Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.
Obes Rev. 2019 Apr;20(4):588-598. doi: 10.1111/obr.12815. Epub 2019 Jan 15.
The study aims to systematically review the available evidence regarding weight loss interventions (lifestyle, surgical, and pharmacological) for obesity in adults aged over 60 years. A search of prospective, randomized studies took place in January 2018, on Medline (Web of Science) and PubMed databases. Search terms included the following: elderly, obese, hypocaloric, pharmacotherapy, and bariatric surgery. Abstracts were screened for eligibility. A total of 256 publications regarding lifestyle interventions were identified; of these, 69 studies were eligible. As no eligible studies were identified for pharmacotherapy or bariatric surgery, the search was broadened to include non- randomized studies. Four pharmacotherapy and 66 surgery studies were included. Lifestyle intervention had similar weight loss efficacy in older compared with younger people, with positive effects on a number of relevant outcomes, including physical function and cardiovascular parameters. There was little data regarding obesity pharmacotherapy in older persons. The available data for bariatric surgery indicate comparable weight loss and resolution of type 2 diabetes, with similar or slightly higher complication rates in older compared with younger people. Older age alone should not be considered a contraindication to intensive lifestyle or surgical intervention for obesity. There are insufficient data to guide clinical decisions regarding obesity pharmacotherapy in older people.
本研究旨在系统回顾针对 60 岁以上成年人肥胖的减肥干预措施（生活方式、手术和药物治疗）的现有证据。2018 年 1 月，我们在 Medline（Web of Science）和 PubMed 数据库中进行了前瞻性随机研究的检索。检索词包括：老年人、肥胖、低热量、药物治疗和减重手术。对摘要进行了筛选以确定是否符合纳入标准。共确定了 256 篇关于生活方式干预的出版物；其中，有 69 项研究符合纳入标准。由于没有发现药物治疗或减重手术的合格研究，因此将搜索范围扩大到包括非随机研究。纳入了 4 项药物治疗和 66 项手术研究。与年轻人相比，生活方式干预在老年人中具有相似的减肥效果，并对许多相关结局产生积极影响，包括身体功能和心血管参数。关于老年人肥胖的药物治疗数据很少。现有的减重手术数据表明，在老年人和年轻人中，体重减轻和 2 型糖尿病的缓解情况相似或略高，并发症发生率相似或略高。单纯年龄增长不应该成为对肥胖进行强化生活方式或手术干预的禁忌症。目前还没有足够的数据来指导老年人肥胖药物治疗的临床决策。
