Overweight what to do. Pharmacological methods that may be effective. Classification of obesity in children

Excess MT occurs when the energy value of the diet exceeds the energy expenditure of a person. There is an accumulation of fat, which over time can lead to the development of a disease - obesity.

Obesity - metabolic and alimentary chronic illness, which is manifested by the excessive development of adipose tissue and progresses with a natural course.

Epidemiology. According to WHO and domestic studies, about 50% of the population of European countries is overweight, 30% is obese. To a greater extent, this is typical for women, especially older ones. age groups.
A significant increase in the number of obese people, including in developed countries, a trend towards an increase in the prevalence of obesity among individuals young age and children make this problem socially significant.
Assessment methods. Compliance with BW (body weight) is most often assessed using body mass index (BMI) or Quetelet index.

BMI = body weight (kg) / height2 (m2)

With an increase in BMI, the risk of developing comorbidities increases. At the same time, the risk of complications, especially cardiovascular and metabolic ones, depends not only on the degree of obesity, but also on its type (localization of body fat). The most unfavorable for health and characteristic for men is abdominal obesity(AO), in which fat is deposited between internal organs in the waist area. The deposition of fat in the thighs and buttocks, more typical for women, is called gluteofemoral.
There is a simple and fairly accurate way to assess the nature of the distribution of fat - the measurement of waist circumference (WC). OT is measured in a standing position, midway between the lower edge of the chest and the crest ilium along the midaxillary line (not at the maximum size and not at the level of the navel). The test is objectified and correlates with the degree of fat accumulation in the intra- and extra-abdominal space according to magnetic resonance imaging (MRI).

If WC is ≥ 94 cm in men and ≥ 80 cm in women, AO is diagnosed, which is an independent risk factor for CVD. Persons with AO are advised to actively reduce BW.

Overweight/obesity is an independent risk factor for CVD and forms a cascade of secondary risk factors. Adipose tissue, especially visceral, it is metabolically active endocrine organ, releasing into the blood substances involved in the regulation of CCC homeostasis.
An increase in adipose tissue is accompanied by an increase in the secretion of free fatty acids, hyperinsulinemia, insulin resistance, hypertension, and dyslipidemia.
Overweight/obesity and concomitant risk factors increase the likelihood of developing a number of diseases, the likelihood of which increases with increasing body weight. At the same time, if the risk of CVD and DM is increased with AO, then the risk of diseases of the spine, joints and veins is higher with the gluteofemoral type. lower extremities.
Overweight and obesity often coexist with hypertension and dyslipidaemia, with BP rising with increasing obesity.
The presence of excess body weight and obesity increases the risk of developing hypertension by 3 times, coronary artery disease by 2 times.
The probability of developing DM in people with excess body weight is 9 times higher, in people with obesity - 40 times. Excess weight significantly reduces life expectancy: on average, from 3–5 years with a slight excess of BW and up to 15 years with severe obesity. Elongation of the vasculature, increased sodium retention in cells, an increase in the activity of the sympathetic-adrenal and renin-angiotensin-aldosterone systems observed with excessive MT, insulin resistance, biological excretion active substances visceral adipose tissue increase the likelihood of developing hypertension. The development of atherosclerosis and coronary artery disease in people with excess MT is facilitated by the closely related hypertension, lipid metabolism disorders (increased TG and LDL-C, decreased HDL-C), insulin resistance, impaired glucose tolerance (IGT), type II diabetes, endothelial dysfunction . In addition, there is an increase in the production of plasminogen activator inhibitor-1 by adipocytes, which helps to reduce the fibrinolytic activity of the blood and increase the risk of thrombosis.

Algorithm for Examining Persons with Overweight and Obesity

Collection of diet anamnesis gives the doctor and patient a visual representation of the patient's eating habits; allows you to develop a diet therapy plan that is adequate to your eating habits; determines the extent and nature of the intervention; develops mutual understanding between the doctor and the patient. In some cases, a 3-7-day survey is carried out (the patient writes down all the food eaten during these days, including servings, quantity, frequency, and presents in writing or send by mail).
Assessment of readiness for treatment. For effective correction of overweight, it is important that patients are ready to follow the recommendations given to them. To do this, they must be motivated to reduce body weight, understand the timing and pace of treatment, for example, know that weight loss due to fat usually does not exceed 0.5-1 kg per week, and in outpatient settings this is a good result. Knowing the motivation of the patient and his previous experience is necessary for the subsequent emotional support of the patient. To assess the patient's readiness for treatment to reduce BW, it is necessary to find out:
the reasons that prompted the patient to start treatment;
understanding by the patient of the causes leading to the development of obesity, and his negative influence on health;
consent of the patient to a long-term change in eating habits and lifestyle;
motivation to reduce MT;
previous experience in reducing BW;
the possibility of emotional support in the family;
understanding the pace and timing of treatment;
the patient's willingness to keep a food diary and control BW.

Objective examination of the patient is necessary to identify other risk factors, comorbidities, contraindications to treatment and develop a strategy for nutritional intervention. The minimum examination of a patient with excess body weight/obesity, along with a general clinical examination, includes: measurement of blood pressure, ECG recording, determination of levels of total cholesterol, triglyceride, glucose in fasting blood serum. If any deviations are detected, additional examination is necessary in accordance with generally accepted diagnostic algorithms.
Definition of contraindications to treatment. WHO experts (1997) determined the range of temporary, absolute and possible, relative contraindications. Temporary (absolute) contraindications for the treatment of obesity: pregnancy; lactation; uncompensated mental illness; uncompensated somatic diseases. Possible (relative) contraindications: cholelithiasis; pancreatitis; osteoporosis. Reduced diets during pregnancy and lactation are absolutely contraindicated.

Expert advice. The increase in MT can be enhanced psychogenic disorders including bulimia nervosa, depression, recurrent episodes of binge eating, night eating syndrome, seasonal affective disorder.
They can be for the patient difficult to overcome obstacles to compliance with the treatment regimen.
If the patient has signs of an eating disorder (attacks of compulsive eating in short periods of time, lack of satiety, eating large amounts of food without feeling hungry, in a state of emotional discomfort, sleep disturbance with night meals combined with morning anorexia, etc. ), consultation of a psychoneurologist or psychiatrist is indicated.
If secondary, endocrine obesity is suspected (Itsenko-Cushing's syndrome, hypothyroidism, etc.), an endocrinologist should be consulted.

obesity treatment

The goals of obesity treatment are:
− a moderate decrease in body weight with a mandatory reduction in the risk of developing associated with obesity diseases;
− MT stabilization;
- adequate control of disorders associated with obesity;
− improving the quality and life expectancy of patients.

