我国成人超重、肥胖和腹型肥胖的流行特点

肥胖患病率在全球呈快速增长趋势。肥胖是指体内脂肪过度堆积,并显著增加心血管代谢紊乱性疾病的发病风险。已观察到在一些人群中,超重/肥胖和腹型肥胖患病率的变化表现不一致。本文就我国超重/肥胖和腹型肥胖患病率的变迁进行总结。     

The prevalence of overweight and obesity among Danish school children

In 14 Danish municipalities physicians have gathered weight and height data from 7541 9th grade students (86.7% of all students in 9th grade participating). Overall 25.2% of the population were overweight (body mass index > 90th percentile). Boys were more frequently overweight than girls (29.3% vs. 21.1%) (P < 0.05). 14.1% of the boys and 8.2% of the girls were obese (body mass index > 97th percentile). Categorizing the participating municipalities by socioeconomic status students in municipalities with low status had a significantly higher prevalence of overweight than students in municipalities with high status. Overweight and obesity among Danish school children is a major concern and there are significant social differences in the prevalence of overweight.     

A national survey of the prevalence of childhood overweight and obesity in Italy

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third-grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8–9 years whose parents agreed to opt-out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third-graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut-offs) ranged from 7.5% (95% confidence intervals 6.7–8.2) in the north to 16.6% (95% confidence intervals 15.8–17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity-related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.     

Overweight and obesity among adults in the Gulf States: A systematic literature review of correlates of weight,weight‐related behaviours,and interventions

Obesity has increased to an epidemic level in the Gulf States. This systematic review is the first to explore the scientific evidence on correlates and interventions for overweight (body mass index [BMI] ≥ 25) or weight‐related behaviours in the region. A systematic search of peer‐reviewed articles was conducted using PubMed and PsycINFO. Ninety‐one studies were eligible for this review including 84 correlate studies and seven intervention studies. Correlate studies of overweight focused on sociodemographic factors, physical activity, and dietary habits. Low physical activity, sedentary behaviour, and unhealthy dietary habits were associated with overweight. The most‐reported sociodemographic correlates of overweight were increased age, being married, low education, urban residence, and unemployment. Correlate studies of physical activity and dietary behaviours mostly focused on sociodemographic variables. Being female and increased age (the latter less consistently) were associated with low physical activity. Interventions were very heterogeneous with respect to the target group, intensity, and behavioural strategies used. The effectiveness of interventions was difficult to evaluate because of the chosen study design or outcome measure, the small sample size, or high attrition rate. Few studies have investigated sociocognitive and environmental determinants of weight‐related behaviours. Such information is crucial to developing health promotion initiatives that target those weight‐related behaviours.     

Age standardization in mapping adult overweight and obesity trends in the WHO European Region

This study aims to improve comparability of available data within the World Health Organization (WHO) European Region taking into account differences related to the aging of the population. Surveys were included if they were conducted on adults aged 25-64 years between 1985 and 2010 in the WHO European Region. Overweight/obesity prevalences were adjusted to the European standard population aged 25-64. Data were entered for each of the 5-year categories between 1981 and 2010. Measured height and weight data were available for males in 16 and females in 24 of the 53 countries. The 50-64-year-olds had higher prevalence of overweight and obesity as compared to the 25-49-year-olds. This pattern occurs in every country, by male and female, in almost all surveys. Age-standardized overweight prevalence was higher among males than females in all countries. Trend data showed increases in most countries. Age-standardized maps were based on self-reported data because of insufficient availability of measured data. Results showed more countries with available data as well as the higher category of obesity in the later surveys. Measured values are needed and age adjustment is important in documenting emerging overweight and obesity trends, independent of demographic changes, in the WHO European Region.     

