Figura Andrea, Rose Matthias, Ordemann Jürgen, Klapp Burghard F, Ahnis Anne
Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany; Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655.
Surg Obes Relat Dis. 2017 Feb;13(2):129-137. doi: 10.1016/j.soard.2016.08.003. Epub 2016 Aug 5.
Patients with severe obesity need to adapt to surgically induced changes in their eating behaviors to maintain treatment success.
This study examined the effects of laparoscopic sleeve gastrectomy (LSG) on weight loss and on 3 dimensions of eating behavior, namely, cognitive restraint, disinhibition, and hunger. Outcomes of the LSG group were compared with a group of conservatively treated (CT) patients, who underwent a 1-year multimodal weight-reduction group program that included dietary advice, physical exercise, psychoeducation, cognitive-behavioral therapy, training in Jacobson's progressive muscle relaxation, and social group support.
The study setting was a multidisciplinary obesity center located in a university hospital.
A sample of 102 patients with obesity were investigated using the Three-Factor Eating Questionnaire before and, on average, 19 (±5) months after weight loss intervention. Of the 102 patients, 62 (age 45.8±10.8 years, 71% females) underwent LSG, and 40 patients (age 50.6±11.3 years, 77.5% females) underwent the CT program. Patients were assigned to either the surgical or the nonsurgical intervention group following clinical guidelines and patient preference.
In the LSG group, total weight loss was 25.9±11.0%, excess weight loss was 52.8±24.1%, and body mass index decreased from 51.4±8.1 to 38.0±7.8 kg/m². In the CT group, total weight loss was 5.4±10.6%, excess weight loss was 13.9±27.1%, and body mass index decreased from 40.3±6.7 to 38.0±7.2 kg/m². Significant improvements in self-reported eating behaviors were observed in both groups, that is, an increased cognitive restraint of eating, a decreased disinhibition of eating control, and a reduced degree of perceived hunger. In contrast, whereas Three-Factor Eating Questionnaire scores before weight loss intervention did not differ between groups, LSG patients reported significantly greater reductions in disinhibition and hunger than CT patients did after weight loss intervention. In both groups, greater weight loss was associated with decreased hunger sensations.
In the second follow-up year, LSG was associated with greater weight loss and greater improvements in self-reported eating behaviors compared with conservative treatment.
重度肥胖患者需要适应手术引起的饮食行为变化，以维持治疗效果。
本研究探讨腹腔镜袖状胃切除术（LSG）对体重减轻以及饮食行为三个维度（即认知抑制、去抑制和饥饿感）的影响。将LSG组的结果与一组接受保守治疗（CT）的患者进行比较，这些患者参加了为期1年的多模式减重团体项目，包括饮食建议、体育锻炼、心理教育、认知行为疗法、雅各布森渐进性肌肉松弛训练和社会群体支持。
研究地点是一家大学医院内的多学科肥胖中心。
对102名肥胖患者在体重减轻干预前以及平均减重干预19（±5）个月后使用三因素饮食问卷进行调查。102名患者中，62名（年龄45.8±10.8岁，71%为女性）接受了LSG手术，40名患者（年龄50.6±11.3岁，77.5%为女性）参加了CT项目。根据临床指南和患者偏好将患者分配到手术或非手术干预组。
在LSG组中，总体重减轻25.9±11.0%，超重减轻52.8±24.1%，体重指数从51.4±8.1降至38.0±7.8kg/m²。在CT组中，总体重减轻5.4±10.6%，超重减轻13.9±27.1%，体重指数从40.3±6.7降至38.0±7.2kg/m²。两组患者自我报告的饮食行为均有显著改善，即饮食的认知抑制增加、饮食控制的去抑制减少以及饥饿感程度降低。相比之下，虽然体重减轻干预前两组的三因素饮食问卷得分没有差异，但LSG患者在体重减轻干预后报告的去抑制和饥饿感降低程度明显大于CT患者。在两组中，体重减轻越多，饥饿感越低。
在第二年随访时，与保守治疗相比，LSG与更多的体重减轻以及自我报告的饮食行为更大改善相关。
