then i would just say that listen, i’m wondering what i could do , so that you would categorically tell me, i think, if you began to humiliate him, humiliate him, disrespect him, of course, yes, why did you ask tatyana this question, well, i’m interested in understanding what can be done in order to destroy, in order to understand, and then what should be done in order to preserve, that is, there is a certain idea, but about what destroys relationships, is it clear now? what is not worth doing, then what is worth doing? the most important thing is that it seems to me that it is worth to talk, well, that is, to communicate a lot, to talk, to explain, to check in with each other, well, at every moment in time, when some situations arise, for example, or some simply, as they say, to dialogue, yes, that is, but you need to find some kind of balance between destructive actions and absolutely creative actions, yes, yes? find some kind of

golden mean, yes, i will give a hint such that as a man, that - the value of conversation in a couple is greatly overestimated by a large number of psychologists who today broadcast in various channels there, but because on in my opinion, just the opposite, the ability to feel each other without talking is higher, when it’s just good for the two of you to be silent, this is also important, well, after all, your marriage is just beginning in this sense... you’ve been married for so long him, but what is definitely worth talking about is about roles, this is what you essentially started with, because on the one hand, of course, in this relationship you can now be in the role of a little girl for whom a man is responsible much older than you, but that won’t last long either, here in what’s the matter, he won’t be interested in it, that’s when tanya is talking about, you will find a balance, because i’m sure that your spouse, in general, is not against it, only for you... well

, let’s just say that yes, naturally , not how, do whatever you want, well, because you can throw yourself now, yes, to the other extreme, you can destroy, or you can rush to the other extreme, where you maintain relationships, just create, you keep running there, spend all your efforts there, but you you need to find yourself in this, with or without a relationship, all episodes on... the triggers podcast you can found on the website of the first channel 1tv.ru, let’s just say that relationships in marriage are not in the sense of not, well, they’re not that important, yes, but now the first thing i have in mind is exactly that and about the fact that, well, there in general, in principle, where am i for myself, that is , right now, i wasn’t there alone for a long time, well, my daughter tells me that it seems like you can’t be alone, but i can’t say that, well, i’m right there at this time.. .

and maybe if you would realize yourself through these parameters, and would not go into a false, real identity, mom, there, a good mother, a wife and so on, yes, because these are identities that are always associated with the role of the other partner, if there is no husband, you are not a wife, if there is no child, you are not a mother, so, now just you need to take this lesson, which 35 years would not have passed or was passed incorrectly, because you don’t like the result, today.

these are the daughters of 16 and the daughters of 16 and the daughter tells me that she is grateful to me that i got divorced, they highlight some of your strengths, something that they like about you, something that impresses, well yes she she often tells me that she likes the kind of relationship we have, she is open with me, it happens that she and my brother sometimes diagnose me in their correspondence there... that i have some kind of adhd, that i am such an advanced child , depression, split personality, yes, now young people like to talk about it, well, just at some point, when my friends usually congratulated me on my birthday, they often told me that you are

an amazing mother, you are a great mother, i am so somehow i don’t know mothers, at some point i it has already become like bad advertising, yes, because it is... just a small part of your personality, and what did you manage to create in relationships with them, do you think, the most important thing is with children, yeah, it seems to me that it worked out, i managed to keep them well, real, that is, they are like that, well, in my opinion, i also understand that they are loved, they are so spoiled, such good, such home children, yes, well, in a good sense, not in the sense that they are from the greenhouse, so... they have grandmothers, grandfathers, mom, dad, well, it’s like so we can say that, in principle, the family is a full cup, but they had a good, happy childhood, that is, you know how to love, in fact, yes, well, that’s great, look, it’s the same thing, just now give it to yourself,

