RU2525007C1 - Method for correction of abdominal obesity - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: method involves a patient's face exposure to full-spectrum natural or artificial light of light intensity not less than 2000 lux for 1-2 hours a day combined with or followed by an exercise load. Additionally, an eating disorder is typed and corrected using psychophysiological techniques. A caloric value of a diet is specified by reducing the patient's regular mean daily energy requirement per a percentage equal to the patient's body weight index with lipid restriction to 40-60 g/day for a period of 6 months with fasting days once every 1-2 weeks. The exercise load is performed in an anaerobic gradual regimen with no weight and resistance on muscle groups of the upper body and waist, with a power load on muscle groups of the lower body until muscular fatigue in the number of 2-3 sets with a rest. They are combined with or followed by a prolonged exercise load at least 4 times a week for 40-60 min in an aerobic regimen with 2-3 acceleration episodes of 3-5 minutes. They are combined with drug-free procedures aiming at improving the regional blood flow, improving the muscular tonus of the anterior abdominal wall and sides, the greater muscle groups of the upper body. If the patient has no insulin resistance syndrome or the sugar blood level less than or equal to 6.1 mmole/l, preparations and biologically active additives containing lipoic acid and vitamin Bare administered. If the patient suffers from insulin resistance syndrome and/or a fasting glucose level of more than 6.1 mmole/l, the preparations of biguanidines containing metformin are prescribed. Diet mistakes require prescribing preparations of lipase inhibitors containing orlistat.EFFECT: higher therapeutic effectiveness taking into account a degree of obesity with reducing side effects of therapy.9 cl, 6 tbl, 3 ex

Description

The method relates to medicine and can be used to correct excess body weight, in particular with abdominal type obesity.

In clinical medicine, obesity is considered as a polyetiological disease, while primary obesity of an alimentary-constitutional nature is the most common and occurs in 70-85% of cases. The development of primary obesity may be due to the action of both endogenous (genetic, physiological, behavioral) and exogenous (lifestyle, inadequate nutrition, social status, economic well-being) factors. Their action is aimed at balancing the processes “energy consumption - energy consumption”. In obesity, this balance is biased towards the absolute or relative prevalence of energy consumption over energy expenditure (1, 2, 3).

The attention of specialists is mainly attracted to abdominal type obesity, since it is it that acts as an independent risk factor for cardiovascular diseases, insulin resistance, type 2 diabetes mellitus, atherosclerosis, and other conditions that accelerate the aging process of the body (4). Abdominal obesity is a common cause of anovulatory infertility and miscarriage (5).

Overweight and obesity are classified based on the WHO body weight classification based on body mass index (BMI). BMI in the range of 25.0-29.9 kg / m ² corresponds to overweight or obesity, 30-34.9 kg / m ² corresponds to obesity of the first degree, 35.0-39.9 kg / m ² to obesity II degrees, 40 and more kg / m ² - obesity III degree.

Abdominal type obesity is detected based on the ratio of waist circumference (OT) to hip circumference (OB): when the ratio is more than 0.85 cu for women and 0.95 cu men are diagnosed with abdominal obesity. This type of obesity occurs in men in 80% of cases, in women - in 55% of cases (6).

Almost all known methods and approaches to correcting body weight are based mainly on reducing the processes of energy consumption and increasing the processes of energy consumption, while often they do not take into account the type and degree of obesity. Methods for correcting body weight, taking into account the type of obesity, are currently not developed. This explains the low effectiveness of treating obesity and frequent relapses of this disease.

There are known constitutional, endocrine-metabolic and psychophysiological features characteristic of the abdominal type of obesity (7). With the abdominal type of obesity, adipose tissue accumulates mainly in the intra-abdominal space, while the level of energy transfer in these patients is normal or elevated, insulin resistance and postprandial hyperglycemia for carbohydrate load, absolute hyperinsulinemia, dyslipidemia, increased basal level of cortisol in the blood and lack of stress are revealed . These features largely determine the predominantly external (less often emotional) type of eating disorders that occurs in patients with abdominal type of obesity, a decrease in the feeling of fullness, and an increase in fat intake in the diet.

The following approaches are used in the treatment of obesity: fasting, diet therapy, physical activity (physiotherapy exercises), drug therapy, physiotherapy, psychotherapy, and surgical treatment methods. These methods are used both in the form of monotherapy and in combination (8).

A known method of treating patients with obesity (9) by low-calorie diet therapy with the restriction of carbohydrate-containing foods and fats. To do this, reduce caloric intake to 1200 kcal, the proportion of fat in the diet should be 25%, the amount of carbohydrates 55% of the daily calorie content, including carbohydrate-containing foods with a glycemic index less than 40 in the diet. With a decrease in the initial body weight by 5% and weight stabilization for 3 months increase calorie content to an estimated value, determined by the formula for calculating daily calories recommended by WHO, taking into account gender, age, weight and physical activity. At the same time, carbohydrate-containing products with a glycemic index of 40-69 are introduced into the diet to reduce weight to a predetermined level. The specified method is not effective enough for abdominal type of obesity. This is due to the fact that it is based on a standard diet with a calorie content of 1200 kcal without taking into account the type and degree of obesity. In addition, restricting the intake of foods with a high glycemic index is ineffective in individuals with external eating disorder, which is most characteristic of abdominal type of obesity. The lack of effectiveness of the method is also due to the fact that it is limited by dietary correction, when used as monotherapy, they reduce consumption levels, but do not stimulate the body's energy expenditure.

A known method of treating obesity (10), including the formation in the patient of aversion to high-calorie foods. This is achieved by conducting indirect psychotherapy in an environment of color and light accompaniment. Conduct behavioral psychotherapy aimed at the formation of an aversion to the specified product by visualizing this product and disgusting objects. Then conduct group training of psychological stability 10 times for 2 hours every other day. The disadvantage of this method is its low efficiency in the treatment of obesity of the abdominal type. This is due to the fact that its implementation leads to a decrease in the level of energy consumption (i.e. consumption of high-calorie foods), but the level of energy expenditure of the body does not increase. In addition, not all high-calorie foods can cause an aversion. Other disadvantages of this method include the fact that one part of the patients is resistant to psychotherapeutic effects, the other is excessively susceptible, which leads to a persistent aversion to food and subsequent depletion of the body. In addition, an aversion to certain foods causes psychological discomfort in patients both during and after treatment.

