RU2264232C2 - Method of treating obesity in case of external type of eating behavior disorder - Google Patents

Abstract

FIELD: psychotherapeutical methods.

SUBSTANCE: method can be used for correcting weight of the human body. When analyzing anamnesis and performing questioning, disorders of eating behavior associated with strengthened response to external stimuli are revealed: a kind of food, advertising of foodstuff, and kind of the person accepting food. When disorders are revealed, rational psychotherapy is performed in order to make patient realize the problem. Active positive emotional and voluntary motivation to achieve final effect is formed, namely decrease of the weight by predetermined number of kilos over a given period of time. Principal representative information perception system (visual, aural, kinesthetic) in patient is determined. Thereafter, formula of change in eating behavior stereotype in waking state is composed in order to normalize eating behavior. Patient is then immersed into trans state and first session of indirectly imposed suggestions is carried out involving repetition of composed formula comprising categories of visual objects, aural impressions, and tactile sensation. 50% of the session time is devoted to principal representative information perception system and other 50% to secondary representative systems. In the second session, patient is immersed into trans state and suggestion of stimulation of early satiation to prevent overeating is performed. Treatment course comprises 3-4 sessions carried out with 3-5-day intervals and additional supporting treatment over a 3-month period including 1 session weekly repeating the first session. Method allows achievement of stable decrease of the weight for a long period of time by way of forming new rational eating behavior stereotype depending on type of eating behavior disorder. Effect is further enhanced owing to use of categories of predominantly representative information perception system in patient.

EFFECT: enhanced weight loss efficiency.

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Description

The invention relates to medicine, and can be used in the correction of human body weight.

In recent decades, the problem of obesity and overweight has become increasingly important both throughout the world and in Russia. Population studies conducted in a number of countries showed that the number of overweight people is 25-30% (Bunina E.M., Voznesenskaya T.G., Korosteleva I.S. Treatment of primary obesity with prolonged dosed fasting in combination with psychotherapy // Journal of Neurology and Psychiatry, No. 12, 2001. - P.37-42).

Any accumulation of fat in the body occurs due to the predominance of energy over its consumption (positive energy balance), i.e. obesity can always be seen as the result of overeating, and therefore it can be called alimentary regardless of whether obesity is primary or secondary.

The modern treatment of nutritional obesity is based on the recognition of the chronic nature of obesity and, therefore, the need for long-term treatment. The desire to get rid of a large number of kilograms in a short time leads to a compensatory increase in food intake and repeated weight gain (the so-called "rebound syndrome" or described by Dr. Brownell as "oh-oh"). Accordingly, reducing weight by 5 - 10 kg over 4-6 months and maintaining this result over the long term is more effective than losing 15 kg in a short time and acquiring 20 kg (Butrova S.A., Bad A.A. Treatment Obesity: Modern Aspects. - Russian Medical Journal, Volume 9, No. 24, 2001. - P.140-146).

There is a method of complex treatment of obesity, including multi-stage complex treatment using at each stage of diet therapy, physical therapy, drug therapy, physiotherapy, psychotherapy (Kreslavsky E.S. Psychotherapy in the rehabilitation system of patients with the alimentary-constitutional form of obesity. Ter. Archive, 1984, t .56, No. 10, pp. 104-107).

Such tactics of psychotherapy in the treatment of obesity, as experience in practical work shows, are ineffective, because patients need a long-term mobilization of emotional-volitional efforts, and most of the patients are not able to adhere to food restrictions and increase motor activity over a long period of time.

Also known is a method of reducing body weight using an autogenic training (Lindemann X. Autogenic training. M: Medicine, 1985. - S.325). Autogenic training is self-hypnosis in a state of relaxation (lower stage) or hypnotic trance (higher stage).

However, the method has the disadvantages of any autogenic training used in isolation without other psychotherapeutic techniques and diet therapy.

There is a method of weight correction using suggestions of suggestion in the wakeful state and an altered level of consciousness with the formation of negative emotions ("nausea") to abuse food with high energy value (RF patent No.2019996, M. class 5 A 61 M 21/00. Bull. No. 18, 1994).

However, a single session of psychotherapy is far from always able to create a strong installation on rational nutritional behavior of a person.

There is a method of treating nutritional obesity, in which, using the methods of psychotherapy, they form a psychological setting for rejecting excess food, reinforce the setting with irritation of acupuncture points, calculate a weight loss program for a given period of time and combine this program with taking and immersion in a light trance state (RF patent No. 2056116 , M. CL 6 A 61 M 21/00; A 61 K 31/485. Bull. No. 8, 1996).

This method is able to reduce weight only for a short period of time and does not contribute to the consolidation of new eating behavior for a longer period.

There is a method of treating obesity by affecting the human body in the sensor and subsensory modes, by listening to specially composed texts of night auto-suggestions, and watching video material with the effect of 13 frames, in which special commands, texts, symbols or images are mounted (RF patent No. 20011132011/14, M. CL 7 A 61 M 21/00, Bull. No. 21, 2003).

