Obezitede Çeşitli Risk Faktörleri ve Dürtüsellik

Obezite gelişiminde, genetikle birlikte sosyal, kültürel, emosyonel ve diyete bağlı faktörler de rol oynamaktadır. Obezite tedavisinde kilo alımının yinelemesinin muhtemel bir öngörücüsü dürtüselliktir. Dürtüsellik ayrıca tedaviyi yarıda bırakma için de öngörücü bir faktör olarak gösterilmiştir. Yapılan çalışmalarda obez kişilerin zayıf olanlara göre daha dürtüsel oldukları gösterilmiştir. Özellikle tıkınırcasına yeme bozukluğu olanlarda dürtüsel özellikler yüksek bulunmuştur. Dürtüsel kişilerin yeme davranışı üzerindeki kontrollerini sağlayamadıkları ve lezzetli, yüksek kalorili besinlere karşı ilgilerinin fazla olduğu belirtilmiştir. Obezite ve dürtüsellik ilişkisini güçlendiren bir diğer konu da dikkat eksikliği hiperaktivite bozukluğu tanısı almış çocuklardaki obezitedir. Beynin ödül merkezindeki dopaminerjik yetersizliğin, dikkat eksikliği ve obezite için ortak etyolojik yol olabileceği ileri sürülmektedir. Çoğu araştırmacı artık kilo kaybetmeye yönelik tedavi yanında kaybedilen kiloyu koruyabilmeye yönelik yaklaşımları da araştırmaktadır. Dürtüsel davranışı azaltmada kullanılan özgül bilişsel davranışçı terapi uygulamalarının obezite tedavisinin bir parçası olarak uygulanması tedavinin başarısını artıracaktır. Obezitenin kronik bir hastalık olduğu unutulmamalı ve uzun süreli takip ve tedaviler planlanmalıdır.

Anahtar Kelimeler:

Dürtüsellik, Obezite, Tedavi, Risk Faktörleri

Risk Factors and Impulsivity in Obesity

In addition to genetic tendency, social, cultural, emotional and diet-related factors play important role in the development of obesity. Impulsivity is the possible predictor of relapse in obesity treatment. Impulsivity is also considered as a predicting factor among patients who quit the treatment. Research has shown that obese people are more impulsive than other people. Impulsive features are especially found to be higher with those who have binge eating disorder. Impulsive people appears to have no control over their behaviors on eating and they have more interest towards food with higher calories. Another issue that strengthens the assocaition between obesity and impulsivity is the obesity in children with attention deficit hyperactivity disorder. Dopaminergic deficiency in the reward centre of the brain can be a common pathway for both attention deficit and obesity. Several approaches have been searched and put forward to sustain the patients' lost weights after diet. Specific cognitive behavioral approaches developed for the treatment of impulsive behavior could contribute much into obesity treatment . Obesity is a chronic disease that requires long term treatment and follow up.

Keywords:

Impulsivity, Obesity, Treatment, Risk Factors,

PDF

___

Pi-Sunyer FX. NHLBI Obesity Education Initiative Expert Panel of the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. Obes Res 1998; 6(Suppl):51S-209S.
Gedik O. Obezite ve çevresel faktörler. Turkish Journal of Endocrinology and Metabolism 2003; 7(Suppl 2):1-4.
Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 3rd ed. New York, Cambridge University Press, 2008.
Schrauwen P, Westerterp KR. The role of high-fat diets and physical activity in the regulation of body weight. Br J Nutrition 2000; 84:417-427.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision. Washington, DC, American Psychiatric Association, 2000.
De Zwaan M, Mitchell JE, Seim HC, Specker SM, Pyle RL, Raymond NC et al. Eating related and general psychopathology in obese females with binge eating disorder. Int J Eat Disord 1993; 15:45-52.
Jackson TD, Grilo CM, Masheb RM. Teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in binge eating disorder. Obes Res 2000; 8:451-458.
Pratt EM, Telch CF, Labouvie EW, Wilson GT, Agras WS. Perfectionism in women with binge eating disorder. Int J Eat Disord 2001; 29:177-186.
Sansone RA, Wiederman MW, Monteith D. Obesity, borderline personality symptomatology and body image among women in a psychiatric outpatient setting. Int J Eat Disord 2001; 29:76-79.
Devlin MJ, Walsh BT, Spitzer RL, Hasin D. Is there another binge eating disorder? A review of the literature on overeating in the absence of bulimia nevroza. Int J Eat Disord 1992; 11:333-340.
Spitzer RL, Yanowsky SA, Wadden T, Wing R, Marcus MD, Stunkard A et al. Binge eating disorder: Its further validation in a multiside study. Int J Eat Disord 1993; 13:137-153.
Yanovski SZ, Nelson JE, Dubbert BK, Spitzer RL. Association of binge eating disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry 1993; 150:1472-1479.
Telch CF, Agras WS. Do emotional states influence binge eating in the obese? Int J Eat Disord 1996; 20:271-279.
Lowe MR, Caputo GC. Binge eating in obesity: toward the specification of predictors. Int J Obes 1991; 10:4-55.
Fassino S, Abbate Daga G, Pierrò A, Leombruni P, Rovera GG. Anger and personality in eating disorders. J Psychosom Res 2001; 51:757-764.
Thompson KM, Wonderlich SA, Crosby RD, Mitchell JE. The neglect link between eating disturbances and aggressive behavior in girls. J Am Acad Child Adol Psychiatry 1999; 38:1277-1284.
Horesh N, Zalsman G, Apter A. Internalized anger, self-control and mastery experience in inpatient anorexic adolescents. J Psychosom Res 2000; 49:247-253.
Milligan RJ, Waller G. Anger and bulimic psychopathology among nonclinical women. Int J Eat Disord 2000; 28:446-450.
Mueller WH, Grunbaum JA, Laberthe DR. Anger expression, body fat and blood pressure in adolescents: Project heartbeat. Am J Hum Biol 2001; 13:531-538.
Lavoie KL, Miller SB, Conway M, Fleet RP. Anger, negative emotions and cardiovascular reactivity during interpersonal conflict in women. J Psychosom Res 2001; 51:503-512.
Fassino S, Leombruni P, Andrea P, Abbate Daga G, Rovera GG. Mood, eating attitudes and anger in obese women with and without binge eating disorder. J Psychosom Res 2003; 54:559-566.
Strien T, Ouwens M. Effect of distress, alexithymia and impulsivity on eating. Eat Behav 2007; 8:251-257.
Pompili M, Girardi P, Tatarelli G, Ruberto A, Tatarelli R. Suicide and attempted suicide in eating disorders, obesity and weight-image concern. Eat Behav 2006; 7:384-394.
Nederkoorn C, Jansen E, Mulkens S, Jansen A. Impulsivity predicts treatment outcome in obese children. Behav Res Ther 2006; 45:1071-1075.
Garner DM, Wooley SC. Confronting the failure of behavioral and dietary treatments for obesity. Clin Psychol Rev 1991; 11:729-780.
Jeffrey R, Epstein LH, Wilson GT, Drewnowski A, Stunkard AJ,Wing RR et al. Long term maintenance of weight loss: Current status. Health Psychol 2000; 19(suppl 1); 5- 16.
