Hallfrisch J, Qiao N, Andres R, Tucker KL. Dietary patterns and changes in body mass index and waist circumference in adults. Am J Clin Nutr. 2003;77:1417-25.

53. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92:1189-96.

54. Wright JD WC-Y. Trends in intake of energy and macronutrients in adults from 1999-2000 through 2007-2008. Hyattsville, MD: National Center for Health Statistics; 2010.

55. Buckland G, Bach A, Serra-Majem L. Obesity and the Mediterranean diet: a systematic review of observational and intervention studies. Obes Rev. 2008;9:582-93.

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57. Popkin BM, Duffey KJ. Does hunger and satiety drive eating anymore? Increasing eating occasions and decreasing time between eating occasions in the United States. Am J Clin Nutr. 2010;91:1342-7.

58. Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA. 2003;289:450-3.

59. Piernas C, Popkin BM. Food portion patterns and trends among U.S. children and the relationship to total eating occasion size, 1977-2006. J Nutr. 2011;141:1159-64.

60. Wansink B, Kim J. Bad popcorn in big buckets: portion size can influence intake as much as taste. J Nutr Educ Behav. 2005;37:242-5.

61. Duffey KJ, Gordon-Larsen P, Jacobs DR, Jr., Williams OD, Popkin BM. Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study. Am J Clin Nutr. 2007;85:201-8.

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The Solution to Obesity May Potentially Be in Your Gut

There is no simple solution to the obesity epidemic. There are several resources, programs, and guides that are geared to help people live a healthy lifestyle through healthy eating and regular physical activity. Now, new research shows that a stomach-specific protein plays a critical role in the progression of obesity, and could potentially lead to the development of therapeutics that would help individuals struggling with achieving and maintaining weight loss.

The study, “Gastrokine-1, an anti-amyloidogenic protein secreted by the stomach, regulates diet-induced obesity,” was published in the journal Scientific Reports and led by David Boone, PhD, associate professor of microbiology and immunology at Indiana University (IU) School of Medicine, and an adjunct professor in the department of biology at the University of Notre Dame.

“Obesity and its sequelae have a major impact on human health,” wrote the researchers. “The stomach contributes to obesity in ways that extend beyond its role in digestion, including through effects on the microbiome. Gastrokine-1 (GKN1) is an anti-amyloidogenic protein abundantly and specifically secreted into the stomach lumen. We examined whether GKN1 plays a role in the development of obesity and regulation of the gut microbiome.”

GKN1 is a stomach protein highly expressed in normal gastric tissue and plays a major role in maintaining gastric mucosal integrity. The researchers showed that curbing GKN1 produced significant differences in weight and levels of body fat in comparison to when the protein was expressed.

“While diet and exercise are critical to maintaining a healthy weight, some individuals struggle with weight loss—even in cases of bariatric surgery, maintaining weight loss can be a challenge,” explained Boone. “These results are an example of how a better understanding of the gut microbiome and the physiological aspects of obesity—how our bodies regulate metabolism and accumulate body fat—could help inform new therapies. ”

The researchers conducted a microbiome analysis of mouse models with and without the GKN1 protein expressed. They observed models without GKN1 weighed less and had lower levels of total body fat and higher percentages of lean mass. When put on a high-fat diet (HFD), models without GKN1 showed resistance to weight gain, increased body fat, and hepatic inflammation.

“Gkn1⁻/⁻ mice were resistant to diet-induced obesity and hepatic steatosis (HFD fat mass (g) = 10.4 ± 3.0 (WT) versus 2.9 ± 2.3 (Gkn1⁻/⁻) p < 0.005; HFD liver mass (g) = 1.3 ± 0.11 (WT) versus 1.1 ± 0.07 (Gkn1⁻/⁻) p < 0.05). Gkn1⁻/⁻ mice also exhibited increased expression of the lipid-regulating hormone ANGPTL4 in the small bowel. The microbiome of Gkn1⁻/⁻ mice exhibited reduced populations of microbes implicated in obesity, namely Firmicutes of the class Erysipelotrichia. Altered metabolism consistent with use of fat as an energy source was evident in Gkn1⁻/⁻mice during the sleep period,” wrote the researchers.

They did not find any evidence of adverse effects such as cancer, diabetes, loss of appetite, malabsorption, or inflammation. The loss of GKN1 expression is associated with gastric cancer. However, they did not find any evidence of gastric cancer in GKN1⁻/⁻ mice. “Although we did not observe spontaneous gastric cancers in GKN1⁻/⁻ mice we cannot rule out the possibility that loss of GKN1 predisposes to gastric cancer in the context of other additional inducers such as inflammation or infection.

Further studies are needed to determine the efficacy of blocking GKN1 to prevent obesity, but this study is a step in potentially creating new therapeutics that could reduce the burden on health care systems and help improve quality of life for patients.

90,000 Obesity treatment, solution of overweight problems in the North-West Administrative District (metro Shchukinskaya, metro Streshnevo, metro Sokol)

Overweight for many today is a very urgent problem. Overweight with an index (BMI) greater than or equal to 30 is called obesity.People of all ages suffer from this ailment; it is especially dangerous for young people, children and adolescents. Obesity provokes severe disturbances in the work of all organs and systems, causes tremendous psychological discomfort, interferes with full-fledged work and study.

