Lim Soo, Nam Ga Eun, Sharma Arya M
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Diabetes Metab J. 2025 Jul;49(4):565-579. doi: 10.4093/dmj.2025.0278. Epub 2025 Jun 11.
Obesity and type 2 diabetes mellitus (T2DM) are among the most urgent global public health challenges, yet differ markedly in recognition and management across medical, social, infrastructure, and policy domains. T2DM is supported by clear diagnostic criteria, defined treatment targets, and broad acceptance as a chronic disease. In contrast, obesity is assessed using imprecise metrics like body mass index, lacks standardized treatment goals, and is often misunderstood as a lifestyle issue rather than a chronic, relapsing disease. This misconception contributes to stigma, discrimination, and unrealistic patient expectations. T2DM receives substantial research funding, comprehensive clinical guidelines, and structured medical education, with strong support from large professional societies and multidisciplinary care models. Obesity care remains underfunded, inconsistently delivered, and underrepresented in medical training. Public health and policy efforts strongly favor T2DM, providing coordinated programs, insurance coverage, and regulatory oversight. Conversely, obesity is marginalized, with limited policy influence and a largely unregulated commercial weight-loss industry. Bridging these disparities requires adopting lessons from T2DM management-such as evidence-based guidelines, improved provider training, expanded insurance coverage, and public health strategies-to enhance obesity care and recognize it as a chronic disease requiring long-term, structured management.
肥胖症和2型糖尿病（T2DM）是全球最紧迫的公共卫生挑战之一，但在医学、社会、基础设施和政策领域的认知与管理方面存在显著差异。T2DM有明确的诊断标准、既定的治疗目标，并被广泛认可为一种慢性病。相比之下，肥胖症是使用体重指数等不精确的指标进行评估的，缺乏标准化的治疗目标，并且常常被误解为一个生活方式问题，而非一种慢性复发性疾病。这种误解导致了污名化、歧视以及患者不切实际的期望。T2DM获得了大量研究资金、全面的临床指南以及结构化医学教育，得到大型专业协会和多学科护理模式的有力支持。肥胖症护理的资金仍然不足，提供方式不一致，在医学培训中的占比也很低。公共卫生和政策举措大力偏向T2DM，提供协调一致的项目、保险覆盖范围以及监管监督。相反，肥胖症被边缘化，政策影响力有限，商业减肥行业在很大程度上缺乏监管。弥合这些差距需要借鉴T2DM管理方面的经验教训，如循证指南、改进医疗服务提供者培训、扩大保险覆盖范围以及公共卫生策略，以加强肥胖症护理，并将其视为一种需要长期结构化管理的慢性病。
