Fawzy F I, Pasnau R O, Wellisch D K, Ellsworth R G, Dornfeld L, Maxwell M
Consultation-Liaison Psychiatry Service, UCLA Neuropsychiatric Institute 90024.
Psychiatr Med. 1983 Sep;1(3):257-73.
Many different treatments for obesity have proven somewhat successful, with none emerging as clearly superior to the others. Surgical approaches, although usually successful at achieving and maintaining weight loss, are accompanied by varied and often harmful side effects. Unless new, safer procedures are developed, treatment may continue to be as hazardous as the obesity itself. Because medical treatment alone has not achieved beneficial, lasting results, research aimed at finding new procedures should be encouraged. Our five-year experience in working with obese patients has led us to the following conclusions: 1. The management of obesity must be a joint venture between psychiatry and medicine. Because of the complex nature of this illness, neither discipline alone can successfully and safely achieve significant initial weight loss coupled with successful long-term maintenance. The use of adjunctive psychological programs in a medical setting can be a successful alternative. 2. Fasting, weight loss, and realimentation must be accompanied by an effort at lifestyle change. Otherwise, patients will continue their self-destructive habits, which will ultimately lead to failure in yet another attempt at sustained weight reduction. The behavioral approach has provided a fairly effective treatment of obesity, sometimes with immediate results. Recent studies support the maintenance effect of behavioral treatments. However, longer studies with follow-ups are needed to better assess the overall effectiveness of these treatments. 3. Despite much false optimism that weight loss is a simple road to happiness, most patients experience some very real problems during the fasting part of the program. Crisis intervention can prove very helpful in terms of reducing stress and preventing dropouts. Group therapy, individual therapy, family therapy, and hypnosis have attained some very limited positive results when used alone; greater success has been reported from combining therapies. Patients generally became more socially effective, physically active, and mentally proficient when exposed to individual therapy together with group and family therapies. 4. Family environment appears to significantly affect compliance and completion. A conflict-laden family environment hampers the patient's ability to deal with the psychological changes encountered in weight loss programs. 5. Many obese patients lack a fundamental knowledge of nutrition, exercise, and health. In addition, most are poorly socialized and require assistance in learning assertiveness and other interpersonal skills. A behaviorally oriented component is very effective in providing these skills.(ABSTRACT TRUNCATED AT 400 WORDS)
许多不同的肥胖治疗方法已被证明有一定成效，但没有一种方法明显优于其他方法。手术治疗虽然通常能成功实现并维持体重减轻，但会伴有各种且往往有害的副作用。除非开发出更安全的新手术方法，否则治疗可能会继续像肥胖本身一样危险。由于单纯的医学治疗尚未取得有益的、持久的效果，因此应鼓励开展旨在寻找新手术方法的研究。我们在治疗肥胖患者方面的五年经验得出了以下结论：1. 肥胖管理必须是精神病学和医学的联合任务。由于这种疾病的复杂性，任何一个学科单独都无法成功且安全地实现显著的初始体重减轻以及成功的长期维持。在医疗环境中使用辅助心理项目可能是一种成功的选择。2. 禁食、体重减轻和恢复进食必须伴随着生活方式的改变。否则，患者将继续他们的自我毁灭习惯，这最终将导致又一次持续减重尝试的失败。行为疗法为肥胖治疗提供了一种相当有效的方法，有时能立即见到效果。最近的研究支持行为疗法的维持效果。然而，需要进行更长时间的随访研究，以更好地评估这些疗法的总体效果。3. 尽管很多人盲目乐观地认为减肥是通往幸福的简单途径，但大多数患者在该项目的禁食阶段会遇到一些非常现实的问题。危机干预在减轻压力和防止患者退出方面可能非常有帮助。单独使用团体治疗、个体治疗、家庭治疗和催眠取得的积极效果非常有限；联合使用多种疗法的成功率更高。当患者同时接受个体治疗以及团体和家庭治疗时，他们通常在社交、身体活动和心理能力方面会变得更有成效。4. 家庭环境似乎对依从性和完成治疗有显著影响。充满冲突的家庭环境会阻碍患者应对减肥项目中遇到的心理变化的能力。5. 许多肥胖患者缺乏关于营养、运动和健康的基本知识。此外，大多数人社交能力差，在学习自信和其他人际交往技巧方面需要帮助。以行为为导向的部分在提供这些技能方面非常有效。（摘要截选至400词）
