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The proposition that lifestyle is a major determinant of community health is explored by contrasting the features of a rural subsistence community in the highlands of Papua New Guinea and the features of the community in urbanized, industrialized Australia. Reference is made to differences in physical environment, housing, work, social situation, human relationships, patterns of disease, population statistics, diet, growth, obesity, physical fitness, blood lipid concentrations, blood pressure, salt intake and the occurrence of hypertension, diabetes, cardiovascular disease and signs of degenerative changes in various tissues. The Papua New Guinea community is seen as a self-reliant, self-contained, socially cohesive subsistence society whose members are well adapted to their physical and social environment, free from major degenerative cardiovascular diseases, with little overt psychiatric illness, but with a heavy burden of infectious disease, with marginal nutritional levels of degenerative disease and disease from psychological stress. It is clear that health, in its fullest sense, is not the prerogative of any one type of society.
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PMID:Lifestyle, health and disease: a comparison between Papua New Guinea and Australia. 73 10

The psychosocial aspects of intestinal bypass of intestinal bypass surgery for massive obesity are considered from the standpoint of their implications for therapeutic decisions. The author's experience with a prospective study of 29 bypass patients, reported in 1974, is summarized. Response to weight loss included improvement in activity levels, mood, self-esteem, interpersonal and vocational effectiveness, and a trend toward more normal eating behavior. Notable changes included decreased use of denial as a coping style, and loss of a self-reinforcing sense of entrapment, resignation, and ineffectiveness associated with massive obesity. Psychiatric illness, when it occurred, did not appear to be the direct result of surgery or weight loss. The available literature in the field is reviewed and compared with these results. While there is much support for the impression of substantial psychosocial benefit following weight loss, most reports place greater emphasis on the psychosocial morbidity and psychiatric hazards associated with bypass surgery. Problems encountered in evaluating these reports are discussed, including the importance of the length of the follow-up interval, and the need to describe the interaction between psychosocial morbidity, the patient's psychosocial base-line, and the somatic status. A plea is made against premature utilization of psychosocial screening criteria while knowledge is still so limited, and tentative guidelines for clinical practice and research are proposed.
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PMID:Psychosocial aspects of intestinal bypass surgery for massive obesity: current status. 83 32

Seventy-seven women discharged from hospital with a diagnosis of myocardial infarction and 207 control patients were investigated. All were under 45 years of age at the time of admission. Heavy cigarette smoking, reported treatment for pre-eclamptic toxaemia, and type II hyperlipoproteinaemia were found to be independent risk factors for myocardial infarction. Reported treatment for hypertension and diabetes are probably also independently associated with subsequent development of the condition, but the associations between myocardial infarction and reported treatment for obesity and psychiatric illness appear to be secondary. Previous publications have suggested that use of oral contraceptives is an independent risk factor. Examination of the effect of several factors combined, suggests that they act synergistically, the presence of three or more factors increasing the risk 128-fold.
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PMID:Risk factors for myocardial infarction in young women. 95 82

The purpose of this brief work is to study and make a general survey of the problem of obesity as related in whatever way, to the use of psychotropic drugs. It is a fact learned through clinical experience and knowledge by clinics and researchers working in the field of psychotropic drugs that patients subjected to extended therapy with such drugs show, in a considerable number of cases, an increase in body weight. We consider that this obesity, the pathogenetic cause of which is attributed to the action of psychotropic drugs, constitutes a serious disadvantageous side-effect of those drugs, since a large number of mental patients discontinue their drug therapy for the reasons that it is responsible for the increase in their body weight. It is a known fact discontinuation of the psychotropic drug treatment generally results in a relapse of their mental disorder.
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PMID:Obesity related to the use of psychotropic drugs, considered in its organic aspect. 105 61

It is a well known fact that one of the side-effects of the psychotropic drugs is a disturbance of body weight in the form of obesity. We believe this to be a serious side-effect because obesity is often the main reason why the patient discontinues his psychopharmaaceutical therapy, thereby causing a recrudescence of his mental illness. We have proposed that this type of obesity be designated by the diagnostic term "psychopharmacotherapeutic obesity". This paper contains a formulation and discussion of views and concepts related to a consideration of the psychodynamic aspect of the subject. Special emphasis has been given to commenting on the problem of psychopharmacotherapeutic obesity from the standpoint of etiogenesis, psychological effects, and its importance in relation and conjunction with the development and formation of the individuals' psychosomatic identity.
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PMID:Obesity related to the use of psychotropic drugs, considered in its psychodynamic aspect. 105 64

A 71-year-old man was noted to habitually snore loudly at night and have a predisposition to somnolence during the daytime. While dozing during the day, he developed cardiac arrest at the time when snoring stopped, and was resuscitated. By means of a respiration monitor, he was diagnosed as having sleep apnea syndrome (SAS) with a combination of obstructive, central, and mixed type. However, neither respiratory insufficiency nor cardiac insufficiency was observed, and there were no abnormal findings on laboratory tests and bronchoscopy. SAS complicated by cardiac arrest is usually seen in cases with concomitant symptoms such as excessive obesity, hypertension, arrhythmia, right heart insufficiency, secondary polycythemia, or mental disorder. The present case abruptly developed cardiac arrest in the absence of such symptoms. This case therefore suggests the importance of screening tests using a respiration monitor during sleep in subjects who have a loud snore or a predisposition to somnolence during the daytime. Although treatment with UPPP alone had no noticeable effect, UPPP treatment combined with sleeping in the lateral position was effective in the present case. The efficacy rate of UPPP has been reported to be 50 to 60%. The early establishment of a method for precise evaluation of the site of obstruction as well as criteria for appropriate application of UPPP are urgently required.
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PMID:[A resuscitated case of sleep apnea syndrome with cardiac arrest]. 160 64