Types of obesity, causes of occurrence

Taking food, a person receives proteins, fats, carbohydrates necessary for the normal functioning of the body. If the amount of consumed kilocalories exceeds their consumption, the work of the brain receptors responsible for appetite is disrupted.Gradually, the amount of food and the duration of its intake increase, the usual portions are no longer able to satisfy the uncontrollable feeling of hunger, the metabolic rate decreases. The result of this process is primary obesity.

The appearance of excess weight is facilitated by:

• hypodynamia;
• lack of age-appropriate physical activity;
• predominance of fatty, spicy, salty and sweet foods in the diet, lack of fiber;
• chronic lack of sleep;
• stressful conditions.

Cost of services

Obesity of non-endocrine nature occurs as a result of dysfunction of the large and small intestines, pancreas, and liver. Unfortunately, genetic predisposition also plays an important role.Extra pounds appear against the background of a reduced production of adrenaline, as a side effect of taking medications, including hormonal contraceptives that are so popular today (in women).

The type of pathology determines the body mass index:

• 30-34.9 – I degree of obesity;
• 35-39.9 – II degree of obesity;
• 40-49.9 – III degree of obesity;
• over 50 – severe obesity.

Fat masses are formed not only under the skin, but also gradually begin to envelop the organs, disrupting their normal functioning. Diabetes mellitus, hypertension, cholelithiasis, kidney dysfunction, musculoskeletal disorders – all this can develop against the background of overweight. Obesity provokes the growth of benign and malignant tumors, significantly increases the risk of heart attacks, strokes and other pathologies of the cardiovascular system. With a body mass index over 50, a lethal outcome is possible.

Diagnostics

The main indicator of the presence of the disease is the body mass index, calculated by the doctor of the center “Emmaklinik” at the first consultation.Before starting treatment, detailed information is also collected about the patient’s lifestyle and the presence of chronic diseases. Next, you need to undergo extended blood biochemistry, ultrasound of the abdominal organs, ECG, gastroendoscopy. Having received the results and summarizing the information received, the doctor makes a final diagnosis and prescribes treatment.

Therapy

An individual nutrition plan is developed for the patient, a set of physical exercises is drawn up. In parallel, the administration of drugs can be prescribed to accelerate metabolism, metabolism.If obesity is caused by endocrine disorders, dysfunction of the digestive tract, they are treated.

A radical way to eliminate a severe stage of obesity is a surgical one – bandaging, shunting and other types of bariatric operations are performed. However, one should not think that this procedure will solve the problem once and for all. The success of therapy is directly related to how accurately the patient follows medical recommendations throughout his life. Failure to comply with the diet, abuse of junk food, alcohol, lack of physical activity contribute to the early return of excess weight.

The specialists of the center “Emmaklinik” will help to cope with obesity of any degree, adjust the diet, improve mood and well-being, restore confidence and good mood.

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90,000 An interdisciplinary approach to solving the problem of obesity in Ukraine

Authors:
B.N. Mankovsky, T. F. Tatarchuk, O. V. Zinych, O. V. Shvets, L. K. Sokolova, N. O. Pertseva, V.I. Velichko

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On February 26, on the eve of World Obesity Day, the first meeting of an interdisciplinary working group of experts to discuss the state of obesity in Ukraine was held in Kiev.

Leading experts and well-known representatives of various public medical organizations, concerned about the growth of socially significant diseases associated with obesity, shared their own experience in managing overweight patients.

Corresponding Member of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Boris Nikitovich Mankovsky (National Medical Academy of Postgraduate Education named after P.L. Shupik, Kiev) noted that many domestic patients do not consider excess body weight a disease and do not see the need to reduce it, despite all the efforts of the medical community to debunk this myth. One of the possible reasons for such an attitude of patients to this problem may be the difficult history of the development of drug treatment for obesity.Many attempts at pharmacotherapeutic correction of excess body weight are associated with the withdrawal of a number of drugs (benfluorex, sibutramine) due to an increase in the incidence of malignant diseases and cardiovascular complications.

An endocrinologist is often approached not for the purpose of correcting excess body weight, but for treating concomitant pathology (diabetes mellitus – DM), solving cosmetic problems. Patients with type 2 diabetes, who categorically do not want to switch to insulin injections to correct glycemia, are extremely interested in losing body weight, they are the ones who most often agree to follow the recommendations for weight loss.Unfortunately, a number of complications of diabetes (diabetic retinopathy, nephropathy) cannot be reversed with normalization of body weight, however, a decrease in body mass index (BMI) values ​​in such cases can prevent the progression of these conditions. Patients with concomitant thyroid pathology, as well as ardent followers of anti-aging medicine, who cannot stabilize their weight against the background of active exercise in the gym, can apply to an endocrinologist in the hope of parting with extra pounds.They come already consciously, in order to find the organic substrate that provoked an increase in body weight.

The professor paid much attention to the problem of stigmatization: the use of the term “obesity” both when communicating with a patient and when specifying it as a diagnosis can nullify all the efforts of a doctor. Indeed, many of those who seek advice, even with morbid obesity, do not want to feel sick and experience significant discomfort when such a diagnosis is made to them.It is advisable to use a softer terminology that is gentle on the psyche of patients.

