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)