Data are accumulating on the direct influence of psychoemotional and psychosocial factors on the inexorable growth of obesity prevalence, and therefore the concept of an interdisciplinary approach is needed, including dietary, physical activity and mental state modifications.Aim. To determine the effectiveness of cognitive-behavioral group the­ra­py (CBGT) in combination with nutritional modifications for body mass (BM) management in women with obesity.Material and methods. The study involved 20 women (mean age 46,6±12,3 years) with a BMI ≥30 kg/m2, rigid to diet therapy. A medical psychologist and a nutritionist conducted CBGT sessions with the participants. Initially, BM, BM index, and eating behavior were assessed (DEBQ, Stunkard, CARDIA questionnaires). In addition, the following were used to study the mental status: Toronto Alexithymia Scale ­(TAS-20), vital exhaustion test, University of California, Los Angeles (UCLA) Loneliness Scale, Test of Self-Conscious Affect (TOSCA), Reeder Stress Inventory, and Psychological Stress Measure (PSM-25). The changes were studied 8 weeks after the start CBGT.Results. After 2 months, the BMI dynamics was -4,33 kg (p<0,001). A decrease in the severity of emotional eating behavior by an average of 0,77 (p<0,001), external eating behavior by 1,05 (p<0,001) points was noted, no significant changes in restrained eating behavior were obtained (p=0,43). According to the CARDIA test, after 2 months of CBGT, the detection rate of pathological significance of BM decreased by 50% (p<0,001); as well as episodes of loss of control over food intake (initially in 5 (25%) (p<0,001)), distress due to loss of control over food intake (initially in 6 (30%) (p<0,001). CBGT in combination with dietary intervention showed a decrease in the severity of chronic stress, which corresponded to an increase in the total score from 1,8±0,75 to 2,0±0,60 (p<0,05), a decrease in vital exhaustion from 5,6±3,89 to 4,1±2,66 (p=0,001) and loneliness from 34,9±12,61 to 29,9±7,57 (p=0,007), a decrease in guilt-proneness from 53,0±8,42 to 42,8±11,18 (p<0,001) and shame-proneness from 38,3±10,99 to 31,6±10,07 points (p=0,014).Conclusion. The mental state of a person has a significant impact on eating behavior and on the regulation of BM, which emphasizes the need for complex interventions to provide effective assistance to people with obesity.

This article reviews common myths and stereotypes about obesity that distort the understanding of its causes and pathogenesis and contribute to the disease stigmatization among the cardiology medical community. Obesity is a chronic, relapsing, multifactorial disease characterized by excessive formation of adipose tissue, progressing in its natural course and, as a rule, having an increased cardiometabolic risk. For effective prevention of complications, it is necessary to start treating obesity at the risk and pre-disease stages (abdominal obesity and overweight). The causes of obesity include genetic, metabolic, social and environmental factors. The review emphasizes that obesity is not exclusively a consequence of a lack of willpower in choosing food products according to the rules of healthy eating or a sedentary lifestyle. Many stereotypes, such as the idea that all patients with excess body weight have an alimentary genesis of the disease and all clinical "findings" are associated with obesity, do not correspond to reality and hinder effective prevention and treatment strategies. No other chronic non-communicable disease is as stigmatized as obesity. Moreover, despite the development of modern pharmacotherapy, behavioral therapy for obesity, and bariatric surgery, there is high clinical inertia in timely initiation of treatment for this disease. Body weight is becoming the same target indicator in general therapeutic practice as blood pressure or glycemia. Modern medicine dictates the need to rely solely on the evidence base to refute myths in order to create a more inclusive and supportive environment that promotes the health and well-being of patients.

This narrative review was prepared by a working group based on actual data at the international and Russian level. The review examines data on the frequency of added sugar consumption in Russia, as well as the changes in prevalence of non-communicable diseases, including obesity and type 2 diabetes, caused by excessive consumption of foods high in simple carbohydrates.

Last time there are a lot of date, published systematic reviews and meta-analyses about relationship between eating behavior and incidence type 2 diabetes. It is known that more than 80% of cases of type 2 diabetes are associated with obesity. In this regard, the nutritional factor is of particular importance in the formation of treatment goals for patients with type 2 diabetes. Today, the disease is no longer a sentence, because achieving remission of type 2 diabetes is possible with the help of nutritional correction. The results of studies shown that a significant decrease in body weight is a predictor of remission of type 2 diabetes. However, the question of the best dietary recommendations for patients with type 2 diabetes remains open. Various dietary patterns (Mediterranean, paleo diet, DASH system, etc.) contribute to the improvement of glycemia, however, there is not enough data indicating a regression of symptoms of type 2 diabetes. In all likelihood, achieving remission is possible only with a significant reduction in daily caloric intake. The ketogenic diet, especially popular in recent times, also improves glycemic control. At the same time, according to the results of a meta-analysis, carbohydrates from whole grains and cereal fibers should not be neglected, because this category of products helps reduce the risk of developing diabetes.

