Many recent findings have been reported on the somatic and psychological aspects of mechanisms related to the regulation of eating. In this paper, we describe therapeutic methods for obesity from these points of view. 1) A clinical outline of the psychological and somatic profiles of obese patients. Personality traits including depression, neuroticism, low self-esteem, and low impulse control have been reported for obese patients. In contrast, research using functional magnetic resonance imaging (fMRI) has reported the possibility that the response reward system during meals is genetically different in obese and normal subjects. In addition, the presence of obesity-related genetic polymorphisms that interfere with weight loss by affecting the basal metabolism rate has been reported. 2) Research on eating and systems that regulate metabolism. When the metabolic control system responsible for preventing weight gain breaks down, fat cells are enlarged. As a result, local inflammation and secretary abnormality of adipocytokine begins. This cycle exacerbates the obesity. 3) Research on appetite in our department. When healthy women under hypnosis imagined eating, their feelings of hunger and their electrogastrograms were similar to what would be seen when eating a real meal. However, none of the eating-related peptides, including ghrelin, showed a significant change. In another study, food intake from a buffet style meal was not correlated with eating-related peptides. Interoceptive awareness and self-reproach were related to caloric intake by multiple regression analysis of psychological tests. 4) New therapeutic approaches to obesity. From the viewpoints of pharmacotherapy and the psychotherapy, the prevention of weight rebound is currently an important theme.

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The term "metabolic syndrome" is one of the worldwide concepts in order to prevent various life-style related diseases, and it is utilized for national health programs in Japan. However, many problems and confusion are argued in clinical and health fields. This study aims to clarify social risks of the discourse of metabolic syndrome from the viewpoint of critical medical anthropology. Problems in the medical dimension are discussed in the 1st report, and problems in social dimension are in the 2nd report. In the process of making diagnostic criteria of metabolic syndrome in Japan, a committee was organized by eight Japanese societies of internal medicine such as Japan Atherosclerosis Society and Japan Society for the Study of Obesity. The committee held several meetings in 2005, but it continued only for one year and therefore it did not appear that enough discussions were conducted to make reasonable consensus. After these meetings, several issues that indicated problems of the Japanese criteria of metabolic syndrome were published by members of this committee. The summary of concerns regarding the metabolic syndrome is as follows. 1) It was not clarified that the diagnostic criteria of the metabolic syndrome is more valuable than that of the sum of its parts ; obesity, hyperlipidemia, hypertension, and hyperglycemia in order to prevent cardiovascular disease in clinical medicine. 2) There is no statistical evidence in the scale of waist measurement in Japanese diagnostic criteria. 3) When those criteria are used in national health services, economic benefit and loss must be evaluated precisely. Is it really possible to prevent cardiovascular disease and reduce the mortality from cardiovascular disease? Is it possible to reduce governmental medical expenditure? In this study, the medical dimension of social risks about the discourse of metabolic syndrome is discussed. There remain a lot of problems that must be resolved in order to achieve the well-being of Japanese citizens.

