Curs psihosomatica 13.05.

2019
Principii generale de psihosomatica
Aplicatii speciale
Subiecte: Un cv, digestive, obezitate, intrebari din partea generala,

Aplicatie despre aspect psihosomatice in obezitate

1. Definit BMI
Cine studiaza? Specialitatile de DZ, nutritive, boli metabolice, endocrinologie, medicina
interna, cardio. (bat campii)

O schema despre pacientul obez: factori nationali sau regionali, gradul de urbanizare,
securitatea sociala, media si cultura, modul de pregatire al alimentelor, factori comunitari,
factori care tin de scoala, de familie, loc de munca, domiciliu, etc.

Clinical practice guidelines for comprehensive medical care of patients with obesity -> insista
pe comprehensive medical care. Nu este sufficient tratamentul medicamentos
Discriminare:
-ridiculizare de profesori, medici, familie
-anecdotic
-portretizari negative in media
-prejudecati la angajare

Atitudinea profesionistilor din domeniul sanatatii:

-atitudine negativa: dependenta de droguri, alcoolismul, problemele de sanitate mintala,
obezitatea
-medicii-asocieri cu: igiena deficitara,noncomplianta, ostilitatea, minciuna, lipsa succesului,
inactivitatea, vointa slaba.
-studentii la medicina; prejudecati substantiale: lipsa de valoare, neplacuti, ciudati, fara
success, lipsiti de autocontrol

Liimitari metodologice
-putine analize sistematice stiintifice
-sunt folosite descrieri scrise, din filme, autoraportari
-nu s-au eliminat factori ca varsta, sex, rasa
Perceptia pacientilor
-insatisfactia generate de greutatea corporala
-conditia fizica precara
-comportamentul alimentar

Amelioraarea calitatii vietii

-imbunatatirea imaginii corporale
-stabilizarea comportamentului alimentar

Increderea in experti
-nivel intalt de educatie reprezinta predictor pentru incredere si atentie
-marirea vizibilitatii in media => ineficienta
-imbunatatirea mesajelor de sanitate publica
-neincrederea in specialist

Implicatiile prejudecatilor in domeniul sanitar

-reticenta de a efectua examene ginecologice
-intarzierea dx de cancer mam
-testul Papanicolau tardive
-anularea programrilor la consultatie

Inlaturarea prejudecatilor
-recunoasterea obezitatii ca o conditie medicala cronica
-abordarea multidisciplinara
-familiarizarea cu resursele comunitatii
-atitudine suportiva
-medii accesibile pentru personae obeze

Lifestyle and behavioural therapy for overweight and obesity

The clinical component of diagnosis of obesity
Diabetes risk, metabolic syndrome and prediabetes, type 2 dyabetes, dyslipidemia, HTA, CV
disease and CV mortality, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Polycystic ovary sdr, female infertility, male hypogonadism, obstructive sleep apnea, asthma,
reactive airway disease, osteoarthritis, urinary stress incontinence, gastroesophageal reflux
disease, depression.

Treatment
Therapeutic benefits of weight loss in patients with overweight and obesity
Lifestyle and behavioral therapy for overweight and obesity
Individualization of pharmacotherapy
Bariatric surgery

Behavioral intervention
-self monitoring of weight
-Food intake and physical activity
-Clear and reasonable goal setting
-Education pertaining to obesity, nutrition and physical activity
-Face to face and group meetings systematic approaches for problem solving
-Stress reduction
-Motivational interviewing

Multidisciplinary team
This team that includes dietititans, nurses, etc

Goals of behavioural intervention

Should be intensified if patients do not achieve a 2.5 %weight loss in the first month of
treatment
-early weight reducation is a key prediction of long-term weight-loss success