Kubwereranso ndi Kufunidwa Kwambiri: Ndemanga Yatsatanetsatane pa Mbiri ya Chakudya Chokhalitsa Chakudya (2015)

Yale J Biol Med. 2015 Sep; 88 (3): 295-302.

Idasindikizidwa pa intaneti 2015 Sep 3.

PMCID: PMC4553650

Zolingalira: Kuledzera

Pitani ku:

Kudalirika

M'zaka zaposachedwapa, lingaliro la chizolowezi cha zakudya latchuka kwambiri. Njira imeneyi ikuvomereza kufanana komwe kulipo pakati pa matenda ogwiritsira ntchito mankhwala osokoneza bongo ndi kudya kwambiri zakudya zokoma komanso zokhala ndi ma calorie ambiri. Gawo la zokambiranazi likuphatikizapo kuti zakudya "zokoma kwambiri" zitha kukhala ndi mphamvu yoledzera chifukwa cha mphamvu yowonjezera chifukwa cha michere ina kapena zowonjezera. Ngakhale lingaliro ili likuwoneka ngati latsopano, kafukufuku wokhudza chizolowezi cha zakudya umaphatikizapo zaka makumi angapo, mfundo yomwe nthawi zambiri siidziwika. Kugwiritsa ntchito kwasayansi kwa liwu loti chizolowezi ponena za chokoleti kunayamba ngakhale m'zaka za zana la 19. M'zaka za zana la 20, kafukufuku wokhudza chizolowezi cha zakudya adasintha njira zingapo, zomwe zimaphatikizapo kusintha kwa chidwi pa anorexia nervosa, bulimia nervosa, kunenepa kwambiri, kapena vuto la kudya mopitirira muyeso. Chifukwa chake, cholinga cha ndemangayi ndikufotokozera mbiri ndi momwe kafukufuku wokhudza chizolowezi cha zakudya amagwirira ntchito komanso kuwonetsa chitukuko chake ndikusintha matanthauzidwe ndi njira zake.

Keywords: kuledzera kwa zakudya, kunenepa kwambiri, kudya mowa kwambiri, kudyetsa anorexia, bulimia, kudalira mankhwala, chokoleti

Introduction

M'zaka zaposachedwapa, lingaliro la chizolowezi cha zakudya lakhala lotchuka kwambiri. Lingaliro limeneli limaphatikizapo lingaliro lakuti zakudya zina (nthawi zambiri zakudya zopangidwa ndi zinthu zambiri, zokoma kwambiri, komanso zopatsa mphamvu zambiri) zingakhale ndi mphamvu yoledzera ndipo mitundu ina ya kudya mopitirira muyeso ikhoza kuyimira khalidwe loledzera. Kutchuka kumeneku kukuonekera osati kokha m'malipoti ambiri a atolankhani ndi mabuku wamba [ 1 , 2 ], komanso kuwonjezeka kwakukulu kwa mabuku asayansi ( Chithunzi 1 ) [ 3 , 4 ]. Mwachitsanzo, mu 2012, buku lofotokoza bwino za chakudya ndi chizolowezi linasindikizidwa chifukwa "sayansi yafika pachimake kwambiri mpaka kufika poti buku losinthidwa liyenera kuvomerezedwa" [ 5 ]. Chidwi chowonjezekachi chikuwoneka kuti chapanga lingaliro lakuti lingaliro la chizolowezi cha chakudya linakhala lofunika kwambiri m'zaka za zana la 21 chifukwa cha kupezeka kwa zakudya zopangidwa ndi zinthu zambiri komanso kuti lingaliro la chizolowezi cha chakudya linapangidwa pofuna kufotokoza kuchuluka kwa kunenepa kwambiri [ 6 ]. Ofufuza ena amatchulanso ntchito yoyambirira mu kafukufuku wokhudzana ndi chizolowezi cha chakudya potchula nkhani zomwe zinafalitsidwa m'zaka za zana lino [ 7 , 8 ].

Chithunzi 1 

Chiwerengero cha zofalitsa za sayansi zokhudzana ndi zakudya m'zaka 1990-2014. Makhalidwe amaimira chiwerengero cha mafilimu omwe akutsatiridwa ndi Webusaiti ya Sayansi yomwe yapangidwa chaka chilichonse padera, pogwiritsa ntchito mawu akuti "kusokoneza zakudya" ndikusankha "mutu" ...

