Obesity: The disease
Obesity: The disease
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DOI：
10.1021/jm0680124
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发表时间：
2006-07-13
影响因子：
7.3
通讯作者：
Bray, George A.
中科院分区：
文献类型：
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作者：
Bray, George A.
两者都增加了体重，以体重指数[（体重，kg）/（身高，m） 2]表示，腰围可以用来评估肥胖的风险，并且随着近20年来肥胖流行的增加，这两个指标都在迅速上升。虽然肥胖是由能量摄入和消耗之间的不平衡造成的，但正是热力学第一定律中这两个组成部分之间的联系，可以为我们应该如何理解、预防和治疗这个问题提供线索。描述对易感宿主起作用的环境因素的流行病学模型为描述当前流行病提供了一个有用的框架。肥胖的病理可以被最好地理解为脂肪细胞的扩大，在一些个体中，脂肪细胞的数量增加。这些大脂肪细胞释放更多的脂肪酸和多种细胞因子，可以为理解肥胖如何产生胰岛素抵抗以及炎症、血栓形成和凝血系统的变化提供基础。因为没有人想肥胖，所以有一个庞大的行业提供各种形式的治疗。虽然我们可以在治疗肥胖方面取得一些成功，但我们很少能治愈它，并且在治疗期间体重稳定，随后在治疗结束后复发是常见的经历。手术干预胃旁路或胃限制是最有效的治疗方法，但死亡率和发病率增加。目前只有两种药物被批准长期使用，而且它们只能产生适度的减肥效果。我的出发点是我们所有人都想拥有健康的体重，没有人想肥胖。近年来，人们对肥胖的兴趣急剧上升，以任何标准衡量，这一问题的普遍性都在迅速增加。肥胖可以被看作是一种慢性、耻辱性的神经化学疾病。在这种情况下，目标是将体重恢复到健康水平，并消除与使用“肥胖”一词相关的污名。在神经化学紊乱的背景下考虑它有一个优势，即关注产生能量平衡扭曲的潜在机制，从而产生不健康的状态。2
Both increased body weight, as expressed in the body mass index [(body weight, kg)/(height, m) 2], and the waist circumference can be used to assess the risk of obesity, and both indices have been rising rapidly as the epidemic of obesity has increased over the past 20 years. Although obesity results from an imbalance between energy intake and expenditure, it is the connections between these two components of the first law of thermodynamics that can provide the clues about how we should understand, prevent, and treat this problem. An epidemiological model that describes the environmental factors that act on a susceptible host provides a useful framework for describing the current epidemic. The pathology of obesity can best be understood as an enlargement of fat cells and in some individuals an increased number of fat cells. These large fat cells release more fatty acids and a variety of cytokines that can provide a basis for understanding how obesity produces insulin resistance and changes in the inflammatory, thrombotic, and coagulation systems. Since no one wants to be obese, there is a large industry offering various forms of treatment. Though we can treat obesity with some success, we rarely cure it, and a plateau in body weight during treatment with subsequent relapse when treatment is terminated is the common experience. Surgical intervention with gastric bypass or gastric restriction is the most effective treatment but at an increased risk of mortality and with substantial morbidity. Only two pharmacological agents are currently approved for long-term use, and they produce only modest weight loss.I start with the premise that all of us want to have a healthy weight and that no one wants to be obese. Interest in obesity has taken a sharp upturn in recent years, and the prevalence of this problem by any standards has increased rapidly. Obesity can be viewed as a chronic, stigmatized, neurochemical disease. 1 In this context, the goal is to return weight to a healthy level and to remove the stigma associated with the use of the word obesity. To consider it in the context of a neurochemical derangement has the advantage of focusing on the underlying mechanisms that produce the distortion in energy balance that produces the unhealthy state. 2