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管理肥胖:基于办公室的策略
Michelle K Keating1, Rachel K Woodruff1, Erin M Saner1
1Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, N.C.
American family physician
|August 22, 2024
概括
美国肥胖率正在上升,影响到41.9%的成年人. 有效的体重管理需要一个全面的方法,包括行为改变,营养,炼,药物,以及必要时的手术.
科学领域:
- 内部医学 内部医学
- 公共卫生 公共卫生
- 内分泌学 在内分泌学.
背景情况:
- 美国肥胖的患病率已达到41.9%,这对公共卫生构成了重大挑战.
- 肥胖是由30公斤/平方米或更高的体重指数 (BMI) 定义的,腰围在老年人中作为潜在的更准确的指标.
- 患者病史应包括诱导体重增加的药物和与肥胖相关的并发症,以及对先前的体重管理工作的评估.
研究的目的:
- 概述美国当前的肥胖患病率.
- 详细推临床评估和实验室测试肥胖.
- 提出一个全面的,多支柱的体重管理方法.
主要方法:
- 审查国家肥胖统计数据.
- 患者病史采集和实验室评估的指导方针.
- 关于五大支柱体重管理策略的建议:行为咨询,营养,体力活动,药物治疗和减肥手术.
- 在BMI≥30kg/m2或BMI≥27kg/m2且有代谢性并发症的患者中考虑药物治疗.
- 转诊减肥手术的标准.
主要成果:
- 全国肥胖患病率为41.9%.
- 建议的初始实验室测试包括CBC,代谢概况,脂质,TSH和A1C.
- 对于特定的BMI和并发性值,建议使用GLP-1受体激动剂等药物进行药物治疗.
- 腹腔外科推适用于符合条件的患者.
结论:
- 有效的肥胖管理需要个性化,综合的方法.
- 体重管理的五大支柱为临床实践提供了一个框架.
- 药物治疗和减肥手术是特定患者群体的关键选择.
- 持续的患者支持和随访对于成功的长期结果至关重要.
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