Using very low calorie diets does not lead to skill building rational nutrition; noted poor tolerance these diets, frequent side effects from the gastrointestinal tract, cholelithiasis, disorders of protein metabolism, electrolyte balance; cases of ventricular fibrillation, etc. The use of diets with moderate calorie restriction (1200 kcal / day) causes a decrease in body weight after 3–12 months to a sufficient extent (on average by 8%).
The energy deficit in the formulation of low-calorie diets can be achieved by reducing the intake of both fats and carbohydrates. It has been proven that the use of low-calorie diets with a restriction of fat and carbohydrates contributes not only to a decrease in body weight, but also to a decrease in blood pressure, and an improvement in the lipid profile.
It is necessary to establish a strict relationship between energy value food and energy consumption. A number of factors are important, and above all, the level of metabolism. Calculations show that the excess daily calories food over energy expenditure by only 200 kcal per day increases the amount of reserve fat by approximately 20–25 g per day and by 3.6–7.2 kg per year. Thus, the term “overeating” does not mean “gluttony”, but only relative overeating, that is, the excess of the caloric value of food over the energy expenditure of the body.
It is also possible to predict the loss of MT. So, if with energy expenditure of 2200 kcal a person receives 1800 kcal daily, then the energy deficit is 400 kcal.
Knowing that 1 g of adipose tissue provides 8 kcal, it can be calculated that in the daily energy balance of the body, 50 g of adipose tissue (400:8) needs to be broken down. Therefore, in 1 week the loss of MT will be 350 g (50 x 7), in 1 month - 1.5 kg, in a year - almost 18 kg. Thus, the main method of treating obesity is dietary, and the main principle of diet therapy is calorie reduction.

Principles of building a diet for overweight and obesity:
− Sharp restriction of consumption easily digestible carbohydrates, sugars up to 10–15 g (3 pieces or teaspoons) or less per day, including “pure” sugar (for sweetening tea, coffee) and sugar contained in drinks, jams, sweets, etc. Confectionery containing high-calorie fat, and sweet carbonated drinks are recommended to be completely excluded.
− Restriction of starch-containing products: bread, products and dishes from cereals, potatoes. You can eat up to 3-4 slices of black or 2-3 slices of white bread per day. You can add a serving of porridge and/or a serving of potatoes. Pasta is best avoided.
− Sufficient (up to 250–300 g) consumption of protein products: meat, fish, poultry, eggs, dairy products. They are essential for the body and are highly nutritious. But when choosing protein foods, preference is given to foods with the lowest fat content (the calorie content of such foods is much lower). If there is no choice, you can cut off visible fat, remove the skin from the chicken, remove the foam from the milk, etc.

− Consumption a large number vegetables (except potatoes) and fruits (up to 1 kg in total). Products and dishes prepared from them are low-calorie and at the same time, due to the large volume of food, create a feeling of satiety. Preference should be given to acidic varieties of fruits and leafy vegetables (citrus fruits, berries, apples, cabbage, lettuce, spinach, etc.).
- Limiting the intake of fat, mainly of animal origin.

− Restriction of salt consumption in order to normalize water-salt metabolism.
It is necessary to limit salt both in its pure form (salt less when cooking, remove the salt shaker from the table), and in the form of salty foods (pickles, marinades, salted fish, etc.).
- Limiting the consumption of spicy snacks, sauces, spices that stimulate the appetite.
− Frequent use food - up to 5-6 times a day, but in small quantities.
- Alcohol is high in calories, so limiting it is important to control BW.

And the so-called “Kremlin Diet”, very similar to it, is built on a strict restriction of carbohydrates, which causes severe dehydration of the body (hence rapid weight loss), a decrease in insulin production and the conversion of carbohydrates into fats with their subsequent deposition. Diet is not balanced, can cause a shift acid-base balance, ketosis, acidosis. In addition, the “Kremlin Diet” is highly atherogenic: the fat level is twice the recommended values (up to 60-64% of calories), and the dietary cholesterol content is 1000-1280 mg / day, which is 4 times higher than the recommended norm.
Separate nutrition in nature does not exist : in any product (meat, milk, etc.) there are proteins, fats, and carbohydrates. A mixed diet is more balanced. So, the lack of the amino acid lysine in buckwheat makes up for milk, where it is in excess. In this way, buckwheat with milk is a balanced dish.
Separate food can only be effective if it is reduced to caloric restriction due to the uniformity of products, it cannot be practiced long time. Treatment of overweight and obesity by fasting is unacceptable, since fasting for more than 3 days impairs metabolic processes in the body, adversely psychological impact(even more increasing the importance of food for a person and stimulating the centers of appetite and hunger), increases the risk of complications (arrhythmias, hypovitaminosis with polyneuritis, skin and hair lesions, etc.).

Patient self-control. An important help in dieting is the patient's Diet Diary, in which he writes down everything he eats and drinks during the week preceding the visit to the doctor. This allows both the patient and the clinician to analyze diet(the amount of food eaten, the frequency of meals, situations that provoke extra meals), identify eating disorders, the cause of failures, the amount and nature of the necessary correction, and also increases the constructive interaction between the doctor and the patient.
Efficiency mark. It is necessary to achieve a decrease in BW by 5-15% of the initial values (depending on BMI) for 3-6 months, and further stabilization of BW. Repeated courses can be carried out in six months, 1 time in 1-2 years with a gradual gradual or smooth slow decrease in MT. It is necessary to realize that a diet is not a one-time action, and its effect will remain only when switching to the principles of a healthy diet with a constant restriction of part of the diet.

Increasing physical activity. The use of physical training in combination with a low-calorie diet provides a greater reduction in BW and prevents weight gain after the end of a low-calorie diet. Regular FA contributes to an increase in the loss of fat mass, especially in the abdominal region, and the preservation of lean mass, a decrease in insulin resistance, an increase in the metabolic rate, and positive changes in lipid profile.

Psychotherapy and behavioral interventions aimed at correcting the eating behavior of patients, increase the effectiveness of diet therapy and increase FA. The drug effect on excess body weight is indicated for: non-pharmacological interventions are ineffective; severe and complicated forms of obesity.
Appetite-reducing serotonergic drugs (such as the antidepressant fluoxetine) that reduce food absorption (orlistat) are used. Drug treatment can be continued up to 6 months, after a break - up to 2 years.