Monga momwe zasonyezedwera mu pepalali, lingaliro ili lonena kuti chizolowezi cha zakudya ndi lingaliro latsopano, lomwe linayamba m'zaka zaposachedwa ndipo lingathe kufotokoza za mliri wa kunenepa kwambiri, ndi lolakwika. Chifukwa chake, nkhaniyi ikupereka mwachidule chitukuko cha kafukufuku wokhudza chizolowezi cha zakudya. Cholinga chimodzi ndikuwonetsa kuti mbiri yake, ngakhale ndi gawo latsopano la kafukufuku, kwenikweni limaphatikizapo zaka makumi angapo ndipo mgwirizano pakati pa chakudya ndi chizolowezi unayamba ngakhale m'zaka za zana la 19. M'zaka za zana la 20, madera ofunikira komanso malingaliro okhudza chizolowezi cha zakudya adasintha kwambiri, monga mitundu ya zakudya ndi matenda azakudya omwe adanenedwa kuti akugwirizana ndi chizolowezi ndi njira zomwe zidagwiritsidwa ntchito pofufuza khalidwe la kudya kuchokera ku lingaliro la chizolowezi ( Chithunzi 2 ). Komabe, nkhaniyi sikufuna kufotokoza kufanana kosiyanasiyana kwa zochitika ndi zamaubongo pakati pa kudya mopitirira muyeso ndi kugwiritsa ntchito mankhwala osokoneza bongo kapena kuganiza za zotsatira zomwe zingatheke ndi zotsatira za lingaliro la chizolowezi cha zakudya pochiza, kupewa, ndi mfundo za anthu. Nkhani zonsezi zakambidwa kwambiri kwina [ 9-21 ]. Pomaliza, nkhaniyi sikufuna kuwunika kutsimikizika kwa lingaliro la chizolowezi cha zakudya.

Chithunzi 2 

Zina zimayang'ana malo ndi zolemba zomwe zasankhidwa m'mbiri ya kafukufuku wodetsa zakudya.

Chakumapeto kwa 19th ndi Kumayambiriro kwa 20th Century: Zoyamba Zoyambirira

Magazini ya Journal of Inebriety inali imodzi mwa magazini oyamba okhudza chizolowezi ndipo inafalitsidwa kuyambira 1876 mpaka 1914 [ 22 ]. Panthawiyi, mawu osiyanasiyana ankagwiritsidwa ntchito pofotokoza kumwa mowa mopitirira muyeso ndi kugwiritsa ntchito mankhwala osokoneza bongo (monga kuledzera chizolowezi, kusamwa mowa, kusasangalala, dipsomania, narcomania, oinomania, uchidakwa, ndi chizolowezi ). Chochititsa chidwi n'chakuti, mawu akuti chizolowezi monga momwe anagwiritsidwira ntchito mu Journal of Inebriety ankatanthauza kudalira mankhwala ena osati mowa ndipo anaonekera koyamba mu 1890 ponena za chokoleti [ 22 ]. Pambuyo pake, mphamvu zoledzeretsa za zakudya "zolimbikitsa" zinatchulidwanso m'magazini ena a magazini [ 17 ]. Mwachitsanzo, Clouston [ 23 ] anati pamene "ubongo umadalira zakudya zolimbikitsa ndi zakumwa kuti ubwererenso ukatopa, pamakhala chilakolako champhamvu komanso chosagonjetseka chokhazikitsa zinthu zolimbikitsa chakudya ndi zakumwa nthawi iliyonse pamene pali kutopa."

Mu 1932, Mosche Wulff, m'modzi mwa akatswiri ofufuza za maganizo, adafalitsa nkhani m'Chijeremani, yomwe mutu wake ungatanthauzidwe kuti "Pa Chovuta Chosangalatsa cha Zizindikiro Zam'kamwa ndi Ubale Wake ndi Chizolowezi" [ 24 ]. Pambuyo pake, Thorner [ 25 ] adatchula za bukuli, nati "Wulff amagwirizanitsa kudya mopitirira muyeso, komwe amatcha chizolowezi cha chakudya, ndi chinthu cholankhulidwa mwalamulo ndipo amachisiyanitsa ndi chizolowezi cha kukhumudwa chifukwa munthu wokonda kudya amangoyamba kugonana m'malo mwa ubale wa maliseche pomwe chizolowezi cha kukhumudwa chimaphatikizapo mwanjira yankhanza komanso yowononga." Ngakhale lingaliro la psychoanalytic ili pa kudya mopitirira muyeso ndi lakale ndipo likuwoneka losokoneza masiku ano, komabe ndizodabwitsa kuona kuti lingaliro lofotokoza kudya mopitirira muyeso ngati chizolowezi linalipo kale m'ma 1930.

1950s: Kugwiritsa Ntchito Nthawi Yake 'Chakumwa Chakudya'

Mawu akuti kuledzera kwa chakudya adayambitsidwa koyamba m'mabuku asayansi ndi Theron Randolph mu 1956 [ 26 ]. Anafotokoza kuti ndi "kusintha kwapadera kwa chakudya chimodzi kapena zingapo zomwe munthu amadya nthawi zonse zomwe zimakhala zovuta kwambiri [zomwe] zimapangitsa kuti zizindikiro zofanana ndi za njira zina zoledzera." Komabe, adanenanso kuti "nthawi zambiri chimanga, tirigu, khofi, mkaka, mazira, mbatata ndi zakudya zina zomwe zimadyedwa nthawi zambiri." Lingaliro ili lasintha, popeza masiku ano zakudya zomwe zimakonzedwa kwambiri zomwe zili ndi shuga wambiri ndi/kapena mafuta ambiri zikukambidwa kuti zitha kukhala zoledzeretsa [ 27 ].