However, the method has the disadvantages of any method of psychotherapy without taking into account the diet and the type of eating behavior.

Also known is a method of treating obesity, including an anamnesis analysis, rational psychotherapy, suggestive action in a state of hypnotic trance, coding for a specified period of time (application for an invention of the Russian Federation No. 20011132298/14, Mcl 7A 61 M 21/00. Bull. No. 21 , 2003).

However, psychotherapy sessions without taking into account the diet and the type of eating behavior are far from always able to create a strong installation on rational human nutritional behavior.

As a prototype, we took a method of treating obesity, in which, at the stage of rational therapy, the achievement of the effect is associated with individual optimization of weight due to overregulation of self-regulating systems of the food center. In a state of meditation, they carry out direct and indirect suggestive effects and form an active, positive emotional-volitional motivation for the implementation of the diet program. Rebuild and subordinate the motivation scheme to socially significant motivations. They limit the amount of food, exclude high-calorie foods for 2-3 months (RF patent No. 2153362, M. cl. 7A 61 M 21/00. Bull. No. 21, 2000).

However, these psychotherapeutic techniques can reduce weight only for a short period of time and does not contribute to the consolidation of new eating behavior for a longer period. In addition, as a result of the work of a psychotherapist, the recommended amount of kilograms is not taken into account, by which it is necessary to reduce weight without harm to health and exclude the possibility of weight gain in the future.

The objective of the present invention is to achieve persistent weight loss over a long period by forming a new rational stereotype of eating behavior depending on the type of eating disorder and enhancing the impact through suggestion using categories of a predominantly representative patient information perception system.

The task is achieved by conducting an anamnesis analysis, questionnaires, diet therapy and rational psychotherapy for weight loss without impaired health. When analyzing the anamnesis and by means of questionnaires, a type of eating disorder is revealed, and when an external type of eating disorder is identified, rational psychotherapy is carried out to recognize the problem by the patient, they form an active positive emotional-volitional motivation to achieve the ultimate goal - weight loss according to a certain program for a given period of time by recommended amount of kilograms. The main representative system for perceiving information by a patient is determined: visual, or auditory, or kinesthetic. In the waking state, they formulate a formula for changing the eating behavioral stereotype, aimed at normalizing eating behavior. After that, the patient is immersed in a trance state and the first session of indirect suggestions is carried out, repeating the formula using categories of visual images, auditory impressions, feelings, and 50% of the session time is spent using categories related to the main representative system and 50% of the session time divide equally between the categories of non-basic representative systems of perception of information. At the second session, the patient is immersed in a trance state and an induction session of stimulation of early saturation is conducted to prevent overeating. Treatment is carried out with a course of 3-4 sessions. Sessions are carried out after 3-5 days, repeated maintenance treatment 1 session per week for 3 months, repeating the first session. Prescribe a low-calorie diet with a reduced calorie content of 1000 kcal in the first month, 1200 kcal in the second month, followed by bringing it to a value that corresponds to the normal needs of the body.

The novelty of the method.

- In the analysis of the anamnesis and by means of questionnaires, a type of eating disorder is revealed, because the existing disorders are fixed in the form of certain neurophysiological stereotypes, accompanied by non-chemical disorders.

- When identifying an external type of eating disorder, rational psychotherapy is carried out to recognize the problem by the patient, they form an active positive emotional and volitional motivation to achieve the ultimate goal - weight loss according to a specific program for a given period of time by the recommended number of kilograms.

- Determine the main representative system of perception of information by the patient visual, or auditory, or kinesthetic.

- Compile in the awake state the formula for changing the eating behavioral stereotype, aimed at normalizing eating behavior.

- Immerse the patient in a trance state and conduct the first session of indirect suggestions, repeating the compiled formula using categories of visual images, auditory impressions, through sensations.

- 50% of the session time is spent using categories related to the main representative system, and 50% of the session time is divided equally between the categories of non-basic representative information perception systems.

- The second session is carried out in a trance state and dedicate stimulation of early saturation to prevent overeating.

- Treatment is carried out with a course of 3-4 sessions after 3-5 days, repeated maintenance treatment 1 session per week for 3 months, repeating the first session.

- Prescribe a low-calorie diet with a reduced calorie content of 1000 kcal in the first month, 1200 kcal in the second month, followed by bringing it to a value that corresponds to the normal needs of the body.

Existing algorithms for the treatment of obesity (diet therapy, physiotherapy, physical activity) without taking into account psychological aspects are not effective enough, since they do not provide as the main target setting - the formation of a rational psychological type of eating behavior that is adequate to the real needs. Neither a decrease in the volume and calorie content of food consumed, nor motor activity alone can provide a positive treatment result. Only an integrated approach combining psychotherapy and diet therapy is a reliable way with which you can fix the patient's proper eating behavior. Therefore, in the practice of treating obesity, various methods of psychotherapy are increasingly used. The use of indirect suggestions in psychotherapy, taking into account the identified main representative system, allows you to increase the effectiveness of the impact and increase the duration of the positive result.

