Wing R R, Greeno C G
University of Pittsburgh School of Medicine, PA 15213.
Baillieres Clin Endocrinol Metab. 1994 Jul;8(3):689-703. doi: 10.1016/s0950-351x(05)80291-5.
This chapter emphasized new directions being pursued in the behavioural treatment of obesity. Behavioural weight-loss programmes are being strengthened by their increased emphasis on low fat intake and exercise, by more direct intervention on behavioural antecedents and consequences of eating, by the use of very low calorie diets (VLCDs) and by the adoption of a chronic disease model and the concomitant lengthening of treatment programmes. With these approaches, initial weight losses of 10-20 kg can be achieved, and maintenance of weight losses of 5-10 kg can be expected. Treatments may also be strengthened by the identification of subgroups of the obese. Recently, progress has been made in this area with the description of a subgroup of the obese who have severe problems with binge eating. Binge eating disorder has been proposed as a new diagnostic category for DSM-IV. From 20 to 45% of the obese who present for treatment suffer from such problems. Obese binge eaters have worse mood and more psychopathology than obese people who do not binge eat, and are more likely to drop out of behavioural weight-control treatments. Although binge eaters may regain weight faster than non-binge eaters, both short- and long-term weight loss of binge eaters and non-binge eaters appear quite similar. Treatments have been identified that show promise in ameliorating binge eating for these patients, but these treatments have not produced weight loss. Although there has recently been concern about the possible negative effects of dieting on mood state, participation in behavioural weight-loss programmes is not associated with worsening mood in obese patients. No psychological variables have distinguished obese from non-obese individuals. Nonetheless, there is substantial prejudice against the obese. Awareness of this prejudice can lead to more sensitive and appropriate treatments for the problem of obesity.
本章重点介绍了肥胖行为治疗的新方向。行为减肥计划通过更加强调低脂肪摄入和运动、对饮食行为的前因后果进行更直接的干预、使用极低热量饮食（VLCDs）以及采用慢性病模型并相应延长治疗计划而得到加强。通过这些方法，最初可实现10 - 20千克的体重减轻，并且有望维持5 - 10千克的体重减轻。对肥胖亚组的识别也可能会加强治疗效果。最近，在这一领域取得了进展，描述了一组患有严重暴饮暴食问题的肥胖亚组。暴饮暴食障碍已被提议作为《精神疾病诊断与统计手册》第四版（DSM - IV）的一个新诊断类别。前来治疗的肥胖者中有20%至45%患有此类问题。与不暴饮暴食的肥胖者相比，肥胖的暴饮暴食者情绪更差，心理病理学问题更多，并且更有可能退出行为体重控制治疗。尽管暴饮暴食者可能比非暴饮暴食者更快地恢复体重，但暴饮暴食者和非暴饮暴食者的短期和长期体重减轻情况似乎相当相似。已经确定了一些对改善这些患者的暴饮暴食有前景的治疗方法，但这些治疗方法并未带来体重减轻。尽管最近有人担心节食可能对情绪状态产生负面影响，但参与行为减肥计划与肥胖患者情绪恶化并无关联。没有任何心理变量能够区分肥胖者和非肥胖者。尽管如此，对肥胖者仍存在大量偏见。意识到这种偏见可以为肥胖问题带来更敏感和恰当的治疗。
