Approximately two out of three adult Americans are overweight or obese. Despite widespread recognition of this disorder, there has been little progress in the past 20 years in finding effective noninvasive treatments for weight loss. The consequences of obesity are increasingly well recognized and include increases in blood pressure, plasma lipids, the onset of type 2 diabetes, sleep apnea, asthma, osteoarthritis and a variety of cancers. Obesity can increase the rate of pregnancy complications and fetal malformations in normoglycemic women. Current medical approaches to obesity, including intensive lifestyle interventions and drug therapies, have been successful in achieving modest weight loss of 4–7%, less than the 1998 NIH Guidelines target of 10%. Surgical approaches, including laparoscopic adjustable gastric banding, vertical banded gastroplasty and Roux-en-Y gastric bypass, are much more successful, achieving weight loss of 15–50%. A treatment gap therefore exists in the management of obese and overweight patients, because many patients desire and would receive great health benefits by achieving weight loss of 7–15%. This review will discuss the dilemma of the treatment gap and explore possible ways by which it may be filled in the future by the use of innovative approaches.

大约三分之二的成年美国人超重或肥胖。尽管人们普遍认识到这种疾病，但在过去 20 年中，在寻找有效的非侵入性减肥疗法方面进展甚微。肥胖的后果越来越广为人知，包括血压升高、血脂升高、2 型糖尿病发病、睡眠呼吸暂停、哮喘、骨关节炎和各种癌症。肥胖会增加血糖正常女性的妊娠并发症和胎儿畸形的发生率。当前针对肥胖的医学方法，包括强化生活方式干预和药物治疗，已成功实现 4-7% 的适度体重减轻，低于 1998 年 NIH 指南 10% 的目标。手术方法，包括腹腔镜可调节胃束带术，垂直带状胃成形术和 Roux-en-Y 胃旁路术更为成功，可减轻 15-50% 的体重。因此，肥胖和超重患者的管理存在治疗差距，因为许多患者希望并且将通过实现 7-15% 的体重减轻来获得巨大的健康益处。这篇综述将讨论治疗差距的困境，并探索未来通过使用创新方法来填补这一困境的可能方式。