A known method for the treatment of obesity (11), including psycho-correction of eating behavior by the marathon method under conditions of asthenia to achieve failure of biorhythms and behavioral stereotypes, the formation of motivation for a healthy diet, attitudes towards success and self-confidence, diet therapy, self-monitoring of eating behavior, psychological defense in case of a situation violations of the diet, psychotherapeutic effects aimed at consolidating the results. Diet therapy includes reducing the calorie intake due to the restriction of carbohydrates, which are especially easily digestible, the exclusion of animal fats from the diet, the inclusion of proteins, fruits and berries (except bananas), vegetables (except potatoes), the exclusion of beer and other alcoholic beverages, and limiting the consumption of salted foods , an exception to the diet of spices and seasonings. The disadvantages of this method include the fact that astenisation and failure of biorhythms in the future can lead to exacerbation of chronic diseases, aggravation of somnological disorders, such as sleep apnea syndrome and Pickwick syndrome, which are already quite common in people with abdominal obesity. Recommendations for diet therapy are not specified, in particular, the recommended number of calories consumed for a particular patient, the timing of compliance with dietary recommendations, and the possibility of expanding the diet are not indicated. This method also does not include measures aimed at increasing the level of energy consumption. This method also does not provide for the possibility of the development of compensatory-adaptive reactions of the body, manifested by the development of "food depression" and a decrease in the level of energy exchange, in response to a decrease in calorie intake, which will lead to low efficiency and, possibly, refusal to continue treatment.

There is a method of treating obesity with an external type of eating disorder (12). During the analysis of the anamnesis and by means of questioning, violations of eating behavior are detected, an active positive emotional-volitional motivation for weight loss is formed, the main representative system of perception of information by the patient is determined (visual, auditory or kinesthetic), a formula for altering the eating behavioral stereotype aimed at normalizing is compiled in an awake state 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; at the second session, immerse the patient in a trance state and conduct a session of suggestion of stimulation of early saturation to prevent overeating; prescribe a standard calorie diet at the initial stage of 1000 kcal / day, then 1200 kcal / day, followed by bringing the daily calorie content to a value that corresponds to the normal needs of the body; repeat psychocorrection sessions according to a certain pattern for 3 months. The specified method is not effective enough for abdominal type of obesity. This is due to the fact that when forming a diet they do not take into account the degree of obesity and the usual daily calorie intake; the method does not allow to activate energy metabolism and thereby increase the expenditure of the energy balance of the body.

A known method of treating obesity in eating disorders (13), including rational psychotherapy, taking into account representative perceptual systems aimed at creating readiness for psychocorrection, motivation for weight loss; conducting a session of suggestive psychotherapy “Butterfly”, in which the patient is told about the butterfly’s development path: a caterpillar — a pupa — a butterfly, associate the butterfly with lightness, freedom, beauty and associate the acquisition of these qualities by the patient during the course of treatment for obesity; patient training for autogenous training; after the first psychocorrection session, a “Rainbow” diet (including multi-colored products) is prescribed once a week for 6 months 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 norm of the body’s needs; at the same time appoint daily walks of 30-40 minutes and climb stairs without an elevator for 10-15 minutes; designate the patient to wear a bracelet or ring, adjustable in size depending on the stage of treatment, the corresponding stage "caterpillar", "pupa", "butterfly" with the corresponding symbols; under a bracelet or ring on the skin paste a patch measuring 0.5 × 0.5 cm containing cinnamon; pressurize a ring or bracelet 3-4 times a day with meals; wear a jug filled with cinnamon for 6 months. Instead of breakfast and dinner, daily dietary therapy includes the Altera Slim cocktail diluted in water, and dishes with a butterfly image are used for eating and drinking. This method is not effective enough for the abdominal type of obesity. This is due to the fact that diet therapy is carried out without taking into account the degree of obesity, the characteristics of eating behavior. Another disadvantage is that physical activity is not dosed, focused on the individual characteristics of the patient. In particular, one of the proposed types of physical activity in the form of climbing stairs without an elevator for 10-15 minutes is heavy in intensity and can provoke a rise in blood pressure or an attack of angina pectoris. Another disadvantage is that in the method the main emphasis is on psychocorrection, which makes the method ineffective for people who are resistant to psychotherapeutic effects. Linking diet therapy to Altera Slim cocktail also limits the use of this method. Great attention in the implementation of this method to the symbolism of the butterfly on rings, amulets, dishes makes it difficult to implement the method in a professional setting (primarily for men).

A known method of treating obesity (14), including the intake of low-calorie food, is simultaneously prescribed medication to the patient, which is carried out by daily intravenous administration of a drug containing thioctic acid (thioctacid) in a dose of 600 mg for 10 days, then this drug is prescribed in tablets in that same dose in the morning 30 minutes before breakfast for 1-2 months. This method is not effective for abdominal type obesity. This is due to the fact that drug therapy using thioctacide is limited mainly by a decrease in insulin resistance, but does not reduce appetite. In addition, taking the indicated therapeutic doses of thioctacide (600 mg) can lead to the development of hypoglycemic conditions, especially against the background of a hypocaloric diet. Another disadvantage of this method is the lack of an indication of the recommended amount of calories consumed for the patient when using hypocaloric food and the lack of consideration for the degree of obesity. In addition, the method does not allow to activate energy metabolism and thereby increase the expenditure of the energy balance of the body.

Closest to the claimed is a method of correcting a person’s body weight, including the use of fasting, low-calorie food, dosed physical activity. Patients are prescribed 3-4-day fasting without limiting fluid intake, consuming low-fat or low-fat foods for one to two consecutive days of starvation, then daily consumption of low-calorie foods 1000-1200 kcal / day until 12-14 days start of treatment; daily exposure to the patient from the face with full-spectrum natural or artificial light with an illumination intensity of at least 2000 lux for 1-2 hours a day at the same time or alternately with daily physical activity (15). This method is not effective for abdominal type obesity and leads to undesirable side effects. This is due to the fact that it does not provide for the correction of the insulin resistance syndrome characteristic of this type of obesity, does not take into account the degree of obesity. The prescribed physical activities do not take into account the specifics of the distribution of body fat in obesity of the abdominal type. In addition, fasting, in addition to other side effects (lowering blood pressure, tachycardia), leads to a decrease in the amount of muscle tissue, which is the main site of lipid oxidation. Another disadvantage of this method is that the standard low-calorie diet of 1000-1200 kcal / day does not take into account the individual characteristics of patients and is difficult to tolerate, especially with the 3rd degree of obesity.

The problem to which the invention is directed, is to increase the effectiveness of the treatment of abdominal obesity, to reduce side effects.