Surgical treatment of obesity (gastroplasty, formation of a “small” stomach, resection of the intestine, etc.) are more often used for obesity III degree with complications (secondary endocrine disorders, hernia spinal column, severe coxarthrosis, etc.). Operations of liposuction, liporesection with plastic surgery abdominal wall and others are of more cosmetic importance and can be performed in the absence of well-known general surgical contraindications, at the request of the patient. To provide people with overweight or obesity with medical care, it seems appropriate:
include in the list of medical services such a service as “reduction of excess body weight and treatment of obesity” and develop an appropriate standard of medical care;
train specialists working in medical prevention rooms, medical prevention departments of polyclinics and health centers to provide medical care to reduce excess body weight and treat obesity;
ensure medical institutions informational materials about the dangers of overweight and the treatment of obesity.

Literature: Appendix 2 to the journal "Cardiovascular Therapy and Prevention", 2011; 10 (6)

7. Overweight bodies and obesity

Excess MT occurs when the energy value of the diet exceeds the energy expenditure of a person. There is an accumulation of fat, which over time can lead to the development of a disease - obesity. Obesity is a metabolic and alimentary chronic disease, which is manifested by excessive development of adipose tissue and progresses in a natural course.

Epidemiology. According to WHO and domestic studies, about 50% of the population of Russia and other European countries have excess MT, 30% are obese. To a greater extent, this is typical for women, especially older age groups. A significant increase in the number of people with obesity, including in developed countries, the trend towards an increase in the prevalence of obesity among young people and children make this problem socially significant.

Assessment methods. Compliance with the appropriate MT is most often assessed using body mass index (BMI) or Quetelet index.
BMI \u003d Body weight (kg) / height 2 (m 2)

With an increase in BMI, the risk of developing comorbidities increases (Table 7). At the same time, the risk of complications, especially cardiovascular and metabolic ones, depends not only on the degree of obesity, but also on its type (localization of body fat). The most unfavorable for health and typical for men is AO, in which fat is deposited between the internal organs in the waist area. The deposition of fat in the thighs and buttocks, more typical for women, is called gluteofemoral.

Table 7. Classification of overweight and obesity (WHO 1998).

There is a simple and fairly accurate way to assess the nature of the distribution of fat - the measurement of waist circumference (WC). OT is measured in a standing position, midway between the lower edge of the chest and the iliac crest along the midaxillary line (not at the maximum size and not at the level of the navel). The test is objectified and correlates with the degree of fat accumulation in the intra- and extra-abdominal space according to magnetic resonance imaging (MRI) data.

If WC is ≥ 94 cm in men and ≥ 80 cm in women, AO is diagnosed, which is an independent risk factor for CVD. Persons with AO are advised to actively reduce BW.

Overweight/obesity is an independent risk factor for CVD and forms a cascade of secondary risk factors. Adipose tissue, especially visceral tissue, is a metabolically active endocrine organ that releases into the blood substances involved in the regulation of CVS homeostasis. An increase in adipose tissue is accompanied by an increase in the secretion of free fatty acids, hyperinsulinemia, insulin resistance, hypertension, and dyslipidemia. Overweight/obesity and concomitant risk factors increase the likelihood of developing a number of diseases, the likelihood of which increases with increasing body weight. At the same time, if the risk of CVD and DM is increased with AO, then the risk of diseases of the spine, joints and veins of the lower extremities is higher with the gluteofemoral type.

Overweight and obesity are often associated with hypertension and dyslipidaemia, with BP rising with increasing obesity. The presence of excess body weight and obesity increases the risk of developing hypertension by 3 times, coronary artery disease by 2 times. The probability of developing DM in people with excess body weight is 9 times higher, in people with obesity - 40 times. Excess weight significantly reduces life expectancy: on average, from 3–5 years with a slight excess of BW and up to 15 years with severe obesity.

Elongation of the vasculature, increased sodium retention in cells, an increase in the activity of the sympathoadrenal and renin-angiotensin-aldosterone systems, insulin resistance, and the release of biologically active substances by visceral adipose tissue observed in excess MT increase the likelihood of developing hypertension. The development of atherosclerosis and coronary artery disease in people with excess MT is facilitated by the closely related AG, lipid metabolism disorders (increased TG and LDL-C, decreased HDL-C), insulin resistance, impaired glucose tolerance (IGT), type II diabetes, endothelial dysfunction. In addition, there is an increase in the production of plasminogen activator inhibitor-1 by adipocytes, which helps to reduce the fibrinolytic activity of the blood and increase the risk of thrombosis.

7.1. Algorithm for Examining Persons with Overweight and Obesity

Assessment of readiness for treatment. For effective correction of overweight, it is important that patients are ready to follow the recommendations given to them. To do this, they must be motivated to reduce body weight, understand the timing and pace of treatment, for example, know that weight loss due to fat usually does not exceed 0.5–1 kg per week, and this is a good result on an outpatient basis. Knowing the motivation of the patient and his previous experience is necessary for the subsequent emotional support of the patient. To assess the patient's readiness for treatment to reduce BW, it is necessary to find out:

the reasons that prompted the patient to start treatment;
understanding by the patient of the reasons leading to the development of obesity and its negative impact on health;
consent of the patient to a long-term change in eating habits and lifestyle;
motivation to reduce MT;
previous experience in reducing BW;
the possibility of emotional support in the family;
understanding the pace and timing of treatment;
the patient's willingness to keep a food diary and control BW.

Objective examination of the patient is necessary to identify other risk factors, comorbidities, contraindications to treatment and develop a strategy for nutritional intervention. The minimum examination of a patient with excess body weight/obesity, along with a general clinical examination, includes: measurement of blood pressure, ECG recording, determination of levels of total cholesterol, triglyceride, glucose in fasting blood serum. If any deviations are detected, additional examination is necessary in accordance with generally accepted diagnostic algorithms.

Definition of contraindications to treatment. WHO experts (1997) identified a range of temporary, absolute and possible, relative contraindications. Temporary (absolute) contraindications for the treatment of obesity: pregnancy; lactation; uncompensated mental illness; uncompensated somatic diseases. Possible (relative) contraindications: cholelithiasis; pancreatitis; osteoporosis. Reduced diets during pregnancy and lactation are absolutely contraindicated.

