What should I do Vlad Titov. Confession will remain secret. Biological causes of excess weight

We really enjoyed. We went to another specialist before, we have something to compare with. She gave us her contact information so that if there were any problems, we could get in touch.

I have a fairly positive opinion. She listened to everything carefully. The doctor is friendly. I explained everything. I like it.

It seemed to me that the doctor was collected and attentive. She makes you feel good, inspires trust, probably competent, I don’t understand it yet. I didn’t really like it, but this is due to the clinic, which means that time is strictly limited. We are not robots, so according to the system, it takes half an hour or an hour to get it done. It’s one thing if there’s some kind of operation, it can be scheduled according to time, but another thing is a conversation with a psychotherapist; of course, you can’t guess. I didn't like that you were strictly within the time frame.

Our reception went well. Repeated appointment. The doctor is friendly. I made an appointment for my next appointment. I liked the clinic. It was convenient to get there, close to the metro.

The reception is good. There is no particular opinion on what I liked or disliked. There was a peculiar question, so I cannot assess the competence and professional skills of the specialist in this situation.

Everything is great. Very friendly doctor. She listened and sent me for the necessary examinations. I will come to see her again to further solve my problem. The admission price is appropriate and the admission conditions are favorable. The clinic is cozy, the doctors are friendly. It's nice to come and chat.

Everything is fine! I think the doctor is a professional in his field! I think she is a highly qualified doctor. It seems that everything is organized and thought out everywhere. The clinic leaves a good impression. The location is convenient, in general, really close to the metro.

The doctor is very attentive and very tactful. Of course, it’s very expensive, but I wouldn’t mind the money for a good result, if only there was one. I liked that everything was clear to the point, he didn’t throw any water, he saw the problem. What the doctor said was fine.

I really liked the doctor, he was professional. The staff at the clinic are not very helpful. The price is VIP, but customers are not greeted and clothes are not served. Everything is crumpled.

This is a special person in the clinic, and that is why people go to this person’s name. Considering the authority of this person, you pay that kind of money. I liked the specialist.

The reception took place on time. The doctor listened and prescribed medications. I then talked to her on the phone. She made recommendations. And she scheduled a follow-up appointment. Everything is fine. Everything was satisfactory. The staff communicated politely. Everything is helpful, no complaints.

Everything is fine. I liked the doctor. She is very friendly. She listened to everything and made recommendations. I really liked how she paid attention. She explained everything in detail and prescribed treatment. The clinic is attentive. The staff completes and completes everything on time. The result is positive. The location is convenient, close to the metro. Very convenient to get to.

I've known her for a very long time. I went to her for a reason. I like her very much. She has really helped me already. No one could, but she helped. The doctor is beyond praise. The attitude was good. We have mutual understanding. This is not the first time I have gone to her.

Very attentive, smart doctor, I wish there were more like him.

Everything was fine. A very nice woman who inspires confidence.

Overall I liked everything. I was satisfied with the doctor.

Of course, the doctor explained everything, there are no complaints. So the doctor is tactful, there are no problems. Qualified specialist.

I believe that this is a very good doctor who hears and sees, understands and perceives. We are delighted with her! The doctor is wonderful!

Vlada Viktorovna Titova

Return to slimness

I gratefully dedicate this book to my teachers A.V. Bobrovsky, V.V. Romatsky, M.A. Gavrilov, as well as to all my patients who taught me a lot and continue to teach me

Introduction

I always knew which way was right. I always knew this for sure, but I never followed it. Do you know why? Because it was too difficult...

From the film "Scent of a Woman"

If you picked up this book, it means that you are familiar with the problem of excess weight firsthand. A huge number of people around the world constantly monitor their weight, and many of them are in a constant struggle with extra pounds. People are not born fat; everyone dreams of returning to slimness.

And again an unequal struggle begins, either with oneself or with one’s body, which is accompanied by severe dietary restrictions up to complete starvation, grueling physical activity and other sophisticated methods of self-torture and self-punishment for the fact that “there was no need to eat up.”

And in the soul, in addition to resentment and self-pity (“Why am I being punished like this? Others eat more than I do, but, as they say, it’s not the horse’s food... I can’t limit myself all my life...”), irritation or aversion to your reflection in the mirror instills fear. After all, all this has already happened in their lives and, most likely, more than once: the result achieved at such a heavy price could not be preserved. In the most unpleasant cases, despair comes along with fear, and one gives up, the weight is allowed to take its course. The consequences of this are very predictable...

