CMAJ. 2010 Marichi 9; 182 (4): 327-328.
doi: 10.1503/cmaj.091142
PMCID: PMC2831667
Valerie H. Taylor , MD PhD, Claire M. Curtis , MA, ndi Caroline Davis , PhD
Kunenepa kwambiri ndi vuto la thanzi padziko lonse lapansi, ndipo omwe akhudzidwa amafunika chithandizo ndi magulu osiyanasiyana othandizira, kuphatikizapo akatswiri azaumoyo wamaganizo, zamankhwala komanso opaleshoni. Ngakhale kuti chifukwa cha kunenepa kwambiri chili ndi mbali zambiri, n'zoonekeratu kuti kudya mopitirira muyeso nthawi zonse kumachita gawo lalikulu. Pamene kudya mopitirira muyeso kumeneku kumakhala kokakamiza komanso kosalamulirika, nthawi zambiri kumatchulidwa kuti "chizolowezi cha chakudya," chizindikiro chomwe chayambitsa mikangano yambiri yachipatala ndi yasayansi. 1
Lingaliro la chizolowezi ndi lovuta, ndipo kufotokoza makhalidwe ake kwayambitsa mkangano waukulu. Ngakhale kuti palibe mgwirizano, ofufuza amavomereza kuti njirayi imaphatikizapo njira yogwiritsira ntchito mokakamiza, ngakhale pakakhala zotsatirapo zoipa pa thanzi ndi chikhalidwe cha anthu. Lingaliro la chizolowezi cha chakudya, lomwe molondola lingasonyeze chizolowezi cha zigawo zinazake za chakudya, lingathe kufotokozedwa mofanana ndi makhalidwe ena osokoneza bongo. Zakudya ndi mankhwala onse awiri zimayambitsa kuleza mtima pakapita nthawi, komwe kumafunika kuchuluka kwa mankhwala kuti munthu aledzere kapena kukhuta. Kuphatikiza apo, zizindikiro zosiya kumwa mankhwala, monga kuvutika maganizo ndi dysphoria, nthawi zambiri zimachitika munthu akasiya kumwa mankhwalawo kapena akamadya pang'ono. Palinso kuchuluka kwa kubwereranso kwa mitundu yonse iwiri ya machitidwe. 2 Zizindikiro izi zokhudzana ndi chakudya zimagwirizana kwambiri ndi zomwe zafotokozedwa mu Diagnostic and Statistical Manual of Mental Disorders (kope lachinayi) 3 za kugwiritsa ntchito mankhwala osokoneza bongo komanso kudalira, zomwe zapangitsa ena kunena kuti chizolowezi cha chakudya chiyenera kuonedwa ngati matenda amisala. 1
Mwachikhalidwe, mawu oti "kuledzera" ankagwiritsidwa ntchito pongogwiritsa ntchito mankhwala osokoneza bongo omwe amayambitsa njira zopezera mphotho ya mesolimbic muubongo. M'zaka zaposachedwapa, lingaliro lalikulu la kuledzera labuka, ndipo mawuwa tsopano akuphatikizapo zomwe zimatchedwa "kuledzera kwa khalidwe." Kusinthaku kwachokera ku kafukufuku wosonyeza kuti dongosolo la mphotho ya mesolimbic limayambitsidwanso ndi zochita zosangalatsa. 4 Ndipotu , maphunziro ojambula zithunzi awonetsa kuti madera enaake a dongosolo la mesolimbic, monga caudate nucleus, hippocampus ndi insula, amayambitsidwa ndi mankhwala komanso chakudya . Zonsezi zimayambitsanso kutulutsidwa kwa striatal dopamine, neurotransmitter yomwe ndi gawo lofunikira la dongosolo la mphotho. Ma opiates amkati, gulu lina la osewera mu njira zopezera mphotho, amayambitsidwanso ndi mankhwala komanso chakudya - makamaka zakudya zotsekemera - pomwe opioid blocker naltrexone yawonetsedwa kuti imachepetsa chilakolako cha zonse ziwiri. 5 Ma compounds omwe amagwira ntchito ngati agonists otsutsana mkati mwa dongosolo la endocannabinoid agwiritsidwanso ntchito pochiza kuledzera kwa mankhwala osokoneza bongo komanso kulimbikitsa kuchepa thupi. 6 Mosiyana ndi zimenezi, odwala ena akalandira chithandizo cha kunenepa kwambiri pogwiritsa ntchito opaleshoni ya m'mimba, ena mwa iwo akhoza kukhala ndi makhalidwe ena osokoneza bongo monga kutchova juga kapena kugwiritsa ntchito ndalama mopitirira muyeso. 7 Chochitika ichi, chomwe chimadziwika kuti "kusamutsa zizolowezi," chimafuna kufufuzidwa kwina koma chimasonyeza kuti, kwa anthu ena, chizolowezi chofuna kuzoloŵa m'mavuto chingakhale chovuta.
