CMAJ. 2010 March 9; 182 (4): 327-328.
PMCID: PMC2831667
Valerie H. Taylor, MD PhD, Claire M. Curtis, MA, uye Caroline Davis, PhD
Kuwedzera muviri dambudziko rehutano hwepasi rose, uye avo vanobatwa vanoda kurapwa nemapoka evanhu vakawanda ekurapa, kusanganisira nyanzvi dzoutano hwepfungwa, mushonga uye kunyange kuvhiyiwa. Kunyange zvazvo chinokonzerwa nokukwirira kwakawanda, zvakajeka kuti kusagadzikana kusingaperi kunoita basa rinokosha. Apo chirongwa ichi chekudya zvekudya chinokumanikidzira uye chisina kudzora, chinowanzosanangurwa se "chidhakwa chekudya," chirevo chakakonzera kukakavara kwakawanda kwekliniki uye yesayenzi.1
Mhedziso yekudhakwa yakaoma, uye kududzira kwezvakananga zvayo kwakakonzera nharo huru. Pasinei nekushaya kubvumirana, vanotsvakurudza zvakadaro vanobvuma kuti izvi zvinosanganisira kushandiswa kwekushanda, kunyange pavanotarisana nehutano husina kunaka uye hwemagariro evanhu. Iko pfungwa yekudhakwa kwezvokudya, izvo zvinonyatsoratidza kuti zvinodhaka kune zvimwe zvikamu zvezvokudya, zvinogona kurondedzerwa nenzira yakafanana nedzimwe maitiro ekurwisa. Zvokudya zvose nezvinodhaka zvinokurudzira kuvhiringidzika kwemazuva, apo kuwedzerwa mari inodiwa kuti ifike uye ichengetedze kudhakwa kana kuti kuora. Mukuwedzera, zviratidzo zvekudzoka, zvakadai sokutambudzika uye dysphoria, kazhinji zvinowanzoitika pakuramba kwechirwere kana panguva yekudya. Panewo huwandu hwakawanda hwekudzoka zvakare nemhando dzose dzekuita.2 Zviratidzo izvi maererano nekudya zvakafanana nepamusoro zvinoshamisa izvo zvinorondedzerwa mu Kuongororwa uye Statistical Manual yeMental Disorders (yechina edition)3 kushandisa zvinodhaka uye kuvimba, izvo zvinoita kuti vamwe varatidze kuti kudhakwa kwezvokudya kunofanira kuonekwa sehosha yepfungwa.1
Mutsika, izwi rokuti "kusvuta" rakashandiswa chete pakushandiswa kwezvinodhaka izvo zvinoita kuti uropi huve neo mesolimbic mubairo munzira. Mumakore achangobva kupfuura, kufungidzirwa kwakanyanya kwekutsvaira kwakabuda, uye izwi ikozvino rinosanganisira izvo zvinonzi "tsika dzekuita zvinodhaka." Kuchinja uku kwakave kwakavakirwa pakutsvakurudza kuri kuratidza kuti mesolimbic mubairo wezvirongwa zvinoshandiswa nemabasa anofadza.4 IIchokwadi, kufungidzirwa kwekufungidzira kwakaratidza kuti nzvimbo dzakasiyana-siyana dzeyisolimbic system, dzakadai sedanda rekucheka, hippocampus uye insula, zvinoshandiswa zvose nemishonga uye nekudya. Zvose izvi zvinokonzera kusunungurwa kwekurota dopamine, neurotransmitter iyo inokosha chikamu chekuwana mubayiro. Nhengo dzemajoka, imwe boka revatambi mumugwagwa wemubairo, inoshandiswawo nemishonga uye nekudya - kunyanya kudya kwakanaka-apo opioid blocker naltrexone yakaratidzwa kuderedza zvido zvezvose.5 Mishonga inoita sevasinganzwisisiki muhupenyu mukati me endocannabinoid system yakashandiswawo zvose pakurapa zvinodhaka uye kukurudzira kuora.6 Kusiyana neizvi, mushure mekurapa kwekuninipiswa nenzira yekugadzira chirwere chekudya, zvikamu zvevashandi zvinogona kuve nezvimwe zvinokanganisa zvinokonzerwa nekubhejera kana kushandiswa kwemhirizhonga.7 Ichi chinoshamisa, chinozivikanwa se "kutengesa kwezvinodhaka," inoda kuwedzera kudzidza asi inoratidza kuti, kune vamwe vanhu, tsika yekuita zvinodhaka ingave yakaoma-wired.
Mukuedza kutsanangura zvinokurudzira kune zvimwe zviitiko zvekumanikidzira kudyisa, vatsvakurudzi vakaronga kuti zvikafu zvinofadza, zvakadai sezvo zvinotapira, zvinyoro kana kuti zvakakora mumafuta, zvinogona kukanganisa nenzira yakafanana nemishonga inowanzoitika.8 Kubva pakuona kwekushanduka-shanduka, ingadai yakave yakagadzirisa zvakanyanya kushandiswa kwezvokudya zvekupa mubayiro, kunyanya panyaya yezvokudya zvakazara mumafuta uye shuga, sezvo zvingashandurwa zvakashandurwa kuva simba.9 Imwe nyanzvi inogamuchirwa yakawanda inotarisa kuti mesolimbic mubairo nzira yakagadziriswa kuti kusimbise zvinokurudzirwa kuswedera uye kuita maitiro ezvakanaka zvakadai sekudya, nokudaro kukurudzira kupona munguva dzenzara.2 Pamusoro pemarudzi mashomanana apfuura, zvisinei, chikafu chekudya chedu chakashanduka zvikuru. Zvakaitika munguva pfupi yapfuura muzvigadzirwa zvezvokudya zvakabvumira kusika nekugadziridzwa kwezvimwe zvekudya kuti zvigadzire kuwedzera zvipo zvavo zvinokomborera (kureva, kutadza kwavo) mukuedza kuwedzerwa kutengesa mumakwikwi anokoshat.10 Mukuwedzera, koriori-dense, zvokudya zvakanyanya-mafuta zvakave zvakawanda uye zvinowanikwa nyore nyore munharaunda zhinji dzeWestern.11 Zvokudya zvinopesana nezvimwe zvakawanda zvinokonzerwa nezvinhu zvinokonzerwa nokuti zviri pamutemo uye hazvina mari. Izvi zvinowanikwa, pamwe chete nemafungiro edu ezvinyorwa zvezvokudya zvakadai, zvinogona kushandiswa kushandisa vanhu vanotambura uye kuwedzera mukana wekuti vanhu "vachishandisa zvisina kunaka" zvokudya, nenzira yakafanana iyo inoshandisa zvisina kunaka zvimwe zvinodhaka.