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

In medicine and psychology, the study of human behavioral responses to various stimuli has more than 100 years. Eating behavior is a special form of interaction between an individual and food, including a complex of unconditioned reflexes and conscious decisions that determines the amount and composition of food eaten under various conditions. The authors undertook an analysis of current data regarding the classification of eating disorders, as well as known methods of diagnostic evaluation.

Министерство здравоохранения Российской ФедерацииФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр терапии и профилактической медицины» Российское общество профилактики неинфекционных заболеваний «УТВЕРЖДАЮ» академик РАН, профессор, директор ФГБУ «НМИЦ ТПМ» Минздрава России, главный внештатный специалист по терапии и общей врачебной практике Минздрава России

Obesity is one of the risk factors for the development and progression of type 2 diabetes (T2D). Decrease in body weight (BW) by 10% from the initial level in patients with T2D and obesity significantly reduces the risk of cardiovascular events. Low effectiveness of measures to reduce body weight in patients with T2D is due to hidden eating disorders against the background of mental imbalance, high levels of anxiety and depression, and frustration with glycemic levels. Solving the problem of the low frequency of achieving target values for reducing weight in type 2 diabetes through the development and evaluation of the clinical effectiveness of cognitive-behavioral therapy protocols is of high scientific and practical significance.

Type 2 diabetes (T2D) is a nutritionally dependent disease. Modern scientific data indicate the possibility of remission of T2D by therapeutic nutrition and lifestyle. The results of prospective studies have been accumulated regarding the impact of micro- and macronutrients, individual foods and food systems on the prevention and treatment of T2D. A flexible system for choosing a nutritional model with proven efficacy and safety in T2D can contribute to better glycemic control and body weight correction.

Ожирение представляет собой социально значимую мультидисциплинарную проблему, сформировавшуюся за непродолжительный период времени. Современные подходы к лечению больных с ожирением базируются на первоочередной необходимости коррекции питания и пищевого поведения вне зависимости от степени ожирения. Однако доступность специализированной диетологической помощи населению в Российской Федерации крайне низкая. Актуальной задачей является обеспечение доступности населения к получению квалифицированной первичной врачебной медико-санитарной помощи по профилю «диетология». С этой целью разработан структурированный подход к проведению консультаций (выполнению трудовых действий) по коррекции питания у взрослых пациентов с избыточной массой тела и ожирением в амбулаторной практике.

На сегодняшний день существует много программ по снижению массы тела, включающих в себя как научно обоснованные подходы, так и «новомодные» методы. С ними связаны мифы по поводу невозможности «удержания» массы тела на достигнутом оптимальном уровне после этапа приверженности той или иной стратегии. Результаты крупных проспективных исследований подтвердили возможность поддержания массы тела в пределах снижения на 10% от исходной на протяжении от 1 года вплоть до 10 лет. Среди предикторов эффективного поддержания массы тела выделяют индивидуальные когнитивные факторы и ряд особенностей диетологических вмешательств. В обзоре приведен анализ результатов клинических исследований, изучающих эффективность снижения массы тела по показателю поддержания достигнутой массы в отдаленном периоде.