Randolph sanali yekhayo amene ankagwiritsa ntchito mawu akuti kuledzera kwa chakudya panthawiyi. Mu nkhani yomwe inafalitsidwa mu 1959, nkhani yokambirana yomwe inakhudza udindo wa chilengedwe ndi umunthu pakuwongolera matenda a shuga inanenedwa [ 28 ]. Pamsonkhanowu, Albert J. Stunkard (1922-2014) [ 29 ], dokotala wa matenda amisala yemwe nkhani yake yoyamba kufotokoza za matenda odya mopitirira muyeso (BED) inasindikizidwa chaka chomwecho [ 30 ], anafunsidwa mafunso. Mwachitsanzo, anafunsidwa kuti, "Limodzi mwa mavuto ovuta komanso ovuta omwe timakumana nawo ndi la kuledzera kwa chakudya, ponse pawiri pa chiyambi cha matenda a shuga ndi chithandizo chake. Kodi pali zinthu zina zomwe zimakhudza thupi zomwe zimachitika mu njira imeneyi kapena zonse ndi zamaganizo? Kodi zimalumikizana bwanji ndi kuledzera kwa mowa ndi kuledzera kwa mankhwala osokoneza bongo?" [ 28 ]. Stunkard anayankha kuti sakuganiza kuti mawu akuti kuledzera kwa chakudya "ndi olondola malinga ndi zomwe tikudziwa zokhudza kuledzera kwa mowa ndi mankhwala osokoneza bongo." Komabe, chofunika kwambiri pa kafukufuku wa mbiri yakale m'nkhaniyi ndikuti adanenanso kuti mawu akuti kuledzera kwa chakudya amagwiritsidwa ntchito kwambiri, zomwe zimatsimikiziranso kuti lingaliro la kuledzera kwa chakudya linali lodziwika bwino pakati pa asayansi ndi anthu onse kuyambira m'ma 1950.

1960s ndi 1970s: Odya Ambiri Osadziwika ndi Omwe Amanena Nthawi Zonse

Bungwe la Overeaters Anonymous (OA), lomwe limadzithandiza lokha pogwiritsa ntchito pulogalamu ya masitepe 12 ya Alcoholics Anonymous, linakhazikitsidwa mu 1960. Chifukwa chake, bungwe la OA limalimbikitsa njira yogwiritsira ntchito mankhwala osokoneza bongo, ndipo cholinga chachikulu cha gululi ndikupewa kugwiritsa ntchito mankhwala osokoneza bongo omwe apezeka (monga zakudya zina). Kafukufuku wochepa wachitika pa OA m'zaka zoposa 50 za kukhalapo kwake, ndipo ngakhale ophunzirawo akuvomereza kuti OA inali yothandiza kwa iwo, palibe mgwirizano wokhudza momwe OA "imagwirira ntchito" [ 31 , 32 ]. Komabe, OA singakhalebe bungwe lokhalo lodzithandiza lokhala ndi malingaliro okhudzana ndi chizolowezi chodya mopitirira muyeso, chifukwa magulu ofanana odzithandiza adakhazikitsidwa m'zaka zotsatira [ 17 ].

Komabe, kafukufuku wa sayansi pa lingaliro la kuledzera kwa chakudya sanalipo m'zaka za m'ma 1960 ndi 1970, koma ofufuza ena nthawi zina ankagwiritsa ntchito mawuwa m'nkhani zawo. Mwachitsanzo, kuledzera kwa chakudya kunatchulidwa pamodzi ndi mavuto ena ogwiritsira ntchito mankhwala osokoneza bongo m'mapepala awiri a Bell m'zaka za m'ma 1960 [ 33 , 34 ] ndipo kunatchulidwa pankhani ya ziwengo za chakudya ndi otitis media mu 1966 [ 35 ]. Mu 1970, Swanson ndi Dinello anatchula za kuledzera kwa chakudya pankhani ya kuchuluka kwa kulemera komwe kumabwereranso pambuyo pochepetsa thupi mwa anthu onenepa [ 36 ]. Pomaliza, ngakhale kuti panalibe khama lofufuza mwadongosolo lingaliro la kuledzera kwa chakudya m'zaka za m'ma 1960 ndi 1970, linkagwiritsidwa ntchito kale ndi magulu odzithandiza okha ndi cholinga chochepetsa kudya kwambiri ndipo linkagwiritsidwa ntchito m'nkhani zasayansi pankhani ya kapena ngakhale ngati mawu ofanana ndi kunenepa kwambiri.