Haasi munhu wese anotsvaga zvinodhaka anova chidhakwa, uye, saizvozvowo, havasi vose vanoratidzwa nepamusoro-mafuta, yakakwirira-koriori yekudya inova inomanikidzira yekudya. Kusiyana uku kwekufungidzirwa kunogona kuonekwa, mune chikamu, kune chimiro chemafuro uye / kana kuhutano hunoenderana nekushandisa zvakanyanya kwenguva, specifically, downregulation ye dopamine D2 receptors dzinobatanidza nehupombwe.12 Kuvhiringidzika kunogonawo kunobva pamhando dzakasiyana dzeunhu. Semuenzaniso, vanhu vakaoma vanowanzove vakanyatsozvipira mubairo uye kurangwa uye kuratidza mafambiro akawanda.13 Kune ava vanhu, simba rinotungamirira kudya zvokudya zvinogona kupfuurira kupfuura physiologic nenzara. Zvokudya zvakawandisa zvinogona kuunza mufaro uye kuderedza marwadzo nenzira yakangofanana nezvimwe zvinodhaka. Kutsvakurudza kunoratidzawo kuti kudya kunowanzoshandiswa senzira yekuzvipa mishonga mukupindura kwezvinhu zvisina kunaka zvemashoko, zvakadai sekuora mwoyo, kuzvidya mwoyo, kusurukirwa, kusuruvara, kutsamwa uye kupesana.14
Mhedziso yekudhakwa haisi kurega basa rekusununguka nekuzvisarudzira. Zvinogona, zvakadaro, zvinopa ruzivo rwekuti nei chikamu chevanhu vane uremu huri kuramba chichirwa.2 Kurondedzera kuneta sekudhakwa ishoko rakasimba uye zvinoreva zvakawanda kupfuura kungochinja kwemashokochete. Inoratidza kuti kuongorora kushandiswa kwemishonga uye kudhakwa kwekudya kunofanira kuva chikamu chechirwere chekuwedzera kuneta, uye, panyaya yekuvhiyiwa gastric, kuti kuongorora kwakadaro kunofanira kunge iri chikamu chinokosha chekutsvaga kutevera. Izvo zvinogonawo kutsanangura kusakwanisa kwekubudirira kwezvirongwa zvehupenyu zvisingaiti pharmacotherapy kana maitiro ekuzvibata zvakanyatsorongedzerwa kugadzirisa zvinodhaka zvechirwere ichi. Zvinofadza kuti pane zvakawanda zvinowanikwa pakati pemishonga inoratidzwa kuti inopesana nezvokudya uye kushandisa zvinodhaka mumhando dzemhuka, uye nzira dzakasiyana-siyana dzekuzvibata -kudzidzira kubvunzurudza, kugadzirisa maitiro ehutano uye zvirongwa zveHNUMX-zvishoma-zvinoshandiswa pakurapa zvose zviri zviviri.
Ikozvino "mafungiro" mafungiro anowanzoshandiswa kuvanhu vane hutano kunoda kuongororwa zvakare. Kunyange zvazvo mushonga ungasave uchibvuma kubvumira kudya zvakanyanya sekudhakwa, hatigoni kufuratira humwe uchapupu hunoita basa rakakonzerwa nehupenyu hwehupenyu hwehutachiona uye zvinokonzera zvakatipoteredza. Kuita izvi kunomirira kliniki yekudzivirira.
Nheyo dzinokosha
- Zvikonzero zvinokonzera kuneta zvakaoma uye zvakananga kune mumwe munhu.
- Chirwere chekuongorora chinogadzira uye tsvakurudzo dzetsva dzinobatanidza nekushandisa zvinodhaka zvakagoverwa nevamwe vanhu vane matambudziko ekuremera.
- Mishonga inowanzoshandiswa kunzvimbo yekudhakwa inogona kubatsira pakugadzirisa zvinetso zveutoro.
Mashoko Omuzasi
Kukwikwidzana: Caroline Davis akagamuchira mari yekufambisa uye yekugara kubva kuCanada Obesity Network kuti ataure zvikamu zvepa pepa paOndity Summit Summit. Hapana akaparidzirwa Valerie Taylor naClaire Curtis.
Mariro: Nebasa rakabatana nemashoko aya, Caroline Davis akatsigirwa chikamu nechipo kubva kuCanada Institutes of Health Research.
Yakabudiswa pa www.cmaj.ca
Vabatsiri: Vose vanyori vakapa chirevo chechinyorwa ichi uye nekugadzirwa nekugadzirisa kwemashoko, uye vose vakabvumirana shanduro yekupedzisira yakatumirwa kubudiswa.
Ichi chinyorwa chaiva chezera rekuongorora.
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