your daughter is in control when he tells you that you underestimate yourself, because essentially you now, here you are 47, have the opportunity to show them another very important thing, that you are an adult, you can do anything and you... will do what you like , without looking back at them, at parents, at husbands, there and so on, here they are we must see that 47 is only the beginning in this sense of life, when we begin to enjoy our life, when you can love yourself, you were able to love them, everything is already with them, and now only for yourself in the good sense of the word, you have a beloved man next to you, in general, in the near future everything will only be wonderful, i think you need to find yourself, that is, that yourself. who you want to be, you know, like when the chumrashka asks the crocodile gene, says who you work, he says the crocodile in the zoo, that's it can you imagine how harmonious this is, well , as a child, you weren’t embarrassed by this answer, a crocodile in the zoo, he’s either an idiot, or cheburashka is an idiot, or we, who are reading

this, but no, in fact, this is an absolutely harmonious emanation of your essence, your essence, your, your inner self, this is what i need to find, which one will you work at the zoo? crocodiles are also good, but you need to find this yourself, who wants to realize herself through some position, through some profession, through some activity, don’t look for a job, find yourself, who wants to realize herself through this or that profession, there is a very simple coaching tool, you can take a piece of paper, when you leave here, or in the notes on your phone, now you will be riding in a taxi, write what you want your day to look like, then you wake up , where did you wake up, what is around you, where did you go, what did you do next, what is your job, how do you feel? in this, when you came, what greets you in the evening, who meets you in the evening, what do you do, through these simple steps you little by little, little by little feel it, i’ll try, no need to try, i’ll try, i’ll do it, good, good that you stopped yourself, thank you very much,

thank you, you’re crying so interestingly, and with everything , the past and the future are a little confused in your head, you’re looking at your own the future, but you see only your past there, well , yes, probably, there is this moment that i... as if i don’t see the future, and what the hell with it, you don’t need to look into the future, look at the present, what kind of yourself are you want to realize through your work and professional activities, thank you very much again, thank you, well, this was the trigger lab podcast, and we talked with yulia about how to find yourself in the ups and downs of life, relationships and professional activities, the hosts of this podcast, tatyana krasnovskaya and sergey nasebyan, were with you, and you, dear viewers, if want to. become a participant in the trigger podcast and be our guest in our studio and understand the issue that is interesting to you personally, fill out the form on the website 1tv.ru,

hello, this is a podcast deception of substances, with you olesya nosova, editor-in-chief of komsomolskaya. truth and the famous endocrinologist zukhra pavlova. zukhra, today let’s talk about obesity and the types of obesity, because it turns out that this is not at all obvious to a non- specialist. fat people look about the same, but it turns out that there are different reasons for this obesity. in general, what, what is happening in the world, how big a problem is this now? oh, a big problem, a pandemic, although vos called the 21st century the obesity epidemic, but in fact it is a pandemic, an epidemic is on one continent, a pandemic is on everyone continents, unfortunately, this pandemic is progressing. that's why we talk so much about obesity, because we can't deal with it. the number of people is increasing, i read here in komsomolskaya pravda, not on the vos website, that

we now have a billion obese people, not so long ago, two or three weeks ago, at lectures on obesity, i said there are more obese people there 700 million is a billion, and this despite the fact that there are more and more ways to combat obesity, and even the whole government is taking great measures, doctors, scientists, there is a huge amount of information going on in the media. propaganda in a good sense, yes, they provide opportunities to independently balance your diet, increase physical activity, and with all this , the number of people is progressively increasing, unfortunately, among children, we used to know for sure that the children’s part is the most slender part, people, well, they are active, they eat only when they want, like mothers don’t try, yes, yes, it was like that, now there are a lot of children. is overweight, obese, and this is even more a problem, because the earlier

obesity begins, the more difficult it will be in adult life, the more difficult it will be to cope with it. yes, we have data that clearly demonstrates how the number of obese people is progressively increasing, and the most interesting thing is that not many years have passed, let’s say, from 1975 to 2014, and less than half a century, the number of people among women among men... that there weren’t any, you can say, yes, yes, that’s true, there’s such an interesting picture floating around on the internet, beach, a lot of people, people on the beach are undressed, in swimsuits, and it says find the full one, and then some year 2000, the same beach, the surroundings have changed a little, the same outlets and people, the sun is not visible, it says find thin, that's how much. this gap is for physiology, for evolution, it’s not even a mix, it’s an imperceptible thing,

