Obesity continues to be among the top health concerns across the globe. Despite our failure to contain the high prevalence of obesity, we now have a better understanding of its pathophysiology, and how excess adiposity leads to type 2 diabetes, hypertension, and cardiovascular disease. Lifestyle modification is recommended as the cornerstone of obesity management, but many patients do not achieve long-lasting benefits due to difficulty with adherence as well as physiological and neurohormonal adaptation of the body in response to weight loss. Fortunately, 5 drug therapies-orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion-are available for long-term weight management. Additionally, several medical devices are available for short-term and long-term use. Bariatric surgery yields substantial and sustained weight loss with resolution of type 2 diabetes, although due to the high cost and a small risk of serious complications, it is generally recommended for patients with severe obesity. Benefit-to-risk balance should guide treatment decisions.

中文翻译：

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肥胖

肥胖仍然是全球最关心的健康问题之一。尽管我们未能控制肥胖的高发率，但我们现在对其病理生理学以及过度肥胖如何导致 2 型糖尿病、高血压和心血管疾病有了更好的了解。生活方式改变被推荐为肥胖管理的基石，但由于依从性困难以及身体对体重减轻做出的生理和神经激素适应，许多患者无法获得长期的益处。幸运的是，有 5 种药物疗法——奥利司他、氯卡色林、利拉鲁肽、芬特明/托吡酯和纳曲酮/安非他酮——可用于长期体重管理。此外，还有多种医疗器械可供短期和长期使用。减肥手术可在解决 2 型糖尿病的同时产生大量和持续的体重减轻，但由于成本高且严重并发症的风险小，通常建议重度肥胖患者进行减肥手术。收益与风险的平衡应指导治疗决策。