RU2427394C1 - Complex method of treating obesity - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, particularly to psychotherapy, psychiatry, therapy, endocrinology. A complex method of treating obesity includes psychotherapy with explaining the disease substance and conducting therapy. Conversation is used to specify significant motivation to reduce weight. The facts that human mentality does not like "interdicts", it shall be agreed about reasonability of correct food behaviour, weight reduction and obligatory physical activity are clarified. A weight reduction treatment program is determined for the recommended period; a diet is prescribed. A technique of "actively experienced mental images" and regeneration of physiological sensation memory of flexibility, fitness, health, power is trained. The formula: "I have lost excessive kilograms, I have left them, I have got rid of them, I feel easy, comfortable, I am slim, beautiful, healthy, I shall make recommended physical exercises regularly to correct a figure " is pronounced silently 3-5 times a week throughout 12 months. Physical exercises is performed for 15-20 min daily throughout 12 months to correct body parts to be constitution-specific loaded. Pedestrian walks for 25-30 minutes are daily. At a stage of dynamic observation, there is prescribed a low-calorie diet for one month with lower caloric content 800 kcal, for the second month - 1200 kcal, to be thereafter carried to a value equal to normal body demand - 1800 kcal. Throughout 6 months of treatment, once a month "support visits" are arranged to control weight reduction, change of eating habits, training of balanced diet skills and healthy life, improving personal responsibility for treatment. The technique of "actively experienced mental images" is combined with a massage session in a massage armchair which is used as a kinesthetic carries anchors; further armchair massage is repeated once a month within 1 year. Depending on obesity type, 10 daily procedures of general massage and rubbing in problem areas of cinnamon essence. In the beginning of treatment, a stage of readiness for changing patient's behaviour is determined, and during treatment, the patient moves up from one stage of readiness to the following stage, with correction of failures and plan withdrawal. For this purpose, when determining motivation of the patient to reduce weight, a stage of readiness of changing patient's behaviour is stated by asking the questions: what is the reason for the changes, what is a benefit of the changes, what is going to be changed, will is the patient able, how to do this, shall the patient do it now, are there any other priorities to motivate the patient to move up the stage of readiness "preparation". The changes of eating habits and eating stereotypes are controlled, the reasons preventing the patient from changing a way of life are analysed, a plan of measures to change way of life consisting of small, easy stages is developed. The Ist stage - to train to stay out from a shop on the way home; never to go shopping while being hungry. The IInd stage - to go shopping by a prepared list; to buy mainly vegetables, fruit and cereals; before buying, to check ingredients on a label and to prefer low-fat products; not to buy products containing easily digestible carbohydrates: sugar and sugar-containing sweets; to use less frequently the products containing hidden fats: sausages; to avoid half-finished products. The IIIrd stage - to generate a stereotype: to have a glass of still water prior to meal; to begin a meal with low-fat soup or salad; to eat small portions, regularly, at least four times a day; to avoid watching TV during meal; not to eat while standing; to give up snacks between meals. The IVth stage - to fix the formed eating habits, by conducting the IInd and IIIrd stages. If the patient moves up to the "active action"; it is recommended to complete the formula said by the patient with the phase "I shall make the recommended physical exercises which will correct a figure regularly", then the patients start making physical exercises. Each "support visit" aims at determining a stage of behaviour change and the stage of "result preservation" involves praise, approval and bearing up; the formula is completed by the phrase "I shall preserve the result". Failures are prevented, and if the "preliminary" stage of behaviour change is stated that testifies to treatment violation then the patient is suggested that efforts are spent knowingly and consequently it is necessary to renew attempts to change eating behaviour and to continue treatment. Such complex treatment with using a kinesthetic anchor, psychotherapy, dynamic observation and control of the stage of behaviour change and treatment depending on this stage allows achieving eating behaviour normalisation and stable weight reduction and prolonged result preservation. ^ EFFECT: method allows higher clinical effectiveness, and also generated new stereotype of eating behaviour and weight normalisation. ^ 5 tbl, 1 ex

Description

The method relates to medicine, in particular to psychotherapy, psychiatry, therapy, endocrinology. The method improves the effectiveness of treatment.

Currently, the effectiveness of the treatment of eating disorders clinically expressed in obesity is extremely low, as most return to their original weight or even exceed it. Increased body weight is also associated with general morbidity and can contribute to certain stigmatization and discrimination of a person in society. Obesity and overweight are considered multifactorial diseases associated with environmental influences, heredity, psychological and physiological factors (Mosolov S.N. Metabolic disorders in antipsychotic therapy / S.N. Mosolov, S.O. Kabanov // Social and clinical psychiatry. - 2003. - No. 2. - S.165-170).

Among the reasons leading to an increase in appetite and excess body weight, psychological ones are also important. These include any emotional experiences that lead to increased appetite. At that time, when irritability, aggression, depression, depressed mood come, a person needs only one meal and these feelings recede. Thus, for some time a person develops a stable strategy: emotional experiences - eating - peace of mind. Food for a person is a sedative, a means of emotional relaxation, a way to get pleasure and gain peace of mind. Perhaps there is a so-called "secondary" or unconscious benefit from extra pounds. Among the significant causes of overeating, one can also note the peculiarities of food education and behavior that contribute to the excess of daily calories over energy costs. So, the body accumulates extra pounds. Perhaps, in connection with the lifestyle, a person eats, as it were, “by inertia”, when there is no need for food and nutrients. We are talking about the so-called food for future use and in reserve, before there is a feeling of hunger. Food before bedtime and a single meal during the day also contributes to the accumulation of fat reserves. The habit of eating “on the run” also plays a certain role. Eating and watching TV at the same time, reading newspapers, lengthy conversations at the dinner table - this diet regime contributes to overweight.