But all the same, sooner or later, as if waking up from oblivion, such a person understands: he needs to lose weight. And again, “torture” with food restrictions, exercise until the point of insanity, resentment and self-pity, and a soul-chilling fear that all this will be in vain.

Why is this happening? Why do many people manage to achieve good results in losing weight, but few manage to maintain the desired weight for life? Is it really impossible to resist stress eating or the temptation of food? Is it possible to lose weight without self-torture and constant feeling of hunger? And how to consolidate the achieved result so that the lost kilograms do not return?

You will find answers to these and many other questions in this book, which contains the most effective practical recommendations and techniques that summarize my twelve years of experience working with overweight patients. I will be happy to share with you the medical, psychological and nutritional knowledge that has already helped more than two thousand people lose weight and free themselves from excess weight in the body and soul.

Let this book be for you a professional navigator on the way to the figure of your dreams, which will promptly warn you about dangerous sections of the road, lurking obstacles and limiting beliefs. Let your meeting with yourself turn into an exciting adventure. Well, all I can do is wish you a happy journey!

With respect and gratitude, Vlada Titova

Individual diagnosis of the causes of excess weight

In front of you is a man suffering from stomach pain. His limbs feel like they're filled with lead. His belly ripples under your fingers. And then you tell the patient: you are exhausted from food!

Egyptian Book of the Belly

Eliminate the cause, then the disease will go away.

Hippocrates, 5th century BC e.

All possible causes of excess weight can be divided into three fundamentally different groups: biological, psychological and social reasons. They are found in different combinations and not only contribute to excess weight gain, but also often prevent it from being lost or maintaining the achieved result. When starting to diagnose your own reasons, pay attention to the fact that none of the listed below, even burdened by heredity, is an irreversible sentence on the path to achieving harmony. So, let's start diagnostics.

Biological causes of excess weight

First group – biological reasons. These include:

♦ heredity;

♦ overeating;

♦ physical inactivity;

♦ metabolism;

♦ stomach volume;

♦ endocrine disorders.

Let's look at them in order.

Heredity

It's no secret that Overweight parents often have overweight children, and sometimes this trend can be traced across a whole series of generations. Paying attention to this fact, scientists have identified a number of genetic mechanisms involved in the regulation of the amount of fat reserves. This is an obesity gene (ob-gene - from the English obesity - “fatness”), which causes the production of a specific protein leptin by fat cells; individual characteristics of the constitution of adipose tissue; genetically determined metabolic rate and intensity; hormonal regulation of the processes of formation and breakdown of fat (scientifically - lipogenesis and lipolysis); features of the functioning of the hunger and appetite centers in a special part of the brain - the hypothalamus.

The type of body constitution also has an innate character: someone was born a fragile asthenic (usually tall and thin), someone was normosthenic, and someone from birth was destined to become a hypersthenic - a person with a high predisposition to be overweight. It would seem that the factors described above leave no chance for those who are “unlucky with their genes” to lose weight. However, scientists, fortunately, claim that this is absolutely not the case. It turns out that the key role in gaining extra pounds is not played by heredity, but by banal overeating, especially against the backdrop of a sedentary lifestyle. So, dear readers, from now on, excuses like “I’ve been fat since birth, I’m unlucky with heredity, so I can’t lose weight” are no longer accepted. In my practice, there were many people who, despite their heredity, lost weight perfectly: some twenty kilograms, some forty, and two people lost as much as seventy-five!

Vlada Viktorovna Titova

Return to slimness

I gratefully dedicate this book to my teachers A.V. Bobrovsky, V.V. Romatsky, M.A. Gavrilov, as well as to all my patients who taught me a lot and continue to teach me

Introduction

I always knew which way was right. I always knew this for sure, but I never followed it. Do you know why? Because it was too difficult...

From the film "Scent of a Woman"

With respect and gratitude, Vlada Titova

Individual diagnosis of the causes of excess weight

In front of you is a man suffering from stomach pain. His limbs feel like they're filled with lead. His belly ripples under your fingers. And then you tell the patient: you are exhausted from food!

Egyptian Book of the Belly

Eliminate the cause, then the disease will go away.

