Elfhag K, Finer N, Rössner S
Obesity Unit, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Diabetes Obes Metab. 2008 Jun;10(6):498-505. doi: 10.1111/j.1463-1326.2007.00740.x. Epub 2007 Jun 26.
To study the associations between weight loss with sibutramine and orlistat with psychological aspects that may interact with patients' response to these drugs.
A total of 478 obese patients with a mean body mass index of 42 +/- 12 kg/m(2) gave self-reported, retrospective data on different types of previous weight loss treatments (sibutramine and orlistat, and Weight Watchers used as a control condition) including the amount of weight lost with these treatments, eating behaviour (Dutch Eating Behaviour Questionnaire) and personality (NEO Personality Inventory - Revised).
Greater weight loss with sibutramine was associated with lower levels of restrained eating and higher levels of 'neuroticism', in particular 'anxiety' and 'depression'. Greater weight loss with orlistat was associated with aspects of the personality dimension 'conscientiousness' (e.g. 'order' and 'deliberation').
Sibutramine may exert its greatest effect in patients whose eating is a 'natural' response to hunger rather than regulated by cognitions and conscious controls. Patients with low levels of restraint could be more sensitive to the satiety-enhancing effect of sibutramine. They may be able to reduce their food intake without cognitive interference and/or start to control their eating most radically in response to enhanced satiety. Enhanced satiety may also help patients withstand a wish to eat triggered by psychological distress. Possible central nervous system effects on mood could also have reduced eating, which was related to distress. The administration regimen of orlistat is more demanding, requiring greater adherence. This can account for the finding that personality attributes such as conscientiousness are important for success.
研究西布曲明和奥利司他减肥与可能影响患者对这些药物反应的心理因素之间的关联。
共有478名平均体重指数为42±12kg/m²的肥胖患者提供了关于既往不同类型减肥治疗（西布曲明、奥利司他以及作为对照的慧俪轻体）的自我报告回顾性数据，包括这些治疗的减重情况、饮食行为（荷兰饮食行为问卷）和性格（大五人格量表修订版）。
服用西布曲明后体重减轻更多与饮食抑制水平较低以及“神经质”水平较高有关，尤其是“焦虑”和“抑郁”。服用奥利司他后体重减轻更多与人格维度“尽责性”的某些方面（如“条理性”和“审慎性”）有关。
西布曲明可能对那些饮食是对饥饿的“自然”反应而非受认知和意识控制调节的患者产生最大效果。饮食抑制水平低的患者可能对西布曲明增强饱腹感的作用更敏感。他们可能能够在没有认知干扰的情况下减少食物摄入量，和/或开始根据增强的饱腹感最彻底地控制饮食。增强的饱腹感也可能帮助患者抵御由心理困扰引发的进食欲望。对情绪的可能中枢神经系统影响也可能减少了与困扰相关的进食。奥利司他的给药方案要求更高，需要更强的依从性。这可以解释尽责性等人格特质对成功很重要这一发现。
