Multidisciplinary clinical consensus on diagnosis and treatment of obesity (2021 edition).

doi:10.3877/cma.j.issn.2095-9605.2021.04.001

Abstract

Abstract:

The prevalence of overweight and obesity in China has reached the top globally, especially for children. The etiology and progression of obesity are still unknown, and the relapse of obesity after weight loss is unavoidable. Therefore, multiple interventions and combined therapy are needed to prevent the incidence and development of obesity. Nutrition therapy, activity modification, lifestyle change, psychology therapy, traditional Chinese medicine, as well as bariatric surgery are effective methods for the treatment of obesity. Current domestic or foreign consensus on obesity are only single or double disciplines guided, and focused only on nutrition or surgery. We should realize that obesity is a complex disease and should be treated over lifetime, and multidisciplinary clinical consensus should be made to exclude particular bias induced by single discipline. Thus, we invited experts in endocrinology, bariatric surgery, traditional Chinese medicine, nutrition, sports medicine, and psychology to write and revise the current multidisciplinary consensus. We hope this consensus could update and improve the diagnosis and treatment of obesity from an interdisciplinary perspective. The management of patients with obesity should be centralized and the treatment should be personalized for the improvement of individual metabolic disorders and comorbidities.

Key words: Obesity, Multidisciplinary, Subtyping, Diagnosis, Treatment, Consensus

Chinese Society of Endocrinology;, Diabetes Society of China Association of Chinese Medicine;, Chinese Society for Metabolic and Bariatric Surgery;, Chinese Society of Diabetes and Bariatric Surgery, Chinese Association of Research Hospitals. Multidisciplinary clinical consensus on diagnosis and treatment of obesity (2021 edition).[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(04): 211-226.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2021.04.001

