This article assesses the problem of obesity as a risk factor for development of severe metabolic complications and different disorders of reproductive function in women of childbearing age. It is pointed that obesity is associated with high prevalence of hyperandrogenemic and hyperplastic disorders, polycystic ovary syndrome, infertility, complications of pregnancy and childbirth. Article discusses the questions of integrated treatment approach of this category of patients, which include non-drug interventions (rational nutrition, lifestyle modification) as well as the use of medications which lower the insulin resistance and hyperinsulinemia to restore ovary function and the possible use of combined oral contraceptives for correction of anovulation.

One of the main goals in treatment of obesity is descending of overall cardiometabolic risk, which is mostly defined by atherogenic changes in blood lipid spectrum. Scientific data, presented in this review confirm that orlistat is effective for treatment of obesity, its introduction significantly increases proportion of patients who reach clinically valuable results. The mechanism of action of orlistat explains its influence on parameters of blood lipids, which doesn't directly depend on the decrease of body mass during treatment. Improvement of cardiometabolic parameters during orlistsat treatment allows to consider this therapy as one of the methods for correction of dyslipidemia

At the present time diabetes mellitus (DM) is a main noninfectious disease that not only significantly influences quality of life and life expectancy of every patient but also represents a heavy burden for the healthcare system. Medico social significance of DM is defined by high prevalence of this disease in population and high risk of its specific macro- and microvascular complications. According to latest data the main chain in the development of all specific complications of DM is chronic hyperglycemia, the important role belongs also to arterial hypertension and dyslipidemia. The multicenter randomized controlled study UKPDS assessed the influence of levels of hyperglycemia and arterial pressure as well as common methods of their corrections on development of complications of type 2 DM. The results of the UKPD study showed the significance of the intensive control of blood glucose and arterial pressure for the prophylaxis of type 2 DM complications and lethal outcomes. These observations allowed development of contemporary recommendations for treatment patients with type 2 DM and defined the target levels of HbAlc (<7,0%) and arterial pressure (<130/80 mm Hg). After the end of the randomized part of the study its participants were observed for 10 years (10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes) to investigate does the intensive therapy have long-term effect on complications of type 2 DM. The results showed the maintenance of positive effects of intensive glucose lowering therapy on the risk of DM complications and lethal outcomes.

The article delineates the definition of concept of insulin resistance as well as the factors that determine tissue insulin sensitivity; defines the conception of «insulin resistance syndrome» (metabolic syndrome), its criteria and diseases that it accompanies. It is pointed that the golden standard for quantitative assessment of insulin action is hyperinsulinemic euglycemic clamp. Different indexes for indirect measurement of insulin resistance and possibilities of use of mathematical models for this matter are discussed.

Diabetes mellitus type 2 (DM2) - is an independent predictor of development of heart failure (HF). Spiroergometry - is a method for studying blood gas exchange parameters, commonly used for specification of HF. The purpose: 1. To study features of gas exchange at patients with DM2 without cardiovascular diseases in comparison with healthy control. 2. To estimate efficiency of metoprolol for correction of metabolic disturbances in patients with DM2. Materials and methods: 12 patients with DM2, aged 48,4±8, without history of cardiovascular diseases and 15 control subjects, aged 43,6±8 underwent cardio-pulmonary exercise test on treadmill, according to Bruce protocol. Exercise energy, VO2 peak, MET, VE max, VCO2 production were observed. Results: Patients with DM2 had a reduced exercise duration (p<0,001), lower peak oxygen consumption (p<0,001), VCO2 production and MET (p<0,005), than controls, representing the same state of hypoxia as in patients with ischemic heart disease (IHD) of functional class 2. The introduction of metoprolol to patients with DM2 significantly increased exercise duration time and VCO2 production (p<0,005). Conclusions: 1. VO2 consumption in patients with DM2 is decreased to the same levels as in persons without DM2, who have IHD and HF. 2. Changes in oxygen-transport in persons with DM2 may serve as a marker of negative influence of the disease on cardiovascular system status. 3. Metoprolol improves parameters of cardio-respiratory system in patients with DM2.

The use of intragastric balloons in patients with morbid obesity (BMI>40) and superobesity (BMI>50) as the only method of treatment did not prove its effectiveness because of high rates of disease relapses. The article presents data showing that the fist line body mass lowering therapy with intragastric balloon before proceeding to bariatric sugery is effective in 78% patients with superobesity in aspects of lowering surgical and anesthesiological risks. Stopping treatment at the point of removal of intragastric balloon is associated with high risk of recurrence of obesity and its comorbid conditions. The use of intragastric balloons in group of high risk patients optimizes the process of selection of candidates for surgical treatment among patients with superobesity

Research objective: to study obesity among 10541 patients in therapeutic, neurologik and cardiologikal practices in 29 cities of the Russian Federation from St.-Petersburg to Vladivostok (COMPASS program). All patients are divided on two groups: with obesity (average BMI=33,7+4,1 kg/m2), and without this disease (average BMI=24,4+3,0 kg/m2). Groups were compared under demographic characteristics; features of a medical route; somatic and mental state. 20% from all patients in mentioned practices in various cities of Russia have obesity. Patients with obesity are predominantly women (middle age 54,0+12,0 year). For these patients low social and economic status (with low educational level, absence of employment, loneliness etc.) are characteristic. Patients with obesity are more often observe in cardiological practice. They suffer from cardiovascular diseases and type 2 diabetes. The hypothesis about obesity formation within mental disorders (depression, food addiction - dependence on food) is presented. Possibility of treatment of patients with the help of sibutramine is discussed.

We report the clinical case which reflects the peculiarities of metabolic syndrome (MS) development in testosterone deficient state. Testosterone deficiency (hypogonadism) is likely to be one of the MS components in men. Clinical case presented demonstrates the pivotal role of complex pathogenetic approach to MS treatment in hypogonadal men. The only combination of diet, exercises and testosterone therapy is beneficial in MS treatment in hypogonadal men.