CMAJ. I-2010 Mashi 9; I-182 (4): 327-328.
I-PMCID: PMC2831667
UValerie H. Taylor, MD PhD, UClaire M. Curtis, I-MA, ne UCaroline Davis, PhD
Ukukhuluphala kuyinkinga yezempilo yomhlaba wonke, futhi labo abathintekile badinga ukwelashwa ngamaqembu atholakala emikhakheni ehlukahlukene, kufaka phakathi ongoti bezempilo yezengqondo, abezokwelapha ngisho nokuhlinzwa. Yize imbangela yokukhuluphala igcwele, kucacile ukuthi ukweqisa ngokweqile kudlala indima ebalulekile. Lapho lolu hlobo lokudla ngokweqile luphoqelela futhi luphelelwe amandla, luvame ukuhlukaniswa ngokuthi “umlutha wokudla,” ilebuli eye yabangela impikiswano enkulu yezempilo nesayensi.1
Umqondo wokulutha uhambisanayo, futhi ukucaciswa kwezimpawu zalo ezichazayo kufake impikiswano enkulu. Naphezu kokuntuleka kokuvumelana, abacwaningi nokho bayavuma ukuthi le nqubo ifaka indlela yokuphoqelela yokusebenzisa, noma ngabe babhekene nemiphumela engemihle yempilo kanye nemiphumela yezenhlalo. Umqondo wokulutha kokudla, ongakhombisa umlutha ezingxenyeni ezithile zokudla, ungachazwa ngendlela efanayo nezinye izindlela zokulutha. Kokubili ukudla nezidakamizwa kubangela ukubekezelelana isikhathi eside, lapho inani elikhulayo lidingeka khona ukuze kufinyelele futhi kugcinwe ukudakwa noma ukwanela. Ngaphezu kwalokho, izimpawu zokuhoxisa, njengokucindezela ne-dysphoria, kuvame ukwenzeka ekuyekeni komuthi noma ngesikhathi sokudla. Kukhona futhi nesibalo esikhulu sokuphinda ubuye nazo zombili lezi zinhlobo zokuziphatha.2 Lezi zimpawu maqondana nokudla okuhambisana nezinga elithile elimangalisa lezo ezichazwe ku Incwadi Yokuhlola Nezibalo Zezinkinga Zengqondo (uhlelo lwesine)3 kokusebenzisa kabi izidakamizwa nokuncika, okuholele abanye ukuthi baphakamise ukuthi ukuluthwa kokudla kufanele kuthathwe njengokugula kwengqondo.1
Ngokwesiko, igama elithi “umlutha” lalisetshenziselwa kuphela ukusetshenziswa kabi kwezidakamizwa ezenza kusebenze ubuchopho be-mesolimbicvuzoways. Eminyakeni yamuva nje, kuye kwavela umcabango obanzi wokulutha, futhi leli gama manje lifaka lokho okubizwa ngokuthi “ukuluthwa kokuziphatha.” Lolu shintsho lususelwe ocwaningweni olukhombisa ukuthi uhlelo lomvuzo we-mesolimbic nalo luvuselelwa yimisebenzi yokuziphatha okuhle.4 Iiqiniso, izifundo zokucabanga zikhombisile ukuthi izindawo ezithile zohlelo lwe-mesolimbic, njenge-caudate nucleus, i-hippocampus ne-insula, zombili izidakamizwa nokudla. Zombili futhi zibangela ukukhishwa kwe-striatal dopamine, i-neurotransmitter eyingxenye ebalulekile yohlelo lwemivuzo. Ama-opoates e-gene, elinye iqembu labadlali emikhondweni yemivuzo, ayenziwa futhi ngezidakamizwa nangokudla - ikakhulukazi ukudla okumnandi — kanti i-opioid blocker naltrexone iye yaboniswa ukunciphisa izifiso zombili.5 Izithako ezisebenza njengama-agonists angaguquki ngaphakathi kohlelo lwe-endocannabinoid nazo zisetshenzisiwe zombili ekwelapheni ukuluthwa kwezidakamizwa nokukhuthaza ukunciphisa umzimba.6 Ngakolunye uhlangothi, ngemuva kokwelashwa kokukhuluphala ngokuhlinzwa kwesisu, iziguli ezingaphansi kweziguli zingathola ezinye izimilo zokuziphatha ezinjengokugembula noma ukusebenzisa imali ngokuphoqelela.7 Le nto, eyaziwa ngokuthi "ukudluliselwa kwemilutha," idinga ukuqhubeka nokufunda kepha iphakamisa ukuthi, kwabanye abantu, ukuthambekela kokuluthwa kungaba nzima.