Hippocrates, 5th century BC e.

Biological causes of excess weight

First group – biological reasons. These include:

♦ heredity;

♦ overeating;

♦ physical inactivity;

♦ metabolism;

♦ stomach volume;

♦ endocrine disorders.

Let's look at them in order.

Heredity

Binge eating

In fact, this is the main factor leading to obesity. At the same time, it is not at all necessary to eat a large amount of food. Many overweight people honestly say that they eat very little and rarely. So what's the deal? Let's figure it out. You probably remember the law of conservation of energy from your school physics course. To maintain a stable body weight, the energy entering the body with food must be equal to the energy expended on the body’s vital functions.

All our energy costs are made up of three components: basal metabolism, food thermogenesis, energy costs for physical work, intellectual activity and emotions. Basic metabolism is the maintenance of respiration, blood pressure, heart function, kidneys, gastrointestinal tract and other organs and systems in a state of complete rest at a comfortable temperature. Basic metabolism accounts for about 60–70% of all energy expenditure. Food thermogenesis is the expenditure of energy on the digestion of food; with three meals a day, it accounts for on average up to 15% of energy expenditure.

✓ Remember: The more often you eat, the more energy is burned through nutritional thermogenesis.

The third item of energy expenditure by our body is directly related to the level of physical activity, which in people with excess body weight often leaves much to be desired, since, unfortunately, very little energy is spent on intellectual work or emotions.

Now let's think about what will happen if more energy than necessary is regularly supplied to the body through food. That's right, all excess will be stored in the form of fat reserves. You may ask why the body acts so “unreasonably”, to its own detriment - after all, it would be possible to put aside reserves, for example, of protein or carbohydrates, rather than fat.

But everything is explained very simply: the ability to accumulate fat in fat cells is the most important mechanism for survival and procreation, which was fixed during the process of evolution at the genetic level. In conditions of famine, when the body needs to live as long as possible, the breakdown of 1 gram of fat releases 9.1 kilocalories of energy, and the breakdown of 1 gram of carbohydrate or protein releases almost half as much. So the body accumulates fat, creating a powerful supply of energy.

Candidate of Medical Sciences, Associate Professor of the Department of Psychosomatics and Psychotherapy, St. Petersburg State Pediatric Medical University

Work experience in psychotherapy since 1998.

Education and activities:

In 2004, at the Research Institute of Psychiatry and Neurology named after. V.M. Bekhtereva defended her PhD thesis on the topic: “Group psychotherapy for patients with heroin addiction.”
From 2005 to 2007 she worked as an assistant at the Department of Psychotherapy of the State Educational Institution of Further Professional Education of St. Petersburg Medical Academy of Postgraduate Education.
From 2005 to 2008, expert on psychotherapy at the city TV channel (Channel 5), author and presenter of a weekly live column on the program “Morning in the Big City”, expert on the programs “Women’s Evening on Fifth” and “Life as Life” with Tatyana Ustinova.
From 2007 to the present - Associate Professor of the Department of Psychotherapy and Psychosomatics of the St. Petersburg State Pediatric Medical University.
From 2007 to 2013 - author and presenter of the programs “The Hour of the Psychotherapist”, “Island of Hope” on weekly live TV and radio broadcasts on the city TV channel TV100.
In 2007-2009 worked as a leading psychotherapist at the VIP weight loss clinic “Doctor Bormental” (Moscow, St. Petersburg).
From 2009 to the present - psychotherapist at the St. Petersburg clinic "RAMI".
In April 2010, the FM-TV project, which includes the programs “Hour of the Psychotherapist” and “Island of Hope,” was awarded the TEFI Award in the category “Best Information and Entertainment Program in Russia.”
In July 2012, she received a European certificate of psychotherapist and became a member of the European Association of Psychotherapy.
In July 2013, she received a certificate of professional recognition from the World Council for Psychotherapy.
In October 2017, she received patent for invention No. 2632777 “Method for weight loss” (co-authored with D.N. Chugunov)

During her time as a doctor, she completed more than 10 advanced training courses in psychotherapy, psychiatry, narcology, medical psychology, pedagogy and evidence-based medicine, and more than 20 advanced training courses at author’s seminars and ten-day courses in psychotherapy and psychology.

Turning points in life happen even to representatives of wild tribes, and the Internet has become a new stress factor...