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2021/V07/I04/211

Figures/Tables 4

References 107

[1]	Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of over weight and obesity among US children, adolescents, and adults, 1999-2002 [J]. JAMA,2004,291(23):2847-2850.
[2]	Wang Y, Wang L, Qu W. New national data show alarming increase in obesity and noncommunicable chronic diseases in China [J]. Eur J Clin Nutr, 2017, 71(1): 149-150.
[3]	Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013 [J]. Lancet, 2014, 384(9945): 766-781.
[4]	Correction to Lancet Diabetes Endocrinol 2021,9:373-92 [J]. Lancet Diabetes Endocrinol, 2021, 9(7): e2.
[5]	王友发, 孙明晓, 薛宏, 等. 《中国肥胖预防和控制蓝皮书》解读及中国肥胖预防控制措施建议 [J]. 中华预防医学杂志, 2019, 53(9): 875-884.
[6]	Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004 - 18 [J]. Lancet, 2021, 398(10294): 53-63.
[7]	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 [J]. Lancet, 2020, 396(10258): 1223-1249.
[8]	九市儿童体格发育调查协作组, 首都儿科研究所. 2005年中国九市七岁以下儿童体格发育调查 [J]. 中华儿科杂志, 2007, 45(8): 609-614.
[9]	Ebbeling CB, Ludwig DS. Sugar-sweetened beverages, genetic risk, and obesity [J]. N Engl J Med, 2013, 368(3): 287.
[10]	González-Muniesa P, Mártinez-González MA, Hu FB, et al. Obesity [J]. Nat Rev Dis Primers, 2017, 3: 17034.
[11]	Haslam DW, James WP. Obesity [J]. Lancet, 2005, 366(9492): 1197-1209.
[12]	Nixon JP, Mavanji V, Butterick TA, et al. Sleep disorders, obesity, and aging: the role of orexin [J]. Ageing Res Rev, 2015, 20: 63-73.
[13]	McKnight RF, Adida M, Budge K, et al. Lithium toxicity profile: a systematic review and meta-analysis [J]. Lancet, 2012, 379(9817): 721-728.
[14]	Shi J, Bao G, Hong J, et al. Deciphering CT texture features of human visceral fat to evaluate metabolic disorders and surgery-induced weight loss effects [J]. EBioMedicine, 2021, 69: 103471.
[15]	Lin Z, Feng W, Liu Y, et al. Machine learning to identify metabolic subtypes of obesity: a multicenter study [J]. Front Endocrinol (Lausanne), 2021, 12: 713592.
[16]	Frühbeck GF, Busetto L, Dicker D, et al. The ABCD of obesity: an EASO position statement on a diagnostic term with clinical and scientific implications [J]. Obes Facts, 2019, 12 (2): 131-136.
[17]	Garvey WT, Mechanick JI. Proposal for a scientifically correct and medically actionable disease classification system (ICD) for obesity [J]. Obesity (Silver Spring), 2020, 28(3): 484-492.
[18]	Saarma M, Goldman A. Obesity: receptors identified for a weight regulator [J]. Nature, 2017, 550(7675): 195-197.
[19]	Ryan DH. Guidelines for obesity management [J]. Endocrinol Metab Clin North Am, 2016, 45(3): 501-510.
[20]	Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists [J]. Obesity (Silver Spring), 2020, 28(4): 01-058.
[21]	仝小林, 段娟, 李敏, 等. 《内经》肥胖三型的科学价值及应用研究的思路与方法 [J]. 江苏中医药, 2009, 41(2): 1-3.
[22]	段娟, 仝小林, 冀博文, 等. 《内经》肥胖三型判别标准的探索与研究 [J]. 中国中医基础医学杂志, 2010, 16(5): 401-404.
[23]	曲伸, 陆灏. 肥胖分类的重新思考与基于代谢的个体化诊断 [J]. 中华内分泌代谢杂志, 2015, (31): 655-658.
[24]	杨玲玲, 倪诚, 李英帅, 等. 王琦治疗肥胖经验 [J]. 中医杂志, 2013, 54(21): 1811-1813.
[25]	俞若熙, 李英帅, 王琦. 中医干预肥胖人群的3个问题 [J]. 中华中医药杂志, 2016, 31(10): 3901-3903.
[26]	Oliveros E, Somers VK, Sochor O, et al. The concept of normal weight obesity [J]. Prog Cardiovasc Dis, 2014, 56(4): 426-433.
[27]	王崇民. 《中国居民膳食指南科学研究报告(2021)》正式发布 [J]. 食品安全导刊, 2021, (3): 15.
[28]	Tuma PA. Dietary guidelines 2020-2025：update on academy efforts [J]. J Acad Nutr Diet, 2019, 119(4): 672-674.
[29]	Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity [J]. Nat Med, 2020, 26(4): 485-497.
[30]	Moon J, Koh G. Clinical evidence and mechanisms of highprotein diet-induced weight loss [J]. J Obes Metab Syndr, 2020, 29(3): 166-173.
[31]	Evangelista LS, Jose MM, Sallam H, et al. High-protein vs. standard-protein diets in overweight and obese patients with heart failure and diabetes mellitus: findings of the Pro-HEART trial [J]. ESC Heart Fail, 2021, 8(2): 1342-1348.
[32]	Magkos F. Protein-rich diets for weight loss maintenance [J]. Curr Obes Rep, 2020, 9(3): 213-218.
[33]	Bricarello LP, Poltronieri F, Fernandes R, et al. Effects of the dietary approach to stop hypertension (DASH) diet on blood pressure, overweight and obesity in adolescents: a systematic review [J]. Clin Nutr ESPEN, 2018, 28: 1-11.
[34]	Azadbakht L, Fard NR, Karimi M, et al. Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial [J]. Diabetes Care, 2011, 34(1): 55-57.
[35]	Soltani S, Shirani F, Chitsazi MJ, et al. The effect of dietary approaches to stop hypertension (DASH) diet on weight and body composition in adults: a systematic review and meta-analysis of randomized controlled clinical trials [J]. Obes Rev, 2016, 17(5): 442-454.
[36]	Yang Z, Scott CA, Mao C, et al. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis [J]. Sports Med, 2014, 44(4): 487-499.
[37]	Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists-Executive Summary [J]. Endocr Pract, 2019, 25(12): 1346-1359.
[38]	Tremblay MS, Carson V, Chaput JP, et al. Canadian 24-hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep [J]. Appl Physiol Nutr Metab, 2016, 41(6 Suppl 3): S311-S327.
