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基层医疗中超重和肥胖的管理-国际循证指南的系统综述。

Management of overweight and obesity in primary care-A systematic overview of international evidence-based guidelines.

机构信息

Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria.

Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.

出版信息

Obes Rev. 2019 Sep;20(9):1218-1230. doi: 10.1111/obr.12889. Epub 2019 Jul 8.

Abstract

Overweight and obesity are increasing worldwide. In general practice, different approaches exist to treat people with weight problems. To provide the foundation for the development of a structured clinical pathway for overweight and obesity management in primary care, we performed a systematic overview of international evidence-based guidelines. We searched in PubMed and major guideline databases for all guidelines published in World Health Organization (WHO) "Stratum A" nations that dealt with adults with overweight or obesity. Nineteen guidelines including 711 relevant recommendations were identified. Most of them concluded that a multidisciplinary team should treat overweight and obesity as a chronic disease. Body mass index (BMI) should be used as a routine measure for diagnosis, and weight-related complications should be taken into account. A multifactorial, comprehensive lifestyle programme that includes reduced calorie intake, increased physical activity, and measures to support behavioural change for at least 6 to 12 months is recommended. After weight reduction, long-term measures for weight maintenance are necessary. Bariatric surgery can be offered to people with a BMI greater than or equal to 35 kg/m when all non-surgical interventions have failed. In conclusion, there was considerable agreement in international, evidence-based guidelines on how multidisciplinary management of overweight and obesity in primary care should be performed.

摘要

超重和肥胖在全球范围内不断增加。在全科医疗中,存在多种方法来治疗有体重问题的人群。为了为超重和肥胖管理的结构化临床路径的制定提供基础,我们对国际循证指南进行了系统综述。我们在 PubMed 和主要指南数据库中搜索了所有在世界卫生组织(WHO)“A 层”国家发布的、针对超重或肥胖成年人的指南。确定了 19 条指南,其中包括 711 条相关建议。其中大多数都认为多学科团队应将超重和肥胖视为一种慢性疾病。体重指数(BMI)应作为常规诊断指标,并且应考虑与体重相关的并发症。建议采用多因素、综合性的生活方式方案,包括减少热量摄入、增加身体活动,并采取措施支持至少 6 至 12 个月的行为改变。体重减轻后,还需要采取长期的体重维持措施。当所有非手术干预都失败时,可以向 BMI 大于或等于 35kg/m²的人群提供减肥手术。总之,国际循证指南在基层医疗中如何进行超重和肥胖的多学科管理方面达成了相当大的共识。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/412b/6852048/9af435df02af/OBR-20-1218-g001.jpg

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