In the modern world, it is becoming increasingly difficult for people to maintain psychological balance.

About, how not to fall into depression or hypochondria in the middle of life,Candidate of Medical Sciences, Associate Professor of the Department of Psychosomatics and Psychotherapy of St. Petersburg State Pediatric Medical University told us in an interviewVlada Titova.

- Perhaps everyone knows that after 35 years a midlife crisis can occur. Is there a chance to bypass it?

A midlife crisis implies a certain reassessment of meanings, values, goals, as well as one’s own past experience - the level of one’s achievements and, which is especially painful, missed opportunities.

Sooner or later, any of us faces such an “inventory”. As a rule, this is a difficult period, and you just need to be prepared for it.

- What leads to a rethinking of life positions?

Usually a whole set of factors plays a role here: experiences associated with growing children, aging parents and inevitable own external changes, relationship problems, job dissatisfaction, etc.

Sometimes the trigger for such experiences can be a simpler reason.

For example, comparison of one's own achievements with what former classmates or other peers have achieved.

Moreover, if previously people only watched the lives of their neighbors and colleagues, then in the era of rapid development of social networks we have the opportunity to follow, say, a classmate who moved to the Bahamas.

Against this background, some begin to feel like losers, worthless and having missed all the opportunities that came their way.

The result is deep disappointment, resentment or fear.

- So, immersion in the virtual world creates additional stress?

After viewing such “ideal pictures,” someone may have the feeling that they are spending time with the wrong people, having the wrong kind of fun, wearing the wrong clothes, etc.

This causes a feeling of inferiority.

It has been actively discussed in the West for several years now. Facebook depression phenomenon. From this point of view, social networks can increase negative emotions and make it difficult to get out of a depressive state.

- It turns out that it is more difficult for us to cope with the problems of middle age than for our parents?

Every day we are forced to deal with a huge flow of information that did not exist before the “Internet era”.

In addition, over the past decades, the emphasis has shifted very much towards career growth and success, and the boundaries of the norm are becoming very blurred.

So these days, various psychological problems have indeed become more common than before. Over the past few decades, the number of non-psychotic disorders has increased almost forty times.

I would like to point out that I am not talking about schizophrenia, bipolar affective disorder or other severe mental illnesses.

Their percentage in society, fortunately, does not change.

We are talking specifically about the neurotic register: adaptation disorders, reactions to stress, depressive and anxiety disorders.

In particular, the midlife crisis is experienced more difficult precisely because of the peculiarities of the modern world.

Today it is more difficult than before to maintain an internal state of stability and security.

- Is there such a term in medicine - “midlife crisis”?

Officially, no. Medicine recognizes the clinical manifestations that accompany it. For example, depressive or anxiety syndrome.

But for psychologists in all countries this, of course, is a fairly stable concept.

Another thing is that its content is always individual. Some might call a midlife crisis the state of a depressed man at a crossroads, regretting missed opportunities.

And for another person, the same crisis may be accompanied by a severe depressive-anxious state and existential experiences of one’s own worthlessness and the meaninglessness of life.

- How to recognize the beginning of this period?

- Middle age crisis- except for those cases when acute shock or shock acted as a provocation, - usually begins gradually.

Appears instability of mood, irritability over trifles, categorical assessments, rises anxiety, internal tension increases, fatigue, sleep may be disturbed.
My head is increasingly filled with unpleasant thoughts, comparisons are not in their favor, the range of interests and hobbies narrows, many begin to withdraw into themselves and do not immediately notice that they have lost the ability to truly enjoy something.

- Should a midlife crisis always be perceived as a problem?

You know, in Chinese and Japanese, the word “crisis” is not by chance composed of two hieroglyphs meaning "danger" and "opportunity".

In fact It is very important to stop from time to time and honestly answer yourself the most important questions.

Who am I and what do I want in life?
Am I doing everything to achieve my goals?
Am I shifting responsibility for some of my failures onto those around me, fate or the socio-political system?

It is when we stand at a crossroads that we need to look back and remember what we put off for later or what we forgot about in the endless bustle.

And finally do it, so that later you won’t regret missed opportunities again.

Any psychological crisis gives us a chance to change something.It can ultimately lead to a transition to a qualitatively new level of perception of oneself, others and life.

- Age-related changes, as a rule, force you to reconsider your attitude towards health. Some even fall into hypochondria. How to deal with this problem?

