Method for correction of gynoid obesity

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used for the correction of gynoid obesity. That is ensured by typing an eating disorder to be psychologically corrected. A diet therapy is prescribed with a caloric value determined by reducing a patient's habitual daily average caloric requirement per a percent equal to the patient's body weight index. That is combined with a low-carbohydrate diet with the carbohydrate content reduced to 40-60 g/day for 2 weeks. That is followed by prescribing a low-fat diet with the fat content reduced to 40-60 g/day for 10 weeks with avoiding fast assimilated carbohydrates having a glycaemic index of more than 50. The diet therapy cycle is repeated. That is combined with graduated aerobic physical exercises with no weight and resistance for the muscle groups of the lower body. There are also performed muscle-strengthening load exercises for the muscle group of the upper body promoting muscle fatigue. Between and after the graduated physical exercises, there are performed prolonged aerobic physical loads at least 5 days a week for 40-60 minutes. That is combined with the drug-free procedures aiming at improving the regional blood flow, increasing gluteofemoral and lower extremities muscle tonus. The low-fat diet involves administering health aids from the group of intestinal membrane-bound alpha-glucosidase and pancreatic alpha-amylase inhibitors. The course of the obesity correction involves administering catechin-containing preparations or biologically active additives. From the second month from the beginning of the obesity correction, the patient's face is exposed to full-spectrum natural or artificial light at intensity of not less than 2,000 lux for 1-2 hours a day simultaneously or alternatively with the physical loads.

EFFECT: method provides the effective weight reduction in the patients with gynoid obesity with reducing side effects.

5 cl, 8 tbl, 2 ex

The method relates to medicine and can be used for the correction of excess body weight in the treatment of obesity.

Obesity is now considered as polietiologic chronically relapsing disease associated with the development of a number of diseases that can shorten life expectancy and reduce its quality (1, 2).

Overweight and obese are classified on the basis adopted by the who classification of body weight considering the magnitude of body mass index (BMI). The BMI figures within 25,0-29,9 kg/m²match overweight or predoziranje, 30-34 .9 kg/m²meet the I degree obesity, of 35.0-39.9 kg/m²- obesity grade II-40 kg/m²- third-degree obesity (1).

The topography of irouleguy allocate method of the type (gluteal-femoral, saphenous, peripheral, bottom type, pear-shaped) and abdominal (Android, visceral, Central, top, type, Apple shape) obesity (2). The ratio of occurrence method and abdominal type of obesity depends on sex and age. Women of the first period of Mature age (from 21 to 35 years), the ratio of 2.7:1, in the group of the second period of Mature age (36 to 55 years) is 1.3:1, in the group of the period of old age (56 years and above) of 0.2:1, respectively. Men Mature period against the same (from 36 to 55 years), the ratio of 0.25:1 (3, 4).

Attention professionals attracts mainly abdominal type of obesity, because it is an independent risk factor for cardiovascular disease, insulin resistance, diabetes type 2, atherosclerosis and other conditions that accelerate the aging process of the organism (5). In women, abdominal obesity is a common cause of anovulatory infertility and miscarriage (6).

Method type of obesity considered primarily from the standpoint of the solutions of cosmetic problems, because in the initial stages of the accumulation of excess weight of fat tissue expressed disturbances of carbohydrate and fat metabolism in women with this type of obesity are rare (7). However, with increasing degrees of obesity are beginning to be identified violations such as method of lipodystrophy, varicose changing the veins of the lower extremities, pathology of locomotor apparatus, but still dominate when the method of obesity, psycho-emotional disorders associated with dissatisfaction with their appearance (8).

Obesity method of the type identified on the basis of the relationship of the circumference waist to hip (ABOUT): when the value of this relationship less than $ 0,85 for women and 0.95 $ for men diagnosed with obesity method type.

Our previous studies (9, 10) revealed a number is institutsionalnyh, endocrine-metabolic and physiological features of the method type of obesity. Method type of obesity is characterized by an increase in subcutaneous fat mainly in gluteofemoral area, often a reduced level of energy exchange at rest, functional hyperinsulinemia, postprandial hypoglycemia on carbohydrate load, lack in the daily rhythm of hormonal regulation of carbohydrate metabolism phase of the evening physiological insulin resistance, the presence of severe stress response of the hypothalamic-pituitary-adrenocortical system on food deprivation and hypoglycemia. These features mainly cause emotional and compulsive types of eating disorders and the increase in the content of carbohydrates in the diet.

It is known that in the treatment of obesity using the following approaches: fasting, diet therapy, exercise (physical therapy), drug therapy, physiotherapy, psychotherapy, surgical methods of treatment. These methods can be used as monotherapy, or in combination (2, 8).