Long‐term changes in prevalence of overweight and obesity in Czech 7‐year‐old children: evaluation of different cut‐off criteria of childhood obesity

The objective of this paper was an evaluation of change in prevalence of overweight and obesity in Czech children, and a comparison of cut‐off points for body mass index references from the Czech Republic (CzR), International Obesity Task Force and WHO. The authors conducted a survey in 7‐year‐old children, and compared data from 1951, 1981, 1991, 2001 and 2008 (WHO cut‐offs). 2008 data were evaluated according to different cut‐offs. Results showed that since 1951 in boys, overweight prevalence increased from 13.0% in 1951 to 26.8% in 2001, in girls from 10.9% to 22.9%. Obesity increased in boys from 1.7% to 8.3%, in girls from 1.7% to 6.9%. From 2001 to 2008 obesity in boys increased; obesity in girls and overweight in both genders decreased. In 2008 cohort the following values were found: overweight and obesity: CzR criteria, percentage was lowest (14.8% boys and 11.1% girls); WHO criteria, highest prevalence (23.5% boys and 19.5% girls); obesity: lowest ratio International Obesity Task Force criteria (4.4% boys, 3.3% girls), highest ratio boys WHO criteria (10.0%), girls CzR criteria (5.0%). Overweight and obesity prevalence increased in 7‐year‐old Czech children since 1951; since 2001 prevalence is plateauing with exception of boys. Using different body mass index references resulted in marked differences in overweight and obesity prevalence.     

Harnessing glucagon‐like peptide‐1 receptor agonists for the pharmacological treatment of overweight and obesity

Over the past 30 years, there has been a dramatic rise in global obesity prevalence, resulting in significant economic and social consequences. Attempts to develop pharmacological agents to treat obesity have met with many obstacles including the lack of long‐term effectiveness and the potential for adverse effects. Historically, there have been limited treatment options for overweight and obesity; however, since 2012, a number of new drugs have become available. A number of peptides produced in the gut act as key mediators of the gut–brain axis, which is involved in appetite regulation. This review discusses the role of the gut–brain axis in appetite regulation with special focus on glucagon‐like peptide‐1. Liraglutide 3.0 mg, a glucagon‐like peptide‐1 receptor agonist that targets this pathway, is now approved for the treatment of obesity and overweight (body mass index ≥27 kg/m²) with comorbidities such as type 2 diabetes, high blood pressure, high cholesterol or obstructive sleep apnoea. In addition, other glucagon‐like peptide‐1 receptor agonists offer promise for obesity management in the future. This review examines how glucagon‐like peptide‐1 receptor agonists promote weight loss and summarizes the clinical data on weight loss with glucagon‐like peptide‐1 receptor agonists.     

The burden of overweight and obesity in the Asia–Pacific region

The rise in the prevalence of overweight and obesity (body mass index ≥25 kg m⁻²) is, in part, a negative consequence of the increasing economic developments of many lower‐ and middle‐income countries in the Asia–Pacific region. To date, there has been no systematic quantification of the scale of the problem in countries of this region. From the most recent nationally representative estimates for the prevalence of overweight and obesity in 14 countries of the region, it is apparent that overweight and obesity is endemic in much of the region, prevalence ranging from less than 5% in India to 60% in Australia. Moreover, although the prevalence in China is a third of that in Australia, the increase in prevalence in China over the last 20 years was 400% compared with 20% in Australia. In addition, across various countries in the region, the population attributable fractions because of overweight and obesity ranged from 0.8% to 9.2% for coronary heart disease mortality, 0.2% to 2.9% for haemorrhagic stroke mortality, and 0.9% to 10.2% for ischaemic stroke mortality. These results indicate that consequences of overweight and obesity for health and the economy of many of these countries are likely to increase in coming years.     

Management of overweight and obesity in primary care—A systematic overview of international evidence‐based guidelines

Overweight and obesity are increasing worldwide. In general practice, different approaches exist to treat people with weight problems. To provide the foundation for the development of a structured clinical pathway for overweight and obesity management in primary care, we performed a systematic overview of international evidence‐based guidelines. We searched in PubMed and major guideline databases for all guidelines published in World Health Organization (WHO) “Stratum A” nations that dealt with adults with overweight or obesity. Nineteen guidelines including 711 relevant recommendations were identified. Most of them concluded that a multidisciplinary team should treat overweight and obesity as a chronic disease. Body mass index (BMI) should be used as a routine measure for diagnosis, and weight‐related complications should be taken into account. A multifactorial, comprehensive lifestyle programme that includes reduced calorie intake, increased physical activity, and measures to support behavioural change for at least 6 to 12 months is recommended. After weight reduction, long‐term measures for weight maintenance are necessary. Bariatric surgery can be offered to people with a BMI greater than or equal to 35 kg/m² when all non‐surgical interventions have failed. In conclusion, there was considerable agreement in international, evidence‐based guidelines on how multidisciplinary management of overweight and obesity in primary care should be performed.     