The solution to this problem is achieved by the fact that they additionally determine the type of eating disorder, carry out its psychophysiological correction; determine the individually recommended caloric value of the diet by reducing the patient’s usual daily average energy requirement by a percentage equal to the patient’s body mass index; the calorie content of the diet is determined by reducing the usual average daily energy requirement of the patient by a percentage equal to the patient’s body mass index, with fat restriction up to 40-60 g / day for up to 6 months with fasting days 1 time in 1-2 weeks; physical exercises are carried out in an aerobic dosed mode without burdening and resistance to the muscle groups of the upper half of the body and waist, with power loads on the muscle groups of the lower body until the muscles become tired in 2-3 sets of rest; simultaneously or after their completion, prolonged physical activity is performed for at least 4 days a week for 40-60 minutes in aerobic mode with 2-3 episodes of acceleration for 3-5 minutes; at the same time, daily non-drug procedures are carried out aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and lateral surface of the trunk, large muscle groups of the upper half of the body; in the absence of a patient's insulin resistance syndrome or blood sugar level of less than or equal to 6.1 mmol / l, medications or dietary supplements containing thioctic acid, vitamin B ₁ are prescribed; in the presence of insulin resistance syndrome and / or fasting glucose of more than 6.1 mmol / l, medications from the biguanide class containing metformin are additionally prescribed; in the presence of errors in the diet, medications are prescribed that belong to the group of lipase inhibitors containing orlistat; taking preparations containing thioctic acid is carried out in a dose of 100-200 mg of thioctic acid simultaneously with taking a preparation containing vitamin B ₁ at a dose of 5-10 mg of vitamin B ₁ per day in the morning for 1 month; the course of this drug correction is repeated after 2 months; “Siofor”, or “Glucophage”, or “Metfogamma-500”, or “Metfogamma-850” are used as medicines from the biguanide group; “Xenical” or “Orsoten” are used as agents from the group of lipase inhibitors; as non-pharmacological procedures aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and sides, large muscle groups of the upper half of the body, alternately every other day apply therapeutic shower and massage; a jet shower is used as a healing shower; as massage use manual or hardware massage; prolonged physical activity is carried out by walking on a treadmill or walking or exercising on a stationary bike.

Description of the invention

A method for correcting abdominal type obesity is as follows.

An anthropometric examination of the patient is carried out, including measuring the waist (OT) and hips (OB) and calculating the OT / O ratio; body mass (MT), standing height, and calculating body mass index (BMI) = weight (kg) / height (m) ² (16). The abdominal type of obesity is established when the OT / OB ratio for men is greater than or equal to 0.95 cu, for women it is greater than or equal to 0.85 cu

Determine the type of eating disorder, the usual average daily energy requirement of the patient. Psychophysiological correction is carried out taking into account the type of eating disorder.

The individually recommended calorie content of the diet is determined by reducing the patient’s usual daily average energy requirement by a percentage equal to the patient’s body mass index. A low-calorie diet is prescribed taking into account the individually recommended calorie content and the restriction of fats to 40-60 g / day for a period of up to 6 months with fasting days 1 time in 1-2 weeks.

Dosed physical exercises are carried out in an aerobic mode without burdening and resistance to muscle groups of the upper half of the body and waist, with power loads on muscle groups of the lower body until the muscles become tired in 2-3 sets of rest. At the same time or after completion of the course of these physical activities, depending on the physical fitness and well-being of the patient, prolonged physical activity is carried out daily for 40-60 minutes in aerobic mode with 2-3 episodes of acceleration for 3-5 minutes.

Perform daily exposure to the patient from the face with full-spectrum natural or artificial light with an illumination intensity of at least 2000 lux for 1-2 hours per day at the same time or alternately with daily physical activity.

At the same time, daily non-drug procedures are carried out aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and lateral surface of the trunk, large muscle groups of the upper half of the body.

If the patient does not have an insulin resistance syndrome (HOMA index less than 2.84 cu) (8) or a blood sugar level of less than or equal to 6.1 mmol / l, medications or dietary supplements containing thioctic acid, vitamin A are prescribed B ₁ . Acceptance of preparations containing thioctic acid is carried out in a dose of 100-200 mg of thioctic acid simultaneously with the administration of a preparation containing vitamin B ₁ at a dose of 5-10 mg of vitamin B ₁ per day in the morning for 1 month. The course of the specified drug correction is repeated after 2 months.

If the patient has an insulin resistance syndrome (HOMA index is more than or equal to 2.84 cu) and / or when the fasting glucose level is more than 6.1 mmol / l, medications from the biguanide class containing metformin are additionally prescribed.

If there are errors in the diet, medications are prescribed that belong to the group of lipase inhibitors containing orlistat.

As medications from the biguanide group, “Siofor”, or “Glucophage”, or “Metfogamma-500”, or “Metfogamma-850” are used.

As means from the group of lipase inhibitors, Xenical or Orsoten is used.

As non-pharmacological procedures aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and lateral surface of the trunk, large muscle groups of the upper half of the body, therapeutic shower and massage are used for 20-30 days. Shower and massage alternate every other day.

A jet shower is used as a healing shower. As massage use manual or hardware massage.

The type of eating disorder and the assessment of its severity in points are determined using the DEBQ questionnaire, which includes four independent questionnaires (8). Patients with an abdominal type of obesity are characterized by a predominantly external, less commonly an emotiogenic type of eating disorder. The number of points in the questionnaire reveals clinically significant cases of eating disorders. For boundary values, the excess of which indicates the presence of clinically significant eating disorders, take the following values in points: emotional - 2.03; compulsive - 2.60; external - 2.68; restrictive - 2.43 points (8).

To determine the patient’s usual daily average energy needs, the patient fills out a food diary for 3-5 days, which reflects the time and amount of food taken in grams (or standard portions or pieces). On the basis of the diaries, an assessment is made of the patient’s usual daily average energy requirement (SEEP) (in calories), and calculations are made using special programs or food calorie tables. The following parameters are determined: the regularity of food intake, the amount of food taken, the amount and percentage of the main food ingredients in each of the meals and total per day (proteins, fats, carbohydrates, calories). Calorie calculation is carried out, for example, using the computer program “Calorie Counting” (17). From the list of products selected that product or dish that the patient took, in the column "quantity" enter the mass of the product in grams, and the program automatically calculates. SESP can also be determined using the computer program "Somatonic" (18).

Psychophysiological correction of a type of eating disorder is as follows.

In the case of an external type of eating disorder, classes are held as part of the School for Obese People, aimed at creating motivation for a healthy lifestyle, discussing the etiology of obesity, the formation of a somatic pathology combined with obesity, principles and approaches to diet therapy, the need for motor activity, and medication and non-drug therapy. An external type of eating disorder is characterized by a connection of food intake not with endogenous physiological stimuli, but with external stimuli, such as the type of food, food for company, product advertising, etc. For the external type of eating disorder, for example, the Gillian Riley method (19) based on a technique called “Plans,” which helps keep overeating under control. Reception is based on the fact that the patient has learned to plan what he will eat, in what volume and with what frequency. He must create this picture of the food intake in the mind before starting the food intake. You can start preparing for this approach in advance (a few days earlier) when the patient goes to the store to buy groceries for a week. Important in the implementation of this approach is the end of the creation of the "Plan" by the time the meal begins.

With an emotiogenic type of eating disorder, there is a connection between food intake and endogenous physiological stimuli, non-observance of the time interval between meals. Psychophysiological correction is aimed at personal growth, increasing self-esteem, strengthening motivation for treatment, normalizing and maintaining rational eating behavior. To control negative emotions and the ability to relax, the biofeedback technique can be used (20), which in this case is necessary to synchronize the basic physiological functions of the body. Using psychophysiological approaches allows the patient to develop a conscious and calm attitude to food under conditions of psycho-emotional stress and other borderline psychological conditions.

