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최형진
내용
1. 비만
2. 식욕조절기전
3. 식욕과중독
4. 스트레스
5. 진단
음식중독?/식이중독?
6. 치료
내용
1. 비만
2. 식욕조절기전
3. 식욕과중독
4. 스트레스
5. 진단
음식중독?/식이중독?
6. 치료
Human evolution = Obesity?
Obesity Related Diseases
2012 JCEM Regulation of food intake, energy balance, and body fat mass- implications for the pathogenesis and treatment of obesity
비만치료?
Psychotherapy
동기부여식사요법+운동요법
Pharmacotherapy
(출처: 자료-교육과학기술부(2012), 그림-연합뉴스(2012)/ 재인용 : 미래창조과학부)
미래창조과학부(장관최문기)는 2013년사회문제해결형기술개발사업으로▲암치료부담증가▲아동·청소년비만▲유해화학물질유출등 3개분야의과제를선정하고앞으로 3년간 270억원을지원한다고 6일밝혔다.
내용
1. 비만
2. 식욕조절기전
3. 식욕과중독
4. 스트레스
5. 진단
음식중독?/식이중독?
6. 치료
Modern Obesity
Genetic Environmental
Prader
Willi
Leptin Deficiency
Modern Environment
Physiologic Control of Energy Metabolism
Appetite Energy Expenditure
Obesity
T2DM
Hypertension
HungerPhysiological desire
AppetitePsychological desire
2012 JCEM Regulation of food intake, energy balance,
and body fat mass- implications for the pathogenesis
and treatment of obesity
Appetite
Appetite
Appetite
Calorie Restriction
2012 Nature Medicine Shedding pounds after going under the knife
↑Agrp
↑NPY
↓POMC
↑Agrp
↑NPY
↓POMC
Contro l Ad lib- fed Pair - fed350
375
400
425
450
Cu
mu
lative
fo
od
in
take
(g
)
*
Food intake
*P < 0.05
Mean±SEM
0 7 14 21180
200
220
240
260
280
300
320
340 Control
Ad lib-fed
Pair-fed
Day
Weig
ht
(g)
*: P < 0.05 vs.
control†: P < 0.05 vs. paired-fed
†*†
*†*†
*†*†
*†*†
*† ††
*††
†† *†† † †*†
*†
Body weight
Mean±SEM
Impact Factor = 3.534
Impact Factor = 6.31
Genetics of eating behavior
2011 Genetics of eating behavior
식욕촉진호르몬Ghrelin
식전 ↑
체중감소시↑
2002 NEJM Plasma Ghrelin Levels after Diet-Induced Weight Loss or Gastric Bypass Surgery
2011 NEJM Long-term persistence of hormonal adaptations to weight loss.
N=50
Determination of the settling point
for food intake
Food
Availability
PalatabilityLeptin Resistance↑Adiposity↑ Leptin↑
2010 Trends in Endocrinology and Metabolism- Obesity and leptin resistance- distinguishing cause from effect
New Set Point
2014 NRE Hormonal and neural mechanisms of food reward, eating behavior and obesity
Anatomy
Paraventricular Nucleus (PVN, PVH)
Lateral Hypothalamus Area (LHA)
Arcuate Nucleus (ARC, ARH)
2008 Obesity Central and Peripheral Regulation of Food Intake and Physical Activity
식욕조절중추
보상시스템
대뇌피질
음식섭취 에너지소비
시각자극
후각자극
미각자극
내용
1. 비만
2. 식욕조절기전
3. 식욕과중독
4. 스트레스
5. 진단
음식중독?/식이중독?
6. 치료
“Obesity and drug addiction may share common hedonic mechanisms”
2011 Neuron. Reward mechanisms in obesity- new insights and future directions
Liking and Wanting
• “Liking” (hedonic impact)
• “Wanting” (incentive motivation)
• Learning (associations and predictions)
• “Wanting” without “liking”– Addictive incentive-sensitization
• A mechanism of drug addiction
• Sensitized “wanting” can rise even if “liking” declines for the same reward
– Hypothetically, if a similar brain mechanism applies to obesity and eating disorders, some individuals could compulsively crave and seek food, but not derive higher pleasure from it.
2010 Brain Research- The tempted brain eats- Pleasure and desire circuits in obesity and eating disorders
2013 The Addictive
Dimensionality of Obesity
Addictive Dimensionality
of Obesity
Model
Food Reward and Obesity
2009 Relation of obesity to consummatory and anticipatory food reward
2012 Feed-forward mechanisms- Addiction-like behavioral and molecular adaptations in overeating
2012 Feed-forward mechanisms- Addiction-like behavioral and molecular adaptations in overeating
내용
1. 비만
2. 식욕조절기전
3. 식욕과중독
4. 스트레스
5. 진단
음식중독?/식이중독?