Prevalence of obesity and overweight in urban adult Nigerians

Obesity is increasingly a major health problem in parts of the developing world. It has reached epidemic proportions among Africans living in the Western Hemisphere; similar potential may exist in urban Africa. We explored this possibility in an urban setting in Nigeria, Africa's most populous nation. A screening survey was carried out among randomly selected 998 civil servants, 581 men and 417 women, in Ibadan, a major Nigerian city. Biographical data were collected using standardized questionnaires, and measurements of anthropometric indices, blood pressures and plasma glucose concentration. Obesity and overweight were defined by body mass index based on international criteria. Prevalence of obesity was 8.82% (confidence interval [CI] = 7.13%, 10.75%), overweight 17.45% (CI = 15.12%, 19.95%), and overweight plus obesity = 26.18% (CI = 23.47%, 29.03%). Prevalence of obesity among the women was 17.27% (CI = 13.76%, 21.24%) and for men 2.75% (CI = 1.58%, 4.43%). Among the women 42% were obese or overweight compared with 15% of the male population. Obesity and overweight were associated with higher socioeconomic status. Prevalence of obesity and overweight in the study population is comparable to rates seen in many industrialized countries, and rapidly emerging urbanized populations in Africa.     

Prevalence of overweight and obesity in Eti-Osa LGA, Lagos, Nigeria

In many of the urban centres of the developing countries, a change in lifestyle due to increased affluence has been observed. It has been shown that change in lifestyle is an important factor in the global epidemic of overweight and obesity. The aim of this study was to assess the influence of lifestyle and socioeconomic class on the prevalence of overweight and obesity amongst adolescents from rural and urban centres in Lagos, Nigeria. This is a cross-sectional prospective survey carried out on a sample of 1504 randomly selected adolescents, aged between 10 and 19 years, from six public secondary schools located in urban and rural areas of the Eti-Osa local government area of Lagos State, Nigeria. A self-designed completed questionnaire was used to determine the participants' socio-demographic characteristics. Anthropometric measurements were taken to calculate their body mass index (BMI). The overall prevalence rates of overweight and obesity in the urban and rural areas, respectively, were 3.7% and 0.4%, and 3.0% and 0.0%. Socioeconomic class did not significantly affect the BMI values. Overweight is an evolving problem, while obesity is seemingly not a problem yet in adolescent school-aged children in Lagos State, Nigeria.     

Physical activity interventions in early life aimed at reducing later risk of obesity and related non‐communicable diseases: A rapid review of systematic reviews

To identify useful components of interventions aimed at prevention of childhood obesity and related non‐communicable diseases (NCDs), which included physical activity and which targeted any or all of four life‐course stages: peri‐conception; pregnancy; infancy and toddlerhood (0 to 23 months); and early childhood (24 to 59 months). In May 2016, WHO Geneva searched the Cochrane Library and PubMed for systematic reviews of interventions including physical activity to prevent childhood obesity or risk factors for obesity‐related NCDs. Using a narrative synthesis, the efficacy of randomized controlled trials (RCTs) to alter energy balance outcomes (measures of weight status or body fatness) was characterized by life‐course stage, study characteristics, intervention functions (as defined in the behaviour change wheel), and level of the socio‐ecological model (SEM) targeted. The quality of included systematic reviews was assessed. We retrieved 82 reviews from the World Health Organization (WHO) search, of which 23 were eligible for the present synthesis. The number of eligible studies by life‐course stage was: 0 (peri‐conception); 0 (pregnancy); 8 (infancy and toddlerhood, age 0 to 23 months; seven RCTs; age); and 37 (early childhood, age 24 to 59 months; 30 RCTs;). Thus, there was a lack of evidence for physical activity interventions during peri‐conception and pregnancy. Almost all relevant studies in the 0‐ to 23‐ and 24‐ to 59‐month life‐course stages were multicomponent interventions (ie, targeted physical activity, dietary, and/or sedentary behaviours). Interventions with evidence of efficacy tended to target multiple levels of the SEM, with emphasis on parents, and extend over long periods. Effective intervention elements for early life obesity prevention included classes on parenting skills, alteration of the kindergarten playground, and financial incentives. Evidence from low‐ and middle‐income countries was scarce, and evidence for intervention effect on obesity‐related NCDs was missing. Future physical activity interventions in toddlerhood and early childhood aimed at prevention of obesity should adopt the characteristics typical of effective interventions identified by the present synthesis. There is an urgent need for more evidence on physical activity interventions set in low‐ and middle‐income countries and which target the peri‐conception and pregnancy periods.     