Corresponding Member of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Tatyana Feofanovna Tatarchuk (State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after O.M. Lukyanova of the National Academy of Medical Sciences of Ukraine”, Kiev) age periods of life of girls, girls, women with overweight turn to a gynecologist. As a rule, the reasons for contacting a pediatric gynecologist for parents of children 6-12 years old are premature sexual development, the appearance of signs of inverted puberty (androgenic hair growth, hirsutism, “male” odor).In the vast majority of cases, neither parents nor children are embarrassed by the presence of overweight or obesity. Many people take this as a testament to the ability to provide the child with good nutrition. The main reason for seeking medical advice for adolescents aged 12-18 years is cosmetic problems that complicate the course of obesity – acne, profuse and painful periods, male-pattern hair, and in some cases organic problems such as functional ovarian cysts.Young women 18-30 years old, in addition to complaints inherent in the age group 12-18 years old, are worried about the absence of menstruation, the inability to get pregnant. And again, despite the presence of significant complaints, patients do not pay due attention to BMI, not counting obesity as the main reason for changing their condition. Representatives of the age group 30-40 years old are primarily concerned about malignant formations of the mammary glands, endometrial pathology, infertility. They often have hyperprolactinemia. The identification of such diseases makes women seriously think about the duration and quality of their life, they begin to take measures to correct body weight, strictly following all the doctor’s recommendations. In the older age cohort (50-70 years old), in the structure of gynecological pathology associated with obesity, bleeding and oncological diseases predominate. In some cases, the reason for contacting a gynecologist is aesthetic problems, recommendations of other specialists (endocrinologist, psychiatrist), to whom women turned to, trying to normalize their body weight.

Professor T.F. Tatarchuk paid great attention to the problem of weight correction in married couples wishing to conceive a child.Women suffering from infertility carefully follow the medical recommendations, especially after several unsuccessful attempts to conceive with the help of assisted reproductive technologies. Their husbands are less likely to adhere to recommendations for normalizing body weight, since they believe that being overweight does not affect their reproductive health. Pregnant and lactating mothers practically do not think about the negative impact of obesity, since they believe that in this situation it is necessary to “eat for two”, unreasonably absorbing a huge amount of condensed milk and nuts for better development of the fetus or child. Cancer and hormone phobia is widespread among domestic patients, but there are no fears of the negative consequences of obesity.

This opinion was supported by Doctor of Medical Sciences Olesya Vadimovna Zinych (State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kiev) . She emphasized that in the structure of people who turn to endocrinologists because of obesity, women who suffer from infertility or who have experienced an uncontrolled increase in body weight after several in vitro fertilization procedures predominate.In addition, patients with pathology of the musculoskeletal system, accompanied by pronounced articular syndrome, and young women with comorbid depression, who want to arrange their personal life, wish to reduce body weight. Sleep apnea syndrome, early menopause against the background of an increase in BMI values ​​can also be reasons for treatment. Such patients rarely apply for a consultative appointment on their own, more often they are recommended to exclude endocrinological pathology by reproductive specialists, orthopedic traumatologists, and pulmonologists.

The head of the VGO “Association of Nutritionists of Ukraine”, Candidate of Medical Sciences Oleg Vitalievich Shvets presented the problem of obesity from the point of view of a gastroenterologist. Persons suffering from obesity rarely immediately turn to a nutritionist, more often overweight patients come to the representatives of this specialty. Gastroenterologists consult patients with both overweight and morbid obesity on the background of concomitant pathology of the gastrointestinal tract – non-alcoholic fatty liver disease, chronic pancreatitis, metabolic syndrome.Parents of overweight adolescents and patients who have undergone bariatric surgery are frequent visitors to gastroenterology rooms.

Unfortunately, among those who follow all medical recommendations, only 10% can achieve normal body weight. Lack of motivation is one of the many reasons for the ineffectiveness of behavior and diet therapy. Often it is necessary, together with the patient, to look for a reason that can force him to change his usual way of life. At the same time, you should not aim the patient at careful control of body weight, it is better to use other indicators: waist or hip size, level of sexual activity, quality of sleep. Many patients insist on the development of a clear action plan, diet, not only for the next week, but also for several months. However, following a strict schedule for at least 30 days, patients become extremely tired of psychological pressure and often give up trying to normalize body weight. Most obese patients crave easy solutions to the problem of excess weight, relying on a magic pill and not wanting to waste time on long and painstaking work on themselves.In such cases, intimidating motivation does not work; motivating tactics will be of great benefit. The speaker confirmed that erectile dysfunction, infertility, arterial hypertension are more significant problems for patients than overweight.

Head of the Odessa Region Family Medicine Association, Doctor of Medical Sciences, Professor Valentina Ivanovna Velichko (Odessa National Medical University) drew the attention of those present to the difficulty of not only achieving “ideal” body weight, but also maintaining it. The approach to obesity changed with the development of society: if at first being overweight was welcomed, as it was evidence of a sufficient amount of food, then already in the Roman Empire, the attitude towards well-fed members of society was transformed: Hippocrates recommended “to walk a lot so as not to be obese.” The fashion for curvy bodies and stout women returned to the Middle Ages. This trend continues now: active advertising campaigns are being conducted in the media to promote “XXL girls” with a pronounced overweight.Many of these models do not perceive their condition as a disease, but such a body weight is already a pathology. The quiet tacit consent of those around them gives them the opportunity to consider themselves absolutely healthy, instilling confidence in a cloudless future.