that is, nothing has changed genetically, we understand that these are mainly external factors, external factors are nutrition, this movement, circadian rhythms, on the twenty-fifth year forecast, i will say that it has already come true in the twenty-fourth year, according to the data, most men in our country will be obese... is it in our country or in the world in our russia in our country there are general data, but the data on countries, for example, north america and in general american and south america, there are significantly more obese and overweight people there than is acceptable in southeast asia, that is, i don’t know, vietnam, laos, japan in this regard are more structural, less overweight people than africa. or america we in this list, thank god, it is not in first

place, but there are such interesting statistics for post-soviet countries, and there we differ, women are in second place after one of the baltic countries, and men are in sixth, in last place , in my opinion, there is nineteenth, twentieth, i don’t remember, and among women among men - tajikistan, but one might get the impression that the more ... economically developed a country is, the more people there are with regret. now the trend is changing in many countries, say, with less developed economy, the number of overweight people is increasing progressively, this is due to what products become available due to cheap food, yes, which , as a rule, is not physiological, not very, yeah, well, what’s interesting is that all over the world, that in russia women have a percentage. people with obesity are higher, this is this, this is because of what, this is not

because women, well, in principle, eat more, but because there are also hormonal characteristics, we have more estrogens, and estrogens in their own way contribute more to the essence a set of adipose tissue, although it all depends on age, on the initial condition, of course on genetic factors, but with all this, if you pay attention to a woman of reproductive age... with a figure like a guitar, yes, then this is just a woman with such good hips, with good mammary glands, that is, the subcutaneous fat layer predominates over the vesceral one. over those in the abdomen, or on the abdomen, and this is a healthier state, therefore a woman of reproductive age with a certain excess of adipose tissue mainly in the subcutaneous layer, this is a healthy woman who is reproductive, nature is very puzzled that everything will be fine with her, because the most important thing for nature is reproduction. zukhra, you said that in 1930

there will be 30% of men, unfortunately, 33% - this is according to who data, these are the forecasts, and for women, what is their dynamics? unfortunately, it's the same. there will be more of them, because there are already about so many of them now, we have dynamics, i also really like this information on our districts, we won’t present it here, it’s difficult there it’s enough to figure it out like this, but the point is that we have very different dynamics in different federal districts, the minimum number of obese and overweight people in the north caucasus district, in the siberian district, for example, there is the largest number, and here there is such a very... an important factor that also needs to be taken into account, where a person lives in a warm place, well, he potentially moves more and eats less fatty foods that help to warm up, yes, and where it’s cold, people spend a lot of time moving less, but you can’t go skiing or take a walk there at -30 or -20, well, frankly speaking, you’re practically in hibernation in front of the tv,

practically, but that’s why this is also one of the factors that needs to be taken into account. an interesting scientific observation is that people who started to play sports intensively, well , as i understand it, these are those people who have never exercised before, after some time, and maybe even very quickly, they stop doing homework very intensively affairs, at least on the same day, because they apparently they implicitly believe that since i tensed up in the gym, then at home, why should i wash the floor there, i’ve already fulfilled my quota of physical activity and so on, that’s what scientists did.

remember, in the summer when it’s hot, eat a sandwich with butter and caviar, for example, you want much less or with cheese than in winter, when this food is more acceptable, you want this fatty, warm, hot, but because you need to warm up, well, it’s cold, this is not the most important thing, but this also has its place, we talked about timosha, by the way, patients sometimes come and say: i’m timosha, timosha’s manul. let me remind you that in the fall, in the fall, timosha’s pallas’s cat gained weight, went for fattening, he gained twice as much weight in order to survive the winter normally, but by the way, now timosha has lost weight, lost weight, and yes, he spent everything he saved up over the winter , and he is ready for spring, for active events and so on, he has returned to his previous form, and for many people this is also typical,