[39]	Mathus-Vliegen EM. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline [J]. Obes Facts, 2012, 5(3): 460-483.
[40]	Liu R, Hong J, Xu X, et al. Gut microbiome and serum metabolome alterations in obesity and after weight-loss intervention[J]. Nat Med, 2017, 23(7): 859-868.
[41]	Turnbaugh PJ, Ley RE, Mahowald MA, et al. An obesityassociated gutmicrobiome with increased capacity for energy harvest [J]. Nature, 2006, 444(7122): 1027-1031.
[42]	Depommier C, Everard A, Druart C, et al. Supplementation with Akkermansia muciniphila in overweight and obese human volunteers: a proof-of-concept exploratory study [J]. Nat Med, 2019, 25(7): 1096-1103.
[43]	Ridaura VK, Faith JJ, Rey FE, et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice [J]. Science, 2013, 341(6150): 1241214.
[44]	Sun L, Xie C, Wang G, et al. Gut microbiota and intestinal FXR mediate the clinical benefits of metformin [J]. Nat Med, 2018, 24(12): 1919-1929.
[45]	Zmora N, Suez J, Elinav E. You are what you eat: diet, health and the gut microbiota [J]. Nat Rev Gastroenterol Hepatol, 2019, 16(1): 35-56.
[46]	de Wit L, Luppino F, van Straten A, et al. Depression and obesity: a meta-analysis of community-based studies [J]. Psychiatry Res, 2010, 178(2): 230-235.
[47]	Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis [J]. Int J Obes(Lond), 2010, 34(3): 407-419.
[48]	Rutledge T, Groesz LM, Savu M. Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population [J]. Obes Surg, 2011, 21(1): 29-35.
[49]	Claes L, Vandereycken W, Vandeputte A, et al. Personality subtypes in female pre-bariatric obese patients: do they differ in eating disorder symptoms, psychological complaints and coping behaviour? [J]. Eur Eat Disord Rev, 2013, 21(1): 72-77.
[50]	Carr D, Friedman MA. Is obesity stigmatizing? Body weight, perceived discrimination, and psychological wellbeing in the United States [J]. J Health Soc Behav, 2005, 46(3): 244-259.
[51]	Eisenberg ME, Neumark-Sztainer D, Story M. Associations of weight-based teasing and emotional well-being among adolescents [J]. Arch Pediatr Adolesc Med, 2003, 157(8): 733-738.
[52]	MacLean PS, Wing RR, Davidson T, et al. NIH working group report: innovative research to improve maintenance of weight loss [J]. Obesity (Silver Spring), 2015, 23(1): 7-15.
[53]	Hjelmesaeth J, Rosenvinge JH, Gade H, et al. Effects of cognitive behavioral therapy on eating behaviors, affective symptoms, and weight loss after bariatric surgery: a randomized clinical trial [J]. Obes Surg, 2019, 29(1): 61-69.
[54]	Sharma M. Behavioural interventions for preventing and treating obesity in adults [J]. Obes Rev, 2007, 8(5): 441-449.
[55]	Svetkey LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial [J]. JAMA, 2008, 299(10): 1139-1148.
[56]	Pearl RL, Puhl RM. The distinct effects of internalizing weight bias: an experimental study [J]. Body Image, 2016, 17: 38-42.
[57]	Kalarchian MA, Levine MD, Arslanian SA, et al. Familybased treatment of severe pediatric obesity: randomized, controlled trial [J]. Pediatrics, 2009, 124(4): 1060-1068.
[58]	Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline [J]. J Clin Endocrinol Metab, 2015, 100 (2): 342-362.
[59]	Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes [J]. N Engl J Med, 2016, 375(4): 311-322.
[60]	Yu X, Xu L, Zhou Q, et al. The Efficacy and safety of the Chinese herbal formula, JTTZ, for the treatment of type 2 diabetes with obesity and hyperlipidemia: a multicenter randomized, positive-controlled, open-label clinical trial [J]. Int J Endocrinol, 2018, 2018: 9519231.
[61]	Pratt KJ, Balk EK, Ferriby M, et al. Bariatric surgery candidates′ peer and romantic relationships and associations with health behaviors [J]. Obes Surg, 2016, 26(11): 2764-2771.
[62]	Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity [J]. Endocr Pract, 2016, 22(Suppl 3): 1-203.
[63]	Collet TH, Dubern B, Mokrosinski J, et al. Evaluation of a melanocortin-4 receptor (MC4R) agonist (Setmelanotide) in MC4R deficiency [J]. Mol Metab, 2017, 6(10): 1321-1329.
[64]	Zhou Q, Chang B, Chen XY, et al. Chinese herbal medicine for obesity: a randomized, double-blinded, multicenter, prospective trial [J]. Am J Chin Med, 2014, 42(6): 1345-1356.
[65]	侯瑞芳, 刘晓倩, 金昕, 等. 泄热化浊方治疗胃热滞脾证肥胖患者的临床研究 [J]. 辽宁中医杂志, 2019, 46(1): 65-69.
[66]	金昕, 侯瑞芳, 陶枫, 等. 防风通圣散调节体重和体脂的研究进展 [J]. 世界中西医结合杂志, 2017, 10(12): 146-150.
[67]	曾慧妍, 肖颖馥, 张锦明, 等. 基于中医辅助传承系统的中医药治疗单纯性肥胖方剂组方规律分析 [J]. 广州中医药大学学报, 2017, 34(4): 612-616.
[68]	马兰军, 李峰, 李波. 决明子对肥胖大学生部分形态和生理指标干预效果的实验研究 [J]. 时珍国医国药, 2009, 20(1): 41-43.
[69]	郭姣红, 李旭炯, 岳嘉, 等. 怀牛膝对去卵巢肥胖大鼠体重和肿瘤坏死因子-α的影响 [J]. 成都医学院学报, 2008, 3(2): 100-102.
[70]	Huang LH, Liu CY, Wang LY, et al. Effects of green tea extract on overweight and obese women with high levels of low density-lipoprotein-cholesterol (LDL-C): a randomised, double-blind, and cross-over placebo-controlled clinical trial [J]. BMC Complement Altern Med, 2018, 18(1): 294.
[71]	Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Obesity Society [J]. Circulation, 2014, 129(25 Suppl 2): S102-S138.
[72]	Hubbard VS, Hall WH. Gastrointestinal surgery for severe obesity [J]. Obes Surg, 1991, 1(3): 257-265.