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"). Accordingly, reducing weight by 5-10 kg over 4-6 months and maintaining this result over the long term is more effective than losing a large number of kilograms (10-15 kg) in a short period of time, followed by a ricochet increase in weight (15 -20 kg). Any specialist understands that this is a temporary decrease in the severity of one of the symptoms of obesity, and by no means a cure.

Nutrition correction is the basis of therapeutic measures and today is recognized by all authors (Tereshchenko I.V. Problems of treating obesity. - Clinical medicine, No. 7, 2002, p.9-13, Melnichenko G.A. Obesity in the practice of an endocrinologist. Russian medical Journal, Volume 9, No. 2, 2001, pp. 82-87). Along with diet therapy, correction of eating behavior should be carried out, as in most patients there are violations of psychological forms of eating behavior that contribute to increased craving for food (Vakhmistrov A.V., Voznesenskaya T.G., Posokhov S.I. Clinical and psychological analysis of eating disorders Behavior in Obesity, Journal of Neurology and Psychiatry, No. 12, 2001, pp. 19-24).

“Eating Disorders” (RPEs) in a number of domestic publications are referred to as “eating disorders”. Common to all RPPs are the following symptoms: a change in diet (decrease or increase in the amount of food); violation of the subjective image of your own body and the image of "I"; endocrine and metabolic disorders accompanying a change in body weight in one direction or another. In the pathogenesis of all RPPs, both physiological causes (impaired central regulation of appetite control) and psychological (personality traits of patients, family relationships, relationships of children and parents) play a role (Starostina E., 2005).

There are three main types of eating disorders: external, emotional, restrictive (Voznesenskaya T.G., 2004). Emotiogenic eating behavior (EPP) (hyperphagic reaction to stress or "food drinking").

In many developed countries, there is a significant increase in the number of patients with RPP, resulting in the emergence of many nutritional-dependent diseases. In numerous studies carried out in our country and abroad, it is noted that changes in eating behavior and related eating disorders can lead to diseases such as obesity, diseases of the cardiovascular system, gastrointestinal tract, etc. (Oganov R .G et al., 1990; Kasatkina, E.P. and Odud, E.A., 1993; Keys A., 1981; James WPT et al., 1988). Moreover, there are great difficulties in changing the formed eating behavior even by people with severe illnesses, despite intensive training in their correction of nutrition and even an immediate threat to life if the requirements are not met.

According to the method of V.I. Mirkin for the correction of body weight form a group of patients who first and repeatedly came to the session. The session begins with individual psychotherapy of re-visiting patients. Then they put the patient in the Romberg pose and report information on the number of kilograms of weight loss for the entire course of treatment. Fix the installation. The patient is immersed in a trance state and instilled a change in eating behavior. Derived from trance, prescribe a protein-vegetable diet and fasting days. The course of treatment up to 12 months consists of psychotherapy sessions and compliance with a protein-vegetable diet with a restriction of calorie intake and a decrease in carbohydrate content in it (RF Patent No. 2113242, A61M 21/00; dated 20.06.1998, B.I. No. 17 )

However, this treatment method, which consists in a long course of treatment (12 months) with a protein-vegetable diet and limiting the calorie intake and lowering the carbohydrate content in it, is difficult to achieve and requires a long-term mobilization of strong-willed efforts from the patient, which leads to the rejection of the recommended regimen treatment and inevitable breakdown.

Currently, hypocaloric diets are used to treat obesity. Most often in domestic medicine, Pevzner’s diet No. 8 is used (V. A. Oleneva. Clinical Nutrition for Obesity. A Guide to Clinical Nutrition edited by M. A. Samsonov and A. A. Pokrovsky. M., Med., 1992. S.175-178).

However, this diet, despite the low calorie content of 1,500 kcal and the balanced amount of protein, vitamins and dietary fiber in its composition, is, firstly, quite uniform, provided that it will be necessary to use it for a long time. A patient who, as a rule, possesses approximate information about dietetics and about the rules for replacing some dishes and products with others, may experience inevitable difficulties that will lead to deviations from the diet and even a breakdown. Secondly, this diet does not form the skills of a balanced diet and therefore, having stopped its observance, the patient often gains weight (inevitable rebound syndrome). Thirdly, the regime of prohibitions in nutrition to maintain weight, existing for a long time, reduces the quality of life of the patient.

In the practice of treating obesity, various methods of psychotherapy are increasingly used.

The known method Naumchik L.M. reduction in overweight, in which previously find out the causes that led the patient to obesity, and the motives that prompted him to do weight loss. Based on this information, individual psychological attitudes are found for conducting psychotherapy and compiling formulas for autogenic training. Conduct 3-10 sessions of psychotherapy for 30 minutes, while the suggestion is carried out in a state of wakefulness and in a state of meditation. At the same time, it is suggested that the immune system is activated and self-regulation is restored. Daily weighing is carried out and, with a decrease in the initial weight of 7-10%, a low-calorie diet is prescribed for the next 25-35 days, taking herbal medicines that improve metabolic processes, carry out myostimulation and perform physical exercises on simulators for at least three classes per week for 30 min (RF Patent No. 2136323, A61M 21/00; dated 10.09.1999, B.I. No. 21).

However, 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. In addition, as a result of the work of a psychotherapist, the recommended number of kilograms is not taken into account, by which it is necessary to reduce weight without harm to health.

The closest is the method, including conducting psychotherapy explaining the essence of the disease and ongoing therapy, determining the treatment program, how many kilograms and for what period the patient is recommended to reduce weight, the purpose of the diet. Application for invention RU No. 2008118731, IPC A61M 21/00, priority dated 05/12/2008, BIMP No. 32, publ. November 20, 2009, p. 70.

They conduct an educational lecture on what motivation is, its importance for successful achievement of the result, by means of conversation they determine a significant motivation for weight loss, explain that the human psyche does not like "prohibitions", it is necessary to agree with her on the appropriateness of proper eating behavior, weight loss and compulsory physical activity.

