成年人減重與預防增重的適當介入策略

1. 成年人減重與預防增重的適當介入策略 2001 ACSM Position Stand 台灣師大 方進隆教授

2. 摘要 • In excess of 55% of adults in the United States are classified as either overweight (BMI= 25-29.9 kg/m.m) or obese (BMI greater than 30 kg/m.m). • 超過55% 的美國成年人體重不是過重就是肥胖.

3. 摘要 重視這明顯的公共健康問題 • To address this significant public health problem, the ACSM recommends that the combination of reductions in energy intake and increase in energy expenditure, through structured exercise and other forms of physical activity,be a component of weight loss intervention program.

4. 美國運動醫學會建議 • 結合減少能量攝取和增加能量消耗的方式來減重. • 透過結構式或其他型態的身體活動, 讓這些活動成為介入計劃的一部份.

5. 減少能量攝取500-1000 kcal/day 脂肪攝取< 30% • An energy deficit of 500-1000 kcal/day achieved through reduction in total energy intake is recommended. • Moreover, it appears that reduction dietary fat intake to < 30% of total energy intake may facilitate weight loss by reducing total energy intake.

6. 摘要 • Although there may be advantages to modifying protein and carbohydrate intake, the optimal doses of these macro-nutrients for weight loss have not been determined.

7. 每週中度運動時間至少150分鐘, 有明顯健康效果. • Significant health benefits can be recognized with participation in minimum of 150 min of moderate intensity exercise per week, and overweight and obese adults should progressively increase to this initial exercise goal. • 體重過重者與肥胖者開始運動時要達到這個目標.

8. 每週能逐漸運動至200-300分鐘, 長期減重效果更佳 • However, there may be advantages to progressively increasing exercise to 200-300 min of exercise per week, as recent scientific evidence indicates that this level of exercise facilitates the long-term maintenance of weight loss.

9. 重量訓練可增加肌力與身體功能, 但可能無法減低能量攝取減少所導致的肌肉質量流失. • The addition of resistance exercise to a weight loss intervention will increase strength and function but may not attenuate the loss of fat-free mass typically observed with reductions in total energy intake and loss of body weight.

10. 藥物治療在醫療需要時才使用,此法配合食物和運動行為改變更有效藥物治療在醫療需要時才使用,此法配合食物和運動行為改變更有效 • When medically indicated, pharmacotherapy may be used for weight loss, but pharmacotherapy appears to be most effective when used in combination with modification of both eating and exercise behaviors.

11. 摘要 • The ACSM recommends that the strategies outlined in this position paper be incorporated into interventions targeting weight loss and the prevention of weight regain for adults. • 本聲明所列的策略融入介入計劃時, 重點在於成年人的減重及預防減重後體重再增加的現象.

12. 簡介 • Obesity has been shown to be associated with chronic diseases and health conditionings such as heart disease, diabetes, cancer, hyperlipidemia, hypertension, and hyperinsulinemia. • The risk associated with obesity is concerning because it estimated that about 55-60 % of adults over the age of 18 have a BMI>25, with about 22% having BMI> 30.

13. introduction • Moreover, the prevalence of individuals with a BMI>25 in the USA increase from 44 to 52 % from the late 1970s to early 1990s, with the prevalence of individuals with BMI >30 increasing from 13 to 21%. • 再最近二十年間, 體重過重與肥胖者的比率皆增加不少.

14. 美國每年花一千億美金來治療與肥胖有關的疾病, 約健保費用的5-10% • The increased prevalence of overweight and obesity has resulted in an estimate $100 billion spent to treat obesity-related condition annually, with the direct costs of obesity being about 5-10% of the health care dollars spent annually.

15. 針對肥胖者減重, 而是針對運動員, 小孩或是青少年. • For the purpose of this position stand, recommendations will be limited to weight loss in overweight and obese adults, and will not address weight loss related to sport and athletic performance, nor weight loss interventions specifically targeting children and adolescents.

16. 體重過重與肥胖的定義 • Within this position stand, overweight is define as a BMI equal to 25-29.9 kg/m.m, with obesity defined as a BMI >= 30 kg/m.m.

17. Identifying adults for whom weight loss is recommended • Studies have consistently shown a linear or J-shaped relationship between BMI and relative risk of morbidity and/or mortality. • BMI與疾病或死亡率的關係形成J 形.

