Tahrani Abd A, Morton John
Novo Nordisk A/S, Søborg, Denmark.
Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
Obesity (Silver Spring). 2022 Apr;30(4):802-840. doi: 10.1002/oby.23371.
Modest weight loss (5%-10%) is clinically meaningful in patients with overweight or obesity. However, greater weight loss may be required to achieve improvements in or remission of certain weight-related complications. Therefore, this study reviewed the effect of large weight loss (≥10%). Most studies reporting large weight loss and relevant outcomes used bariatric surgery or lifestyle modifications.
Benefits of large weight loss were observed in patients with various overweight- or obesity-related complications, including improvements in comorbidities such as type 2 diabetes and hypertension. Improvements in glucose metabolism and cardiovascular risk factors were observed in patients who achieved large weight loss through lifestyle interventions or pharmacotherapy (phentermine/topiramate 15/92 mg once daily or subcutaneous semaglutide 2.4 mg once weekly). Other benefits associated with large weight loss included reduced cancer risk and improvements in knee osteoarthritis, sleep apnea, fertility-related end points, and health-related quality of life. While costly, bariatric surgery is currently the most cost-effective intervention, although most weight-management programs are deemed cost-effective.
Overall, large weight loss has a major beneficial impact on overweight- and obesity-related complications. Large weight loss should be the main treatment target when modest weight loss has had insufficient effects on obesity-related complications and for patients with severe obesity.
适度减重（5%-10%）对超重或肥胖患者具有临床意义。然而，可能需要更大幅度的减重才能改善或缓解某些与体重相关的并发症。因此，本研究回顾了大幅减重（≥10%）的效果。大多数报告大幅减重及相关结果的研究采用了减肥手术或生活方式改变。
在患有各种超重或肥胖相关并发症的患者中观察到了大幅减重的益处，包括改善2型糖尿病和高血压等合并症。通过生活方式干预或药物治疗（每日一次服用15/92毫克苯丁胺/托吡酯或每周一次皮下注射2.4毫克司美格鲁肽）实现大幅减重的患者，其糖代谢和心血管危险因素得到改善。与大幅减重相关的其他益处包括降低癌症风险以及改善膝骨关节炎、睡眠呼吸暂停、生育相关终点和健康相关生活质量。虽然减肥手术成本高昂，但目前是最具成本效益的干预措施，尽管大多数体重管理项目也被认为具有成本效益。
总体而言，大幅减重对超重和肥胖相关并发症具有重大有益影响。当适度减重对肥胖相关并发症效果不佳时，以及对于重度肥胖患者，大幅减重应成为主要治疗目标。