Then, after 2 days, they are taught the methodology of “Actively Experienced Thought Images” - they offer to mentally smooth their body, imagining that the movement of the hands removes a layer of excess adipose tissue and long-term psychological dirt, thus restoring physiological memory, forcing it to return to its former sense of flexibility, fit, health, strength; pronounce to themselves the formula "I lost my extra pounds. I left them, I got rid of them. I feel comfortable. I am slim, beautiful, healthy. I will regularly perform the recommended physical exercises that will correct the figure, "I recommend that you independently carry out this technique 3-5 times a week for 12 months.

Depending on the type of obesity, it is recommended to perform physical exercises for 15-20 minutes daily for 12 months with abdominal obesity, which is characterized by excessive deposition of adipose tissue in the abdomen and upper torso, prescribed exercises to reduce the volume of the waist and abdomen, with femoral-gluteal or lower type obesity recommend exercises to strengthen the muscles of the buttocks, hips, with a mixed or intermediate type of obesity recommend exercises to reduce the waist and abdomen and exercises to strengthen the mouse q buttocks, hips, daily walks for 25-30 minutes.

At the stage of dynamic observation, it is recommended that one month follow a low-calorie diet with a reduced calorie content of 800 kcal, in the second month - 1200 kcal, followed by a calorie adjustment to a value corresponding to the body's normal requirement - 1800 kcal.

During 6 months of treatment, “support visits” are carried out once a month to monitor weight loss, change in eating habits, the formation of good nutrition skills and a healthy lifestyle, and increase personal responsibility for their treatment.

The disadvantages of the method

The stage of readiness for changing the patient’s behavior is not determined and the patient is not transferred from the “preparation” stage to the “save results” stage. There is no fixation of the desired reaction - weight loss after psychotherapist’s sessions, by some “anchor”, which can cause the necessary experience, which is similar to conditioned-reflex stimulus-reflex connections.

The objective of the present invention is to increase the effectiveness of the treatment of obesity in a complex way, including dynamic observation using psychotherapeutic methods to transfer patients to the stages of behavior change, increasing motivation for treatment by anchoring and using cinnamon.

The problem is achieved by a comprehensive method of treating obesity, including psychotherapy with an explanation of the essence of the disease and ongoing therapy. Significant motivation for weight loss is determined by conversation. They explain that the human psyche does not like "prohibitions", it is necessary to agree with her on the appropriateness of proper eating behavior, weight loss and mandatory physical activity. Determine the treatment program for weight loss for the recommended period, prescribe a diet. They teach the methodology of “Actively Experienced Thought Images” with the restoration of physiological memory about the sensation of flexibility, fit, health, strength. The following formulas are taught to pronounce to oneself: “I lost my extra pounds, I left them, I got rid of them, I’m easy, comfortable, I’m slim, beautiful, healthy, I will regularly perform the recommended physical exercises that will correct my figure,” - 3-5 once a week for 12 months. Perform physical exercises for 15-20 minutes daily for 12 months to correct body parts that need to be given a load depending on the type of physique. Hiking daily for 25-30 minutes. At the stage of dynamic observation, for one month, a low-calorie diet with a reduced calorie content of 800 kcal, in the second month - 1200 kcal, followed by a calorie adjustment to a value corresponding to the norm of the body's needs - 1800 kcal. During 6 months of treatment, “support visits” are carried out once a month to monitor weight loss, change in eating habits, the formation of good nutrition skills and a healthy lifestyle, and increase personal responsibility for their treatment.

Training in the methodology of “Actively experiencing thought patterns” is carried out during a massage session in a massage chair, which acts as a kinesthetic anchor, then massage in the chair is repeated 1 time per month for 1 year. Depending on the type of obesity, 10 general massage procedures are performed daily with rubbing cinnamon aromatic oils into problem areas.

At the beginning of treatment, the stage of readiness for changing the patient’s behavior is determined and in the process of treatment it is transferred from one stage of readiness to the next stage, with correction in case of breakdowns and departure from the intended program. To do this, when determining the patient’s motivation for weight loss, they determine the stage of readiness to change the patient’s behavior, asking questions: what is the meaning of the changes, what are the benefits of the changes, what will change, will he be able to, how to do it, do it now, are there any other priorities that motivate the patient to go to the stage of readiness “preparation”. They control changes in eating habits and stereotypes of nutrition, analyze the reasons that impede a change in the patient’s lifestyle, and develop an action plan to change the lifestyle, consisting of small, easily completed steps. Stage I - learn not to go to the store on the way home from work; never leave the house hungry for shopping in the store. Stage II - make purchases according to a pre-compiled list; to buy mainly vegetables, fruits and cereals; Before buying, study the composition of the product on the label and give preference to products with a low fat content; Do not buy products containing easily digestible carbohydrates: sugar and sugar-containing sweets; less likely to use foods containing hidden fats: sausages, sausage; Avoid convenience foods. Stage III - to form a stereotype: before a meal, drink a glass of water without gas; start food with low-fat soup or salad; eat in small portions, regularly, at least four times a day; Do not watch TV while eating; do not eat foods while standing; refuse snacks between meals. Stage IV - to consolidate the formed eating habits by performing stages II and III.

When the patient moves to the stage of “active action”, it is recommended that the phrase “I will regularly perform the recommended physical exercises that will correct the figure” be entered into the formula pronounced by the patient, after which the patients begin to perform physical exercises. At each meeting of the “support visit”, the stage of behavior change is determined and, at the stage of “preserving the results”, the patient is praised, approved and encouraged, the phrase “I will support the achieved result” is entered into the formula. Disruptions are prevented, and if the stage of behavioral change is “preliminary”, which indicates a violation of treatment, they are convinced that the efforts were spent not in vain and therefore, attempts to change eating behavior and continue treatment should be resumed.

