Yeme Bağımlılığı
Özet
Yeme bağımlılığı, özellikle 21. yüzyılda obezitenin küresel artışıyla önem kazanan ve tanı kriterleri Yale Yeme Bağımlılığı Ölçeği'ne (YYBÖ) dayandırılan karmaşık bir olgudur. Literatürde yeme bağımlılığının bir yeme bozukluğu mu, davranışsal bir bağımlılık mı yoksa obeziteyle ilişkili bir mental bozukluk mu olduğu tartışılmaktadır. Nörobiyolojik çalışmalar; aşırı işlenmiş, basit karbonhidrat ve yağ açısından zengin gıdaların mezolimbik dopaminerjik yolaklar ile opioid sistemi üzerinde tıpkı psikoaktif maddeler gibi güçlü ödüllendirici etkiler yarattığını ve zamanla D2 reseptör yoğunluğunu azaltarak tolerans, yoksunluk ve aşerme döngülerine yol açtığını göstermektedir. "İsteme" (aşerme) mekanizmasının "hoşlanma" hissine kıyasla bağımlılık davranışında daha belirleyici olduğu saptanmıştır. Toplum çalışmalarında yeme bağımlılığı sıklığı %16,2 ile %19,9 arasında değişmekte; obez popülasyonda ve yeme bozukluğu olanlarda bu oran belirgin şekilde yükselmektedir. Dürtüsellik ve duygu düzenleme güçlüğü gösteren adölesanlarda da risk yüksektir. Yeme bağımlılığına özel onaylanmış bir farmakolojik tedavi olmamakla birlikte, obezite tedavisinde kullanılan naltreksan-bupropion kombinasyonu gibi ödül merkezini hedefleyen ilaçlar ile bilişsel davranışçı terapi (BDT), psiko-eğitim ve bariyatrik cerrahiyi içeren bütüncül yaklaşımlar tedavide öne çıkmaktadır.
Food addiction is a complex phenomenon that has gained prominence especially in the 21st century with the global rise of obesity, and its diagnostic criteria are based on the Yale Food Addiction Scale (YFAS). It is debated in the literature whether food addiction should be classified as an eating disorder, a behavioral addiction, or an obesity-related mental disorder. Neurobiological studies show that highly processed foods rich in simple carbohydrates and fats create powerful rewarding effects on the mesolimbic dopaminergic pathways and the opioid system, similar to psychoactive substances, and lead to tolerance, withdrawal, and craving cycles by reducing D2 receptor density over time. It has been found that the mechanism of "wanting" (craving) plays a more decisive role in addictive behavior compared to the feeling of "liking". In community studies, the prevalence of food addiction varies between 16.2% and 19.9%, and this rate increases significantly in the obese population and individuals with eating disorders. The risk is also high among impulsive adolescents who experience emotion dysregulation. Although there is no approved pharmacological treatment specific to food addiction, holistic approaches featuring medications targeting the reward center, such as the naltrexone-bupropion combination used in obesity treatment, along with cognitive behavioral therapy (CBT), psychoeducation, and bariatric surgery, come to the forefront in management.
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