Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine and Rocky Mountain VA Medical Center, Anschutz Medical Campus, Aurora, CO, USA.
J Clin Endocrinol Metab. 2021 Jun 16;106(7):1854-1866. doi: 10.1210/clinem/dgab091.
Obesity is a chronic disease that is difficult to manage without holistic therapy. The therapeutic armamentarium for obesity primarily consists of 4 forms of therapy: lifestyle modification (ie, diet and exercise), cognitive behavioral therapy, pharmacotherapy, and bariatric surgery.
Evidence was consolidated from randomized controlled trials, observational studies, and meta-analyses.
After 2 years, lifestyle interventions can facilitate weight loss that equates to ~5%. Even though lifestyle interventions are plagued by weight regain, they can have substantial effects on type 2 diabetes and cardiovascular disease risk. Although 10-year percentage excess weight loss can surpass 50% after bariatric surgery, weight regain is likely. To mitigate weight regain, instituting a multifactorial maintenance program is imperative. Such a program can integrate diet, exercise, and pharmacotherapy. Moreover, behavioral therapy can complement a maintenance program well.
Obesity is best managed by a multidisciplinary clinical team that integrates diet, exercise, and pharmacotherapy. Bariatric surgery is needed to manage type 2 diabetes and obesity in select patients.
肥胖是一种慢性病，如果没有整体治疗，很难进行管理。肥胖症的治疗方法主要包括 4 种治疗形式：生活方式改变（即饮食和运动）、认知行为疗法、药物治疗和减重手术。
证据来自随机对照试验、观察性研究和荟萃分析。
2 年后，生活方式干预可以促进体重减轻，相当于约 5%。尽管生活方式干预受到体重反弹的困扰，但它们对 2 型糖尿病和心血管疾病风险有显著影响。尽管减重手术后 10 年的超重百分比可能超过 50%，但体重仍有可能反弹。为了减轻体重反弹，必须实施多因素维持方案。这样的方案可以整合饮食、运动和药物治疗。此外，行为疗法可以很好地补充维持方案。
肥胖症最好由一个多学科的临床团队进行管理，该团队整合饮食、运动和药物治疗。对于某些患者，需要进行减重手术来治疗 2 型糖尿病和肥胖症。