There is a method of modeling the figure in the conservative treatment of obesity (11). For modeling the figure in the conservative treatment of obesity massages, applying the principle of contrast in the effect on R is lichnye types of skin receptors. Optionally use the massage balls. This gradually massage the area of the inner surface of the thigh; the area of the back of the thigh; the areas along the length of the legs; the area of the calf muscle, gluteal region; the area of the paravertebral muscles of the back; the waist; the entire surface of the back; the scope of the broadest muscle of the back; the region of the anterior surface of the femur; the region of the anterior abdominal wall; at the same time the hips and belly; the area of the oblique muscles. The course is five to ten treatments twice a week. The disadvantage of this method is that this method only serves mainly to improve blood and lymph circulation in the areas exposed to massage, to expect a significant reduction of body weight reduction is not necessary, as there is no impact on the key mechanisms contributing to the accumulation of adipose tissue in the body, namely the processes of eating (diet therapy, psychotherapy - correction of eating behavior), as well as on the processes of energetic cost locomotor activity and therapeutic exercise. In addition, the inventive method is proposed to use "powerful, frequent sliding of hands nested in the palm of massage balls towards each other on the inner thigh...". Strong effect on subcutaneous fat in this area often leads which leads to her trauma and the formation of subcutaneous hematoma. Trauma to the skin and subcutaneous tissue may contribute to further proliferation of connective tissue in this area and aggravation of cellulite.

A known method of reducing overweight and correction, in which carry out the introduction of a microneedle with a rounded end to one of auricular points (APS), holding it under the skin, remove the other end from the other AT a record clip. Mitroglou leave points on 60-360 days. After the introduction and fixing of the microneedle in AT start of exposure on adipose depot. Effects include deep finger massage zone fat depots within 5-10 minutes After the end of the massage implement the introduction of the acupuncture needle into the fat zone. When this needle repeatedly rotate around its axis, is wound on her adipose tissue and sharp movement remove the needle. When a big degree of obesity can be entered triangular acupuncture needle. Similarly handle other areas of fat depot. The impact on these fat depots spend 10-60 days (12). Weaknesses of the proposed method is the lack of control over the process of eating, because the effect of microneedle into one of auricular points can be with a very wide range from a reduction of food intake by 5% to full refusal of food intake over the first period, that is fraught with complications. Furthermore, the method does not affect the processes of energetic cost. The next disadvantage of the proposed method is the impossibility of its realization in individuals with skin diseases, in addition, with a concomitant diabetes in a field of acupuncture needles into the subcutaneous fat may develop an inflammatory process.

The known method combined ultrasonic liposuction, which define the boundaries of the surgical field and the thickness of the removed adipose tissue and areas with cellulite, is carried out using an ultrasonic probe destruction of fat cells with simultaneous suction of the formed fatty detritus emulsified adipocytes from the zone liposuction through the holes of the channel of the ultrasonic probe; a bandage in the postoperative period is carried out with the use of antiseptic solutions and water-soluble ointments with simultaneous non-narcotic analgesics, sedatives and antibiotic therapy with broad-spectrum antibiotics within 4-7 days after surgery (13). The disadvantage of this method are, first of all, the risks of complications during and after surgery, namely the effect and tolerability of anesthesia, portability, analgetika is, antibacterial drugs; development of the inflammatory process and consequences of fibrosing process in subcutaneous adipose tissue. Such impacts aesthetic purposes in gluteofemoral (femoral-gluteal region) may contribute to the subsequent deposition of fat in other areas, such as the accumulation of intra adipose tissue, which will lead to the development of abdominal type of obesity. In addition, the subcutaneous fat gluteofemoral region is a place of transformation of sex steroids, in this regard, removing it may lead to an imbalance of sex hormones.

There is a method of treating obesity in emotional type eating disorders. When analyzing the history and surveys reveal eating disorders associated with emotional discomfort. Conduct psychotherapy sessions that focus on understanding the problems of the patient; form a positive active socially significant motivation for weight loss on dietprogram over an established period of time for the recommended number of pounds; psychotherapy sessions conducted by the suggestion by immersing the patient in a trance state, using neuro-linguistic programming. During the session the patient is offered a choice of at least three n is the most realistic for him the means of correcting emotional type eating disorders, when this technique is used to "anchor" neuro-linguistic programming with the formation of the indifferent, indifferent and calm attitude to food when stressed. For all persons assigned to the standard diet calorie at the initial stage in the 1000-1200 kcal/day (14). The disadvantage of this method is that it does not take into account the type of obesity, in particular features of the method of obesity type; forming diets do not take into account the severity of obesity. Psychotherapy is aimed primarily at changing the stereotype of eating behavior, not to change movement patterns, which reduces the efficiency of the method. It is known that in response to treatment, including limiting the inflow of energy substrates in the body develops a complex of compensatory-adaptive processes, which result in reducing the intensity of energy metabolism and development of food depression. When using this method does not use any methods (exercise, hydrotherapy, massage and others), activating the energy currency of the body, which may reduce the effectiveness of this method in the later stages of treatment.