The method is as follows:

When a patient complains of excess weight, an anamnesis is analyzed, a diagnosis of the type of eating behavior (by questioning) is made, the reason that caused obesity is found out. After this, cerebral and endocrine forms of obesity are excluded.

Based on the analysis of the medical history and questionnaire, the type of eating behavior (PP) is identified.

There are 3 types of eating disorders known: external type;

emotiogenic type, it includes compulsive eating disorder and night eating syndrome; and restrictive type.

External type (ETPP). External eating behavior is manifested by an increased reaction not to internal, homeostatic stimuli for eating (the level of glucose and free fatty acids in the blood, gastric motility, etc.), but to external stimuli, such as food type, food advertisement, person type eating, etc. It is this feature that underlies overeating for company and snacking on the street.

A person with external eating behavior takes food in all cases when he sees it, when it is available to him. The basis of an increased response to external stimuli of food intake is not so much an increased appetite as a decreased satiety.

With the predominance of this type of PP, a person begins to eat, regardless of the feeling of hunger, on when, in what quantity and how many times he ate. Therefore, for the treatment of these disorders, exposure comes first in a representative system of information perception.

The first stage of treatment is rational psychotherapy to understand the problem of the patient. During the initial conversation with the doctor, a psychotherapist and a nutritionist, a confidential contact is established at the conscious and subconscious levels. This is done with the help of questions aimed at assessing the patient’s perceptions of his condition: “What is obesity, overweight? What are the effects of obesity? How to deal with it? Are you overweight? Why do you want to lose weight? Do you have weight loss experience, which one? How did you feel at that moment? How fast and how much do you want to lose weight? Will you buy new things or alter old ones? Is this real? In what parts of the body do you want to lose weight, why? And what will you do to lose weight? You will lose weight, but your skin will remain elastic, without wrinkles?

After this, a nutritionist clarifies the real problems of malnutrition. The calculation of the patient’s body mass index is carried out according to the formula: Body mass index = weight (in kg) / height ² (in cm). Based on the indicators of body mass index, the patient achieves a really achievable result: how many kilograms and for how long it is necessary to reduce weight, since the desire to get rid of a large number of kilograms in a short time leads to a compensatory increase in food intake and repeated weight gain (the so-called “rebound syndrome” ") And may cause health problems. At the same time, they form an active positive emotional-volitional motivation to achieve the ultimate goal.

At the second stage, the identification of socially significant motivations for weight loss follows. Trying to lose weight, in fact for weight loss, is doomed to failure. Success awaits only those for whom a slim figure is not a goal, but a means to improve not only their health, but also solve some equally important life problems (see your grandchildren and great-grandchildren, look attractive, climb stairs without difficulty, like men )

The method involves the following stages of the psychotherapist's work with the patient. The patient is located in a chair, he is offered to take a comfortable posture, after which the psychotherapeutic session begins.

The patient sets out the recommended result: how many kilograms and for how long he will lose weight without compromising health. At the same time, the doctor determines the main representative system for the perception of information by the patient (this is the system by which the person receives and processes information from the outside world), compiles a formula for changing the eating behavioral stereotype taking into account the terms of the main representative system, monitors the external manifestations of the patient’s emotional reactions and changes physiological parameters: autonomic reactions, eye movements, intonation, pace, speech volume, non-verbal (wordless) behavior denia - facial expressions, pantomimics.

The first step for a better understanding and awareness of the problem is the patient is told about the types of eating disorders and the external type is clarified by the following questions: the time of eating, the amount of food eaten (in everyday measures: a piece, soup ladle, spoon, etc.), what exactly he ate, the main thing is why he ate: hunger, appetite, it was time for food, for company, I myself don’t know why, mechanically, for the future, to calm down, to relieve aggression or internal stress, to please myself, I see food and eat, at home, alone, with family, with friend, at work, on the street ie, on the move, in the restaurant, cafe, etc. Then, information is given that the basis for an increased response to external stimuli of food intake is not so much increased appetite as reduced satiety. Satiety (satiety) is the lack of desire to eat caused by eating. In fact, it is the opposite of a feeling of appetite and hunger. Saturation is more than the disappearance of hunger. It is accompanied by a feeling of pleasure and a feeling of fullness of the stomach. There are two types of saturation - early, or complete (before absorption and assimilation of food), and later, or complete (after assimilation of eaten food). Cessation of food at early saturation is an ideal physiological moment of nutrition.

Knowing this mechanism of nutrition regulation, it is possible to recommend to a patient with an external type of eating behavior to strengthen the stimulation of early satiety to prevent overeating:

1) to eat in a pleasant environment, slowly, chewing food thoroughly;

2) without distraction during meals for talking, watching TV shows and other moments that inhibit the process of normal saturation;

3) the table should be well served, the food is pleasant in appearance, fragrant;

4) it is recommended to dine with your favorite and calm music.

All this ensures the emergence of timely, early satiety, and normalizes appetite in accordance with the true energy needs of the body.