1980s: Ganizirani za Anorexia ndi Bulimia Nervosa

M'zaka za m'ma 1980, ofufuza ena anayesa kufotokoza kuletsa chakudya komwe anthu omwe ali ndi anorexia nervosa (AN) amawonetsa ngati khalidwe loledzera (kapena "kudalira njala") [ 37 ]. Mwachitsanzo, Szmukler ndi Tantam [ 38 ] adati "odwala omwe ali ndi AN amadalira zotsatira zamaganizo komanso mwina zakuthupi za njala. Kuchepa thupi kwambiri kumachitika chifukwa cha kulekerera mpaka kufa ndi njala zomwe zimapangitsa kuti chakudya chichepetsedwe kwambiri kuti chipeze zotsatira zomwe akufuna, komanso pambuyo pake pamakhala zizindikiro zosasangalatsa za 'kusiya' kudya." Lingaliroli pambuyo pake linathandizidwa ndi kupezeka kwa ntchito ya machitidwe a opioid achilengedwe mu AN [ 39 , 40 ]. Komabe, chodziwikiratu ndi chakuti ntchito ya endorphins idakambidwanso mosiyana, ndiko kuti, kunenepa kwambiri [ 41 , 42 ]. Mofananamo, kunenepa kwambiri kudafufuzidwa motsatira dongosolo la kuledzera kwa chakudya mu kafukufuku wofalitsidwa mu 1989, momwe anthu onenepa kwambiri adayerekezeredwa ndi olamulira kulemera kwabwinobwino pamlingo wawo wa "kuyimira chinthu" [ 43 ].

Panalinso maphunziro ena okhudza bulimia nervosa (BN) kuchokera ku lingaliro la chizolowezi, lomwe linachokera ku gawo la zamaganizo a umunthu. Maphunziro awa adayambitsidwa ndi nkhani ziwiri kuchokera mu 1979, zomwe zidanena za zigoli zokwera pamlingo wa umunthu wokonda chizolowezi mwa anthu onenepa kwambiri [ 44 ] koma zigoli zotsika mwa anthu omwe ali ndi anorexia ndi onenepa kwambiri poyerekeza ndi osuta fodya [ 45 ]. Maphunziro oyerekeza pakati pa magulu a odwala omwe amadalira mankhwala osokoneza bongo ndi omwe ali ndi bulimic adaperekanso zotsatira zosasinthasintha, pomwe maphunziro ena adapeza zigoli zofanana pa miyeso ya umunthu m'magulu osiyanasiyana ndipo maphunziro ena adapeza kusiyana [ 46-49 ] . Maphunziro awa pa umunthu wokonda chizolowezi mu BN adatsagana ndi kafukufuku, momwe kugwiritsa ntchito mankhwala osokoneza bongo kunapezeka kuti ndi fanizo lothandiza pochiza BN [ 50 ] ndi chitukuko cha "Foodaholics Group Treatment Program" [ 51 ].

1990s: Zosokoneza ndi Zotsutsa

Pambuyo pa kuyesa koyamba kufotokoza matenda okhudzana ndi kudya ngati chizolowezi, panali ndemanga zambiri zomwe zinafalitsidwa m'zaka za m'ma 1990 ndi 2000, momwe chitsanzo cha chizolowezi cha matenda okhudzana ndi kudya chinakambidwa mozama kutengera malingaliro, thupi, ndi zina [ 52-55 ] . Komabe, kupatula nkhani zingapo, ziwiri momwe umunthu wokonda kudya mwa anthu omwe ali ndi matenda okhudzana ndi kudya kapena kunenepa kwambiri unafufuzidwa [ 56 , 57 ] ndi ziwiri momwe milandu yachilendo yokhudza kumwa karoti ngati chizolowezi inanenedwa [ 58 , 59 ], kafukufuku watsopano wawonekera: chokoleti.

Chokoleti ndi chakudya chomwe anthu ambiri amachikonda kwambiri m'madera akumadzulo, makamaka pakati pa akazi [ 60 , 61 ], komanso chakudya chomwe anthu nthawi zambiri amakhala nacho ndi mavuto okhudzana ndi kudya [ 27 , 62 ]. Zinadziwika kale mu 1989 kuti chokoleti ili ndi mafuta ambiri komanso shuga wambiri, zomwe zimapangitsa kuti ikhale "chinthu chabwino kwambiri" [ 63 ] - lingaliro lomwe likufanana ndi malingaliro okhudza zakudya "zokoma kwambiri" zomwe zimawonjezera chilakolako patatha zaka 25 [ 3 , 27 ]. Kuwonjezera pa kapangidwe ka chokoleti, zinthu zina monga mphamvu zake zomvera kapena zosakaniza zamaganizo monga caffeine ndi theobromine zinakambidwanso ngati zomwe zimapangitsa kuti chokoleti ikhale ngati choledzeretsa [ 64 , 65 ]. Komabe, zotsatira za xanthine za chokoleti zapezeka kuti sizingafotokoze kukonda chokoleti kapena kumwa kwake ngati choledzeretsa [ 61 ].

Kafukufuku wochepa adachitika pomwe anthu otchedwa "okonda chokoleti" kapena "okonda chokoleti" adafufuzidwa. Kafukufuku woyamba unali wofotokoza momwe anthu amakhumbira ndi kumwa pakati pa zinthu zina [ 66 ]; wina unayerekeza miyeso yofanana pakati pa "okonda chokoleti" ndi zowongolera [ 67 ]; ndipo kafukufuku wina anayerekeza magulu otere pa mayankho aumwini ndi a thupi la munthu akakhudzidwa ndi chokoleti [ 68 ]. Komabe, vuto lalikulu la maphunzirowa linali lakuti mkhalidwe wa "chizolowezi cha chokoleti" umachokera pa kudzizindikiritsa, komwe kumakhala kosavuta kutsanzira ndi kuvomerezeka ndipo kumachepetsedwa ndi mfundo yakuti anthu ambiri omwe si akatswiri alibe tanthauzo lenileni la chizolowezi. Pomaliza, maphunziro awiri adafufuza mgwirizano pakati pa "chizolowezi cha chokoleti" ndi chizolowezi cha zinthu zina ndi machitidwe ndipo adapeza ubale wabwino, koma wochepa kwambiri [ 69 , 70 ].