18. Magnitude of weight loss recommendation • An initial weight loss goal should be to decrease body weight by 5-10% and to sustain this magnitude of weight loss long-term. • 開始減重的目標應減少體重5-10% ,而維持一段長的時間.

19. Magnitude of weight loss recommendation • However, even though a weight loss of < 10% is associated with initial improvements in risk factors, the maintenance of a weight loss that is < 10% may not result in the improvements in these risk factors being sustained long-term. Therefore, long-term health benefits may be maximized with sustained weight loss of >= 10% of initial body weight.

20. 最後的減重還是要大於10% • 雖然開始減重在10% 以內, 會與改善健康之危險因素有關. 但長時間維持在減重10% 以內, 可能無法導致危險因素的改善. 因此, 為維持長期健康的好處, 減重要超過最初體重的10% 以上.

21. 飲食建議 每天減少能量攝取500-1000 kcal • The absolute energy intake should be adjusted based on body weight to elicit an energy deficit 500-1000 kcal/d. With this deficit, a minimum weight loss of 0.5-0.9 kg per week would be realistic. • 這樣每週至少可以減重0.5-0.9 公斤. 這是很實際的.

22. 快速減重並無證據指出其長期減重效果比保守的減重好快速減重並無證據指出其長期減重效果比保守的減重好 • Currently, there is no evidence that a faster rate or greater magnitude of initial loss will improve long-term weight loss outcomes compared with more conservative approaches.

23. 辦別需要減重的成年 腰圍男性大於102公分女性大於 88公分 • It has been shown that a girth measurement of the abdomen provides an adequate clinical health screening procedures. Thus, weight loss is recommended when the girth of abdomen is >= 102 cm in men and >= 88 in women.

24. 非常低能量食物 • 過低的能量攝取初期產生較大的減重, 並不表示能維持長期的減重效果 • Excessively low levels of energy intake to produce a greater magnitude of initial weight loss do not necessarily translate into better maintenance of weight loss long-term.

25. 大部分人的減重並不需要採用非常低能量的食物大部分人的減重並不需要採用非常低能量的食物 • Therefore, use of VLCD may not be recommended for weight loss in most individuals, but use of a VLCD may be appropriate when medically indicated. • 有醫療需要時, 才採用非常低能量的食物.

26. 運動建議Exercise recommendation • Despite the importance of exercise, there is little evidence that suggests that exercise alone produce magnitudes of weight loss that are similar to what can be achieved with dietary modification. 即使運動很重要, 但是很少有證據指出只有靠運動, 或是只藉飲食攝取所減少的重量是否相同.

27. 其他因素皆控制, 運動能夠明顯減少體重 • It was shown that when the energy deficit is held constant and other factors that affect energy balance are controlled, exercise can induce significant weight loss. • 減少能量攝取和其他影響的因素都維持一致, 運動能夠明顯減少體重.

28. 減重的運動處方Exercise prescription considerations for weight loss • 減重的運動要考慮有關的運動量, 強度和方式. • It is important to consider the amount, intensity, and type of exercise that should be recommended for weight loss.

29. 減重初期與末期的運動計劃不同 • The recommended level of exercise for sedentary adults during the initial phase of weight loss should be differentiated from the amount of exercise that can be achieved at later stages in the weight loss process.

30. 減重的運動處方 • The amount of exercise necessary to improve fitness may be different than the amount of exercise necessary for successful long-term weight loss. • 用以改善體適能的運動量, 和用以減重的運動量會不相同.

31. 運動時間與減重Exercise duration and weight loss • The current public health recommendation for physical activity is for individuals to participate in at least 30 min of moderate intensity physical activity on most, preferably all, days of the week. • 現在公共健康的建議是每天從事中度的運動三十分鐘, 每週最好每天皆能運動.

32. 運動時間與減重 Exercise duration and weight loss • This recommendation has typically been interpreted as a minimum of 150 min of physical activity per week (5 d, 30 min/d) and is based primarily on the effects of exercise on cardiovascular disease and other chronic conditions. • 每週最少150 分 (5 天,每天30分)主要是為改善心肺疾病與其他慢性疾病

33. 運動時間與減重 • However, that levels of exercise greater than this minimum recommended amount may be important for maintaining weight loss long-term. • 但是, 超過每週至少150 分的運動量是維持長期減重很重要的因素.

