The Psychology of Behavior Change: A Neglected but Necessary Aspect of Obesity Management.
The Psychology of Behavior Change: A Neglected but Necessary Aspect of Obesity Management.
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行为改变的心理学：肥胖管理中被忽视但必要的方面。
DOI：
10.1016/j.gastha.2023.02.007
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Balakrishnan, Maya
中科院分区：
文献类型：
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作者：
Balakrishnan, Maya
肥胖已达到流行病的程度。这已经转化为非酒精性脂肪性肝病（NAFLD）的惊人高患病率，现在是医生遇到的最常见的肝病。预计到2030年，NAFLD将影响美国1.009亿成年人;预计它还将导致失代偿性肝硬化、肝细胞癌和肝脏相关死亡率的增加。1虽然NAFLD的有效药物治疗并不存在，但体重减轻5%-10%可改善肝脏脂肪，脂肪性肝炎和纤维化。因此，减肥管理和咨询已成为医生治疗NAFLD的重要组成部分。这篇评论的目的是介绍一种临床算法，用于接近行为改变的认知方面，这是NAFLD患者减肥咨询的一个重要但经常被忽视的方面。成功地影响患者的行为是减肥的核心。限制卡路里和每周150-200分钟的体力活动是长期减肥的既定决定因素。不幸的是，大多数NAFLD患者并没有减轻体重。一般而言，在1年内，从事肝病护理的患者中不到1/5的患者经历具有临床意义的体重减轻（CSWL，相对于基线体重减轻5%）。2近年来，减肥干预措施作为解决体重减轻率低的潜在解决方案越来越受到关注和热情。而且，他们工作。减肥手术会导致体重从基线下降15%到45%，这取决于方法。3然而，许多NAFLD患者不符合减肥手术标准。此外，在干预后7-10年，减肥人群可能会恢复最初体重减轻的38%。一个压倒性的原因是行为复发。4减肥是一个复杂的过程。神经激素、环境和心理因素影响肥胖。在所有三个领域进行干预至关重要。然而，在肥胖管理的讨论中，经常被忽视的是对行为变化的心理驱动因素的考虑。许多患者认识到需要少吃多运动来减肥。然而，他们描述了启动和维持这些行为变化的几个认知障碍。其中最主要的是渴望，低动力，不切实际的减肥期望和低自我效能。与此同时，大多数医生都很清楚热量限制对促进和维持减肥的重要性;他们知道国家指南建议的体力活动的最佳目标。然而，很少有人接受过足够的培训，以识别，修改或沟通影响生活方式改变的认知因素。有一个迫切需要在该领域的临床为基础的战略，可以支持患者通过行为改变的心理过程。理想情况下，这些策略将与药理学和减肥干预措施一起部署，以支持长期减肥。对行为心理学的理论理解对于制定这样的策略很重要。双重过程理论为理解提供了一种范式。它还提供了对认知因素的深入了解，这些因素可以干预，以支持患者改变减肥行为。
Obesity has reached epidemic proportions. This has translated to a staggeringly high prevalence of nonalcoholic fatty liver disease (NAFLD), which now represents the most common liver disease encountered by physicians. NAFLD is projected to affect 100.9 million adults in the United States by 2030; it is also anticipated to lead to increasing rates of decompensated cirrhosis, hepatocellular carcinoma, and liver-related mortality. 1 While effective pharmacotherapies for NAFLD do not exist, weight loss of 5%–10% improves hepatic fat, steatohepatitis, and fibrosis. Weight loss management and counseling has thus become a crucial component of physicians’ role in treating NAFLD. The purpose of this commentary is to introduce a clinical algorithm for approaching the cognitive aspects of behavior change, which is an important, but often overlooked, aspect of weight loss counseling among patients with NAFLD. Successfully influencing patients’ behaviors is central to weight loss. Calorie restriction and physical activity for 150–200 minutes weekly are wellestablished determinants of long-term weight loss. Unfortunately, most patients with NAFLD do not lose weight. In general, fewer than one out of 5 patients engaged in hepatology care experience clinically significant weight loss (CSWL, as 5% weight loss from baseline) over 1 year. 2 In recent years, bariatric interventions have received increasing attention and enthusiasm as potential solutions for these poor weight loss rates. And, they work. Bariatric surgery induces anywhere from 15% to 45% weight loss from baseline, depending on the method. 3 However, many patients with NAFLD do not meet bariatric surgery criteria. Furthermore, 7–10 years following intervention, bariatric populations may regain up to 38% of initial weight lost. An overwhelming reason for this is behavioral relapse. 4 Weight loss is a complex process. Neurohormonal, environmental, and psychological factors influence obesity. Intervening on all 3 domains is vital. Often neglected in the discourse on obesity management, however, is a consideration of the psychological drivers of behavioral changes. Many patients recognize the need to eat less and to exercise more in order to lose weight. However, they describe several cognitive barriers to initiating and maintaining these behavioral changes. Chief among them are cravings, low motivation, unrealistic weight loss expectations, and low self-efficacy. Meanwhile, most physicians are well aware of the importance of calorie restriction to promote and maintain weight loss; they know the optimal target of physical activity as suggested by national guidelines. Very few, however, have received adequate training to recognize, modify, or communicate about the cognitive factors that influence lifestyle changes. There is a pressing need in the field for clinic-based strategies that can support patients through the psychological process of behavioral change. These strategies would ideally be deployed alongside pharmacologic and bariatric interventions to support longterm weight loss. A theoretical understanding of behavioral psychology is important for developing such strategies. The dual process theory offers one paradigm for understanding. It also offers insight into cognitive factors that can be intervened upon to support patients in making behavioral changes for weight loss.