现行指南是否在加剧体重歧视？对肥胖患者护理的持怀疑态度的体重观点。
Are Current Guidelines Perpetuating Weight Stigma? A Weight-Skeptical Approach to the Care of Patients with Obesity.
机构信息
VA Puget Sound Health Care System, Seattle, WA, USA.
Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
出版信息
J Gen Intern Med. 2023 Feb;38(3):793-798. doi: 10.1007/s11606-022-07821-w. Epub 2022 Sep 22.
Abstract
Significant controversy exists regarding the evidence to support the clinical benefits and risks of weight loss interventions for individuals with obesity. United States Preventative Task Force (USPSTF) guidelines recommend weight loss for all individuals with obesity while weight-neutral models such as Health at Every Size promote weight inclusivity, focusing on body acceptance rather than weight loss. We discuss how lifestyle-based weight-centric paradigms, such as the USPSTF Guidelines, may increase weight stigma and weight cycling, and many of their purported clinical benefits are not supported by existing evidence. However, we also acknowledge the clear benefits of metabolic surgery in high-risk individuals, and the potential benefits for pharmacotherapy for obesity in selected patients. Herein we describe a weight-skeptical approach to the care of patients with obesity that aims to use available evidence to support patient-centered care.
摘要
关于肥胖人群减肥干预的临床获益和风险的证据存在很大争议。美国预防服务工作组 (USPSTF) 指南建议所有肥胖人群减轻体重，而健康大小即每一个人都健康等体重中立模式则提倡体重包容性，注重接受身体，而不是减轻体重。我们讨论了基于生活方式的以体重为中心的模式，如 USPSTF 指南，可能会增加体重污名和体重循环，并指出其许多所谓的临床益处没有现有证据支持。然而，我们也承认代谢手术在高危人群中的明显益处，以及在选定患者中使用肥胖药物治疗的潜在益处。在此，我们描述了一种对肥胖患者护理的持怀疑态度的方法，旨在利用现有证据来支持以患者为中心的护理。
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3
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iScience. 2021 Sep 20;24(10):102995. doi: 10.1016/j.isci.2021.102995. eCollection 2021 Oct 22.
4
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JAMA Netw Open. 2021 Sep 1;4(9):e2124516. doi: 10.1001/jamanetworkopen.2021.24516.
5
Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study.
Lancet Diabetes Endocrinol. 2021 Jul;9(7):419-426. doi: 10.1016/S2213-8587(21)00088-7. Epub 2021 May 11.
6
Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants.
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