People often misunderstand their body image. Some patients with normal BMI consider themselves overweight and put a lot of effort into weight loss. At the same time, many women and men with overweight (in fact, pre-obesity) are absolutely sure that their body weight is ideal, and their figure is quite slender.

Professor V.I. Velichko cited the results of one study that looked at the medical histories of people born in 1920-1930. in different countries to analyze the factors contributing to impaired carbohydrate tolerance, obesity and early cardiovascular death. It was found that the body weight at birth is of great importance: children whose weight did not exceed 2.5 kg had a high risk of developing obesity, diabetes, early cardiovascular death in adulthood compared with children whose birth weight was about 4 kg …Rapid weight gain in the first year of life or during the first 3 years of life turned out to be the factors that “reprogram” the metabolic processes of the child’s body, predisposing to the appearance of excess weight. As they grow up, children are faced with another significant factor – forced physical inactivity, especially during a long stay at the school desk. Many schoolchildren begin to rapidly gain weight precisely due to a decrease in physical activity, and in fact children suffering from obesity often transfer it into adulthood.

The only specialist who goes through all stages of growing up with a child is a family doctor. Therefore, the attention of general practitioners should be focused on the diagnosis and detection of obesity. One should not keep silent about the presence of excess body weight, it is necessary to tell the patient about this, even if he went to the outpatient clinic for a sore throat or a runny nose. Family physicians should know how much care they should recommend to obese children and adults, what risk factors to look for, and what to advise patients to prevent further weight gain.Having a protocol adapted for instrumental and laboratory capabilities, a family doctor will be able to answer questions such as whether a given child needs to lose weight? or not to resort to limiting the diet, because taking into account the active growth of the child, weight redistribution can be expected? or should a slight (0.7-0.9 kg / month) decrease in body weight be envisaged? All these nuances should be specified in the national regulatory document for the management of patients with overweight / obesity.

Doctor of Medical Sciences Lyubov Konstantinovna Sokolova (State Institution “Institute of Endocrinology and Metabolism named after V.I.V.P. Komisarenko NAMS of Ukraine “) and Doctor of Medical Sciences, Professor Natalia Olegovna Pertseva (Dnepropetrovsk Medical Academy of the Ministry of Health of Ukraine). It is necessary to take active measures to actualize the problem of obesity and combat it in our country. A possible way out of this situation can be the creation of national recommendations, protocols for the correction of obesity. They should be developed by a multidisciplinary team of specialists, consisting of endocrinologists, obstetricians-gynecologists, gastroenterologists, cardiologists, surgeons, nutritionists, taking into account the current international standards.

* * *

Concluding the first meeting of the interdisciplinary working group, the experts emphasized the need to consolidate clinical approaches to the management of obese patients, form a unified diagnostic algorithm and therapeutic tactics, create a national information and regulatory document, and an interdisciplinary consensus on obesity. In the near future, it is planned to hold a second meeting of the working group, within the framework of which the possibility of creating this normative act will be considered.

Prepared by Lada Matveeva

Medicna newspaper “Zdorov’ya Ukrainy 21 storichchya” No. 5 (474), birch 2020 p.

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Solving problems in adults and adolescents in the treatment of obesity with acupuncture .. Treatment in Moscow, prices, appointments and consultations

The problem of obesity and its treatment is one of the leading places in modern medicine. Obesity is one of the most common diseases.According to the Institute of Nutrition (1998), about 30% of the entire population of the world and more than half of the Russian population are overweight.

Obesity leads to numerous complications of various spheres of the body’s life, which complicates the adaptation of a person in society, limits his social, personal contacts, increases the risk of cardiovascular diseases, creates problems of the musculoskeletal system, respiratory, gastroenterological, endocrine, reproductive, etc. …vital systems.

The causes of the onset and progression of obesity are rooted in complex metabolic and neurochemical processes occurring mainly in the midline structures of the brain or reticular formation. The maturation of patterns of the biochemical, physiological organization of the brain, the formation of a sequence of functional connections at various levels correlates with the formation of an integral system of peptide-mediator balance in the brain. Hypothalamic peptides are regulated by feedback with other brain structures through the involvement of systems of various neuropeptides and monoamines.Imbalances in this system often lead to difficultly predictable changes in the neurohumoral, hormonal, biochemical sphere, in particular, in the regulation of body weight.

Due to the breadth and frequency of complications in obesity, more and more new treatments are being undertaken. But, as a rule, the personal characteristics of patients, the polymorphism of concomitant diseases and the appointment of standard therapy are not taken into account, which leads to refusal of treatment due to decompensation in the mental sphere or to a high percentage of relapses.

Obesity is often combined with eating disorders, psycho-vegetative syndrome, pathology of the emotional sphere, which makes it necessary to use elements of psychotherapy along with the usual methods of treatment and reflexology.

Acupuncture for obesity, the use of reflexology techniques is associated and depends on the type of disease.

Today it is customary to distinguish between 3 main types of obesity:

• Exogenous-constitutional.
• Cerebral
• Endocrine obesity

Acupuncture for obesity.A certain role in the treatment of obesity is played by the acupuncture technique, which is designed for a long (more than 1 year) period and is conditionally divided into 3 stages:

• Stage 1 corresponds to 12-15 reflexology procedures, which are usually carried out every other day.
• Stage 2 in 2-3 months, is 10-12 sessions
• 3 stage after 10-11 months (from the first) 10-12 procedures as well.