in the winter they gain or even go to the fryer for winter, and in the summer they lose it very actively. dumped, and often this is associated with dachas, with vegetable gardens, but this is bad in general or acceptable, it’s practically a natural move, if only it’s plus or minus 2-3 kg, when we ’re talking about some big jumps, this is of course bad, there’s nothing good about it, and i often noted earlier in the clinic that in the summer, practically, patients with type 2 diabetes simply disappear, they almost never exist, they prescribed themselves more medications in advance. to go to the dacha in the summer, and it’s not just that they were far from the clinic, they were much less worried about the problems there with sugars, because at this dacha there is constant activity, there is no time for sugar, and sugar does not bother him, he knows that the person is busy, he is active, everything is fine with weight gain, and accordingly everything is fine with sugars, if all other recommendations are followed ,

here it would probably be good to say, when we talk about obesity, here i would really... i would like to say about what in general is the main mechanism for the accumulation of adipose tissue, if we take it quite literally, simply, then remembering our great compatriot lomanosov, who together in words discovered the law of conservation of mass, as much comes as remains, well, in such a simple presentation, then obesity, it’s just about this, if a person eats 2.0 calories, he spends only together with physical... activity and some basic needs, for the operation of the mechanism 1,500, then 500 kilocalories will not go anywhere, they will be stored in adipose tissue, this is how our physiology works, because...

at the same time, we still have real frosts, and - i would really like it to be balance, that is, this is how much we spend, this is we have to consume so much, but what ’s happening here, firstly, food has become very accessible, even in my childhood everything was a little different, now it’s absolutely everywhere, not just at home at your table, well , just like that at every step, it changes a little with - in its balance, more fat, more simple carbohydrates, all this refined stuff, unfortunately, in our country such a phenomenon

as sarcopenia is actively spreading, sarcopenia is when muscle tissue is replaced by fat, and a person it's a little jelly-like, it's kind of like well-built, but he does not have a sufficient amount of muscle mass, and this is practically the basis of our health, well -functioning and sufficient in volume, and not... only fat, but also muscle, and above all, probably, muscle tissue, although we also need to emphasize when there is little adipose tissue, it is not enough, it is in short supply, there will be no fewer problems, about the same, they will be a little different, but it will also be a rather sick organism, with a lot of high all sorts of unfavorable risks, for sure just like when a person has a lot of fatty tissue, so the balance has changed, the regulations have changed, now very often people eat at... at night and late in the evening, because they go to bed in the morning, yes, this factor makes its changes, and we everyone is hypodynamic, we sit here, we take the elevator up,

we drive in the car, we are in a horizontal position in front of the tv, when we go to bed, activity has greatly decreased, even something as simple as walking, and so, despite the fact that this is the main the mechanism is associated with a large the arrival of energy... resources than consumption, there are a lot of features, we have such a classification, we won’t go into its subtleties, it’s professionally complicated enough, but so that everyone understands, there are two big divisions: primary, elemental, so-called obesity or exogenous-constitutional, it’s more complicated, so primary elemental and symptomatic, that’s the primary, most often people come across: with such pictures, obesity in the form of an apple, obesity in the form of a pear, here in the form of a pear - this is when the lower one is larger part of us is so dense, it is typical

for women, obesity, which is abdominal, is more characteristic of men, but this does not mean that a woman cannot have an abdominal form of obesity, it is simply more typical for men, and there are mixed and abdominal and in the shape of a pear, it happens when it is already very large... one division is elemental and symptomatic, there may be an endocrine one, but we often hear a patient say: i have something with hormones, sometimes something with hormones really helps development

obesity, and the endocrinologist here must remove the main cause to help the person get rid of it, but there will still be overeating, or we often hear such a statement, after covid or during covid, they gave me injections with some kind of hormone, and after that i was very depressed. .. yes, most often this hormone is a glucorticoid hormone, dexsomitozone, which actually saved a person’s life, they saved the person, there was no time for any subsequent endocrine disorders, it was necessary to save the person, they saved him, but what do they do? glucocorticoids, they increase the level of the main hunger hormone, they often talk about it now, grillin, it even has the same name, you can feel that it is very powerful , this grillin and. and it causes an increase in receptors for hormones that stimulate our appetite, and the person really wants to eat uncontrollably, it is very difficult for him to explain that he does not need to eat, he will not hear.