2000s: Animal Models ndi Neuroimaging

Kumayambiriro kwa zaka za m'ma 2000 — pafupifupi zaka 40 kuchokera pamene OA idakhazikitsidwa — kafukufuku woyeserera adasindikizidwa momwe chithandizo cha odwala omwe ali ndi bulimic ndi onenepa kwambiri ndi pulogalamu ya masitepe 12 chidanenedwa [ 71 ]. Komabe, kupatula njira yochiritsira iyi, cholinga cha zaka khumi izi chinali kufufuza njira za mitsempha zomwe zimayambitsa kudya mopitirira muyeso ndi kunenepa kwambiri zomwe zingafanane ndi zomwe zapezeka kuchokera ku kudalira mankhwala osokoneza bongo. Mwa anthu, njira izi za mitsempha zidafufuzidwa makamaka ndi positron emission tomography ndi functional magnetic resonance imaging. Mwachitsanzo, nkhani yodziwika bwino yolembedwa ndi Wang ndi anzake [ 72 ] idanenanso za kupezeka kwa dopamine D2 receptor yotsika kwambiri mwa anthu onenepa poyerekeza ndi zowongolera, zomwe olembawo adazitanthauzira ngati chogwirizana ndi "matenda osowa mphotho" ofanana ndi omwe apezeka mwa anthu omwe ali ndi kudalira mankhwala osokoneza bongo [ 73 , 74 ]. Mwachitsanzo, kafukufuku wina adapeza kuti madera ofanana a ubongo amayatsidwa panthawi yomwe munthu amadya chakudya ndi mankhwala osokoneza bongo, ndipo kafukufuku momwe mayankho a mitsempha ku zinthu zomwe zimadya zakudya zokhala ndi ma calorie ambiri adafufuzidwa adapeza kuti anthu omwe ali ndi BN ndi BED amawonetsa mphamvu zambiri m'madera a ubongo okhudzana ndi mphotho poyerekeza ndi olamulira, monga momwe anthu omwe amadalira mankhwala osokoneza bongo amasonyezera mphamvu zambiri zokhudzana ndi mphotho poyankha zizindikiro zokhudzana ndi mankhwala osokoneza bongo [ 75 , 76 ].

Mzere wina wofunikira wa kafukufuku wokhudza kugwiritsa ntchito mankhwala osokoneza bongo m'zaka khumi izi unali zitsanzo za makoswe. Mu imodzi mwa njira zimenezi, makoswe amasowa chakudya tsiku lililonse kwa maola 12 kenako amapatsidwa mwayi wopeza shuga ndi chow kwa maola 12 [ 77 ]. Makoswe omwe adadutsa mu ndondomekoyi ya shuga ndi chow kwa milungu ingapo adapezeka kuti akuwonetsa zizindikiro za chizolowezi monga kusiya kugwiritsa ntchito shuga akachotsedwa, ndipo adawonetsanso kusintha kwa mankhwala a mitsempha [ 77 , 78 ]. Kafukufuku wina adapeza kuti makoswe omwe amapatsidwa chakudya cha "cafeteria" chokhala ndi ma calories ambiri adanenepa, zomwe zidaphatikizidwa ndi kuchepa kwa ma striatal dopamine D2 receptors ndikupitiliza kudya zakudya zokoma ngakhale zotsatira zake zinali zowopsa [ 79 ]. Pomaliza, maphunzirowa akusonyeza kuti kumwa shuga wambiri kungayambitse khalidwe lofanana ndi chizolowezi ndipo, kuphatikiza ndi kudya mafuta ambiri, kumawonjezera kulemera kwa makoswe [ 80 ] ndipo ma neural circuits ophatikizana amakhudzidwa ndi kukonza zizindikiro zokhudzana ndi chakudya ndi mankhwala komanso kuwongolera khalidwe la kudya ndi kugwiritsa ntchito mankhwala osokoneza bongo, motsatana.

2010s: Kuunika kwa Kusokoneza Chakudya mwa Anthu ndi Kupititsa patsogolo Kufufuza Zanyama

