Nieuwe inzichten in oorzaken en gevolgen van verstoringen in de energiebalans. Amersdoort, 11 maart 2013 Jaap Seidell VU/VUmc
motief tactiek gedrag effect lagere prijzen winstmaximalisatie en overproductie van landbouw grotere porties betere smaak toename van inname van energierijke voedingsmiddelen (calorieën) toename obesitas grote beschikbaarheid
Huang TT et al, CDC, 2009
Two hormones, i.e. testosterone and cortisol 36,38,4_, are known to be responsible for upper body predominance of fat mass. In all probability, excess testosterone is not involved in diabetogenic obesity. On the other hand, induced hypercorticism, even to a minor degree but of long duration, in obesity is probably both the cause COMBES R., BOYER J., VAGUE J.: Reponse de Ia cortisolémie au of tetracosactide the android aspects intraveineux of such en obesity fonction and de a factor Ia masse in maintaining grasse et de insulin sa resistance. repartifion topographique - Diabete et M&ab. 5, 79, 1979.
Cushing syndrome
Psychology and obesity
The models of acute versus chronic brain ER stress in obesity/t2d syndrome. Purkayastha S et al. PNAS 2011;108:2939-2944 2011 by National Academy of Sciences
Low dose synacthen test in 210 men showing cortisol responsiveness according to birthweight (data from the Hertfordshire Study). Byrne C D Br Med Bull 2001;60:153-171 2001 by Oxford University Press
Social Stress, Visceral Obesity, and CAA Social Stress, Visceral Obesity, and Coronary Artery Atherosclerosis in Female Primates Carol A. Shively, Thomas C. Register and Thomas B. Clarkson
Coronary Artery Disease and visceral fat accumulation in monkeys
Subordinate stress, depression and abdominal obesity in men
Hypogonadism, Obesity and Insulin Resistance Body Fat Insulin Sensitivity Endogenous T T E2 Aromatase Kapoor et al. Clin Endocrinol 2005;63:239-250. Pitteloud et al. JCEM 2005;90:2636-2641. Dhindsa et al. Diabetes Care 2007;30:1860-2. Altered Leydig cell function E2 = Estradiol 17
Less Specific Symptoms and Signs of Androgen Deficiency Decreased: Energy Motivation Initiative Aggressiveness Self-confidence Feeling sad or blue, depressed mood, dysthymia Poor concentration and memory Sleep disturbance, increased sleepiness Mild anemia (normochromic, normocytic) Increased: Body fat Body mass index (BMI) Diminished physical or work performance Bhasin et al. JCEM. 2006;91:1995-2010.
Obesity and cancer risk
Associations of WHR and BMI with psychological outcomes in women (Lapidus et al, 1989) BMI WHR Degree of mental disorder ns + Feeling stress - + sleeplessness - + nightmares ns + tranquilizers ns + antidepressants ns + Sleeping tablets - ns
The Hypothalamus. The hypothalamus is responsible for all of these bodily functions. A bit like the fat controller!! 3/12/2013 23
The breakdown of the hypothalamus 3/12/2013 24
Weight loss (percentage from baseline over 2 years) among participants in the intensive medical intervention (IMI) group of the Louisiana Obese Subjects Study compared with the usual care condition (UCC) group Ryan, D. H. et al. Arch Intern Med 2010;170:146-154. Copyright restrictions may apply.
crucial external to integrated shift social context encourages this shift when... good rationale & clear achievement pathway provided (autonomy & competence) within a supportive relationship that allows expression of feelings (relatedness) genuine choice is offered (autonomy)
self-determination theory (SDT) looking at well-being through the lens of self-determination theory www.psych.rochester.edu/sdt SDT is a general theory of motivation & personality that has evolved over the past three decades SDT suggests humans, like plants or other animals, intrinsically strive for need satisfaction & flourishing social contexts can support or thwart this need striving with major effects for health & well-being Deci, E. L. and R. M. Ryan (1985). Intrinsic motivation and self-determination in human behavior. New York, Plenum. Deci, E. L. and R. M. Ryan (2000). The "what" and "why" of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry 11: 227-268.
three key psychological needs competence relatedness autonomy autonomy personal choice not compulsion by outside forces competence capable & effective not incompetent & inefficient relatedness regular emotional intimacy & shared activities not isolation & loneliness Reis, H. T., K. M. Sheldon, et al. (2000). Daily well-being: the role of autonomy, competence, and relatedness. Pers Soc Psychol Bull 26(4): 419-435. Sheldon, K. M., A. J. Elliot, et al. (2001). What is satisfying about satisfying events? Testing 10 candidate psychological needs. J Pers Soc Psychol 80(2): 325-39.
Plato Phaedrus (370 BC): The Charioteer represents intellect, reason, or the part of the soul that must guide the soul to truth; one horse represents rational or moral impulse or the positive part of passionate nature (e.g., righteous indignation); while the other represents the soul's irrational passions, appetites, or concupiscent nature. The Charioteer directs the entire chariot/soul, trying to stop the horses from going different ways, and to proceed towards enlightenment.
- Sociability - Agression - Attachment - Violence - Affection - Self-interest - Companionship - Utilitarianism - Sharing food - Indulgence - Maintaining health - Pleasure
Obese patients have unrealistic weight loss goals Outcome Weight (lbs) % Reduction Initial 218 0 Dream 135 38 Happy 150 31 Acceptable 163 25 Disappointed 180 17
Conclusies Gedragsverandering altijd moeilijk Bij cancer survivors wellicht moeilijker (meer of minder intrinsieke motivatie). Meer onderzoek nodig naar factoren die intrinsieke motivatie verhogen bij deze groep Lange begeleiding nodig voor blijvende gedragsverandering. Motiverende gespreksvoering hoort bij competenties.