Obesity is not a disorder in DSM but is one of the more dangerous epidemics confronting the world today. There are too forms of Maladaptive Eating Patterns in people who are obese. The first is binge eating, and the second is night eating syndrome. More Interesting is the pattern of night eating Syndrome that occurs in between 6% and 16% of obese individuals seeking weight-loss treatment but in as many as 55% of those with extreme obesity seeking bariatric surgery. Individuals with night Eating Syndrome consumes a third or more of their daily intake after their evening meal and get out of bed at least once during the night to have a high calorie snack. In the morning, however, they are not hungry and do not usually eat breakfast. These individuals do not binge during their night eating and seldom purge.
Night eating Syndrome is an important target for treatment in any obesity program to reregulate patterns of eating so that individuals eat more during the day, when their energy expenditure is highest.
As we advance technologically, we are getting fatter. That is the promotion of an inactive, sedentary lifestyle and the consumption of a high-fat, energy dense diet is the largest single contributor to the obesity epidemic.
Not everyone exposed to the modernized environment and this is where genetics, Physiology and personality come in. On average, genetic contributions may constitute a smaller portion of the cause of obesity than cultural factors.
Psychological processes, particularly hormonal regulation of appetite, play a large role in the initiation and maintenance of eating and vary considerably from individual to individual. Individuals with addictive obese eating behavior including less control over eating and feelings of withdrawal if access to food is limited, show similar patterns of reward neurocircuitry in the brain as do those with substance abuse, Psychological processes of emotional regulation, impulse control, attitudes and motivation toward eating, and responsiveness to the consequences of eating are also important in some lower income groups, eating and drinking in readily available fast food outlets actually does seem to reduce stress, but with damaging physical consequences. Many of these attitudes are as well as eating habits are strongly influenced by family and close friends. Thus, it seems that obesity spreads through Social networks.
The treatment of obesity is only moderately successful at the individual level. Treatment is usually organized in a series of steps from least intrusive to most intrusive depending on the extent of obesity.
- Self-directed weight loss programs.
- Commercial self-help programs, such as weight watchers.
- Professionally directed behavior modification programs, which are the most effective treatment.
- Surgery, as a last resort.
David H. Barlow, BOSTON UNIVERSITY
V. Mark Durand, UNIVERSITY OF SOUTH FLORIDA- ST. PETERSBERG
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