34. 運動強度與體重控制Exercise intensity and weight loss • It appears that a sufficient amount of moderate-intensity (55-69% MHR) exercise can be beneficial for management of body weight. • 55-69%最大心跳率的中度運動如有足夠的運動量, 就有助於減重.

35. 運動強度與體重控制 • 少數的研究指出需要較高強度(> 70% MHR)的運動方式來控制體重. • with limited published scientific evidence from randomized trials to support the necessity of more vigorous (> 70% MHR) forms of exercise for management of body weight long-term.

36. 間斷性運動與體重控制Intermittent exercise and weight loss • The use of intermittent exercise may be advantageous for individuals that dislike continuous exercise or perceived barriers to continuous exercise. • 間斷性運動對一些不喜歡連續運動的人有好處.

37. 生活方式與減重Lifestyle activity and weight loss • Lifestyle activity appears to be a promising alternative to structured forms of exercise. • 除了結構性(規律性)的運動, 融入生活方式的運動可能是一種很好減重的替代方法.

38. 生活方式與減重 • Further research is necessary to examine the effectiveness of specific forms of lifestyle physical activity to change both body weight, cardiorespiratory fitness, and risk factors that may be common in overweight adults. 有必要去研究特殊形式的生活方式運動對於改變減重, 心肺功能與危險因素的影響.

39. 重量訓練與減重Resistance exercise and weight loss • Although resistance exercise may improve muscular strength in overweight adults, there is no scientific evidence to suggest that resistance exercise is superior to more commonly used forms of endurance exercise for weight loss. 沒有研究證據指出重量訓練比其他有氧運動的減重果好.

40. Pharmacological weight loss treatment 減重的藥物處理 • All current guidelines consider pharmacotherapy to be an adjunct to lifestyle modification intervention and limit their use to patients with BMI> 30, or a BMI > 27 with additional comorbidities. 現代指導原則是, 藥物治療配合生活方式改變介入只限定在BMI> 30, 或 BMI > 27而有疾病的人.

41. 減重的藥物處理 • There are only two prescription drugs that are approved in the united states by FDA. • Siburramine and orlistat 這兩種藥是美國食物藥物管理局核准的.

42. sibutramine • 是抑制serotonin and noradrenaline再吸收的藥物(reuptake inhibitor.) • Adverse events: 不良作用: 增加平均動脈壓, 心舒壓與安靜心跳率.

43. sibutramine • 有些人使用要小心, 高血壓,或血壓控制不好的人不能使用. • Use with caution in patients with high BP and should not used uncontrolled or poorly controlled BP.

44. Orlistat 胃腸道解脂脢抑制劑, 減少身體對脂肪的吸收. • Lipase inhibitor that works in the gastrointestinal tract to reduce the body’s absorption of fat. • 不良作用Adverse events: 改變排便的習慣changes in bowel habits, 脂肪瀉痢steatorrhea, and fecal urgence等.

45. Orlistat • Reduces the absorption of fat-soluable vitamines (A,D,E,K). Supplement of fat-soluble vitamin. • 減少脂溶性維生素(A,D,E,K)的吸收, 要補充脂溶性維生素.

46. 總結 Summary of weight loss recommendations for the lay public • It have been shown that 29 % of men and 44% of women are attempting to lose weight. • 有29 %的男性與 44%的女性嘗試減重.

47. 總結 Summary • 但只有 22%的男性與19% 的女性減少能量攝取和每週運動超過150分鐘.

48. Summary雖然適度的改變能量攝取與運動對大部分的人是安全的 Summary雖然適度的改變能量攝取與運動對大部分的人是安全的 • 1, although moderate changes in energy intake and exercise are typically safe for most individuals consult with their personal physician or other trained health care professional before engaging in a weight loss program. • 在減重計劃前請教醫師或其他專業人員.

49. Summary • 2, It is recommended that individuals with a BMI > 25 consider engaging in weight loss efforts to reduce their body weight. • BMI > 25的人要減重.

50. Summary • 3, It is recommended that individuals undertaking non-medically supervised weight loss initiatives reduce energy intake by 500-1000 kcal/d to elicit a weight loss of about 0.5-0.9 kg/week. • 以非醫療監控的減重方式, 每天減少500-1000 kcal的能量攝取, 每週減重 0.5-0.9 kg.