Prevention and treatment
Prevention and treatment of obesity ultimately involves eating less and being more physically active. Though this action sounds simple, long-term weight loss has proven exceedingly difficult to achieve. A US National Institutes of Health consensus statement indicated that adults who remain in conventional weight loss programmes can realistically expect a maximum weight loss of only 10% (a small fraction of excess adiposity). About half of this modest weight loss is regained within a year, and virtually all is regained within 5 years.124 The relative intellectual and psychological immaturity of children compared with adults, and their susceptibility to peer pressure present additional practical obstacles to the successful treatment of childhood obesity. For this reason, most efforts to reduce obesity in children have used either family-based or school-based approaches, though pharmacological and surgical treatments are also available.
Adolescent Trial for Cardiovascular Health) intervention, using an approach similar to Pathways although not specifically designed for obesity prevention, also aimed to reduce dietary fat consumption and increase physical activity. Once again, the intervention caused changes in the targeted behaviours, but BMI did not differ between intervention and control schools after 2 academic years.141 Thus, with the exception of Planet Health, school-based interventions, involving multiple sites, have not reduced obesity prevalence, despite their intensive and, in some instances, multi-year designs.
Pharmacological and surgical treatments
Elucidation of the physiological basis of bodyweight regulation, and sequencing of the human genome provide the opportunity to develop new antiobesity agents. Each of a growing number of endogenous molecules known to affect bodyweight—eg, leptin, hypothalamic melanocortin 4 receptor, and mitochondrial uncoupling proteins—are potential targets for pharmacological manipulation. Enthusiasm for a pharmacological cure of obesity must be tempered, however, by three observations. First, most drugs used for treatment of obesity over the past century, from thyroid extract in the 1890s to Phen/fen in the 1990s,142 have had potentially life-threatening complications. Second, because drugs do not produce permanent changes in physiology or behaviour they are effective only so long as they are taken, raising the spectre of life-long treatment. Third, the two agents most often used in the treatment of adult obesity, sibutramine and orlistat, produce modest weight loss, ranging from about 3–8% compared with placebo.143 Four experimental drugs have produced weight loss in small-scale studies that involved children with special conditions—namely, metformin in obese adolescents with insulin resistance and hyperinsulinaemia,144 octreotide for hypothalamic obesity,145 growth hormone in children with Prader-Willi syndrome,146 and leptin for congenital leptin deficiency.147 When there is no inherent biological cause of obesity, pharmacological treatment should be prescribed only for children who have complications, and even then only after careful consideration of immediate and long-term risks and benefits and in the context of a comprehensive weight-management programme, as advocated by Yanovski.148
Scattered case reports, dating back several decades, have examined the use of bariatric surgery for the
treatment of severe obesity in childhood.148 With current techniques—generally, the roux-en-y gastric bypass— dramatic weight loss has been reported. However, serious complications of this procedure can result, including perioperative mortality, wound dehiscence, bowel obstruction, gastrointestinal bleeding, cholelithiasis, infection, and chronic nutritional deficiencies. As emphasised by Strauss and co-workers,149 this approach constitutes, at best, a last resort for severely obese adolescents.
ป้องกันและการรักษา ป้องกันและรักษาโรคอ้วนสุดเกี่ยวข้องกับการรับประทานอาหารน้อย และมีการใช้งานจริงมากขึ้น แม้ว่าการกระทำนี้เสียงง่าย น้ำหนักระยะยาวได้พิสูจน์ไปยากที่จะบรรลุ คำสั่งมติเราชาติสถาบันสุขภาพระบุว่า ผู้ใหญ่ที่อยู่ในโปรแกรมการสูญเสียน้ำหนักปกติสามารถจริงคาดว่าน้ำหนักสูงสุดเพียง 10% (ส่วนเล็ก ๆ ของ adiposity ส่วนเกิน) ประมาณครึ่งหนึ่งของน้ำหนักนี้เจียมเนื้อเจียมตัวเป็นจากภายในปี และแทบทั้งหมดคือจากภายในร้านที่ทางปัญญา และจิตใจที่สัมพันธ์กันของเด็กเปรียบเทียบกับผู้ใหญ่ years.124 5 และง่ายของพวกเขาเพื่อนความดันปัจจุบันอุปสรรคปฏิบัติเพิ่มเติมในการรักษาโรคอ้วนในวัยเด็กประสบความสำเร็จ ด้วยเหตุนี้ ส่วนใหญ่พยายามลดโรคอ้วนในเด็กได้ใช้วิธี ตามครอบครัว หรือโรงเรียน แต่ยังมีบริการ pharmacological และผ่าตัดนอกจากนี้ยังมุ่งแทรกแซงคดีวัยรุ่นสุขภาพหัวใจและหลอดเลือด) การใช้วิธีการคล้ายกับหลักแม้ว่าจะไม่ออกแบบมาสำหรับการป้องกันโรคอ้วน การลดปริมาณอาหารไขมัน และเพิ่มกิจกรรมทางกายภาพ อีกครั้ง แทรกแซงที่เกิดจากการเปลี่ยนแปลงในพฤติกรรมเป้าหมาย แต่ BMI ไม่แตกต่างกันระหว่างการแทรกแซงและควบคุมโรงเรียนหลังจาก years.141 ศึกษา 2 ดังนี้ ยกเว้นดาวเคราะห์สุขภาพ งานโรงเรียน เกี่ยวข้องกับหลายไซต์ ไม่ได้ลดโรคอ้วนชุก แม้ มีการเร่งรัด และ ในบาง กรณี การออกแบบหลายปีPharmacological และผ่าตัดรักษาElucidation of the physiological basis of bodyweight regulation, and sequencing of the human genome provide the opportunity to develop new antiobesity agents. Each of a growing number of endogenous molecules known to affect bodyweight—eg, leptin, hypothalamic melanocortin 4 receptor, and mitochondrial uncoupling proteins—are potential targets for pharmacological manipulation. Enthusiasm for a pharmacological cure of obesity must be tempered, however, by three observations. First, most drugs used for treatment of obesity over the past century, from