Abordaje del cambio de hábitos alimentarios y estilos de vida en el manejo de sobrepeso y obesidad: consideraciones prácticas

Violeta Moizé, Gemma Peralta


Debido a la diversidad de factores que potencialmente contribuyen al desarrollo y mantenimiento del sobrepeso y obesidad, las guías clínicas específicas de tratamiento recomiendan un abordaje terapéutico multidisciplinar en el que intervienen, principalmente, médicos especialistas en endocrinología y nutrición, enfermería, psicólogos y dietistas-nutricionistas. Durante los últimos años, el acelerado aumento de la prevalencia de obesidad y la escasa respuesta al tratamiento convencional a largo plazo provocó un cambio de paradigma en el modelo de tratamiento y la relación terapéutica. Partimos de un modelo terapéutico paternalista y jerarquizado entre médico y paciente a un modelo de decisiones compartidas que tiene como objetivo empoderar al paciente en el control y toma de decisiones de su enfermedad. Este artículo tiene como objetivo revisar y proporcionar algunas de las pautas de manejo que favorecen un enfoque práctico centrado en el paciente y la importancia de potenciar la adhesión de la persona al programa como medida de éxito del tratamiento.
Otro aspecto importante que se recoge en este documento hace referencia al modelo de comunicación entre el terapeuta y el paciente mediante la entrevista motivacional, para generar un proceso favorable al cambio. Para finalizar este primer enfoque, se considerarán brevemente, aspectos relacionados con la adhesión al tratamiento por su estrecha relación con el mantenimiento del peso perdido a largo plazo. Finalmente, y dada la situación de pandemia que estamos viviendo, se consideraran aspectos relevantes que impactan de manera especial a la población a la que hacemos referencia en este artículo.

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Collaboration NC; NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017; 390(10113): 2627–42.

Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H, Widmer D, Yumuk V, Schutz Y. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019;12(1):40-66.

Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, Kushner RF, Daniels SR, Wadden TA, Tsai AG, Hu FB, Jakicic JM, Ryan DH, Wolfe BM, Inge TH. The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocr Rev. 2018 1;39(2):79-132.

American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Obesity Expert Panel, 2013. Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the The Obesity Expert Panel, 2013. Obesity (Silver Spring). 2014;22 Suppl 2:S5-39.

Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22(1):5-13.

Kuipers SJ, Cramm JM, Nieboer AP. The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Serv Res. 2019 8;19(1):13].

Kraschnewski JL, Boan J, Esposito J, Sherwood NE, Lehman EB, Kephart DK, Sciamanna CN. Long-term weight loss maintenance in the United States. Int J Obes (Lond). 2010;34(11):1644-54.

Willer CJ, Speliotes EK, Loos RJ, Li S, Lindgren CM, et al. Genetic Investigation of Anthropometric Traits Consortium. Six new loci associated with body mass index highlight a neuronal influence on body weight regulation. Nat Genet. 2009;41(1):25-34.

Stunkard AJ, Foch TT, Hrubec Z. A twin study of human obesity. JAMA. 1986, 4;256(1):51-4.

Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S-225S.

Unick JL, Beavers D, Jakicic JM, Kitabchi AE, Knowler WC, Wadden TA, Wing RR; Look AHEAD Research Group. Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: results from the Look AHEAD trial. Diabetes Care.2011;34(10):2152-7.

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;7:346(6):393-403.

Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-41.

Time crunch: PCPs swamped with chronic care management. Disease Management Advisor, 2005;11,(7):73-78.

Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005; 5;293(1):43-53.

Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M,Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008,17;359(3):229-41.

https://www.who.int/chp/knowledge/publications/adherence_report/en/. Ultimo acceso 14/10/2020.

Horne R,Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 1999, 47:555-567.

Miller WR, Rollnick, S. Motivational interviewing: Preparing people for change (2nd ed.) (2002). New York: Guilford Press.

Miller WS, Ross G. Toward a Theory of Motivational Interviewing. Am Psychol. 2009; 64(6): 527–537.

Bandura, A. Self-efficacy: Toward a Unifying Theory of Behavioral Change Psychological Review Stanford University, 1977; 84, 2:191-215.

Resnicow K, McMaster F, Bocian A, Harris D, Zhou Y, Snetselaar L, Schwartz R, Myers E, Gotlieb J, Foster J, Hollinger D, Smith K, Woolford S, Mueller D, Wasserman RC. Motivational interviewing and dietary counseling for obesity in primary care: a RCT. Pediatrics. 2015 Apr;135(4):649-57.