Full saturation occurs with increasing levels of nutrients in the blood, such as glucose, that is, after the assimilation of a significant part of the food eaten. Overeating and excess weight are inevitable in the event of a regular cessation of food exclusively at the stage of full saturation.

In the regulation of hunger and satiety, the work of the brain is of great importance. In several parts of the brain, there are complex structures responsible for regulating appetite. First of all, these are the centers of hunger and satiety in the sub-hill regions (hypothalamus) and the corresponding formations in the limbic system and the cerebral cortex.

Then the psychotherapist suggests that the patient in an awake state formulate a formula for changing the eating behavioral stereotype, aimed at normalizing eating behavior.

Table 1 Formula for Nutritional Behavioral Stereotype (PPP) Desired condition The initial state K * good mood, I want to communicate with people without constraining my weight (mental attitude) K * no mood, shy to visit B * small (about the size of clothes) In big A * easy gait, dexterous (about the sound of steps) A * heavy, awkward gait A * - audio system
B * - visual system
K * - kinesthetic system

The patient in detail for all three types of representative systems of perception of information (audio, visual, kinesthetic) describes the initial state (IP). According to an audio representative system - what do you hear from others about your weight ?; according to a visual representative system - how do you look ?, often look in the mirror ?, what size of clothes do you wear ?; according to the kinesthetic representative system - how do you feel ?, what is your mood ?.

After this, the patient is immersed in a trance state and a session of indirect suggestions is carried out, repeating the formula made using a change in the eating behavioral stereotype.

You now have the initial state (IS) and wish to have the desired state (FS) for somatic health, for career advancement, for mental well-being.

How useful can a food-borne behavioral stereotype (PPP) - a healthy, state (FS) - become for your health? The patient is responsible.

How tangible will be the difference between the state (LS) and the state (IS). The patient is responsible.

How do you know that a state (FS) is more comfortable than a state (IP)? The patient is responsible.

The more difficult it is to develop PPP - healthy now, the easier it is to maintain it later.

The farther the state (FS) is for you today, the closer it can come tomorrow.

What do you think, how quickly can you develop PPP - a healthy person? The patient is responsible.

How strong are the faculty members - healthy and condition (FS) in general, how much you will achieve a positive result. The more time you spend on reaching a state (FS), the less time it can take to achieve a state (FS) as a whole.

What signs could be a confirmation of the possibility of achieving a state (FS) now? The patient is responsible.

The less possible it seems to you to perform PPP - healthy in separate parts. All the more likely may be its implementation in its entirety.

How easy it is for you to imagine a state (LS) mentally, it is just as easy to achieve it in reality.

How much depends on you the implementation of PPP - healthy in separate parts, the implementation of the state (FS), the state of the stomach (FS) can be just as independent.

Do you prefer to achieve a state (GC) or a state (GC) of the stomach, having previously implemented PPP - healthy or not realizing it?

Perhaps in the near future you will not reach the state (FS) as fully as you can imagine now. Maybe. For some time you will feel the state (IS) and with PPP - healthy, in any case, it is useful for the body to provide a choice of the optimal (ideal) weight and its changes now.

So, you want to achieve optimal weight. The optimal weight for you, in your opinion, will be how many kilograms? The patient is responsible.

How regularly do you intend to visit a psychotherapist?

You could visit a doctor about the optimal weight or sub-optimal weight, about a mood disorder or for any other reason, in any case, now you can have your own time.

And the more you doubted the success of the course, the more unexpected and pleasant the result will be.

The duration of the psychotherapeutic session of 20 minutes includes a session of indirect suggestions and the repetition of the compiled formula for changing the eating behavioral stereotype. With the leading representative system - visual - the formula of the altered eating behavioral stereotype includes categories related to perception through visual images (50%) - 10 minutes regarding perception through auditory impressions (25%) - 5 minutes regarding perception through sensations (25%) - 5 minutes from the time of the session. With the leading representative system - the auditory one - the formula of the altered eating behavioral stereotype includes categories related to perception through auditory impressions (50%) - 10 minutes, visual images (25%) - 5 minutes, concerning perception through sensations (25%) - 5 minutes, from the time of the session. With the leading representative system - kinesthetic - the formula for altered eating behavioral stereotype includes categories related to perception through sensations (50%) - 10 minutes, auditory impressions (25%) - 5 minutes, visual images (25%) - 5 minutes, from the time of session.

After the first session of psychotherapy, a dietitian conducts training of the patient in dietetics for 1.5-2.0 hours. To reduce body weight, a dietitian for 1 month prescribes a patient a diet with a total calorie content of 1000 kcal. A dietitian selects foods and dishes based on the individual preferences of the patient and recommends a set of foods and dishes of low energy value. Then, for 1 month, calorie content increases to 1200 kcal, after which it is brought to a value that corresponds to the norm of the patient's body needs for nutrients and energy, taking into account gender, age, height, weight and physical activity. The following basic principles are the cornerstone of diet therapy: protein intake, restriction of animal fat intake, restriction of easily digestible carbohydrates. A low-calorie diet is quite easily tolerated thanks to the psychotherapeutically achieved deactivation of the problem, normalization and awareness of adequate eating behavior, strengthening the saturation process, and stabilizing the psycho-emotional state.

