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  • Factor de Impacto: 1,314(2015)
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doi: 10.1016/S1575-0922(06)71128-7
Originales
Diferencias clínicas entre pacientes obesos mórbidos con y sin atracones
Clinical differences between morbidly obese patients with and without binge eating
Francisco Arias Horcajadasa,, , Sergio Sánchez Romeroa, Juan José Gorgojo Martínezb, Francisca Almódovar Ruizb, Sonia Fernández Rojoa, Francisco Llorente Martína
a Unidad de Psiquiatría. Fundación Hospital Alcorcón. Alcorcón. Madrid. España
b Unidad de Endocrinología. Fundación Hospital Alcorcón. Alcorcón. Madrid. España
Recibido 27 octubre 2005, Aceptado 20 febrero 2006
Resumen
Objetivos

Evaluar las diferencias clínicas de pacientes obesos con y sin alteraciones de la conducta alimentaria.

Pacientes y método

Se estudió a 210 pacientes con obesidad mórbida derivados de forma consecutiva y por diferentes motivos a una consulta de psiquiatría en un hospital general. Se realizó una entrevista clínica, se valoró la presencia de comorbilidad psiquiátrica y se aplicó una serie de escalas de psicopatología y sobre conducta alimentaria: Escala de Depresión de Beck (BDI), Escala de Ansiedad de Beck (BAI), Inventario de Obsesiones-Compulsiones de Maudsley (MOCI), Escala de Impulsividad de Barrat (BIS), Inventario de Trastornos de la Alimentación (EDI), Test de Actitudes hacia la Comida (EAT), Test de Bulimia de Edimburgo (BITE) y Cuestionario sobre la Figura Corporal (BSQ). La muestra se dividió en 2 grupos: pacientes con conductas de atracones según la definición de la Clasificación Internacional de Enfermedades (CIE-10) y el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV) y pacientes sin esas conductas. En el primer grupo se incluyó a 14 pacientes con bulimia nerviosa, 32 con criterios de trastorno por atracón y 15 con atracones sin criterios para uno de los dos trastornos citados (total, 61 pacientes con atracones y 149 sin atracones).

Resultados

Los pacientes con atracones tenían más alteraciones psicopatológicas, fundamentalmente mayor prevalencia de distimia, eran más impulsivos según la escala BIS y obtenían puntuaciones más elevadas en algunas escalas que valoraban la alteración de la conducta alimentaria. Estos pacientes tenían más antecedentes familiares de trastornos de la conducta alimentaria (TCA) y presentaban mayor insatisfacción corporal a pesar de un menor índice de masa corporal (IMC). Este grupo refería mayores limitaciones funcionales por su obesidad y presentaba mayor obsesión sobre el peso y la comida.

Conclusiones

Por lo tanto, los obesos mórbidos con atracones forman un grupo posiblemente homogéneo (independientemente de que tuvieran diagnóstico del trastorno de la conducta alimentaria) y diferenciado del resto de los obesos mórbidos por tener más alteraciones psicopatológicas, fundamentalmente de tipo afectivo, mayor impulsividad y mayor severidad en las escalas que evalúan los síntomas nucleares de los trastornos de la conducta alimentaria e insatisfacción corporal.

Resumen
Objectives

To evaluate clinical differences between morbidly obese patients with and without binge eating.

Patients and method

We evaluated 210 morbidly obese outpatients who were consecutively referred for psychiatric evaluation in a general hospital for distinct reasons. We carried out a clinical interview, evaluated psychiatric comorbidity, and applied the following scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburgh (BITE), and Body Shape Questionnaire (BSQ). The sample was divided into two groups: patients with binge eating according to ICD-10 and DSM-IV criteria and those without binge eating. There were 61 patients with binge eating (14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill the criteria for bulimia or binge eating disorder) and 149 patients without binge eating.

Results

Patients with binge eating showed more psychopathology, a greater prevalence of dysthymia, higher impulsivity scores according to the BIS scale and higher scores on some of the scales that evaluated eating disorders. These patients had a greater number of familial antecedents of eating disorders and showed greater body dissatisfaction, despite having a lower body mass index. Patients with binge eating also showed greater obesity-induced functional disability and greater obsessiveness about weight and body shape.

Conclusions

The results of this study suggest that morbidly obese patients with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population. Distinguishing features consist of more severe psychopathology, especially affective disorder, greater impulsivity, and greater severity in scales evaluating core symptoms of eating disorders and body dissatisfaction.

Palabras clave
Atracones, Alteraciones psicopatológicas, Obesidad mórbida, Trastorno por atracón, Trastornos de la conducta alimentaria, Impulsividad
Key words
Binge eating, Psychopathology, Morbid obesity, Binge eating disorder, Eating disorder, Impulsivity
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Correspondencia: Dr. F. Arias Horcajadas. Unidad de Psiquiatría. Fundación Hospital Alcorcón. Avda. Budapest, s/n. 28922 Alcorcón. Madrid. España
Copyright © 2006. Sociedad Española de Endocrinología y Nutrición