Biopsychosocial model of excess weight gain

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Obesity must be treated and this need is justified by its adverse effects on the body. Adults who are overweight (BMI greater than 25) or obese (BMI greater than 30) are at increased risk of early mortality and are more susceptible to many health conditions, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea. , problems with blood vessels and heart. Recent data shows that 20% of people who die from cancer are obese, making it the second leading risk factor after smoking for developing the deadly disease. Obesity affects the economy, and among its psychosocial consequences, scientists identify neglect of one's appearance, deterioration in quality of life and deep depression. The severity of the problem is influenced by its prevalence. This is especially obvious in America: the Center for Disease Control notes that 34% of Americans are overweight, and 31% are truly obese. Consequently, 65% of the nation has a BMI of more than 25, while back in 1994 this number was 56%, and in 1980 it was 46. Over the past 20 years, the number of obese people has almost doubled. In Russia, the numbers are less critical, but still cause concern: 40% of the population is overweight, some of these people are truly obese. Globally, the World Health Association is concerned about obesity and calls for action. Fortunately, to significantly reduce the chance of negative consequences, an obese person usually only needs to lose 10% of their total weight. This slight reduction has a positive effect on blood sugar levels, blood pressure and blood composition.

Assessing the scope of the problem

Initially, how negatively weight affects the chances of early mortality was determined by the ratio of actual weight to ideal weight. And that, in turn, was calculated depending on height, gender and statistics collected by insurance companies - they had the opportunity to assess whether people with what weight die more often. However, this concept of ideal weight had a significant drawback: it was determined by those people who could afford life insurance, and these were predominantly men, and from the middle class and above. It was also calculated based on the fact of death itself, and not on what caused it - therefore, it was difficult to assess how much susceptibility to disease is at what weight. In the last decade, the concept of ideal weight has been replaced by BMI, which is calculated differently based on weight in kilograms and height in square meters. To evaluate it, you can use the table.

This is what the BMI categories look like, according to the World Health Association classification.
In general, the higher it is, the higher the risk of developing diseases and, as a result, death. The risk also depends on the amount of visceral fat. Several large epidemiological studies have shown that, regardless of BMI, the more abdominal fat, the greater the risk of developing coronary heart disease, hypertension, stroke, sleep disorders (even sleep apnea, which affects the brain and... for which you can choke). Find out the causes of excess weight and ways to quickly lose weight

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Studies using CT scans have shown that, among patients with the same level of obesity, those with high levels of visceral fat suffered more from disease. Therefore, it is a clinical indication for computed tomography and resonance imaging of adipose tissue. The level of abdominal fat is determined by waist circumference. In women, a volume above 90 centimeters is considered dangerous, in men more than 100. It should be measured around the abdomen, at the level of the iliac crest (it is located below the navel, where the sharp bones protrude). People with a BMI above 35 do not have their waist circumference measured because the risk is already very significant. But, fortunately, there are now many obesity treatment methods that can help cope with this problem.

Etiology

The underlying cause of obesity is very simple - positive energy balance (that is, consuming more calories than the body needs). But the factors that cause such an imbalance are numerous and varied. For example, these include metabolism and hormonal balance, which determine the weight range in which a person will remain throughout his life. And while behavioral factors are also responsible for the prevalence of obesity, up to 70% of how much a person will weigh depends on genetic factors. More than 300 genes are associated with obesity (although problems with just one of them will not be enough to cause the disease). On the subject: Get rid of wrinkles on the neck At the same time, genetic predisposition does not mean that a person cannot lose weight so much that it affects his health. It means that the same changes in habitual diet and activity level in different people, with different genes, will give completely different results.

Factors influencing the development of obesity:

• Genetic predisposition. The formation of obesity is genetically determined. There are many studies of families, extended pedigrees and twins whose relatives had non-insulin-dependent diabetes mellitus . The results of these studies have led to the firm belief that insulin resistance is genetically determined.

• Excessive nutrition. The most important environmental factors contributing to the development of obesity are excess consumption of fatty foods and low physical activity. The basis for the accumulation of fat mass in the body is overeating animal fats containing saturated fatty acids. If the mass of fat consumed exceeds the body's ability to oxidize it, then obesity develops and progresses.