The second suggestion session is carried out in a trance state and dedicate stimulation of early satiety to prevent overeating.

At the same time, they explain to the patient in a clear language what hunger is. Hunger is a general feeling that consists in the feeling of emptiness and cramping of the stomach, as well as in the instinctive understanding of the need for food. Feeling of hunger occurs when the body's reserves have decreased below the level necessary for energy balance. Hunger is a physiological regulator of the amount of food consumed.

One of the essential, but not necessary factors that enhance the feeling of hunger, are the reduction of an empty stomach. These contractions are perceived by the nerve endings (mechanoreceptors) of the stomach wall and are transmitted to the brain, where a feeling of hunger is formed.

It is easy to imagine that the overeating person has a “distended” stomach. And he receives the first satiation only when the stomach is full. As a result, much more food is consumed than the body needs. Reducing the volume of the stomach by enhancing its muscle tone allows you to get true saturation with the help of a small amount of food.

In the formation of hunger, an important role is played by the amount of glucose dissolved in the blood. A decrease in its concentration below a certain level is closely related to the sensation of an "empty stomach" - powerful contractions of its muscular membrane.

According to many studies, the severity of hunger depends on the temperature of the surrounding space. A person consumes food in an amount inversely proportional to the ambient temperature. This is due to the operation of the thermoregulation system and may explain a slight increase in hunger in the open air and in the cold season. A cold outside the window and being in a well-heated room do not increase the appetite, meaning the temperature of the immediate human environment.

Treatment is carried out with a course of 3-4 sessions. The third and fourth sessions repeat the first session. Sessions are repeated after 3-5 days. Repeated maintenance treatment 1 session per week for 3 months, repeating the first session.

Example 1. Patient L., 34 years old, a lawyer, complained of overweight, fatigue, decreased working capacity, feelings of weakness, shortness of breath when walking and physical exertion, worsening mood, periodic headaches associated with raising blood pressure to 150 / 90 mmHg Art. Weight 82 kg, height 164 cm.

In the process of the initial conversation, a medical history is collected, the questionnaire is filled out. The patient said that for two years notes increased appetite. The desire to eat often arises when she sees food and when food is available to her. Moreover, this desire comes even in those cases when it is not hungry. Over the past 2 years, weight has increased by 8 kg. In parallel with weight gain, weakness, decreased working capacity, and irritability began to be noted. She tried twice to lose weight on her own: first with a diet, then with fasting. However, after a weekly weight loss of 4 kg resulting from these measures, she added 8 kg over 1 month. During the initial conversation with the patient, the psychotherapist and the dietitian explained to the patient that the causes and consequences of being overweight are too complex to single out one and find a simple and unique solution: “There are much more differences between overweight people than similarities. For each person, the solution to the weight problem depends on its own combination of factors: hereditary, nutritional, physical activity and emotions. In general, the best reasons for losing weight are those that are "born" in you, and not those that other people tell you about. In the same way, it is you - and not other people - who can best analyze what benefits you can get from losing weight. Losing weight means reaching your target weight and preventing it from gaining weight again. This is not a one-time event, but a long process leading to better health, well-being and appearance. Weight loss begins with choosing a goal that is both realistic, achievable and that you can save. Failure to choose the right goal for yourself is the main reason why many people are unable to cope with being overweight. They expect that they will lose much weight, lose weight quickly, and for this we need such restrictions that cannot be adhered to for a long time. ”

“You gained weight not in one or three months, but in 2 years. So the path in the opposite direction will take quite a long time. Remember the proverb: "Slower you go - you will continue."

"It is well known that weight loss even by 5-10% can bring significant benefits to your health, for example, lowering blood pressure, improving your well-being and appearance, proving to you that you can reduce and maintain weight that is comfortable for you."

Here are two simple rules by which you can determine how much time you need to achieve your goal:

1) the rate of weight loss should be no more than 1 kg per week, ideally from 0.5 to 1 kg per week. Slow but steady weight loss is better for health, it is more realistic and the result achieved is then easier to maintain;

2) to achieve your target weight, you do not need to eat less than 1200 kcal per day. A diet with stronger restrictions is difficult to follow for a long time, it can only be followed for a short time. A very low-calorie diet can only be used under medical supervision.

1 kilogram of excess weight = 8000 kilocalories (kcal).

To lose 1 kg, you need to burn 8000 kcal more than you eat. For example, if you reduce the daily calorie content by 600 kcal, then you will lose 1 kg in 14 days - this will be approximately 0.5 kg per week. After 6 months you will lose weight by 13 kg - safely and without severe restrictions and torment with food. This goal is realistic, achievable, and it can be held.

The dietitian will calculate how many calories per day you need to reduce and maintain weight. It depends on your height, weight, gender, age and level of physical activity.

