Unit of Clinical Epidemiology, Karolinska Institutet, T2, SE17176, Stockholm, Sweden.
Therap Adv Gastroenterol. 2013 Jan;6(1):77-88. doi: 10.1177/1756283X12459413.
The upward trend in obesity prevalence across regions and continents is a worldwide concern. Today a majority of the world's population live in a country where being overweight or obese causes more deaths than being underweight. Only a portion of those qualifying for treatment will get the health care they need. Still, a minor weight loss of 5-10% seems to be sufficient to provide a clinically significant health benefit in terms of risk factors for cardiovascular disease and diabetes. Diet, exercise and behavior modifications remain the current cornerstones of obesity treatment. Weight-loss drugs play a minor role. Drugs which were available and reasonably effective have been withdrawn because of side effects. The fact that the 'old' well known, but pretty unexciting tools remain the basic armamentarium causes understandable concern and disappointment among both patients and therapists. Hence, bariatric surgery has increasingly been recognized and developed, as it offers substantial weight loss and prolonged weight control. The present review highlights the conventional tools to counter obesity, lifestyle modification, pharmacotherapy and bariatric surgery, including some of the barriers to successful weight loss: (1) unrealistic expectations of success; (2) high attrition rates; (3) cultural norms of self-acceptance in terms of weight and beliefs of fat being healthy; (4) neighborhood attributes such as a lack of well-stocked supermarkets and rather the presence of convenience stores with low-quality foods; and (5) the perception of the neighborhood as less safe and with low walkability. Prevention is the obvious key. Cost-effective societal interventions such as a tax on unhealthy food and beverages, front-of-pack traffic light nutrition labeling and prohibition of advertising of junk food and beverages to children are also discussed.
肥胖症在各地区和各大洲的流行呈上升趋势，这是一个全球性的问题。如今，世界上大多数人生活在一个国家，在这个国家，超重或肥胖导致的死亡人数超过了体重过轻导致的死亡人数。只有一部分符合治疗条件的人会得到他们所需的医疗保健。尽管如此，体重减轻 5-10%似乎足以提供显著的临床健康益处，降低心血管疾病和糖尿病的风险因素。饮食、运动和行为改变仍然是肥胖治疗的当前基石。减肥药物的作用较小。由于副作用，曾经可用且合理有效的药物已被撤回。事实上，由于“旧的”众所周知但相当无趣的工具仍然是基本的武器库，这引起了患者和治疗师的理解和失望。因此，减重手术越来越受到认可和发展，因为它可以提供显著的体重减轻和长期的体重控制。本综述强调了对抗肥胖的传统工具，包括生活方式改变、药物治疗和减重手术，以及成功减肥面临的一些障碍：（1）对成功的不切实际的期望；（2）高退出率；（3）对体重的自我接受的文化规范和对脂肪健康的信念；（4）社区属性，如缺乏库存充足的超市，而便利店则提供低质量的食品；以及（5）社区的安全性和步行便利性较差的看法。预防是显而易见的关键。还讨论了一些具有成本效益的社会干预措施，如对不健康食品和饮料征税、包装正面营养标签以及禁止向儿童宣传垃圾食品和饮料。