Closest to the claimed method is the body weight of a person involving the use of fasting, low-calorie food,dosed physical load. The patient should be administered 3-4-day fasting without limiting fluid intake, use low-fat or fat-free products within one to two days following the release of hunger, then the daily consumption of low-calorie food 1000-1200 kcal/day to 12 to 14-th day from the beginning of the treatment; daily exposure to the patient by a person full spectrum of natural or artificial light with a light intensity of 2,000-2,500 Lux for 1-2 hours a day simultaneously or alternately with daily physical activity (15). This method is not effective when the method of obesity and leads to unwanted side effects. This is because it does not provide a specific correction of relative insulin resistance characteristic of the method of the type of obesity, and does not take into account the degree of obesity. Prescribed physical activity do not take into account the specifics of the distribution of fat in the method of obesity. In addition, starvation in addition to other side effects (decreased blood pressure, tachycardia) leads to a decrease in muscle tissue, which is the main site of lipid oxidation. Another disadvantage of this method is that the standard low-calorie diet 1000-1200 kcal/day poorly tolerated by patients with severe step is new and obesity often leads to the development of diet depression.

The problem to which the invention is directed, is to increase the efficiency of the treatment method of obesity, reduction of side effects. The solution of this problem is achieved by the fact that further define the type of eating disorders, exercise its physiological correction; calorie diet is determined by reducing the usual daily energy needs of a patient on a percentage, equal to the value of the body mass index of the patient; designate a low-carb diet with restriction of carbohydrates to 40-60 g/day duration 2 weeks, then low-fat diet with fat restriction up to 40-60 g/day for 10 weeks and simultaneous with the exception of receiving a fast utilizable carbohydrates with a glycemic index of more than 50; cycle therapy repeat; at the same time spend dosed physical load in aerobic mode without burdening and resistance to muscle groups the lower half of the body, perform strength exercises for muscle groups of the upper half of the body weight, causing fatigue of the muscles; in the breaks or after the end of the dosed physical activity spend prolonged physical activity at least 5 days a week lasting 40-60 minutes in aerobic mode; at the same time conducting non-pharmacological treatments aimed at improving the region the material flow, the increased tone of the muscles in the gluteal-femoral region and lower limbs; in the period of application of low-fat diets are prescribed medications belonging to the group of inhibitors of membrane-bound intestinal alpha-glucosidase and pancreatic alpha-amylase; for course correction of obesity prescribed drugs or dietary supplements that contain catechins; the impact on the patient side face full spectrum of natural or artificial light is conducted from the second month from the beginning of the correction of obesity, prolonged physical exertion exercise by walking on a treadmill or walking or training on a stationary bike; as a non-pharmacological treatments aimed at improving regional blood flow, increased tone muscles of the gluteal-femoral region, use manual or hardware massage, underwater shower-massage, then turpentine baths; as drugs or dietary supplements that contain catechins, used drugs, including green tea extract; as inhibitors of membrane-bound intestinal alpha-glucosidase and pancreatic alpha-amylase used drugs, containing acarbose.

Description of the invention

Treatment of obesity method type is as follows.

Conduct and tropamerica examination of the patient, including the measurement of the girth of the waist and hips (ABOUT) and calculation of the ratio of FROM ABOUT; determination of body mass (MT), growth, standing and calculation of body mass index (BMI) = weight(kg)/height (m)²(16). Method type of obesity set at a ratio of FROM ABOUT for men less than 0.95$, for women less than 0,85 $

Determine the type of eating disorders and exercise its physiological correction.

Determine individually the recommended calorie diet by reducing habitual daily energy needs of a patient on a percentage, equal to the value of the body mass index of the patient.

Treatment based on diet, beginning with the appointment of low-carb diets limit carbohydrates to 40-60 g/day and given individually recommended calorie diet lasting at least 2 weeks. Then designate the low-fat diet with fat restriction up to 40-60 g/day and simultaneous with the exception of receiving a fast utilizable carbohydrates with a glycemic index over 50 and considering individually the recommended calories for up to 10 weeks with fasting days at least 1 time in 2 weeks. The cycle then diet again.

At the same time spend dosed physical load in aerobic mode without burdening and resistance on the muscle groups of the lower half of the body for 20-30 repetitions of each exercise C is 2-3 sets. For muscle groups of the upper half of the body performed strength exercises for 8-10 reps 2-3 sets, with weights that cause fatigue of the muscles to the 8-10th repetition, with rest between sets. During breaks or after the end of the dosed physical activity in aerobic mode spend prolonged exercise in the aerobic mode (walking on a treadmill or walking or training on the bike) at least 5 days a week lasting 40-60 minutes

Starting from the second month of starting treatment phototherapy: within 10 days of each month have daily impact on the patient side face full spectrum of natural or artificial light with a light intensity of at least 2000 Lux for 1-2 hours a day simultaneously or alternately with physical exertion.

While conducting non-pharmacological treatments aimed at improving regional blood flow, increase muscle tone the gluteal-femoral region and lower extremities, including the course manual or hardware massage and underwater shower-massage, then taking turpentine baths.