[73]	Cummings DE, Cohen RV. Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery [J]. Lancet Diabetes Endocrinol, 2014, 2(2): 175-181.
[74]	Aminian A, Chang J, Brethauer SA, et al. ASMBS updated position statement on bariatric surgery in class Ⅰ obesity (BMI 30-35 kg/m²) [J]. Surg Obes Relat Dis, 2018, 14(8): 1071-1087.
[75]	Schauer PR, Nor Hanipah Z, Rubino F. Metabolic surgery for treating type 2 diabetes mellitus: now supported by the world's leading diabetes organizations [J]. Cleve Clin J Med, 2017, 84(7 Suppl 1): S47-S56.
[76]	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版) [J]. 中国实用外科杂志, 2019, 39(4): 6-11.
[77]	Paulus GF, de Vaan LE, Verdam FJ, et al. Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis [J]. Obes Surg, 2015, 25(5): 860-878.
[78]	中华医学会外科学分会内分泌外科学组, 中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会胃肠外科学组, 等. 中国肥胖病外科治疗指南(2007) [J]. 中国实用外科杂志, 2007, 27(10): 759-762.
[79]	中华医学会糖尿病学会, 中华医学会外科学分会. 手术治疗糖尿病专家共识 [J]. 中华糖尿病杂志, 2011, 3(3): 205-208.
[80]	Pareek M, Bhatt DL, Schiavon CA, et al. Metabolic surgery for hypertension in patients with obesity [J]. Circ Res, 2019, 124(7): 1009-1024.
[81]	Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes [J]. Arq Bras Endocrinol Metabol, 2011, 55(6): 367-382.
[82]	Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis [J]. Jama, 2004, 292(14): 1724-1737.
[83]	Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults [J]. Cochrane Database Syst Rev, 2014, (8): Cd003641.
[84]	王存川. 肥胖与代谢病外科学 [M]. 北京: 人民卫生出版社, 2014.
[85]	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版) [J]. 中华普通外科杂志, 2017, 32(9): 807-812.
[86]	王勇, 张旭. 减重及代谢疾病患者围手术期静脉血栓栓塞症预防[J]. 中国实用外科杂志, 2017, 37(2): 129-132.
[87]	Suchartlikitwong S, Laoveeravat P, Mingbunjerdsuk T, et al. Usefulness of the ReShape intragastric balloon for obesity [J]. Proc (Bayl Univ Med Cent), 2019, 32(2): 192-195.
[88]	Forssell H, Norén E. A novel endoscopic weight loss therapy using gastric aspiration: results after 6 months [J]. Endoscopy, 2015, 47(1): 68-71.
[89]	Camilleri M, Toouli J, Herrera MF, et al. Intra-abdominal vagal blocking (VBLOC therapy): clinical results with a new implantable medical device [J]. Surgery, 2008, 143(6): 723-731.
[90]	Rajagopalan H, Cherrington AD, Thompson CC, et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes: 6-month interim analysis from the firstin- human proof-of-concept study [J]. Diabetes Care, 2016, 39(12): 2254-2261.
[91]	Cherrington AD, Rajagopalan H, Maggs D, et al. Hydrothermal duodenal mucosal resurfacing: role in the treatment of metabolic disease [J]. Gastrointest Endosc Clin N Am, 2017, 27(2): 299-311.
[92]	Syed MI, Morar K, Shaikh A, et al. Gastric artery embolization trial for the lessening of appetite nonsurgically (GET LEAN): six-month preliminary data [J]. J Vasc Interv Radiol, 2016, 27(10): 1502-1508.
[93]	Ma S, Hou D, Zhang Y, et al. Trends in abdominal obesity among Chinese children and adolescents, 1993-2015 [J]. J Pediatr Endocrinol Metab, 2021, 34(2): 163-169.
[94]	Chen S, Binns CW, Zhang Y. The importance of definition in diagnosing obesity: a review of studies of children in China [J]. Asia Pac J Public Health, 2012, 24(2): 248-262.
[95]	妇幼健康研究会, 妇女儿童肥胖控制专业委员会, 中国儿童代谢健康型肥胖定义与管理专家委员会. 中国儿童代谢健康型肥胖定义与筛查专家共识 [J]. 中国妇幼健康研究, 2019, 30(12): 1487-1490.
[96]	Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity-assessment, treatment, and prevention: an endocrine society clinical practice guideline [J]. J Clin Endocrinol Metab, 2017, 102(3): 709-757.
[97]	Quattrin T, Cao Y, Paluch RA, et al. Cost-effectiveness of family-based obesity treatment [J]. Pediatrics, 2017, 140(3): e20162755.
[98]	Mead E, Atkinson G, Richter B, et al. Drug interventions for the treatment of obesity in children and adolescents [J]. Cochrane Database Syst Rev, 2016, 11: CD012436.
[99]	Michalsky M, Reichard K, Inge T, et al. ASMBS pediatric committee best practice guidelines [J]. Surg Obes Relat Dis, 2012, 8(1): 1-7.
[100]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国儿童和青少年肥胖症外科治疗指南(2019版) [J/CD]. 中华肥胖与代谢病电子杂志, 2019, 5(1): 10-16.
[101]	Griggs CL, Perez NP, Jr., Goldstone RN, et al. National trends in the use of metabolic and bariatric surgery among pediatric patients with severe obesity [J]. JAMA Pediatr, 2018, 172(12): 1191-1192.
[102]	Gunatilake RP, Perlow JH. Obesity and pregnancy: clinical management of the obese gravida [J]. Am J Obstet Gynecol, 2011, 204(2): 106-119.
[103]	Moos MK, Dunlop AL, Jack BW, et al. Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age [J]. Am J Obstet Gynecol, 2008, 199(6 Suppl 2): S280-S289.
[104]	Karmon A, Sheiner E. Pregnancy after bariatric surgery: a comprehensive review [J]. Arch Gynecol Obstet, 2008, 277(5): 381-388.
[105]	Global BMIMC, Di Angelantonio E, Bhupathiraju Sh N, et al. Body-mass index and all-cause mortality: individualparticipant-data meta-analysis of 239 prospective studies in four continents [J]. Lancet, 2016, 388(10046): 776-786.
[106]	Bosello O, Vanzo A. Obesity paradox and aging [J]. Eat Weight Disord, 2021, 26(1): 27-35.
[107]	朱翠玲, 曲伸. 以疾病为中心的肥胖伴2型糖尿病的联合治疗及中心化建设 [J]. 中华糖尿病杂志, 2020, 12(10): 850-853.