In the case of an emotiogenic type of eating disorder, in particular, the Gillian Riley method (19) can be used, based on a technique called the Times. According to this reception, after the end of a meal (full meal or snack), the patient himself appoints the time for the next meal. As a result, it is necessary to endure until the appointed time without consuming food. To begin with, it is recommended to appoint a time in the range from 1 to 4 hours. If the time interval is over, and the patient does not feel hunger, he has a choice: eat and schedule the next meal or skip the meal and schedule the next time.

In the first month, 3-5 classes of psychophysiological correction are carried out, in the subsequent 1 or 2 classes are carried out only if the patient has a stop of weight loss or if the patient so desires.

Diet therapy is as follows.

The patient is prescribed a diet taking into account the individually recommended calorie content and the restriction of fats to 40-60 g / day for a period of up to 6 months with fasting days 1 time in 1-2 weeks.

The individually recommended caloric value of the diet is determined by reducing the patient’s usual daily average energy requirement (SEC) by a percentage equal to the patient’s body mass index (BMI). For example, a patient’s ESDP is 3245 kcal / day, and a BMI of 37.5 kg / m ² .

Individually recommended dietary calorie content = DECS - 37.5% DECS, namely: 3245-1217 = 2028 kcal / day.

The patient is given 3 or 5 meals a day with the exception of digestible carbohydrates with a glycemic index of more than 70.

The fasting day includes mono-food intake, for example, kefir - 1 liter of kefir per day or cottage cheese - up to 500 g of cottage cheese per day or apple - up to 1 kg of apples per day at the patient’s choice.

Due to the difficulty of selecting food and dishes in the patient’s diet in strict accordance with the individually recommended calorie content, deviation from its value to 100 kcal per day is possible in the direction of increase or decrease.

Example of a diet with a restriction of fats up to 40-60 g / day

Breakfast 1: porridge (buckwheat, oat, pearl barley); rye bread, tea, coffee, vegetable or fruit juices without added sugar.

Breakfast 2: carrots or apples or pears.

Lunch: vegetarian cabbage soup (on vegetable broth); raw or stewed vegetables (cabbage, carrots, tomatoes, cucumbers, onions, green onions, parsley, salad) seasoned with vegetable oil; boiled meat (or steamed cutlet); dried fruit compote (sugar free).

Snack: 1-2 teaspoons of fruit and nut mixture (for example, prunes, dried apricots, raisins, walnuts, lemon, honey).

Dinner: fish, lean meat (boiled or steamed) or soy products; vegetable stew or a side dish of cereals (buckwheat, oatmeal, barley); green tea.

Depending on the degree of obesity corresponding to the BMI value (16), the patient is assigned the planned amount of weight loss over 6 months with retention and / or subsequent reduction in the achieved body weight over the next 6 months. For example, with the third degree of obesity (BMI = 40 or more kg / m ² ), the goal can be set to reduce BMI to 35.0-39.9 kg / m ² (obesity of the II degree), with the second degree of obesity - to BMI = 30 -34.9 kg / m ² , corresponding to obesity I degree. The choice of the planned value for weight loss is individual.

At the end of the correction course according to the claimed method, the achieved results are consolidated by transferring the patient to an isocaloric diet adjusted for the physical activity coefficient corresponding to the patient's labor group (21).

Physical exercise

Physical activity is carried out simultaneously with the course of diet therapy.

Dosed physical activity is carried out in physical therapy classes in an aerobic dosed mode without burdening and resistance to the muscle groups of the upper half of the body and waist, with power loads on the muscle groups of the lower body until the muscles become tired in 2-3 sets of rest. Exercises for muscle groups of the upper half of the body and muscle groups of the waist carry out up to 60-80 repetitions of each exercise, which can be divided into 2-3 approaches without burdens and resistance. On muscle groups of the lower body they perform strength exercises of 10 repetitions in 2-3 sets. Weight is selected in order to fatigue the muscles to the end of the approach. Rest between sets - 1-3 minutes. Course duration - 1 month.

At the end of the course of physiotherapy exercises, or at the same time, depending on the physical fitness and health of the patient, at least 4 times a week carry out prolonged 40-60 minutes of physical activity (walking on a treadmill or walking or exercising on an exercise bike) in aerobic mode with 2 -3 episodes of acceleration for 3-5 minutes. The duration of the course is 5-6 months.

After completing the correction course of abdominal type obesity according to the claimed method, patients are recommended to maintain physical activity by walking, and / or walking on a treadmill, and / or cycling, and / or exercise on a stationary bike, and / or swimming in the pool, and / or water aerobics classes. Motor activity is most conveniently assessed in steps. The optimal mode is 7500-12000 steps per day.

Phototherapy

Light therapy is carried out at any period starting from 2 months from the start of treatment.

When exposed to artificial light, full-spectrum fluorescent lamps with a light intensity of at least 2000 lux are used. The distance from the patient’s face to the artificial light source is 50-60 cm, the patient should be in front of the light source without fixing his gaze. The optimal duration of exposure is 1-2 hours per day at the same time or alternately with physical activity. The duration of the course is 12-14 days.

When using natural light, the patient is prescribed daily 1-2-hour walks in the open air depending on the light intensity (for example, 1 hour in sunny or 2 hours in cloudy weather). The intensity of lighting in cloudy weather, as a rule, is 2000-2500 lux, in sunny - up to 10000 lux. Light therapy in the open air is carried out throughout the course of the correction according to the claimed method. It can be combined with dosed physical activity in the open air.

Exposure to natural or artificial light is carried out in the morning or afternoon, so as not to cause a failure of the circadian rhythms of the patient's body.

Non-drug effects include shower, massage.

They are aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and lateral surface of the trunk, large muscle groups of the upper half of the body.

Apply manual or hardware massage in the area of the indicated problem areas of the patient. Hardware massage is carried out using a muscle stimulator with a signal frequency of 600 Hz. The duration of the procedure is 20-40 minutes, a course of 10-15 procedures carried out after 1 day.

Massages alternate every other day with a therapeutic shower (jet shower, or Charcot's shower). The impact is directed to the above problem areas of the patient’s body. When carrying out showers, the water temperature is gradually reduced from 34-32 ° C to 25-20 ° C, the jet pressure is gradually increased from 1.5 to 3 atm (in the abdomen - not more than 1.5 atm). The duration of the procedure is 5-10 minutes, a course of 10-15 procedures carried out after 1 day.

After 2-3 months, a repeat of the course may be recommended.

Medication

In the absence of insulin resistance syndrome (HOMA index less than 2.84 cu) (8) or a sugar level of less than or equal to 6.1 mmol / l, drug effects are limited by the intake of thioctic acid and vitamin B ₁ as described above. They are part of the pyruvate dehydrogenase complex and mediate the efficient use of glucose in the Krebs cycle. The applied dosage of thioctic acid is significantly lower than the therapeutic, but in combination with vitamin B _{1 is} sufficient to normalize carbohydrate metabolism in this category of patients.

