Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1002_Библиотеки_им_академика_М_И_Перельмана

effort, minimizes the effect of distractors, as well as increases energy, motivation, and persistence for them to be achieved [15]. Goal setting is acknowledged as an evidence-based behavioral change strategy, due to its specic, measurable, and pal­pable characteristic [16]. DEB in people with obesity is inuenced by a phenome­non studied in animals, called cue-potentiated eating [17] or, in humans, unplanned eating, which is dened by a much more intense behavior of searching for food after an exposure to environmental food cues. Stimulus control interventions improve DEB by helping patients to identify and modify such cues [18]. Structured problem­solving techniques comprise, in essence, methods to assist patients in identifying personal problems underlying specic symptoms leading to DEB and, consequently, to weight gain and in developing suitable skills to solve these problems [19, 20]. The technique encompasses different phases, beginning with the delimitation of the problem, its clarication, and the elaboration of a plan to approach it, being comple­mented by a clear establishment of objectives, besides the encouragement to the description of available proposals targeting at the resolution of the problem [19, 20]. It is common for patients searching for obesity treatment to have very vague, unreal, or hard-to-solve problems, as well as poorly dened or intangible strategies to deal with these problems. Although controversial, the phenomenological similarity of DEB in obesity with substance use disorders seems frequently unescapable. Such similarity is supported by a series of neuroimaging ndings showing superposition of neural pathways in both conditions [21]. Thus, just as what occurs with substance addicts, individuals with obesity need assistance in order to avoid relapses and to learn to deal with loss of control. In this sense, it is essential to add that diets stimu­late a predominantly cognitive control over food, which is easily lost when one has to deal with a negative affect or an environmental stressor, leading to the abandon­ment of diets, when not to eating disorders [22]. Weeks to months before DEB emerge in an individual on a diet, dysfunctional emotions and cognitions may already sign that a relapse is on the way. Teaching patients to recognize and develop skills to deal with these negative mental states is the primary goal of relapse preven­tion. Signs of cognitive relapses include cravings and thoughts about places, people, and things associated with past substance or food uses, associated with minimiza­tion of the consequences of a relapse. Physical relapse, in turn, occurs when a patient has already engaged in DEB, with varying levels of lack of control. Loss of control over eating has been identied not only in major eating disorders, such as bulimia nervosa and binge eating disorder, but also in conditions such as grazing, nibbling, or snack eating, which could be considered subsyndromal eating disorders [23], where small amounts of food are recurrently consumed without planning between meals. It is important to keep in mind that many dietary programs endorse several meals per day or small low carb snacks between meals and that such orienta­tions might be subverted as subsyndromal eating disorders by some patients with obesity.