If you know how many calories a day you consume, reduce this amount by 20%, and you will get how many kilocalories you need to consume daily for safe and easy weight loss.

Really achievable goal in the first stage, weight loss by 5-10% of the original.

Remember: there are no "magic" diets, no "magic" exercises, no "miraculous" pills, if you continue to maintain your previous lifestyle.

There is only you, your desire to achieve results and daily work towards a healthy lifestyle with a change in eating habits!

In close cooperation with a dietitian and psychotherapist, you can find methods that are right for you.

Then the dietitian determined that the patient is diagnosed with alimentary obesity, the body mass index is 30.3 kg / m ² , which means the presence of obesity of 1 degree. Given that normal body weight corresponds to a body mass index of 25 kg / m ² , we calculate the weight to which the patient will tend to lose weight. The normal weight in this case should be 67.5 kg. Recommended weight loss - 82-67.5 = 14.5 kg. The patient is set up and wants to lose weight in 1 month by 7 kg. However, to prevent a return to the original weight (82 kg) and persistently maintain the achieved result, the nutritionist recommends a treatment course for 6 months: 1st month - weight loss by 3 kg, 2-4th month - by 2.5 kg monthly, then 5-6 month - 2 kg per month. To assess the patient’s nutrition, the dietitian gives explanations on keeping a “food diary” for 1 week (including working days and days off), which will record the time, amount and name of the foods eaten. The dietitian asked the patient to come in 1 week.

In a conversation with a psychotherapist, the patient substantiated the motivation for treatment by the fact that she wants to wear elegant clothes, move up the career ladder, and be attractive. Then she described her feelings and emotions in this case: “I clearly see my perspectives while losing weight. From my point of view I will have an easy, gait. Clothing size will be smaller. I will feel the look of others. " By the terms (I see clearly, perspectives, from my point of view, view) that the patient uses when answering questions, it can be determined that the leading representative system is visual. At this time, the patient is in a state of wakefulness (clear consciousness). The therapist notes the external manifestations (physiological, vegetative) of the patient's positive emotions: an increase in the volume and pace of speech, clarity of pronunciation, revitalization of facial expressions. The patient's face turned pink, the voice became louder, the movements were smooth, liberated, there was a symmetry and evenness of gestures, the predominance (stereotype) of the eyeballs moving up - to the right and down (the patient is right-handed). This meant that the patient was actively tuned for recovery. After that, the therapist asked the patient: did she know what a trance is. After listening to the answer, he explained that this is a short-term blackout of consciousness, this is a normal natural state that a person experiences every day, but at the same time you will hear and talk with me all. A natural trance, when you are in transport and “thinking”, didn’t notice how you arrived, look at the book, but don’t remember the text, etc. They compose a formula for changing the food behavioral stereotype taking into account the terms of the main representative system.

Then the first session is held in a trance state, in which, through indirect suggestions, the formula for changing the eating behavioral stereotype is repeated many times. Since we have determined that the patient’s leading representative system is visual, the formula for the altered eating behavioral stereotype will include categories related to perception through visual images (50%) - 10 minutes regarding perception through auditory impressions (25%) - 5 minutes relating to perception through sensations (25%) - 5 minutes from the time of the session.

You now have an initial state (IP) and wish to have a desired state (FS) in order to have somatic health and mental well-being in the future.

How useful do you see food behavioral stereotype (PPP) - healthy, state (FS) for your health? The patient responds while in a trance state - for me this is very important.

How tangible will be the difference between the state (FS) and (IP) for you. The patient answers, I will see it.

How do you know that a state (FS) is more comfortable compared to a state (IP). The patient responds, from my point of view I will look good, buy myself a smaller skirt.

The more difficult it is to develop PPP - healthy now, the easier it is to see it, to see clearly, to support later.

The farther the state (FS) is for you today, the closer it can come tomorrow, from your point of view.

What do you think, how quickly can you develop PPP - a healthy person. The patient is responsible for the intended period of one year.

How strong are the faculty members - healthy and condition (FS) in general, how much you will achieve a positive result. The more time you spend on reaching a state (FS), the less time it can take to achieve a state (FS) as a whole.

What signs could be a confirmation of the possibility of achieving a state (FS) now? The patient replies that something is happening to me, I feel confident that I will achieve the result.

The less possible it seems to you to perform PPP - healthy in separate parts. All the more likely may be its implementation in its entirety.

How easy it is for you to imagine a state (LS) mentally, it is just as easy to achieve it in reality.

How much depends on you the implementation of PPP - healthy in separate parts, the implementation of a state (FS), a state of satiety of the stomach and an indifferent attitude to food in the absence of hunger (FS) can be just as independent.

Perhaps you will not reach the state (FS) in the near future so completely. As far as you can imagine it now. Maybe. For some time you will feel the state (IS) and eat without hunger, but with PPP - healthy, in any case, it is useful for the body to make a choice about the optimal (ideal) weight and its changes now.

So, you want to achieve optimal weight. The optimal weight for you, in your opinion, will be how many kilograms? The patient responds, 67.5 kg.