Expert advice. The increase in MT can increase psychogenic disorders, including bulimia nervosa, depression, recurring episodes of severe overeating, night eating syndrome, seasonal affective disorders.

They can be for the patient difficult to overcome obstacles to compliance with the treatment regimen. If the patient has signs of an eating disorder (attacks of compulsive eating in short periods of time, lack of satiety, eating large amounts of food without feeling hungry, in a state of emotional discomfort, sleep disturbance with night meals combined with morning anorexia, etc. ), consultation of a psychoneurologist or psychiatrist is indicated.

If secondary, endocrine obesity is suspected (Itsenko-Cushing's syndrome, hypothyroidism, etc.), an endocrinologist should be consulted.

7.2. obesity treatment

The goals of obesity treatment are:

a moderate decrease in body weight with a mandatory decrease in the risk of developing obesity-related diseases;
MT stabilization;
adequate control of obesity-related disorders;
improving the quality and life expectancy of patients.

Diet therapy for obesity. Reducing the calorie content of the diet and creating an energy deficit is the main principle of nutritional intervention. According to the severity of energy deficiency, diets with moderate calorie restriction (1200 kcal/day) and very low calorie content (500–800 kcal/day) are distinguished. The latter contribute to a more pronounced decrease in BW (1.5–2.5 kg/week) compared with a moderately reduced calorie diet (0.5–1.4 kg/week), but only at the initial stage of treatment. Long-term results (after 1 year) of using diets with moderate and severe calorie restriction did not show a significant difference in the decrease in BW. The use of very low calorie diets does not lead to the formation of rational nutrition skills; there is a poor tolerance of these diets, frequent side effects from the gastrointestinal tract, cholelithiasis, disorders of protein metabolism, electrolyte balance; cases of ventricular fibrillation, etc. The use of diets with moderate caloric restriction (1200 kcal / day) causes a decrease in BW after 3-12 months to a sufficient extent (on average by 8%).

The energy deficit in the formulation of low-calorie diets can be achieved by reducing the intake of both fats and carbohydrates. It has been proven that the use of low-calorie diets with a restriction of fat and carbohydrates contributes not only to a decrease in body weight, but also to a decrease in blood pressure, and an improvement in the lipid profile.

It is necessary to establish a strict relationship between the energy value of food and energy consumption. A number of factors are important, and above all, the level of metabolism. Calculations show that the excess of daily calorie intake over energy expenditure by only 200 kcal per day increases the amount of reserve fat by approximately 20–25 g per day and by 3.6–7.2 kg per year. Thus, the term “overeating” does not mean “gluttony”, but only relative overeating, that is, the excess of the caloric value of food over the energy expenditure of the body.

It is also possible to predict the loss of MT. So, if with energy expenditure of 2200 kcal a person receives 1800 kcal daily, then the energy deficit is 400 kcal. Knowing that 1 g of adipose tissue provides 8 kcal, it can be calculated that in the daily energy balance of the body, 50 g of adipose tissue (400:8) needs to be broken down. Therefore, in 1 week the loss of MT will be 350 g (50 x 7), in 1 month - 1.5 kg, in a year - almost 18 kg. Thus, the main method of treating obesity is dietary, and the main principle of diet therapy is calorie reduction.

Principles of building a diet for overweight and obesity:

Sharp restriction of the consumption of easily digestible carbohydrates, sugars to 10–15 g (3 pieces or teaspoons) or less per day, including “pure” sugar (for sweetening tea, coffee) and sugar contained in drinks, jams, sweets, etc. Confectionery products containing high-calorie fat, and sweet carbonated drinks are recommended to be completely excluded.
Restriction of starchy products: bread, products and dishes from cereals, potatoes. You can eat up to 3-4 slices of black or 2-3 slices of white bread per day. You can add a serving of porridge and/or a serving of potatoes. Pasta is best avoided.
Sufficient (up to 250–300 g) consumption of protein products: meat, fish, poultry, eggs, dairy products. They are essential for the body and are highly nutritious. But when choosing protein foods, preference is given to foods with the lowest fat content (the calorie content of such foods is much lower). If there is no choice, you can cut off visible fat, remove the skin from the chicken, remove the foam from the milk, etc.
Consumption of a large number of vegetables (except potatoes) and fruits (up to 1 kg in total). Products and dishes prepared from them are low-calorie and at the same time, due to the large volume of food, create a feeling of satiety. Preference should be given to acidic varieties of fruits and leafy vegetables (citrus fruits, berries, apples, cabbage, lettuce, spinach, etc.).
Limiting the intake of fat, mainly of animal origin.
Restriction of salt intake in order to normalize water-salt metabolism. It is necessary to limit salt both in its pure form (salt less when cooking, remove the salt shaker from the table), and in the form of salty foods (pickles, marinades, salted fish, etc.).
Limiting the consumption of spicy snacks, sauces, spices that stimulate the appetite.
Frequent meals - up to 5-6 times a day, but in small quantities.
Alcohol is high in calories, so limiting it is important for BW control.

Popular "trendy" diets are based on the principles of strict nutritional restriction with a reduction in calories to 1000–1500 kcal. These diets do not always take into account the principles of rational nutrition. Their use is possible for a limited period of time (2-6 weeks) in apparently healthy individuals with only overweight/obesity. True, fairly balanced diets of 1200-1500 kcal can be used for longer, and in practically healthy older women - almost constantly. It should be borne in mind that dietary restrictions in children can lead to growth and developmental arrest, and in adolescence - to endocrine disorders. Relatively simple in terms of technical implementation is a variable diet (during the day, dishes from one product are used). The diet contains elements of separate nutrition, but is not balanced and suitable for people without serious diseases. Also, the so-called fasting days are not balanced. They can be practiced 1-2 times a week and only after consulting a doctor. The Atkins diet and the so-called "Kremlin diet" very similar to it are built on a strict restriction of carbohydrates, which causes severe dehydration of the body (hence rapid weight loss), a decrease in insulin production and the conversion of carbohydrates into fats with their subsequent deposition. The diet is not balanced, can cause a shift in acid-base balance, ketosis, acidosis. In addition, the “Kremlin Diet” is highly atherogenic: the fat level is twice the recommended values (up to 60–64% of calories), and the dietary cholesterol content is 1000–1280 mg/day, which is 4 times higher than the recommended norm.