6. 치료
2009 Nat Rev Endocrinol. Stress and disorders of the stress system
Stress and Food Intake
2009 Trends in Endocrinology and Metabolism- Stress-induced obesity and the emotional nervous system
Stress and addiction
(substance or food)
2013 Stress as a Common Risk Factor for Obesity and Addiction
2013 Stress as a Common Risk Factor for Obesity and Addiction
Model of insulin resistance, regional brain
activation, and food craving in obese individuals
2012 Diabetes Care. Neural Correlates of Stress- and Food- Cue-Induced Food Craving In Obesity
Viscous cycle driving weight gain
2012 Ghrelin signalling and obesity- At the interface of stress, mood and food reward
Canonical Pathways that Regulate
Stress Responses and Energy Balance
2014 Cell Metabolism. Neuroendocrine Circuits Governing Energy Balance and Stress Regulation- Functional Overlap and Therapeutic Implications
Functional Interactions between Homeostatic
Metabolic Signaling, Physiological Responses to
Stress, and Reward-Driven Food Intake
2014 Cell Metabolism. Neuroendocrine Circuits Governing Energy Balance and Stress Regulation- Functional Overlap and Therapeutic Implications
2013 Stress as a Common Risk Factor for Obesity and Addiction
내용
1. 비만
2. 식욕조절기전
3. 식욕과중독
4. 스트레스
5. 진단
음식중독?/식이중독?
6. 치료
Behavioral Addiction vs. Substance Addiction
Food Addiction in the Light of DSM-5
2014 Food Addiction in the Light of DSM-5
Food Addiction in the Light of DSM-5
2014 Food Addiction in the Light of DSM-5
Food Addiction in the Light of DSM-5
2014 Food Addiction in the Light of DSM-5
Gambling disorder criteria according to the DSM-5 and
possible corresponding food addiction criteria
2014 Food Addiction in the Light of DSM-5
“Eating Addiction” “Food Addiction”
Behavioral Addiction Substance Addiction
Yale Food Addiction Scale
음식중독점수
A U C
과다섭취 0 0 1
지속적탐식혹은중단실패 1 1 1
음식관련과도한시간/행위소요 2 0 1
음식관련사회적, 직업적, 여가제약 0 2 4
해로운결과알면서계속탐닉 1 1 1
내성 (점점더큰자극탐닉) 0 1 2
금단증상 1 0 1
신체적손실초래 0 0 2
종합중독점수 5 5 11
/표준
/표준
/표준
/표준
/표준
/표준
/표준
총콜레스테롤 LDL콜레스테롤 중성지방
A
U
C
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
A U C
인슐린저항성
/표준
/표준
/표준
/표준
/표준
/표준
/표준
/표준
/표준
/표준
A U C
Leptin
/표준
/표준
/표준
/표준
/표준
/표준
/표준
공복혈당 간기능수치(AST) 간기능수치(ALT)
A
U
C
혈액검사
DLPFC
ACCDLPFC, ACC (ASH) 생크림에대해저항/고민하는반응Executive functioning, conflict monitoring
생크림중독반응 (CYH)
Left Insula: positive emotional processing
Ventromedial prefrontal cortex: reward processing
Left Insula
VMPFC
내용
1. 비만
2. 식욕조절기전
3. 식욕과중독
4. 스트레스
5. 진단
음식중독?/식이중독?
6. 치료
2012 NEJM A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children
TAX on
Sugar Sweetened Beverages
NYC to Ban
Large Sugar Drinks
BAN on
Sugar Sweetened Beverages
2014.10.27.
Soda School
No-Soda School
Obese Family Lean Family
2012 Can Food and Addiction Change the Game
2012 Cell Metabolism Energy Intake and Exercise as Determinants of Brain Health and Vulnerability to Injury and Disease
Bupropion for
Smoking Cessation
2014 Cell Metabolism.
Neuroendocrine Circuits
Governing Energy Balance
and Stress Regulation-
Functional Overlap and
Therapeutic Implications
2011 Nature. Brain buzz
Transcranial direct current stimulation (tDCS)
Treatment for cravings for alcohol, cigarettes and
sweets
ModifytDCS Measure
tDCS Disease Treatment Indications
tDCS Decreases Food Craving
Real tDCS
Sham tDCS
Real tDCS
Sham tDCS
Craving Trouble resisting
2011 Appetite. Prefrontal cortex transcranial direct current stimulation (tDCS) temporarily reduces
food cravings and increases the self-reported ability to resist food in adults with frequent food craving
Long-term tDCS Treatment
Decreases Food Intake
2014 AJCN Repetitive electric brain stimulation reduces food intake in humans
Clinical Trial
fMRI tDCS
CBNUH
KBSI YBRAIN (KAIST)
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