How regularly do you intend to visit a psychotherapist?

You could visit a doctor about the optimal weight or sub-optimal weight, about a mood disorder or for any other reason, in any case, now you can have your own time.

And the more you doubted the success of the course, the more unexpected and pleasant the result will be.

The duration of a psychotherapeutic session is 20 minutes. After the session, the therapist returned the patient to an awake state.

The psychotherapist asked the patient to come to the second session after 3 days with a feeling of hunger.

The next session was started with the doctor saying: "How wonderful you look! Your outfit has become freer? How are you feeling?". The patient replied that she began to control the use of food, did not pay attention to colored, attractive advertisements at stores, her weight decreased by 300 g, her mood was good. The psychotherapist touched the patient’s hand during the conversation and observed external manifestations of positive emotions, as well as signs of a mild trance state. Then, in a language that was understandable to the patient, it was explained what hunger was and an installation for early saturation was given.

The second session in a trance state is dedicated to suggesting stimulation of early satiety to prevent overeating.

The duration of a psychotherapeutic session is 20 minutes. After the session, the therapist returned the patient to an awake state.

After completing the second session of psychotherapy, a nutritionist began to work with the patient. He, together with the patient, conducted an analysis of the nutrition diary. It turned out that in the diet there is an excess of easily digestible carbohydrates (bakery products, sugar-containing drinks, confectionery), products containing hidden fats (sausages, mayonnaise, etc.), a deficiency of vitamins and minerals that ensure normal metabolism, fiber (vegetables, fruits) ) and low-fat protein-containing products (meat, fish, legumes). The nutritionist prescribed the patient a diet with a reduced calorie content of 1000 kcal - a set of products and dishes, taking into account these principles and individual preferences of the patient.

At this second session ended. The third session was asked to come in 5 days.

The third session. The patient came to the reception peppy, the weight decreased by another 500 g from the original weight. The third psychotherapeutic session is carried out as the first.

After the third session, the weight decreased by another 250 g, the mood became smooth, the sleep was calm. A month later, the weight decreased by 4 kg, it was planned to 3.5 kg.

Then, the dietitian provided the patient with recommendations for maintaining the achieved results: the caloric value of food in the first month is 1000 kcal, then 1200 kcal - 1 month, followed by bringing it to a value corresponding to the needs of the body, i.e. 1900 kcal.

Repeated maintenance treatment was carried out after 3 months, 1 session per week, repeating the first session.

Follow-up - after 6 months, the weight decreased by 14 kg and has been held for twelve months already within 67-69 kg. Headaches are not noted, blood pressure indicators are normal. To maintain weight, the patient enrolled in a sports group, where in addition to swimming in the pool, she plays volleyball 2 times a week. The patient received promotion through the ranks, family relations returned to normal, and the result of the therapy was satisfied.

Example 2

The patient of Peninsula, 42 years old, the director of the company, appealed about overweight, shortness of breath when rising above the 3rd floor. Weight 78 kg, height 166 cm.

In the process of collecting an anamnesis and questioning, it turned out that weight gain associated with increased appetite has been observed for the past 1.5 years. This fact connects with the specifics of his work, frequent business negotiations with banquets in restaurants, and the desire to eat often arises in the absence of a feeling of hunger, often at the sight of food and for the "company". For 1.5 years, the weight increased by 6 kg. I tried to independently reduce weight using hypocaloric diets for 1-1.5 months, however, after the termination of such reduced nutrition, the weight returned to its original forms. The dietitian determined that the patient is diagnosed with alimentary obesity, the body mass index is 28.4 kg / m, which means the presence of obesity of 1 degree. Given that normal body weight corresponds to a body mass index of 25 kg / m, we calculate the weight that the patient will tend to lose weight. The normal weight in this case should be 68.7 kg. Recommended weight loss - 78-68.7 = 9.2 kg, approximately 9 kg. A dietitian recommends a course of treatment for 4 months: 1st month - weight loss by 3 kg, 2-4th month - by 2 kg monthly. To assess the patient’s nutrition, the dietitian gives explanations on keeping a “food diary” for 1 week (including working days and days off), which will record the time, amount and name of the foods eaten. The nutritionist asked the patient to come in 1 week.

In a conversation with a psychotherapist, the patient substantiated an active positive emotional-volitional motivation for treatment by the fact that she wants to move up the career ladder and be attractive. Then she described her feelings and emotions in this case: “I will feel a light, gait. I will be comfortable in the clothes a few sizes smaller. I will be comfortable among the people around me. " According to the terms (feel light, comfortable, comfortable), which the patient uses when answering questions, it can be determined that the main representative system is kinesthetic. They compose a formula for altering a nutritional behavioral stereotype, taking into account the terms of the main representative system.