The novelty of the method

- Training in the methodology of “Actively experiencing thought patterns” is carried out in a massage chair, which acts as a kinesthetic anchor, similar to conditioned reflex stimulus – reflex connections, and every time the patient sits down in a massage chair, blood circulation will normalize in all groups of blood vessels, which guarantees proper oxygen supply to muscles, relieves their fatigue and has a beneficial effect on the nervous system, increases immunity, symptoms of fatigue and irritability disappear, sleep normalizes, and decreases I have an appetite and enhances the associative relationship of a massage chair - weight loss. Subsequently, the massage in the chair is repeated 1 time per month for 1 year. Massage chairs successfully combine both traditional and the latest methods of treatment, normalizing blood circulation in all groups of vessels, in turn, guarantees the correct supply of oxygen to muscles, relieves their fatigue and has a beneficial effect on the human nervous system. This leads to the fact that the symptoms of various diseases of the musculoskeletal system disappear. In addition, massage chairs - a reliable way to prevent ailments associated with metabolic disorders, and strengthens the conditioned reflex massage chair - weight loss. If you use massage chairs regularly, an improvement in overall health is guaranteed. After all, the cause of many diseases is the deterioration of the body's metabolism as a result of stagnation in the cervical, thoracic, lumbar and sacral parts of the spine, thighs and buttocks.

- Conduct 10 daily general massage procedures with rubbing cinnamon flavor oil in problem areas, cinnamon contains substances that are similar in chemical composition to the hormones of happiness - endorphins, which increase mood and reduce appetite.

- At the beginning of treatment, the stage of readiness for changing the patient’s behavior is determined and in the process of treatment it is transferred from one stage of readiness to the next stage, with correction in case of breakdowns and departure from the intended program. This allows you to increase motivation for changing behavior and achieve better treatment results.

- They control the change in eating habits and stereotypes of nutrition, analyze the reasons that impede a change in the patient’s lifestyle, and develop an action plan to change the lifestyle, consisting of small, easily completed steps. The patient, quickly achieving success in the implementation of individual stages, receives positive emotions and incentives that give him the strength to move on.

- When the patient moves to the stage of “active action”, it is recommended that the phrase “I will regularly perform the recommended physical exercises that will correct the figure” be entered into the formula pronounced by the patient, after which the patients begin to perform physical exercises.

- During the “support visit” they transfer the patient to the stage of behavioral change “preserving the results”, praise, encourage and encourage the patient, enter the phrase “I will maintain the achieved result” into the formula, prevent disruptions, and if the disruptions are identified and the stage of behavior change is identified “ preliminary, ”it is suggested that the effort was not wasted, and therefore, attempts to change eating behavior and continue treatment should be renewed.

Such complex treatment using kinesthetic anchors, psychotherapy, dynamic monitoring with the control of the stage of behavior change and treatment depending on this stage allows to achieve normalization of eating behavior and persistent weight loss of the patient while maintaining the achieved result for a long time.

The method is as follows.

When contacting a patient with complaints of excess weight, a diagnosis of the cause of obesity is carried out. After this, cerebral and endocrine forms of obesity are excluded.

The patient is located in a chair, he is offered to take a comfortable position, after which he sets out the desired result: to reduce weight and fix the result for a long time.

The psychotherapist conducts a conversation explaining the essence of the disease and the therapy. Then it determines how many kilograms and for which period the patient is recommended to reduce weight, according to the formula proposed by the World Health Organization, determines the value of the body mass index (BMI): BMI = weight (in kg): height ² (m), based on which it determines the presence of obesity and the risk of concomitant diseases (table 1).

Table 1 BMI obesity classification and risk of concomitant diseases Types of Obesity BMI kg / mg ² Risk of concomitant diseases Body mass deficiency <20.0 - Normal body weight 20.0-25.0 Normal Overweight > 25.0 Moderate Obesity 1 degree > 25.0-29.9 Elevated Obesity 2A degree 30.0-34.9 Tall Obesity 2B degree 35.0-40.0 Very tall Obesity 3 degrees > 40.0 Extremely tall

Given that normal body weight corresponds to a body mass index of 25 kg / m ² , the nutritionist based on the above formula WHO BMI = weight (in kg): height ² (m), calculates the weight that the patient will tend to lose weight : desired weight = BMI equal to normal body weight (25 kg / m ² ) × height ² (m). Then the doctor determines the number of kilograms by which it is recommended to reduce weight by the formula: the number of kilograms by which it is recommended to reduce weight = initial weight - desired weight.

They conduct an educational lecture on what motivation is, its importance for successful achievement of the result. The psychotherapist tells the doctor that motivation (motivation) is one of the most important and powerful mechanisms and incentives for self-regulation and self-improvement. Motive (set in motion, push) is an object that acts as a satisfaction of a need. This is a stable personal property, which, as it were, from the inside, from a person encourages him to improve certain actions in order to acquire the necessary subject of need (perceived, represented, conceivable). Motivation is not a static state, but a dynamic process that fluctuates in time and space depending on the state of the individual and environment. Motivation is influenced by external and internal influences, and the leading, as a rule, is the internal influence (internal motivation). External influences act as “social soil”. Significant motivation for weight loss is determined through conversation, among them: health problems, self-affirmation, a bad example for children, condemnation of loved ones and others, career advancement, love, betrayal of a husband or significant man, desire to change wardrobe, "for company with a girlfriend" , without motivation (table 2).

table 2 Significant motivations that prompted to see a doctor No. p / p Reason prompting you to see a doctor Percentage of patients responding one Health problems 75% 2 Self-affirmation 26.4% 3 Bad example to children 13.8% four Condemnation of loved ones and others 10.2% 5 Career advancement 37.3% 6 Love fifteen% 7 Cheating on a husband or significant man 9.8% 8 The desire to change the wardrobe 22% 9 "For company with a friend" four% 10 No motivation 3.9%

Motivation for a change in behavior depends on the patient's readiness for change. 5 stages of readiness for changing the behavior of patients are determined: preceding, reflection, preparation, active action, preservation of the result (Prochaska et al., 1993).

