Beaulac Julie, Sandre Daniella
Psychology Department, The Ottawa Hospital, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Psychology Department, The Ottawa Hospital, Ottawa, ON, Canada.
Perspect Public Health. 2017 May;137(3):162-172. doi: 10.1177/1757913916653425. Epub 2016 Jun 27.
Patient selection of weight management treatment option is often guided by a variety of factors. Currently, there is no comprehensive tool to facilitate informed decision-making for patients and clinicians. This article aims to synthesise evidence on the treatment effectiveness, health benefits, risks, and patient experiences of treatment options presently available at the Weight Management Clinic at The Ottawa Hospital (TOH), as a first step towards developing a decision aid.
Narrative and systematic reviews published in English between 1999 and 2014 were included that focused on one or more of the following weight management treatments in adults aged 18 years and over: roux-en-y gastric bypass (RYGB), sleeve gastrectomy (SG), medically supervised meal replacement, and behavioural or lifestyle intervention.
Overall, bariatric surgeries have received the greatest research attention and have been associated not only with greater weight loss and health benefit but also with greater risks, complications, and financial cost. Dietary programmes demonstrated weight loss and health benefits to a lesser extent than with surgery but were associated with lower and shorter-term risks and complications. Behavioural and lifestyle interventions have been studied less yet have shown significant, albeit small, weight loss outcomes alone and in combination with dietary or surgical options; they also appear to be the lowest risk interventions. Patient experiences of weight management options are mixed and not well understood.
Further research is needed; however, this review identified some general trends related to weight loss outcomes, benefits, risks, and barriers for weight management options that have implications for shared treatment decision-making.
体重管理治疗方案的患者选择通常受多种因素指导。目前，尚无全面的工具来促进患者和临床医生做出明智的决策。本文旨在综合渥太华医院（TOH）体重管理诊所目前提供的治疗方案在治疗效果、健康益处、风险及患者体验方面的证据，作为开发决策辅助工具的第一步。
纳入1999年至2014年间以英文发表的叙述性和系统性综述，这些综述聚焦于18岁及以上成年人的以下一种或多种体重管理治疗方法：胃旁路手术（RYGB）、袖状胃切除术（SG）、医学监督下的代餐以及行为或生活方式干预。
总体而言，减肥手术受到的研究关注最多，不仅与更大程度的体重减轻和健康益处相关，还与更高的风险、并发症及经济成本相关。饮食方案在体重减轻和健康益处方面的表现不如手术，但风险和并发症较低且持续时间较短。行为和生活方式干预的研究较少，但单独或与饮食或手术方案联合使用时均显示出显著的体重减轻效果，尽管幅度较小；它们似乎也是风险最低的干预措施。患者对体重管理方案的体验不一，且尚未得到充分了解。
需要进一步研究；然而，本综述确定了一些与体重减轻结果、益处、风险及体重管理方案障碍相关的总体趋势，这些趋势对共同的治疗决策具有启示意义。