减重膳食种类	简要组成	适用人群	作用
限能量平衡饮食	是一类在限制能量摄入的同时保证基本营养需求的膳食模式，其宏量营养素的供能比例应符合平衡膳食的要求	各类人群	（1）显著降低体质量、脂肪量及动脉粥样硬化发生的风险；（2）改善血脂及胰岛素抵抗；（3）延长寿命、延迟衰老
低能量膳食	适量减少脂肪和碳水化合物的摄入，将正常自由进食的能量减去30%~50%的膳食模式。通常需要在医师指导下进行	需要减轻体质量者，如单纯性肥胖；为控制病情减少机体代谢负担的病人，如糖尿病、心血管疾病等	短期内有效降低体质量，改善糖脂代谢
极低能量膳食	通常指每天只摄入400~800 kcal能量，主要来自蛋白质，而脂肪和碳水化合物的摄入受到严格限制	重度肥胖病人术前快速减重治疗或逆转肥胖的初发2型糖尿病	短期内有效降低体质量，改善糖脂代谢
轻断食模式	也称间歇式断食，一类采用5+2模式，即一周中5 d相对正常进食，其他2 d（非连续）则摄取平常的1/4能量（女性约500 kcal/d，男性约600 kcal/d）的膳食模式	超重人群	（1）减肥减重；（2）调节血糖血脂；（3）改善胰岛素敏感性；（4）延缓衰老；（5）改善肠道微生物群环境；（6）减少患癌风险
地中海饮食^[33]	特点是多摄入蔬菜、水果、橄榄油、豆类、全谷类食品、坚果，适量摄入红酒，少量食用精加工食品、乳制品、红肉及植物油	适合各类人群长期使用	降低心血管疾病、帕金森综合征、阿尔茨海默病及糖尿病的发生率，降低恶性肿瘤的死亡率
江南饮食	以米类为主食，新鲜蔬菜水果摄入量充足；动物性食物以猪肉和鱼虾类为主，鱼虾类摄入相对较高，猪肉摄入量低，少油少盐	各类人群	利于体质量管理和心血管代谢性疾病的防控、代谢获益
高蛋白饮食^[34]	一类每天蛋白质摄入量>每天总能量的20%或1.5 g/(kg·d)，但一般≤每天总能量的30%或2.0 g/(kg·d)的膳食模式	伴有高甘油三酯、高低密度脂蛋白胆固醇血症或因肥胖导致并发症需要短期内快速减肥的人	有助于降低体质量、减体质量后的维持、防止体质量反弹
低碳水化合物饮食^[34]	目前国内外尚无其供能比的统一标准，一般为20%~40%	肥胖、超重人群、心脏代谢性疾病风险人群如2型糖尿病和非酒精性脂肪肝病人。还被用于精神运动紊乱、肿瘤病人及运动人群	低碳水化合物饮食在快速降低体质量上，优于其他饮食方法。短期应用效果确切，不良反应远远少于药物，卫生经济学效益显著，节省医疗费用
低脂饮食^[34]	目前尚无统一的低脂膳食定义，但通常指每天膳食总脂肪占膳食总热量的30%以下或者全天脂肪摄入量<50 g	BMI≥24 kg/m²的超重或肥胖人群	（1）摄入热量少；（2）低热量饮食下易动员脂肪；（3）短时间体质量有效下降
素食饮食	指食物中不包含肉类、家禽和鱼类的膳食模式。根据是否进食蛋类及奶制品，素食人群可进一步区分为严格素食、奶素、蛋素和蛋奶素	糖尿病、肥胖病人	有助于降低肥胖、糖尿病、肠癌、骨质疏松等代谢性疾病的发病风险，对延缓病程进展大有助益
代餐^[35]	市场有售以液体、粉末或小吃等形式食物代替1天中1~2顿餐，但至少有1餐食用正常食物，用来限制能量摄入的富含矿物质和维生素的非处方产品	超重、肥胖病人	不仅能有效降低超重和（或）肥胖病人的食欲、控制能量密度，还能防止饮食摄入控制过程中必需营养素缺乏。代餐依从性较好，有助于维持长期减重效果，甚至改变饮食行为习惯