At stage 1 - “anticipating” - patients underestimate the benefits of change and are afraid of the difficulties for their implementation. As a rule, these are patients who are not ready for lifestyle changes, they avoid talking about it and defend themselves if pressure is put on them. As a rule, these patients can be met on an outpatient basis, for example, by an endocrinologist, a general practitioner, where they turned for any emergency, but not in connection with overweight. At this stage, patients still have no intention in the near future to change something in their lives. If it is difficult for the patient to assess the nature of the diet and remember what he ate in recent days, he is probably at a preliminary stage. It is necessary to find out whether the patient understands the relationship between his state of health and the nature of nutrition. If not, it really is at a preliminary stage.

At stage 2 - “reflection” - the patient thinks about his problems. At this stage, the patient has a desire to take action to change lifestyle and nutrition. But they still doubt, are not confident in their abilities, exaggerate difficulties, but realize that their excess weight contributes to poor health. Patients experience conflicting feelings about changes in their lives, but realize that their excess weight is a problem, although they are not confident in their abilities, exaggerate the difficulties. Patients are ready for change, but not enough.

At the 3 stages of readiness for changes - “preparation” - patients think about the need for action and are ready for some actions in the near future, but do not allow thoughts of changing their habits. For example, the patient already understands that the nature of his diet can adversely affect his health, believes that the benefits of changes will outweigh the difficulties that he may encounter, but he sees many obstacles to his change. In this case, you need to help the patient remove the obstacles to lifestyle changes. You should find out who in the patient's family is engaged in the procurement of products; whether the patient is eating out; Does the patient have unrealistic ideas about the degree of diet changes. A detailed analysis of these issues will help the patient go to the immediate planning of changes in the diet. You can offer the patient several ways that are not very difficult to perform. For example, when there is no feeling of hunger, and out of habit there is a desire to eat, you can drink a glass of water.

At the 4 stages - “active action” - the patient already understands that his diet is improper, negatively affects his health, and is ready to observe certain restrictions on the diet, but the temptation to eat unacceptable foods “for company” is still great. At this stage, patients begin to take active steps to change eating habits and stereotypes of nutrition. This stage is characterized by high commitment and enthusiasm on the part of patients. The most common experiences for them are fears about the possibility of returning to the old way of life. It is necessary to help the patient in the development of a clear plan of measures for changing lifestyle. It is important to divide the plan into small, easy-to-do steps.

At the 5th, final, stage of the behavior change model - “preserving the result” - patients make efforts to preserve changes in eating habits and lifestyle for a longer period.

It is not true that all reflections on the stages look linear. The most common spiral pattern of change. A breakdown is possible at some stage, after which attempts are resumed again. At the same time, a person thinks that he has failed completely and all his hard efforts have been wasted. However, this is not circular motion, but an upward spiral. Stage “A” is marked - not ready for change, “B” - not sure of readiness, “C” - ready for change.

Then, in order to increase the patient’s readiness for change, the psychotherapist asks her questions during the conversation: What is the meaning of the changes? What are the benefits of change? What will change? Will I be able to? How am I supposed to do this? Do it now? What about other priorities? After receiving the answer to the questions, the therapist explains that our psyche does not like “prohibitions”, we need to agree with her on the appropriateness of proper eating behavior, weight loss and mandatory physical activity. Invites the patient to the session after 2 days.

At the second meeting, the doctor is interested in the patient’s condition and explains that the desire to be slim and light is activated by learning the methodology of “Actively experienced thought patterns” (NI Sherstennikov Health Reserve. - 2nd ed., Revised. - M.: AIF LLC -Grint ", 2003. - 285 s).

Training in the technique is carried out during a massage session in a massage chair, which acts as a kinesthetic anchor. Massage in the chair is repeated 1 time per month for a year.

The doctor suggests closing his eyes, against the background of calm, pleasant music, mentally stroking his body, imagining that the movement of his hands removes a layer of excess fat tissue and long-term psychological dirt from him. In this work, a person resembles an archaeologist who carefully removes layers of earth and sand in order to remove from them a precious find from the past. You clean off the invisible layers of feelings, layers of children's insults. Somewhere there, in the depths of the subconscious, there is a sensation of a young, strong, slim, beautiful body. Imagine that excess weight and psychological dirt are collected in the form of a heavy, ugly ring on the hips and pulled down. Mentally rotate the basin clockwise, imagining that with this movement an imaginary ring spins. When the ring collects all the excess fat, mentally lower it down to the feet. Then again lift it mentally to the chest, twist and lower it to the floor. And so several times, until you feel that the ring is full and heavy, lower it to the floor, mentally step over it and go ahead without looking back. With great conviction and inner belief that you are losing weight, say the following formula to yourself: “I lost my extra pounds. I left them, I got rid of them. I feel comfortable. I am slim, beautiful, healthy. I will perform regularly recommended physical exercises that will correct the figure. " Then they ask to open their eyes and talk about what they managed to imagine. It is recommended to independently carry out this technique 3-5 times a week for 12 months.

When the patient moves to the stage of "active action", it is recommended that the phrase "I will regularly perform recommended physical exercises that will correct the figure" be entered into the formula pronounced by the patient. After which, patients begin to exercise.

Determine the type of obesity. They recommend performing 10 general massage procedures with rubbing cinnamon aromatic oils into problem areas.

