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Now an exogenous-constitutional (alimentary) obesity is one of the most widespread forms of pathology among the population, bringing to the emergence and development of many diseases which reduce a life expectancy of the person. It is favored by the marked imbalance of a diet and a low physical activity which is combined with an escalating psychological loading. This problem becomes even more actual in connection with a low efficiency of existing and widely advertized methods of the obesity treatment.

A psychotherapist or a psychologist should be surely involved in the treatment of the patient with obesity – he/she is a unique expert who works with feelings of patients and can help to change their psychological sets, to create another relation to them and to the people around. One of the most important points in the obesity therapy is a motivation of the patient for the treatment.

It is necessary for a doctor to understand what can become a stimulus to start the treatment as the reason of overeating is not only a stress which people try to overcome with the help of eating, it is, as a rule, a lack of love, care, safety, etc. The psychologist can and must help the patient, having an excess weight, to understand the reason of his/her problem and to correct his/her way of life and food behavior properly.

A psychotherapeutic treatment of obesity is directed, first of all, to the identification of a role of psychological and social factors in the course of an illness formation, a formation of necessary mechanisms of a psychological adaptation and protection, a development of more constructive models of behavior in reply to stressful factors.

At present there are “various psychological approaches to the problem of the obesity emergence, the most recognized among them are psychoanalytic concepts, researches of a dependent behavior, psychosocial theories and the theories considering the obesity as a result of an overeating (or a reaction to the stress)”. 

According to various researches the patients with obesity suffer from depression, anxiety, life deterioration, decrease in self-image, a social disadaptation and other violations. There is a certain interrelation between the obesity and the depression. “The depression and other mental violations develop approximately in 20-30 % of the patients with the obesity who did not manage to reduce their weight in various clinics”. Some patients have an increase of anxiety which leads to turning on habitual psychological protective mechanisms. Thus, inconsistent data on the connection of emotional and other psychological frustrations and the obesity are found by researches: for example, “there is data that, contrary to the assumptions of the authors, the depression of some patients after treatment of the excess weight did not decrease”.

The problem of obesity is directly connected with various psychological parameters: depression, anxiety, social disadaptation and phobia, quality of life, various types of food behavior (restrictive, emotional and extranational types of overeating), etc.

Among the psychosocial factors, favoring the formation of the reactions, it is possible to allocate family, national and cultural food traditions. “In the anamnesis of such patients the formation of the response way to a stressful situation has been noted since childhood; and further fixing of this disadaptive and at the same time socially acceptable protective mechanism that is especially brightly shown during the psychological “crisis periods” (the beginning of a family life, the birth of the child) also takes place”.

Besides, the patients with obesity face an evident emotional pressure, a high level of uneasiness and a stress, auto- and hetero- aggression, isolation, distrustfulness, restraint, a tendency to an easy emergence of frustration, prevalence of negative emotions over positive in a combination to an evident aim to achieve high purposes. It allows speaking about “psychological problems of the personality as a compensational and socially acceptable source of positive emotions using a hyperalimentation and a hypodynamia which lead to the obesity”. Stereotypes of food behavior as a way of psychological protection are fixed and formed.

This indicates the need of changes in food behavioral stereotypes and the formation of the personality adaptation to decrease an excess weight by a psychotherapeutic correction of the obesity, change of self-image of the personality, correction of social factors promoting the formation of the reactions.

The success of the treatment is also favored by the patient’s understanding of the connection between features of his/her personality and the excess weight that affects, first of all, the efficiency of correction of the body weight and the remote results of the therapy. “The system of chains and problems of psychocorrectional work at the obesity depends on the age, personal, social and psychological factors and motivators and should be based on the identification and correction of those personal characteristics which favor the hyperalimentation and the hypodynamia formation as forms of pathological response to a psychotrauma”.

It should be focused on the clarification of the role of psychosocial factors in the obesity formation, the formation of adequate mechanisms of a mental adaptation, the training of patients to more constructive behavior. The orientation to the motivational sphere of the personality with the help of which the patient perceives a normal caloric diet not as a restriction but as a unique, natural food ration should prevail in it.

The obesity is connected with public prejudices and also with an appearance discontent. The obesity can become the reason for  low self-esteem and depression.

The absence of the feeling of safety, hypersensibility and isolation among corpulent people are dominating. Sometimes an affected self-confidence is found among them supported by internal imaginations that I am “ the greatest” (the best, the cleverest), I have “the strongest control over the emotions”, and so on. These imaginations, inevitably, again and again, break life and appear again, creating a vicious circle.