During the application of low-fat diets are prescribed medications belonging to the group of inhibitors of membrane-bound intestinal alpha-glucosidase and pancreatic alpha-amyl is s, containing the active substance acarbose. Throughout the course correction of obesity prescribed drugs or dietary supplements that contain catechins.

Type eating disorders and assessment of its severity in points determined using the questionnaire DEBQ, including four independent form (2). For patients with method type of obesity is characterized mainly emotional, with its extreme manifestation in the form of compulsive types of eating disorders, rare externalities type eating disorders. The number of points in the questionnaire to detect clinically significant cases of eating disorders. For limiting values above which indicates the presence of a clinically significant eating disorders, take the following value in points: emotional - 2,03; compulsive - 2,60; externalities of 2.68; restrictive - 2,43 points (2). For patients with method type of obesity is characterized mainly emotional, less - externalities type eating disorders.

To determine the habitual daily energy needs of the patient for 3-5 days fills a food diary, which reflects the time and the number of accepted foods in grams (or standard portions or pieces). On the basis of these diaries assessing Pref is offered by the average daily energy requirements (SSEP) of the patient (in calories) the calculations are made using special programs or tables calorie food. Define the following parameters: frequency of food intake, the number of accepted food, the amount and percentage of the main food ingredients in each meal and total per day (proteins, fats, carbohydrates, calories). The calorie calculation is carried out, for example, by using computer programs "Rhyme calories" (16). From the above list of products, select the product or dish, which was accepted by the patient, in the column "number" enter the product weight in grams, and the program automatically calculates. STEP may also be calculated using the computer program "Solitonic" (17).

Psychophysiological correction type eating disorders is as follows.

When emotional type eating disorders relationship exists meal with endogenous physiological stimuli, failure to comply with the time interval between meals. Psychophysiological correction aimed at personal growth, increased self-esteem, enhancing motivation for treatment, normalization and maintenance of rational eating behavior. To control negative emotions and the ability to relax can be used biofeedback technique (18), in which data is m if necessary to synchronize the main physiological functions of the body. The use of psychophysiological approaches allows us to develop the patient's conscious and relaxed attitude to food in terms of emotional stress and other psychological edge States.

When emotional type eating disorders can be used, in particular, the method Gillian Riley (19)based on the reception called "Times". According to the reception after the end of the meal (a meal or snack) patient appoints a time for the next meal. In the end, it is necessary to wait till the appointed time without eating. For the beginning is recommended to assign a time interval from 1 to 4 hours. If the time interval is overcome, and the patient is not experiencing hunger, he has a choice: to eat and to assign the next meal or skip a meal and assign the next time.

In the first month spend 3-5 sessions of psycho-correction in the next 1 or 2 classes per month are performed only in the case if the patient noted a stop weight loss or at the patient's request.

When externalities type eating disordered teach classes in the framework of the "School for persons with obesity", aimed at creating incentives for healthy lifestyles, discuss the etiology of obesity, the formation of co about what Iranian somatic pathology, principles and approaches to therapy, the need for physical activity, medication and non-medication therapy. For externalities-type eating disorders characterized by the relationship of the meal not with endogenous physiological stimuli and external stimuli, such as type of food, food company, product advertisement, etc. When externalities type eating disorders can be used, for example, a method Gillian Riley (19)based on the reception called "Plans", which helps to keep the eating under control. Admission is based on the fact that the patient has learned to plan what he will eat, how much and how often. He must create this picture of the meal in mind before you start eating. You can start preparing for this approach in advance (a few days earlier), when the patient goes to the store for food shopping for the week. Important in the implementation of this approach is that the end of creating a "Plan" to the beginning of the meal.

For correction of combined eating disorders (emotional and externalities) are used simultaneously 2 methods: "Times" and "Plans".

Diet therapy is as follows.

At the beginning of treatment the patient should receive 3-5 meals a day low-carb diet based on individually recommended calories and limiting the receiving carbohydrates to 40-60 g/day for a period of 2 weeks.

An example of a diet with restriction of carbohydrates to 40-60 g/day

Breakfast 1: scrambled eggs, cheese, sausage, cheese, tea, coffee without sugar.

Breakfast 2: kefir.

Lunch: raw or steamed vegetables (cabbage, carrots, tomatoes, cucumbers, onions, green onions, parsley, lettuce, served with vegetable oil, meat or boiled chicken (or chicken, steamed), tea or coffee.

Afternoon snack: cheese or cottage cheese.

Dinner: fish or meat or chicken (boiled or fried); vegetable stew or vegetable salad; green tea.

Then the patient is prescribed a low-fat diet to suit individually recommended calorie and fat restriction up to 40-60 g/day for up to 10 weeks with fasting days at least 1 time per 1-2 weeks. Also exclude from the diet carbohydrates with a glycemic index of more than 50 (table 1).

In fasting day take monopis, for example, kefir - receive 1 liter of kefir a day or cottage cheese reception to 500 g of cottage cheese a day or Apple - receive up to 1 kg of apples per day on the choice of the patient.

