Department of Gastroenterology, Changi General Hospital, Singapore.
J Gastroenterol Hepatol. 2013 Dec;28 Suppl 4:59-63. doi: 10.1111/jgh.12407.
According to World Health Organization, in 2010 there were over 1 billion overweight adults worldwide with 400 million adults who were obese. Obesity is a major risk factor for diabetes, cardiovascular disease, musculoskeletal disorders, obstructive sleep apnea, and cancers (prostate, colorectal, endometrial, and breast). Obese people may present to the gastroenterologists with gastroesophageal reflux, non-alcoholic fatty liver, and gallstones. It is important, therefore, to recognize and treat obesity. The main cause of obesity is an imbalance between calories consumed and calories expended, although in a small number of cases, genetics and diseases such as hypothyroidism, Cushing's disease, depression, and use of medications such as antidepressants and anticonvulsants are responsible for fat accumulation in the body. The main treatment for obesity is dieting, augmented by physical exercise and supported by cognitive behavioral therapy. Calorie-restriction strategies are one of the most common dietary plans. Low-calorie diet refers to a diet with a total dietary calorie intake of 800-1500, while very low-calorie diet has less than 800 calories daily. These dietary regimes need to be balanced in macronutrients, vitamins, and minerals. Fifty-five percent of the dietary calories should come from carbohydrates, 10% from proteins, and 30% from fats, of which 10% of total fat consist of saturated fats. After reaching the desired body weight, the amount of dietary calories consumed can be increased gradually to maintain a balance between calories consumed and calories expended. Regular physical exercise enhances the efficiency of diet through increase in the satiating efficiency of a fixed meal, and is useful for maintaining diet-induced weight loss. A meta-analysis by Franz found that by calorie restriction and exercise, weight loss of 5-8.5 kg was observed 6 months after intervention. After 48 months, a mean of 3-6 kg was maintained. In conclusion, there is evidence that obesity is preventable and treatable. Dieting and physical exercise can produce weight loss that can be maintained.
根据世界卫生组织的数据，2010 年全球有超过 10 亿超重成年人，其中 4 亿人肥胖。肥胖是糖尿病、心血管疾病、肌肉骨骼疾病、阻塞性睡眠呼吸暂停和癌症（前列腺癌、结直肠癌、子宫内膜癌和乳腺癌）的主要危险因素。肥胖患者可能因胃食管反流、非酒精性脂肪肝和胆结石而就诊于胃肠病学家。因此，识别和治疗肥胖症很重要。肥胖的主要原因是摄入的卡路里和消耗的卡路里之间的不平衡，尽管在少数情况下，遗传和某些疾病，如甲状腺功能减退、库欣病、抑郁症以及使用抗抑郁药和抗惊厥药等药物，也会导致体内脂肪堆积。肥胖症的主要治疗方法是节食，辅以体育锻炼，并辅以认知行为疗法。限制热量的策略是最常见的饮食计划之一。低热量饮食是指总热量摄入为 800-1500 的饮食，而极低热量饮食每天的热量摄入少于 800 卡路里。这些饮食方案需要在宏量营养素、维生素和矿物质方面保持平衡。饮食中 55%的热量来自碳水化合物，10%来自蛋白质，30%来自脂肪，其中总脂肪的 10%由饱和脂肪组成。达到理想体重后，可逐渐增加饮食中卡路里的摄入量，以保持摄入的卡路里和消耗的卡路里之间的平衡。定期进行体育锻炼可通过增加固定膳食的饱腹感来提高饮食的效率，并且有助于维持饮食引起的体重减轻。Franz 的一项荟萃分析发现，通过限制热量和运动，干预后 6 个月体重减轻 5-8.5 公斤，48 个月后平均维持 3-6 公斤。总之，有证据表明肥胖是可以预防和治疗的。节食和体育锻炼可以产生可以维持的体重减轻。