Pofuna kufotokoza chifukwa chake anthu ena amadya mopitirira muyeso mopitirira muyeso, ofufuza apereka lingaliro lakuti zakudya zokoma kwambiri, monga zomwe zili ndi shuga, mchere kapena mafuta ambiri, zimatha kugwiritsidwa ntchito molakwika mofanana ndi mankhwala wamba. 8 Kuchokera ku lingaliro la chisinthiko, zikanakhala zogwirizana kwambiri kuti kudya chakudya kukhale kopindulitsa, makamaka pankhani ya zakudya zokhala ndi mafuta ndi shuga wambiri, popeza zimatha kusinthidwa mwachangu kukhala mphamvu . 9 Chiphunzitso chovomerezeka kwambiri chimasonyeza kuti njira yopezera mphoto ya mesolimbic inasintha kuti ilimbikitse chilimbikitso choyandikira ndikuchita zinthu zopindulitsa mwachibadwa monga kudya, motero kulimbikitsa kupulumuka nthawi ya njala. 2 Komabe, m'mibadwo ingapo yapitayi, malo athu odyera asintha kwambiri. Zatsopano mu ukadaulo wazakudya zalola kupanga ndi kusintha zakudya zina kuti ziwonjezere mphamvu zawo zopindulitsa (monga, kukoma kwawo) pofuna kuwonjezera malonda pamsika wopikisana kwambiri . 10 Kuphatikiza apo, zakudya zokhala ndi ma calorie ambiri, zokhala ndi mafuta ambiri zakhala zambiri ndipo zimapezeka mosavuta m'madera ambiri akumadzulo. 11 Chakudya chimasiyananso ndi zinthu zina zambiri zoledzeretsa chifukwa ndizovomerezeka komanso zotsika mtengo. Kupezeka kumeneku, pamodzi ndi zomwe timakonda mwachibadwa pa zakudya zotere, kungagwiritsidwe ntchito kudyera anthu ofooka komanso kuwonjezera mwayi woti anthu "azigwiritsa ntchito molakwika" chakudya, mofanana ndi momwe anthu omwe ali ndi vutoli amagwiritsira ntchito molakwika zinthu zina zomwe zimawasokoneza.