Separate food does not exist in nature: in any product (meat, milk, etc.) there are proteins, fats, and carbohydrates. A mixed diet is more balanced. So, the lack of the amino acid lysine in buckwheat makes up for milk, where it is in excess. Thus, buckwheat porridge with milk is a balanced dish. Separate nutrition can be effective only if it is reduced to calorie restriction due to the uniformity of products, it cannot be practiced for a long time. Treatment of excess body weight and obesity by fasting is unacceptable, since fasting for more than 3 days disrupts metabolic processes in the body, has an adverse psychological effect (further increasing the importance of food for a person and stimulating appetite and hunger centers), increases the risk of complications (arrhythmias, hypovitaminosis with polyneuritis phenomena). , skin and hair lesions, etc.).

Efficiency mark. It is necessary to achieve a decrease in BW by 5–15% of the initial values (depending on BMI) for 3–6 months, and further stabilization of BM. smooth slow decrease in MT. It is necessary to realize that a diet is not a one-time action, and its effect will remain only when switching to the principles of a healthy diet with a constant restriction of part of the diet.

Psychotherapy and behavioral interventions aimed at correcting the eating behavior of patients, increase the effectiveness of diet therapy and increase FA.

Medicinal effects on excess BW indicated for: ineffectiveness of non-pharmacological interventions; severe and complicated forms of obesity.

Appetite-reducing serotonergic drugs (such as the antidepressant fluoxetine) that reduce food absorption (orlistat) are used. Drug treatment can be continued up to 6 months, after a break - up to 2 years.

Surgical treatment of obesity (gastroplasty, formation of a “small” stomach, resection of the intestine, etc.) are more often used for obesity of the III degree with complications (secondary endocrine disorders, hernia of the spinal column, severe coxarthrosis, etc.). Operations of liposuction, liporesection with abdominal wall plasty, etc. are of more cosmetic importance and can be performed in the absence of well-known general surgical contraindications, at the request of the patient.

For the provision of medical care to persons with excess body weight or obesity, it seems appropriate:

include in the list of medical services such a service as "reduction of excess body weight and treatment of obesity" and develop an appropriate standard of medical care;
train specialists working in medical prevention rooms, medical prevention departments of polyclinics and health centers to provide medical care to reduce excess body weight and treat obesity;
provide medical institutions with information materials about the dangers of overweight and the treatment of obesity.

Overweight results from either not proper nutrition, or a sedentary lifestyle, or a combination of the first and second. The diet of a person with a similar problem is dominated by carbohydrate and fatty foods. As you know, carbohydrates and fats have the highest energy value, that is, they are more caloric than proteins. The latter do not pose any threat to humans, but rather serve as a building material, perform enzymatic and many other functions in the human body. That is why many diets are based on protein diet nutrition. So why is being overweight dangerous?

An increased amount of fats in the human diet leads to the fact that the liver does not have time to process them, and the level of low density lipoproteins in the blood rises. They tend to be deposited on the walls of blood vessels and, over time, gradually clog them. As a result, the lumen of the vessels narrows, and it is more difficult for blood to pass through the vessels, i.e., increased vascular resistance occurs, which leads to arterial hypertension. High blood pressure is the cause of rapid "wear" of blood vessels, kidneys and myocardium of the heart. Arterial hypertension triggers a cascade of responses in the body, which are closed in " vicious circle».

For example, hypertension leads to wear and tear of the myocardium, which in turn leads to heart failure. Thus, the heart loses its ability to adequately supply blood to peripheral organs due to the fact that it pushes blood with less force. big circle circulation. A state of hypoxia occurs when the organs do not have enough oxygen, which should bring them arterial blood. The brain and kidneys react most acutely to the state of hypoxia. The kidneys secrete the enzyme angiotensin 1, which is converted to angiotensin 2 in the lungs, which further constricts blood vessels so that blood comes to the kidneys better, which further aggravates the condition. arterial hypertension. But besides the fact that the heart loses the ability to adequately supply peripheral organs with blood, it gradually loses the ability to supply blood to itself. This phenomenon is called angina pectoris, which is characterized by sharp pain behind the sternum during exercise or even at rest. For the brain, high blood pressure threatens the risk of stroke. But it's just not complete list possible consequences.

As mentioned above, the amount of low density lipoproteins in the bloodstream increases. And besides the above-mentioned chain of pathological processes, under their influence, another, no less dangerous, may arise. Being deposited on the walls of blood vessels, they can contribute to the disruption of the interaction of insulin with insulin receptors in peripheral tissues, in other words, the occurrence diabetes 2 types.

Elevated fat content can lead to fatty infiltration of the liver. The liver cells are replaced by fat cells- adipocytes - and the liver gradually loses the ability to perform its functions. This is, first of all, the synthesis of the most important proteins of our body, for example, blood coagulation factors, resulting in increased bleeding. The liver performs a detoxifying function, for example, in the neutralization of alcohol or any drug, which is also gradually lost.

All of the above consequences of obesity can manifest themselves not separately, but in a complex way. This phenomenon is called the metabolic syndrome. A whole range of measures has been developed to protect the human body from such phenomena. To do this, you should eat right, exercise, control your pressure, stop smoking. If you are obese, then the main rule is to use preventive measures in conjunction with modern drugs which lower blood pressure and lower low-density lipoprotein levels. Be healthy!

Obesity (Latin obesitas - fullness, fattening) is a chronic disease, which is characterized by the accumulation of excessive adipose tissue in the human body, which leads to an increase body weight. The disease is progressive and is accompanied endocrine disorders . A gradual increase in body weight leads to irreversible processes in the cardiovascular and respiratory systems.

To date, in the health care of our country, and indeed the whole world as a whole, such a disease as obesity occupies almost the first place in its prevalence. According to WHO statistics, since 1980, the number of cases of this disease has doubled; in 2008, 1.5 billion people aged 20 years and older suffered from excess weight, but about statistical figures childhood and it's scary to say - 40 million children. Almost 3 million people die each year from overweight or obesity.

Moreover, about 44% of diabetes mellitus, 27% of coronary heart disease and 7 to 40% oncological diseases are due to being overweight. Generally speaking, this disease is spreading quite quickly around the globe from year to year. To fight overweight are being developed various methods this is a variety of diets, and training, and surgical treatment of obesity.

Causes of obesity

The common cause of obesity is slow metabolism, as a result of which the number of calories that enter the body with food is not burned, while forming excessive accumulation of fat. However, many factors lead to a slowdown in metabolism, so the causes of obesity, ultimately, may be different.