In the presence of insulin resistance syndrome (HOMA index is greater than or equal to 2.84 cu) (8) and / or with an fasting glucose level of more than 6.1 mmol / l, medications from the biguanide class containing metformin, such as Siofor, are additionally prescribed ”, Or“ Glucofage ”, or“ Metfogamma-500 ”, or“ Metfogamma-850 ”and others. The main mechanism of action of metformin is to reduce the concentration of glucose in the blood by inhibiting the formation of glucose (gluconeogenesis) in the liver. In addition to inhibiting gluconeogenesis in the liver, metformin increases tissue sensitivity to insulin, enhances peripheral glucose uptake (by phosphorylation of GLUT-4 factor), increases fatty acid oxidation, and decreases glucose absorption from the gastrointestinal tract. Metformin is taken at a dose of 500 mg at night for the first 3-6 months.

If there are errors in the diet, medications are prescribed that belong to the group of lipase inhibitors containing orlistat, such as Xenical or Orsoten. They help to reduce the absorption of fats from the gastrointestinal tract. They are specific and reversible inhibitors of gastrointestinal lipases with a long-lasting effect. The therapeutic effect is carried out in the lumen of the stomach and small intestine and consists in the formation of a covalent bond with the active serine region of the gastric and pancreatic lipases. In this case, an inactivated enzyme loses its ability to break down food fats in the form of triglycerides into absorbable free fatty acids and monoglycerides. Since undigested triglycerides are not absorbed, the resulting decrease in calorie intake leads to a decrease in body weight. Thus, the therapeutic effect of the drug is carried out without absorption into the systemic circulation.

Acceptance of these drugs is necessary only in cases where the patient has exceeded the fat content in the food taken. If a meal is skipped or if the food does not contain fat more than the recommended norm, then you can skip taking these drugs.

The whole set of distinguishing features of the claimed method is aimed at correcting disorders characteristic of abdominal type obesity. The method allows the patient to switch from external or emotiogenic to the normal type of eating behavior. The appointment of diet therapy, taking into account the usual daily average energy needs of the patient and his body mass index, allows the patient to follow a diet without fasting, which helps to reduce body weight. Drug therapy aimed at lowering blood sugar levels, necessary for patients with abdominal type obesity, is formed taking into account the severity of deviations of this indicator from the norm and can be limited by the use of thioctic acid in combination with vitamin Bi or supplemented with biguanides. The use of thioctic acid in combination with vitamin B ₁ allows to achieve a decrease in blood sugar when using a lower (compared to therapeutic) dosage of thioctic acid, which eliminates its side effects. Conducting dosed physical exercises during physical therapy exercises aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and sides, large muscle groups of the upper half of the body, not only allows you to activate energy metabolism and thereby increase the expenditure of the energy balance of the body, but also contributes to in combination with non-drug therapy (shower, massage) to reduce body fat in problem areas characteristic of abdominal type obesity, without losing the mouse hydrochloric mass. The use of prolonged physical activity not only contributes to the activation of energy metabolism, but also forms the patient’s habit of active physical activity, which is the prevention of weight gain.

Case Studies

Example 1

Patient G., 37 years old, body weight upon admission 84.5 kg, height 162 cm, waist (OT) - 98 cm, hips (OB) - 107 cm. Complaints of frequent headaches associated with a rise in blood pressure, shortness of breath when walking uphill, insomnia, snoring in a dream. The patient first decided to do body weight correction in a specialized medical institution due to the therapist explaining the relationship between obesity and high blood pressure up to 150/90 mm Hg. Prior to this, women used to have hungry days at home (1-2 days refrained from eating, or sharply limited the amount of food taken for several days).

A general clinical examination was conducted. Based on anthropometric parameters, the body mass index was calculated, which amounted to 32.2 kg / m ² , and the OT / OB ratio characterizing the type of obesity, which amounted to 0.92 cu Blood sugar - 5.1 mmol / L. NOMA index 1.8 cu Diagnosis at admission: primary obesity of the 1st degree, according to the android type, slowly progressing course. Concomitant diseases: Arterial hypertension of the 1st stage, 1 degree, risk 2.

According to the results of the questionnaire survey using the DEBQ questionnaire (8), boundary values were determined, which on scales amounted to 0.92 points for emotiogenic eating disorders, 1.17 points for compulsive disorders; external - 3.0; restrictive - 2.8 points, respectively. The conclusion is made about the external type of eating disorder associated with restrictive eating disorder.

Based on the medical history, dietary assessment, and questionnaire data from the DEBQ questionnaire, patient G. was determined that the main reason for weight gain was overeating, caused not by hunger, but mainly by external stimuli, such as eating, appetizing smell, well-served table, good company at the table. It was established that the patient normally tolerates food restrictions.

A psychophysiological correction of the external type of eating behavior was carried out by conducting classes in the framework of the "School for obese people", aimed at creating motivation for a healthy lifestyle, weight loss. The patient discussed the etiology of obesity, the formation of a somatic pathology associated with obesity (common chronic non-infectious diseases such as coronary heart disease, arterial hypertension, diabetes mellitus), principles and approaches to diet therapy, the need for increased motor activity, drug and non-drug therapy. During inpatient treatment, 5 classes were conducted with the patient on the psychophysiological correction of eating behavior.

To correct the external type of eating disorder, the Gillian Riley method (19) was used, based on a technique called “Plans”.

Based on the data of patient’s diaries, patient G. assessed the patient’s usual daily average energy requirement (SEEP) (in calories), and the calculations were performed using the Calorie Counting computer program (17). The results are presented in table 1. It is shown that the patient consumes an increased amount of calories. So if the patient's daily need, taking into account the labor group (labor group 2), should be 2537 kcal / day, then the caloric excess was 2820-2537 = 283 kcal / day. Fats prevailed among the nutrients consumed, the consumption of foods with a high fat content is largely associated with the external type of eating behavior, as it does not cause a quick feeling of fullness, as a result of which patients overeat more than necessary. In addition, the patient had a disturbed diet. Breakfast was completely absent, most of the food intake was in the afternoon, and after dinner, after 2-3 hours, just before bedtime, the patient again took food.

The individually recommended calorie content of the diet was determined by reducing the patient’s usual daily average energy requirement (SEC) by a percentage equal to the patient’s body mass index (BMI), namely 2820-908 (BMI - 32.2%) = 1912 kcal. An approximate diet of the recommended patient G. diet with a fat content of 50 g / day is shown in table 2. The patient followed the prescribed diet for 6 months, observing fasting days 1 time per week with the voluntary choice of mono-diet during the day (kefir or cottage cheese or apple).

Dosed physical activity was performed according to the claimed method. The duration of the course is 1 month. In the next 5 months, the patient made daily walking walks lasting 40-60 minutes in the daytime with 2-3 episodes of acceleration for 3-5 minutes.