减重膳食种类	简要组成	适用人群	作用
限能量平衡饮食	是一类在限制能量摄入的同时保证基本营养需求的膳食模式，其宏量营养素的供能比例应符合平衡膳食的要求	各类人群	（1）显著降低体质量、脂肪量及动脉粥样硬化发生的风险；（2）改善血脂及胰岛素抵抗；（3）延长寿命、延迟衰老
低能量膳食	适量减少脂肪和碳水化合物的摄入，将正常自由进食的能量减去30%~50%的膳食模式。通常需要在医师指导下进行	需要减轻体质量者，如单纯性肥胖；为控制病情减少机体代谢负担的病人，如糖尿病、心血管疾病等	短期内有效降低体质量，改善糖脂代谢
极低能量膳食	通常指每天只摄入400~800 kcal能量，主要来自蛋白质，而脂肪和碳水化合物的摄入受到严格限制	重度肥胖病人术前快速减重治疗或逆转肥胖的初发2型糖尿病	短期内有效降低体质量，改善糖脂代谢
轻断食模式	也称间歇式断食，一类采用5+2模式，即一周中5 d相对正常进食，其他2 d（非连续）则摄取平常的1/4能量（女性约500 kcal/d，男性约600 kcal/d）的膳食模式	超重人群	（1）减肥减重；（2）调节血糖血脂；（3）改善胰岛素敏感性；（4）延缓衰老；（5）改善肠道微生物群环境；（6）减少患癌风险
地中海饮食^[33]	特点是多摄入蔬菜、水果、橄榄油、豆类、全谷类食品、坚果，适量摄入红酒，少量食用精加工食品、乳制品、红肉及植物油	适合各类人群长期使用	降低心血管疾病、帕金森综合征、阿尔茨海默病及糖尿病的发生率，降低恶性肿瘤的死亡率
江南饮食	以米类为主食，新鲜蔬菜水果摄入量充足；动物性食物以猪肉和鱼虾类为主，鱼虾类摄入相对较高，猪肉摄入量低，少油少盐	各类人群	利于体质量管理和心血管代谢性疾病的防控、代谢获益
高蛋白饮食^[34]	一类每天蛋白质摄入量>每天总能量的20%或1.5 g/(kg·d)，但一般≤每天总能量的30%或2.0 g/(kg·d)的膳食模式	伴有高甘油三酯、高低密度脂蛋白胆固醇血症或因肥胖导致并发症需要短期内快速减肥的人	有助于降低体质量、减体质量后的维持、防止体质量反弹
低碳水化合物饮食^[34]	目前国内外尚无其供能比的统一标准，一般为20%~40%	肥胖、超重人群、心脏代谢性疾病风险人群如2型糖尿病和非酒精性脂肪肝病人。还被用于精神运动紊乱、肿瘤病人及运动人群	低碳水化合物饮食在快速降低体质量上，优于其他饮食方法。短期应用效果确切，不良反应远远少于药物，卫生经济学效益显著，节省医疗费用
低脂饮食^[34]	目前尚无统一的低脂膳食定义，但通常指每天膳食总脂肪占膳食总热量的30%以下或者全天脂肪摄入量<50 g	BMI≥24 kg/m²的超重或肥胖人群	（1）摄入热量少；（2）低热量饮食下易动员脂肪；（3）短时间体质量有效下降
素食饮食	指食物中不包含肉类、家禽和鱼类的膳食模式。根据是否进食蛋类及奶制品，素食人群可进一步区分为严格素食、奶素、蛋素和蛋奶素	糖尿病、肥胖病人	有助于降低肥胖、糖尿病、肠癌、骨质疏松等代谢性疾病的发病风险，对延缓病程进展大有助益
代餐^[35]	市场有售以液体、粉末或小吃等形式食物代替1天中1~2顿餐，但至少有1餐食用正常食物，用来限制能量摄入的富含矿物质和维生素的非处方产品	超重、肥胖病人	不仅能有效降低超重和（或）肥胖病人的食欲、控制能量密度，还能防止饮食摄入控制过程中必需营养素缺乏。代餐依从性较好，有助于维持长期减重效果，甚至改变饮食行为习惯