M'zaka zaposachedwapa, ofufuza ayesa kufotokoza molondola ndikuwunika chizolowezi cha zakudya. Mwachitsanzo, Cassin ndi von Ranson [ 81 ] adasintha mawu akuti "mankhwala" ndi "kudya mopitirira muyeso" mu kuyankhulana kokonzedwa bwino kwa mfundo zodalira zinthu mu ndemanga yachinayi ya Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) ndipo adapeza kuti 92 peresenti ya omwe adatenga nawo mbali ndi BED adakwaniritsa zofunikira zonse zodalira zinthu. Njira ina inali kupanga Yale Food Addiction Scale (YFAS), yomwe ndi muyeso wodziwonetsa wekha wowunikira zizindikiro za chizolowezi cha zakudya kutengera njira zodziwira chizolowezi cha chizolowezi cha mankhwala mu DSM-IV [ 82 ]. Makamaka, YFAS imayesa zizindikiro zisanu ndi ziwiri zodalira zinthu monga momwe zanenedwera mu DSM-IV ndi zinthu zonse zokhudzana ndi chakudya ndi kudya: 1) kumwa mankhwalawa mochuluka kapena kwa nthawi yayitali kuposa momwe amafunira (mwachitsanzo, "Ndimadzipeza ndikupitiriza kudya zakudya zina ngakhale kuti sindilinso ndi njala."); 2) chilakolako chokhazikika kapena kuyesa mobwerezabwereza kusapambana (mwachitsanzo, "Kusadya mitundu ina ya chakudya kapena kuchepetsa mitundu ina ya chakudya ndi chinthu chomwe ndikuda nkhawa nacho."); 3) kuthera nthawi yambiri kupeza kapena kugwiritsa ntchito mankhwalawa kapena kuchira ku zotsatira zake (monga, “Ndimapeza kuti zakudya zina zikasowa, ndimayesetsa kwambiri kuti ndizipeze. Mwachitsanzo, ndimayendetsa galimoto kupita kusitolo kukagula zakudya zina ngakhale kuti ndili ndi njira zina zomwe ndingapeze kunyumba.”); 4) kusiya zochita zofunika pagulu, zantchito, kapena zosangalatsa chifukwa chogwiritsa ntchito mankhwala osokoneza bongo (monga, “Pakhala nthawi zina pamene ndimadya zakudya zina pafupipafupi kapena mochuluka kwambiri moti ndinayamba kudya chakudya m'malo mogwira ntchito, kukhala ndi nthawi ndi banja langa kapena anzanga, kapena kuchita zinthu zina zofunika kapena zosangalatsa zomwe ndimakonda.”); 5) kupitiriza kugwiritsa ntchito mankhwala osokoneza bongo ngakhale kuti ndili ndi mavuto amisala kapena akuthupi (monga, “Ndinapitiriza kudya zakudya zamtundu womwewo kapena chakudya chofanana ngakhale kuti ndinali ndi mavuto amaganizo ndi/kapena akuthupi.”); 6) kulolera (monga, “Pakapita nthawi, ndapeza kuti ndikufunika kudya kwambiri kuti ndipeze zomwe ndikufuna, monga kuchepetsa malingaliro oipa kapena chisangalalo chowonjezeka.”); ndi 7) zizindikiro zosiya kusuta (monga, “Ndakhala ndi zizindikiro zosiya kusuta monga kusokonezeka maganizo, nkhawa, kapena zizindikiro zina zakuthupi pamene ndinachepetsa kapena kusiya kudya zakudya zina.”). Zinthu zina ziwiri zimayesa kukhalapo kwa vuto lalikulu lachipatala kapena kuvutika maganizo komwe kumachitika chifukwa cha kudya mopitirira muyeso. Mofanana ndi DSM-IV, chizolowezi cha zakudya “chingathe kupezeka” ngati zizindikiro zitatu kapena zingapo zapezeka ndipo vuto lalikulu lachipatala kapena kuvutika maganizo kulipo [ 82 , 83 ].

YFAS yakhala ikugwira ntchito zambirimbiri m'zaka zapitazi za 6, zomwe zimasonyeza kuti anthu omwe ali ndi vuto loti "matenda" amatha kusiyanitsidwa ndi omwe alibe "matenda" pazambiri zosiyana siyana kuchokera pazinthu zozizwitsa zozizira , psychopathology, malamulo othandizira, kapena kutengeka kwa zochitika za thupi ndi khalidwe monga ma multilocus maonekedwe okhudza dopaminergic chizindikiro kapena mayendedwe a magalimoto ku chakudya chokwanira cha calorie [62]. Ngakhale YFAS yakhala ngati chida chothandizira kufufuzira mowa-monga kudya, ndizowona, sizingwiro ndipo zowonjezereka zafunsidwa [84]. Mwachitsanzo, zapezeka kuti pafupifupi 50 peresenti ya anthu okalamba kwambiri omwe ali ndi BED amalandira matenda a YFAS ndipo anthuwa amasonyeza kuti ali ndi matenda akuluakulu okhudzana ndi kudya komanso odwala matenda ambiri kuposa anthu okalamba omwe ali ndi BED omwe samalandira YFAS.85,86]. Malingana ndi zofukufukuzi, tawonetseratu kuti chizoloŵezi cha zakudya monga kuyeza ndi YFAS chingangoyimira mawonekedwe oopsa kwambiri a BED [87,88]. Kuwonjezera pamenepo, chitsanzo cha mankhwala osokoneza bongo chikupitirizabe kukambirana kwambiri ndi akatswiri ena ofufuza omwe akutsimikiziridwa kuti ndi ovomerezeka [3,7,21,89-91], pamene ena amakangana motsutsana ndi zotsatira zosiyana za thupi za mankhwala osokoneza bongo komanso zakudya zina monga shuga, malingaliro, ndi zina [84,92-97]. Zomwe zaposachedwapa, zakhala zikuperekedwa kuti ngakhale pali njira yodya kudya yomwe ingatchedwe moledzeretsa, mawu akuti chizoloŵezi chakumwa ndizolakwika chifukwa palibe wodzitetezera, ndipo, motero, ayenera kukhala ngati khalidwe kuledzera (mwachitsanzo, "kudya mowa") [98].