Non-drug correction procedures included exposure every other day with a jet shower (Charcot's shower) on problem areas of the body according to the claimed method. The duration of the procedure is 5-10 minutes, a course of 10 procedures. The effects of a jet shower alternated every other day with manual massage of the anterior abdominal wall and lateral surface of the trunk, large muscle groups of the upper half of the body, including the back, 10 procedures.

The patient was prescribed taking preparations containing thioctic acid at a dose of 100 mg / day (thioctacyte) and vitamin B ₁ at a dose of 5 mg / day according to the claimed method with a repeat of the course after 2 months.

After 3 months from the start of correction, the patient underwent a course of light therapy by exposure to artificial light (full-spectrum fluorescent lamps) with an illumination intensity of 2000 lux for 14 days.

Due to nutritional errors, the patient took 15 times in 3 months the drug from the group of lipase inhibitors - “Xenical”.

1 month after the start of correction according to the claimed method, the decrease in body weight was 3.5 kg, after 3 months - 5.8 kg, after 6 months - 8.6 kg. Body weight was 75.9 kg, BMI decreased to 28.9 kg / m ² , OT / OB - 0.89, blood sugar 4.7 mmol / L.

The survey found that the patient had a stable stereotype of eating behavior according to the Gillian Riley method: she plans food purchases, takes food with the TV turned off, takes a small amount of food at one time, eats slowly, chewing food carefully, etc. The patient notes a sharp reduction "Temptations", the number of meals without a feeling of hunger. In addition, fasting days helped start breakfast and avoid eating at night. Headaches rarely concern, increased physical performance, normalized sleep, blood pressure within 130/80 mm Hg

After a year, body weight decreased to 72.2 kg, BMI = 27.6 kg / m ² , which corresponds to obesity, OT - 87 cm, OB - 101 cm, the ratio OT / OB - 0.86 cu The patient reported that she was satisfied with the results, that she fully accepted the formed healthy lifestyle.

Example 2

Patient K., 42 years old, body weight upon admission 122.9 kg, height 185.5 cm, waist (OT) - 122 cm, hips (OB) - 119 cm. Complaints about raising blood pressure to 160-180 / 90-100 mmHg, which objectively does not feel, heart palpitations, shortness of breath when climbing stairs to the 3rd floor, pain in the lumbar spine, fatigue. Increased blood pressure over the past 5 years, continuous antihypertensive therapy over the past 3 years, taking 2 antihypertensive drugs. Over the past 5 years, body weight has increased by 10 kg. The patient associates weight gain with a hypodynamic lifestyle and unhealthy diet.

A general clinical examination was conducted. Based on anthropometric parameters, the body mass index was calculated, which characterizes the severity of obesity, which amounted to 35.9 kg / m ² , and the OT / OB ratio, which characterizes the type of obesity, which amounted to 1.03 cu Blood sugar level - 6.4 mmol / l, NOMA index 3.1 c.u. Diagnosis at admission: primary obesity of the 2nd degree, according to the android type, slowly progressing course. Concomitant diseases: arterial hypertension 2 stages, 2 degrees, fasting hyperglycemia, risk 3.

According to the results of the survey on the DEBQ questionnaire, the boundary values were determined, which on the scales amounted to 0.77 points for emotiogenic eating disorders, 1.83 for compulsive disorders; external - 2.8; restrictive - 1.6 points, respectively. The conclusion is made about the external type of eating behavior.

Psychophysiological correction of the external type of eating behavior was carried out by conducting classes in the "School for obese people", during the course of classes the issues of weight gain, the association of android obesity with common chronic non-infectious diseases such as coronary heart disease, arterial hypertension, diabetes mellitus were discussed nutrition and diet therapy, the need for physical activity, as well as classes to increase the level of motivation to reduce body weight. During inpatient treatment, 5 lessons were held with the patient.

To correct the external type of eating disorder, the Gillian Riley method (19) was used, based on a technique called “Plans”.

Based on the data of patient K.'s diaries, the usual daily average energy requirement (SEEP) of the patient (in calories) was evaluated, and the calculations were performed using the Somatonic computer program (18). The results are presented in table 3. It is shown that the patient consumes an increased amount of calories. So if the patient's daily need, taking into account the labor group (labor group 1), should be 3301 kcal / day, then the caloric excess was 3816-3301 = 515 kcal / day. Among the nutrients consumed in the diet, fats and carbohydrates with a high glycemic index prevailed.

The individually recommended calorie content of the diet was determined by reducing the patient’s usual daily average energy requirement (BEC) by a percentage equal to the patient’s body mass index (BMI), namely 3816-1370 = 2446 kcal. An exemplary diet recommended for patient K. diets with a fat content of 60 g / day is shown in Table 4. The patient followed the prescribed diet for 6 months, observing fasting days 1 time in 2 weeks with the voluntary choice of mono-diet during the day (kefir or cottage cheese or apple) .

Light therapy was carried out using a daylight lamp for 12 days according to the claimed method. Dosed physical activity was carried out daily in physical therapy classes in an aerobic dosed mode according to the claimed method. The duration of the course is 1 month. At the same time and in the next 5 months, the patient was prescribed prolonged physical activity lasting 40-60 minutes on a treadmill with 2-3 episodes of acceleration for 3-5 minutes.

Non-medical procedures included exposure every other day with a jet shower (Charcot's shower) on problem areas of the body according to the claimed method. The duration of the procedure is 5-10 minutes, a course of 10 procedures. The effects of a jet shower alternated every other day with an apparatus massage. Myostimulation of the anterior abdominal wall and lateral surface of the trunk was performed 10 procedures.

The patient was prescribed taking preparations containing thioctic acid (thioctacyte) at a dose of 200 mg / day, vitamin B ₁ - at a dose of 10 mg / day in the morning for 1 month (thiamine chloride in tablets), after 2 months the course was repeated. Additionally, Metformin was prescribed at a dose of 500 mg at night for 6 months.

In the first 3 months, the patient came to sessions with a psychotherapist twice, despite the systematic weight loss. The patient justified his visits with the desire to confirm the correctness of the implementation of therapeutic measures.

1 month after the start of correction according to the claimed method, the decrease in body weight was 4.8 kg, after 3 months - 10.6 kg, after 6 months - 15.8 kg. Body weight was 107.1 kg. BMI was 31.1 kg / m, OT / OB - 0.97, blood sugar level 5.3 mmol / L.

The patient noted that he began to understand his diet, began to distinguish between true and false hunger, planning for a full stomach of the next meal, allowed him not to overeat “for company”. He said that out of 2 antihypertensive drugs, he switched to taking one while holding blood pressure within 120-130 / 80 mm Hg. Physical performance increased significantly, sleep normalized, the heartbeat does not bother.

After a year, the body weight is 105.5 kg, BMI = 30.6 kg / m ² , which corresponds to 1 degree of obesity, OT - 110 cm, OB - 114 cm, the OT / OB ratio - 0.96 cu The patient said that he was satisfied with the results, in this weight he feels comfortable, and in the future he will adhere to recommendations for maintaining the achieved results.