This is primarily due to low physical activity and poor nutrition, frequent use spicy and fatty foods, especially fatty varieties meat, various sweets, pasta. Wrong image life, long sleep, chronic, smoking, are also causes of excess weight. Eating a large amount of high-calorie foods, as well as sugary carbonated drinks, also contributes to the accumulation of fat in the body.

The disease may also be related to hormonal drugs, as well as with frequent stress. In some cases, excessive body weight is due to a hereditary factor - increased activity lipogenesis enzymes or decrease in activity.

Some diseases can also lead to obesity, for example, ( insulinoma , gyrothyroidism ), then such obesity is called endocrine. Diseases nervous system associated with damage to the hypothalamus, lead to hypothalamic obesity.

In addition, certain medications can also lead to obesity, for example, corticosteroids and various antidepressants . Another factor contributing to weight gain is age. Usually after 30 years there is a restructuring of special centers of the brain, among which is the center responsible for appetite. This means that in order to suppress the feeling of hunger, a person needs large quantity food. In addition, with age, a person's metabolism slows down, which leads to gradual increase weight.

Food rich in easily digestible carbohydrates is not able to be absorbed properly if you do not balance your diet with foods that have enough protein. Wrong diet women leads to the fact that the fetus in the third trimester of pregnancy is already forming a predisposition to excess weight. This is where childhood obesity comes in.

obesity symptoms

Constantly increasing body weight is the main symptom of obesity. Against the background of excess weight, symptoms such as shortness of breath, fatigue, swelling of the lower extremities, increased appetite appear, while patients prefer oily and heavy food. Patients may also be disturbed by bouts of night hunger and. In a woman, changes affect genital area, the menstrual cycle is disturbed, signs may appear, in men it decreases. Hyperpigmentation of the skin may also appear, especially on the arms and elbows, as well as the appearance of small stretch marks ( striae ) on the neck, thighs and abdomen.

These symptoms of obesity appear long before excess weight begins to interfere with the normal rhythm of life, so many patients do not consider their weight to be overweight. In the first stages of the disease, a person's weight increases up to 20% and gradually increases. An equally important symptom of the disease is hypertension. tends to settle on the walls of blood vessels, thereby impeding blood flow.

Fat deposits can be distributed evenly, and the person for a long time does not pay attention to the appearance of excess weight. In the case when the accumulation occurs in certain places, the signs of obesity are more noticeable. In children, this localized obesity leads to growth retardation.

Obesity in children most often develops due to acquired metabolic disorders, as well as heredity. Usually obesity can be observed at 1 year, and at 10-15 years. In children 10-15 years old, the cause of obesity is usually hypothalamic syndrome, which is characterized by the appearance of stretch marks on the hips, buttocks, mammary glands. There is an increase blood pressure may also increase intracranial pressure.

Diagnosis of obesity

The World Health Organization classifies obesity according to BMI, that is body mass index. BMI is calculated by the ratio of weight to square centimeter of body area. If BMI is equal to or greater than 25, then it is simple overweight , if 30 or more - obesity . As a classification option, BMI ranks first in terms of overweight detection methods, since it is the same for both sexes and all age categories.

Accurate calculations BMI produced according to the following formulas:

less than 0.0185 g/sq. see - underweight (dystrophy);
0.0185-0.0249 g/sq. cm. - normal mass body;
0.025-0.0299 g/sq. see - overweight;
0.030-0.0349 g/sq. see - the first degree of obesity;
0.035-0.039 g/sq. see - the second degree of obesity;
more than 0.040 g/sq. see - the third degree of obesity.

With obesity of the fourth degree, the actual body weight exceeds the ideal weight by more than 100%.

To measure body weight in people over 65, athletes, pregnant women and children, these formulas are being amended.

Diagnosis of obesity is also carried out according to the formula for calculating BMI Broca's index method. The basis of this method is the ratio of height and body weight. A ratio is considered normal at which body weight equals height minus 100 in centimeters. But the calculation will be correct only within 155-170 cm of growth.

If a person suffers from obesity of I and II degrees, then he has complaints of weakness, drowsiness, a sharp decline mood, increased, irritability. It can also bother chronic, as well as nausea. When exercising, it appears tachycardia and shortness of breath . With the I degree of obesity, the patient is worried about shortness of breath when performing exercise medium intensity, but the performance remains at the same level. Already with obesity of the II degree, working capacity is significantly reduced, the patient complains of swelling of the legs, as well as pain in the spine.

With obesity of the III degree, a person develops body disproportion, shortness of breath worries almost constantly, blood circulation is disturbed. Against the background of general lethargy and apathy, the patient's appetite is increased. For the IV degree of obesity, it is characteristic that a person becomes disabled, his mental state is disturbed, he does not care about anything except food.

To diagnose obesity, several factors must be considered. Firstly, the age of the patient is taken into account when the first signs of the disease appeared, recent changes in body weight, lifestyle, food preferences, presence, intensity of physical activity, use of various medicines(hormones, various food additives, laxatives).

Thus, the doctor, in order to make a diagnosis of overweight or obesity, determines BMI in order to classify the disease according to severity, determines the ratio of waist circumference to hip circumference to determine the nature of the distribution of fatty tissues in the body, and then measures blood pressure. After that, the patient is sent for tests. Held laboratory research blood, to determine the level cholesterol and lipoproteins high and low density in order to detect violations fat metabolism, as well as echocardiography to determine the pathologies of the heart and the entire circulatory system. In case of menstrual irregularities, gynecological examinations and ultrasound procedure pelvic organs.

Complications of obesity

Obesity is characterized as a disease in which the patient has excessive body fat that create additional load on the musculoskeletal system , cardiovascular and respiratory system . Therefore, complications are primarily manifested by diseases of these systems and organs. Obesity is dangerous for health, for its longevity, and can lead to premature death.

Obesity very often leads to the development, circulatory disorders, diseases of the heart, joints, liver and biliary tract, as well as diabetes. In obese people, the likelihood of thrombosis in the veins of the legs is 2.5 times higher than in people with normal weight. Obese women under 40 years of age are most at risk of thrombosis.

Fat tends to accumulate in men in the abdominal cavity ( abdominal obesity ), and in women - on the buttocks and thighs ( pelvic obesity ). With abdominal obesity, the likelihood of the appearance and development of coronary disease heart, which leads to an increase in blood pressure, an increase in the content of fats in the blood and the development non-insulin dependent diabetes mellitus . Weight loss leads to a decrease in blood pressure in patients suffering from hypertension, and for patients with non-insulin-dependent diabetes, this allows drug therapy to be discontinued.

