Du er her

Psyken og magen

USUNT Manglende viljestyrke eller fysiologiske prosesser? Å behandle overvekt med psykoterapi eller endring i atferd fungerer ikke, mener artikkelforfatter Morten Nordmo. Foto: lassedesignen / Shutterstock / NTB Scanpix

Teorien om at overvekt opprettholdes på grunn av psykologiske prosesser og mangel på viljestyrke, mangler empirisk støtte.

Publisert
2. januar 2020

Behandling av voksne pasienter med overvekt med psykoterapi eller basert på atferdsendringer fungerer ikke. Slik konkluderte vi i en nylig publisert litteraturoppsummering i tidsskriftet Obesity Reviews (Nordmo, Danielsen & Nordmo, 2019). Vi undersøkte godt designede studier, med lite frafall og ingen tiltak i oppfølgingsperioden, og fant at den gjennomsnittlige deltageren ikke har noen effekt av behandlingen, enten den består av dietter, trening eller kognitiv atferdsterapi. Disse nedslående resultatene indikerer at kroppsvekt er under sterk fysiologisk kontroll, og at en folkehelsestrategi som baserer seg på slanking, ikke vil lykkes.

Hvorfor tror vi likevel at vi kan lykkes med å gå ned i vekt gjennom å endre tanker og atferd?

Du må være abonnent eller medlem av Psykologforeningen for å lese videre.

Ikke abonnent? Få 12 papirutgaver og ubegrenset tilgang til alle digitale utaver for 1495 i året

Teksten sto på trykk første gang i Tidsskrift for Norsk psykologforening, Vol 57, nummer 1, 2020, side 28-31

Kommenter denne artikkelen

Allison, D.B., Faith, M.S., & Gorman, B.S. (1996). Publication bias in obesity treatment trials? International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity, 20, 931–937.

Andersen, E., & Grimsmo, A. (1999). Langtidsresultater ved slanking i selvhjelpsgrupper. Tidsskrift for Den norske legeforening, 119, 14–7.

Cannon, G. (2005). Dieting. Makes you fat? British Journal of Nutrition, 93, 569–570. https://doi.org/10.1079/bjn20041382

Cooper, Z., Doll, H.A., Hawker, D.M., Byrne, S., Bonner, G., Eeley, E., … Fairburn, C.G. (2010). Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up. Behaviour Research and Therapy, 48, 706–713. https://doi.org/10.1016/j.brat.2010.03.008

Cooper, Z., & Fairburn, C.G. (2001). A new cognitive behavioural approach to the treatment of obesity. Behaviour Research and Therapy, 39, 499–511. https://doi.org/10.1016/s0005-7967(00)00065-6

Coutinho, S.R., Rehfeld, J.F., Holst, J.J., Kulseng, B., & Martins, C. (2018). Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity. American Journal of Physiology-Endocrinology and Metabolism, 315, 91–98. https://doi.org/10.1152/ajpendo.00322.2017

Danielsson, P., Kowalski, J., Ekblom, Ö., & Marcus, C. (2012). Response of Severely Obese Children and Adolescents to Behavioral Treatment. Archives of Pediatrics & Adolescent Medicine, 166, 1103–1108. https://doi.org/10.1001/2013.jamapediatrics.319

Fothergill, E., Guo, J., Howard, L., Kerns, J.C., Knuth, N.D., Brychta, R., … Hall, K.D. (2016). Persistent metabolic adaptation 6 years after «The Biggest Loser» competition. Obesity, 24, 1612–1619. https://doi.org/10.1002/oby.21538

Franz, M.J., VanWormer, J.J., Crain, A.L., Boucher, J.L., Histon, T., Caplan, W., … Pronk, N.P. (2007). Weight-loss outcomes: A systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. Journal of the American Dietetic Association, 107, 1755–1767. https://doi.org/10.1016/j.jada.2007.07.017

Gaesser, G.A., Tucker, W.J., Jarrett, C.L., & Angadi, S.S. (2015). Fitness versus Fatness: Which influences health and mortality risk the most? Current Sports Medicine Reports, 14, 327–332. https://doi.org/10.1249/JSR.0000000000000170