Such long-term acupuncture for obesity is determined by the very essence of complex neurohumoral processes occurring in cells, etc.n. “Memory” of cellular nutrition, which lasts for 10-11 months. Indeed, a rapid weight loss develops a “compressed spring” effect, in which weight is gained to the initial, and sometimes even higher, in a very short period of time.

There are no revolutionary changes in reflexology itself, developed by ancient Vietnamese medicine. The classical technique obesity acupuncture using known points is applied.

Auriculopuncture. Superficial multi-needle reflexology of problem areas.Corporate and remote locations.

Acupuncture for obesity. Interesting moments.

In particular, leaving microneedles in the auricle for 3-10 days at points of suppression of hunger. Prolonged irritation of these points with alternating auricles in some patients leads to a persistent decrease in appetite and, as a result, weight loss.

Irritation of the gastric points with the aim of affecting the muscular wall of the stomach, a slight reduction in its volume, which leads to a subjective feeling of satiety from a slightly smaller volume of food.

The presence of certain neurological disorders in obese patients, often with impaired eating behavior, forces the use of techniques aimed at treating neurosis.

Local reflexology, which includes elements of pharmacopuncture, electropuncture, mainly the so-called. problem areas.

Long-term results of acupuncture treatment for obesity in more than 100 patients – during the year, a decrease in body weight from 2 to 18% of the initial.With the subsequent stabilization at these figures for many years.

Acupuncture for obesity

High rates of childhood obesity increase the risks of COVID-19 – Rossiyskaya Gazeta

In a number of countries in the WHO European Region, every third child aged six to nine is overweight or obese. The highest obesity rates are found in the Mediterranean countries, but in this region the situation is gradually beginning to improve. This is evidenced by the results of a new report on the fourth round of data collection under the WHO European Childhood Obesity Surveillance Initiative (COSI), which has been conducted regularly since 2015.

How the situation is changing, experts discussed at the European Congress on Obesity, which took place this week (this year it was held online). A report from the WHO European Office provides the latest data on children aged 6-9 years from 36 countries in the Region.

Experts noted that the spread of childhood obesity is of particular concern in connection with the COVID-19 epidemic.

“Potentially, COVID-19 could exacerbate one of the most alarming trends in the WHO European Region – an increasing prevalence of childhood obesity,” said WHO Regional Director for Europe Dr Hans Henri P.Kluge).

“Overweight and obesity are directly linked to life-threatening noncommunicable diseases such as cardiovascular disease, diabetes and cancer. To ensure a bright future for the next generation, we need to implement evidence-based and evidence-based policies that will reduce the level of childhood obesity, “added Mr. Kluge, noting two key areas in this work: organizing a healthy diet and increasing physical activity.

WHO experts believe that COVID-19 is likely to lead to an increase in the prevalence of childhood obesity in the WHO European Region – this was facilitated by quarantine measures, school closures and, as a result, restricting children’s access to healthy school meals. At the same time, there was a decrease in physical activity in children, further increasing the risk of the spread of obesity.

However, the report noted that in some of the 13 European countries that are regularly monitored, the situation is at least not worse: the prevalence of overweight and obesity has stabilized or decreased.“Greece, Spain, Italy, Portugal, which have the highest rates of obesity in children, and Slovenia showed a downward trend in the prevalence of both overweight and obesity. The decline in overweight among boys ranged from 4 to 12 percentage points, and among girls – in the range from 3 to 7 “, – noted in the WHO European Bank.

Experts attribute this development of events to the fact that in recent years in some of these countries, WHO recommended measures have been taken to combat obesity: for example, a tax on sugar-sweetened beverages was introduced, restrictions on food marketing, and physical education lessons were included in the compulsory program for schoolchildren.

The latest COSI data was obtained from 36 countries participating in the survey in the 2015-16 and 2016-2017 school years. About 250,000 children of primary school age were examined. – Researchers collected data on overweight, physical activity and diet among boys and girls.

Overall, the prevalence of overweight (including obesity) was 29% among boys and 27% among girls aged six to nine; the prevalence of obesity was 13% among boys and 9% among girls.That is, in fact, every third child has problems.

However, these figures do not reflect significant differences between countries. Thus, the highest prevalence of obesity is observed in the Mediterranean countries – in Greece, Cyprus, Spain and Italy. More than 40% of boys and girls there suffer from overweight, and from 19% to 24% of boys and from 14% to 19% of girls from obesity.

The lowest, most favorable rates were recorded in the countries of Central Asia: Kyrgyzstan, Tajikistan and Turkmenistan.In these countries, between 5% and 12% of boys and girls are overweight and less than 5% are diagnosed with obesity.

Scientists correlated the prevalence of weight problems with the lifestyle of children, their eating habits.

On average, almost 80% of children ate breakfast every day, about 45% ate fruit daily, while only one in four children had vegetables in their daily diet. Moreover, in different countries, these indicators could differ several times.

