单纯性肥胖与认知行为治疗 肥胖的原因.pptVIP

减重效果惊人 （10）参考书 肥胖终身性疾病，与环境相关，在物质丰富的年代，无论肥胖的预防与治疗都相当不易 内科医生缺少工具（药物），饮食指导单一，更缺少对肥胖认知行为的认识 * Figure 1. Mean (±SE) Changes in Weight from Baseline to Week 62. The weight-loss program was started at week 0 and completed at week 10. ITT denotes intention to treat * * Figure 3. Mean (±SE) Fasting and Postprandial Ratings of Hunger and Desire to Eat at Baseline, 10 Weeks, and 62 Weeks. Ratings were based on a visual-analogue scale ranging from 0 to 100 mm. Higher numbers indicate greater hunger or desire. * These findings support the possibility that compensatory physiological changes eventually overpower the patient’s behavioral ability to adhere to a reduced number of calories required to maintain the reduced body weight state. It also supportsIt also supports the hypothesis that weight regain has a strong physiological basis and is not simply the result of the voluntary resumption of poor eating habits. This is an important concept for endocrinologists to understand whentreating obese patients because it validateswhymedications that change one’s physiology or hormone levels may be indicated and helpful in long-term weight loss treatment. 生长激素促分泌素受体(GHSR)的内源性 配体 * 肥胖的原因 减重需长期坚持、综合治疗 能量负平衡：减少能量摄入 通过提高基础代谢 及运动量，增加能  量消耗节食治疗是最基础也是最重要的治疗手段 肥胖治疗核心 DDPOS研究 Lancet. 2009 Nov 14;374(9702):1677-86. March , 2007 Comparison of the Atkins, Zone, Ornish,and LEARN Diets for Change in Weightand Related Risk Factors Among OverweightPremenopausal Women Gardner et al,JAMA,2007.296-298 N Engl J Med.?2011 Oct 27;365(17):1597-604 体重变化 N Engl J Med.?2011 Oct 27;365(17):1597-604 Leptin代偿性降低 N Engl J Med.?2011 Oct 27;365(17):1597-604 胃肠道激素变化 N Engl J Med.?2011 Oct 27;365(17):1597-604 饥饿感及食欲变化 N Engl J Med.?2011 Oct 27;365(17):1597-604 不同减重方式对肥胖相关激素影响 激素 产生部位 食欲或脂肪？存 节食减重后变化 减肥手术后变化 NPY 下丘脑和脑 干 ↑ ↑ ↓ Ieptin 脂肪 ↓ ↓ ↑ ghrelin 胃底部 ↑ ↑ ↓ GLP-1 未段回肠 ↓ ↓ ↑ PYY 远端小肠 ↓ ↓ ↑ CCK ↓ ↓ ? GIP 十二指肠、空肠上段 ↑ ↑ ↓ Amylin β细胞 ↓ ↓ 认知行为疗法 认知