Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana.
Diabetes Obes Metab. 2021 Feb;23 Suppl 1:50-62. doi: 10.1111/dom.14200. Epub 2020 Nov 24.
Against the backdrop of obesity as a major public health problem, we examined three questions: How much weight loss is needed to benefit patients with obesity? How well do current therapies do in producing weight loss? What strategies can be used to improve patient outcomes using evidence-based studies. This paper reviews literature on the outcomes of lifestyle, diet, medications and surgical treatments for obesity using literature searches for obesity treatments. Current treatments, including lifestyle, diet and exercise, produce a weight loss of 5% to 7% on average. Despite continued attempts to identify superior dietary approaches, most careful comparisons find that low carbohydrate diets are not significantly better than low fat diets for weight loss. The four medications currently approved by the US Food and Drug Administration for long-term management of obesity are not as effective as surgery, adding about 5% on average to lifestyle approaches to weight loss. Two new medications that are under investigation, semaglutide and tirzepatide, significantly improve on this. For all treatments for weight loss, including lifestyle, medications and surgery, there is enormous variability in the amount of weight lost. Examination of this literature has yielded evidence supporting baseline and process predictors, but the effect sizes associated with these predictors are small and there are no prospective studies showing that a personalized approach based on genotype or phenotype will yield uniform success. Because obesity is a chronic disease it requires a 'continuous treatment model' across the lifespan.
在肥胖成为主要公共卫生问题的背景下，我们研究了三个问题：肥胖患者需要减轻多少体重才能受益？目前的疗法在减肥方面效果如何？有哪些策略可以利用基于证据的研究来改善患者的治疗效果？本文通过对肥胖治疗的文献检索，综述了生活方式、饮食、药物和手术治疗肥胖的结果。目前的治疗方法，包括生活方式、饮食和运动，平均可使体重减轻 5%至 7%。尽管人们一直在努力寻找更优越的饮食方法，但大多数仔细的比较发现，低碳水化合物饮食在减肥方面并不比低脂肪饮食好多少。目前美国食品和药物管理局批准用于肥胖长期管理的四种药物并不像手术那样有效，平均只能增加生活方式减肥方法的 5%左右。正在研究的两种新药物，司美格鲁肽和替西帕肽，在这方面有显著改善。对于包括生活方式、药物和手术在内的所有减肥治疗方法，体重减轻的幅度都存在很大的差异。对这些文献的研究得出了支持基线和治疗过程预测因素的证据，但这些预测因素的相关效应大小较小，并且没有前瞻性研究表明基于基因型或表型的个性化方法会取得一致的成功。由于肥胖是一种慢性疾病，它需要在整个生命周期中采用“连续治疗模式”。
