Ryan Donna H, Yockey Sarah Ryan
Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA.
Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, New Orleans, LA, USA.
Curr Obes Rep. 2017 Jun;6(2):187-194. doi: 10.1007/s13679-017-0262-y.
One begins to see improvement in glycemic measures and triglycerides with small amounts of weight loss, but with greater levels of weight loss there is even greater improvement. In fact, the relationship between weight loss and glycemia is one that is very close.
This is fortunate for diabetes prevention; it takes only small amounts of weight loss to prevent progression to type 2 diabetes from impaired glucose tolerance, and after the 10 kg of weight loss, one cannot demonstrate much additional improvement in risk reduction. Modest weight loss (5 to 10%) is also associated with improvement in systolic and diastolic blood pressure and HDL cholesterol. With all these risk factors, more weight loss produces more improvement. Further, for patients with higher BMI levels (>40 kg/m), the ability to lose the same proportion of weight with lifestyle intervention is equal to that of those with lower BMI levels, and there is equal benefit in terms of risk factor improvement with modest weight loss. For some comorbid conditions, more weight loss is needed-10 to 15%-to translate into clinical improvement. This is true with obstructive sleep apnea and non-alcoholic steatotic hepatitis. There is a graded improvement in improvements in measures of quality of life, depression, mobility, sexual dysfunction, and urinary stress incontinence, whereby improvements are demonstrable with modest weight loss (5-10%) and with further weight loss there are further improvements. For polycystic ovarian syndrome and infertility, modest weight loss (beginning at 2-5%) can bring improvements in menstrual irregularities and fertility. Moderate weight loss (5-10%) has been shown to be associated with reduced health care costs. Reduction in mortality may take more than 10% weight loss, although definitive studies have not been done to demonstrate that weight loss per se is associated with mortality reduction. Clinicians in medical weight management should bear in mind that the target should be health improvement rather than a number on the scale. The individual patient's targeted health goal should be assessed for response rather than a prescribed percentage weight loss.
人们开始发现，少量体重减轻就能使血糖指标和甘油三酯有所改善，而体重减轻幅度越大，改善效果越明显。事实上，体重减轻与血糖之间的关系非常密切。
这对糖尿病预防来说是幸事；只需少量体重减轻就能防止糖耐量受损发展为2型糖尿病，体重减轻10千克后，在降低风险方面就无法显示出更多的额外改善。适度体重减轻（5%至10%）也与收缩压和舒张压以及高密度脂蛋白胆固醇的改善有关。对于所有这些风险因素，体重减轻越多，改善效果越明显。此外，对于体重指数较高（>40kg/m²）的患者，通过生活方式干预减轻相同比例体重的能力与体重指数较低的患者相同，适度体重减轻在改善风险因素方面的益处也相同。对于一些合并症，需要更多的体重减轻——10%至15%——才能转化为临床改善。阻塞性睡眠呼吸暂停和非酒精性脂肪性肝炎就是如此。在生活质量、抑郁、活动能力、性功能和尿失禁等方面的改善呈梯度变化，适度体重减轻（5%至10%）就能显示出改善效果，进一步减轻体重则会有更大改善。对于多囊卵巢综合征和不孕症，适度体重减轻（从2%至5%开始）可改善月经不调和生育能力。适度体重减轻（5%至10%）已被证明与医疗保健成本降低有关。可能需要超过10%的体重减轻才能降低死亡率，不过尚未有确定性研究表明体重减轻本身与死亡率降低有关。医学体重管理方面的临床医生应牢记，目标应该是改善健康状况，而不是体重秤上的数字。应该评估个体患者的目标健康目标的反应，而不是规定的体重减轻百分比。