Emzameni wokuchaza isisusa kwamanye amacala wokudla ngokweqile okucindezelayo, abacwaningi bahlongoza ukuthi ukudla okudla kakhulu, njengaleyo okunoshukela, okunosawoti noma okunamafutha amaningi, kunamandla okuhlukumeza ngendlela efana nezidakamizwa ezejwayelekile.8 Ngokombono wokuziphendukela kwemvelo, bekungaba yinto eguquguqukayo kakhulu ukuthi ukusetshenziswa kokudla kube nomvuzo, ikakhulukazi endabeni yokudla okunamafutha noshukela, ngoba kungashintshwa ngokushesha kube amandla.9 Umbono owemukelwa kabanzi wokuthi indlela yomvuzo we-mesolimbic yavela ukuze kuqiniswe isisusa sokusondela futhi uhlanganyele ekuziphatheni okuhle kwemvelo njengokudla, ngaleyo ndlela kukhuthaza ukusinda ngezikhathi zendlala.2 Ezizukulwaneni ezimbalwa ezedlule, kepha imvelo yethu yokudla isishintshe kakhulu. Ukuthuthuka kwakamuva kobuchwepheshe bokudla kuvumele ukwakhiwa nokuguqulwa kokudla okuthile ukuze kusebenze ngokwamandla impahla yabo evuzayo (okuwukuthi, amandla abo) emzameni wokukhulisa ukuthengisa emakethe yokuncintisana kakhulut.10 Ngaphezu kwalokho, i-calorie-dense, ukudla okunamafutha amaningi sekugcwele futhi kutholakala kalula emiphakathini eminingi yaseNtshonalanga.11 Ukudla kubuye kuhluke kwezinye izinto eziningi eziluthayo ngoba kusemthethweni futhi kushibhile. Lokhu kufinyeleleka, kuhlangene nokuthanda kwethu kwangaphakathi kokudla okunjalo, kungasetshenziswa ukuxhaphaza abantu ababuthakathaka futhi kwandise amathuba wokuthi abantu "bazosebenzisa kabi" ukudla, ngendlela efanayo nokuthi imilutha isebenzisa kabi ezinye izinto eziluthayo.