thyroid extract in the 1890s to Phen/fen in the 1990s,142 have had potentially life-threatening complications. Second, because drugs do not produce permanent changes in physiology or behaviour they are effective only so long as they are taken, raising the spectre of life-long treatment. Third, the two agents most often used in the treatment of adult obesity, sibutramine and orlistat, produce modest weight loss, ranging from about 3–8% compared with placebo.143 Four experimental drugs have produced weight loss in small-scale studies that involved children with special conditions—namely, metformin in obese adolescents with insulin resistance and hyperinsulinaemia,144 octreotide for hypothalamic obesity,145 growth hormone in children with Prader-Willi syndrome,146 and leptin for congenital leptin deficiency.147 When there is no inherent biological cause of obesity, pharmacological treatment should be prescribed only for children who have complications, and even then only after careful consideration of immediate and long-term risks and benefits and in the context of a comprehensive weight-management programme, as advocated by Yanovski.148รายงานกรณีกระจาย ลช่วยมาหลายทศวรรษ มีการตรวจสอบการใช้ผ่าตัด bariatric นี้รักษาโรคอ้วนรุนแรงใน childhood.148 ด้วยเทคนิคปัจจุบัน — ข้าม roux-น้ำ-y ในกระเพาะอาหารทั่วไป ซึ่งมีรายงานการสูญเสียน้ำหนักอย่าง อย่างไรก็ตาม ภาวะแทรกซ้อนที่รุนแรงของขั้นตอนนี้อาจทำให้ รวมถึง perioperative ตาย dehiscence แผล ลำไส้อุดตัน ระบบเลือด cholelithiasis ติดเชื้อ และทรงคุณค่าทางโภชนาการเรื้อรัง เป็น emphasised โดยสโทรสและ co-แรงงาน 149 วิธีการนี้ ถือ ที่สุด ท้ายสำหรับวัยรุ่นที่อ้วนอย่างรุนแรง
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Prevention and treatment
Prevention and treatment of obesity ultimately involves eating less and being more physically active. Though this action sounds simple, long-term weight loss has proven exceedingly difficult to achieve. A US National Institutes of Health consensus statement indicated that adults who remain in conventional weight loss programmes can realistically expect a maximum weight loss of only 10% (a small fraction of excess adiposity). About half of this modest weight loss is regained within a year, and virtually all is regained within 5 years.124 The relative intellectual and psychological immaturity of children compared with adults, and their susceptibility to peer pressure present additional practical obstacles to the successful treatment of childhood obesity. For this reason, most efforts to reduce obesity in children have used either family-based or school-based approaches, though pharmacological and surgical treatments are also available.
Adolescent Trial for Cardiovascular Health) intervention, using an approach similar to Pathways although not specifically designed for obesity prevention, also aimed to reduce dietary fat consumption and increase physical activity. Once again, the intervention caused changes in the targeted behaviours, but BMI did not differ between intervention and control schools after 2 academic years.141 Thus, with the exception of Planet Health, school-based interventions, involving multiple sites, have not reduced obesity prevalence, despite their intensive and, in some instances, multi-year designs.
Pharmacological and surgical treatments
Elucidation of the physiological basis of bodyweight regulation, and sequencing of the human genome provide the opportunity to develop new antiobesity agents. Each of a growing number of endogenous molecules known to affect bodyweight—eg, leptin, hypothalamic melanocortin 4 receptor, and mitochondrial uncoupling proteins—are potential targets for pharmacological manipulation. Enthusiasm for a pharmacological cure of obesity must be tempered, however, by three observations. First, most drugs used for treatment of obesity over the past century, from thyroid extract in the 1890s to Phen/fen in the 1990s,142 have had potentially life-threatening complications. Second, because drugs do not produce permanent changes in physiology or behaviour they are effective only so long as they are taken, raising the spectre of life-long treatment. Third, the two agents most often used in the treatment of adult obesity, sibutramine and orlistat, produce modest weight loss, ranging from about 3–8% compared with placebo.143 Four experimental drugs have produced weight loss in small-scale studies that involved children with special conditions—namely, metformin in obese adolescents with insulin resistance and hyperinsulinaemia,144 octreotide for hypothalamic obesity,145 growth hormone in children with Prader-Willi syndrome,146 and leptin for congenital leptin deficiency.147 When there is no inherent biological cause of obesity, pharmacological treatment should be prescribed only for children who have complications, and even then only after careful consideration of immediate and long-term risks and benefits and in the context of a comprehensive weight-management programme, as advocated by Yanovski.148
Scattered case reports, dating back several decades, have examined the use of bariatric surgery for the
treatment of severe obesity in childhood.148 With current techniques—generally, the roux-en-y gastric bypass— dramatic weight loss has been reported. However, serious complications of this procedure can result, including perioperative mortality, wound dehiscence, bowel obstruction, gastrointestinal bleeding, cholelithiasis, infection, and chronic nutritional deficiencies. As emphasised by Strauss and co-workers,149 this approach constitutes, at best, a last resort for severely obese adolescents.
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