Depending on the type of obesity, exercise is recommended for 15-20 minutes daily for 12 months. For abdominal obesity, which is characterized by excessive deposition of adipose tissue in the abdomen and upper body, exercises to reduce the waist and abdomen are prescribed; for femoral-gluteal or lower type of obesity, exercises are recommended to strengthen the muscles of the buttocks, thighs, with mixed, or intermediate type of obesity recommend exercises to reduce the volume of the waist and abdomen, and exercises to strengthen the muscles of the buttocks, hips (Pravdina N.B. Lose weight with a fairy. Favorite exercises. A practical guide for that to please yourself and others. - St. Petersburg: Publishing House "Neva", 2005. - 160 s).

Exercise to strengthen the legs and hips - “Boat”.

We are sometimes worried about deposits on the hips, they form a "breeches."

Sit on the floor, legs apart as wide as possible. Imagine yourself for a second as a rower in a boat in the midst of stormy waves. However, do not forget that you are a woman, not a boatswain, avoid sudden movements, move smoothly, watch your breath. Keep your legs straight, bending your knees as little as possible. Without lifting your heels off the floor, pull your socks toward you and turn them to the sides. Place your palms of outstretched hands on the floor behind you. Perform a breathing exercise: exhale, inhale through the nose, breathe out through the mouth, hold your breath, lower your head, draw your stomach in. Then move your hands behind your back, bend over and place your hands on the floor directly in front of you. Without lifting your fingers from the floor, move your hands forward, gradually bending lower and lower. Hold in the farthest position, counting to 8. Free your breath, take the initial position. Repeat 3 times. Increase the number of repetitions gradually.

Exercise to strengthen the buttocks - "Strength-5".

This exercise takes only 5 minutes a day, will help to achieve the ideal “waist-hip” ratio, increase tonus, and help you gain confidence in your abilities.

Lie on the floor face up, spread your arms to the sides along the shoulder line with your palms down and bend your knees, placing your feet on the floor. Slowly raise your hips up while keeping your head, shoulders, arms and forearms pressed to the floor. Bend the lower back slightly and tighten the muscles of the buttocks, then smoothly return to the starting position. Do 6-7 sets. This exercise is aimed at improving the shape and tone of the buttocks.

Exercise for the abdomen and hips - "Cat".

It activates the most diverse parts of your body. Spread a rug on the floor. Get down on your palms and knees. Arms and back are straight. Do not tilt your head, look straight ahead. Exhale, inhale, then exhale forcefully and take the main pose: tilt your head and at the same time bend your back, raising it as high as possible. Hold this position for 8-10 accounts. Free your breath, take the initial pose. Repeat the exercise three times and relax. You have a great opportunity to find a slim and beautiful figure.

Daily walks for 25-30 minutes.

At the stage of dynamic observation, a 1-month hypocaloric diet with a reduced calorie content of 800 kcal, with a reduced calorie content of 1200 kcal in the second month, with subsequent adjustment to a value corresponding to the norm of the body's need, 1800 kcal is recommended. (tab. 3, 4.5).

Table 3 An approximate daily set of products of hypocaloric diets used in the treatment of obesity in the clinical nutrition clinic of the Institute of Nutrition RAMS Product set Caloric intake 1800 kcal 1200 kcal 800 kcal Milk 300 200 200 Kefir nonfat 200 200 200 Lean meat 120-150 120-150 one hundred Fish one hundred one hundred one hundred Cottage cheese 200 one hundred one hundred Eggs 1 PC. 1 PC. 1 PC. Butter twenty fifteen 10 Groats twenty fifteen 10 Oil grows. 25 fifteen 10 Sour cream 15-20 10-15 10 Fresh white cabbage 300-400 200-250 150-200 Carrots, tomatoes, other vegetables 300-400 200-300 150-200 Potatoes 200 one hundred one hundred The apples 200 200 one hundred Rye bread 100-150 - -

Table 4 An example of a daily diet of 800 kcal. First breakfast: vegetable salad with rast. oil 150-170 g sugar free coffee 200 g Lunch: An Apple 100 g Dinner: borsch or vegetarian soup 250 g boiled chicken 120 g Snack: rosehip broth 200 g Dinner: vegetable stew 120 g At night: kefir (yogurt, yogurt) without sugar 200 g

Table 5 An example of a daily diet of 1200 kcal. First breakfast: boiled meat 50 g non-starchy vegetables 100-150 g coffee or tea with milk 200 g Lunch: fat-free cottage cheese 100 g tea without sugar with milk 1 tbsp. Dinner: borsch or vegetarian soup Ѕ servings beef stroganoff 50 g vegetable stew 120-150 g. sugar free compote 1 tbsp. Snack: an Apple 100 g (diameter 5-6 cm) Dinner: boiled fish 100 g Boiled potatoes 100 g tea without sugar with milk 1 tbsp. At night: kefir (yogurt, yogurt) without sugar 1 tbsp.

Subsequently, the calorie intake is brought to normal - 1800 kcal.

To develop good nutritional skills, it is recommended to create a table with the rational replacement of high-calorie foods with equivalent and varied foods, but low-calorie ones.

Draw up a plan of action to change the lifestyle, consisting of small, easily completed steps. Stage I - learn not to go to the store on the way home from work; never leave the house hungry for shopping in the store. Stage II - make purchases according to a pre-compiled list; to buy mainly vegetables, fruits and cereals; Before buying, study the composition of the product on the label and give preference to products with a low fat content; Do not buy products containing easily digestible carbohydrates: sugar and sugar-containing sweets; less likely to use foods containing hidden fats: sausages, sausage; Avoid convenience foods. Stage III - to form a stereotype: before a meal, drink a glass of water without gas; start food with low-fat soup or salad; eat in small portions, regularly, at least four times a day; Do not watch TV while eating; do not eat foods while standing; refuse snacks between meals. Stage IV - to consolidate the formed eating habits by performing stages II and III.

