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1.武警重庆总队医院内分泌科,重庆 400061
2.重庆市渝北区人民医院内分泌科,重庆 401120
董晓颖,Email:dxy079@126.com,研究方向:内分泌及代谢病相关研究。
廖 涌,Email:liaoyong00133@sina.com。
收稿:2026-04-09,
修回:2026-04-14,
录用:2026-04-15,
纸质出版:2026-05-28
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董晓颖,崔龙,尹经霞,等.美国糖尿病协会《超重和肥胖标准化管理指南》解读[J].重庆医科大学学报,2026,51(5):587-596.
Dong Xiaoying,Cui Long,Yin Jingxia,et al.Interpretation of key points in the American Diabetes Association’ Obesity Association Standards of Care in Overweight and Obesity[J].Journal of Chongqing Medical University,2026,51(5):587-596.
董晓颖,崔龙,尹经霞,等.美国糖尿病协会《超重和肥胖标准化管理指南》解读[J].重庆医科大学学报,2026,51(5):587-596. DOI: 10.13406/j.cnki.cyxb.004102.
Dong Xiaoying,Cui Long,Yin Jingxia,et al.Interpretation of key points in the American Diabetes Association’ Obesity Association Standards of Care in Overweight and Obesity[J].Journal of Chongqing Medical University,2026,51(5):587-596. DOI: 10.13406/j.cnki.cyxb.004102.
自2025年起,美国糖尿病协会(American Diabetes Association,ADA)下属的肥胖协会(ADA’s Obesity Association,ADAOA)陆续发布首部《超重和肥胖标准化管理指南》的部分章节。指南围绕肥胖及其相关合并症、并发症,在筛查、诊断和管理等方面给出了系统的循证推荐,旨在为肥胖管理提供全面、可操作的规范化框架,以期改善肥胖患者的长期健康结局。目前指南的总体架构与方法学、体重歧视与偏见、成人肥胖药物治疗等核心内容已分阶段发布,本文将针对上述内容进行要点解析。
Since 2025,the American Diabetes Association(ADA) ’s Obesity Association has officially released the first Standards of Care in Overweight and Obesity. The guideline systematically present evidence-based recommendations for the screening,diagnosis,and management of obesity and obesity-related diseases or complications,with the goal of establishing a comprehensive and actionable standardization framework for obesity care to improve long-term health outcomes of individuals with obesity. There chapters,including Introduction and methodology,Weight stigma and bias and Pharmacologic Treatment of Obesity in Adults,have been sequentially published. This article provides an interpretation of the core recommendations of the guideline.
Bannuru RR . Introduction and methodology: standards of care in overweight and obesity:2025 [J ] . BMJ Open Diab Res Care , 2025 , 13 ( Suppl 1 ): e004928 .
Bannuru RR . Weight stigma and bias: standards of care in overweight and obesity: 2025 [J ] . BMJ Open Diab Res Care , 2025 , 13 ( Suppl 1 ): e004962 .
American Diabetes Association Professional Practice Committee for Obesity . Pharmacologic treatment of obesity in adults: Standards of care in overweight and obesity [J ] . BMJ Open Diab Res Care , 2025 , 13 ( Suppl 1 ): e005729 .
Charlesworth TES , Banaji MR . Patterns of implicit and explicit attitudes: Ⅳ. change and stability from 2007 to 2020 [J ] . Psychol Sci , 2022 , 33 ( 9 ): 1347 - 1371 .
Korner J , Aronne LJ . The emerging science of body weight regulation and its impact on obesity treatment [J ] . J Clin Invest , 2003 , 111 ( 5 ): 565 - 570 .
Lowe MR . Self-regulation of energy intake in the prevention and treatment of obesity: is it feasible? [J ] . Obes Res , 2003 ,11 Suppl : 44S - 59S .
Sumithran P , Prendergast LA , Delbridge E , et al . Long-term persistence of hormonal adaptations to weight loss [J ] . N Engl J Med , 2011 , 365 ( 17 ): 1597 - 1604 .
Fothergill E , Guo JE , Howard L , et al . Persistent metabolic adaptation 6 years after “The Biggest Loser” competition [J ] . Obesity , 2016 , 24 ( 8 ): 1612 - 1619 .
Moiz A , Filion KB , Toutounchi H , et al . Efficacy and safety of glucagon-like peptide-1 receptor agonists for weight loss among adults without diabetes: a systematic review of randomized controlled trials [J ] . Ann Intern Med , 2025 , 178 ( 2 ): 199 - 217 .
Roh E , Choi KM . Hormonal gut-brain signaling for the treatment of obesity [J ] . Int J Mol Sci , 2023 , 24 ( 4 ): 3384 .
