Pennington Biomedical Research Center/LSU, Baton Rouge, LA, USA.
Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, CIBEROBN, IdiSNA, Spain.
Lancet. 2016 May 7;387(10031):1947-56. doi: 10.1016/S0140-6736(16)00271-3. Epub 2016 Feb 10.
A modern approach to obesity acknowledges the multifactorial determinants of weight gain and the health benefits to be derived from weight loss. Foundational to any weight loss effort is lifestyle change, diet, and increased physical activity. The approach should be a high quality diet to which patients will adhere accompanied by an exercise prescription describing frequency, intensity, type, and time with a minimum of 150 min moderate weekly activity. For patients who struggle with weight loss and who would receive health benefit from weight loss, management of medications that are contributing to weight gain and use of approved medications for chronic weight management along with lifestyle changes are appropriate. Medications approved in the USA or European Union are orlistat, naltrexone/bupropion, and liraglutide; in the USA, lorcaserin and phentermine/topiramate are also available. Surgical management (gastric banding, sleeve gastrectomy, and Roux-en Y gastric bypass) can produce remarkable health improvement and reduce mortality for patients with severe obesity.
一种现代的肥胖治疗方法承认体重增加的多因素决定因素，以及减肥带来的健康益处。任何减肥努力的基础都是生活方式的改变、饮食和增加身体活动。这种方法应该是一种高质量的饮食，患者将坚持，并伴随着一份运动处方，描述频率、强度、类型和时间，每周至少进行 150 分钟的适度活动。对于那些在减肥方面有困难的患者，以及那些从减肥中受益的患者，管理导致体重增加的药物，并使用批准的药物进行慢性体重管理，同时进行生活方式的改变是合适的。在美国或欧盟批准的药物有奥利司他、纳曲酮/安非他酮和利拉鲁肽；在美国，氯卡色林和 phentermine/topiramate 也可用于肥胖症的治疗。手术治疗（胃带、胃袖状切除术和 Roux-en Y 胃旁路术）可以显著改善严重肥胖患者的健康状况并降低死亡率。
