浅谈认知行为治疗在肥胖治疗中的研究与应用

肥胖的治疗方法多种多样,各自具有不同的针对性和疗效特点,如何选择是一个最佳的治疗方案这是一个富有争议的话题。近年来,在肥胖心理学研究成果的基础上,发展了一系列的认知行为治疗方法,也开始应用于肥胖的治疗之中。不少追踪研究表明,该方法对于肥胖的长期疗效较佳,表现出广泛的应用前景。     

吉林省城市中小学生超重与肥胖的现状研究

为了更好地了解吉林省城市中小学生的超重和肥胖现状及其影响因素,选取吉林省20所学校的17 893名中小学生(8岁～15岁)进行体格测量与问卷调查.调查结果显示,中小学生超重和肥胖总体检出率为30.5％,并且有39.9％的中小学生对体重的自我认知情况与实际检测结果不相符,存在体重认知的偏移.可见,控制儿童青少年超重与肥胖的工作已刻不容缓,应引起全社会高度重视,从低年级儿童入手,做到早期预防.     

肥胖矛盾现象及其对治疗的启示

肥胖是目前全球性最大的慢性病,它既是多种心血管与代谢病的主要危险因素,也是重要的致病因子.肥胖与高血压、高血脂、糖尿病等密切相关,相互重叠增加心血管疾病的患病率.近年来研究发现体重指数与心血管预后及靶器官损害呈负相关,有学者将肥胖与心血管死亡率的矛盾现象称为肥胖矛盾.这种现象的出现引起了人们的关注,探讨其发生的可能机制时未来心血管疾病的治疗提供了一个新的启示.     

肥胖男性血浆脂联素水平及影响因素

检测正常男性血浆脂联素水平,探讨其与各检测指标之间的相关性。选取正常男性96例,按体重指数（BMI）将上述两组分为2个亚组：肥胖（BMI≥25kg／m^2）组40例及体重正常（BMI〈25kg／m^2）组56例,测定空腹血浆脂联素浓度。肥胖组的血浆脂联素水平[（7．48±3．4）μg／m1]明显低于体重正常组[（10．57±4．73）μg／m1],差异有显著的统计学意义（P〈0．01）。相关分析显示血浆脂联素与体重指数（BMI）、腰围（WC）、血压（BP）、总胆固醇（TC）、血清胰岛素（FINs）、胰岛素抵抗指数（HOMA-IR）之间存在负相关,与高密度脂蛋白胆固醇（HDL-C）正相关。BMI、WC、HOMA-IR为影响血浆脂联素水平的独立因素。男性肥胖者血浆脂联素水平较体重正常者明显降低,血浆脂联素水平可能与肥胖及其相关疾病相关。     

肥胖男性血浆脂联素水平及影响因素

检测正常男性血浆脂联素水平,探讨其与各检测指标之问的相关性.选取正常男性96例,按体重指数(BMI)将上述两组分为2个亚组:肥胖(BMI≥25 kg/m2)组40例及体重正常(BMI<25 kg/m2)组56例,测定空腹血浆脂联素浓度.肥胖组的血浆脂联素水平[(7.48±3.4)μg/ml]明显低于体重正常组[(10.57±4.73)μg/ml],差异有显著的统计学意义(P＜0.01).相关分析显示血浆脂联素与体重指数(BMI)、腰围(WC)、血压(BP)、总胆固醇(TC)、血清胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)之间存在负相关,与高密度脂蛋白胆固醇(HDL-C)正相关.BMI、WC、HOMA-IR为影响血浆脂联素水平的独立因素.男性肥胖者血浆脂联素水平较体重正常者明显降低,血浆脂联素水平可能与肥胖及其相关疾病相关.     