will understand all his activities, all thoughts about food, against this background it is easy to gain excess weight, so yes, there are such options, but there are also medicinal features, sometimes we we take some kind of drug and note that we have become constantly hungry, this has never happened before, yes, when we prescribe certain drugs and know that such a situation will happen, without these drugs there is no way, some special important story that need to be overcome precisely with the help of these medications, we say, you know, your appetite will increase, please try to limit such and such high-calorie foods so that this set is smaller than it can be, and thus we we will help the patient during that period, who needs to take these medications, take a smaller amount, that is , the reasons are very different, i don’t understand anything what’s happening, we seemed to be in love, no?

why are you running from me, what kind of love, why are you talking like that, leave me alone, and in our yard, tomorrow on the first day, who is more dangerous, a bee or a wasp, and if there is any difference between these bites, summer topics in the program live healthy, on monday on the first, this is a podcast deception of substances, we... another such frequent statement that we hear from friends, from patients, we have such genetics: mother, grandmother, everyone was overweight and i have no chance of getting rid of it, in such situations you need to figure it out, well , there is such a concept as monogenic, that is, when there is a gene mutation, there actually

everything is clear and so... but in the majority of 95% of cases when a person is overweight, these are so-called polymorphisms, these are predispositions, and to certain changes, and this is not a verdict at all, here a person should or can know about this, it is now fashionable to make genetic passports, yes, and everything is there for sure.

and the final products of glazing, which we have talked about many times, will be very tasty anyway if you just add finely chopped onions, carrots and so on, without frying, so most often people have such a stupor, and then they think that it will ruin the borscht, it’s just not anymore, i know, my family is the same, yes, yes, we are also rich in culinary traditions, yes, yes, yes, yes, yes, that’s why when people say olivier on the new year’s table it should be with mayonnaise, i say, well, god bless it, once a year, yes, a disaster will not happen, but if you regularly eat like this, it will definitely have negative consequences, so as an exclusive of maintaining family traditions once a year, for your health, you will even feel certain such things, which you haven’t felt before, so figuratively speaking, the cleansed receptors of the tongue will immediately let you clearly understand that it will seem

tastier. no, no, well, of course, everyone will react in their own way, most likely, but there was such an experiment in my family, once upon a time my relatives decided to make a conspiracy , they went to a fast food restaurant, and they wanted, well , to keep it a little secret, to eat something that they once thought was delicious, so they came, laughed, brought it with them, so to speak, with irrefutable evidence, and i was surprised , what is it, they say, we went, we wanted to, as they say, little by little... eat up, have a blast, but it turned out to be not as tasty as it was before, that’s why sometimes it works like that when you haven’t eaten it all for a long time , you don't understand why you liked it, yes, a lot conversations around how to define obesity, yes, what is obesity, what classical criteria do we use to make such a diagnosis, well, there is the well-known body mass index, this is a calculated indicator of the ratio

of body weight, well, kilograms and height. that is, we divide body weight by height squared, we get a value depending on the obtained value, we understand this is a deficit. body weight, everything less than eighteen is normal body weight, and up to 25 is overweight, from 25 to 29.9, well, figuratively speaking, from 30, from 30 to 5 units - this is obesity of one degree or another, depending on - that is, zukhra, you thought so, obesity of the seventh degree, that is, it is 40-45, yes 45-50 50 55 yes. but this person can already say that he has already lost 18 kg, we started not so long ago and well, the normal normal

period of time for this, for what period , in my opinion, it seems to me almost less than a month , yes it has passed no no no, definitely more than 18 kg cannot be lost in a month because that it is dangerous and has its consequences. weight needs to be lost gradually, the classic, classic step is 4 kg per month, and but when we use certain medications, this step increases a little, because we reduce the risks of those troubles that threaten people who quickly lose weight, so there is no need to rush, remember, no, well, zuhra, there are a lot of women who cannot lose 3 kg lose your whole life, there are such women, of course, but in order... to start losing weight, we will talk about this in another program, well , just briefly looking ahead, subtract 500 from your current color and you will start losing weight, but here you go give up two sandwiches a day, the weight will begin to decrease,