Chromium supplementation in overweight and obesity: a systematic review and meta‐analysis of randomized clinical trials

The increased prevalence of obesity has made the use of dietary supplements as weight reducing agents highly popular, but their efficacy has not been proven. One such supplement is chromium. The purpose of this review was to evaluate the evidence for or against the efficacy of chromium supplementation in overweight and obese individuals. Electronic searches were conducted in Medline, Embase, Amed and The Cochrane Library. The bibliographies of located articles were also searched. No age, gender or language restrictions were imposed. The reporting quality of identified randomized clinical trials (RCTs) was assessed using a methodological checklist adapted from the Consolidated Standard of Reporting Trials Statement and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Thirty‐nine trials were identified and 20 were included. There were variations in reporting quality of included studies. A meta‐analysis of 11 studies showed a statistically significant difference in weight loss favouring chromium over placebo (mean difference (MD): ?0.50 kg; 95% confidence interval (CI): ?0.97, ?0.03). There was a high statistical heterogeneity. Adverse events included watery stools, vertigo, headaches and urticaria. The evidence from available RCTs shows that chromium supplementation generates statistically significant reductions in body weight. The magnitude of the effect is small, and the clinical relevance is uncertain. Future trials should last at least 16 weeks and greater uniformity in the measuring and assessment tools for body composition is recommended.     

Prevalence of obesity in the United States

Obesity is a major public health problem in the United States. Data on measured heights and weights indicates that the prevalence of obesity has significantly increased among the US population over the past 30 years. Data collected from 1999 to 2002 estimates that nearly 1/3 of adults are obese (27.6% of men and 33.2% of women) and one in six children and adolescents is overweight. Increased prevalence of excessive weight is noted among all age, gender and racial/ethnic groups; however, disparities exist. There is a need for further research to better understand why these increases have occurred, why the observed disparities exist and how to reverse these trends.     

The association between childcare arrangements and risk of overweight and obesity in childhood: a systematic review

Over 80% of preschool‐aged children experience non‐parental childcare. Childcare type has the potential to influence weight outcomes, but its impact on childhood overweight/obesity is not well established. This review aims to (i) systematically evaluate the effects of childcare type on childhood overweight/obesity risk and (ii) investigate the impact of childcare intensity and age at commencement. Five electronic databases were searched for observational studies quantifying an association between childcare type ≤5 years and weight outcomes <18 years. Twenty‐four studies were included (n = 127,529 children). Thirteen studies reported increased risk of overweight/obesity in children attending informal care (n = 9) or centre care (n = 4) vs. parental care. Seven studies reported decreased risk of overweight/obesity for children in centre vs. ‘non‐centre’ care (parental and informal). Four studies reported no association between informal or centre care and overweight/obesity. Early (<3 years) informal care, especially by a relative, was associated with increased risk of overweight/obesity. Higher intensity childcare, especially when commenced early (<1 year), increased overweight/obesity risk. Later (≥3 years) centre care was associated with decreased risk of overweight/obesity. Early informal care, earlier commencement age and higher intensity represent a risk for childhood obesity. Exploration of the obesogenic aspects of these contexts is essential to inform preventative measures.