Perdomo Carolina M, Cohen Ricardo V, Sumithran Priya, Clément Karine, Frühbeck Gema
Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; Metabolic Research Laboratory, CIBEROBN, ISCIII, IdiSNA, Clínica Universidad de Navarra, Pamplona, Spain.
The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil.
Lancet. 2023 Apr 1;401(10382):1116-1130. doi: 10.1016/S0140-6736(22)02403-5. Epub 2023 Feb 9.
The goal of obesity management is to improve health. Sustained weight loss of more than 10% overall bodyweight improves many of the complications associated with obesity (eg, prevention and control of type 2 diabetes, hypertension, fatty liver disease, and obstructive sleep apnoea), as well as quality of life. Maintenance of weight loss is the major challenge of obesity management. Like all chronic diseases, managing obesity requires a long-term, multimodal approach, taking into account each individual's treatment goals, and the benefit and risk of different therapies. In conjunction with lifestyle interventions, anti-obesity medications and bariatric surgery improve the maintenance of weight loss and associated health gains. Most available anti-obesity medications act on central appetite pathways to reduce hunger and food reward. In the past 5 years, therapeutic advances have seen the development of targeted treatments for monogenic obesities and a new generation of anti-obesity medications. These highly effective anti-obesity medications are associated with weight losses of more than 10% of overall bodyweight in more than two-thirds of clinical trial participants. Long-term data on safety, efficacy, and cardiovascular outcomes are awaited. Long-term studies have shown that bariatric surgical procedures typically lead to a durable weight loss of 25% and rapid, sustained improvements in complications of obesity, although they have not yet been compared with new-generation highly effective anti-obesity medications. Further work is required to determine optimal patient-specific treatment strategies, including combinations of lifestyle interventions, anti-obesity medications, endoscopic and bariatric surgical procedures, and to ensure equitable access to effective treatments.
肥胖管理的目标是改善健康状况。总体体重持续减轻超过10%可改善许多与肥胖相关的并发症（如2型糖尿病、高血压、脂肪肝疾病和阻塞性睡眠呼吸暂停的预防和控制），以及生活质量。维持体重减轻是肥胖管理的主要挑战。与所有慢性病一样，管理肥胖需要采取长期、多模式的方法，要考虑到每个个体的治疗目标以及不同治疗方法的益处和风险。结合生活方式干预，抗肥胖药物和减肥手术可改善体重减轻的维持情况以及相关的健康获益。大多数现有的抗肥胖药物作用于中枢食欲途径以减少饥饿感和食物奖赏。在过去5年中，治疗方面的进展见证了针对单基因肥胖的靶向治疗以及新一代抗肥胖药物的研发。这些高效抗肥胖药物在超过三分之二的临床试验参与者中可使总体体重减轻超过10%。目前正在等待关于安全性、有效性和心血管结局的长期数据。长期研究表明，减肥手术通常可导致持久减重25%，并使肥胖并发症迅速、持续改善，不过尚未将其与新一代高效抗肥胖药物进行比较。需要进一步开展工作以确定针对特定患者的最佳治疗策略，包括生活方式干预、抗肥胖药物、内镜和减肥手术的联合应用，并确保公平获得有效治疗。