Si aliyense amene amamwa mankhwala osokoneza bongo amene amakhala chidakwa, ndipo mofananamo, si aliyense amene amamwa zakudya zokhala ndi mafuta ambiri komanso zopatsa mphamvu zambiri amene amakhala wodya kwambiri. Kusiyana kumeneku kwa kutengeka maganizo kungayambitsidwe, pang'ono, ndi chibadwa cha majini ndi/kapena kusintha kwa ubongo chifukwa chogwiritsa ntchito mopitirira muyeso pakapita nthawi, makamaka, kuchepetsa dopamine D2 receptors yolumikizidwa ndi khalidwe loledzera. 12 Kufooka kungayambitsidwenso ndi makhalidwe osiyanasiyana a umunthu. Mwachitsanzo, anthu onenepa kwambiri nthawi zambiri amakhala okhudzidwa kwambiri ndi mphotho ndi chilango komanso kusonyeza makhalidwe opupuluma kwambiri. 13 Kwa anthu awa, mphamvu zomwe zimayendetsa kudya chakudya zimatha kupitirira njala ya thupi. Zakudya zokoma kwambiri zimatha kubweretsa chisangalalo ndikuchepetsa ululu mofanana ndi zinthu zina zoledzera. Kafukufuku akuwonetsanso kuti kudya nthawi zambiri kumagwiritsidwa ntchito ngati njira yodzichiritsira nokha poyankha mavuto amalingaliro, monga kupsinjika maganizo, nkhawa, kusungulumwa, kutopa, mkwiyo ndi mikangano pakati pa anthu. 14
Lingaliro la kuledzera silimachotsa udindo wa ufulu wosankha ndi kusankha munthu payekha. Komabe, lingapereke chidziwitso cha chifukwa chake gulu la anthu onenepa kwambiri likupitirizabe kulimbana. 2 Kuika kunenepa ngati chizolowezi ndi mawu amphamvu ndipo kumatanthauza zambiri osati kungosintha tanthauzo la mawu. Zimasonyeza kuti kuyezetsa kuledzera ndi kudya kwambiri kuyenera kukhala gawo lachizolowezi la chithandizo cha kunenepa kwambiri, ndipo, pankhani ya opaleshoni ya m'mimba, kuyezetsa koteroko kuyenera kukhala gawo lofunika kwambiri pakutsata pambuyo pa opaleshoni. Zingafotokozenso kusapambana kwa mapulogalamu a moyo omwe saphatikizapo mankhwala kapena njira zamakhalidwe zomwe zimapangidwira kuthana ndi vuto la kuledzera la matendawa. Chochititsa chidwi n'chakuti, pali kugwirizana kwakukulu pakati pa mankhwala omwe akuwonetsedwa kuti amasokoneza kugwiritsa ntchito chakudya ndi mankhwala osokoneza bongo m'zinyama, ndipo njira zofanana zamakhalidwe - kuyankhulana kolimbikitsa, chithandizo cha khalidwe la chidziwitso ndi mapulogalamu 12-step - zimagwiritsidwa ntchito pochiza matenda onse awiri.
Malingaliro omwe ali ndi vuto pano omwe nthawi zambiri amagwiritsidwa ntchito kwa anthu onenepa kwambiri amafunikanso kupendanso. Ngakhale mankhwala sangavomerebe kudya mopitirira muyeso ngati chizolowezi, sitinganyalanyaze umboni womwe ukuonetsa mbali yomwe ikuchitika chifukwa chokhala pachiwopsezo cha chilengedwe komanso zoyambitsa zachilengedwe. Kuchita izi kungayimire kuchipatala.
Mfundo zazikulu
- Zomwe zimayambitsa kunenepa ndizovuta komanso zimadziwika kwa iwo.
- Kuphatikiza kwakukulu kwakuphatikiza ndi zopezeka muubongo zomwe zimalumikizidwa ndi kugwiritsa ntchito mankhwala osokoneza bongo zimagawidwa ndi anthu ena omwe ali ndi vuto lolemera.
- Njira zochizira zomwe zimagwiritsidwa ntchito kumalo osokoneza bongo zitha kukhala zothandiza pakuthana ndi mavuto a kunenepa.
Mawu a M'munsi
Zokonda Zopikisana: Caroline Davis adalandira ndalama zoyendera ndi malo ogona kuchokera ku Canadian Obesity Network kuti apereke mbali zina za pepalali pa Msonkhano woyamba wa Obesity. Palibe amene adalengeza kuti Valerie Taylor ndi Claire Curtis ndi omwe ali m'gululi.
Ndalama: Pa ntchito yokhudzana ndi ndemanga iyi, Caroline Davis adathandizidwa pang'ono ndi ndalama zothandizira kuchokera ku Canadian Institutes of Health Research.
Yofalitsidwa kale pa www.cmaj.ca
Olemba: Olemba onse adathandizira pa lingaliro la nkhaniyi komanso pakupanga ndi kusintha malembawo, ndipo onse adavomereza mtundu womaliza womwe waperekedwa kuti usindikizidwe.
Nkhaniyi idawunikiridwa.
ZOKHUDZA
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