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[ADA2012]解读体重管理策略
——美国西奈山医学院Cathy A. Nonas教授访谈
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作者:C.A.Nonas 2012/6/10 14:36:00    加入收藏
内容概要:Nonas教授:首先,减轻体重应该适度。我认为这是非常重要的。查阅相关文献你会发现,医生以及其他的临床工作者都希望能够最大限度地减轻其患者的体重,体重降低5%~10%可为患者带来临床获益,即使患者的体重仍高达400磅。

  <International Diabetes>: If we are doing an obesity intervention, whether it is a lifestyle intervention or even a new drug, what kind of reduction in weight would you be looking for?
  Dr Nonas: We would first be looking for a modest reduction. I think that is very important. If you look at the literature, physicians and other clinicians are not dissimilar from their patients in that they expect bigger weight losses than the research bears out, which is 5%-10% to give you a clinical benefit even if you are 400lbs. I think it is important to realize that and I also think it is important to note that environment does make a big difference and asking your patient to be vigilant seven days a week, 24 hours a day is very hard and you shouldn’t be surprised if they gain weight even if they know what to do. But then it would be very helpful if physicians brought these patients back to their offices more often because the weigh-in, that relationship with the physician, is really important. Even if you use the diabetes paradigm as the incentive to bring them back on a quarterly basis, that would be very helpful to many.

  《国际糖尿病》:对肥胖实施干预时,您会选择生活方式干预还是应用新药来减轻体重?
  Nonas教授:首先,减轻体重应该适度。我认为这是非常重要的。查阅相关文献你会发现,医生以及其他的临床工作者都希望能够最大限度地减轻其患者的体重,体重降低5%~10%可为患者带来临床获益,即使患者的体重仍高达400磅。我认为临床上要充分认识到这一点,而且环境因素对体重有重要的影响。要求患者每周七天,每天24小时都保持警觉状态是非常难的,因此即使他们知道该怎么做他们的体重也会出现反弹,这一点都不足为奇。 但是经常要求患者进行随访将对减轻其体重非常有用,因为医生与患者间的关系真的是非常重要的。即使你按照糖尿病患者的要求他们每个季度进行一次随访,对很多人来说这也是非常有用的。

  <International Diabetes>: A lot of studies on lifestyle interventions have had trouble showing consistent weight loss and weight loss that comes off and stays off. The POWER study was the first time that it was shown that weight loss could be maintained especially in a cost-effective way. How do you think we can improve these interventions to allow people to achieve some reasonable weight loss let alone keeping weight off?
  Dr Nonas:I don’t think it is interventions per se; I think it is environment we live in where bigger is better and bigger things are often cheaper and whenever we meet people we do it around food. Environment makes a very big impression. I say that because when you think about what a physician does, a physician gives their patients strategies basically to defend themselves against the environment. Then the patient has the sole responsibility, where I do believe from a public health position, we also need to change the environment. That said, a physician has to be clued into that difficulty and we have seen again and again that the more times you can get a patient in, the longer you can keep them in after they have lost weight, the better they do. Even if they gain weight back, they may not gain all the weight back and that’s an important principle. We have seen from the Diabetes Prevention Study and others, that even though they gain back weight, it still reduces the risk of progressing to diabetes. Physicians shouldn’t be discouraged because after 18 months their patient has only lost 2% but in reality their patient would have otherwise gained 3% or 5% if they hadn’t been there to guide them. And what’s more they are at less risk.

 

  《国际糖尿病》:很多有关生活方式干预的研究都无法获得持续的减重效果。POWER研究首次显示,减重效果能够以一种极具成本效益的方式得到维持。您认为我们应当怎样改善这些干预措施从而使人们达到并维持合理的减重效果?
  Nonas教授:我认为重要的不是干预本身,而是我们所处的环境尤其是食物。我们所处的环境是越大越好。环境对减重具有非常大的影响。因为医生给他们的患者提供的减重策略都是以针对环境为基础的。从公众健康的角度来看的话,患者唯一需要做的就是改变环境。医生需要解决这一困难,我们已经不止一次地发现,医生与患者沟通的次数越多,其减重效果将保持得越好、越长久。即使他们的体重有所反弹,但其反弹的幅度将很小。这是一项非常重要的原则。从糖尿病预防研究及其他研究我们可以发现,即使这些患者的体重反弹了,他们进展为糖尿病的风险仍然是降低的。医生对干预18个月后他们患者的体重仅降低了2%这一点不应该感到气馁,因为不对其进行指导的话,他们的患者的体重可能会增加3%~5%。这已经 能够使他们的发病风险降低了。
 



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