• Obstructive sleep apnea syndrome (stopping breathing) during sleep. The syndrome often accompanies obesity, and the combination of these conditions is now commonly referred to as syndrome Z. Obesity is the main risk factor for the development of obstructive sleep apnea, which affects 50% of obese people. On the other hand, if this condition develops in connection with the presence of other risk factors (any reason leading to disruption of normal nasal breathing), obesity may be a consequence of breathing disorders during sleep. As a result of chronic hypoxia during sleep, there are no nightly peaks in the release of somatotropic hormone, which contributes to the development of insulin resistance. The effect of weight change on obstructive sleep apnea has been extensively studied in clinical studies. Fasting and post-exercise glucose levels increased depending on the severity of the syndrome.

• Physical inactivity. Decreased physical activity is the second most important environmental factor after overeating, contributing to the development of obesity and insulin resistance. With physical inactivity, the metabolism of fats, the utilization of their intermediate products of transformation into muscle and adipose tissue slow down, and the consumption of glucose by muscles decreases, which leads to the development of insulin resistance.

• Arterial hypertension. In some cases, arterial hypertension may be the primary link in the mechanism of obesity development. Long-term, untreated or poorly treated arterial hypertension causes deterioration of peripheral circulation, which leads to a decrease in tissue sensitivity to insulin and, as a consequence, to a relative increase in the level of insulin in the blood and insulin resistance.

Principles of obesity treatment:

The cornerstone that is followed in the treatment of metabolic syndrome is non-drug measures aimed at reducing body weight, changing eating patterns, giving up bad habits such as smoking and alcohol abuse, increasing physical activity, i.e.
formation of a so-called healthy lifestyle. Non-drug treatment is more physiological and accessible. The non-drug treatment program for metabolic syndrome at our clinic includes dietary interventions and exercise that result in a reduction in obesity. Losing body weight helps correct metabolic disorders, increase tissue sensitivity to insulin and lower blood pressure, significantly reducing and delaying the risk of complications. If non-drug treatment methods are insufficiently effective or there are certain indications, the need for drug correction of body weight arises, but these measures are also carried out against the background of ongoing non-drug treatment of obesity.

Non-drug treatment of obesity:

Weight loss in patients with obesity and arterial hypertension should occur gradually and smoothly. At the same time, it is not necessary to reduce weight to “ideal” levels. It is enough to reduce it by 5-10% from the original. Rapid weight loss, on the contrary, can become a certain stress for the body and have dire consequences.

Non-drug weight loss interventions include:

• moderate hypocaloric diet
• healthy lifestyle with changing eating habits
• keeping a food diary
• physical exercise

Reasons for gaining excess weight

Obesity reduces life expectancy by an average of 3-5 years with moderate excess weight and up to 15 years with severe obesity. The need for food is one of the primary biological needs; it is aimed at maintaining life. Eating behavior includes attitudes, behaviors, habits and emotions related to food that are individual to each person.

Although nutrition is certainly a physiological need, the psychological component plays a huge role in our eating behavior. Currently, there is a biopsychosocial model that comprehensively examines the causes of excess weight accumulation and the possibilities of getting rid of it.

1) Biological reasons (but do not exaggerate their importance!)

Sedentary lifestyle Hereditary predisposition State of energy metabolism And in passing, we note that the biological component of excess weight largely depends on the psychological component.

2) The reasons are psychological. Psychological dependence on food. Food is used to correct mood, similar to alcohol or nicotine. If men “drench” grief and boredom with alcohol, then women “melt” their negative emotions into fat. Cakes and chocolates improve your mood and do not cause censure from society. Hyperphagic stress response – when food is consumed during or after stress. Using food for more successful socialization: to improve communication with loved ones, colleagues, friends.

Rational nutrition system for obesity:

The main and most physiological method of treatment is considered to be rational nutrition. The concept of “rational nutrition” includes not only the consumption of “healthy” and the exclusion of “harmful” foods, a rational diet, the right combination of foods, methods of preparing food without fat, but also certain behavior during each meal.

