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肥胖症Obesity

肥胖患者的体重比理想体重重20％或更多。

体重过重是一个重要的公共卫生问题，因为它与以下因素有关：

  • 二型糖尿病
  • 高血压和中风
  • 高脂血症
  • 某些癌症

根据身体质量指数 (BMI) 对肥胖进行分级：

  • 健康体重18.5-24.9
  • 超重 25-29.9
  • 肥胖 I 30-34.9
  • 肥胖二级 35-39.9
  • 肥胖 III 40 或以上

成人超重、肥胖和中心性脂肪沉积的测量指标 (3)

  • 使用 BMI 作为超重和肥胖的实际衡量标准。请谨慎解释，因为它不是中心性肥胖的直接衡量标准
  • 对于 BMI 低于 35 kg/m2 的成年人，测量并使用他们的腰围身高比以及 BMI 作为中心肥胖的实际估计值，并使用这些测量值来帮助评估和预测健康风险（例如，2 型糖尿病、高血压或心血管疾病）

具有南亚、中国、其他亚洲人、中东、黑非洲或非洲-加勒比家庭背景的人容易出现中心性肥胖，并且他们的心脏代谢风险发生在较低的BMI时，因此使用较低的BMI阈值作为超重和肥胖的实际衡量标准：

  • 超重：BMI 23 千克/平方米至 27.4 千克/平方米
  • 肥胖：BMI 27.5 kg/m2 或以上

对于这些人群，通常通过降低 2.5 kg/m2 的阈值来确定 2 级和 3 级肥胖

对于肌肉质量较高的成年人，应谨慎解释 BMI，因为它可能无法准确衡量这一群体的中心性肥胖。

谨慎解释 65 岁及以上人群的 BMI，考虑到合并症、可能影响功能能力的疾病以及年老时略高的 BMI 可能产生的保护作用。

儿童BMI（3）：

  • 使用以下分类来定义儿童和青少年的超重或肥胖程度：
    • 超重：BMI 第 91 百分位数 + 1.34 个标准差 (SD)
    • 临床肥胖：BMI 第 98 百分位数 + 2.05 SD
    • 严重肥胖：BMI 99.6 百分位数 + 2.68 SD

      在解释 BMI 低于 91 百分位数时，尤其是 BMI 图表中的健康体重类别时，需要运用临床判断，因为处于这一类别的儿童或年轻人可能仍然有中心性肥胖

SIGN 之前曾总结过适度（10%）减肥对健康的益处，尽管具体益处因个人初始体重、当前健康状况和减肥程度而异）（4）

  • 死亡
    • 过早死亡率降低 20-25%
    • 死于糖尿病相关并发症的风险降低 30%
    • 死于癌症的风险降低 40%
  • 血压
    • 收缩压下降10mmHg
    • 舒张压下降20mmHg
  • 糖尿病患者空腹血糖水平下降 50%
  • 脂质
    • 总胆固醇下降 10% LDL 胆固醇下降 15%
    • 高密度脂蛋白胆固醇增加 8%

到 2030 年，预计全球 38% 的成年人口将超重，另有 20% 将肥胖 (5)

参考：

 

 

An obese patient is 20% or more heavier than their ideal weight.

Excess body weight is an important public health problem because it is associated with:

  • type II diabetes mellitus
  • hypertension and stroke
  • hyperlipidaemia
  • some cancers

Obesity is graded according to the Body Mass Index (BMI):

  • Healthy weight 18.5-24.9
  • Overweight 25-29.9
  • Obesity I 30-34.9
  • Obesity II 35-39.9
  • Obesity III 40 or more

Measures of overweight, obesity and central adiposity in adults (3)

  • use BMI as a practical measure of overweight and obesity. Interpret it with caution because it is not a direct measure of central adiposity
  • in adults with BMI below 35 kg/m2, measure and use their waist-to-height ratio, as well as their BMI, as a practical estimate of central adiposity and use these measurements to help to assess and predict health risks (for example, type 2 diabetes, hypertension or cardiovascular disease)

People with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background are prone to central adiposity and their cardiometabolic risk occurs at lower BMI, so use lower BMI thresholds as a practical measure of overweight and obesity:

  • overweight: BMI 23 kg/m2 to 27.4 kg/m2
  • obesity: BMI 27.5 kg/m2 or above

For people in these groups, obesity classes 2 and 3 are usually identified by reducing the thresholds highlighted by 2.5 kg/m2

Interpret BMI with caution in adults with high muscle mass because it may be a less accurate measure of central adiposity in this group.

Interpret BMI with caution in people aged 65 and over, taking into account comorbidities, conditions that may affect functional capacity and the possible protective effect of having a slightly higher BMI when older.

BMI in children (3):

  • define the degree of overweight or obesity in children and young people using the following classifications:
    • overweight: BMI 91st centile + 1.34 standard deviations (SDs)
    • clinical obesity: BMI 98th centile + 2.05 SDs
    • severe obesity: BMI 99.6th centile + 2.68 SDs

      Use clinical judgement when interpreting BMI below the 91st centile, especially the healthy weight category in BMI charts because a child or young person in this category may nevertheless have central adiposity

The health benefits of modest (10%) weight loss was previously summarised by SIGN- although the precise benefits will vary in individuals depending on initial body weight, current health and degree of weight loss) (4)

  • mortality
    • 20-25% reduction in premature death
    • 30% reduction in the risk of dying from diabetes-related complications
    • 40% reduction in the risk of dying from cancer
  • Blood pressure
    • 10mmHg decrease in systolic blood pressure
    • 20mmHg decrease in diastolic blood pressure
  • Diabetes 50% fall in fasting blood glucose levels
  • Lipids
    • 10% fall in total cholesterol 15% fall in LDL cholesterol
    • 8% increase in HDL cholesterol

By 2030 an estimated 38% of the world’s adult population will be overweight and another 20% will be obese (5)

Reference:

 

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