Shukla Alpana P, Buniak William I, Aronne Louis J
Center for Weight Management and Metabolic Clinical Research, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York.
J Cardiopulm Rehabil Prev. 2015 Mar-Apr;35(2):81-92. doi: 10.1097/HCR.0000000000000112.
Obesity is a major health priority in the United States, as well as globally. It is associated with multiple comorbidities and reduced life expectancy. Effective management of obesity involves producing an intervention plan tailored to the individual patient. Potential contributory factors to weight gain, including dietary habits, physical inactivity, associated medical conditions, and medications, should be identified and addressed. Lifestyle interventions comprising diet modification, physical activity, and behavior therapy are foundational to the management of obesity. Caloric restriction is the most important component in achieving weight loss through negative energy balance, whereas sustained physical activity is important in maintaining the weight loss. Adjunctive therapies in the form of pharmacotherapy and bariatric surgery are required in patients who do not achieve targeted weight loss and health goals with lifestyle interventions. Currently there are 3 drugs approved for long-term management of obesity, orlistat, phentermine/topiramate extended release, and lorcaserin, and there are 2 on the horizon, bupropion/naltrexone and liraglutide. Bariatric surgery is an effective strategy recognized to produce durable weight loss with amelioration of obesity-related comorbidities and should be considered a treatment option in eligible patients.
肥胖在美国以及全球都是主要的健康优先事项。它与多种合并症相关，并会缩短预期寿命。肥胖的有效管理包括制定针对个体患者的干预计划。应识别并解决导致体重增加的潜在因素，包括饮食习惯、缺乏身体活动、相关的医疗状况和药物。包括饮食调整、体育活动和行为疗法在内的生活方式干预是肥胖管理的基础。热量限制是通过负能量平衡实现体重减轻的最重要组成部分，而持续的体育活动对于维持体重减轻很重要。对于通过生活方式干预未达到目标体重减轻和健康目标的患者，需要采用药物治疗和减肥手术等辅助疗法。目前有3种药物被批准用于肥胖的长期管理，即奥利司他、缓释苯丁胺/托吡酯和氯卡色林，还有2种即将获批，即安非他酮/纳曲酮和利拉鲁肽。减肥手术是一种有效的策略，被认为能产生持久的体重减轻并改善与肥胖相关的合并症，应被视为符合条件患者的一种治疗选择。