血压正常的超重和肥胖人群的肾功变化

为了探讨健康体检中血压正常的超重和肥胖人群的肾功有无变化。对3756例体检者测量身高、体重、血压,检测各项生化指标,计算肾小球滤过率（GFR）、体质指数（BMI）。结果显示：男性的eGFR较女性低。年龄与eGFR相关性强。消除了性别和年龄的影响后,分析表明随着体质指数的升高,eGFR逐渐降低,而肌酐却无差异。我们发现血压正常的超重和肥胖人群体检虽肌酐正常,但eGFR却明显下降,表明存在肾功损害,故我们需早期识别,定期复诊,防止肥胖相关性肾病发生。     

肥胖致心肌脂毒性的机制的研究进展

肥胖是体内脂质过度沉积的一种状态,其不仅可引起糖脂代谢紊乱、胰岛素抵抗,从而继发糖尿病、高血压、冠心病等疾病,而且当脂质水平超过脂肪细胞的储存容量及出现胰岛素抵抗时,血液中游离脂肪酸含量会随之升高,进而可引起脂质在心脏的异位沉积.沉积于心肌细胞的脂质可进一步通过神经酰胺、内质网应激等机制影响心肌细胞的结构和功能,最终导致心力衰竭的发生.但肥胖所致心肌脂毒性具体机制不明,本文就肥胖所致心肌脂毒性可能机制做一综述.     

关于低出生体重儿诊疗最优化原则的思考

出生体重及低出生体重发生率是衡量社会发展和妇幼保健状况的重要指标.低出生体重不仅直接增加新生儿和婴儿的患病率和死亡率,而且与儿童的远期预后如生长发育落后、智力低下、脑瘫及成年期胰岛素抵抗密切相关.通过运用诊疗最优化的原则,对低出生体重儿进行预防,及早干预治疗,可提高其生命质量.     

关于低出生体重儿诊疗最优化原则的思考

出生体重及低出生体重发生率是衡量社会发展和妇幼保健状况的重要指标。低出生体重不仅直接增加新生儿和婴儿的患病率和死亡率,而且与儿童的远期预后如生长发育落后、智力低下、脑瘫及成年期胰岛素抵抗密切相关。通过运用诊疗最优化的原则,对低出生体重儿进行预防,及早干预治疗,可提高其生命质量。     

An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1–9, and sessions 10–16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.     

Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study

Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre-surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.     

大肠癌的早期诊断与治疗研究进展

大肠癌的早期诊断与治疗是临床研究的热点。本文主要从大肠癌人群筛查、粪便检查、基因诊断以及内镜诊断,从早期大肠癌内镜下黏膜切除术和内镜下黏膜剥离术的研究进展进行述评。     

The Effects of Object Weight on the Kinematics of Prehension

The purpose of these experiments was to determine the effects of object weight and condition of weight presentation on the kinematics of human prehension. Subjects performed reaching and grasping movements to metal dowels whose visible characteristics were similar but whose weight varied (20, 55, 150, 410 g). Movements were performed under two conditions of weight presentation, random (weight unknown) and blocked (weight known). Three-dimensional movements of the thumb, index finger, and wrist were recorded, using a WATSMART system to obtain information regarding the grasp and transport components. The results of the first experiment indicated that object weight and condition of presentation affected the temporal and kinematic measures for both the grasp and transport components. In conjunction with the results of a second experiment, in which time in contact with the dowel was measured, it was shown that the free-motion phase of prehension (i.e., up to object contact) was invariant over the different conditions, however. The changes were observed in the finger-object interaction phase (when subjects applied forces after contact with the dowel), prior to lift-off. These results were interpreted as indicating (a) object weight does not influence the planning and execution of the free-motion phase of prehension and (b) there are at least two motor control phases involved in prehension, one for making contact with the object and the other for finger-object interaction. The changing contributions of visual, kinesthetic, and haptic information during these two phases is discussed.     

