Surgical and Nonsurgical Interventions for Obesity in Service of Preserving Cognitive Function.
Surgical and Nonsurgical Interventions for Obesity in Service of Preserving Cognitive Function.
复制标题
DOI：
10.1097/psy.0000000000000203
复制
发表时间：
2015-07
影响因子：
3.3
通讯作者：
Gunstad J
中科院分区：
文献类型：
--
作者：
Haley AP;Alosco ML;Gunstad J
本文的目的是强调目前已知的肥胖相关的认知障碍和减肥相关的认知改善的机制，并讨论现有治疗方法的优点和缺点。该手稿基于现场辩论，介绍了运动干预和减肥手术与认知功能相关的主要优点和缺点。这场现场辩论是在2013年10月由美国心身学会组织的为期一天的糖尿病、肥胖和大脑会议上进行的。虽然已经确定减肥手术往往会导致更大的体重减轻，更好的血糖控制和认知改善（效应大小范围在0.61至0.78之间）在干预后的前一至两年比非手术治疗，医疗并发症是可能的，超过五年的随访数据有限。相比之下，非手术疗法已在各种临床环境中进行了广泛的研究，并已证明它们可以在长达10年的时间内维持积极的健康结果，但其认知益处往往较为温和（效应大小范围为0.18至0.69），并且长期方案依从性，特别是在肥胖个体中尚不确定。与其争论手术或非手术治疗肥胖是否更好，还需要更多的研究来确定最有效和最实用的方法组合，以确保尽可能多的患者获得持续的积极健康结果。
The purpose of this article is to highlight what is currently known about the mechanisms of obesity-related cognitive impairment and weight-loss-related cognitive improvement, and discuss the benefits and drawbacks of available treatments. The manuscript is based on a live debate, presenting the main advantages and disadvantages of exercise interventions and bariatric surgery as related to cognitive functioning. The live debate took place during a one-day conference on Diabetes, Obesity and the Brain, organized by the American Psychosomatic Society in October of 2013. While it is well established that bariatric surgery tends to lead to greater weight loss, better glycemic control, and cognitive improvement (effect sizes ranging between 0.61 to 0.78) during the first one to two years post intervention than non-surgical treatments, medical complications are possible, and follow-up data beyond five years is limited. In contrast, non-surgical therapies have been extensively studied in a variety of clinical settings and have proved that they can sustain positive health outcomes up to 10 years later, but their cognitive benefits tend to be more modest (effect sizes ranging from 0.18 to 0.69) and long-term regiment compliance, especially in obese individuals is uncertain. Rather than focusing on debating whether surgical or no-surgical interventions for obesity are better, additional research is needed to identify the most efficient and practical combination of approaches to ensure sustained positive health outcomes for the largest number of patients possible.