Under no circumstances should you allow yourself to go hungry. Fasting is not an acceptable treatment for obesity . During fasting, human tissue cells do not receive glucose, the main source of energy, and switch to an alternative source of nutrition - fats. As a result of the breakdown of one's own fat depots, free fatty acids accumulate, and their excess is destroyed with the formation of ketone bodies. In this regard, our experts recommend that the patient limit his daily calorie intake in a way that the patient can adhere to for life without a constant feeling of hunger, decreased mood and deterioration in well-being. Short-term medicinal and non-medicinal measures aimed at weight loss are not justified. You cannot sharply limit caloric intake for a short period of time, because this does not help to change the eating pattern, but contributes to a compensatory decrease in the basal metabolic rate and, consequently, rapid weight gain after stopping this dietary regimen.

Eating habits:

When creating a balanced diet, our endocrinologists will help you calculate the number of calories that can be consumed per day, taking into account individual energy consumption. Based on the daily calorie intake, a menu for the whole day is compiled. At the same time, it is possible to consume foods taking into account your usual preferences .

Particular attention to rational nutrition should be paid not only to people who are already obese, but also to those who have a hereditary predisposition to obesity, diabetes, arterial hypertension and atherosclerosis. In this case, proper nutrition will serve as a means of preventing the development of these diseases.

Since unhealthy eating behavior and habits in obese patients develop over decades, they need to be changed gradually, over a long period of time. Weight loss of 2-4 kg per month is considered harmless to health. Obese patients are not able to cope with such tasks on their own. An important role in helping the patient is given to the attending physician - an endocrinologist. However, it is important that the patient himself takes an active position and strives to change his lifestyle.

Keeping a food diary:

Keeping a food diary helps patients change their eating behavior. This disciplines the patient, helps to streamline the diet, forming a conscious attitude towards changing the diet and quality of nutrition. Before starting to work on changing his diet and in the process of acquiring rational nutrition skills, the patient must, at least once a week, describe each of his meals for the whole day: time of reception, number of servings and name of products. Then analyze your notes yourself, or better yet with the help of a doctor. Keeping a food diary helps the patient understand mistakes in choosing foods and their quantity.

Obesity overeating

“Yes, how long do I eat there? I hardly eat anything, but the weight is still creeping up. And where does it come from?” - have you encountered similar reasoning from a fat person, or perhaps you say so yourself?

In fact, weight gain can only occur if a person eats more calories than he expends (we do not take into account complex genetic diseases or serious metabolic disorders, when obesity is caused by health problems). So excess weight is almost always a consequence of overeating and excessive caloric intake.

It may seem like you eat almost nothing, but it’s that same coffee and cookies consumed at work every 2 hours to unwind that turns you from slender to fat. An abundance of simple carbohydrates in your diet, a love of baking and sweets, the habit of adding extra to yourself, regular all-inclusive vacations, three-course lunches, fast food dinners on weekends - this is what ruins you.

With obesity, overeating and an excess of simple carbohydrates, fat deposits accumulate in the upper part of the body: on the face, around the neck, in the chest area, on the abdomen. And the arms and legs can remain quite thin.

To start losing weight with this type of obesity, you need:

• Strictly limit sweets, any confectionery, pastries, sugar, starchy carbohydrates (if you don’t know how to dose sweets, then it’s better to give them up completely until you pull yourself together).
• Replace the usual sweets with dried fruits, nuts, fruits, berries, natural jelly and pastilles made from them based on agar-agar.
• Eliminate from your diet any carbonated drinks and store-bought juices (they contain a lot of sugar!), fast food, processed foods, dishes and foods that contain mayonnaise or margarine (as well as any other hydrogenated fats), highly fatty and fried foods.
• Reduce the amount of sugar you add to food and drinks when preparing (you can train yourself to drink tea and coffee without sugar at all or add zero-calorie stevia to them).
• Adjust your drinking regime by starting to drink 1.5-2 liters of purified water per day.
• Start drinking a glass of water in the morning on an empty stomach and an hour before bedtime, a glass half an hour before each meal and an hour after, stop drinking water during meals.
• Buy a gym membership and exercise 2-3 times a week for 1-1.5 hours, focusing on cardio (or at least train at home daily for 30-45 minutes).

