Dixon John B, Anderson Margaret, Cameron-Smith David, O'Brien Paul E
Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria 3181, Australia.
Obes Res. 2004 Nov;12(11):1895-902. doi: 10.1038/oby.2004.235.
To explore the hypothesis that sustained weight loss in severely obese patients may have benefits that are independent of their attained BMI.
We conducted a comparison of two weight-stable groups with BMI in the 30 to 35 kg/m(2) range. Subjects (n = 79) were selected obese patients 3 years after laparoscopic adjustable gastric band surgery, and controls (n = 79) were obese patients seeking weight loss therapy. Subjects were selected in a de-identified manner from our database to best match the control group. A range of clinical, biochemical, and questionnaire measures were obtained to assess obesity-related health status
Subjects maintained a mean weight loss of 32.8 +/- 18 kg after surgery. The weight loss subjects had significantly lower fasting plasma glucose, insulin, and triglyceride concentrations, along with higher high-density lipoprotein-cholesterol levels and better indirect measures of insulin sensitivity when compared with controls (p < 0.05 for all). In addition, aminotransferase levels, neutrophil counts, and globulin levels were also significantly lower in weight loss subjects. All differences in laboratory variables remained significant after controlling for BMI. The subjects also reported better health-related quality of life, fewer symptoms of depression, and greater satisfaction with their appearance than controls.
These findings suggest that the post-weight loss state conveys benefits that are greater than predicted by the attained BMI. These findings may have important implications regarding the expectations of weight loss therapy, and mechanisms for this effect should be carefully sought.
探讨重度肥胖患者持续减重可能具有独立于其达到的体重指数（BMI）的益处这一假设。
我们对BMI在30至35kg/m²范围内的两个体重稳定组进行了比较。研究对象（n = 79）为腹腔镜可调节胃束带手术后3年的肥胖患者，对照组（n = 79）为寻求减重治疗的肥胖患者。从我们的数据库中以去识别身份的方式选择研究对象，以使其与对照组最佳匹配。获取了一系列临床、生化和问卷调查指标，以评估与肥胖相关的健康状况。
手术后，研究对象平均减重32.8±18kg。与对照组相比，减重的研究对象空腹血糖、胰岛素和甘油三酯浓度显著降低，高密度脂蛋白胆固醇水平升高，胰岛素敏感性的间接指标更好（所有p < 0.05）。此外，减重的研究对象转氨酶水平、中性粒细胞计数和球蛋白水平也显著较低。在控制BMI后，实验室变量的所有差异仍然显著。研究对象还报告称，与对照组相比，他们的健康相关生活质量更好，抑郁症状更少，对自己外表的满意度更高。
这些发现表明，减重后的状态所带来的益处大于达到的BMI所预测的益处。这些发现可能对减重治疗的期望具有重要意义，应仔细探寻这种效应的机制。