病人信息	男性，90 kg，BMI 29.4 kg/m²
减重需求	每周需减重0.5 kg
运动计划	1周运动要消耗2 800 kcal +饮食少摄入700 kcal=3 500 kcal
运动项目	以有氧运动游泳、快走和跳操为主，合并抗阻训练
运动强度	中等运动强度
运动频率	1周5次有氧运动、2次抗阻训练
运动持续时间	每周进行5次有氧运动，每次40 min游泳或55 min快走，以及2次利用哑铃等器械的抗阻训练（每次2组，每组重复8~12次，每周2次）；因为90 kg体质量成年人完成1 h中等强度游泳或快走分别消耗约700和500 kcal能量，所以每次有氧运动可消耗约440 kcal能量，5次共消耗2 200 kcal；而每次抗阻训练约消耗300 kcal能量，2次600 kcal，合计2 800 kcal
运动注意事项	出现不适如胸痛、胸闷、心慌等要降低运动强度或停止运动，运动前准备活动、运动后整理活动；穿合适的鞋、不要在雾霾天运动、运动后要保暖等
运动方案的调整	经一段时间运动后，可检查减重效果，适时做出调整

病人信息	男性，90 kg，BMI 29.4 kg/m²
减重需求	每周需减重0.5 kg
运动计划	1周运动要消耗2 800 kcal +饮食少摄入700 kcal=3 500 kcal
运动项目	以有氧运动游泳、快走和跳操为主，合并抗阻训练
运动强度	中等运动强度
运动频率	1周5次有氧运动、2次抗阻训练
运动持续时间	每周进行5次有氧运动，每次40 min游泳或55 min快走，以及2次利用哑铃等器械的抗阻训练（每次2组，每组重复8~12次，每周2次）；因为90 kg体质量成年人完成1 h中等强度游泳或快走分别消耗约700和500 kcal能量，所以每次有氧运动可消耗约440 kcal能量，5次共消耗2 200 kcal；而每次抗阻训练约消耗300 kcal能量，2次600 kcal，合计2 800 kcal
运动注意事项	出现不适如胸痛、胸闷、心慌等要降低运动强度或停止运动，运动前准备活动、运动后整理活动；穿合适的鞋、不要在雾霾天运动、运动后要保暖等
运动方案的调整	经一段时间运动后，可检查减重效果，适时做出调整