Example 3

Patient M., 48 years old, body weight upon admission 128.1 kg, height 166 cm, waist (OT) -120 cm, hip (OB) - 135 cm. Complaints of pain in the knee joints when walking and lower back and prolonged static load, episodic rises in blood pressure up to 165/95 mm Hg, shortness of breath when walking, severe weakness. The patient is not the first time trying to reduce body weight, once starving for 10 days, during the famine, body weight decreased by 10 kg, but over the next year the increase in body weight was 14 kg. The second attempt to reduce body weight by "coding" did not produce a significant effect.

A general clinical examination was conducted. Based on anthropometric parameters, the body mass index was calculated, which amounted to 46.5 kg / m ² , and the OT / OB ratio characterizing the type of obesity, which amounted to 0.89 cu Blood sugar - 6.0 mmol / L. NOMA Index 2.4 cu Diagnosis at admission: Primary obesity of the 3rd degree, according to the android type, recurrent course. Concomitant diseases: Arterial hypertension 2 stages, 2 degrees, obesity, dyslipidemia, risk 3.

Based on the results of the survey on the DEBQ questionnaire, the boundary values were determined, which on the scales amounted to 2.9 points for emotiogenic eating disorders, 1.8 for compulsive ones; external - 1.4; restrictive - 1.4 points, respectively. Thus, the patient revealed an emotiogenic type of eating disorder, in which overeating, as a rule, is associated with psycho-emotional stress.

A psychophysiological correction of the emotiogenic type of eating behavior was carried out by conducting classes in the framework of the "School for obese people." Psychophysiological correction was aimed at personal growth, increasing self-esteem, strengthening motivation for treatment, normalizing and maintaining rational eating behavior. To control negative emotions and the ability to relax, a biofeedback technique can be used. During the game session, the patient learned to relax and control her emotions. The method of Gillian Riley (19) was also used, a technique called “Times” was applied.

Based on the data from the food diaries of patient M., an assessment was made of the patient’s usual daily average energy requirement (SEEP) (in calories), and the calculations were performed using the Calorie Counting computer program (17). The results are presented in table 5. It is shown that the patient consumes an increased number of calories. So if the patient's daily need, taking into account the labor group (labor group 1), should be 2698.8 kcal / day, then the caloric excess was 3165.7-2698.8 = 466.9 kcal / day. Among the nutrients consumed in the diet, fats and carbohydrates with a high glycemic index prevailed. In a state of psychoemotional stress, the patient, in her expression, “could chew constantly during the evening, something”, preference was given to chocolates. The individually recommended calorie content of the diet was determined by reducing the patient’s usual daily average energy requirement (SEC) by a percentage equal to the patient’s body mass index (BMI), namely 3165.7-1472.0 (BMI - 46.5%) = 1693.7 kcal . An approximate diet for the recommended patient M. diet with a fat content of 40 g / day is shown in table 6. The patient followed the prescribed diet for 6 months, observing fasting days 1 time per week with the voluntary choice of a mono diet during the day (kefir, or cottage cheese, or apple )

Physical activity was carried out daily in physical therapy classes in an aerobic dosed mode according to the claimed method. The duration of the course is 1 month. In the next 5 months, the patient made daily walking walks lasting 40-60 minutes in the daytime with 2-3 episodes of acceleration for 3-5 minutes.

Non-drug correction procedures included exposure every other day with a jet shower (Charcot's shower) on problem areas of the body according to the claimed method. The duration of the procedure is 5-10 minutes, a course of 10 procedures. The effects of a jet shower alternated every other day with manual massage of the anterior abdominal wall and lateral surface of the trunk, large muscle groups of the upper half of the body, including the back, 10 procedures.

The patient was prescribed drugs containing thioctic acid (Thioctacitum) at a dose of 100 mg / day in the morning for 1 month, vitamin B ₁ - at a dose of 5 mg / day in the morning for 1 month (thiamine chloride in tablets), after a 2-month break this the course was repeated.

After 3 months from the start of correction, the patient underwent a course of light therapy by exposure to artificial light (full-spectrum fluorescent lamps) with an illumination intensity of 2000 lux according to the claimed method.

The drug from the group of lipase inhibitors - “Xenical took 5 times, the need for admission was due to attending holidays and corporate events and the lack of diet meals at these events.

1 month after the start of correction according to the claimed method, the decrease in body weight was 5.8 kg, after 3 months - 12.5 kg, after 6 months - 17.7 kg, amounting to 110.4 kg. BMI was 40.1 kg / m ² , OT / OB - 0.86, blood sugar 5.2 mmol / L.

During the survey, it was found that the patient successfully implements the method of correction of the emotiogenic type of malnutrition according to Gillian Riley: determining the time intervals between meals and began to eat on a schedule. In the case of a state of increased psychoemotional stress, he uses auto-training and relaxation techniques to relieve stress or switches to another type of activity, for example, goes for a walk.

Against the background of a decrease in body weight, blood pressure stabilized, shortness of breath during walking decreased, pain in the knee joints decreased.

After a year, body weight decreased to 104.3 kg, BMI = 37.9 kg / m ² , which corresponds to 2 degrees of obesity, OT - 106 cm, OB - 124 cm, the ratio OT / OB - 0.85 cu The patient intends not to stop there. The program for consolidating the achieved results was planned for the next six months and the next target body weight of 98-100 kg was determined.

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Table 1 Assessment of the average daily energy needs of patient G. (example 1) Proteins, g Fats, g Carbohydrates, g Kcal Breakfast 0 0 0 0 Dinner 29th 51 56 799 Dinner 31 64 45 880 For the night 52 69 78 1141 Total 112 184 179 2820

table 2 An approximate diet recommended to the patient G. low-calorie diet with a fat content of 50 g / day (example 1) Food & Dishes Qty Proteins, g Fats, g Carbohydrates, g Kcal Breakfast Rye bread fifty 3.3 0.6 17.1 87.1 Loose buckwheat porridge 140 8.9 2.2 45.9 241.1 Milk 2.5% fat. one hundred 2,8 2,5 4.7 53,2 Total: 300 15.0 5.3 67.7 381.4 Lunch Pear 150 0.6 0.5 14.3 63.5 Total: 150 0.6 0.5 14.3 63.5 Dinner Ukrainian shaped bread 80 5.5 1,0 30.9 155.2 Sauerkraut cabbage soup with potatoes 200 1,2 4.2 5,4 65.0 The vinaigrette 150 2.0 5,0 11.7 100.6 Boiled Chicken 140 37.8 10.5 0,0 253.3 Stewed apples 200 0.4 0,0 44,2 178.4 Total: 780 46.9 20.7 92.2 752.5 High tea Fruit and nut mixture thirty 1,5 2.1 14.7 83.7 Total: thirty 1,5 2.1 14.7 83.7 Dinner Rye bread one hundred 6.6 1,2 34.0 173.4 Ground cucumbers 70 0.6 0.1 1.8 10,2 Tomatoes 80 0.9 0.2 3.0 17,2 Braised White Cabbage 200 4.0 6.6 19,2 153.5 Boiled beef 90 25.8 13.3 0,0 230,2 Total: 550 37.8 21,4 58.1 584.4 Ratio in% 22.1 25.9 51.7 Total: 1810 101.7 50,0 246.9 1865.6

