Sørensen T I A
Danish Epidemiology Science Centre, Institute of Preventive Medicine, Copenhagen University Hospital, Denmark.
Obes Rev. 2003 Feb;4(1):3-7. doi: 10.1046/j.1467-789x.2003.00090.x.
There are many good reasons to expect that weight loss in overweight and obese subjects should lead to reduced mortality, not least because the general risk factor profile of several diseases responsible for the excess mortality associated with overweight and obesity improves with weight loss. However, observational long-term population studies have shown that weight loss in overweight subjects leads to increased long-term mortality, even if the studies are well controlled with regard to known confounding factors, including hazardous behaviour and underlying diseases that may lead to both weight loss and increased mortality. It seems unfeasible to wait for the multiple randomized clinical trials of sufficient quality, size and duration that may resolve this question. Therefore, the recommendations about weight loss must be based on the weaker evidence that can be obtained in short-term clinical trials and the observational population studies. Several studies have tried to address the problem by distinguishing intentional from unintentional weight loss, but only few do so by gathering information about the intention to lose weight before weight loss is observed. These studies suggest that intentional weight loss is associated with increased mortality. Recommendations to healthy overweight and obese subjects to lose weight must be based on an explicit weighing of the short-term well-documented benefits of weight loss, including improvement of quality of life, against the possible risk of an increased mortality in the long-term
有很多充分的理由预期超重和肥胖个体的体重减轻会降低死亡率，尤其是因为与超重和肥胖相关的几种导致额外死亡的疾病的总体风险因素状况会随着体重减轻而改善。然而，长期的观察性人群研究表明，超重个体的体重减轻会导致长期死亡率增加，即使这些研究在已知混杂因素方面得到了很好的控制，包括可能导致体重减轻和死亡率增加的危险行为和基础疾病。等待足够质量、规模和时长的多项随机临床试验来解决这个问题似乎并不可行。因此，关于体重减轻的建议必须基于在短期临床试验和观察性人群研究中所能获得的较薄弱证据。一些研究试图通过区分有意和无意的体重减轻来解决这个问题，但只有少数研究是在观察到体重减轻之前收集有关减肥意图的信息来做到这一点的。这些研究表明，有意的体重减轻与死亡率增加有关。向健康的超重和肥胖个体提出减肥建议时，必须基于对体重减轻的短期充分记录的益处（包括生活质量的改善）与长期可能增加的死亡风险进行明确权衡。