At the same time, 27% of children regularly eat sweets, and snacks with an excess of salt – 14%.The percentage of children eating these unhealthy foods more than three days a week also varied significantly across countries, with levels of sweets ranged from 5% to 62% and savory snacks from less than 1% to 35%.

In terms of physical activity, on average one in two children went to school on foot or cycling. In all countries, most children spent at least one hour a day playing outside (62% to 98% in different countries).

At the same time, children from families with a higher level of education, as a rule, regularly went in for sports or dancing.

WHO regrets that there is no data on the obesity situation in the younger age group. Meanwhile, it is important to lower the age threshold when studying the prevalence of obesity in children, also regularly screening children under the age of five.

Why cities need to find solutions to climate change and obesity

The climate crisis and the rapid spread of obesity are two intertwined greatest challenges of our time.

Signs of climate change cannot be ignored, from record temperatures and worldwide wildfires to rising sea levels and bleaching of coral reefs.At the same time, the rapid jump in mortality from non-communicable diseases, among which obesity is the main risk factor, has not subsided.

Every year 41 million people worldwide die prematurely from diabetes, cardiovascular disease and stroke. In addition to human tragedy, this problem is associated with massive economic losses.

According to experts from the World Economic Forum and the Harvard School of Public Health, over two decades to 2030.the cost of noncommunicable diseases will amount to $ 30 trillion, roughly equal to the combined annual GDP of the two largest economies in the world: the United States and China.

Cities cover only 2% of the land area, but they account for 70% of CO emissions associated with heat and electricity production ²

Shanghai, China

While civil society and activists are rallying together to engage the government in the fight against two intertwined issues – climate change and poor health, it is worth noting that they have one important thing in common: they can – and should – be addressed at the city level.

More than half of the world’s population now lives in cities and urban environments. Although cities cover only 2% of the land area, they account for 70% of CO emissions from heat and electricity production ² .

Cities also have a huge impact on our health. Two-thirds of people with diabetes live in cities, and the urban population, on average, is more likely to develop obesity or overweight than rural residents.

The future state of the climate and the health of future generations depend on the decisions made regarding food, electricity, green space and transport.

C40 Climate Change International Network, and Novo Nordisk’s Cities Changing Diabetes program, which brings together public and private sector representatives, are working together at the city level to address public health and change climate.

We started our joint work with the development of the most promising ways of transportation in the city – walking and bicycles. An infrastructure with spacious, protected and well-positioned cycle paths and sidewalks contributes to the mobility of urban dwellers. The implementation of such measures at the city level can help to significantly reduce harmful emissions, which is necessary to maintain a favorable climate in the future, as well as reduce the risk of developing cardiovascular diseases and type 2 diabetes.

The Ecobici Affordable Cycling Program Saves Mexico City US $ 26M in Reduced Healthcare Costs

Mexico City, Mexico

An example of how urban traffic can be transformed is New York’s pedestrian-only Times Square, a network of bike paths throughout London, the Made to Move project in Manchester, and a complex of pedestrian and bike paths in Barcelona’s superblocks.

Every city needs to make an extra effort to tackle the climate crisis and public health issues seriously. Here are three aspects that, in our opinion, are extremely important for strengthening work in this direction:

• First, the city needs strong case studies to show how specific solutions can improve public health or reduce emissions. That is why, in five cities, we carried out work to identify possible factors, obstacles and difficulties.Launched in 2010 in Mexico City, the Ecobici program today has over 300,000 users, 444 stops and 6,000 bicycles. Residents of the city have access to unlimited travel around the city for 45 minutes. It is estimated that Ecobici users saved the city US $ 26 million in reduced healthcare costs, and each increased life expectancy by 10 months.
• Second, cities need reliable data to drive change.Through the Cities Beat Diabetes Program and the C40 Pedestrian and Cyclist Benefit Model, cities can quantify the health and economic benefits of walking and cycling. Community support for the program in Bangalore City has expanded the scope of its implementation, including by contributing to the improvement of sidewalks and cycle paths. Using a theoretical model, it was found that the adoption of such measures allows residents to reduce the number of car trips by 154 million per year.At the same time, the life expectancy of each participant in the program increases by almost two years with a significant decrease in the incidence of type 2 diabetes.
• Third, the government and, in particular, city mayors need to understand and be able to justify the economic benefits of these measures. There is growing evidence that investing in active transport infrastructure improves public health, reduces harmful emissions and, as a result, saves the city’s budget in the long term.In making tough decisions about the use of limited resources, city leaders need to be able to show that the proposed changes are aimed at long-term savings, not spending.

Of all the lessons and ideas that we have learned during our work, perhaps the most important is the idea that change – now or later – is possible, and its implementation gives strength and improves the quality of life.

Mayors need to create the right environment so that millions more in other cities around the world will join the thousands of people walking around New York, cycling the streets of London, or taking advantage of the expanded public transport network in Bogota.This will improve their health and reduce their carbon footprint.

The solution to the problem of climate and health preservation – in cities. And at the forefront is the well-being of people.

Prepared with contributions from Mark Watts, Executive Director of the C40 Cities Program.

Published online in The Telegraph.

Difference between obesity and overweight

Many people today are preoccupied with the problems of excess weight, strive to be fit, lead a healthy lifestyle.At the same time, the number of people on the planet who are overweight or obese is gradually increasing. These concepts are often confused. But being overweight and obesity are not the same thing. Let’s take a look at the key differences.

