Wimalawansa Sunil J
a Department of Medicine, Endocrinology, Metabolism & Nutrition, UMDNJ-RWJMS, New Brunswick, NJ 08903, USA.
Expert Rev Endocrinol Metab. 2013 May;8(3):275-288. doi: 10.1586/eem.13.13.
Obesity is one of the key noncommunicable diseases leading to significant comorbidities. In recent years, obesity has become a major public health issue and has threatened the wellbeing of millions of patients. Although there are multiple reasons for people becoming obese, sustained positive energy balance - energy intake is greater than energy expenditure - is the key for accumulating excess bodyfat. Prevention of obesity by lifestyle changes, healthy eating and increased physical activity are more cost effective than pharmacotherapy, bariatric surgery or ultimately treating complications of Type 2 diabetes mellitus (T2DM). Not all patients with obesity experience complications such as T2DM. The distribution of bodyfat is important in determining whether a person is obese and healthy or needs medical attention; however, the use of BMI alone will not differentiate this. Obesity patients with excess abdominal fat have the highest risk for T2DM, insulin resistance and thus, higher incidence of cardiovascular diseases. Obesity-associated complications can be reversed through healthy eating habits and increased duration and intensity of physical activity. Increasing work- and leisure-related physical activities increase the energy expenditure, having salutary effects on weightloss programs. Although treating symptoms of obesity and related disorders is important, it is not a solution for the obesity epidemic. Causes that lead to weight-gain need to be identified in individual patients, who should be educated about the causes of weight gain and ways to prevent it, and be provided with simple and practical interventions to lose weight.
肥胖是导致严重合并症的主要非传染性疾病之一。近年来,肥胖已成为一个重大的公共卫生问题,威胁着数百万患者的健康。尽管人们肥胖有多种原因,但持续的正能量平衡——能量摄入大于能量消耗——是积累多余体脂的关键。通过改变生活方式、健康饮食和增加体育活动来预防肥胖比药物治疗、减肥手术或最终治疗2型糖尿病(T2DM)的并发症更具成本效益。并非所有肥胖患者都会出现如T2DM等并发症。体脂分布对于确定一个人是否肥胖且健康或是否需要医疗关注很重要;然而,仅使用BMI并不能区分这一点。腹部脂肪过多的肥胖患者患T2DM、胰岛素抵抗的风险最高,因此心血管疾病的发病率也更高。肥胖相关并发症可通过健康的饮食习惯以及增加体育活动的时长和强度来逆转。增加与工作和休闲相关的体育活动可增加能量消耗,对减肥计划有有益影响。尽管治疗肥胖及相关疾病的症状很重要,但这并非解决肥胖流行问题的办法。需要在个体患者中找出导致体重增加的原因,应对他们进行关于体重增加原因及预防方法的教育,并为他们提供简单实用的减肥干预措施。