Background and Aims : To determine the quality characteristics of nutrition in individuals with low cardiovascular risk (SCORE 2 < 2,5%) and to assess the relationship of nutritional characteristics with metabolic disorders and body composition.Methods: The study included 90 patients: 43.8 ± 3.2 years, 37 men (47%) and 41 womеn (53%). 62 (69%) participants with central obesity (CO), low cardiovascular risk (SCORE ≤1%, SCORE 2 < 2,5%, CMDS 0-1). All patients were provided with a nutritional questionnaire consisting of 11 questions.Results: Inappropriate nutrition was registered in all patients with CO. A number of diet factors had a correlation with TG, LDL, TC, WC, body fat mass, hepatic steatosis and epicardial fat. Among them: processed meat (r = 0.3; r = 0.4; r = 0.3; r = 0.4; r = 0.4; r = 0.4; r = 0.48, respectively; p = 0.001), the absence of nuts (r = 0.4; r = 0.4; r = 0.3; r = 0.4; r = 0.4; r = 0.4; r = 0.3, respectively; p = 0.001), insufficient quota of fruits and vegetables (r = 0.7; r = 0.7; r = 0.6; r = 0.7; r = 0.7; r = 0.5; r = 0.7 , respectively; p = 0.001). It is important that according to the nutritional scale the cardiovascular diseases risk became higher in 57% of patients.Conclusions: The low cardiovascular risk group is very heterogeneous due to the high prevalence of central obesity and unbalanced nutrition. The food scale helps to identify problem areas of the diet within 2 minutes. Background and Aims : To determine the quality characteristics of nutrition in individuals with low cardiovascular risk (SCORE 2 < 2,5%) and to assess the relationship of nutritional characteristics with metabolic disorders and body composition. Methods: The study included 90 patients: 43.8 ± 3.2 years, 37 men (47%) and 41 womеn (53%). 62 (69%) participants with central obesity (CO), low cardiovascular risk (SCORE ≤1%, SCORE 2 < 2,5%, CMDS 0-1). All patients were provided with a nutritional questionnaire consisting of 11 questions. Results: Inappropriate nutrition was registered in all patients with CO. A number of diet factors had a correlation with TG, LDL, TC, WC, body fat mass, hepatic steatosis and epicardial fat. Among them: processed meat (r = 0.3; r = 0.4; r = 0.3; r = 0.4; r = 0.4; r = 0.4; r = 0.48, respectively; p = 0.001), the absence of nuts (r = 0.4; r = 0.4; r = 0.3; r = 0.4; r = 0.4; r = 0.4; r = 0.3, respectively; p = 0.001), insufficient quota of fruits and vegetables (r = 0.7; r = 0.7; r = 0.6; r = 0.7; r = 0.7; r = 0.5; r = 0.7 , respectively; p = 0.001). It is important that according to the nutritional scale the cardiovascular diseases risk became higher in 57% of patients. Conclusions: The low cardiovascular risk group is very heterogeneous due to the high prevalence of central obesity and unbalanced nutrition. The food scale helps to identify problem areas of the diet within 2 minutes.

The low cardiovascular risk group according to SCORE in relation to the clinical and laboratory characteristics of patients is very heterogeneous, which leads to the presence of a residual risk of cardiovascular events. This category may include individuals with a family history of cardiovascular disease at a young age, with abdominal obesity (AO), endothelial dysfunction, and high levels of triglyceride-rich lipoproteins. In this regard, an active search is underway for new metabolic markers within the low cardiovascular risk group. The purpose of the study was to compare the nutrition, the adipose tissue distribution in low cardiovascular risk individuals, depending on the AO. Material and methods. The study included 86 healthy low risk (SCORE<1%) patients (mean age 42.6±2 years), who were divided into 2 groups: with AO [waist circumference (WC) >=94 cm in men and >=80 cm in women] - 44 patients (32% of men) and without AO - 42 patients (38% of men). The body composition was carried out using the bioimpedance analyzer. The distribution of ectopic fat deposits in the liver, pancreas and epicardial region was studied using ultrasound methods. A frequency questionnaire (Diet Risk Score) was used to assess nutrition. Results. In low risk patients with AO, signs of unhealthy diet are statistically significantly more common (in 52 in the main group vs 2% in the control group, p<0.01), ectopic deposition of adipose tissue in the liver (53 vs 9%, p<0.001), pancreas (56% in the main group, absent in the control group, p<0.001), epicardia l region (the epicardial fat thickness median is 4.24 mm in the main group vs 2.15 mm in the control group) compared with a control group. Conclusion. The low cardiovascular risk group is very heterogeneous. One of the markers of heterogeneity is central obesity - a marker of unhealthy diet, subclinical ectopic fat deposition and hypertriglyceridemia. Patients with AO of the low cardiovascular risk group require a more thorough examination with the obligatory determination of waist circumference, ultrasound assessment of the liver and pancreas parenchyma, and determination of the epicardial fat thickness. Using a short nutrition questionnaire allows you to quickly identify signs of unhealthy diet and discuss them with the patient.

Ожирение является результатом взаимодействия генетических, эпигенетических, психологических, социальных и многих других факторов. Основная причина ожирения — потребление с пищей избыточного количества калорий, превышающего энергозатраты организма. Прием пищи регулируется двумя взаимодополняющими факторами: гомеостатическим и гедонистическим. Гомеостатический путь активизируется в условиях истощения запасов энергии, усиливая мотивацию к еде. Гедонистический механизм, основанный на получении удовольствия, ведет к увеличению потребления пищи в период достатка энергии, в крайних случаях вызывая схожее с зависимостью состояние. В статье рассматриваются механизмы регулирования потребления пищи, их взаимодействие, доказательства пищевой зависимости и причины усиления роли гедонистического регулирования аппетита в эпидемии ожирения.