药物名称	药理机制	推荐剂量	用法	1年减重幅度	不良反应及注意事项
奥利司他^[61]	特异性胃肠道脂肪酶抑制剂，通过抑制胃肠道的脂肪酶和胰酶，减少肠腔黏膜对脂肪的吸收	120 mg每天3次，随餐服用	口服	2.9~3.6 kg	脂肪便、脂肪泻、腹痛、腹胀、肛门排气增多和大便失禁等，多于治疗后1周内出现，随着用药时间延长，可逐渐耐受，治疗3个月后，发生率明显降低。影响脂溶性维生素（维生素A、D、E）等吸收，需补充复合维生素。中国食品药品监督管理局（CFDA）已批准
利拉鲁肽	胰升糖素样肽受体激动剂，作用于下丘脑，增加饱食信号、减少饥饿信号，延迟胃排空、减少胃酸分泌，起到减重作用	起始：0.6 mg每天1次最大：3.0 mg每天1次	皮下注射	4.8~8.4 kg	恶心、腹泻、便秘、呕吐、消化不良、腹痛，目前CFDA仅批准用于2型糖尿病的治疗，未批准用于肥胖症的治疗
芬特明/托吡酯	芬特明是拟交感神经胺类厌食药物，促进下丘脑释放儿茶酚胺，通过减少食欲减重。托吡酯可增强γ-氨基丁酸神经递质活性、调节电压门控离子通道、抑制兴奋性谷氨酸受体或碳酸酐酶，抑制食欲和增强饱腹感	起始：3.75 mg/23 mg每天1次最大：15 mg/92 mg每天1次	口服	8~12.6 kg	心率加快、自杀倾向、急性闭角性青光眼、情感和睡眠障碍、认知损伤等。由于芬特明/托吡酯会导致心率加快，故禁用于甲状腺功能亢进及心血管疾病的病人。突然停用托吡酯可引起抽搐，若减重效果不满意，应逐渐停药。CFDA未批准用于肥胖症的治疗
纳曲酮/安非他酮^[62]	安非他酮是去甲肾上腺素、5-羟色胺、多巴胺再摄取的弱抑制剂，可增加大脑中特定受体的多巴胺水平，抑制食欲。纳曲酮是阿片样受体拮抗剂，两种药物协同抑制下丘脑饥饿中枢，减少食物摄入	起始：8 mg/90 mg每天1次最大：16 mg/180 mg每天2次	口服	3.9~5.9 kg	恶心、头痛、便秘、头晕、呕吐、口干、血压升高、心率加快等。禁用于未控制的高血压病人。CFDA未批准用于肥胖症的治疗
Setmelanotide	为黑皮质素4受体激动剂（melanocortin 4 receptor agonists，MC4RA）。MC4R基因变可导致食欲过盛和早发严重肥胖。Setmelanotide可恢复MC4R通路的功能，减少病人的饥饿感、降低体质量^[63]				目前FDA仅批准用于前阿片黑素细胞皮质激素、前蛋白转化酶枯草杆菌蛋白酶/kexin 1型或瘦素受体缺陷等罕见遗传性肥胖的减重治疗。CFDA未批准上市

Please choose a citation manager

Content to export