Individually recommended calorie diet is determined by reducing the usual daily energy needs of the patient (SSAP) a percentage equal to the amount of body mass index of the patient (BMI). For example, SAP patient equal 2780 kcal/day and BMI of 34.8 kg/m². Individually recommended calories on the Yety = SEP OF 34.8% SAP, namely 2781-968=1812 kcal/day.

An example of a diet with restriction of fat up to 40-60 g/day

Breakfast 1: kasha (buckwheat, oats, barley), rye bread, tea, coffee, vegetable or fruit juices without added sugar.

Breakfast 2: the carrot or an Apple or a pear.

Lunch: soup vegetarian (vegetable broth); raw or steamed vegetables (cabbage, carrots, tomatoes, cucumbers, onions, green onions, parsley, lettuce, served with vegetable oil; boiled meat (or chicken, steamed); compote of dried fruits (without sugar).

Afternoon tea: 1-2 teaspoons of fruit and nut mixtures (e.g., prunes, dried apricots, raisins, walnuts, lemon, honey).

Dinner: fish, lean meat (boiled or steam) or soy products, vegetable stew or side dish of cereals (buckwheat, oats, barley); green tea. After completing the course of therapy, repeat it again.

Due to the difficulty of matching food and meals in the diet of the patient in strict accordance with individually recommended calorie possible deviation from its value to 100 kcal per day in the direction of increase or decrease.

Depending on the degree of obesity, the corresponding value of BMI (16), the patient determine the planned reduction of body weight within 6 months, which is, for example, 10% of baseline body weight, retaining and/or decreasing dostignutoi body mass over the next 6 months. For example, when the body weight of 85 kg (first degree of obesity BMI = 33,2 kg/m²), the target weight will be 76,5±1,0 kg

Upon completion of the course correction by the claimed method consolidating gains realized by the patient's transfer to low-calorie diet adjusted for the activity coefficient corresponding to the group work the patient (20).

Physical activity

Physical activity takes place simultaneously with a course of diet.

Spend dosed physical load in aerobic mode without burdening and resistance on the muscle groups of the lower half of the body for 20-30 repetitions of each exercise for 2-3 sets. For muscle groups of the upper half of the body performed strength exercises for 8-10 reps 2-3 sets, with weights that cause fatigue of the muscles by the 10th repetition, with rest between sets.

During breaks or after the end of the dosed physical activity in aerobic mode spend prolonged exercise in the aerobic mode for at least 5 days a week lasting 40-60 minutes (walking on a treadmill or walking or training on the exercise bike and other) without acceleration. The course duration is 6 months.

Individuals new to exercise, start classes (2-3 weeks) is conducted at a safe level of light and medium the th power, with a gradual increase of stress during training. Control of heart rate. If the threshold value that is determined by the known methods, for example, according to (21) or table 2, physical activity ceased. Pulse recovery to baseline within 10-20 minutes after practice is an indicator of safety for the student. A sign of the effectiveness of practice and the coming of fitness and adequacy of physical activity, is the gradual decrease in heart rate at rest. Physical activity bring a sense of "muscle of joy", which is important for persons with overweight due to the switching of the dominant pleasure and joy derived from food on the positive emotions that arise from physical exertion.

After completion of the course correction of obesity method of the type stated in the way patients are recommended to support physical activity through walking and/or walking on a treadmill, and/or Biking, and/or training on a stationary bike and/or swim in the pool, and/or water aerobics. Locomotor activity is most convenient to evaluate the steps. The optimal mode - 7500-12000 steps a day.

Non-drug effects of

Conducting manual or massage apparatus, for example, using a special muscle stimulator, gluteofemoral region (buttocks, hips) Orientation procedures improving lymphatic drainage. Myostimulation as a method of influence on the muscles weak pulse discharge current, resulting in muscle contraction, increases local blood flow and lymph drainage, which leads to the restoration of metabolic processes, reduce swelling, eliminate stagnation in the subcutaneous fat. Massage apparatus using the muscle stimulator is carried out with a signal frequency of 450 Hz. Duration of the procedure is 20-40 minutes, a course of 10-15 treatments after 1 day.

Underwater shower-massage is carried out at a temperature of bath water 36-37°C, the temperature massaging jets - 40-50°C, the pressure - 1-4 ATM (100-300 kPa). Duration of the procedure is 15-30 minutes, a course of 10-15 treatments after 1 day.

1 month after completing the course, underwater shower-massage appoint turpentine baths, which can activate the sympathetic system, metabolic processes, improve peripheral circulation, increase regional venous outflow. The finished emulsion is added to water in amount of 35 ml of emulsion 200 sauna water. Gradually adding 5 ml of the emulsion (maximum 60 ml). Water temperature 36-37°C, duration of treatment 10 min, the rate of 8-12 treatments 1-2 days.

