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Когнитивные и мозговые механизмы поведения, связанного с перееданием при ожирении у женщин
Obstetrician-gynecologist, as well as doctor of any other specialty, is a psychologist to some extent. At the same time obstetrician-gynecologist often meets female patients suffering from obesity: pregnant women with alimentary-constitutional obesity, gynecologic patients of reproductive age with infertility and visceral obesity development (polycystic ovary syndrome), menopausal age patients with metabolic syndrome. Often these patients have eating disorders. Therefore, knowledge of the cognitive and brain mechanisms of overeating behavior in obese women is of great importance for the obstetrician-gynecologist. Analysis of published works shows that the nature of obesity is complex. It is important to distinguish such phenomena as obesity, compulsive overeating, and food addiction; they can be observed in combination or independently of each other. Obesity, as well as food addiction, often have a genetic nature. Compulsive overeating is more often acquired and can be influenced by a range of factors. Compulsive overeating is associated with certain structural and functional changes in the brain, such as a decrease in gray matter and regional cerebral blood flow in the visual, sensorimotor and prefrontal areas of the cortex, which leads to impaired cognitive control and visual information processing when presented with food stimuli. This results in such patients becoming more vulnerable when visualizing food stimuli and characterized by a lack of control over overeating. A consequence of this is stronger activation of the beta rhythm in the orbitofrontal cortex, insular lobe, occipital cortex, postcentral and spindle cortex both in response to food stimuli and at rest, which indicates high excitability of such patients and their propensity for impulsivity and behavioral disinhibition. Taking the above mentioned into account, it is reasonable to recommend to patients with compulsive overeating to train cognitive control with simultaneous use of means for reduction of excitability and anxiety (relaxation, self-hypnosis, biofeedback trainings, etc.). On the medication side, the brain gamma-aminobutyric acid and glutamate systems may be potential targets for treatment of patients with compulsive overeating, as these systems are associated with the beta rhythm, whose activation is increased in individuals with eating disorders, prone to compulsive overeating.