Moyad M A
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0330, USA.
Semin Urol Oncol. 2001 Nov;19(4):247-56.
Obesity, despite becoming a recognized epidemic in the United States and many countries around the world cannot be necessarily defined, measured, and treated in a simplified fashion. Numerous organizations have classified overweight and obesity using different anthropometric parameters. Older methods to determine the extent of obesity, such as crude weight and skin calipers, contain serious limitations. For example, measuring abdominal obesity cannot be determined using calipers. Other methods such as lean body mass, body mass index (BMI), and waist-to-hip ratio (WHR) are more commonly used in epidemiologic studies but also contain inherent errors. More expensive and technologically advanced methods, such as densitometry, dual-energy x-ray absorptiometry (DEXA), and bioelectrical impedance analysis are also helpful, but the time and cost of using these methods in large-scale studies are a concern. Numerous options for treating obesity exist, and the clinician should be made aware of their strengths and limitations. Lifestyle changes are not only cost effective, but may be the best approach for individuals who desire to lose weight or to maintain their weight while becoming more fit. The addition of drug therapy is also a possibility. A variety of pharmacotherapy interventions are available to the patient on a short-term basis. In addition, two drugs have Food and Drug Administration approval for the long-term treatment of obesity. Drug therapy should be viewed as adjunctive treatment to lifestyle changes for the individuals who qualify based on their BMI and other comorbidities. Drug therapy carries several adverse effects, and the potential for indefinite treatment continues to be an area of controversy. Therefore, a multidisciplinary approach to treating obesity must be considered in any patient who is obese. These treatments in combination with drug therapy in some cases have provided some of the best results in randomized trials. Obesity needs to be considered a chronic disease that requires long-term commitment and multidisciplinary treatment to achieve the desired results. Unless therapy is individualized, it may be difficult to reverse the dramatic trends in obesity rates that have been observed over the past several decades.
肥胖，尽管在美国和世界上许多国家已成为一种公认的流行病，但却未必能以一种简单的方式进行定义、测量和治疗。众多组织使用不同的人体测量参数对超重和肥胖进行了分类。较老的确定肥胖程度的方法，如粗略体重和皮肤卡尺测量法，存在严重局限性。例如，无法使用卡尺测量腹部肥胖情况。其他方法，如瘦体重、体重指数（BMI）和腰臀比（WHR），在流行病学研究中更常用，但也存在固有误差。更昂贵且技术更先进的方法，如密度测定法、双能X线吸收法（DEXA）和生物电阻抗分析也有帮助，但在大规模研究中使用这些方法的时间和成本令人担忧。治疗肥胖有多种选择，临床医生应了解其优缺点。生活方式的改变不仅具有成本效益，而且对于那些希望减肥或在变得更健康的同时维持体重的人来说可能是最佳方法。药物治疗也是一种选择。患者可在短期内使用多种药物治疗干预措施。此外，有两种药物已获得美国食品药品监督管理局（FDA）批准用于长期治疗肥胖。对于符合基于BMI和其他合并症标准的个体，药物治疗应被视为生活方式改变的辅助治疗。药物治疗有多种不良反应，而且无限期治疗的可能性仍是一个有争议的领域。因此，对于任何肥胖患者都必须考虑采用多学科方法治疗肥胖。在某些情况下，这些治疗方法与药物治疗相结合在随机试验中取得了一些最佳效果。肥胖需要被视为一种慢性病，需要长期投入和多学科治疗才能取得理想效果。除非治疗是个性化的，否则可能难以扭转过去几十年中观察到的肥胖率急剧上升的趋势。
