Department of Medicine, Division of Endocrinology and The Ottawa Hospital, University of Ottawa, 210 Melrose Ave, Ottawa, ON K1Y 4K7, Canada.
Atherogenomics Laboratory, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON K1Y 4W7, Canada.
Metabolism. 2020 Dec;113:154388. doi: 10.1016/j.metabol.2020.154388. Epub 2020 Oct 7.
Current obesity treatment strategies include diet, exercise, bariatric surgery, and a limited but growing repertoire of medications. Individual weight loss in response to each of these strategies is highly variable. Here we review research into factors potentially contributing to inter-individual variability in response to treatments for obesity, with a focus on studies in humans. Well-recognized factors associated with weight loss capacity include diet adherence, physical activity, sex, age, and specific medications. However, following control for each of these, differences in weight loss appear to persist in response to behavioral, pharmacological and surgical interventions. Adaptation to energy deficit involves complex feedback mechanisms, and inter-individual differences likely to arise from a host of poorly defined genetic factors, as well as differential responses in neurohormonal mechanisms (including gastrointestinal peptides), metabolic efficiency and capacity of tissues, non-exercise activity thermogenesis, thermogenic response to food, and in gut microbiome. A better understanding of the factors involved in inter-individual variability in response to therapies will guide more personalized approaches to the treatment of obesity.
目前的肥胖症治疗策略包括饮食、运动、减重手术，以及越来越多的有限药物治疗。针对这些策略的个体减肥效果差异很大。在这里，我们回顾了可能导致肥胖症治疗反应个体间差异的研究，重点是在人类中的研究。与减肥能力相关的公认因素包括饮食依从性、身体活动、性别、年龄和特定药物。然而，在控制了这些因素之后，在行为、药理学和手术干预方面，体重减轻的差异似乎仍然存在。对能量缺乏的适应涉及复杂的反馈机制，个体间的差异可能源于大量定义不明确的遗传因素，以及神经激素机制（包括胃肠道肽）、代谢效率和组织容量、非运动活动产热、对食物的产热反应和肠道微生物组的差异反应。更好地了解治疗反应个体间差异所涉及的因素将指导更个性化的肥胖症治疗方法。
