肥胖與精神疾病的關係~之二

An Overview of Treatments for Obesity in a Population With Mental Illness

Obesity is associated with early mortality and has overtaken smoking as the health problem with the greatest impact on quality of life, mortality, and morbidity. Despite public health initiatives and numerous commercial enterprises focusing on weight loss, obesity rates continue to rise. In part, this is because obesity is a multifaceted, complex illness, impacted by numerous social, psychological, and behavioural factors that are unrecognized in most current initiatives. One significant factor associated with obesity is mental illness. While having a psychiatric illness does not make weight gain inevitable, it does often require that additional tools be added to lifestyle recommendations around diet and exercise. The following article reviews the common approaches to obesity management and addresses how these strategies can be implemented in psychiatric care. It is important that health professionals involved in the care of people with a mental illness become familiar with the interventions available to control and treat the obesity epidemic, as this will improve treatment compliance and ultimately lead to improved physical and psychological outcomes.

Can J Psychiatry. 2012;57(1):13–20

孫銘聰醫師comment: 肥胖在精神疾病患者上是個相當需要關注的問題，在治療上也需要更多介入，目前有以下幾種療法是有幫助的：

1. 認知行為療法（Cognitive behavioral therapy, CBT），特別是抑鬱症和暴飲暴食的飲食失調;
2. 基於正念的壓力減少(Mindfulness-based stress reduction)
3. 辯證行為治療(Dialectical behavioral therapy)，其中重點介紹影響識別和調控能力
4. 人際心理治療(Interpersonal psychotherapy)
5. 動機訪談(Motivational interviewing)。

其中認知行為療法與動機訪談是目前最有效的治療，而目前減肥門診也提供相關治療方式，增強減肥朋友的動機與行為治療。

此外，藥物與手術在肥胖的控制上也有幫助，藥物治療可以漸少6%的體重，手術則可以減少20-30%的體重。

總而言之，肥胖在精神疾病的朋友，需要除了飲食、運動、生活習慣的改變外，更多了許多的精神性療法，以期加強動機與鞏固治療效果。