Stone Tori, DiPietro Loretta, Stachenfeld Nina S.
John B. Pierce Laboratory, Yale School of Medicine, 290 Congress Avenue, New Haven, CT 06519
Department of Exercise & Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW, Washington DC 20052.
Surveillance data from the general US population indicate a continued increase in the prevalence of overweight and obesity that is consistent with weight gain trends observed globally among industrialized countries. Physical inactivity and obesity are closely linked conditions and they account for a large burden of chronic disease and impaired function. The underlying agent in the etiology of obesity is a long-term positive energy balance; however, the pathways determining the rate and extent of weight gain due to a positive energy are complex. Engaging in regular, moderate-intensity physical activity for at least 150 min/week can help maintain energy balance and prevent excessive weight gain; however, this minimum requirement may not be sufficient for reversing already-existing obesity and chronic disease. In fact, physical activity closer to 300 min/week may be necessary for successful weight loss and weight loss maintenance. Regimented exercise programs alone may not be the most effective treatment for people with obesity, however. Rather, lifestyle changes that increase total daily energy expenditure need to be accompanied by dietary counseling for reducing daily caloric intake. Also, accumulating the necessary exercise and lifestyle physical activity in intermittent bouts, rather than one long continuous bout, can improve adherence and the success of weight loss regimens. It is also important for both clinicians and patients to understand that a simple solution to obesity treatment does not exist due to the constellation of underlying mechanisms that drive energy balance. Indeed, physiological, behavioral, environmental, and genetic factors play both independent and interrelated roles that contribute to the complex etiology of obesity. Research from numerous scientific disciplines has shaped our understanding of obesity. While the relative contributions of insufficient energy expenditure versus excessive energy intake to obesity development continue to be debated, there is general agreement that exercise is a key element for both prevention and treatment. Future research should focus on the prevention of excess weight gain over the life course. In addition to the behavioral and intervention studies of the past several decades, an understanding of the regulatory processes governing energy intake, energy storage, and energy expenditure and how the reinstatement of exercise can correct the disruption of neural pathways is vital to the future of obesity research. Finally, public health science needs to link with public health practice to better enable the translation of this knowledge into policies that can alter the environment in a way that promotes an active lifestyle for all. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.
来自美国普通人群的监测数据表明，超重和肥胖的患病率持续上升，这与工业化国家全球范围内观察到的体重增加趋势一致。缺乏身体活动与肥胖密切相关，它们是慢性病和功能受损的主要原因。肥胖病因的根本因素是长期的正能量平衡；然而，决定正能量导致体重增加的速度和程度的途径很复杂。每周至少进行150分钟的有规律的中等强度体育活动有助于维持能量平衡并防止体重过度增加；然而，这一最低要求可能不足以逆转已有的肥胖和慢性病。事实上，每周接近300分钟的体育活动对于成功减肥和维持体重可能是必要的。然而，单纯的有组织的锻炼计划可能不是肥胖者最有效的治疗方法。相反，增加每日总能量消耗的生活方式改变需要辅以饮食咨询以减少每日热量摄入。此外，将必要的锻炼和生活方式体力活动分散在间歇性的时段进行，而不是一次长时间连续进行，可以提高依从性和减肥方案的成功率。临床医生和患者都必须明白，由于驱动能量平衡的潜在机制错综复杂，不存在简单的肥胖治疗方法。事实上，生理、行为、环境和遗传因素发挥着独立且相互关联的作用，共同导致了肥胖的复杂病因。众多科学学科的研究塑造了我们对肥胖的理解。虽然能量消耗不足与能量摄入过多对肥胖发展的相对贡献仍在争论中，但人们普遍认为运动是预防和治疗的关键要素。未来的研究应侧重于预防一生中体重过度增加。除了过去几十年的行为和干预研究外，了解能量摄入、能量储存和能量消耗的调节过程以及运动恢复如何纠正神经通路的破坏对于肥胖研究的未来至关重要。最后，公共卫生科学需要与公共卫生实践相结合，以便更好地将这些知识转化为政策，从而以促进所有人积极生活方式的方式改变环境。如需全面涵盖内分泌学的所有相关领域，请访问我们的在线免费网络文本，网址为WWW.ENDOTEXT.ORG。