Table 3 Assessment of the average daily energy needs of patient K. (example 2) Proteins, g Fats, g Carbohydrates, g Kcal Breakfast thirty 26 98 746 Dinner 59 67 121 1323 Dinner 68 95 155 1747 Total 157 188 374 3816

Table 4 An exemplary diet of patient K.'s low-fat, low-calorie diet (Example 2) Food & Dishes Qty Proteins, g Fats, g Carbohydrates, g Kcal Breakfast Borodino bread one hundred 6.8 1.3 40.7 207.0 Low-fat cottage cheese 150 27.0 0.9 2.7 132.0 Kefir low-fat 250 7.5 0.1 9.5 75.0 Natural honey fifteen 0.12 0,0 12.0 47.1 Total: 515.0 41,4 2,3 64.9 461.1 Lunch Biscuits thirty 2,8 3,1 20.5 124.5 Sugar (sand) 10 0,0 0,0 10.0 37.9 Roasted coffee beans (dry) 10 1.4 1.4 0.3 20,2 Total: 50,0 4.2 4.5 30.8 182.6 Dinner Borodino bread one hundred 6.8 1.3 40.7 207.0 Frizzy pearl barley 200 6.2 0.8 46.0 212.0 Boiled beets one hundred 1.8 0,0 10.8 49.0 Chicken breast 150 32,4 12.7 0,0 252.0 Sauerkraut cabbage soup with potatoes 250 1,5 5.3 6.8 80.0 Stewed apples 250 0.5 0,0 30.5 124.0 Total: 800,0 49.2 20.1 134.8 924.0 High tea Grapefruit juice 250 0.75 0,0 20,0 90.0 Total: 250,0 0.8 0,0 20,0 90.0 Dinner Borodino bread one hundred 6.8 1.3 40.7 207.0 Braised White Cabbage 250 5,0 8.3 24.0 187.5 Boiled beef 120 31,0 23.5 0,0 331.8 Rafinated sugar fifteen 0,0 0,0 15.0 56.9 Total: 485.0 42.8 33.1 79.7 756.2 Total 2100.0 138.4 60.0 330.2 2440.9

Table 5 Assessment of the average daily energy requirement of patient M. (example 3) Proteins, g Fats, g Carbohydrates, g Kcal Breakfast 13 9 45 313 Dinner 40 37 91 857 Dinner 54 68 80 1148 During the evening 12 47 94 847 Total 119 161 310 3165

Table 6 An approximate diet of the recommended patient M. low-calorie diet with a fat content of 50 g / day (example 3) Selected Products weight (g) proteins (g) fats (g) carbohydrates. (g.) calorie. (kcal) Breakfast Rye bread fifty 3.3 0.6 17.1 90.5 Friable barley porridge 150 5.10 0.6 33.15 162.00 Suluguni thirty 5.85 5.8 0.00 85.50 Total: 230 14.25 7.0 50.25 338 Lunch Pear 150 0.60 0.4 14.25 63.00 Total: 150 0.6 0.4 14.25 63 Dinner Rye bread fifty 3.30 0.6 17.10 90.50 The vinaigrette 200 2.60 7.8 15.60 152.00 Stewed Plums 200 1.00 0,0 47.80 192.00 Steam Chips 80 11.20 9.0 6.56 155.20 Beetroot soup 200 1.00 4.0 8.40 72.00 Total: 730 19.1 21,4 95.46 693.7 High tea Yogurt 1.5% Sweet 150 7.50 2.2 12.75 105.00 Total: 150 7.5 2.2 12.75 105 Dinner Rye bread 75 4.95 0.9 25.65 135.75 Boiled white cabbage 150 3.00 0 14.40 67.50 Chicken breast one hundred 21.62 8.1 0.00 168.00 Total: 325 29.6 9.0 40.05 416.25 1585 71.05 40,0 212.76 1685.95

Claims (9)

1. A method for the correction of the abdominal type of obesity, including diet therapy, exposure to the patient from the face with full-spectrum natural or artificial light with an intensity of illumination of at least 2000 lux for 1-2 hours a day, simultaneously or alternately with physical activity, characterized in that it is further determined type of eating disorder, carry out its psychophysiological correction; calorie diet is determined by reducing the usual average daily energy requirement of the patient by a percentage equal to the patient’s body mass index with fat restriction up to 40-60 g / day for up to 6 months with fasting days 1 time in 1-2 weeks; physical exercises are carried out in an aerobic dosed mode without burdening and resistance to the muscle groups of the upper half of the body and waist, with power loads on the muscle groups of the lower body until the muscles become tired in 2-3 sets of rest; simultaneously or after their completion, prolonged physical activity is performed for at least 4 days a week for 40-60 minutes in aerobic mode with 2-3 episodes of acceleration for 3-5 minutes; at the same time, they carry out non-drug procedures aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and sides, large muscle groups of the upper half of the body; in the absence of a patient's insulin resistance syndrome or blood sugar level of less than or equal to 6.1 mmol / l, medications or dietary supplements containing thioctic acid, vitamin B ₁ are prescribed; in the presence of insulin resistance syndrome and / or fasting glucose of more than 6.1 mmol / l, medications from the biguanide class containing metformin are additionally prescribed; in the presence of errors in the diet, medications are prescribed that belong to the group of lipase inhibitors containing orlistat. 2. The method according to claim 1, characterized in that the administration of preparations containing thioctic acid is carried out in a dose of 100-200 mg of thioctic acid per day in the morning for 1 month at the same time as taking a preparation containing vitamin B _1; the course of drug correction is repeated after 2 months. 3. The method according to claim 1, characterized in that the administration of preparations containing vitamin B ₁ is carried out in a dose of 5-10 mg of vitamin B ₁ per day in the morning for 1 month simultaneously with the preparation containing thioctic acid; the course of drug correction is repeated after 2 months. 4. The method according to claim 1, characterized in that as a medicament from the biguanide group, “Siofor”, or “Glucophage”, or “Metfogamma-500”, or “Metfogamma-850” are used. 5. The method according to claim 1, characterized in that as the means of the group of lipase inhibitors used "Xenical" or "Orsoten". 6. The method according to claim 1, characterized in that as non-pharmacological procedures aimed at improving regional blood flow, increasing muscle tone of the anterior abdominal wall and sides, large muscle groups of the upper half of the body, a therapeutic shower or massage is used. 7. The method according to claim 6, characterized in that the jet shower is used as a therapeutic shower. 8. The method according to claim 6, characterized in that as a massage used manual or hardware massage. 9. The method according to claim 1, characterized in that prolonged physical activity is carried out by walking on a treadmill, or walking, or exercising on a stationary bike.