Uli Naveen, Sundararajan Sumana, Cuttler Leona
Division of Endocrinology and Diabetes, Rainbow Babies and Childrens Hospital, Cleveland, Ohio 44106, USA.
Curr Opin Endocrinol Diabetes Obes. 2008 Feb;15(1):37-47. doi: 10.1097/MED.0b013e3282f41d6a.
To provide an overview of treatments for childhood obesity, highlighting recent advances and recommendations.
The three main treatment modalities are lifestyle interventions, medications, and bariatric surgery. Recent data support the short-term effectiveness of lifestyle interventions, and show that continued behavioral intervention increases the likelihood of a sustained effect for up to 2 years. New studies and regulatory decisions on medications for obesity (including orlistat, sibutramine, and metformin) are discussed. Emerging data suggest substantial weight loss after bariatric surgery in morbidly obese adolescents but also indicate adverse effects. An expert panel recently provided guidelines that alter definitions of obesity and offer a framework for obesity management. These guidelines are compared with others, and integrated recommendations presented.
While primary prevention of childhood obesity is important, broadly effective methods to do so are not yet available. Given the large population of obese children and the risks they face, an emphasis on treatment is also critical. We suggest a staged approach, emphasizing early intervention and lifestyle changes. We also suggest limiting bariatric surgery to selected adolescents in Institutional Review Board-approved research studies. Health-policy interventions can facilitate both prevention and treatment of childhood obesity.
概述儿童肥胖的治疗方法，重点介绍近期进展和建议。
三种主要治疗方式为生活方式干预、药物治疗和减肥手术。近期数据支持生活方式干预的短期有效性，并表明持续的行为干预可提高长达2年的持续效果的可能性。讨论了关于肥胖症药物（包括奥利司他、西布曲明和二甲双胍）的新研究和监管决定。新出现的数据表明，减肥手术可使病态肥胖青少年大幅减重，但也显示出有不良影响。一个专家小组最近提供了改变肥胖定义并为肥胖管理提供框架的指南。将这些指南与其他指南进行了比较，并提出了综合建议。
虽然儿童肥胖的一级预防很重要，但尚未有广泛有效的方法。鉴于肥胖儿童数量众多及其面临的风险，强调治疗也至关重要。我们建议采用分阶段方法，强调早期干预和生活方式改变。我们还建议将减肥手术限制在机构审查委员会批准的研究中选定的青少年。卫生政策干预可促进儿童肥胖的预防和治疗。
