澳大利亚皇家学院Practition将军ers (RACGP) recognises that obesity is one of the most important health issues facing Australia and affects the health, wellbeing and productivity of many Australians.1–3肥胖是直接或间接地与许多慢性疾病，也导致显著的发病率。vwin998sport
General practice has a central role to play in the prevention and management of obesity. This role needs to be supported through improved funding of effective and evidence-based services and therapies. Funding for research into obesity prevention and management is also much needed.
Obesity affects individuals, their families and/or carers and the wider community. The causes of obesity are multiple and complex, and the condition requires lifelong management.4,5
People living with obesity commonly experience stigmatisation and social inequity in daily life6– a situation compounded because systemic inequity and stigmatisation currently limit access to effective treatments.7,8
The worldwide prevalence of obesity has increased over recent decades, reflecting the significant contribution of changes in lived environments and lifestyle factors.4,9
To work effectively and equitably towards reducing obesity in our communities, we need a balanced combination of individual and public health measures.10,11
自2008年以来肥胖一直是澳大利亚国家卫生优先领域;3currently, approximately two-thirds of Australian adults have a body weight in the overweight or obese categories.1Obesity causes metabolic and hormonal changes in the individual.五它也与其他慢性疾病，如糖尿病，心脏疾病，骨关节炎和某些癌症的风险增加有关。12
The causes of obesity are multiple and complex, and include epigenetics13,14(a change in the way genes are expressed) and alteration in the gut microbiome1五（生活在肠道细菌和细胞），等等。虽然肥胖的遗传已经在双胞胎研究显示16and clinical practice, only a small percentage of patients have a purely genetic cause (eg leptin deficiency)17,18or a purely medical cause (eg hypothalamic tumour) for their obesity. For the majority of patients at genetic risk of developing obesity, environmental factors (physical, social and economic)19facilitate weight gain.
尽管生活在澳大利亚的肥胖成年人的25％，据估计，<一般惯例协商的1％20centre around obesity. Of those Australian adults who qualify for bariatric metabolic surgery based on body mass index (BMI) alone, uptake of surgery is unacceptably low. This reflects barriers to access and inequities as evidenced by <12% of these surgeries being performed in the public healthcare system.21
The prevalence of obesity in Aboriginal and Torres Strait Islander communities is alarming.22Obesity is thought to contribute to 16% of the health gap between Aboriginal and Torres Strait Islander peoples and the total Australian population.22The inequity in health service access and provision for Australians with obesity is further accentuated in those from Aboriginal and/or Torres Strait Islander backgrounds.
重量gain may be a consequence of symptoms such as impaired motivation or self-care, insomnia, inactivity or unhealthy relationships with food.25–27
General practice, as a fundamental component of primary care, has always been the foundation of management of chronic diseases in the Australian community.32人们认识到，科医师（GP）需要更好地支持帮助肥胖症患者中发挥作用。33,34
目前我们有一个“致胖”的环境不支持的人，使他们的营养和体力活动水平健康的决定。9,19Obesity prevention requires a whole-of-systems approach that includes not only the healthcare sector, but also public health safeguards, town planning, transport, nutrition and education.9,35–37
重量偏差和侮辱是影响健康和生活与肥胖的人福利的严重问题。7People with obesity may avoid healthcare if they feel shamed about their weight. Public obesity messages that focus only on weight and individual factors contribute to stigma and bias.8The emphasis should shift from loss of weight to gain in heath.五
Recognise the importance of obesity
Obesity is both a cause and consequence of many other chronic conditions and diseases. It is expected to have periods of relapse and remission and, given its progressive nature, lifelong management will be required.38Obesity represents a disturbance in normal physiology,39is detrimental to health, and is associated with many comorbidities.12The RACGP recommends increased government support for effective services, therapies and surgical procedures.
The RACGP recognises the need for a change in public policy to support healthy environments, where healthy options are readily available and affordable. To prioritise their health, individuals increasingly must work against the environments in which they live.10,11,40The RACGP advocates that the focus of the health message be on ‘gaining health’ rather than simply ‘losing weight’, recognising that obesity is about more than body weight.41
Recognise the key role of GPs in managing obesity
The RACGP recognises that a skilled and enabled primary care workforce is essential for obesity prevention and management.33,34全球定位系统are in a unique position to bridge issues that cross primary care and public health; GPs deal with individuals day to day, but also have a deep understanding of the communities in which they work. The Department of Health has made available Medicare Benefits Schedule (MBS) provisions for GPs in this role, via the use of Chronic Disease Management Plans for the care of individuals with complex obesity.
Education and support for GPs in managing obesity
The RACGP recognises the need for more education of registrars and GPs in prevention, detection and management of obesity, and importantly the need for awareness of stigmatisation and inequity.
Many GPs have the skills required to provide professional advice to individuals at risk of developing obesity, but they need to be supported to provide effective, evidence-based management to patients with obesity.33,34
In the context of holistic health promotion, GPs are key to promoting obesity prevention by identifying patients at higher risk.
The stigmatisation of obesity in our communities is a major problem, and well-intentioned but insensitive comments or policies may do more harm than good.6–8作为步骤减少肥胖的指责，该RACGP承诺使用人 - 第一语言和结束使用污蔑的图像和信息。
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- 澳大利亚卫生和福利研究所。Australia’s health 2014. Cat. no: AUS 178. Canberra: AIHW, 2014.
- 澳大利亚卫生和福利研究所。提高疾病的澳大利亚的负担(including references to National Health Priority Areas). Canberra: AIHW, 2018. [Accessed 23 January 2019].
- 世界卫生组织。全球卫生观察站（GHO）数据：肥胖。日内瓦：世界卫生组织，2019. [Accessed 15 January 2018].
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- Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews: An official journal of the International Association for the Study of Obesity 2015;16(4):319–26.
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- Rutter H, Bes-Rastrollo M, de Henauw S, et al. Balancing upstream and downstream measures to tackle the obesity epidemic: A position statement from the European Association for the Study of Obesity. Obes Facts 2017;10(1):61–63.
- Willcox S. Chronic diseases in Australia: Blueprint for preventive action. Melbourne: Australian Health Policy Collaboration, 2015.
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- Stunkard AJ, Harris JR, Pedersen NL, McClearn GE. The body-mass index of twins who have been reared apart. N Engl J Med 1990;322(21):1483–87.
- Farooqi IS, O›Rahilly S. Genetic factors in human obesity. Obes Rev 2007;8 Suppl 1:37–40.
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- Britt H, Miller G, Henderson J, et al. General practice activity in Australia 2015–16. General practice series 40. Sydney: Sydney University Press, 2016.
- 澳大利亚卫生和福利研究所。重量loss surgery in Australia 2014–15: Australian hospital statistics. Cat. no: HSE 186. Canberra: AIHW, 2017.
- Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2017 report. Canberra: AHMAC, 2017.
- Dickerson FB, Brown CH, Kreyenbuhl JA, et al. Obesity among individuals with serious mental illness. Acta Psychiatr Scand 2006;113(4):306–13.
- Galletly CA, Foley DL, Waterreus A, et al. Cardiometabolic risk factors in people with psychotic disorders: The second Australian national survey of psychosis. Aust N Z J Psychiatry 2012;46(8):753–61.
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