The associations between generalized obesity measured as body mass index (BMI), or adipose tissue distribution, measured as the waist/hip circumference ratio (WHR), on one hand, and a number of socioeconomic, somatic as well as psychologic and mental health variables on the other, were analysed in a population study of women (1462 participants, aged 38-60 years, participation rate 90.1%). The anthropometric measurements were adjusted for their influence on each other. BMI, but not WHR, was negatively associated with socioeconomic status and education. Increased WHR correlated to a number of somatic diseases from different organ systems, including diabetes mellitus, infectious respiratory and abdominal diseases. Even more striking were strong correlations to a number of variables indicating accident proneness as well as mental disorder, and increased use of antidepressants and tranquilizers. BMI and WHR were also associated to different personality profiles. Furthermore, the use of alcohol and smoking were positively correlated to the WHR. In contrast, most of these associations were not seen with the BMI--sometimes even negative correlations were found. Exceptions were, however, varicose veins, joint problems and surgery for gall bladder disease, which were positively correlated to BMI only. Blood pressure, plasma triglycerides and uric acid were positively correlated to both BMI and the WHR, plasma cholesterol, however, only to the WHR. Obesity (high BMI) and abdominal adipose tissue distribution (high WHR) clearly show differences in their associations to various health variables. It is hypothesized that an arousal syndrome might be a contributing factor to cause symptoms of psychological maladjustment, including psychosomatic disease. Hypothetically, in parallel, an accumulation of depot fat in the abdominal depot, might follow as a consequence of neuroendocrine dysregulation of endocrine secretions.
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PMID:Obesity, adipose tissue distribution and health in women--results from a population study in Gothenburg, Sweden. 278 94

This report investigates childhood and adolescent obesity through a comparison with anorexia nervosa, an eating disorder typically associated with the opposite end of the eating behavior spectrum. Many similarities in the etiologies of the two conditions are discussed, particularly with regard to the influence of family interactional patterns. More specifically, it appears that the families of both anorexics and the obese are characterized by overprotectiveness and enmeshment, resulting in a poor sense of identity and effectiveness. Such children, usually compliant and dependent in childhood, misuse the eating function in an attempt to assert their independence and gain control of their lives in adolescence. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), anorexia nervosa, but not obesity, meets the definition of an eating disorder. Although it appears that DSM-III-R is accurate in not classifying obesity as an eating disorder, it is important to keep the etiological similarities of the two conditions in mind when treating obesity.
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PMID:Determinants of adolescent obesity: a comparison with anorexia nervosa. 328 9

One hundred and fifty-three consecutive patients referred to the Royal Prince Alfred Hospital for consideration of gastric bariatric surgery (surgery for obesity) were assessed pre-operatively by the one psychiatrist, with regard to social, psychological and psychiatric factors. Fifty-one patients (33%) were considered to be uncomplicated from a psychiatric point of view. Eighty-eight patients (58%) had identifiable psychopathology and 14 patients (9%) were of doubtful motivation. Thirty patients (20%) were rejected from the treatment programme after the initial assessment because of overt psychiatric illness, severe situational stress, insufficient motivation or lack of significant support. Six of these patients after further assessment or after responding to psychiatric treatment were reviewed and found suitable for a bariatric operation. Of the 113 patients who had a bariatric procedure performed, 17 patients (15%) required postoperative psychiatric management. while the need for psychiatric assessment of patients presenting for bariatric surgery is disputed by some, our experience would indicate that careful pre-operative screening by a liaison psychiatrist, familiar with morbid obesity and its surgical management, is useful in any bariatric surgical programme. Such screening should identify and enable exclusion of the small number of patients who for psychiatric reasons, are poor risk candidates. A number of other patients in whom identifiable psychopathology will be discerned, will require pre-operative psychiatric management. While such a programme will decrease postoperative psychiatric problems, these will not be eliminated in the morbidly obese, and the assessing liaison psychiatrist will have a valuable role to play in the collaborative postoperative management of such patients.
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PMID:Pre-operative psychiatric assessment of patients presenting for gastric bariatric surgery (surgical control of morbid obesity). 346 May 50

During a study of 72 patients submitted to jejeunoileostomy for obesity seven were found in whom compulsive, episodic overeating was associated with depressive mood disturbance. When followed up nine to 27 months after operation all seven had lost weight and had also lost the habit of compulsive eating. In all cases psychiatric symptoms improved or disappeared, and symptom substitution was not observed. Obesity rather than psychiatric disorder is usually the main problem in such patients. The implications for psychoanalytic and other concepts of obesity are discussed.
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PMID:Beneficial effects of jejeunoileostomy on compulsive eating and associated psychiatric symptoms. 443 87


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