At this time, the patient is in a state of wakefulness (clear consciousness).

table 2 Formula for Nutritional Behavioral Stereotype (PPP) with a Leading Representative Kinesthetic System Desired condition The initial state K * feel a good mood, I want to communicate with people without restraint, comfortable (mental attitude) K * I feel a lack of mood, not comfortable among the people around me In * it is convenient to feel a few sizes smaller in clothes (about the size of clothes) B * I feel the inner constriction in large clothes A * easy gait, comfortable (about the sound of steps) A * heavy, shackled A * - audio system
B * - visual system
K * - kinesthetic system

Then the first session is held in a trance state, in which, through indirect suggestions, the formula for changing the eating behavioral stereotype is repeated. Since we determined that the patient’s leading representative system is kinesthetic, the formula for the altered eating behavioral stereotype will include categories related to perception through sensations (50%) - 10 minutes regarding perception through auditory impressions (25%) - 5 minutes regarding perception through visual images (25%) - 5 minutes from the time of the session.

The psychotherapist asked the patient to come to the second session after 3 days with a feeling of hunger.

The next session was started with the doctor saying: "How wonderful you look! Your outfit has become freer! How are you feeling?" The patient replied that she began to control the use of food, did not pay attention to colored, attractive advertisements at stores, her weight dropped by 500 g, her mood was good.

The second session in a trance state is dedicated to suggesting stimulation of early satiety to prevent overeating.

The duration of a psychotherapeutic session is 20 minutes. After the session, the therapist returned the patient to an awake state.

After completing the second session of psychotherapy, a nutritionist began to work with the patient. He, together with the patient, conducted an analysis of the nutrition diary. The daily caloric intake was within 2800 kcal. The nutritionist prescribed the patient a diet with a reduced calorie content of 1000 kcal - a set of products and dishes, taking into account these principles and individual preferences of the patient. The excess calories in this patient arose due to the excessive consumption of products containing hidden fats (smoked meats, sausages, fatty meats, cheeses). Therefore, the calorie content of the diet is reduced precisely due to the data of fat-containing products. Carbohydrate-containing products are left in the same volume, unchanged, because the patient practically does not consume “sweet” foods containing simple sugars.

At this second session ended. The third session was asked to come in 5 days.

The third session. The patient came to the reception peppy, the weight decreased by another 400 g from the original weight. The third psychotherapeutic session is carried out as the first.

After the third session, the weight decreased by another 450 g, the mood became smooth, the sleep was calm. A month later, the weight decreased by 3.2 kg, and it was planned to 3 kg.

Then, the dietitian provided the patient with recommendations for maintaining the achieved results: the caloric value of food in the first month is 1000 kcal, then 1200 kcal - 1 month, followed by bringing it to a value corresponding to the needs of the body, i.e. 1600 kcal.

The fourth psychotherapeutic session is carried out in the same way as the first, and is aimed at consolidating the stimulation of early satiation.

Repeated maintenance treatment was carried out after 3 months, 1 session per week, repeating the first session.

Follow-up - after 4 months, the weight decreased by 8.5 kg and has been held for twelve months in the range of 68-69.5 kg. Shortness of breath when walking, climbing stairs does not celebrate. To maintain weight, the patient completely revised her diet, she freely replaces the previous fat-containing products with their analogues, but with a lower fat content. The patient began to adhere to a diet. The specifics of the work does not allow her to avoid lunch and dinner in cafes and restaurants, however she is more careful in choosing a menu and, most importantly, she feels an indifferent attitude to advertising with a look of products, feels calm to a richly served table.

Thus, the proposed method for the treatment of obesity with an external type of eating disorder allows you to achieve weight loss for the intended time, to maintain the result for a long time.

The method is used during the "School of overweight correction" in the Municipal Center for Medical Prevention, in the endocrinology clinic at IGBM No. 1 of Novokuznetsk.

Claims (2)

1. A method of correcting a person’s body weight, including an anamnesis analysis, diet therapy with the exception of high-calorie foods and rational psychotherapy for weight loss without impairment of health, characterized in that when analyzing the anamnesis and by questioning reveal eating disorders associated with an increased reaction to external stimuli: type of food, advertising of food products, type of person taking food, and when it is detected, conduct rational psychotherapy to recognize the problem by the patient, form an active position A strong emotional and volitional motivation to achieve the ultimate goal - weight loss according to the program for a given period of time by the recommended number of kilograms, determine the patient's main representative information perception system: visual, auditory or kinesthetic, compose in a wakeful state a formula for changing a food behavioral stereotype aimed at normalizing eating behavior, after this the patient is immersed in a trance state and spend the first session of indirect suggestions, repeating with the left formula using categories of visual images, auditory impressions, by means of sensations, moreover, 50% of the session time is spent using categories related to the main representative system and 50% of the session time is divided equally between the categories of non-basic representative information perception systems, in the second session, the patient is immersed into a trance state and conduct a session of induction of early saturation stimulation to prevent overeating, treatment is carried out in a course of 3-4 sessions, sessions in 3-5 days, rep 1 molar supportive treatment session a week during 3 months, repeating the first session. 2. The method according to claim 1, characterized in that a low-calorie diet with a reduced calorie content of 1000 kcal in the first month, 1200 kcal in the second month, followed by bringing it to a value corresponding to the normal needs of the body.