well, it all depends on what the initial and weight is, and different things, but the body mass index is the parameter that helps us establish obesity. degree of obesity, calculate, let's say, cardiovascular risks and so on and so forth, but not the most objective criterion, because today we mentioned sarcopenic obesity, sarcopenia will not show, it will not show, it will show that a person is of absolutely normal weight or even underweight or underweight may show, and this criterion can lead us astray, or if in front of you is a bodybuilder... you don’t even need to take a bodybuilder, if you take nikolai voloev, and such a well-known athlete of ours is already a political figure, he also has a good degree of obesity according to his body mass index , but the person has a lot of muscle mass and he doesn’t

have any excess fatty tissue at all, in any case, i don’t know, i haven’t seen nikolai for a long time, i hope he’s doing well, good health, so if in front of you is a person with a lot of muscle mass, mass index body may show some... but he has an excess not due to fat, but due to muscles, so this is a somewhat crafty indicator, parameter, but there are, and there are more objective ones, we can determine the circumference of steel, but the circumference of the waist is more objective criterion, there are certain ethnic characteristics, for russia, for europe, there are certain criteria, for men the circumference of the waist should be less than 94 cm, and for women less than eighty, but this is not the case everywhere, americans have different criteria, for men they have 102 cm , and in women 88, but if per, why is this objectively so or just say so, well, if

you look at the american population, that’s why they are so surprised when they look at our video from the patriarch’s ponds, well, that is, these are such giveaways, but a little, but how - it seems to me that they help their citizens a little bit, because... these are mostly immigrants from europe, and at one time their descendants are already here, if you have a japanese man or a japanese woman, then there are different criteria, the japanese have - this is the only nation whose waist circumference should be smaller, normal, than women, men have 85, and women have 90, and this is... according to some criteria, it is clear that with our own eyes we can understand, yes, that a person is overweight, but the waist circumference is not always exactly the same for us it will help, just like body mass index, if we have a person

with sarcopenic obesity, and here only bioimpedance analysis of body composition comes to the rescue, or denstometry, this is the most objective gold standard in determining body composition, but you won’t send it to.. . x-ray every time a person to him determine body composition, for example, when we lose weight, this analysis is carried out very often, we look at what we are losing, because a person can lose both... fat tissue and muscle tissue in the process, going for an x-ray every time is not very good , therefore , a fairly objective method is bioimpedance analysis of body composition, it does not have any such difficulties, it is technically simple, does not cause harm to the body, and is not financially expensive, and what is it based on, we use it so often this is the name, everything is very simple, even if

in english it is resistance, biobiological resistance, that is , a low -intensity current passes through the human body, it does not harm the person in any way, encountering the resistance of different tissues, bone, muscle, fat, the apparatus calculates the volume of these tissues and liquids, by the way, actually give out such a picture in the form of plates, beautiful exact parameters there, and we know. how many kilograms of muscle adipose tissue, how many kilograms, well, can be converted into liters of water in body, in percentage terms, this percentage ratio is very important for us, because sometimes a person comes and says: oh, doctor, i’m like this - i got a wonderful result of bioimpedances, i say, and what’s so wonderful about it, he says: i’m on i’m 70% muscle, i say, what are you, show me the pokan biobredast, apparently. no, and i

slowly begin to explain to the person that this is basically impossible, that’s why we have diagnostic methods, they are objective, again the podcast is deception substances, we are talking today about the causes of obesity in the studio, the editor-in-chief of komsomolskaya pravda olesya nosova and i am an endocrinologist zuhra pavlova. zukhra, let’s do a little more probioimpedance, well, what does that mean, it’s just bad. the whole body, if it were measured normally,

the device completes what it might look like , yes, so the same, say, bioimpedance, which is particularly objective, conducted research, compared the data with densametry data of this gold standard of x-ray research, and the data coincides almost completely, therefore... when we explain to the patient that you have lost weight remarkably, in your opinion, but unfortunately you have lost the most valuable thing, you have lost muscle mass and water, so let us still return to those recommendations that were given initially, you will balance the food this way, and not the way you want, yes, because a person sometimes, when, let’s say, there is a decrease in appetite against the background of medications, he begins to eat something that is not so healthy. because i don't really want to eat, how tasty it is, well, it goes without saying,

