An ''ecological'' approach to the obesity pandemic
An ''ecological'' approach to the obesity pandemic
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DOI：
10.1136/bmj.315.7106.477
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发表时间：
1997-08-23
影响因子：
--
通讯作者：
Swinburn, B
中科院分区：
文献类型：
--
作者：
Egger, G;Swinburn, B
肥胖在许多国家日益流行，这意味着它现在应该被视为一种流行病。 1 澳大利亚的一项估计表明，在过去十年中，成年人平均体重每天增加 1 克。 2 随着人们对肥胖、营养和运动的了解、认识和教育不断增加，这种情况发生了。有人建议，如果未来要取得进展，就必须进行范式转变。 3传统上，体重增加被认为是由吃得太多或运动太少或两者兼而有之引起的（体重变化=能量摄入-能量消耗）。这导致人们寻找能量代谢中的小缺陷，例如食物热效应的降低来解释肥胖。 4 治疗以卡路里计算为主，公共卫生信息鼓励人们平衡摄入和输出。随着对能量储存、食欲机制和能量代谢之间动态关系的日益了解以及对营养分配的更广泛认识，这种范式已经发生了变化。 5 6 根据研究表明，脂肪平衡等同于能量平衡，7 建立了脂肪平衡方程（脂肪储存变化率=脂肪摄入率-脂肪氧化率）。 5 该方程比原来的静态方程更具动态性，反映了正常自由获取食物条件下的能量平衡。由于脂肪摄入和氧化并不紧密平衡，8 这种方法不需要代谢异常或基因突变来解释体重增加。事实上，生活在相同环境中的人之间的体脂差异可以更好地描述为正常的生理变化。这种范式更有助于解释个体体内脂肪随时间的变化，但它并不能解释个体内部和周围对肥胖的更广泛影响。
The increasing prevalence of obesity in many countries means that it should now be considered a pandemic. 1 One estimate from Australia suggests that over the past decade the average adult has been adding 1 gram a day to body weight. 2 This has occurred in the face of increasing knowledge, awareness, and education about obesity, nutrition, and exercise. It has been suggested that a paradigm shift is necessary if future progress is to be made. 3Traditionally, weight gain was thought of as caused by eating too much or exercising too little, or both (changes in weight= energy intake-energy expenditure). This led to the search for small deficiencies in energy metabolism such as a reduced thermic effect of food to explain obesity. 4 Treatment was dominated by calorie counting, and public health messages extolled people to balance their intake and output. This paradigm has changed with the increasing understanding of the dynamic relations between energy stores, appetite mechanisms, and energy metabolism and of the wider recognition of nutrient partitioning. 5 6 From studies which have shown that fat balance is equivalent to energy balance, 7 the fat balance equation was developed (rate of change of fat stores= rate of fat intake-rate of fat oxidation). 5 This equation is more dynamic than the original static equation and reflects energy balance under normal conditions of free access to foods. Because fat intake and oxidation are not closely balanced, 8 this approach does not need metabolic abnormalities or genetic mutations to explain weight gain. Indeed, the differences in body fat between people living in the same environment could be better described as normal physiological variation. This paradigm is more helpful in explaining changes in body fat within an individual over time, but it does not account for the wider influences within and around individuals on obesity.