Department of Nutrition Sciences, University of Alabama at Birmingham, and the Birmingham VA Medical Center, Birmingham, Alabama.
Endocr Pract. 2013 Sep-Oct;19(5):864-74. doi: 10.4158/EP13263.RA.
Recent advances in lifestyle intervention programs, pharmacotherapy, and bariatric surgery have enabled the development of medical models for the treatment of obesity. Regarding pharmacotherapy, in 2012 the U.S. Food and Drug Administration approved two new effective and safe weight-loss medications, phentermine/topiramate extended release and lorcaserin, which has greatly augmented options for medically assisted weight loss.
The rationale for advantages of a complications-centric medical model over current body mass index (BMI)-centric indications for therapy is examined.
Currently, the baseline BMI level is the principle determinant of indications for obesity treatment using medication and surgery. However, the BMI-centric approach fails to target therapy to those obese patients who will benefit most from weight loss. In contrast, a complications-centric medical model is proposed that will earmark the modality and intensity of the therapeutic intervention based on the presence and severity of complications that can be ameliorated by weight loss.
The complications-centric approach to "medicalizing" obesity care employs weight loss primarily as a tool to treat obesity-related complications and promotes the optimization of health outcomes, the benefit/risk ratio, and the cost-effectiveness of therapy.
生活方式干预计划、药物治疗和减肥手术的最新进展使得肥胖治疗的医学模式得以发展。关于药物治疗，2012 年美国食品和药物管理局批准了两种新的有效和安全的减肥药物，即 phentermine/topiramate 缓释片和lorcaserin，这大大增加了医学辅助减肥的选择。
考察了以并发症为中心的医学模式相对于当前以体重指数（BMI）为中心的治疗适应症的优势。
目前，基线 BMI 水平是使用药物和手术治疗肥胖的适应症的主要决定因素。然而，BMI 为中心的方法无法将治疗针对那些最能从减肥中受益的肥胖患者。相比之下，提出了一种以并发症为中心的医学模式，该模式将根据可通过减肥改善的并发症的存在和严重程度来确定治疗干预的方式和强度。
以并发症为中心的方法将“肥胖症”医学化，主要将减肥作为治疗肥胖相关并发症的工具，并促进了治疗的健康结果、获益/风险比和成本效益的优化。
