Wharton Sean, Lee Jasmine, Christensen Rebecca Ag
The Wharton Medical Clinic, Hamilton, ON, Canada.
School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
Diabetes Metab Syndr Obes. 2017 Oct 4;10:413-417. doi: 10.2147/DMSO.S141571. eCollection 2017.
Current methods for the treatment of excess weight can involve healthy behavior changes, pharmacotherapy, and surgical interventions. Many individuals are able to lose some degree of weight through behavioral changes; however, they are often unable to maintain their weight loss long-term. This is in part due to physiological processes that cannot be addressed through behavioral changes alone. Bariatric surgery, which is the most successful treatment for excess weight to date, does result in physiological changes that can help with weight loss and weight maintenance. However, many patients either do not qualify or elect to not have this procedure. Fortunately, research has recently identified changes in neurochemicals (i.e., orexigens and anorexigens) that occur during weight loss and contribute to weight regain. The neurochemicals and hormones may be able to be targeted by medications to achieve greater and more sustained weight loss. Two medications are approved in adjunction to lifestyle management for weight loss in Canada: orlistat and liraglutide. Both medications are able to target physiological processes to help patients lose weight and maintain a greater amount of weight loss than with just behavioral modifications alone. Two other weight management medications, which also target specific physiological processes to aid in weight loss and its maintenance, a bupropion/naltrexone combination and lorcaserin, are currently pending approval in Canada. Nonetheless, there remain significant barriers for health care professionals to prescribe medications for weight loss, such as a lack of training and knowledge in the area of obesity. Until this has been addressed, and we begin treating obesity as we do other diseases, we are unlikely to combat the increasing trend of obesity in Canada and worldwide.
目前治疗超重的方法包括健康行为改变、药物治疗和手术干预。许多人能够通过行为改变减轻一定程度的体重；然而，他们往往无法长期维持体重减轻。这部分是由于仅靠行为改变无法解决的生理过程。减肥手术是迄今为止治疗超重最成功的方法，确实会导致有助于减肥和维持体重的生理变化。然而，许多患者要么不符合条件，要么选择不进行这种手术。幸运的是，最近的研究发现了减肥过程中发生的神经化学物质（即促食欲素和抑食欲素）变化，这些变化会导致体重反弹。神经化学物质和激素可能可以通过药物来靶向作用，以实现更大程度和更持久的体重减轻。在加拿大，有两种药物被批准与生活方式管理联合用于减肥：奥利司他和利拉鲁肽。这两种药物都能够针对生理过程，帮助患者减肥，并比仅靠行为改变维持更大程度的体重减轻。另外两种体重管理药物，一种安非他酮/纳曲酮组合和洛卡塞林，也针对特定生理过程来辅助减肥及其维持，目前正在加拿大等待批准。尽管如此，医疗保健专业人员在开具减肥药物方面仍然存在重大障碍，例如在肥胖领域缺乏培训和知识。在这个问题得到解决之前，并且我们开始像治疗其他疾病一样治疗肥胖症之前，我们不太可能对抗加拿大乃至全球肥胖症日益增长的趋势。