Excess weight is not a scientific concept. This is a condition in which a person has several extra pounds that exceed their normal weight. That is, in the presence of a couple or even 10 extra pounds, a person does not feel physical discomfort, he feels healthy. Losing excess weight is not so difficult, it is enough to reconsider your diet, add physical activity, and the weight will calmly go away.

Obesity is a completely different medical problem. Obesity is the accumulation of excess fatty deposits, which are located not only under the skin, but also often affect internal organs. Obesity is accompanied by concomitant diseases. Fat accumulations fill the space inside the abdominal cavity, metabolism is disturbed, the cardiovascular and musculoskeletal systems are overloaded.

An obese person also experiences psychological discomfort.Getting rid of obesity just by playing sports is not always possible. This requires an integrated approach, sometimes long-term medical treatment. Extra pounds with obesity can appear not only from an excess of fatty foods, but also due to hormonal disorders, low mobility, hereditary diseases. And getting rid of this problem can be very difficult.

A specialist will help you to accurately determine the presence of obesity or just a few extra pounds. The most popular criterion for assessing weight is body mass index.When overweight, it ranges from 20 to 30. A BMI over 30 indicates obesity. But this method of diagnosis is not always objective. It is necessary to take into account gender, age, height, hereditary factor when determining the parameters. This is best handled by a nutritionist.

Obesity causes irreparable harm to the body. In the body, metabolic processes are disrupted, there is a threat of the development of diabetes mellitus. At the same time, the risk of developing a heart attack, hypertension increases, blood vessels are damaged, blood supply, including to the brain, deteriorates.The risk of stroke is increasing. Huge loads on the spine lead to osteochondrosis, arthritis, arthrosis. Sexual dysfunction or infertility sets in.

To solve the problem of excess weight or obesity, you must consult a doctor. He will help determine the source of the problem, suggest solutions, including medical ones. First of all, you need to start by changing your lifestyle. Low physical activity contributes to the accumulation of extra pounds not only on the waist, but also on the hips, abdomen and arms.You need to work out a training schedule for yourself, regularly perform the exercises suggested by the specialist. The second key point is food control. You need to understand how often and what exactly to eat. Monitor the calorie content of food, adjust the portion size. The diet should include vegetables, fruits, a sufficient amount of liquid. And the amount of sugar, salt, fatty foods and smoked meats eaten is better to reduce.

Last but not least, in pursuit of a beautiful figure you need to know when to stop.Excessive obsession with diets, dietary supplements and diet pills will only do harm. Uncontrolled fasting, little-studied substances will not help to reduce weight, but will also cause digestive disorders and other stomach problems. And this only worsens health. For a proper diet, you need to consult a dietitian. Diseases of the endocrine system will help control the endocrinologist. A qualified gastroenterologist will deal with stomach diseases. Only the solution of all problems in the complex will help the body to be healthy.

Latest News

90,000 Obesity – a non-communicable epidemic of the 21st century uMEDp

On December 14, 2006, within the framework of the V Moscow Assembly “Health of the Capital-2006” in the building of the Moscow Government on Novy Arbat, a satellite symposium of the “Abbot” company was held “The problem of overweight and obesity in modern medicine: simple questions and difficult decisions. View from the perspective of the patient and the specialist. ” The symposium was attended by the chief endocrinologist of the Department of Health of St.Moscow, chief physician of the endocrinological dispensary, MD, M.B. Antsiferov (“Overweight and obesity in modern medicine. State of the problem yesterday, today, tomorrow”), Head of the Department of Endocrinology and Diabetology, Moscow State University of Medicine and Dentistry, Doctor of Medical Sciences, Professor A.M. Mkrtumyan (“The essence of modern obesity therapy: solving aesthetic problems or the way to reduce mortality”), Professor, Peace of Mind Center for Psychotherapy (New York, USA)
A.G. Rapoport (“To understand is to help. The problem of excess weight through the eyes of a patient”).The symposium discussed topical issues of organizing a systemic fight against the obesity epidemic, issues of advanced training of doctors and their level of awareness of the severity of the disease and effective methods of its therapy.

M.B. Antsiferov MD, chief endocrinologist of the Moscow Department of Health, chief physician of the endocrinological dispensary

BUT.M. Mkrtumyan MD, DSc, Professor, Head of the Department of Endocrinology and Diabetology, MGMSU

A.G. Rapoport Professor at the Peace of Mind Center for Psychotherapy (New York, USA)

Obesity is characterized by WHO as a non-communicable epidemic of the 21st century: more than a billion people on the planet are overweight, and 300 million of them are obese. In the US, 61% of the population is overweight (obesity is observed in every third inhabitant), in the UK – 51%, in Germany – 50%.Studies in the United States have shown that obesity causes an estimated 300,000 deaths each year. In Russia, 54% of the population is overweight.

Obesity – the epidemic of our century

The problem of obesity has been known to us since ancient times, and I think it will concern humanity throughout the entire third millennium.

This is a very large-scale problem, so today we will try to clarify the question: what is this – an epidemic of a new infectious disease? If it is an epidemic, how widespread is it? And what can be effective ways to deal with it?