Akuwona wonke umuntu ovezwa izidakamizwa eba umlutha, futhi, ngokufanayo, akuyena wonke umuntu otholwa nokudla okunamafutha aphezulu, ane-khalori ephezulu eba umdlwenguli ophoqelelayo. Lokhu kwehluka kokungabikhona kungenzeka ukuthi, ngokwengxenye, kuthathwa kusengaphambili lofuzo kanye / noma ukuzivumelanisa nobuchopho ekusebenziseni ngokweqile ngokuhamba kwesikhathi,ikakhulukazi, phansi kwe-dopamine D2 ama-receptors axhunyaniswe nokuziphatha okuluthayo.12 Ukulimazeka nakho kungaqhamuka ezicini zobuntu obuhlukahlukene. Isibonelo, abantu abakhuluphele bavame ukuzwela kakhulu ukuvuza nokujeziswa futhi babonise nokuziphatha okuphoqelela ngokwengeziwe.13 Kulabantu, amandla okushayela ukusetshenziswa kokudla kungenzeka ukuthi adlulele ngale kwendlala yomzimba. Ukudla okumnandi kakhulu kungahle kukulethele ubumnandi futhi kunciphise nobuhlungu ngendlela efana nezinye izinto eziluthayo. Ucwaningo luphinde luveze ukuthi ukudla kudla kuvame ukusetshenziswa njengendlela yokuzilapha ngokwakho ukuphendula isimo esingesihle somoya, njengokucindezelwa, ukukhathazeka, isizungu, isizungu, ulaka kanye nokuxabana kwabantu.14
Umqondo wokuba umlutha awushayi indiva indima yenkululeko yokuzikhethela nokuzikhethela komuntu. Noma kunjalo, kunganikeza ukuqonda ukuthi kungani i-subset yabantu abanokukhuluphala ngokweqile iqhubeka nokulwa.2 Ukuhlukanisa ukukhuluphala njengomlutha kuyisitatimende esinamandla futhi kusho okungaphezu koshintsho kuma-semantics. Kubonisa ukuthi ukuhlolwa kokuluthwa umlutha nokudla kokudla okulukhuni kufanele kube yingxenye yendlela yokwelapha ukukhuluphala, futhi, esimweni sokuhlinzwa kwesisu, lokho kuhlolwa kufanele kube yingxenye yokulandelwa kwe-postoperative. Kungase futhi kuchaze ukungaphumeleli kwempumelelo yezinhlelo zokuphila ezingafaki amasu e-pharmacotherapy noma amasu wokuziphatha enzelwe ngqo ukubhekana nengxenye yokuluthwa kwalokhu kugula. Ngokuthabisako, kunokuqhekeka okukhulu phakathi kwemithi ekhonjelwe ukuthi iphazamise ukudla nokusetshenziswa kabi kwezidakamizwa kumamodeli wezilwane, kanye nokungenelela kokuziphatha okufanayo -ukuxoxisana ngemibuzo, izindlela zokuziphatha zokuqonda kwengqondo kanye nezinhlelo zezinyathelo ze-12 - zisetshenziswa ekwelashweni kwalezi zimo zombili.
Isimo sengqondo “sokusola” samanje esivame ukusetshenziswa kubantu abanokukhuluphala ngokweqile sidinga ukuthi siphinde sihlolisiswe. Yize umuthi ungemukeli ukwelashwa okucindezelayo okulutha njengemlutha, asikwazi ukubushaya indiva ubufakazi obuqhakambisa iqhaza elidlalwe yikuba sengozini kwe-biologic kanye nezimbangela zemvelo. Ukwenza kanjalo kuzobonisa ukumiswa kwemitholampilo.
Amaphuzu ayisihluthulelo
- Izimbangela zokukhuluphala ziyinkimbinkimbi futhi zithize kumuntu ngamunye.
- Ukwakheka kokuxilongwa okuyisisekelo nokutholakele kwe-neurologic okuxhumene nokusetshenziswa kabi kwezidakamizwa kwabiwa ngabantu abathile abanezinkinga zesisindo.
- Izindlela zokwelapha ezisetshenziselwa ngokwesiko endaweni yokuluthwa zingasiza ekuphatheni izinkinga zesisindo.
Imibhalo yaphansi
Izithakazelo zokuncintisana: UCaroline Davis uthole imali yokuhamba neyendawo yokuhlala evela eCanada Obesity Network ukwethula izici zaleli phepha engqungqutheleni yokuqala ye-Obesity Summit. Akekho omenyezelwe uValerie Taylor noClaire Curtis.
Imali: Ngomsebenzi ohlobene nalokhu kuphawula, uCaroline Davis wasekwa ngokwengxenye isibonelelo esivela kwaCanada Institutes of Health Research.
Okushicilelwe ngaphambilini e- www.cmaj.ca
isandla: Bonke ababhali bafake isandla emcabangweni wale ndatshana nasekuthuthukisweni nasekuhlelweni kombhalo, futhi bonke bagunyaza uhlobo lokugcina olungenisiwe ukuze lushicilelwe.