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This study aims to clarify the social risks of the discourse on metabolic syndrome from the view point of critical medical anthropology. The problems in medical dimension are indicated in 1^<st> report, and problems in social dimension are discussed in this 2^<nd> report. Critical medical anthropology is one of the important branches of medical anthropology, and it frequently called as political economic medical anthropology. It emphasizes the importance of political power and economic forces in shaping health, disease, illness experience, and health care. One of the roles of critical medical anthropology is to evaluate whether social health services are properly provided improving availability and effectiveness of peoples' health care. First, social risks utilizing the concept of metabolic syndrome are discussed through four main theories of critical medical anthropology ; medicalization, healthizm, stigma, and health disparities. In this contemporary society, medical systems expand toward controlling our all-around living conditions. Metabolic syndrome may urge this medicalizaion powerfully, and many ordinary people's self-identity and life decisions have come to depend on medical model. More than two million words connected with "metabolic syndrome" can be found in website by Google search, such as "diet", "supplement", "beauty cosmetic", "health food", and so on. This phenomenon shows the wide spread of healthizm in our society. Although Ottawa charter for health promotion described that the fundamental conditions and resources for health are various environments surrounding people such as peace, income, a stable eco-system, sustainable resources, social justice, and equity, but Japanese legislation for health promotion mainly emphasize responsibility of the people to strive for health. Metabolic syndrome may also enforce social stigma, and many people having obesity will be discriminated. In addition, health disparities are now serious problems in developed countries. There are close relations between obesity and poverty. Second, the articles about metabolic syndrome on Japanese newspapers and magazines are analyzed. More than a half of these articles show the risk of metabolic syndrome from the view of biomedicine, and recommend healthy food and exercises. Only five percent of these articles argued on problems about the concept or diagnostic criteria of metabolic syndrome. The system of physical checkup for the Japanese citizens from forty to seventy-four years old focusing on metabolic syndrome was established by national health services in 2008. If the consultation rate for physical checkup is low, social health insurance premium may be increased as a penalty in this system. In consideration of lack in scientific evidence of the Japanese metabolic syndrome diagnostic criteria, this system could be a pointless political institution. It is essential to deal with these socio-cultural problems in order to design ideal medical care systems. The cooperation between medical professionals and socio-cultural scientists is expected.

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Team medical care that includes a clinical psychologist is known to be effective in the treatment of obesity. Moreover, the use of personality scales as one of the tools for understanding psycho-social variables related to both obesity patients and treatment personnel has provided valuable information. Although research on the association between personality and obesity has increased rapidly, only a few studies have been conducted with Japanese obesity patients. In this study, we used the following personality scales : Revised NEO Personality Inventory (NEO-PI-R), Tokyo University Egogram II (TEGII), and Toronto Alexithymia Scale-20 (TAS-20) to investigate differences between obesity patients that visited a university hospital and non-clinical adults (healthy control group). The responses of the two groups to the personality scales were analyzed using t-tests. Results indicated no significant difference between the groups. Then, the obesity patients were classified into three groups based on their BMI and their responses were reanalyzed using analyses of variance. The results indicated obesity patients with a BMI of over 35 (class II) had significantly higher neuroticism scores (especially anxiety and depression), as well as difficulties in identifying feelings. These results suggest that personality assessment would be useful in medical interventions for obesity patients with a high BMI.

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This paper discusses psychotherapeutic approaches toward patients suffering from obesity. It is based on the authors'clinical practice in the field of internal medicine at a general hospital. In the practice of clinical psychology, it is important to cooperate with patients with obesity and collaborative treatment with a various related medical staff in addition to general internal treatments. First of all, the clinical psychologist needs to understand the patients'psychological difficulties. Implementation of the psychotherapeutic approaches were recommended for patients who had multiple psychological risk factors, suffering from depression and/or psychological distress, and also for adolescent patients. Various approaches such as individual psychotherapy, group therapy, and psychoeducation could be implemented and be based on the needs of patients and a medical staff. Furthermore, school-based psychoeducational programs for students to prevent obesity and promote better physical and mental health may be needed.

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Objectives : Many health care workers are assigned to shift work, and experience sleepiness and fatigue, which increase the risk of near-accidents or malpractice, posing a problem regarding risk management and ethical issues. This study investigated the relationships among near-accidents in a state of sleep insufficiency in nurses, sleep disorder, and burnout. Method : The survey was conducted in September 2004 involving 2,588 nurses from 15 medical facilities using a self-administered questionnaire to investigate their near-accident experience, Japanese version of the Pittsburgh Sleep Quality Index (PSQI) score, and the Todai Health Index (THI) score. Results : 52.3% of nurses had PSQI scores of 5.5 or more, and 30.3% of nurses were identified as having symptoms of burnout, with THI scores of 4 or higher. Near-accident experience was observed in 67.9%, and its associated factors were younger nurses (p=0.002), shift work (p<0.001), sleep disorder (p<0.001), and burnout (p<0.001). More than 80% of nurses with symptoms of sleep disorder and burnout had experienced a near-accident even among non-shift workers (p<0.001). Conclusion : The results suggest the need to identify the cause of near accidents, and deal with burnout and sleep disorders among nurses.

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