Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Nat Rev Endocrinol. 2018 Jun;14(6):331-344. doi: 10.1038/s41574-018-0002-8.
The increased prevalence of adolescent obesity and associated short-term and long-term complications emphasize the need for effective treatment. In this Review, we aim to describe the evidence for, and elements of, behaviour management and adjunctive therapies and highlight the opportunities and challenges presented by obesity management in adolescence. The broad principles of treatment include management of obesity-associated complications; a developmentally appropriate approach; long-term behaviour modification (dietary change, increased physical activity, decreased sedentary behaviours and improved sleep patterns); long-term weight maintenance strategies; and consideration of the use of pharmacotherapy, more intensive dietary therapies and bariatric surgery. Bariatric surgery should be considered in those with severe obesity and be undertaken by skilled bariatric surgeons affiliated with teams experienced in the medical and psychosocial management of adolescents. Adolescent obesity management strategies are more reliant on active participation than those for childhood obesity and should recognize the emerging autonomy of the patient. The challenges in adolescent obesity relate primarily to the often competing demands of developing autonomy and not yet having attained neurocognitive maturity.
青少年肥胖症的患病率不断上升，以及与之相关的短期和长期并发症，强调了有效治疗的必要性。在这篇综述中，我们旨在描述行为管理和辅助疗法的证据和要素，并强调青少年肥胖管理所带来的机遇和挑战。治疗的基本原则包括：管理肥胖相关并发症；采取适合发展阶段的方法；长期行为改变（饮食改变、增加身体活动、减少久坐行为和改善睡眠模式）；长期体重维持策略；以及考虑使用药物治疗、更强化的饮食疗法和减重手术。对于严重肥胖的患者，应考虑进行减重手术，并由经验丰富的青少年医学和心理社会管理团队中的熟练减重外科医生进行操作。青少年肥胖症的管理策略比儿童肥胖症更依赖于积极参与，并且应该认识到患者正在逐渐获得自主权。青少年肥胖症的挑战主要与发展自主性和尚未达到神经认知成熟之间经常存在的竞争需求有关。