Karlsson, J., Taft, C., Rydén, A., Sjöström, L., & Sullivan, M. (2007). Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: The SOS intervention study. International Journal of Obesity, 31, 1248–1261. https://doi.org/10.1038/sj.ijo.0803573

Khodaee, M., Olewinski, L., Shadgan, B., & Kiningham, R.R. (2015). Rapid Weight Loss in Sports with Weight Classes. Current Sports Medicine Reports, 14, 435–441. https://doi.org/10.1249/jsr.0000000000000206

Maffei, M, Halaas, J., Ravussin, E., Pratley, R.E., Lee, G.H., Zhang, Y., … Ranganathan, S. (1995). Leptin levels in human and rodent: Measurement of plasma leptin and ob RNA in obese and weight-reduced subjects. Nature Medicine, 1, 1155-1165. https://doi.org/10.1038/nm1195-1155

Müller, M.J., & Bosy-Westphal, A. (2013). Adaptive thermogenesis with weight loss in humans. Obesity, 21, 218–228. https://doi.org/10.1002/oby.20027

Nordmo, M., Danielsen, Y.S., Nordmo, M. (2019). The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments. Obesity Reviews, 1–15. https://doi.org/10.1111/obr.12949

Pietiläinen, K.H., Saarni, S.E., Kaprio, J., & Rissanen, A. (2012). Does dieting make you fat? A twin study. International Journal of Obesity, 36, 456-463. https://doi.org/10.1038/ijo.2011.160

Polivy, J., & Herman, C.P. (1985). Dieting and binging: A causal analysis. American Psychologist, 40, 193- 205. https://doi.org/10.1037//0003-066x.40.2.193

Saarni, S.E., Rissanen, A., Sarna, S., Koskenvuo, M., & Kaprio, J. (2006). Weight cycling of athletes and subsequent weight gain in middleage. International Journal of Obesity, 30, 1639-1649. https://doi.org/10.1038/sj.ijo.0803325

Stunkard, A.J., Faith, M.S., & Allison, K.C. (2003). Depression and obesity. Biological Psychiatry, 54, 330–337. https://doi.org/10.1016/S0006-3223(03)00608-5

Stunkard, A., & McLaren-Hume, M. (1959). The results of treatment for obesity: A review of the literature and report of a series. AMA Archives of Internal Medicine, 103, 79–85.

Telch, C.F., & Agras, W.S. (1994). Obesity, binge eating and psychopathology: Are they related? International Journal of Eating Disorders, 15, 53–61. doi:10.1002/1098-108X(199401)15:1

Thong, Y.H. (1982). Obesity in evolutionary perspective. Medical hypotheses, 8, 431-435.

            https://doi.org/10.1016/0306-9877(82)90001-9

van Hees, M.L.J.M., Rotter, T., Ellermann, T., & Evers, S.M.A.A. (2013). The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: A systematic review. BMC Psychiatry, 13, 22-35. https://doi.org/10.1186/1471-244X-13-22

Våge, V. (2018, 31 Mars). Feilaktig om fedmekirurgi. Hentet fra: https://www.dagensmedisin.no/artikler/2018/03/31/feilaktig-om-fedmekirurgi/

Whitaker, R.C., Wright, J.A., Pepe, M.S., Seidel, K.D., & Dietz, W.H. (1997). Predicting obesity in young adulthood from childhood and parental obesity. New England Journal of Medicine, 337, 869–873. https://doi.org/10.1056/nejm199709253371301

Wilson, G.T., & Fairburn, C.G. (2000). The treatment of binge eating disorder. European Eating Disorders Review, 8, 351–354. https://doi.org/10.1002/1099-0968(200010)8:5<351::aid-erv382>3.0.co;2-2

Wing, R.R., & Phelan, S. (2005). Long-term weight loss maintenance. The American Journal of Clinical Nutrition, 82, 222–225. https://doi.org/10.1093/ajcn.82.1.222s