Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgery, University Hospital, Uppsala, Sweden.
J Intern Med. 2024 Aug;296(2):139-155. doi: 10.1111/joim.13816.
In this multi-professional review, we will provide the in-depth knowledge required to work in the expanding field of obesity treatment. The prevalence of obesity has doubled in adults and quadrupled in children over the last three decades. The most common treatment offered has been lifestyle treatment, which has a modest or little long-term effect. Recently, several new treatment options-leading to improved weight loss-have become available. However, long-term care is not only about weight loss but also aims to improve health and wellbeing overall. In the era of personalized medicine, we have an obligation to tailor the treatment in close dialogue with our patients. The main focus of this review is new pharmacological treatments and modern metabolic surgery, with practical guidance on what to consider when selecting and guiding the patients and what to include in the follow-up care. Furthermore, we discuss common clinical challenges, such as patients with concurrent eating disorder or mental health problems, and treatment in the older adults. We also provide recommendations on how to deal with obesity in a non-stigmatizing way to diminish weight stigma during treatment. Finally, we present six microcases-obesity treatment for persons with neuropsychiatric disorders and/or intellectual disability; obesity treatment in the nonresponsive patient who has "tried everything"; and hypoglycemia, abdominal pain, and weight regain after metabolic surgery-to highlight common problems in weight-loss treatment and provide personalized treatment suggestions.
在本次多专业综述中，我们将提供深入的专业知识，以帮助您在肥胖治疗这一不断扩展的领域中开展工作。过去三十年来，成年人肥胖的患病率增加了一倍，儿童肥胖的患病率增加了四倍。最常提供的治疗方法是生活方式治疗，但这种治疗方法的长期效果甚微或效果不佳。最近，一些新的治疗方法——可导致体重减轻——已经出现。然而，长期护理不仅关乎体重减轻，还旨在全面改善健康和幸福感。在个性化医疗时代，我们有义务与患者密切对话，量身定制治疗方案。本次综述的主要重点是新的药物治疗和现代代谢手术，并就选择和指导患者时需要考虑什么，以及在随访护理中需要包含什么，提供实用指导。此外，我们还讨论了常见的临床挑战，如伴有饮食障碍或心理健康问题的患者，以及老年患者的治疗问题。我们还就如何以非污名化的方式处理肥胖问题提出了建议，以减轻治疗过程中的体重污名化。最后，我们提供了六个微型案例——神经精神障碍和/或智力残疾患者的肥胖治疗；对“尝试过一切”但仍无反应的患者的肥胖治疗；以及代谢手术后出现低血糖、腹痛和体重反弹，以突出体重减轻治疗中的常见问题，并提供个性化的治疗建议。
