Department of Endocrinology &Nutrition, CIBEROBN, Clínica Universidad de Navarra, University of Navarra, IdiSNA, Avda. Pío XII 36, 31008 Pamplona, Spain.
Nat Rev Endocrinol. 2015 Aug;11(8):465-77. doi: 10.1038/nrendo.2015.84. Epub 2015 Jun 9.
The obesity epidemic, combined with the lack of available and effective treatments for morbid obesity, is a scientific and public health priority. Worldwide, bariatric and metabolic surgeries are increasingly being performed to effectively aid weight loss in patients with severe obesity, as well as because of the favourable metabolic effects of the procedures. The positive effects of bariatric surgery, especially with respect to improvements in type 2 diabetes mellitus, have expanded the eligibility criteria for metabolic surgery to patients with diabetes mellitus and a BMI of 30-35 kg/m(2). However, the limitations of BMI, both in the diagnosis and follow-up of patients, need to be considered, particularly for determining the actual adiposity and fat distribution of the patients following weight loss. Understanding the characteristics shared by bariatric and metabolic surgeries, as well as their differential aspects and outcomes, is required to enhance patient benefits and operative achievements. For a holistic approach that focuses on the multifactorial effects of bariatric and metabolic surgery to be possible, a paradigm shift that goes beyond the pure semantics is needed. Such a shift could lead to profound clinical implications for eligibility criteria and the definition of success of the surgical approach.
肥胖症的流行，加上针对病态肥胖症缺乏有效治疗方法，这是一个科学和公共卫生的重点。在全球范围内，为了有效帮助严重肥胖患者减轻体重，以及因为这些手术的代谢效果良好，减重和代谢手术的数量不断增加。减重手术的积极效果，尤其是在改善 2 型糖尿病方面，已经扩大了代谢手术的适应证，包括糖尿病和 BMI 为 30-35kg/m²的患者。然而，BMI 的局限性，无论是在患者的诊断还是随访中，都需要考虑，特别是在确定患者在减重后实际的肥胖程度和脂肪分布方面。为了提高患者的受益和手术的效果，需要了解减重和代谢手术之间的共同特征，以及它们的不同方面和结果。为了实现以关注减重和代谢手术的多因素效应为重点的整体方法，需要超越纯粹语义学的范式转变。这种转变可能会对手术适应证的标准和手术方法的成功定义产生深远的临床影响。