Shi QY , Wang Y , Hao QK , et al . Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials [J ] . Lancet , 2024 , 403 ( 10434 ): e21 - e31 .
Lincoff AM , Brown-Frandsen K , Colhoun HM , et al . Semaglutide and cardiovascular outcomes in obesity without diabetes [J ] . N Engl J Med , 2023 , 389 ( 24 ): 2221 - 2232 .
Marso SP , Daniels GH , Brown-Frandsen K , et al . Liraglutide and cardiovascular outcomes in type 2 diabetes [J ] . N Engl J Med , 2016 , 375 ( 4 ): 311 - 322 .
Malhotra A , Grunstein RR , Fietze I , et al . Tirzepatide for the treatment of obstructive sleep apnea and obesity [J ] . N Engl J Med , 2024 , 391 ( 13 ): 1193 - 1205 .
Sanyal AJ , Newsome PN , Kliers I , et al . Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis [J ] . N Engl J Med , 2025 , 392 ( 21 ): 2089 - 2099 .
Jastreboff AM , le Roux CW , Stefanski A , et al . Tirzepatide for obesity treatment and diabetes prevention [J ] . N Engl J Med , 2025 , 392 ( 10 ): 958 - 971 .
Wadden TA , Foreyt JP , Foster GD , et al . Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial [J ] . Obesity , 2011 , 19 ( 1 ): 110 - 120 .
Wadden TA , Walsh OA , Berkowitz RI , et al . Intensive behavioral therapy for obesity combined with liraglutide 3.0 Mg: a randomized controlled trial [J ] . Obesity , 2019 , 27 ( 1 ): 75 - 86 .
Wadden TA , Bailey TS , Billings LK , et al . Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial [J ] . Jama , 2021 , 325 ( 14 ): 1403 .
Wadden TA , Chao AM , Machineni S , et al . Author Correction: Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial [J ] . Nat Med , 2024 , 30 ( 6 ): 1784 .
Jastreboff AM , Aronne LJ , Ahmad NN , et al . Tirzepatide once weekly for the treatment of obesity [J ] . N Engl J Med , 2022 , 387 ( 3 ): 205 - 216 .
Wing RR , Lang W , Wadden TA , et al . Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes [J ] . Diabetes Care , 2011 , 34 ( 7 ): 1481 - 1486 .
Sorli C , Harashima SI , Tsoukas GM , et al . Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes(SUSTAIN 1):a double-blind,randomised,placebo-controlled,parallel-group,multinational,multicentre phase 3a trial [J ] . Lancet Diabetes Endocrinol , 2017 , 5 ( 4 ): 251 - 260 .
Bliddal H , Bays H , Czernichow S , et al . Once-weekly semaglutide in persons with obesity and knee osteoarthritis [J ] . N Engl J Med , 2024 , 391 ( 17 ): 1573 - 1583 .
Kahn SE , Deanfield JE , Jeppesen OK , et al . Effect of semaglutide on regression and progression of glycemia in people with overweight or obesity but without diabetes in the SELECT trial [J ] . Diabetes Care , 2024 , 47 ( 8 ): 1350 - 1359 .
郝 彤 , 曹 涛 , 计 鹏 , 等 . 施万细胞在糖尿病周围神经病变中的作用研究进展 [J ] . 中华烧伤与创面修复杂志 , 2023 ( 12 ): 1190 - 1194 .
Hao T , Cao T , Ji P , et al . Research advances on the role of Schwann cells in diabetic peripheral neuropathy [J ] . Chin J Burns Wounds , 2023 ( 12 ): 1190 - 1194 .
le Roux CW , Astrup A , Fujioka K , et al . 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised,double-blind trial [J ] . Lancet , 2017 , 389 ( 10077 ): 1399 - 1409 .
Torgerson JS , Hauptman J , Boldrin MN , et al . XENical in the prevention of diabetes in obese subjects(XENDOS) study [J ] . Diabetes Care , 2004 , 27 ( 1 ): 155 - 161 .
Rosenstock J , Wysham C , Frías JP , et al . Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes(SURPASS-1):a double-blind,randomised,phase 3 trial [J ] . Lancet , 2021 , 398 ( 10295 ): 143 - 155 .
Garvey WT , Frias JP , Jastreboff AM , et al . Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2):a double-blind,randomised,multicentre,placebo-controlled,phase 3 trial [J ] . Lancet , 2023 , 402 ( 10402 ): 613 - 626 .
Davies M , Færch L , Jeppesen OK , et al . Semaglutide 2·4 Mg once a week in adults with overweight or obesity,and type 2 diabetes (STEP 2):a randomised,double-blind,double-dummy,placebo-controlled,phase 3 trial [J ] . Lancet , 2021 , 397 ( 10278 ): 971 - 984 .