On the part of the digestive organs, such complications of obesity develop as, pancreatitis , cholelithiasis .

Obese patients are often prone to the formation of malignant tumors. In men they amaze prostate and rectum , and for women uterus , ovaries and milk glands . Besides, menstrual disorders, gallbladder disease occurs in such women much more often than in women with normal weight. All this leads to a violation of the reproductive function.

obesity treatment

To lose weight, obese patients need to consume fewer calories than they expend. There are three methods to achieve this goal:

self-help;
psychological methods;
clinical programs.

In the case of self-help, patients on their own, or in special groups, relying on the developed methods of losing weight, try to normalize your diet, do physical education. To psychological methods weight loss include motivate yourself to lose weight, for example, the desire to surprise everyone around with their beauty and harmony, or to wear a new dress small size. Such motivation should be relevant, and related to life position person. Such motivation should be combined with proper diet and daily physical activity.

It is very important to treat obesity in a complex way, i.e. strive to reduce body weight different ways, with the help of diet therapy, physiotherapy, exercise and medication.

Program complex treatment obesity usually consists of two stages - phase of weight loss (approximately 3-6 months) and mass stabilization stage (6 months).

In addition, nutritionists teach obese patients to eat right, control their health and the quality of nutrition. It is very important that the patient is aware of the need to change their eating habits and lifestyle.

Obesity treatment programs teach how to eat right, how to change lifestyle and eating habits to achieve results. For this, doctors recommend a balanced low calorie diet based on reducing the consumption of carbohydrates and fats of animal origin, while maintaining the required amount of proteins, vitamins, and minerals in the diet. Doctors will help to individually select products, taking into account the age, degree of obesity, taste and lifestyle of the patient. You can not starve and use diets with sharp restrictions in fats and carbohydrates. Introduce foods into the diet high content fiber , which contribute to rapid saturation and accelerate the passage of products through the intestines (bran, green beans, oats, whole wheat). Meals should be fairly frequent (5-6 times a day). Fasting days are also useful (1 time per week). For those who are obese I-II degrees, doctors recommend moderately limiting fat intake.

An individual system of physical activity is developed for the patient, taking into account his lifestyle and changes in diet. Most effective daily morning exercises , as well as, i.e. brisk walking, jogging, cycling, aerobics, football. These classes should be systematic and frequent (3-5 times a week). You need to choose those physical activities that bring you pleasure. A professional fitness trainer will not only control its execution, but also correct it depending on the patient's condition. If an obese patient has diseases of the heart, blood vessels, the load should be light, focusing on the pulse.

Medical therapy helps to increase the effectiveness of other methods of treatment, and in patients with II degree obesity, drug treatment begins simultaneously with a change in lifestyle and nutrition. However drug therapy not recommended for pregnant women, children, and patients over 65 years of age.

Among the drugs used in the treatment of obesity, doctors prescribe drugs that suppress appetite, promote the release of retained fluids in the body, as well as increase energy expenditure and reduce absorption. nutrients in the body. For example, it prevents the absorption of fats in the intestines, but its side effect is the presence of loose stools. contributes to a decrease in appetite and an increase in energy expenditure, but affects cardiovascular system. Also drugs for normalization can be used. hormonal background. Medicines for weight loss should be prescribed only by the attending physician. However, many patients supplement their treatment with special teas and fees for weight loss, as well as biologically active additives .

In diseases of obesity against the background of other diseases, for example, diabetes mellitus, diseases musculoskeletal system, digestive organs, treatment of the underlying disease is mandatory.

Psychocorrection sessions can also be held with the patient, in which the psychotherapist will help to understand the causes of obesity.

For the treatment of patients with obesity of the IV degree is used surgical treatment of obesity. Such operations should be carried out exclusively in institutions that specialize in this type of surgical interventions and only by qualified surgeons. It is in this case that patients tolerate the operation better, and complications occur in less than 10% of patients with a high degree of risk. There are several surgical methods for the treatment of obesity: - removal of excess fatty tissue from under the skin; - removal of the large abdomen, the establishment of gastric rings, contributing to a decrease in the volume of the stomach, which contributes to the acceleration of saturation; bypass enteroanastomoses in which parts are removed from the digestive system small intestine. Such operations can lead to sudden weight loss, about half the patient's excess weight, and gradually slows down. Weight loss helps to improve the general condition of the patient, increase his activity and efficiency, mood also improves. In addition, the operation reduces the complications caused by obesity.

It is important to remember that weight loss is easier to achieve with a combination of diet and exercise, physical therapy and medication. beneficial action provided to obese patients thermal treatments– mud procedures, hot dry-air baths, salt and coniferous baths, steaming, swimming in the pool, light-thermal baths, wet wraps. Also useful sauna - a dry hot bath of the Finnish sample. It is advisable to use occupational therapy and general massage.

It is important to note that obesity in infants is purely dietary, older children are treated in the same way as adults.

Nutrition for obesity

Since the main cause of obesity is binge eating, then doctors advise to regulate nutrition, the same recommendations include the prevention of obesity. It is important that food with a small amount of calories causes a feeling of satiety. When preparing dishes for an obese patient, they try not to salt the food. Limit food intake great content carbohydrates - bread, flour, sugar, cereals, potatoes, various sweets. You can eat black bread and bread with bran in the amount of 300 g per day. Fats in the diet are limited, but not completely excluded, they can be 50-75 g per day. Cholesterol-rich foods are the liver, egg yolk- removed from the diet. Vegetable oil is better to use unrefined, about 25-30 ml. in a day. Alcohol is prohibited. Doctors are allowed to arrange a curd day, when 60 g of sour cream, 600 g of cottage cheese, 2 cups of coffee (with milk and without sugar) and 2 cups of rosehip broth are allowed. Also fruit and vegetable days when allowed consumption of 1.5 kg. raw vegetables or fruits for 5-6 doses, apple day (2 kg. raw apples), or meat day, when 250-350 g of boiled meat is allowed for 5-6 meals, and a boiled side dish without salt, 2 cups of rosehip broth.

With obesity III-IV degrees, patients completely remove cereals from the diet and pasta, sugar, honey, sweets, while increasing the amount of vegetables consumed and are especially useful vegetable salads seasoned with vegetable oil. Also for such patients, it can also be used, which is carried out in a hospital under the supervision of a doctor.

