In today's world the problem of obesity is discussed in the context of non-communicable diseases, leading to significant encumbrances on society. This article provides information about the basics of the regulation of energy balance and eating behavior. Particular attention is paid to the role of neurotransmitters, including serotonin, a metabolic disorder that is one of the suspected causes of eating disorders. Demonstrated experience in the use of sibutramine in the world, and in the Russian practice, taking into account the impact on the development of comorbid conditions and their complications.

Aim. To study the influence of SERT and GNB3 gene polymorphisms on the results of the treatment of obesity by serotonin-norepinephrine reuptake inhibitors.Methods. Patients who didn’t achieve significant weight loss in 3 month period during PrimaVera Study were selected for the genetic evaluation and compared with the group of “effective treatment”. The study included 66 patients (57 females and 9 males), mean age 39.29 ± 12.64 years, who received Reduxin (sibutramine + MCC) at the dose of 10 mg. Term follow-up was 3 months. Clinical examination and determination of biochemical parameters was performed at baseline and at the end of the observation period. In order to assess the type of eating behavior and identify hidden depressions a validated questionnaire was used (questionnaire "The types of eating disorders» (DEBQ), Beck Depression Scale). Also conducted a genetic study to assess SERT and GBN3 gene polymorphisms.Results. In the second group presence of S-allele SERT-gene was significantly associated with higher rates of external type of eating behavior. A statistically significant correlation between the genotype or allele of either body weight, rates of blood pressure, heart rate and cholesterol have not been found. In the first group there was a statistically significant association of S-allele carrier with less weight loss -2.8 kg (compared to l-allele) and higher rates at baseline glucose 5.38 ± 0.63 mmol / l (compared to L-allele of -3.28 kg and 5.04 ± 0.91 mmol / l).In the study of GBN3 polymorphism in the second group among CC genotype carriers there were higher levels of systolic blood pressure (SBP) before treatment (129.27 ± 9.16 mmHg), SBP and diastolic blood pressure after 3 months of treatment (127.36 ± 8.16 and 78.36 ± 4.3 mmHg) compared with CT genotype (117.27 ± 12.5; 115.45 ± 10.6; 72.91 ± 6.0 mm Hg, respectively) (p 0.05). Also among the carriers of C-allele there were more severe manifestations of depressive syndrome in comparison with T-allele carriers.Conclusion. Among the carriers of S-allele of SERT gene body weight loss during Reduxin treatment was lower than among the carriers of the L-allele; among the carriers of CC genotype of GBN3 gene higher blood pressure was higher at baseline and during Reduxin treatment, as well as more severe symptoms of a depressive syndrome.

The purpose of the article is to consider stress as one of the etiological factors of obesity and metabolic syndrome. The review discusses both endocrine and social aspects of stress as a syndrome of adaptation to the current situation in Russian society. It is emphasized that lifestyle factors contributing to the growth of overweight are gaining popularity in the society, and the high incidence of obesity is directly related to the level, quality and lifestyle of a modern man. Constant nervous tension, negative emotions, fear in conditions of abundance of food directly contributes to obesity, which is associated with a large number of other serious diseases. Chronic hyperactivation of the hypothalamic-pituitary-adrenal axis and chronic hypersecretion of cortisol, if persistence is not a purely physiological condition. Endocrine mechanisms mediating the development of metabolic disorders on the background of chronic stress include activation of the hypothalamic-pituitary-adrenal system, changes in eating behavior, hyper-production of glucagon and triglyceride accumulation in visceral fat depots. Processes and social changes occurring in modern society contribute to the construction of everyday socio-cultural environment characterized by increased stress. Chronic stress in combination with physical inactivity, the result of improper lifestyle of modern people, becomes an effective factor contributing to the spread among the population of Russia not only overweight, but also various forms of obesity. It is emphasized that at the state level there is an urgent need to adopt and implement effective programs and mechanisms to ensure the population meets modern requirements and environmental standards of healthy food, rationalization of food distribution among the population, the formation of a culture of food consumption, improving the quality of life of the population and the culture of a healthy lifestyle, teaching the population the correct stress-coping behavior.

The present review considers modern concepts of the physiological mechanisms of the formation of food behavior in a norm at several levels, beginning with the cellular level and ending with the level of functional systems. Neuroimaging methods used for both the study of the pathophysiological foundations of eating disorders and for determining the target for neurostimulation techniques are described. Methods of non-invasive brain stimulation such as transcranial magnetic stimulation and transcranial electrical stimulation, the mechanisms of their influence and aspects of safety of application are reviewed, the latest data on the results of studies on the use of the above methods in the therapy of obesity are summarized.

Pharmacotherapy is an essential component of obesity treatment, as well as efforts focused on changing the lifestyle, correcting the food consumption and increasing the physical activity. The administration of central-acting drugs as pharmacotherapy of obesity is pathogenetically justified and allows improving the effectiveness of treatment. In this article, the use of sibutramine, a serotonin and norepinephrine reuptake inhibitor, is considered in various aspects of endocrinologists practice. In addition to aforesaid there is an application of a specific clinical observation.