Nauck M , Frid A , Hermansen K , et al . Efficacy and safety comparison of liraglutide,glimepiride,and placebo,all in combination with metformin,in type 2 diabetes [J ] . Diabetes Care , 2009 , 32 ( 1 ): 84 - 90 .
Davies MJ , Bergenstal R , Bode B , et al . Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial [J ] . JAMA , 2015 , 314 ( 7 ): 687 .
Garvey WT , Ryan DH , Bohannon NJV , et al . Weight-loss therapy in type 2 diabetes: effects of phentermine and topiramate extended release [J ] . Diabetes Care , 2014 , 37 ( 12 ): 3309 - 3316 .
Hollander P , Gupta AK , Plodkowski R , et al . Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes [J ] . Diabetes Care , 2013 , 36 ( 12 ): 4022 - 4029 .
Hollander PA , Elbein SC , Hirsch IB , et al . Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study [J ] . Diabetes Care , 1998 , 21 ( 8 ): 1288 - 1294 .
de Lemos JA , Linetzky B , le Roux CW , et al . Tirzepatide reduces 24-hour ambulatory blood pressure in adults with body mass index≥27 kg/m 2 :surmount-1 ambulatory blood pressure monitoring substudy [J ] . Hypertension , 2024 , 81 ( 4 ): e1010 - e43 .
Wilding JPH , Batterham RL , Calanna S , et al . Once-weekly semaglutide in adults with overweight or obesity [J ] . N Engl J Med , 2021 , 384 ( 11 ): 989 - 1002 .
Gadde KM , Allison DB , Ryan DH , et al . Effects of low-dose,controlled-release,phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults(CONQUER): a randomised,placebo-controlled,phase 3 trial [J ] . Lancet , 2011 , 377 ( 9774 ): 1341 - 1352 .
Pi-Sunyer X , Astrup A , Fujioka K , et al . A randomized,controlled trial of 3.0 Mg of liraglutide in weight management [J ] . N Engl J Med , 2015 , 373 ( 1 ): 11 - 22 .
Davies MJ , Aronne LJ , Caterson ID , et al . Liraglutide and cardiovascular outcomes in adults with overweight or obesity: A post hoc analysis fromSCALErandomized controlled trials [J ] . Diabetes Obesity Metabolism , 2018 , 20 ( 3 ): 734 - 739 .
Hankosky ER , Wang H , Neff LM , et al . Tirzepatide reduces the predicted risk of atherosclerotic cardiovascular disease and improves cardiometabolic risk factors in adults with obesity or overweight: SURMOUNT-1 post hoc analysis [J ] . Diabetes Obesity Metabolism , 2024 , 26 ( 1 ): 319 - 328 .
Kosiborod MN , Abildstrøm SZ , Borlaug BA , et al . Semaglutide in patients with heart failure with preserved ejection fraction and obesity [J ] . N Engl J Med , 2023 , 389 ( 12 ): 1069 - 1084 .
Kosiborod MN , Petrie MC , Borlaug BA , et al . Semaglutide in patients with obesity-related heart failure and type 2 diabetes [J ] . N Engl J Med , 2024 , 390 ( 15 ): 1394 - 1407 .
Butler J , Shah SJ , Petrie MC , et al . Semaglutide versus placebo in people with obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF DM randomised trials [J ] . Lancet , 2024 , 403 ( 10437 ): 1635 - 1648 .
Kosiborod MN , Deanfield J , Pratley R , et al . Semaglutide versus placebo in patients with heart failure and mildly reduced or preserved ejection fraction:a pooled analysis of the SELECT,FLOW,STEP-HFpEF,and STEP-HFpEF DM randomised trials [J ] . Lancet , 2024 , 404 ( 10456 ): 949 - 961 .
Packer M , Zile MR , Kramer CM , et al . Tirzepatide for heart failure with preserved ejection fraction and obesity [J ] . N Engl J Med , 2025 , 392 ( 5 ): 427 - 437 .
Zile MR , Borlaug BA , Kramer CM , et al . Effects of tirzepatide on the clinical trajectory of patients with heart failure,preserved ejection fraction,and obesity [J ] . Circulation , 2025 , 151 ( 10 ): 656 - 668 .
Loomba R , Abdelmalek MF , Armstrong MJ , et al . Semaglutide 2·4 Mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised,placebo-controlled phase 2 trial [J ] . Lancet Gastroenterol Hepatol , 2023 , 8 ( 6 ): 511 - 522 .
Loomba R , Hartman ML , Lawitz EJ , et al . Tirzepatide for metabolic dysfunction–associated steatohepatitis with liver fibrosis [J ] . N Engl J Med , 2024 , 391 ( 4 ): 299 - 310 .
