臨床外科76巻4号

2021年04月発行

特集 肥満外科A to Z 総論

肥満症の病態と行動心理

著者： 齋木厚人¹

所属機関： ¹東邦大学医療センター佐倉病院 糖尿病内分泌代謝センター

ページ範囲：P.399 - P.405

【ポイント】
◆BMI 35 kg/m²以上で肥満に起因ないし関連し減量を要する健康障害を伴う場合，高度肥満症と診断される．
◆減量・代謝改善手術は，肥満に関連するあらゆる健康障害を改善する可能性がある．
◆高度肥満症は心理社会面が関与する病気であり，リバウンドする病気である，という理解が必要である．

参考文献

1）Kaufman AS, McNelis J, Slevin M, et al：Bariatric surgery claims-a medico-legal perspective. Obes Surg 16：1555-1558, 2006

2）Saiki A, Yamaguchi T, Tanaka S, et al：Background characteristics and postoperative outcomes of insufficient weight loss after laparoscopic sleeve gastrectomy in Japanese patients. Ann Gastroenterol Surg 3：638-647, 2019

3）Nagayama D, Imamura H, Sato Y, et al：Inverse relationship of cardioankle vascular index with BMI in healthy Japanese subjects：a cross-sectional study. Vasc Health Risk Manag 13：1-9, 2016

4）Nagayama D, Watanabe Y, Yamaguchi T, et al：New index of abdominal obesity, a body shape index, is BMI-independently associated with systemic arterial stiffness in real-world Japanese population. Int J Clin Pharmacol Ther 58：709-717, 2020

5）Saiki A, Yamaguchi T, Sasaki A, et al：Background characteristics and diabetes remission after laparoscopic sleeve gastrectomy in Japanese patients with type 2 diabetes stratified by BMI：subgroup analysis of J-SMART. Diabetology International（in print）

6）日本肥満症治療学会メタボリックサージェリー検討委員会．メタボリックサージェリーの動向—わが国での健全な定着に向けて．肥満症治療学展望別冊，2016，pp 31-37

7）Noseda A, C Kempenaers, M Kerkhofs, et al：Sleep apnea after 1 year domiciliary nasal-continuous positive airway pressure and attempted weight reduction. Potential for weaning from continuous positive airway pressure. Chest 109：138-143, 1996

8）Sarkhosh K, Sarkhosh K, Switzer NJ, et al：The impact of bariatric surgery on obstructive sleep apnea：a systematic review. Obes Surg 23：414-423, 2013

9）Dixon JB, Schachter LM, O'Brien PE, et al：Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea：a randomized controlled trial. JAMA 308：1142-1149, 2012

10）Chen J, Muntner P, Hamm LL, et al：The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med 140：167-174, 2004

11）Praga M, Hernández E, Morales E, et al：Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant 16：1790-1798, 2001

12）龍野一郎，他：食欲中枢異常による難治性高度肥満症の実態調査報告書．平成28年度厚生労働科学研究費補助金難治性疾患等政策研究事業，2016

13）Saiki A, D Nagayama, M Ohhira, et al：Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy. Int J Obes 29：1115-1120, 2005

14）McGavock JM, Victor RG, Unger RH, et al：American College of Physicians and the American Physiological Society. Adiposity of the heart, revisited. Ann Intern Med 144：517-524, 2006

15）Hirano K, Ikeda Y, Zaima N, et al：Triglyceride deposit cardiomyovasculopathy. N Engl J Med 359：2396-2398, 2008

16）Vest AR, Young JB：Should we target obesity in advanced heart failure? Curr Treat Options Cardiovasc Med 16：284, 2014

17）Saiki A, Kanai R, Nakamura S, et al：Impact of Mental Health Background and Nutrition Intake on Medium-Term Weight Loss in Japanese Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Facts 13：371-383, 2020

18）Kalarchian MA, Marcus MD, Levine MD, et al：Psychiatric disorders among bariatric surgery candidates：relationship to obesity and functional health status. Am J Psychiatry 164：328-334, 2007

19）林　果林，加藤祐樹，山口　崇，他：高度肥満症患者に併存する精神疾患：うつ症状を中心に．日心療内誌20：267-272，2016

20）Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, et al：Psychosocial evaluation of bariatric surgery candidates：a survey of present practices. Psychosom Med 67：825-32, 2005

21）Mechanick JI, Apovian C, Brethauer S, et al：Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures-2019 update：cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic ＆ Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists-Executive Summary. Endocr Pract 25：1346-1359, 2019

22）小山朝一，宮下　洋，山村重雄，他：ロールシャッハ・テストを用いた肥満症患者の性格特性分析　ハイラムダスタイルについて．肥満研15：39-44，2009