Please note that sometimes obese binge eating is confused with an eating disorder, specifically binge eating disorder. To understand what you are dealing with: a banal lack of willpower and restraint or, after all, an eating disorder, differentiate according to the main manifestations.

Thus, with a normal eating disorder, a person states his love for tasty food, he admits that he often eats for company, while watching TV or reading a book, out of boredom and lack of emotions. If we are talking about compulsive overeating, then you will be faced with the fact that a person eats on the sly, when no one sees, more often he overeats at night or alone, while in public demonstrating restraint in portions.

After overeating, he is tormented by a feeling of guilt and shame, he engages in self-flagellation and may even punish himself for another weakness. A nutrition consultant can understand this quite simply - you just need to ask leading questions and monitor the answers or at least the client’s reaction (people with eating disorders often hide their difficult relationship with food, trying to look completely adequate).

A nutritionist whose course is aimed at helping people with compulsive overeating should first of all use psychotherapy techniques, and only then adjust the diet towards reducing portions and calories.

Physical activity for obesity:

Increasing physical activity is very important and should be considered a necessary part of a weight loss program. It is known that increasing physical activity not only promotes greater weight loss, but also allows you to maintain the achieved results. Before starting classes and choosing the type of physical exercise, the patient should consult a doctor. Physical activity and exercise should be enjoyable and well tolerated .

If, for health reasons, a doctor prohibits a patient from doing aerobics and shaping, this does not mean that physical activity cannot be increased. The simplest but most effective way to increase physical activity is walking. Moreover, it is not the pace of walking that is important, but the distance traveled. One hour of walking burns 400 kcal, and jogging for 20-30 minutes only 250-375 kcal. Physical activity may include playing, walking, gardening, or playing sports such as swimming.

Fighting obesity: first steps

August 18, 2011

You can get rid of excess weight, but you need to know a few rules: medical examination, correct training and taking care of your heart.

Losing weight in obese people is not an easy process.
This is not just an improvement in external data according to the “golden formula” - eat less and move more. One of the main aspects in the fight against obesity is strengthening the cardiovascular system and creating positive motivation for physical activity.
Marina Makarova, head of the exercise therapy department of the Center for Restorative Medicine and Rehabilitation of the Treatment and Rehabilitation Center of the Ministry of Health and Social Development of Russia, talks about where very overweight people should start exercising.

All roads lead to a doctor

If obesity of at least the second degree has already developed, then the fight against excess weight cannot consist only of increasing physical activity and reducing calorie intake. “The effect of a large number of extra pounds on the body does not simply go away,” notes Makarova. It is necessary to increase physical activity under the supervision of a doctor
. You will need an examination of the cardiovascular and respiratory systems, blood vessels of the extremities and the condition of the musculoskeletal system. The data obtained will help determine whether it is worth increasing physical activity without restrictions. Otherwise, treatment and additional use of medications will be required.

Main muscle

Don't start a new life on Monday and study until you're exhausted. To begin with, an obese person needs training of the cardiovascular system
, and only then – active burning of fats and strengthening muscles.
After all, if the heart is not sufficiently trained, further increasing the load will only worsen its condition. In addition, excess load and subsequent fatigue, pain in muscles and joints and increased appetite contribute to the appearance of a defeatist mood
and refusal to try to get in good shape.

The simplest workout

A frequent companion to obesity is disturbances in the functioning of the cardiovascular system. Therefore, if problems with blood circulation do not affect the lower extremities, the maximum load in the form of walking
is indicated to gradually improve heart function.
“In addition, walking, despite its apparent simplicity, is a very physiological activity,” says Makarova, “during which almost the entire body begins to work: not only the legs, but also the muscles of the back and arms.” Start your workouts with a comfortable step. If you don’t yet have joint problems that
, then you can walk almost indefinitely. Despite the fact that walking is a cyclic load, consisting of repetition of the same movements, it cannot be called monotonous and boring. Even a walk through a familiar area of ​​the city is always a new experience.

