Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
Can Fam Physician. 2012 May;58(5):517-23.
To explore the reasons why long-term weight loss is seldom achieved and to evaluate the consequences of various weight trajectories, including stability, loss, and gain.
Studies evaluating population weight metrics were mainly observational. Level I evidence was available to evaluate the influence of weight interventions on mortality and quality of life.
Sustained weight loss is achieved by a small percentage of those intending to lose weight. Mortality is lowest in the high-normal and overweight range. The safest body-size trajectory is stable weight with optimization of physical and metabolic fitness. With weight loss there is evidence for lower mortality in those with obesity-related comorbidities. There is also evidence for improved health-related quality of life in obese individuals who lose weight. Weight loss in the healthy obese, however, is associated with increased mortality.
Weight loss is advisable only for those with obesity-related comorbidities. Healthy obese people wishing to lose weight should be informed that there might be associated risks. A strategy that leads to a stable body mass index with optimized physical and metabolic fitness at any size is the safest weight intervention option.
探讨长期减肥效果不佳的原因，并评估各种体重变化轨迹（包括稳定、减轻和增加）的后果。
评估人群体重指标的研究主要为观察性研究。一级证据可用于评估体重干预对死亡率和生活质量的影响。
打算减肥的人中只有一小部分能实现持续减肥。在高正常和超重范围内死亡率最低。最安全的体重变化轨迹是稳定体重并优化身体和代谢健康。对于肥胖相关合并症患者，有证据表明减肥可降低死亡率。对于减肥的肥胖个体，也有证据表明健康相关生活质量得到改善。然而，健康肥胖者的体重减轻与死亡率增加有关。
只有肥胖相关合并症患者才适合减肥。希望减肥的健康肥胖者应被告知可能存在相关风险。以任何体重达到身体质量指数稳定且身体和代谢健康得到优化的策略是最安全的体重干预选择。
