Walsh B T, Kissileff H R, Hadigan C M
Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, New York 10032.
Ann N Y Acad Sci. 1989;575:446-54; discussion 454-5. doi: 10.1111/j.1749-6632.1989.tb53265.x.
Despite our strong belief in the utility of laboratory studies of eating behavior, we also note several caveats on the data thereby obtained. First, it must be assumed that subjects' behavior is influenced by the laboratory environment and is not identical to eating behavior in a "normal" setting. Second, not all bulimic subjects who were screened for these studies actually participated, so that it is possible that the sample of patients from whom we obtained data differed in some ways from a general clinical population of women with bulimia. Nonetheless, we believe that our data provide compelling evidence that the disturbed eating behavior characteristic of bulimia nervosa can be profitably studied in the laboratory. Even under structured laboratory conditions, most bulimic patients rated one of their multicourse meals as typical of a binge, and, during that meal, consumed a much larger amount of food and ate more rapidly than did controls who were asked to overeat. The significant correlations between the sizes of the multicourse and single-course binge meals and between the size of laboratory binge meals and the size of the "naturally occurring" binge meals reported to the dietician suggest that a reproducible phenomenon is being examined. The results of our studies suggest that the abnormalities of eating behavior in bulimia nervosa cannot be viewed simply as a disturbance of carbohydrate consumption or even as the episodic consumption of a certain type of food. Rather, eating behavior in this syndrome appears more generally disturbed. The most striking difference between the binge and the nonbinge meals of bulimic patients and between the binge eating of patients and the overeating of normal persons is the amount of food consumed, not the macronutrient composition of the meals. In addition, for all four meal types, the patients were hungrier after the end of the meal than were the controls, even though the patients' average caloric intakes were generally larger and their average hunger ratings before the meals did not differ from those of the controls. Certainly, self-induced vomiting may contribute to this abnormality, but it was also observed after nonbinge meals when vomiting did not occur. Together, these data are consistent with the notion that the essential appetitive abnormality in bulimia nervosa lies in the control of the amount of food consumed, not in the consumption of a particular macronutrient or type of food. Patients with bulimia nervosa appear less responsive than normal to the signals that lead to the termination of a meal.(ABSTRACT TRUNCATED AT 400 WORDS)
尽管我们坚信饮食行为的实验室研究具有实用性，但我们也注意到由此获得的数据存在一些限制。首先，必须假定受试者的行为会受到实验室环境的影响，与“正常”环境下的饮食行为并不相同。其次，并非所有为这些研究筛选的贪食症受试者都实际参与了研究，因此我们获取数据的患者样本可能在某些方面与贪食症女性的一般临床人群有所不同。尽管如此，我们认为我们的数据提供了令人信服的证据，表明神经性贪食症特有的紊乱饮食行为可以在实验室中得到有益的研究。即使在结构化的实验室条件下，大多数贪食症患者将他们的一顿多道菜餐评为典型的暴饮暴食，并且在那顿饭期间，他们比被要求暴饮暴食的对照组摄入了更多的食物，吃得也更快。多道菜和单道菜暴饮暴食餐的量之间以及实验室暴饮暴食餐的量与向营养师报告的“自然发生”暴饮暴食餐的量之间的显著相关性表明正在研究一种可重复的现象。我们的研究结果表明，神经性贪食症的饮食行为异常不能简单地被视为碳水化合物消耗的紊乱，甚至不能被视为某种特定类型食物的间歇性消耗。相反，这种综合征中的饮食行为似乎更普遍地受到干扰。贪食症患者的暴饮暴食餐与非暴饮暴食餐之间以及患者的暴饮暴食与正常人的暴饮暴食之间最显著的差异在于食物摄入量，而不是餐食的宏量营养素组成。此外，对于所有四种餐食类型，患者在餐食结束后比对照组更饥饿，尽管患者的平均热量摄入量通常更大，并且他们在餐前的平均饥饿评分与对照组没有差异。当然，自我催吐可能导致这种异常，但在未发生呕吐的非暴饮暴食餐后也观察到了这种情况。总之，这些数据与以下观点一致，即神经性贪食症的基本食欲异常在于对食物摄入量的控制，而不是对特定宏量营养素或食物类型的消耗。神经性贪食症患者似乎对导致餐食结束的信号的反应比正常人更不敏感。（摘要截选至400字）
