背景與目的：
肥胖是一個重要的公共健康議題，不僅與多個生理共病症有關，也與個體的心理健康密切相關。文獻指出肥胖者的飲食障礙盛行率較高，然國內研究仍很少探討肥胖者之飲食障礙傾向。因此，本研究以醫學中心體重管理門診肥胖患者對象，旨在瞭解門診求診之成年肥胖患者的飲食障礙盛行率及相關因子，並觀察計畫性減重介入對其飲食異常行為的影響。

方法：
本研究以2009-2011年間至成大醫院體重管理門診求診之肥胖患者為對象，共收集18-55歲之132名體重管理門診肥胖患者（60 名男性，72名女性；身體質量指數≧25.0 公斤/公尺2），以及公開招募103名非肥胖志願者作為對照組（38名男性，65名女性；身體質量指數=18.5-24.9 公斤/公尺2）。
第一部分為橫斷性研究，使用中文版飲食態度量表-26題（簡稱EAT-26）評估與比較肥胖患者與非肥胖對照組之飲食障礙風險，以≧11分為飲食障礙高危險切點及≧20分為疑似飲食障礙切點，並以EAT-26的三個次量表評估飲食異常行為的向度與嚴重程度。
第二部分為縱貫性研究，於六個月計畫性減重介入後再次以EAT-26評估肥胖患者之介入後的飲食異常行為，比較介入前後飲食異常行為的變化，並分析人口學特徵（性別、年齡、社經地位、婚姻狀態）、身體質量指數、腰圍、生活型態（吸菸史、喝酒史、運動習慣、減重經驗）等可能的交互影響因子。

結果：
第一部分研究：肥胖患者之飲食障礙高危險與疑似飲食障礙的盛行率分別為35.6%及10.6%，非肥胖者為23.3%及6.8%，肥胖患者在飲食障礙高危險的盛行率、EAT-26總分與「節食」次量表分數均顯著高於非肥胖者；兩組在疑似飲食障礙比例、「暴食與食物偏見」及「口腔控制」次量表則未達顯著差異。以複邏輯斯迴歸分析發現較年長、未婚、身體質量指數較低、腰圍較大為肥胖患者達飲食障礙高危險之顯著影響因子。
第二部分研究：132名肥胖患者中，共有104名完成六個月減重介入，完成率為78.8%。有抽菸史及曾經減重三次以上為患者流失的顯著影響因子。介入後之飲食障礙高危險與疑似飲食障礙的盛行率分別為52.9%及21.2%，肥胖患者在飲食障礙高危險與疑似飲食障礙的盛行率、EAT-26總分與「節食」次量表分數均顯著增加。依介入前是否為飲食障礙高危險分為兩組，飲食障礙高危險組在「暴食與食物偏見」分數顯著降低，非飲食障礙高危險組在EAT-26總分、「節食」、「暴食與食物偏見」分數均顯著增加，飲食障礙高危險組介入後之EAT-26總分、「節食」分數顯著高於非飲食障礙高危險組。以複邏輯斯迴歸分析發現，介入前達飲食障礙高危險、減重經驗三次以上、有喝酒史、無吸菸史、採飲食治療介入為介入後達飲食障礙高危險的顯著影響因子。

結論與建議：
體重管理門診肥胖患者之飲食障礙風險高於非肥胖者，不僅有較高的節食程度，且似乎呈現不同於非肥胖者的人口學特徵與生活型態。飲食障礙高危險組患者於介入後仍有較高的飲食異常傾向，且基準期飲食異常為介入後飲食異常的重要危險因子，顯示體重管理計畫雖能改善患者的肥胖狀態，但對於飲食異常行為的改善十分有限。此外，本研究初步使用EAT-26篩檢之肥胖患者飲食障礙高危險盛行率，接近國內外相關研究結果，且次量表分數能反映肥胖患者介入前後飲食異常程度變化。整體而言，建議臨床上應落實飲食障礙篩檢，並適時提供心理諮詢，以跨領域團體合作模式提供生理-心理-社會整合取向的體重管理模式。

Obesity was associated with eating disorder. However, only a few studies had focused on the disordered eating behavior among obese adults. The aims of this study were to study the disordered eating behavior and effect of programmed weight loss on obese outpatients. A total of 132 aged 18 to 55 year-old obese outpatients from weight management outpatient clinic and 103 non-obese volunteers were enrolled. The disordered eating behavior was assessed using Eating Attitudes Test (EAT-26) with the cut-off point for high-risk eating disorder (HRED) and probable eating disorder (PED) at ≧11 and ≧20 respectively, and with three subscales scores to assess dimension and severity. Higher prevalence of HRED, total score of EAT-26 and “dieting” subscale score were in the obese outpatients than non-obese adults. The prevalence of HRED and PED, total score of EAT-26, and “dieting” subscale score increased significantly after intervention. Compared with non-ED group, the post-interventional total score of EAT-26 and “dieting” subscale score were significantly higher in ED-group. This study indicated that obese outpatients had higher risk of eating disorder than non-obese adults, and the effect of programmed weight loss intervention on disorder eating behavior was limited. It is suggested that implement the screening of eating disorder and provide programmed weight loss intervention across multi-professionals based on bio-psycho-social approach for obese outpatients are necessarily.

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