Miller W C
Exercise Science Programs, The George Washington University Medical Center, Washington, DC 20052, USA.
Sports Med. 2001;31(10):717-24. doi: 10.2165/00007256-200131100-00002.
Traditional diet and exercise treatments for obesity have been ineffective in reducing the prevalence of overweight in the population. Treatment outcomes for overweight can be measured in terms of physical parameters (e.g. bodyweight, percentage body fat, body mass index), medical terms (e.g. blood pressure, blood glucose control, blood lipid levels), psychological terms (e.g. eating pathology, self-esteem, mood state) and behavioural terms (e.g. frequency of exercise, eating patterns, self healthcare). Regardless of the specific outcome measures used to define successful treatment, the desired outcome must be maintained for several years to be considered effective. Energy restrictive diets cause significant initial bodyweight loss, but are plagued with high dropout- and relapse-rate. Low-fat diets have met with minimal success for bodyweight control, but nonetheless can significantly lower blood lipid levels. High-protein/low-carbohydrate diets are claimed to be the most effective in reducing bodyweight, but there are no scientific data to support these claims. Persons on these types of diets are also at the greatest risk for metabolic adverse effects. Nondieting approaches and programmes that stress 'health at any size' have not been researched rigorously, but preliminary data show minimal bodyweight loss with significant improvements in psychological state, eating pathology and well-being. Exercise is the only variable that consistently shows effectiveness in physiological, medical, psychological and behavioural outcomes. A treatment programme that has the greatest potential for success, regardless of outcome measure, is a programme that consists of 4 key components. These components are: (i) pre-evaluation, where historical information is gathered and used to set programme goals, objectives and outcome measures; (ii) exercise, wherein enjoyable exercise is encouraged for health, bodyweight control and well being; (iii) a behavioural plan, which is based on patterns of eating and activity that will lead to the desired outcome measures; and (iv) a maintenance plan, that helps the individual develop skills for maintaining newly developed behaviours.
传统的肥胖饮食和运动疗法在降低人群超重患病率方面一直无效。超重的治疗效果可以通过身体参数（如体重、体脂百分比、体重指数）、医学指标（如血压、血糖控制、血脂水平）、心理指标（如饮食病理、自尊、情绪状态）和行为指标（如运动频率、饮食模式、自我保健）来衡量。无论用于定义成功治疗的具体结果指标是什么，期望的结果都必须维持数年才能被认为是有效的。能量限制饮食会导致最初体重显著下降，但却存在高退出率和复发率的问题。低脂饮食在控制体重方面收效甚微，但仍能显著降低血脂水平。高蛋白/低碳水化合物饮食据称在减轻体重方面最有效，但尚无科学数据支持这些说法。采用这类饮食的人也面临着最大代谢不良反应风险。强调“任何身材都健康”的非节食方法和计划尚未得到严格研究，但初步数据显示体重减轻很少，而心理状态、饮食病理和幸福感有显著改善。运动是唯一始终在生理、医学、心理和行为结果方面显示出有效性的变量。无论结果指标如何，最有成功潜力的治疗方案是一个包含四个关键组成部分的方案。这些组成部分是：(i) 预评估，即收集历史信息并用于设定方案目标、目的和结果指标；(ii) 运动，鼓励进行有益健康、控制体重和促进幸福感的有趣运动；(iii) 行为计划，该计划基于将导致期望结果指标的饮食和活动模式；以及(iv) 维持计划，帮助个人培养维持新形成行为的技能。
