Kushner Robert F, Shapiro Marla
Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
Ann Med. 2025 Dec;57(1):2521433. doi: 10.1080/07853890.2025.2521433. Epub 2025 Jun 26.
Obesity is a chronic condition of dysregulated energy balance that is caused by a confluence of nutritional, neurological, hormonal and metabolic factors. Clinically, obesity is associated with myriad consequences to overall health. Treatment should be based on a shared decision-making process between the patient and their professional team that considers the stage of the disease, wellness goals and desired lifestyle and can include a combination of behavioural and lifestyle interventions, pharmacological therapies and surgery. The chronic nature of obesity necessitates adjustments in treatment plans to match the evolving needs and goals of the patient over time, establishing a 'care continuum.'
We conducted a broad, narrative literature search using PubMed for articles published on the assessment, diagnosis and treatment of adults with obesity.
In this narrative literature review, we outline evidence-based best practices for the diagnosis and assessment of obesity along with the various available treatment modalities. We also present considerations for treating patients with obesity with a focus on the selection of obesity medications based on severity, concurrent conditions, mechanisms of action and treatment goals. Finally, we discuss lifestyle management, the shift from weight loss to weight maintenance, and the implications of these changes in the care continuum.
Continued, individualized treatment of patients with obesity from diagnosis to weight maintenance is imperative for sustained weight reductions, and strategies should be tailored to the changing needs of patients over time.
肥胖是一种能量平衡失调的慢性疾病,由营养、神经、激素和代谢等多种因素共同导致。临床上,肥胖与对整体健康的众多后果相关。治疗应基于患者与其专业团队之间的共同决策过程,该过程要考虑疾病阶段、健康目标和期望的生活方式,治疗方法可包括行为和生活方式干预、药物治疗及手术的组合。肥胖的慢性性质需要随着时间推移调整治疗计划,以匹配患者不断变化的需求和目标,从而建立一个“连续照护”。
我们使用PubMed对已发表的关于成人肥胖评估、诊断和治疗的文章进行了广泛的叙述性文献检索。
在本叙述性文献综述中,我们概述了肥胖诊断和评估的循证最佳实践以及各种可用的治疗方式。我们还提出了治疗肥胖患者的注意事项,重点是根据严重程度、并发疾病、作用机制和治疗目标选择肥胖症药物。最后,我们讨论了生活方式管理、从体重减轻到体重维持的转变以及这些变化在连续照护中的影响。
从诊断到体重维持,对肥胖患者持续进行个体化治疗对于持续减轻体重至关重要,并且策略应根据患者随时间变化的需求进行调整。