Leake GJ, King SA. Effect of counselor expectations on alcoholic recovery. Alcohol Health and Research World. 1977;11(3):16–22Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 1983; 51: 390–395.

Prochaska, J. O., & DiClemente, C. C. Stages and processes of self-change of smoking: Toward an integrative model of change. Jour Consulting Clin Psyc (1983). 51, 390–395.

Prochaska JO, DiClemente CC. Toward a comprehensive model of change. In W. R. Miller, & N. Heather (Eds.) 1986, Treating addictive behavior: Processes of change New York: Plenum 3–27.

Prochaska JO, DiClemente CC, Norcross, JC. In search of how people change: Applications to addictive behaviors. American Psychologist, 1992; 47:1102–1114.

Pascarella G., Strumia A., Piliego C. et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med 2020.

Wang Y., Wang Y., Chen Y., Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020; 92:568-576.

Francis H.M., Stevenson R.J., Oaten M.J., Mahmut M.K., Yeomans M.R. The Immediate and Delayed Effects of TV: Impacts of Gender and Processed-Food Intake History. Front Psychol 2017; 8:1616

Moynihan A.B., van Tilburg W.A., Igou E.R., Wisman A., Donnelly A.E., Mulcaire J.B. Eaten up by boredom: consuming food to escape awareness of the bored self. Front Psychol 2015; 6:369.

Cellini N., Canale N., Mioni G., Costa S. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res 2020;e13074

Mazza C., Ricci E., Biondi S. et al. A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int J Environ Res Public Health 2020; 17

Ozamiz-Etxebarria N., il-Santamaria M., Picaza-Gorrochategui M., Idoiaga-Mondragon N. Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain. Cad Saude Publica 2020; 36:e00054020

Wang C., Pan R., Wan X. et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health 2020; 17.

Wolf M.S., Serper M., Opsasnick L. et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med 2020.

Xiao H., Zhang Y., Kong D., Li S., Yang N. Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China. Med Sci Monit 2020; 26:e923921.

Cardi V., Leppanen J., Treasure J. The effects of negative and positive mood induction on eating behaviour: A meta-analysis of laboratory studies in the healthy population and eating and weight disorders. Neurosci Biobehav Rev 2015; 57:299-309.

Gluck M.E. Stress response and binge eating disorder. Appetite 2006; 46:26-30.

Hawkley L.C., Thisted R.A., Cacioppo J.T. Loneliness predicts reduced physical activity: cross-sectional & longitudinal analyses. Health Psychol 2009; 28:354-363.

Roberts C.J., Campbell I.C., Troop N. Increases in weight during chronic stress are partially associated with a switch in food choice towards increased carbohydrate and saturated fat intake. Eur Eat Disord Rev 2014; 22:77-82.

Torres S.J., Nowson C.A. Relationship between stress, eating behavior, and obesity. Nutrition 2007; 23:887-894.

Ammar A., Brach M., Trabelsi K. et al. Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey. Nutrients 2020; 12.

Di R.L., Gualtieri P., Pivari F. et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med 2020; 18:229.

RodrÃguez-Pérez C., Molina-Montes E., Verardo V. et al. Changes in Dietary Behaviours during the COVID-19 Outbreak Confinement in the Spanish COVIDiet Study. Nutrients 2020; 12

Scarmozzino F., Visioli F. Covid-19 and the Subsequent Lockdown Modified Dietary Habits of Almost Half the Population in an Italian Sample. Foods 2020; 9.

Sidor A., Rzymski P. Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients 2020; 12.

Simon G.E., Von K.M., Saunders K. et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006; 63:824-830.

Rubino F., Cohen R.V., Mingrone G. et al. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery. Lancet Diabetes Endocrinol 2020; 8:640-648

Chua J.L., Touyz S., Hill A.J. Negative mood-induced overeating in obese binge eaters: an experimental study. Int J Obes Relat Metab Disord 2004; 28:606-610.

Dashti H.S., Scheer F.A., Jacques P.F., Lamon-Fava S., Ordovás J.M. Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Adv Nutr 2015; 6:648-659.

Henriksen R.E., Torsheim T., Thuen F. Loneliness, social integration and consumption of sugar-containing beverages: testing the social baseline theory. PLoS One 2014; 9:e104421.

Huang J.W., Lin Y.Y., Wu N.Y. The effectiveness of telemedicine on body mass index: A systematic review and meta-analysis. J Telemed Telecare 2019; 25:389-401.ç

Morriss R., Patel S., Malins S. et al. Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial. BMC Med 2019; 17:16.

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