It must be said that hypochondria was a common phenomenon at all times. But now it has often begun to transform into the so-called “cyberchondria”, in which a person searches on the Internet for the reasons for his illness - and immediately finds a huge number of diseases, one more terrible than the other.

People begin to sign up for an endless number of examinations, do not trust their results, and change specialists. As a result, they paint themselves into a corner and plunge into even greater despair.

Preventing such developments is actually very simple. There is no need to try to diagnose yourself: without a medical education, it is impossible to do this.

For example, if you enter the query “headache” into a search engine, the first ten pages of links will be on brain tumors, although according to statistics they occur in thousandths of a percent.

And the most common causes of headaches(tension, migraine, problems in the cervical spine, hypertensive crises, a consequence of long-standing head injuries and many others) will not be mentioned on the first pages at all.

Can you imagine the impression such information can make on an already frightened person with a headache?

So the best insurance against hypochondria is an annual preventive examination.

- How did it happen that the midlife crisis is perceived by many primarily as the “prerogative” of the stronger sex?

No wonder. After all, a man is a breadwinner, a breadwinner, who often takes responsibility for a large number of relatives onto his shoulders, which is invariably associated with accumulating fatigue.

Especially if a difficult period has come in the relationship or there is no material stability.

Sometimes the voltage reaches such a peak that any discharge is used: someone runs away from the family, someone starts drinking, and someone becomes aggressive.

- However, women also go through this stage. Can we say that it is easier for them to survive it?

- It would be a big mistake to assume that women cope with a crisis easier than men. They just tend to have slightly different experiences.

Firstly, they are associated with rejection of one’s appearance, especially taking into account age-related changes and individual characteristics.

It’s no secret that very thin women often suffer no less than those prone to obesity.
Women with small breasts look with envy at those who have large breasts, and happy owners of a large bust are often embarrassed by it.
Some people don’t like their nose, some don’t like their figure, some don’t like their height or body proportions.

These experiences become especially painful if a woman fails to build a reliable relationship.

Secondly, women worry much more than men about the lack of family and children- after all, the female period of fertility is limited. With age, most people have a growing fear of being left on the bench in the bride market.

Thirdly, women, due to their higher emotional vulnerability, find it more difficult to cope with situations of infidelity, betrayal by loved ones, friends or business partners.

And fourthly, in recent years, the number of women who believe that they cannot realize themselves, discover and reveal their abilities, or find a purpose in life has been growing exponentially. These women ask questions of self-actualization and the search for the meaning of life no less than men.

- There is a version that residents of some countries are unaware of middle-age syndrome. This is true?

To be honest, I have never encountered such data. As I have already said, any person faces certain kinds of experiences and claims to himself, regardless of culture and characteristics of upbringing.

Even representatives of Aboriginal tribes that have survived to this day face the same difficulties.True, they solve them in their own way.

For example, in Togo, tribal elders take a newborn from its mother on the first day of its life and take it to the forest.

They sit in a circle, place the baby in the center and sit silently for a while.

At some point, one of them begins to sing a unique melody, and gradually the rest join him - and their voices intertwine into a unique composition.

Then the baby is returned to the family.

And many years later, when in adulthood this person has problems, he is again taken into the forest, placed in the center of the circle and they begin to sing that very melody intended only for him.

It is designed to remind him of his true purpose and that he has lost his way and forgotten something important.

- The example is amazing. But, unfortunately, modern people, as a rule, do not have such support. What to do if you feel like you are going down the wrong road?

It is very important that someone is nearby at this moment. Lonely people have an extremely difficult time going through difficult periods.

Your loved ones who care about what happens to you should remind you of the most important things.

Unfortunately, during crises, many people push others away and withdraw into themselves. This is fundamentally wrong.

Such periods are experienced many times easier, faster and more productive if you have supportive and understanding people nearby.

In extreme cases, help can also be found on the Internet - it can become a source of not only psychological problems, but also salvation.

A crisis can cripple even a very strong and self-confident person.

But fortunately, there are many more caring people than is commonly believed. And a complete stranger, whom we might never have met in life, can become close.

It is in such situations that it is very important for us to know that there are people who are on the same wavelength with us.published . If you have any questions about this topic, ask them to the experts and readers of our project .

Interviewed by Tatyana Khruleva