Phototherapy spend every month for 10 days, starting from the second month of starting treatment during the whole subsequent course Leche is ment to achieve the target body weight (especially in the winter time). Exercise effects on the patient side face full spectrum natural light or artificial light intensity 2000-2500 Lux within 1-2 hours a day simultaneously or alternately with daily dosed physical activity. If the patient performs daily walk in the day time duration not less than 60 minutes, exposure to full spectrum light artificial origin is not required.

Medication effects

During the period of application of the low-fat diet according to the claimed method to eliminate relative hyperinsulinemia on carb intake and reduced absorption of carbohydrates from the gastrointestinal tract using drugs belonging to the group of inhibitors of pancreatic alpha-amylase and membrane-bound intestinal alpha-glucosidase containing the active substance acarbose, for example "Glucobay". Inactivated enzymes are thus lose the ability to break down complex carbohydrates to monosaccharides. It reduces the formation and absorption of glucose in the intestine, decreasing postprandial hyperglycemia, daily fluctuations in blood glucose. While these drugs do not increase incretia insulin and does not cause hypoglycemia.

These drugs are taken orally, at the beginning of the meal; in the dose of 50 mg times a day. Increasing doses of 100-200 mg 3 times a day is from 4-8 week intervals based on two criteria - the level of glucose in the blood after 1 hour after a meal and individual tolerability.

During the course of the correction of obesity method of the type prescribed drugs or biologically active food supplements containing catechins selected from the group comprising the extract of green tea, such as Green tea extract ECCO PLUS 2 tablets 3 times a day or Vader Super Nova Cape", 1 capsule 3 times a day. Duration 1 month, then 1 month break, and repeat 3 course within 6 months. Catechins are substances from the group of flavonoids. They have antioxidant properties, and can also increase insulin sensitivity, reduce oxidative stress, stimulate the metabolism, which contributes to the normalization of carbohydrate and fat metabolism.

Examples of specific performance

Example 1.

A patient, 36 years of age, body weight at admission 88,2 kg, height 167 cm, waist circumference (FROM) - 85 cm, hip (ABOUT) - 119 see complaints of shortness of breath during physical exertion, increased sweating, fatigue, dissatisfaction with their appearance, increased irritability, unreasonable anxiety, which is removed by eating mostly carbohydrate (candy, p is Chenier, baked). Previous attempts at weight loss through starvation and strict low-calorie diet (1000 kcal/day) was ineffective.

The patient was given a comprehensive physical examination. On the basis of anthropometric parameters was calculated body mass index equal to 32,6 kg/m Ratio FROM ABOUT amounted to $ 0,75 Diagnosis at admission: primary obesity 1 degree, by method type, relapsing course. Comorbidities: neurocirculatory dystonia of mixed type.

According to the results of the survey by questionnaire DEBQ were determined boundary values on scales amounted to emotional eating disorders - 2.46 points, compulsive - 2,8; externalities - 1,6; restrictive - 1.2 points, respectively. Thus, the patient revealed emotional type of eating disorders with its extreme expression in the form of compulsive eating disorders.

Physiological correction of eating disorders. The results of the survey were discussed with the patient, in the framework of the "School for persons with obesity", in this course, we discussed the causes of weight gain, failure of previous attempts at weight loss and relapse rates of weight gain were discussed consequences of obesity and other

On the basis of an the of mnase, assessment of diet data of the survey by questionnaire DEBQ the patient, it was determined that the primary cause of weight gain was eating in stressful situations. In this regard, to control negative emotions, increase stress tolerance and ability to recover used the technique of biofeedback (BFB). Biofeedback training allows you to record achieved change through voluntary self-regulation, with the main objective to use the skills and techniques of biofeedback for the control of eating behavior. Classes are conducted using complex biofeedback LAB".

For the correction of emotional eating disorders they used the technique of "Times."

During stationary phase was conducted 3 psychotherapy sessions and 4 classes on complex biofeedback LAB. At the outpatient stage support sessions were conducted with a frequency of 1 session every 2 weeks for 6 months.

Diet therapy.

The estimation of daily energy needs (SSAP) patient A. presented in table 3. It was shown that the patient consumes a high amount of calories. The daily need of the patient with regard to group work (group work (I) in the norm should be 2288 kcal/day. Thus, caloric surplus amounted 2712-2288=424 kcal/day. Among the consumed nutrients, vitanyi prevailed fast carbohydrates, which is largely associated with emotional type of eating behavior.

On the basis of the received SAP evaluated individually recommended calorie diet = 2712-884(BMI of 32.6%)=1827 kcal.

The patient was assigned to a low-carb diet according to the claimed method in two weeks. Sample diets are shown in table 4. Then the patient was switched to low-fat (40-60 g/day of fat) diet with calorie 1827 kcal per day for 10 weeks. Sample diets low-fat diets are presented in table 5.