At each meeting of the “support visit”, during the 6 months of treatment, once a month, the stage of behavior change is determined and, at the “save results” stage, the patient is praised, approved and encouraged, the phrase “I will support the achieved result” is entered into the formula, and breakdowns are prevented and if the stage of behavioral change is “preliminary,” which indicates a violation of treatment, it is suggested that the effort was not wasted and therefore attempts should be resumed to change eating behavior and continue treatment.

Example 1. Patient S., 42 years old, a housewife, approached about overweight. Weight 87.6 kg, height 169 cm. The patient said that for two years she has noted increased appetite, aggravated after stress and family problems, as a result of which her weight increased by 9 kg in 3 months. In parallel with weight gain, weakness, decreased working capacity, and irritability began to be noted. The often arising psychoemotional tension was "relieved" by using a large number of high-calorie foods. She tried twice to lose weight on her own: first with a diet, then with fasting. However, after the weight loss of 4.5 kg obtained as a result of these measures, I added 7 kg within 1 month. Cerebral and endocrine forms of obesity are excluded.

The patient is located in a chair, she is offered to take a comfortable pose, after which she sets out the desired result: reduce weight by 14 kg and fix the result for a long time.

The psychotherapist conducts a conversation explaining the essence of the disease and the therapy. Then it determines how many kilograms and for what period the patient is recommended to reduce weight, according to the formula proposed by the World Health Organization, determines the value of the body mass index (BMI): BMI = weight (in kg): height ² (m). The doctor 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 mass corresponds to a body mass index of 25 kg / m ² , the weight that the patient will aim to calculate is calculated. The normal weight in this case should be 72.3 kg. Recommended weight loss - 87.6-72.3 = 15.3 kg. The patient is tuned and wants to lose weight in 1 month by 7 kg. However, to prevent a return to the original weight (87.6 kg) and persistently maintain the achieved result, the doctor recommends a course of treatment for 6 months: 1-2 month — weight loss by 3 kg monthly, 3-4 month — by 2, 5 kg per month, then 5-6 months - 2 kg per month.

They conduct an educational lecture on what motivation is and its importance for successful achievement of a result. Significant motivation for weight loss is determined by conversation. The following motivations were revealed in the patient: a desire to change the wardrobe, get a job, improve health.

Determined the stage of readiness for a change in behavior. It was revealed that the patient is at the stage of “reflection”. The doctor explained to her that it was wrong to assume that the transition from stage to stage of changes looked linear. The most common spiral pattern of change. A breakdown is possible at some stage, after which attempts are resumed again. At the same time, a person thinks that he has failed completely and all his hard efforts have been wasted. However, this is not circular motion, but an upward spiral. Then, in order to increase the patient’s readiness for change, the psychotherapist asks her questions during the conversation: What is the meaning of the changes? What are the benefits of change? What will change? Will I be able to? How am I supposed to do this? Do it now? What about other priorities? After receiving the answer to the questions, the therapist realizes that the patient has moved to the next stage of readiness - “preparation”. The psychotherapist explains that the human psyche does not like "prohibitions", it is necessary to agree with her on the appropriateness of the formation of rational eating behavior, weight loss and mandatory physical activity. The patient replied: with a decrease in body weight, my health will improve; I will be more attractive; I decided, then I can achieve the intended results; for this I will follow the doctor’s recommendations. The doctor invites the patient to the session after 2 days.

At the second meeting, the doctor is interested in the patient’s condition and explains that the desire to be slim and light can be activated by teaching the methodology of “Actively experienced thought patterns” and suggests that you sit in a massage chair and turn it on. The patient is offered to close her eyes, against the background of calm, pleasant music, mentally stroking her body, imagining that the movement of her hands removes a layer of excess adipose tissue from him. In this work, a person resembles an archaeologist who carefully removes layers of earth and sand in order to remove from them a precious find from the past. You clean off the invisible layers of feelings, layers of children's insults. Somewhere there, in the depths of the subconscious, there is a sensation of a young, strong, slim, beautiful body. Imagine that excess weight and psychological dirt are collected in the form of a heavy, ugly ring on the hips and pulled down. Mentally rotate the basin clockwise, imagining that with this movement an imaginary ring spins. When the ring collects all the excess fat, mentally lower it down to the feet. Then again lift it mentally to the chest, twist and lower it to the floor. And so several times, until you feel that the ring is full and heavy, lower it to the floor, mentally step over it and go ahead without looking back. With great conviction and inner faith that you are losing weight, say the following formula to yourself: “I lost my excess weight. I left them, I got rid of them. I feel comfortable. I am slim, beautiful, healthy. I will perform regularly recommended physical exercises that will correct the figure. " Then they ask to open their eyes and talk about what they managed to imagine. The patient colorfully told that she presented all the excess weight in the form of fat and removed the layers of fat with her hands from the body. At the same time I felt lightness, the feeling that I got rid of something, there was calm and a feeling that I had a rest. They recommend that the patient pronounce to herself the formula “I lost my extra pounds. I left them, I got rid of them. I feel comfortable. I am slim, beautiful, healthy. I will regularly perform the recommended physical exercises that will correct the figure. " The patient is at the stage of "active action". It is recommended to independently carry out this technique 3-5 times a week for 12 months and begin to perform physical exercises. The phrase “I will regularly perform the recommended exercises that will correct the figure” was introduced into the formula pronounced by the patient. The patient repeated the massage in the chair 1 time per month for 1 year.

Identified femoral-gluteal or lower type of obesity. The patient attended 10 general massage procedures with rubbing cinnamon aromatic oils into problem areas. She performed physical exercises for 15-20 minutes every day for 12 months. Exercise to strengthen the legs and hips - “Boat” and exercise to strengthen the buttocks - “Strength-5”.

