Advances in Psychosomatic Medicine最新文献

Binge eating disorder (BED) is characterized by recurrent episodes of uncontrollable eating, even when not hungry, until uncomfortably full, occurring at least twice a week for a 6-month period. This is differentiated from bulimia nervosa (BN) by the lack of compensatory mechanisms such as purging/laxative abuse. There are significantly higher levels of psychiatric symptoms in patients with BED as compared to those without BED. Furthermore, depressive symptomatology may increase the patient's vulnerability to binge eating as well as to relapse after treatment. Grazing is defined as eating small amounts of food continuously. BED in the pre-bariatric patient can manifest as 'grazing' about 2 years post-bariatric surgery. Treatment should be directed at eating behavior, associated psychopathology, weight and psychiatric symptoms. Cognitive behavior therapy is based on changing the patient's erroneous ways of thinking about themselves, the world and how others perceive them. This includes a focus on normalizing food intake as well as challenging dysfunctional thinking, identifying feelings, and developing non-food coping skills. It increases a sense of control and therefore helps the patient adhere to behavior change strategy, as well as improving mood and reducing associated psychopathology. Interpersonal therapy is based on the relationship between negative mood low self-esteem traumatic life events, interpersonal functioning and the patient's eating behavior. The rationale being that eating represents maladaptive coping with underlying difficulties. While psychotherapy either CBT or IPT leads to decrease in disordered eating behaviors and improved psychiatric symptoms, it has little effect on weight hence; its benefit is optimal when used in conjunction with bariatric surgery.

Obesity in our country is a growing concern. There are several different options for weight loss; however, individuals must be self-motivated and amendable to change in order to achieve success with their weight loss goals. Several strategies used by professionals in the US today to treat overweight and obesity, include diet therapy, exercise, behavior modification, pharmacotherapy, and surgery. The focus of the American Dietetic Association (ADA) Weight Management Position Statement is no longer just on weight loss but now on weight management. Reaching one's ideal body weight is recommended but not often realistic. Frequently, the goal of treatment shifts to maintenance of ones current weight or attempts at moderate weight loss. Lifestyle modification or behavioral modification interventions rely on analyzing behavior to identify events that are associated with appropriate vs. inappropriate eating, exercise, or thinking habits. Certain primary strategies that have been found to be useful for helping people change their behaviors so that they can lose weight and maintain their weight loss, include self-monitoring, stimulus control, cognitive restructuring, stress management, social support, physical activity, and relapse prevention. Weight loss programs should strive to combine a nutritionally balanced dietary regimen with exercise and lifestyle modifications at the lowest possible cost. There are several different methods used for dietary modifications; low calorie diets, very low calorie diets, fasting, formula diets and meal replacement programs, and popular diets. Bariatric surgery is gaining popularity as it has been an effective way to treat obesity. Following gastric bypass surgery, the patients must be prepared to modify their eating behaviors and dietary selections to assist with weight loss and prevent potential complications. Patients should be educated on the dietary guidelines extensively prior to surgery and again post-operatively.

Obesity is strongly associated with conditions such as hypertension, diabetes mellitus and osteoarthritis that have known adverse health outcomes. The rising prevalence of obesity threatens to overburden our health care system. As a result, the need for safe and effective treatment options is urgent. Unfortunately, pharmacologic treatment options have been disappointing either because of poor side effect profiles or limited long-term efficacy. Our goal is to review currently available pharmacologic treatments and the data supporting their use so that practicing physicians may better incorporate them into a comprehensive, long-term treatment strategy for their patients. We focus on orlistat and sibutramine as these are the two medicines approved by the FDA for long-term treatment of obesity. In addition, we review briefly agents approved for short-term use as well as agents such as zonisamide and topiramate which have shown some promise as weight loss agents in specific clinical circumstances. Finally, we highlight one medicine currently in phase III clinical trials, an endocannabinoid receptor antagonist. Given the overwhelming research focus on this disease, it is likely that the coming years will bring more treatment options, raising the chance that our patients will have meaningful and sustained weight loss.

Interactions between our conserved 'thrifty genotype' and current trends toward reduced physical activity and increased food intake are posited as the root cause of the rising prevalence of obesity in the modern era. The past decade has seen tremendous advances in our understanding of the physiological regulation of energy balance and adiposity, and important insights into the pathogenesis of obesity. We have gained a more comprehensive view of the energy homeostasis system from the discovery of the adiposity hormone leptin, the subsequent identification of hypothalamic and other brain neuropeptide systems controlling energy balance, and the progress in understanding the molecular mechanisms by which cells can sense and respond to changes in metabolic state. Numerous targets have been identified for potential pharmacological and genetic approaches to obesity management. Some of the most recent developments are prototypic compounds that manipulate fat metabolism, both in peripheral tissues and in the brain, to reduce body fat synthesis and storage and to increase fat oxidation, to reduce food intake, and to increase energy expenditure.