if you need to eat few calories, then why waste them on pumping, it’s better to eat something tasty, yes, due to this tasty thing, fatty tissue leaves in smaller quantities, and muscle tissue escapes, oh, oh-oh -oh, how you can see it very significantly on the scales, the muscles are heavy, and i always tell the patient, please tell me, what do you see more, changes in numbers on the scales or you? clothes become big, so if the patient says: not clothes, this is the second time i’ve changed things there, this is very good option, because adipose tissue is voluminous, a decrease in size is a good indicator, even if there is not very much on the scale, it is important for us not to see the numbers, but they are also important, of course, but not a priority, it is important for us that the body composition becomes physiological, so that there is as much fat as needed, by the way, how much fat is needed in men up to 24% is normal from... it is a priority not so much the scales as

the ratios, because then the person will be healthy, which means that in terms of diagnosis we talked about the methods, i would really like to so that certain parameters are also included in this diagnosis, i often hear... we will not say what tests need to be taken, yes, because despite the fact that they are largely repeated from patient to patient, each patient has his own characteristics, when... a doctor examines a patient, he sees certain signs of certain diseases or conditions, and adds something else, so when they say: what should i test? a patient calls, let’s say, wants to come for an appointment, says: what should i give? and i always tell him: i’ll examine you first, question you, then i will assign you the scope of the examination.

so, i often hear from my colleagues when they say that defining some parameters there is pointless. they don’t talk about anything, well, for example, there is a hormone called leptin, when it was discovered in the last century, scientists had the feeling that a revolution had taken place, now we, with the help of this leptin and its analogues, will cure everyone of obesity, this is a saturation hormone, but it turned out that when these laboratory animals were given this hormone, some actually lost weight, but some did not didn’t react to this at all. i mean, they just didn’t want to eat, they felt full all the time, full, yes, that’s really how it worked, there was no increased appetite, so the rats and other animals lost weight, but some of the rats didn’t lose weight and even gained it, so, in fact, this hormone, like insulin, is such

an indicator of the volume of adipose tissue, that is , if you and i see an overweight person with some kind of morbid degree of obesity, we already understand: he will have and insulin a lot, and there is a lot of leptin, and the worst thing is that resistance to this other hormone very often develops, stability, they cannot act, leptin cannot tell the brain that there is enough food, there is no need to eat more, insulin cannot provide the same the passage of glucose into the cell, saturate this cell and give the hunger center and other substances there a signal: stop, we no longer need to eat, but due to this... resistance, there is a lot of glucose in the blood, a lot of insulin in the blood, a person is always hungry, i always want to eat, and until three bitches, literally, especially in the evening, when the activity of the same insulin is at its highest, sometimes, to show the patient what is happening in his body, this is not such

a big expense, but when you show how much the same insulin is raised, you not only can calculate insulin resistance, and explain, we have such a problem. it is fraught with something, overcome it with willful efforts, control yourself, it’s impossible, sometimes it’s like this, to show off, in medicine there is even one like this, during anatomy exams, to show, this part, you have to show, for the patient this visual image, it is very sobering, it defines such a boundary, now like this, and if you take another step in the same direction, it will be even worse, there will be... diabetes , there will be cardiovascular pathologies and so on and so forth, i generally picture obesity as the sun, but i have such a positive approach, no, yes, why not, yes, why bother anyway? so i’m drawing this sun to show that the basis of many diseases

is obesity, and the sun has there are rays, here is one of the rays - these are cardiovascular diseases, in addition to obesity, a person will have carbohydrate disorders. prediabetes, there is increased glycemia on an empty stomach or after eating, diabetes itself and some other troubles, this will be a violation of the lipid cholesterol profile, and we have an incorrect balance of fats, and this will contribute to atherosclerosis , again, cardiovascular diseases, this is a violation balance of sex hormones, androgen deficiency, followed by erectile dysfunction, violation reproductive... which very often develops against the background of overweight or obesity, this is a disorder, you and i often discussed this at one time, of purine metabolism, that same gout, and hyperuricia.