Physical activity

To increase levels of physical activity were assigned daily prolonged exercise in the aerobic mode: walking on a treadmill moderate intensity (speed of 4-5 km/h, heart rate 100-115 BPM), or exercise on a stationary bike (HR-100-110 beats/min) optional depending on the condition of the patient on the day of the course duration 40 minutes daily or Hiking in the daytime duration 40-60 minutes. Dosed physical load in aerobic mode duration 20-30 min were conducted according to the claimed method in the premises or while walking.

Non-pharmacological methods of correction

At stationary phase, conducted manual massage gluteofemoral region - 10 procedures, as well as underwater shower-massage 10 procedures cher the C day; one month after the end of the last was assigned to the course turpentine baths. Starting from the second month of treatment, monthly patient took place over 10 days 1.5 to 2-hour sessions of phototherapy by impact on the patient side face full spectrum artificial light, as described above. To the effects of natural light equated Hiking outdoors in the day time duration not less than 60 minutes.

Medical therapy. As preparations containing acarbose, the patient was assigned to Glucobay" 50 mg 3 times a day while on a low-fat diet. As preparations containing catechins, was appointed "Green tea extract ECCO PLUS 1 tablet 3 times a day for months, then 1 month break with two repetitions of the course within 6 months.

After 3 months from start of treatment, the weight loss was 6.8 kg, 6 months - 9.3 kg and amounted to 78.9% kg After 6 months from the start of treatment, body weight decreased by 9.3 kg and amounted to 78.9% kg, BMI = 28,2 kg/m²that corresponds to the stage of predoziranje FROM - 82 cm - 112 cm, FROM/ABOUT = $ 0,73 Not been observed eating disorders. During the implementation of the claimed method is not identified side effects. It is allowed to transfer the patient from the category of "obesity 1 degree in the category "predomina".

In R. the result of the implementation of the recommendations after completion of the course correction of obesity in the claimed method, the patient continued to follow a diet, to perform physical activity in the form of walks and morning gymnastics, which contributed to a further reduction of body weight. A year later, the body weight decreased to 75 kg, the value of BMI decreased to 26.9, - 81 cm, ABOUT - 109, FROM/ABOUT - $ 0,74 Thus, the trend toward weight reduction.

Example 2.

Patient C., 42 years old, body weight at admission 107 kg, height 167 cm, waist circumference (FROM) - 102 cm, hip (ABOUT) - 128 see Complaints about headaches, irritability, anxiety, shortness of breath when walking fast, dissatisfaction with their appearance. The patient is not the first time resorted to trying to reduce body weight, previous attempts were initially led to weight loss, but after weight again returned to the original and even exceeded it.

Conducted physical examination. On the basis of anthropometric parameters were calculated body mass index, characterizing the severity of obesity, which totaled 38.4 kg/m²and the ratio of FROM ABOUT characterizing the type of obesity, which amounted to 0.8 cu Diagnosis at admission: primary obesity 2 degrees, by method type, slowly progressive course with relapses of weight gain. Comorbidities: chronic cholecystoenteric in remission.

According to the results of the survey by questionnaire DEBQ were determined grayskiesraena, which scales amounted to emotional eating disorders - 2.2 points, compulsive - 1,5; externalities - 2,8; restrictive - 2.6 points, respectively. Thus, the patient revealed a combined type of eating disorders, including emotional, externalities and restrictive eating disorders.

On the basis of anamnesis, evaluation of diet data of the survey by questionnaire DEBQ the patient C. it was determined that the primary cause of weight gain was overeating, due to both emotional reaction to stress and external stimuli, such as type of food, the delicious smell. This guilt after episodes of "food drunkenness" provoked episodes of rejection of the meal or the patient themselves provoked vomiting.

Physiological correction of eating disorders

In the classroom within the framework of the "School for obese persons" with the patient conducted classes of rational psychotherapy in which the following issues were discussed: balanced nutrition and diet therapy, physical activity and adequate amount of physical activity, the relationship of obesity with chronic non-communicable diseases, as well as exercises to increase the level of motivation for weight loss.

For correction of combined violations of the food bearing the Oia (emotional and external) used 2 methods "Times" and "Plans". According to the technique of "Time" after the end of the meal the patient appoints a time for the next meal. In the end, it is necessary to wait till the appointed time without eating. For the beginning is recommended to assign a time interval from 1 to 4 hours. If the time interval is overcome, and the patient is not experiencing hunger, he has a choice: to eat and to assign the next meal or skip a meal and assign the following time. According to the technique of "Plans" - the patient is taught to plan what she will eat, how much and how often. Offered to the patient to provide a picture of the meal in mind before you start eating. Pay attention to what is important in the implementation of this approach is that the end of creating a "Plan" to the beginning of the meal.

During the period of inpatient treatment was conducted 5 sessions of psycho-correction in the subsequent 1 lesson a month before reaching 6 months. since the beginning of the correction of obesity in the claimed method.

Diet therapy

The estimation of daily energy needs (SSAP) patient C. are presented in table 6. It was shown that the patient consumes a high amount of calories, namely 2675 kcal/day. So, if the daily needs of the patient with regard to group work (group work 2) in the norm should be 249 kcal/day, the caloric surplus amounted 2675-2498=179 kcal/day. Among of nutrients consumed in the diet on carbohydrates and fats accounted for 45% and 43% of the total calorie food, respectively.