Lo mbhalo ubuyekezwe ontanga.
IZINDAWO ZOLWAZI
I-1. UDavis C, uCarter JC. Ukudla ngokweqile okuxakayo njengesifo sokulutha. Ukubuyekezwa komqondo kanye nobufakazi. Isifiso. I-2009; 53: 1-8. [I-PubMed]
I-2. Volkow ND, O'Brien CP. Izinkinga ze-DSM-V: Ngabe ukukhuluphala kufanele kufakwe njengokuphazamiseka kwengqondo? NginguJ Psychiatry. I-2007; 164: 708-10. [I-PubMed]
I-3. Iseluleko sokuxilonga nesibalo sokuphazamiseka kwengqondo. I-4. I-Arlington (VA): I-American Psychiatric Association; I-1994.
I-4. Kelley AE, Schiltz CA, Landry CF. Izinhlelo ze-Neural eziqashwe yizintambo eziphathelene nezidakamizwa nokudla: izifundo zokuqalwa kofuzo ezifundeni ze-corticolimbic. Physiol Behav. I-2005; 86: 11-4. [I-PubMed]
I-5. Yeomans MR, Grey RW. Imiphumela ye-naltrexone ekudleni kokudla kanye noshintsho ekuthambekeni kokudla ngemuva kokudla: ubufakazi bokubandakanyeka kwe-opioid kumphumela we-appetizer. Physiol Behav. I-1997; 62: 15-21. [I-PubMed]
I-6. I-Pelchat ML. Ukuluthwa kokudla kubantu. J Nutr. I-2009; 139: 620-2. [I-PubMed]
I-7. I-Sogg S. Isebenzisa kabi utshwala ngemuva kokuhlinzwa kwe-bariatric: i-epiphenomenon noma i-"Oprah" into? I-Surg Obes Lidlulise Dis. I-2007; 3: 366-8. [I-PubMed]
I-8. Salamone JD, Correa M, Mingote S, et al. I-Nucleus ibutha i-dopamine kanye nemigomo yomzamo ekuziphatheni kokudla: imiphumela yezifundo zokugqugquzelwa kwemvelo, ukusebenzelana kwengqondo nokusebenzisa kabi izidakamizwa. J Pharmacol Exp Ther. I-2003; 305: 1-8. [I-PubMed]
I-9. U-Erlanson-Albertsson C. Ushukela uvusa uhlelo lwethu lomvuzo. Amaswidi akhipha ama-opiates avuselela isifiso sokudla kwe-sucrose - i-insulin ingacindezela lokho. Lakartidningen. I-2005; 102: 1620-2. I-1625, 1627. IsiSwidi. [I-PubMed]
I-10. UKessler D. Ukuphela kokudla ngokweqile: ukulawula ukuthambekela kokudla okungenakuphela kwaseNyakatho Melika. I-Toronto (ON): McClelland noStewart; I-2009.
I-11. I-Monsivais P, Drewnowski A. Izindleko ezikhuphukayo zokudla okuphansi kwamandla-amandla. J Am Diet Assoc. I-2007; 107: 2071-6. [I-PubMed]
I-12. Roberts AJ, Koob GF. I-neurobiology yokulutha: ukubuka konke. I-Alcohol Health Res World. I-1997; 21: 101-6. [I-PubMed]
I-13. UDavis C, uLeviitan RD, uCarter J, et al. Ukuziphatha komuntu kanye nokuziphatha kokudla: isifundo esilinganayo sokulawula inkinga yokudla kokudla. I-Int J I-Disord. I-2008; 41: 243-50. [I-PubMed]
I-14. UDavis C, uStrachan S, uBerkson M. Ukuzwela ukuvuza: imiphumela yokudla ngokweqile nokukhuluphala. Isifiso. I-2004; 42: 131-8. [I-PubMed]
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