Carry on - with charging

strengthening muscles
is recommended for obese people . First of all, the back muscles. With excess weight and lack of load, they gradually lose the ability to support the spine, and the intervertebral discs have to support the body weight. This causes pain and discomfort. And it is because of them that an overweight person often refuses physical activity altogether. The thigh muscles also need training to remove excess stress from the hip and knee joints, which can experience degenerative changes over time due to excess weight. Also spend time strengthening your gluteal and calf muscles.

If you want to go to the gym

Men are most often bored with gymnastics and prefer weight machines
.
But start classes after the approval of your doctor, and they should only take place under the strict supervision of the instructor. Select the load in such a way that you can do at least 20 repetitions of one movement, and the classes last at least 45 minutes - then the cardiovascular system will also have time to get involved. cyclic cardio training
in your gym program . For example, on an exercise bike or elliptical trainer. After all, the first goal of physical activity in the fight against obesity is to improve the condition of the cardiovascular system.

The most important

Before increasing exercise, obese people should be examined by a doctor.
Start your workouts with comfortable walking and light exercise that strengthens your muscles. You can also exercise in the gym, but under the supervision of a trainer and not forgetting about training the cardiovascular system. Tags:

• Heart and blood vessels
• Diets
• Overweight
• Safety
• Weight loss
• Therapeutic diets

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• aris2907 tell me, is running before bed effective or should you only do it in the morning?

Obesity – the “plague” of the 21st century

Obesity, as recognized by the World Health Organization, is considered a non-infectious epidemic of the present time due to its widespread prevalence among the population, high risk of developing cardiovascular diseases, early disability of patients and premature mortality. According to the World Health Organization, about 30% of the world's inhabitants are overweight, of which 16% are women and 14% are men. The number of obese people progressively increases by 10% every 10 years.

Obese people are 50% more likely to develop hypertension than people of normal weight. According to studies, for every extra 4.5 kg of weight, systolic (upper) blood pressure increases by 4.4 mm Hg. in men and by 4.2 mm Hg. among women. A number of studies have revealed a direct proportional relationship between body weight and overall mortality. Obesity of the first degree increases the risk of developing non-insulin-dependent diabetes mellitus by 3 times, of the second degree by 5 times and of the third degree by 10 times.

Of particular danger is the central type of obesity with predominant fat deposition in the abdominal area - abdominal obesity. The frequent combination of internal obesity, disorders of carbohydrate and lipid metabolism, breathing disorders during sleep, arterial hypertension and the presence of a close connection in the developmental mechanisms between them served as the basis for distinguishing them into an independent syndrome - metabolic.

Experts from the World Health Organization assessed the situation regarding the prevalence of metabolic syndrome as follows: “We are facing a new pandemic of the 21st century, covering industrialized countries. This could be a demographic disaster for developing countries. The prevalence of metabolic syndrome is 2 times higher than the prevalence of diabetes, and its growth rate is expected to increase by 50% in the next 25 years.”

At the same time, extra pounds significantly increase the risk of developing such serious diseases as arterial hypertension, type II diabetes mellitus, and coronary heart disease, so it is very important to monitor your weight. Endocrinologists at our clinic will help you bring your weight back to normal.

How to determine if you are obese

You can understand how much your body weight has increased by calculating its index. To do this, you need to divide your weight in kilograms by the value obtained by squaring your height in meters. In people with normal weight, the BMI should not exceed 25. Sometimes treatment for obesity in men and women may be necessary, even if the problem is not noticeable outwardly. If the BMI is from 25 to 30, then the excess is insignificant, and a person, in the absence of health problems, may not go to obesity treatment clinics; it is enough to follow a diet so that the weight returns to normal. If the BMI exceeds 30, then treatment for grade 1 obesity is necessary.

There is a simpler way to find out if obesity treatment is needed that doesn't involve weighing yourself. After measuring your waist circumference, compare the resulting figure with the maximum for normal weight. If obesity is detected in women, treatment should begin with a mark on the measuring tape of 88 cm. For men, this figure is 102 cm.

The BMI value is a relative indicator of the presence of obesity. You can reliably find out whether excess weight is dangerous for your health and life by contacting a specialist. Very often, stage 3 obesity cannot be treated independently. This is due to the reasons for the deposition of excess fat.