Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany.
Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany.
Lancet Diabetes Endocrinol. 2018 Mar;6(3):249-258. doi: 10.1016/S2213-8587(17)30292-9. Epub 2017 Sep 14.
Obesity increases the risk of several other chronic diseases and, because of its epidemic proportions, has become a major public health problem worldwide. Alarmingly, a lower proportion of adults have tried to lose weight during the past decade than during the mid-1980s to 1990s. The first-line treatment option for obesity is lifestyle intervention. Although this approach can decrease fat mass in the short term, these beneficial effects typically do not persist. If a large amount of weight loss is not an easily achievable goal, other goals that might motivate people with obesity to adopt a healthy lifestyle should be considered. In this setting, the concept of metabolically healthy obesity is useful. Accumulating evidence suggests that, although the risk of all-cause mortality and cardiovascular events might be higher in people with metabolically healthy obesity compared with metabolically healthy people of a normal weight, the risk is substantially lower than in individuals with metabolically unhealthy obesity. Therefore, every person with obesity should be motivated to achieve a normal weight in the long term, but more moderate weight loss sufficient for the transition from metabolically unhealthy obesity to metabolically healthy obesity might also lower the risk of adverse outcomes. However, how much weight needs to be lost for this transition to occur is under debate. This transition might be supported by lifestyle factors-such as the Mediterranean diet-that affect cardiovascular risk, independent of body fat. In this Series paper, we summarise available information about the concept of metabolically healthy obesity, highlight gaps in research, and discuss how this concept can be implemented in clinical care.
肥胖增加了多种其他慢性疾病的风险，而且由于其流行程度，已成为全球主要的公共卫生问题。令人震惊的是，与 20 世纪 80 年代至 90 年代相比，在过去十年中，尝试减肥的成年人比例较低。肥胖的一线治疗选择是生活方式干预。尽管这种方法可以在短期内减少脂肪量，但这些有益的效果通常不会持续。如果大量减肥不是一个容易实现的目标，那么应该考虑其他可能促使肥胖者采取健康生活方式的目标。在这种情况下，代谢健康型肥胖的概念很有用。越来越多的证据表明，尽管与体重正常的代谢健康者相比，代谢健康型肥胖者全因死亡率和心血管事件的风险可能更高，但风险明显低于代谢不健康型肥胖者。因此，每个肥胖者都应该被激励在长期内达到正常体重，但更适度的减肥足以从代谢不健康型肥胖过渡到代谢健康型肥胖，也可能降低不良后果的风险。然而，为了实现这种转变，需要减轻多少体重仍存在争议。这种转变可能得到生活方式因素的支持，如影响心血管风险的地中海饮食，而与体脂肪无关。在本系列论文中，我们总结了有关代谢健康型肥胖概念的现有信息，突出了研究中的差距，并讨论了如何在临床护理中实施这一概念。