The main diet for obesity is diet number eight. This diet is based on reducing the caloric content of the diet due to easily digestible carbohydrates with elevated content squirrel. It contains an increased amount of proteins (120 g), reduced amount fat (70 g), 200-250 g carbohydrate, 1 liter of liquid. Diet number eight allows only food cooked in boiled, baked and stewed form. The consumption of fried foods and foods that stimulate appetite, seasonings, and spices is limited. For drinks and sweet foods, xylitol or sorbitol is used. Subject to diet number 8, the following are allowed:

rye and wheat bread;
vegetable soups, beetroot, okroshka, borscht, fat-free meat broths;
low-fat varieties of fish and meat;
up to 1.5 eggs per day;
kefir, milk, fat-free cottage cheese, cheese, curdled milk, butter- limited;
buckwheat, barley and pearl barley friable porridges;
cabbage, cucumbers, zucchini;
unsweetened berries, fruits, compotes;
mineral water, tea, coffee with milk (without sugar), vegetable, berry and fruit juices.

Completely excluded from the diet for obesity White bread, pastry, fatty meat and fish, sausages, smoked meats, fatty cottage cheese, fatty cheeses, cream, semolina, rice, pickled vegetables, grapes, sugar, sweets, ice cream, mayonnaise, mustard, horseradish, chocolate.

Although diet number eight allows you to “lose” a few pounds in the first month, it should be followed for a long time. At right approach monthly weight loss will be 1-2 kg, and this will not adversely affect overall health, as often happens with other diets.

In the presence of diseases associated with obesity, the use of diet No. 8 should be agreed with the attending physician.

You can start keeping a food diary where you can write down what you ate, how much, when and why. It will help in the early stages of treatment, when lifestyle and eating habits change very seriously.

Prevention of obesity

Obesity prevention is about eliminating and maintaining a balanced diet. To prevent the development of obesity in baby, you need to systematically weigh it, especially with a hereditary predisposition to obesity. It is very important to organize proper nutrition in adolescents, as well as timely detection of diseases that are accompanied by endocrine or hypothalamic obesity .

Usually, the mass (weight) of the body in kilograms is considered, which is determined as the result of a simple arithmetic operation: a person’s height (in centimeters) minus 100. True, such calculations are not accurate enough. For more accurate calculation use the Beckert index: 103 is subtracted from the body length at L = 155-165 cm; 106 at L = 166-175 cm; 110 at L = 175 cm and above.

Causes of overweight

Body weight, 10-20% higher than normal, is considered excessive. More than 20% overweight is considered obese varying degrees. There are several theories that prove that two factors are the causes of overweight - internal (congenital prerequisites) and external (food culture).

Congenital Factors

According to one theory, the cause of overweight may be a genetic predisposition that determines the physique. Genes can determine the number of fat cells and metabolic rate. So, if one of your parents is obese, you have a 40% chance of becoming obese over time; if both of your parents are obese, the chance increases to 80%. If both parents are thin, there is less than a 10% chance that you will become obese.

In accordance with the theory of a given weight, the mass of fat that a person carries in himself is biologically set or programmed, so a person’s attempts to weigh less or more than what his body “wants” are doomed to failure.

The authors of the third theory argue that the culprit of overweight is an innate type of metabolism - slow or accelerated. Individuals with a slow metabolism tend to be overweight, with an accelerated one - to thinness.

External factors

According to the theory external influences, the reason for the discrepancy between body weight and age standards is the lack of general culture and, above all, food culture, which determine the general and “eating” behavior of the individual.

In some families, literally the whole life “revolves” around food: parents preach the “clean plates” rule and praise their children for eating a hearty meal to the crumbs. There is another extreme - indifference to food. In such families, there is no established diet, no one thinks about the choice food products according to their biological value.

Inappropriate eating behavior is often identified disorganization person. Such a person is guided not so much by internal physical sensations (feeling of hunger), but by reactions to the type, color and availability of food, or to the time of day for which he is programmed to eat. This situation is aggravated by the fact that in our time food is available around the clock - at home, in educational institutions, restaurants and grocery stores.

Make a person eat stress, boredom, danger, anxiety or loneliness; some people reward themselves with food for " good behavior". Usually, parents calmed or rewarded them in this way in childhood, which contributed to the formation of an appropriate behavioral program in them, which was preserved for life. In such a person, eating can act as a response to all kinds of stress. But if a person uses them as an excuse for gluttony, he has a number of new emotional problems associated with overeating. A kind of vicious circle is formed: depression causes overeating, and overeating causes depression.

Influence external factors on human eating behavior is strengthened by the increasingly widespread lack of physical activity. In this age of automation, everything is done by a button. By pressing a button, you can turn on and off the TV, take the elevator, open the garage door. Therefore, it is difficult for a person to force himself to show physical activity. However, immobility combined with overeating is fraught with obesity.

So, human body weight depends on two factors: internal (genetically programmed) and external (food culture). But the genetic programs are just a "suggestion", and their implementation depends on external conditions, i.e. genetic programs in the process of implementation may change. Because becoming digestive system and eating behavior is carried out in specific conditions of the lifestyle, determined by the level of culture, the role of nutrition culture should be considered a priority in the process of forming the body weight of an individual.

Consequences of being overweight

The harmful effects of excess body weight are divided into physiological, social and psychological.

physiological consequences. Excess body weight creates the prerequisites for the emergence of many health disorders: wear and tear of the joints due to negative mechanical effects, overloads; tendency to varicose veins veins, thrombosis, embolism, shortness of breath, hernia formation, heart failure, infectious diseases skin; increased risk of complications and death in surgical operations; development of cirrhosis of the liver due to its obesity; complications during childbirth; diseases associated with metabolic disorders; increase in pressure; diabetes; kidney disease, kidney stones bile ducts; gout; reduction in life expectancy. On average, excess body weight reduces life expectancy in men with a 10% excess of the norm by 13%, with a 20% excess - by 25%, with a 30% excess - by 42%, and in women by 9, 21 and 30% respectively.

Social and psychological consequences. The life of overweight young people tends to be less interesting and less romantic; they are often ridiculed and humiliated by their peers. Such students are inactive, cannot keep up with others, and as a result, they may develop an inferiority complex. Difficulties in choosing your own style of clothing force you to turn to a plain or even conservative manner of dressing. Graduates with overweight often experience difficulties when trying to get a job. Their fullness leads the employer to the idea of apathy and morbidity.