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减重手术后的饮食失调:临床方面、对结果的影响和干预策略。

Disordered eating after bariatric surgery: clinical aspects, impact on outcomes, and intervention strategies.

机构信息

School of Psychology, University of Minho, Braga, Portugal.

Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, USA.

出版信息

Curr Opin Psychiatry. 2019 Nov;32(6):504-509. doi: 10.1097/YCO.0000000000000549.

Abstract

PURPOSE OF REVIEW

Disordered eating behaviors (DEBs) are associated with poor weight outcomes following bariatric surgery. We describe DEBs most relevant to this population, their associations with weight outcomes, and emerging data on interventions for DEBs.

RECENT FINDINGS

Loss of control eating episodes and grazing have been the most well studied DEBs in bariatric samples. Although DEBs often remit after surgery even without targeted intervention, a subgroup of patients have persistent or newly developed DEBs postoperatively. Preoperative DEBs have little effect on weight outcomes, whereas preoperative impulse control-related features commonly associated with DEBs (e.g., inhibitory control) may have stronger predictive value. Postoperatively, DEBs appear to exert robust effects on concurrently measured weight. Postoperative interventions hold promise for optimizing treatment outcomes.

SUMMARY

We recommend the following to improve clinical care and move research forward: a common language for DEB constructs is needed to improve cross-talk among researchers and care providers; diagnostic schemes and assessment tools may require tailoring for the bariatric population; mechanisms underlying improvements in DEBs following surgery should be clarified; ongoing monitoring of DEBs in the postoperative period is warranted; and a stepped-care approach may improve weight outcomes in a cost-effective manner.

摘要

目的综述

饮食失调行为(DEBs)与减重手术后体重不良结局相关。我们描述了与该人群最相关的 DEBs、它们与体重结局的关联,以及 DEBs 干预措施的新数据。

最近的发现

在减重样本中,失去控制的进食发作和暴食行为是研究最多的 DEBs。尽管 DEBs 即使在没有针对性干预的情况下,手术后通常也会缓解,但仍有一部分患者在手术后存在持续或新出现的 DEBs。术前 DEBs 对体重结局几乎没有影响,而术前与冲动控制相关的常见特征(如抑制控制)可能具有更强的预测价值。术后,DEBs 似乎对同时测量的体重有很强的影响。术后干预有望优化治疗结果。

总结

为了改善临床护理和推动研究进展,我们建议:需要为 DEB 结构使用通用语言,以促进研究人员和护理提供者之间的交流;诊断方案和评估工具可能需要针对减重人群进行调整;需要阐明手术后 DEBs 改善的机制;应在术后期间持续监测 DEBs;阶梯式护理方法可能以具有成本效益的方式改善体重结局。

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