Castelnuovo Gianluca, Pietrabissa Giada, Manzoni Gian Mauro, Cattivelli Roberto, Rossi Alessandro, Novelli Margherita, Varallo Giorgia, Molinari Enrico
Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania.
Department of Psychology, Catholic University of Milan, Milan.
Psychol Res Behav Manag. 2017 Jun 6;10:165-173. doi: 10.2147/PRBM.S113278. eCollection 2017.
Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial, social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account the possible contribution of mHealth and the stepped-care approach in health care.
肥胖是一种慢性疾病，与许多医学并发症和合并症的风险因素相关，如心血管疾病、某些类型的癌症、骨关节炎、高血压、血脂异常、高胆固醇血症、2型糖尿病、阻塞性睡眠呼吸暂停综合征以及不同的社会心理问题和精神病理障碍。肥胖是一种高度复杂的多因素疾病：遗传、生物、心理、行为、家庭、社会、文化和环境因素会以不同方式产生影响。基于证据的改善体重减轻、维持健康体重以及减少相关合并症的策略通常整合不同的干预措施：饮食、营养、身体、行为、心理方面的，必要时还有药物和手术方面的。此类治疗在多学科背景下由内分泌学家、营养师、饮食学家、物理治疗师、精神科医生、心理学家，有时还有外科医生组成的临床团队来实施。认知行为疗法（CBT）传统上被认为是治疗暴饮暴食症的最佳既定疗法，也是肥胖症最受青睐的干预措施，尤其从长期来看，可被视为心理方法中的一线治疗；然而，它不一定能成功实现体重减轻。本综述讨论了用于减肥的传统CBT以及其他方案，如强化CBT、强化聚焦CBT、行为减肥治疗、治疗性教育、接受与承诺疗法以及序贯暴饮暴食疗法。考虑到移动健康（mHealth）和分级护理方法在医疗保健中的可能贡献,讨论了肥胖症长期体重管理这一门诊环境和生活方式改变中的真正挑战。
