Meldrum David R, Morris Marge A, Gambone Joseph C
Division of Reproductive Endocrinology and Infertility, Department of Reproductive Medicine, University of California, San Diego, California.
Diabetes Education and Nutrition Department, Mercy Regional Medical Center, Durango, Colorado.
Fertil Steril. 2017 Apr;107(4):833-839. doi: 10.1016/j.fertnstert.2017.02.104. Epub 2017 Mar 11.
Obesity has become pandemic owing to an obesogenic environment (inexpensive calorie dense food, technologies and structure of communities that reduce or replace physical activity, and inexpensive nonphysical entertainment) and excessive emphasis on low fat intake resulting in excessive intake of simple carbohydrates and sugar. Effects are greater for women owing to their smaller size and extra weight gain with each pregnancy, with 38% of American adult women being obese. Women are responsible for more than three-fourths of the more than 400 billion dollars of excess direct health care expenditures due to obesity. They are less likely to conceive naturally and with fertility treatments, more likely to miscarry, and have more prematurity and other complications with their pregnancies. We describe the many causes, including key roles that a dysbiotic intestinal microbiome plays in metabolic derangements accompanying obesity, increased calorie absorption, and increased appetite and fat storage. Genetic causes are contributory if these other factors are present but have limited effect in isolation. The numerous health consequences of obesity are discussed. The authors itemize ways that an individual and societies can mitigate the pandemic. However, individual will power, the will of society to enact change, and willingness of the public to accept outside intervention frustrate efforts to stabilize or reverse this crisis. The most promising strategies are education and efforts by individuals to make responsible choices several times every day to protect, most effectively by prevention, their most valuable asset.
由于致肥胖环境（廉价的高热量食物、减少或取代体力活动的社区技术与结构，以及廉价的非体力娱乐）以及过度强调低脂肪摄入导致简单碳水化合物和糖的过量摄入，肥胖已成为一种流行病。女性受到的影响更大，因为她们身材较小，每次怀孕体重都会额外增加，美国成年女性中有38%肥胖。肥胖导致的超过4000亿美元额外直接医疗支出中，超过四分之三由女性承担。她们自然受孕以及接受生育治疗时受孕的可能性更低，流产的可能性更高，怀孕时早产及出现其他并发症的情况更多。我们描述了肥胖的诸多成因，包括肠道微生物群失调在肥胖伴发的代谢紊乱、热量吸收增加、食欲及脂肪储存增加中所起的关键作用。如果存在其他这些因素，遗传因素会起一定作用，但单独来看影响有限。文中讨论了肥胖带来的众多健康后果。作者列举了个人和社会可以缓解这一流行病的方法。然而，个人意志力、社会推动变革的意愿以及公众接受外部干预的意愿阻碍了稳定或扭转这一危机的努力。最有前景的策略是开展教育，以及个人每天多次做出负责任选择的努力，最有效的方式是通过预防来保护自己最宝贵的资产。