On the basis of the received SAP was calculated individually recommended calorie diet = 2675-1027(BMI-38,4%)=1648 kcal. The approximate ration corresponding to a low-carb diet, taking into account individually recommended caloric content are shown in table 7. After 2 weeks of starting treatment, the patient was switched to low-fat (50±10 g fat) diet to suit individually recommended calorie diet for 10 weeks. An example of low-fat diets are presented in table 8.

Physical activity

Dosed physical load were carried out in the form of morning gymnastics duration 20-30 min, as described above, with emphasis on the muscle groups of the lower body without the use of weights and resistance. For muscle groups of the upper half of the body were included strength training with weights. To increase levels of physical activity were assigned daily prolonged physical activity - walking on a treadmill aerobic moderate intensity (speed of 3.5-4 km/h, heart rate 95-110 BPM) duration of 40 minutes daily or Hiking outdoors in the day time duration 40-60 minutes (optional).</>

Non-pharmacological methods of correction

At stationary phase, carried out the course of manual massage, alternating with the myostimulation gluteofemoral region, the rate of underwater shower-massage, 1 month after the last course turpentine baths.

Starting from the second month of treatment, monthly during the 10 days were 1.5 to 2-hour sessions of phototherapy by impact on the patient side face full spectrum artificial light, as described above. To the effects of natural light equated Hiking outdoors in the day time duration not less than 60 minutes.

Drug therapy

As preparations containing acarbose, the patient was prescribed Glucobay" 50 mg 3 times a day for 2 months while on a low-fat diet; for course correction of obesity as a preparation containing catechins, applied BAA "Vader Super Nova Cape" 1 tablet 3 times a day for months, then 1 month break and repeat, only 3 of the course within 6 months.

For the first 3 months from start of treatment, the weight loss was 7.4 kg after 6 months and 10.3 kg, and body mass were 96.7 kg BMI=34,6 kg/m²that corresponds to 1 degree of obesity, 95 cm, and 120 cm, FROM/ABOUT = 0,79 $ Not observed signs of eating disorders. During the realization of the purpose of the claimed method is not identified side effects. This allowed to conclude that the reduction in severity of obesity method type. In the implementation of the recommendations made after the end of the course correction of obesity in the claimed method, the patient complied with the recommendations on diet, physical activity in the form of walks and morning gymnastics, which contributed to a further reduction of body weight. A year later the body weight reached 92,5 kg, BMI = 33,2, which corresponds to the obesity of 1 degree, 90 cm, ABOUT - 115, FROM/ABOUT - 0,78 $

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Treatment of obesity method type

1. The correction method of the method of obesity, including diet therapy, the impact on the patient side face full spectrum of natural or artificial light with a light intensity of at least 2000 Lux for 1-2 hours a day simultaneously or alternately with physical activity, characterized in that it further determine the type of eating disorders, exercise its physiological correction; calorie diet is determined by reducing the usual daily energy needs of a patient on a percentage, equal to the value of the body mass index of the patient; designate a low-carb diet with restriction of carbohydrates to 40-60 g/day duration 2 weeks, then low-fat diet with fat restriction up to 40-60 g/day for 10 weeks and simultaneous with the exception of receiving a fast utilizable carbohydrates with a glycemic index of more than 50; cycle therapy repeat; at the same time spend dosed physical load in aerobic is egime without burdening and resistance on the muscle groups of the lower half of the body, conduct strength exercises for muscle groups of the upper half of the body weight, causing fatigue of the muscles; in the breaks or after the end of the dosed physical activity spend prolonged physical activity at least 5 days a week lasting 40-60 minutes in aerobic mode; at the same time conducting non-pharmacological treatments aimed at improving regional blood flow, increase muscle tone the gluteal-femoral region and lower limbs; in the period of application of low-fat diets are prescribed medications belonging to the group of inhibitors of membrane-bound intestinal alpha-glucosidase and pancreatic alpha-amylase; for course correction of obesity prescribed drugs or dietary supplements that contain catechins; the impact on the patient side face full spectrum of natural or artificial light is conducted from the second month from the beginning of the correction of obesity.

2. The method according to claim 1, characterized in that prolonged physical activity exercise by walking on a treadmill, or walking, or training on a stationary bike.

3. The method according to claim 1, characterized in that as a non-pharmacological treatments aimed at improving regional blood flow, increase muscle tone the gluteal-femoral region, applied R is the offered hardware or massage in gluteofemoral region, underwater shower-massage, then turpentine baths.

4. The method according to claim 1, characterized in that the quality of drugs, or dietary supplements containing catechins, used drugs, including green tea extract.

5. The method according to claim 1, characterized in that as inhibitors of membrane-bound intestinal alpha-glucosidase and pancreatic alpha-amylase used drugs, containing acarbose.