Epstein LH, Valoski AM, Kalarchian MA, McCurley J. Do children lose and maintain weight easier than adults: A comparison of child and parent weight changes from six months to ten years. Obes Res 1995; 3:411-417.
Davis C, Strachan S, Berkson M. Sensitivity to reward: Implications for overeating. Appetite 2004; 42:131-138.
Hjördis B, Gunnar E. Characteristics of drop-outs from a long term behavioral treatment program for obesity. Int J Eat Dis 1989; 8:363-368.
Nasser JA, Gluck ME, Geliebter A. Impulsivity and test meal intake in obese binge eating women. Appetite 2004; 43:303-307.
Bourget V, White DR. Performance of overweight and normal weight girls on delay of gratification task. Int J Eat Dis 1981; 3:63-71.
Bonato DP, Boland FJ. Delay of gratification in obese children. Addict Behav 1983; 7:71-74.
Davis C, Levitan RD, Muglia P, Bewel C, Kennedy JL. Decision making deficits and overeating: A risk model for obesity. Obes Res 2004; 12:929-935.
Odent M. Attention deficit hyperactivity disorder (ADHD) and obesity: Two facets of the same disease? Med Hypotheses 2010; 74:139-141.
Agranat Meged AN, Deitcher C, Goldzweig G, Leibson L, Stein M, Galili Weisstub E. Childhood obesity and attention deficit hyperactivity disorder: A newly described comorbidity in obese hospitalized children. Int J Eat Dis 2005; 37:357-359.
Arnsten AF. Fundamentals of attention deficit hyperactivity disorder: circuits and pathway. J Clin Psychiatry 2006; 67:7-12.
Arnsten AF. Stimulants: therapeutic actions in ADHD. Neuropsychopharmacology 2006; 31:2376-2383.
Wang GJ, Volkow ND, Fowler JS. The role of dopamine in motivation for food in humans: implications for obesity. Expert Opin Ther Targets 2002; 6:601-609.
Blum K, Chen TJ, Meshkin B, Downs BW, Gordon CA, Blum S et al. Reward deficiency syndrome in obesity: a preliminary cross-sectional trial with a Genotrim variant. Adv Ther 2006; 23:1040-1051.
Need AC, Ahmadi KR, Spector TD, Goldstein DB. Obesity is associated with genetic variants that alter dopamine availability. Ann Hum Genet 2006; 70:293-303.
Meguid MM, Fetisso v SO, Varma M, Sato T, Zhang L, Laviano A et al. Hypothalamic dopamine and serotonin in the regulation of food intake. Nutrition 2000; 16:843- 857.
Jensen PS, Hinshaw SP, Kraener HC, Lenora N, Newcorn JH, Abikoff HB et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry 2001; 40:147-158.
Leddy JJ, Epstein LH, Jaroni JL, Roemmich JN, Paluch RA, Goldfield GS et al. Influence of methylphenidate on eating in obese men. Obes Res 2004; 12:224-232.
Goldfield GS, Lorello C, Doucet E. Methylphenidate reduces energy intake and dietary fat intake in adults: a mechanism of reduced reinforcing value of food? Am J Clin Nutr 2007; 86:308-315.
Robbins TW. Chemistry of the mind: neurochemical modulation of prefrontal cortical function. J Comp Neurol 2005; 493:140-146.
Liu LL, Li BM, Yang J, Wang YW. Does dopaminergic reward system contribute to explaining comorbidity obesity and ADHD? Med Hypotheses 2008; 70:1118-1120.
Solanto MV. Dopamine dysfunction in AD/HD: integrating clinical and basic neuroscience research. Behav Brain Res 2002; 130:65-71.
Wilens TE. Mechanism of action of agents used in attention deficit/hyperactivity disorder. J Clin Psychiatry 2006; 67:32-38.
Aranda FF, Pinheiro AP, Thornton LM, Berrettini WH, Crow S, Fichter MM et al. Impulse control disorders in women with eating disorders. Psychiatry Res 2008; 157:147-157.
de Zwaan M. Binge eating disorder and obesity. Int J Obes Relat Metab Disord 2001; 25 (Suppl 1):S51-S55.
Grilo CM, Masheb RM, Wilson GT. Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: A randomized double-blind placebo-controlled comparison. Biol Psychiatry 2005; 57:301-309.

ISSN: 1309-0658
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 2009
Yayıncı: Psikiyatride Güncel Yaklaşımlar

Arşiv