The prevalence of obesity in the United States approaches half of the adult population. The COVID-19 pandemic endangers the health of obese individuals. In addition, the metabolic syndrome poses a challenge to the health of obese adults. Bariatric surgery and diet restore metabolic homeostasis in obese individuals; however, it is still unclear which strategy is most effective. For example, intermittent fasting improves insulin sensitivity and diet alone decreases visceral adipose tissue at a disproportionately high rate compared to weight loss. Bariatric surgery causes rapid remission of type 2 diabetes and increases incretins for long-term remission of insulin resistance before meaningful weight loss has occurred. Malabsorptive surgeries have provided insight into the mechanism of altering metabolic parameters, but strong evidence to determine the duration of their effects is yet to be established. When determining the best method of weight loss, metabolic parameters, target weight loss, and risk-benefit analysis must be considered carefully. In this review, we address the pros and cons for the optimal way to restore metabolic homeostasis.

中文翻译：

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体内平衡被破坏和恢复——重新审视 COVID-19 期间肥胖的机制和治疗。

美国肥胖症的患病率接近成年人口的一半。COVID-19 大流行危及肥胖者的健康。此外，代谢综合征对肥胖成人的健康构成挑战。减肥手术和饮食恢复肥胖个体的代谢稳态；然而，目前尚不清楚哪种策略最有效。例如，与减肥相比，间歇性禁食可提高胰岛素敏感性，而单独的饮食会以不成比例的高速率减少内脏脂肪组织。减肥手术导致 2 型糖尿病的快速缓解，并增加肠促胰素以在发生有意义的体重减轻之前长期缓解胰岛素抵抗。吸收不良手术提供了对改变代谢参数机制的深入了解，但尚未确定确定其影响持续时间的有力证据。在确定最佳减重方法时，必须仔细考虑代谢参数、减重目标和风险收益分析。在这篇综述中，我们讨论了恢复代谢稳态的最佳方法的利弊。