Armstrong MJ , Gaunt P , Aithal GP , et al . Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis(LEAN):a multicentre,double-blind,randomised,placebo-controlled phase 2 study [J ] . Lancet , 2016 , 387 ( 10019 ): 679 - 690 .
Blackman A , Foster GD , Zammit G , et al . Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial [J ] . Int J Obes , 2016 , 40 ( 8 ): 1310 - 1319 .
Winslow DH , Bowden CH , DiDonato KP , et al . A randomized,double-blind,placebo-controlled study of an oral,extended-release formulation of phentermine/topiramate for the treatment of obstructive sleep apnea in obese adults [J ] . Sleep , 2012 , 35 ( 11 ): 1529 - 1539 .
Bartholdy C , Overgaard A , Gudbergsen H , et al . Changes in physical activity during a one-year weight loss trial with liraglutide vs placebo in participants with knee osteoarthritis:Secondary analyses of a randomised controlled trial [J ] . Osteoarthr Cartil Open , 2022 , 4 ( 2 ): 100255 .
Baser O , Rodchenko K , Vivier E , et al . The impact of approved anti-obesity medications on osteoarthritis [J ] . Expert Opin Pharmacother , 2024 , 25 ( 11 ): 1565 - 1573 .
Garrison RJ , Kannel WB , 3rd Stokes J , et al . Incidence and precursors of hypertension in young adults:the Framingham Offspring Study [J ] . Prev Med , 1987 , 16 ( 2 ): 235 - 251 .
Forman JP , Stampfer MJ , Curhan GC . Diet and lifestyle risk factors associated with incident hypertension in women [J ] . JAMA , 2009 , 302 ( 4 ): 401 - 411 .
Powell-Wiley TM , Poirier P , Burke LE , et al . Obesity and cardiovascular disease:a scientific statement from the American heart association [J ] . Circulation , 2021 , 143 ( 21 ): e984 - e1010 .
刘 丹 , 张梦灵 , 吴绮楠 . 从4C研究看中国糖尿病患者心血管和癌症结局 [J ] . 重庆医科大学学报 , 2026 , 51 ( 2 ): 183 - 189 .
Liu D , Zhang ML , Wu QN . Cardiovascular and cancer outcomes in Chinese patients with diabetes based on the China Cardiometabolic Disease and Cancer Cohort Study [J ] . J Chongqing Med Univ , 2026 , 51 ( 2 ): 183 - 189 .
罗 玉 , 周 文 , 胡斐斐 , 等 . 内脏脂肪代谢评分与心血管代谢共病及认知分域的关联性 [J ] . 中山大学学报(医学科学版) , 2026 , 47 ( 2 ): 315 - 327 .
Luo Y , Zhou W , Hu FF , et al . The Association between Metabolic Score for Visceral Fat, Cardiometabolic Comorbidities and Cognitive Domain [J ] . J Sun Yat Sen Univ Med Sci , 2026 , 47 ( 2 ): 315 - 327 .
Obokata M , Reddy YNV , Pislaru SV , et al . Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction [J ] . Circulation , 2017 , 136 ( 1 ): 6 - 19 .
Vilar-Gomez E , Martinez-Perez Y , Calzadilla-Bertot L , et al . Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis [J ] . Gastroenterology , 2015 , 149 ( 2 ): 367 - 378 .
Riddle DL , Stratford PW . Body weight changes and corresponding changes in pain and function in persons with symptomatic knee osteoarthritis:A cohort study [J ] . Arthritis Care Res , 2013 , 65 ( 1 ): 15 - 22 .
Bliddal H , Leeds AR , Christensen R . Osteoarthritis,obesity and weight loss:evidence,hypotheses and horizons-a scoping review [J ] . Obes Rev , 2014 , 15 ( 7 ): 578 - 586 .
Leidy HJ , Clifton PM , Astrup A , et al . The role of protein in weight loss and maintenance2 3 4 [J ] . Am J Clin Nutr , 2015 , 101 ( 6 ): 1320S - 1329S .
Panel on Dietary Reference Intakes for Electrolytes and Water ; Standing Committee on the Scientific Evaluation of Dietary Reference Intakes ; Food and Nutrition Board . Dietary Reference Intakes for Water,Potassium,Sodium,Chloride,and Sulfate . Washington,DC,The National Academies Press,2005[M ] . Accessed 16 October 2025 . Available from https://nap .nationalacademies.org/read/10925/chapter/1 https://nap.nationalacademies.org/read/10925/chapter/1 .
Skelley JW , Swearengin K , York AL , et al . The impact of tirzepatide and glucagon-like peptide 1 receptor agonists on oral hormonal contraception [J ] . J Am Pharm Assoc , 2024 , 64 ( 1 ): 204 - 211 .
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