A quarter of the population of economically developed countries of the world have a body weight exceeding the norm by 15%.That is, they are more or less overweight or obese. Therefore, these two concepts appear. According to the WHO forecast, if the same rates of increase in overweight and obesity in the population continue, then by 2010 their number will increase by another 8% and will amount to 33% worldwide, that is, a third of the population will be overweight or obese. And by 2025, according to WHO expert estimates, there will be about 300 million people in the world diagnosed with obesity.

You need to pay attention to how the situation is gradually changing.Because in the last century, a problem in many countries, especially developing countries, was the lack of body weight. If we take the same countries now, then in many of them the percentage of overweight and obesity already reaches 40%, and the problem of underweight is not a problem for most countries now. However, there are countries in the world where in the first place is the problem of not overweight and obesity, but still underweight. These are countries such as Ethiopia, Senegal, Nicaragua, Haiti, in these countries this problem is really expressed.But you should pay attention to the fact that in most of all countries, 20-40% is still accounted for by the overweight and obese population.

Today we call obesity not only the epidemic of our century, but also the disease of the benefits of civilization. Because there are three main factors at work. This is an affordable and high-calorie food, a sedentary lifestyle and chronic emotional stress, depression. There is also a link between cardiovascular disease and obesity.Obesity is not just a cosmetic problem, it is not just a personal matter of every inhabitant of our country. This is, in general, a decrease in the potential of the nation of a separate state, this is a big medical problem. There are risk factors that contribute to the development of myocardial infarction. Among the factors that sharply contribute to the manifestation of myocardial infarction, there are diabetes mellitus, arterial hypertension, and visceral obesity.

When we look at the concept of obesity as a public health problem, we will see that it has undergone certain changes.In 1983, the UK stated that obesity is a major public health problem, comparable to smoking. And in 2001, according to the WHO, obesity was included in the top 10 reasons for the increase in mortality. That is, obesity was given priority in this direction.

And now about the scale of the obesity problem in Russia. According to expert estimates, in Russia the number of people with a body mass index is more than 27, and this is a cross between overweight and obesity, is about 50% of the adult population.However, according to our Ministry of Health, the number of patients from 1999 to 2003, those who are registered in medical institutions, increased 500 thousand to 660 thousand people, that is, there was an increase of almost 200 thousand people in 4 years.

Meridia – the first drug for weight loss

Obesity is a serious condition. The factors for the development of cardiovascular disease in obese patients are extremely high. The higher the body mass index, the higher both women and men have arterial hypertension.It has been proven that it is with excess weight that we have both an increase in cardiac output and an increase in the resistance of the vascular bed. The fate of obesity is too dramatic in terms of a therapeutic approach. Today we have a very short list of drugs. Let’s dwell on the drug Meridia – the only one on the pharmaceutical market in the world. The use of Meridia helps the patient to form the correct eating behavior and adjust the lifestyle in general. 87% of patients are able to adhere to the correct eating behavior developed during treatment.Meridia, as part of a comprehensive long-term weight loss program that includes dietary changes, lifestyle changes and increased physical activity, has proven to be highly effective in weight loss. The unique mechanism of action of Meridia fundamentally distinguishes it from other drugs: Meridia acts on the main cause of excess weight – overeating. The drug accelerates the feeling of fullness, thereby allowing you to reduce the amount of food consumed (by 19%) without stress, reduce the frequency of snacks and eliminate the need for evening meals.

Because of its properties, Meridia is the first weight loss drug now being investigated in SCOUT, a unique multicenter, long-term prospective study to assess the potential benefits of weight management for cardiovascular outcomes in high-risk overweight or obese patients. cardiovascular disease.

To understand is to help!

Psychotherapists and psychologists and, to a lesser extent, psychiatrists, at least people who deal with mental health, it is they who deal with the feelings of patients, with what the patient experiences, who is being treated in general, including who is being treated for overweight.In order to find out what a patient feels, special skills and knowledge are needed, and this is usually not the case with somatic doctors. It seems to me that this is the most important question. Motivation is the most important thing to work with. Because the patient must understand, firstly, how he needs to do what he has not done before. And most importantly, why should he do what he has not done before. And it is very good when the patient understands why the doctor needs it. I will draw a psychological profile of an obese patient.These are people who consider themselves outcasts, who are endowed with some specific psychological problems. At best, these are accentuated people, quite possibly having psychopathic and neurotic traits. All this is aggravated by the attitude towards these people on the part of their relatives, on the part of society, on the part of family and sexual partners, on the part of the whole world around them. They know this very well and come to somatic doctors wanting to get rid of their problem. And here it is very important for the patient to know what you think about how he is feeling.I know that patients experience a constant deficit in the desire of a doctor in general and a doctor who treats obesity. This problem seems to be recognized and even outlined ways to solve it, there are various drugs that, among the psychopharmacological actions, have a powerful behavioral factor that can affect the modification of eating behavior, practically without the patient’s efforts. Another problem is that people eat up stress, i.e. not only eat when they are hungry. And they are not seized by stress itself, but the consequences of stress.That is, these consequences of stress are manifested both in neurotization and in the deficit of love, care, and security. In this case, a person, more than ever, needs the specialist who deals with him to want to ask what the patient is missing. Maybe I can help you with something, can I replace your lack of love, lack of care, lack of security? Very often, the lack of safety is exacerbated when the patient suddenly finds that the doctor is completely uninterested in what is happening to the patient.