[Multi-causal etiology of obesity--case report]

Etiology of obesity is influenced not only by hormonal and metabolic but also psychological factors. With increasing number of eating disorders, the number of patients without visible psychopathic personal features increases, but some personality characteristics which increase vulnerability of human organism and probability of disease exist. Therefore, we pay attention to examinations and therapy of personal characteristics of the patient and his past history. The symptom of the patient is connected not only with special organic changes but also with social environment. Multicausal characteristic of obesity can be documented by case reports of patients in the group therapy within the Programme of Systemic Therapy of Obesity carried out in our Department. In all the case long-term or actual incongruence, which does not make possible the change of life style and active patient's participation in the therapy, necessary precondition for the reduction of weight and its keeping up, is present. The case report of R.K., in which the gradual process of change of subjective feeling and self-exploration of R.K. in the group therapy are documented, is elaborated in more detail. The resulting change of Self is the precondition for more effective intervention at the level of energetic intake--the energetic expenditure. The patient is able to take more responsibility for her food behaviour, smaller dependence on the estimation of other people increases the possibility of permanent change of life style.