Studying of social contacts of the people having the obesity showed that such contacts are much more limited in comparison with the people with normal weight. Such people can name very few people who love them, who give practical support to them or can borrow money to them. The women having obesity report that they contact with men much less.

“Since childhood I have been very fat, grew thin and gained weight again”, Sarah Miller, a 39-year-old teacher, says. “I was given nicknames, I was laughed at, I was humiliated, avoided, and I felt like a monster”, she says. “Many times, while I did not grow older, I would like to die. I have never gone to school dances. I did not go to a school-leaving party. There was nobody whom I could share my experiences to, peculiar at the teenage age”.

Sarah remembers that she was about 20 years old when she shed almost 12 kgs, and for the first time a young man invited her for a date. “Years of treatment were necessary before I found self-confidence”, she admits. “Even now, when all I endured remained far behind, I cannot force to tell myself about details of my antecedents. I am afraid that if I start to remember, what looks today a healed scar will turn into an open wound”.

For Sarah, as well as for many other stout women, a surplus of a fatty tissue is more than a physical problem. This is a celebration of appetite over the will. It is a hurting psychological wound connected with the feelings of loneliness and shame.

Irrespective of the age, self-confidence suffers most of all when having an excess weight as in our society fatness is considered a very big shortcoming. Researchers found out that from the earliest age children treat corpulent people very badly. As a result of one of the polls, the conclusion was made that children treated their contemporaries with ugly faces better than very thick people. Children can be cruel. As our relation to ourselves is formed on the basis of an assessment of other people, the woman, having an excess weight, get used not to love herself since the early childhood.

“Children often give the most awful nicknames to the stout schoolmates”, Sarah says. “When I studied in the seventh grade, I got a calendar in which I marked those days when I was teased. Sometimes there were all the days in a row”.

There are data that people with an excess weight, particularly women, suffer a discrimination both at school and at work, they enter the colleges less often and earn less money, than those who possess the same intelligence and qualification, but, fortunately, appeared to be thinner. “Thickness narrows your possibilities”. Besides a loss of the social and economic status, a woman with an excess weight can have problems with sex, they marry less often, have children less often. It is quite clear that thickness is not only your sizes. There are moral principles related to the thickness. “Stout people treat themselves as if they are guilty that they are thick, firstly, that they became fat, and secondly, that they remain fat”, the researchers Janette Poulivi, the doctor of philosophy, and K.P. Herman consider. The relation is opposite to thin people; their thinness is welcomed in every possible way. The researches show that thick people are considered to be lazy, careless and silly. “A beautiful woman is, certainly, a thin one. The society in every possible way encourages thin people”. In one of researches it was found out that people with an attractive appearance are acquitted more often during judicial proceedings or having equal circumstances they receive lighter penalty than the accused who look less attractive.

Recently the researchers have been interested why some people manage to get rid of an excess weight and not to put it on again. The professor Rosemarie Johnson, the doctor of philosophy, spent 200 hours observing and talking to the people who are growing thin on the well-known program to find the secrets of their success.

She found out that the people who were able to grow thin and keep the same new weight, realized that they not only change the appearance, they change their life. The program of growing thin was something more serious than a simple observance of a diet, some hours of physical exercises and visiting a support group. It became a gradual reorganization of their life.

The women she talked to reflected much and tried to find in themselves what is necessary for them for achievement of the purposes. “Everyone found the decision”, Dr. Johnson says. They looked for the strategy which suited only them, instead of catching other's ideas. As if you use ready recipes and they do not work, you will have a feeling that you are a failure. “Some women to whom I had to talk to interrupted studies according to the program when they convinced that such a technique was not for them, but all of them grew thin”. They realized a role an overeating played in their lives and tried to understand what other functions, besides a hunger satisfying, the food carried out for them. These women put themselves on the first place, having ceased to worry or to feel guilty because first of all they do what they need, and only then they think of the people around. They changed their understanding what a success is and what a failure is, they ceased to consider that can achieve success only having a faultless appearance. They were pleased with each small good luck (irrespective of whether it was accompanied by losing weight or not) and refused to consider small retreats as a failure. They recognized that the skills acquired by them should remain with them all their life because only this way they can keep a normal weight. “They constitute themselves anew as people with normal weight”, Dr. Johnson says.

For the last decades the problem of the prevalence of such a disease as obesity has become more and more actual. According to some information in the countries with a high level of economic development, at least 30 % of the population has a superfluous mass of the body. Obesity reduces life expectancy on the average for 3-5 years if having a moderate surplus of weight and for 15 years if having an evident obesity.

Code: Sample20

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