I made daily walks for 25-30 minutes.

A lifestyle plan has been developed that consists of small, easy-to-follow steps: Stage I - learn not to enter the store on the way home from work; never leave the house hungry for shopping in the store. Stage II - make purchases according to a pre-compiled list; to buy mainly vegetables, fruits and cereals; Before buying, study the composition of the product on the label and give preference to products with a low fat content; Do not buy products containing easily digestible carbohydrates: sugar and sugar-containing sweets; less likely to use foods containing hidden fats: sausages, sausage; Avoid convenience foods. Stage III - to form a stereotype: before a meal, drink a glass of water without gas; start food with low-fat soup or salad; eat in small portions, regularly, at least four times a day; Do not watch TV while eating; do not eat foods while standing; refuse snacks between meals. Stage IV - to consolidate the formed eating habits by performing stages II and III.

At the stage of dynamic observation, we recommended a 1-month hypocaloric diet with a reduced calorie content of 800 kcal, with a reduced calorie content of 1200 kcal in the second month, followed by bringing it to a value corresponding to the norm of the body's needs - 1800 kcal. During 6 months of treatment, once a month, the patient made “support visits” to control weight loss, change in eating habits and lifestyle, increase self-control for her treatment, and she carries out a plan of measures to change her lifestyle. They revealed that weight is being reduced according to the program outlined at the first meeting.

The patient feels well, notes a lack of increased appetite after some family and domestic troubles. There is no weakness, increased performance, disappeared irritability. The patient is at the 5th stage - “preserving the results”. The phrase “I will support the achieved result” was introduced into the formula, and disruptions were prevented.

Follow-up - after 6 months, the weight decreased by 15 kg and has been held for twelve months. The patient got a job, family relations returned to normal, and the result of the therapy was satisfied.

Thus, the proposed method increases the effectiveness of the treatment of eating disorders in obesity, through a comprehensive program consisting of psychotherapeutic, nutritional aspects and physical activity.

The method allows to form a new stereotype of eating behavior and normalize weight.

The method is available to most people, it is harmless, does not give side effects. The method can be successfully used in medical institutions of any type.

The method is used in the "School of overweight correction" GOU DPO Novokuznetsk State Pedagogical University of Roszdrav during the training of cadets.

Claims (1)

A comprehensive method for the treatment of obesity, including psychotherapy explaining the nature of the disease and the therapy, determining by conversation significant motivation for weight loss, explaining that the human psyche does not like “prohibitions”, you need to agree with her on the appropriateness of proper eating behavior, weight loss and mandatory physical activity, the definition of a weight loss treatment program for the recommended period, the appointment of a diet; training in the methodology of “Actively Experienced Thought Images” with the restoration of physiological memory of a feeling of flexibility, fit, health, strength; saying to yourself the formula: “I lost my extra pounds, I left them, I got rid of them, I’m easy, comfortable, I’m slim, beautiful, healthy, I will regularly perform the recommended physical exercises that will correct my figure” 3-5 times a week for 12 months; performing physical exercises for 15-20 minutes daily for 12 months to correct body parts that need to be given a load depending on the type of physique; Hiking daily for 25-30 minutes; at the stage of dynamic observation, one month a low-calorie diet with a reduced calorie content of 800 kcal, in the second month - 1200 kcal, followed by a calorie adjustment to a value corresponding to the body’s needs - 1800 kcal; during 6 months of treatment, once a month, “support visits” are carried out to monitor weight loss, change in eating habits, the formation of good nutrition skills and a healthy lifestyle, increase personal responsibility for their treatment, characterized in that the training is in the methodology of “Actively experienced thoughts "Carried out during a massage in a massage chair, which acts as a kinesthetic anchor, further massage in the chair is repeated 1 time per month for 1 year, depending on the type of obesity daily 10 general massage procedures with rubbing cinnamon aromatic oils into problem areas; at the beginning of treatment, the stage of readiness for changing the patient’s behavior is determined and during the treatment process it is transferred from one stage of readiness to the next stage, with correction for breakdowns and departure from the intended program, for this, when determining the patient’s motivation for weight loss, they determine the stage of readiness to change the patient’s behavior, asking questions: what is the meaning of the changes, what are the benefits of the changes, what will change, whether he can whether to do it now, whether there are other priorities that motivate the patient to go to the “preparation” readiness stage, control changes in eating habits and dietary stereotypes, analyze the reasons that impede the patient’s lifestyle changes, develop an action plan to change the lifestyle, consisting of small, easily completed stages: Stage I - learn not to go to the store on the way home from work; never leave the house hungry for shopping in the store; Stage II - make purchases according to a pre-compiled list; to buy mainly vegetables, fruits and cereals; Before buying, study the composition of the product on the label and give preference to products with a low fat content; Do not buy products containing easily digestible carbohydrates: sugar and sugar-containing sweets; less likely to use foods containing hidden fats: sausages, sausage; avoid semi-finished products; Stage III - to form a stereotype: before a meal, drink a glass of water without gas; start food with low-fat soup or salad; eat in small portions, regularly, at least four times a day; Do not watch TV while eating; do not eat foods while standing; refuse snacks between meals; Stage IV - to consolidate the formed eating habits by performing stages II and III; when the patient moves to the stage of “active action”, it is recommended that the phrase “I will regularly perform the recommended physical exercises that will correct the figure” be entered into the formula pronounced by the patient, after which the patients begin to perform physical exercises, at each meeting of the “support visit” they determine the stage of behavior change and at the stage of “preservation of results” they praise, approve and encourage the patient, enter the phrase “I will support the achieved result” into the formula, prevent disruptions, and if ene Stages of Change "preliminary", indicating that the abuse treatment, then taught that effort well spent, and therefore it is necessary to renew attempts to change eating behavior and continue treatment.