Obesity Bias in Children: The Role of Actual and Perceived Body Size

The aim of this study was to examine how children perceive their body size and whether their actual or perceived body size can explain their anti‐fat views. Four hundred and fourteen 5–6, 7–8 and 9–10‐year‐old children were read short vignettes depicting two characters, one possessing a positive and the other a negative quality. Following each vignette, participants were asked to pick the story characters among thin, average and obese figures. Obesity bias was defined as the attribution of the positive quality to the thin or average figure and the corresponding negative one to the obese. Body mass index determined children's actual body size. Perceived body size was determined with the use of Collins' (1991) figures of increasing size. The results showed that actual body size affected the accuracy of perceived body size. While the majority of average children were accurate at identifying their body size, most overweight and obese children tended to underestimate it. The accuracy of body size perception improved with age. Obesity bias did not relate to children's actual but to their perceived body size: Those who perceived themselves as heavier exhibited less bias. The implications of the findings are discussed in relation to children's developing identity, and suggestions are made for future research. Copyright © 2014 John Wiley & Sons, Ltd.     

Peer-Enhanced Weight Management Treatment for Overweight Adolescents: Some Preliminary Findings

The purpose of this study was to evaluate the utility of adding a peer-based intervention (peer-based skills training [PBST]) to a traditional cognitive–behavioral weight management intervention for overweight adolescents. Sixteen adolescents between the ages of 13 and 16 years and between 30 and 80$percnt; overweight participated in a 16-week group-based weight management program with the addition of peer-based skills training. Adolescents and parents separately attended 60-min group sessions addressing diet, physical activity, and behavior modification techniques. In addition, adolescents attended a 90-min PBST session each week. Group activities included both mental and physical challenges that fostered development of trust, social skills, and self-confidence. Measures of height and weight, as well as questionnaires assessing self-concept, physical self-worth, and social functioning, were obtained prior to treatment, immediately following the 16-week intervention, and 6 months after completion of active treatment. Paired t tests revealed significant improvements over time in measures of physical self-worth, physical appearance and romantic appeal. Adolescents lost an average of 14.73 pounds from the start to end of treatment, and this was maintained at 6-month follow-up. These preliminary findings provide some support for the application of a novel peer-based program as an adjunctive treatment for adolescent weight management intervention.     

耐多药肺结核患者首次就诊过程调查

了解现阶段耐多药肺结核患者的首次就诊过程,分析医患双方对耐多药肺结核患者就诊过程的影响。在全国选取5个项目市,使用自制调查问卷采取面对面方式对样本人群进行访谈式调查。耐多药肺结核患者以文化水平较低、年龄偏大的农民为主。32.6%的患者初次就诊时有全身乏力或消瘦症状,37.6%的患者初次就诊单位为村卫生室或乡镇卫生院,28.4%的患者初次就诊时被误诊,31.6%的患者发生就诊延迟,79.8%的患者在结核病专科医院或防治机构确诊,33.3%的患者确诊延迟。加大对群众结核病相关知识宣传力度,加强结核病防治机构技术力量尤其是实验室诊断技术,加强对参与结核病防治工作医生尤其是村医的专业培训,针对医疗机构转诊建立适当的激励机制。     

Massage Therapy Facilitates Weight Gain in Preterm Infants

Studies from several labs have documented a 31 to 47% greater weight gain in preterm newborns receiving massage therapy (three 15-min sessions for 5–10 days) compared with standard medical treatment. Although the underlying mechanism for this relationship between massage therapy and weight gain has not yet been established, possibilities that have been explored in studies with both humans and rats include (a) increased protein synthesis, (b) increased vagal activity that releases food-absorption hormones like insulin and enhances gastric motility, and (c) decreased cortisol levels leading to increased oxytocin. In addition, functional magnetic resonance imaging studies are being conducted to assess the effects of touch therapy on brain development. Further behavioral, physiological, and genetic research is needed to understand these effects of massage therapy on growth and development.     

I'll Start My Diet Tomorrow: A Solution-Focused Approach to Weight Loss

This article illustrates through a personal case example how Solution-Focused Brief Therapy concepts can help people lose weight and keep it off.     

肥胖的成因、相关疾病及减肥

肥胖严重威胁人们的健康和生活质量,受多种因素的影响,与多种疾病有密切联系。辩证地分析和研究肥胖与其相关因素的关系,有助于肥胖的预防和治疗。