Kafukufuku wa nyama pankhani ya kuledzera kwa chakudya wapita patsogolo m'zaka zaposachedwa. Izi zikuphatikizapo, mwachitsanzo, maphunziro ambiri omwe akuwonetsa zotsatira zosiyana za zigawo zinazake za michere (monga zakudya zokhala ndi mafuta ambiri, zakudya zokhala ndi shuga wambiri, zakudya zokhala ndi mafuta ambiri komanso shuga wambiri, kapena zakudya zokhala ndi mapuloteni ambiri) pa khalidwe la kudya ndi neurochemistry [ 99 , 100 ]. Kafukufuku wina akuwonetsa kuti njira zina zodyera zingakhudzenso ana m'makoswe. Mwachitsanzo, zapezeka kuti m'mimba kudya zakudya zokoma kwambiri kumakhudza zomwe amakonda, kusokonezeka kwa kagayidwe kachakudya, kugwira ntchito kwa ubongo, komanso chiopsezo cha kunenepa kwambiri [ 99 , 101 ]. Njira zatsopano zowunikira khalidwe lofanana ndi kuledzera kwa chakudya zagwiritsidwa ntchito, zomwe zimayesa, mwachitsanzo, kudya mokakamiza pansi pa zochitika zosokoneza [ 102 ]. Pomaliza, kugwiritsa ntchito mankhwala ena, omwe amachepetsa kugwiritsa ntchito mankhwala osokoneza bongo mwa makoswe, kwapezeka kuti kumachepetsa kudya zakudya zokoma ngati kuledzera [ 103 ].

Zotsatira ndi Malangizo Atsogolomu

Liwu loledzera linagwiritsidwa kale ntchito poyang'ana ku chakudya kumapeto kwa zaka za 19th. Pakatikati pa zaka za 20th, mawu akuti chizoloŵezi chakumwa analigwiritsidwa ntchito kwambiri, osati pakati pa anthu omwe anagawidwa koma komanso pakati pa asayansi. Komabe, izi zinali zovuta (ngati zili choncho), ndipo mawuwo nthawi zambiri ankagwiritsidwa ntchito popanda kufufuza. Zolemba zokhudzana ndi zovuta zokhudzana ndi chizoloŵezi cha zakudya zowonongeka kwa anthu zinali zosasowa m'zaka za zana la 20th, ndipo njira yodalitsira matenda odwala ndi kunenepa kwambiri inali kukambidwa mozama makamaka kumapeto kwa zaka zana. Kafukufuku wamakono anagwiritsa ntchito mapulogalamu angapo, omwe amagwiritsidwa ntchito, mwachitsanzo, kuyang'ana kunenepa pakati pa zaka za 20th, kuganizira za AN ndi BN mu 1980s, kugwiritsira ntchito chokoleti mu 1990s, ndikuyang'ana BED ndi - kachiwiri - kunenepa kwambiri mu 2000s chifukwa cha zotsatira za maphunziro ndi zinyama.

Chifukwa chake, ngakhale kafukufuku wokhudza kuledzera kwa zakudya wakula kwambiri m'zaka zaposachedwa, si lingaliro latsopano kapena lingaliro loti lifotokoze kuchuluka kwa kunenepa kwambiri komwe kukukwera. Cholinga cha nkhaniyi ndikuwonjezera chidziwitso cha mbiri yayitali ya lingaliro la kuledzera kwa zakudya komanso njira zake zasayansi zomwe zimasintha kwambiri. Ngati ofufuza aganizira za mbiri iyi, zingakhale zosavuta kupeza mgwirizano pa tanthauzo la kuledzera kwa zakudya ndipo zitha kulimbikitsa njira zofunika zotsatizana zomwe ziyenera kuchitidwa, ndipo, motero, kupita patsogolo m'munda uwu wa kafukufuku kudzathandizidwa [ 104 ].

Mwachitsanzo, mitu yambiri yomwe inayambiranso m'zaka zingapo zapitazi idakambidwa kale zaka makumi angapo zapitazo. Izi zikuphatikizapo, mwachitsanzo, maphunziro okhudza umunthu wokonda chizolowezi chomwe chimayambitsa kudya mopitirira muyeso komanso kugwiritsa ntchito mankhwala osokoneza bongo [ 105 , 106 ] kapena lingaliro loganizira AN ngati chizolowezi [ 107 , 108 ], ndipo mitu yonseyi inalipo kale m'ma 1980. Lingaliro loganizira BN ngati chizolowezi [ 109 ] linayambanso zaka makumi angapo zapitazo. Chifukwa chake, zikuwoneka kuti kuyang'ana kwambiri kunenepa kwambiri pankhani ya chizolowezi cha zakudya m'zaka zaposachedwa (monga, [ 13 , 110 ]) kukuwoneka kolakwika pang'ono, poganizira kuti ofufuza adanena zaka makumi angapo zapitazo kuti kudya ngati chizolowezi sikungokhala kwa anthu onenepa kwambiri ndipo kunenepa kwambiri sikungafanane ndi chizolowezi cha chakudya [ 28 , 50 ].

