Bray George A
Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808, USA.
J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S81-8. doi: 10.1210/jc.2008-1294.
Obesity results from a prolonged small positive energy balance, and its treatment needs to reverse this imbalance.
Citations retrieved from PubMed and The Handbook of Obesity 2008 were selected to illustrate the points.
Many different diets have been tried to treat obesity, and weight loss occurs with all of them. There is currently no evidence that clearly supports a superiority of one macronutrient composition for diets used for weight loss. The principal effect seems to be the degree of adherence to the prescribed calorie reduction. Lifestyle strategies to modify eating behavior can be used in individual counseling sessions or in groups, both of which are important in helping patients modify their patterns of eating. Physical activity is particularly important in helping patients maintain a weight loss once achieved and is less valuable for weight loss itself. Food intake is controlled through many different mechanisms, but only a few drugs have been developed that tap these mechanisms. Orlistat, which blocks intestinal lipase, is one; sibutramine, a serotonin-norepinephrine reuptake inhibitor, is a second. Surgical approaches provide the most dramatic weight loss and have been demonstrated to reduce long-term mortality and reduce the incidence of diabetes.
Weight loss can be achieved by many methods, but the surgical procedures appear to be the most durable.
肥胖是由长期的微小正能量平衡导致的，其治疗需要扭转这种失衡。
从PubMed和《2008年肥胖手册》中检索到的文献被选来说明这些观点。
人们尝试了许多不同的饮食方法来治疗肥胖，所有这些方法都能实现体重减轻。目前没有证据明确支持一种宏量营养素组成在用于减肥的饮食中具有优越性。主要作用似乎是对规定的热量减少的坚持程度。改变饮食行为的生活方式策略可用于个体咨询或团体咨询，这两者对于帮助患者改变饮食习惯都很重要。身体活动对于帮助患者在体重减轻后维持体重特别重要，而对于减肥本身的价值较小。食物摄入通过许多不同机制进行控制，但只有少数药物开发利用了这些机制。奥利司他可阻断肠道脂肪酶，是其中一种；西布曲明是一种5-羟色胺-去甲肾上腺素再摄取抑制剂，是另一种。手术方法能实现最显著的体重减轻，并且已被证明可降低长期死亡率并减少糖尿病发病率。
许多方法都可以实现体重减轻，但手术程序似乎是最持久的。