Nkhani ina yobwerezabwereza ikuwoneka kuti ikukhudza muyeso wa chizolowezi cha zakudya. Monga tafotokozera pamwambapa, panali maphunziro ena m'zaka za m'ma 1990 pomwe chizolowezi cha zakudya chinkadalira kudzizindikiritsa. Nkhaniyi idakambidwanso m'maphunziro aposachedwa, omwe akuwonetsa kuti pali kusiyana kwakukulu pakati pa magulu a chizolowezi cha zakudya kutengera YFAS ndi chizolowezi cha zakudya chomwe munthu amadziona yekha [ 111 , 112 ], motero zikutanthauza kuti tanthauzo la munthu payekha kapena zomwe adakumana nazo pa chizolowezi cha zakudya sizikugwirizana ndi njira yogwiritsira ntchito mankhwala yomwe idaperekedwa ndi YFAS. Ngakhale ofufuza sagwirizana za matanthauzidwe enieni a zizindikiro za chizolowezi cha zakudya [ 84 , 113 ], zikuwoneka kuti miyeso yokhazikika monga YFAS ndiyofunikira kuti apewe kugawidwa mopitirira muyeso kwa chizolowezi cha zakudya. Ngakhale kuti chifukwa cha YFAS, chomwe ndi kutanthauzira miyezo yodalira mankhwala ya DSM kukhala chakudya ndi kudya, ndi chosavuta, chatsutsidwanso chifukwa chimasiyana ndi matanthauzidwe omwe ofufuza ena ali nawo okhudza chizolowezi [ 93 , 98 ]. Chifukwa chake, njira yofunika kwambiri yamtsogolo ingakhale ngati komanso momwe kuledzera kwa chakudya kungayesedwe mwa anthu ena kupatula kugwiritsa ntchito YFAS.

Ngati kafukufuku wokhudza chizolowezi cha zakudya adzatsogozedwa ndi kumasulira kwa miyezo ya DSM yodalira mankhwala kukhala chakudya ndi kudya mtsogolo, funso lofunika lidzakhala lakuti ndi zotsatira ziti zomwe zidzachitike chifukwa cha kusintha kwa miyezo yodziwira chizolowezi cha mankhwala mu ndemanga yachisanu ya DSM yokhudza chizolowezi cha zakudya [ 114 ]. Mwachitsanzo, kodi miyezo yonse ya chizolowezi (monga momwe tafotokozera mu DSM-5) imagwiranso ntchito mofanana pa khalidwe la anthu pakudya? Ngati sichoncho, kodi izi zikuchotsa lingaliro la chizolowezi cha zakudya?

Kupatula mafunso ofunikira awa okhudza tanthauzo ndi muyeso wa chizolowezi cha zakudya, njira zina zofunika zofufuzira zamtsogolo zingaphatikizepo, koma sizingokhala izi: Kodi lingaliro la chizolowezi cha zakudya ndi lofunika bwanji pochiza kunenepa kwambiri kapena kudya kwambiri komanso popanga mfundo za anthu onse? Ngati ndi lofunika, lingagwiritsidwe ntchito bwanji bwino [ 17 , 91 ]? Kodi kuipa (ngati kulipo) kwa lingaliro la chizolowezi cha zakudya [ 115-119 ] ndi kotani ? Kodi mitundu ya nyama yodya ngati chizolowezi ingasinthidwe bwanji kuti iwonetse bwino njira zoyenera mwa anthu [ 120 ]? Kodi kudya ngati chizolowezi kungachepetsedwe kukhala zotsatira zoledzeretsa za chinthu chimodzi kapena zingapo kapena kodi "chizolowezi cha chakudya" chiyenera kulowedwa m'malo ndi "chizolowezi cha kudya" [ 98 ]?

Ngakhale kuti anthu asayansi akhala akudandaula ndi zakumwa za sayansi kwa zaka makumi angapo, izi zimakhalabe zotsutsana kwambiri komanso zomwe zimatsutsana kwambiri, zomwe zimakhala zochititsa chidwi kwambiri. Ngakhale kuti zokhudzana ndi sayansi pa mutuwu mofulumira zinawonjezeka m'zaka zingapo zapitazo, kufufuza kwake kudakali koyambira, ndipo, motero, zotsatira zafukufuku zidzawonjezeka m'zaka zikubwerazi.

Kuvomereza

Wolembayo amathandizidwa ndi thandizo la European Research Council (ERC-StG-2014 639445 NewEat).

achidule

AN anorexia nervosa
 
BN bulimia nervosa
 
bedi kudya zakudya zolimbitsa thupi
 
DSM Kusanthula ndi Buku Lophatikiza la Mavuto a Mitsempha
 
OA Odyera Osadziwika
 
YFAS Yale Food Addiction Scale
 

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