Obesity prevention and management


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.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.

Policy response

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。





  1. 澳大利亚统计局。国家健康年代urvey: First results, Australia 204–15. Cat. no. 4364.0.55.001. Overweight and obesity. Canberra: ABS, 2015.
  2. 澳大利亚卫生和福利研究所。Australia’s health 2014. Cat. no: AUS 178. Canberra: AIHW, 2014.
  3. 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].
  4. 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].
  5. Sharma AM, Campbell-Scherer DL. Redefining obesity: Beyond the numbers. Obesity 2017;25(4): 660–61.
  6. Puhl RM, Heuer CA. Obesity stigma: Important considerations for public health. American Journal of Public Health 2010;100(6):1019–28.
  7. 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.
  8. Ramos Salas X. The ineffectiveness and unintended consequences of the public health war on obesity. Can J Public Health 2015;106(2):e79–81.
  9. Swinburn B, Egger G. Preventive strategies against weight gain and obesity. Obes Rev 2002;3(4):289–301.
  10. 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.
  11. Willcox S. Chronic diseases in Australia: Blueprint for preventive action. Melbourne: Australian Health Policy Collaboration, 2015.
  12. 国家健康与医学研究委员会。临床实践指南的超重和肥胖的在澳大利亚成年人,青少年和儿童的管理。墨尔本:NHMRC,2013。
  13. Barker DJ, Eriksson JG, Forsén T, Osmond C. Fetal origins of adult disease: Strength of effects and biological basis. Int J Epidemiol 2002;31(6):1235–39.
  14. 戈弗雷KM,格鲁克曼PD,汉森MA。代谢性疾病的发展起源:生命过程和代际的观点。趋势内分泌代谢2010; 21(4):199-205。
  15. Rosenbaum M, Knight R, Leibel RL. The gut microbiota in human energy homeostasis and obesity. Trends Endocrinol Metab 2015;26(9):493–501.
  16. 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.
  17. Farooqi IS, O›Rahilly S. Genetic factors in human obesity. Obes Rev 2007;8 Suppl 1:37–40.
  18. Loos RJ. Genetic determinants of common obesity and their value in prediction. Best Pract Res Clin Endocrinol Metab 2012;26(2):211–26.
  19. 穆迪R,Stuckler d,蒙泰罗C,等人。利润和流行病:预防烟,酒和过度加工食品和饮料行业的有害影响。柳叶刀2013; 381(9867):670-79。
  20. Britt H, Miller G, Henderson J, et al. General practice activity in Australia 2015–16. General practice series 40. Sydney: Sydney University Press, 2016.
  21. 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.
  22. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2017 report. Canberra: AHMAC, 2017.
  23. Dickerson FB, Brown CH, Kreyenbuhl JA, et al. Obesity among individuals with serious mental illness. Acta Psychiatr Scand 2006;113(4):306–13.
  24. 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.
  25. 佳佳DB,新人JW,邓恩AL等。心理健康会议报告的研究所:精神障碍患者中肥胖。牛J预防医学2009; 36(4):341-50。
  26. 弗利DL,麦金农A,瓦GF,等人。从一般人群中,按年龄和性别区分成人与精神病心脏代谢风险指标。公共科学图书馆一2013; 8(12):e82606。
  27. Lambert TJ. The medical care of people with psychosis. Med J Aust 2009;190(4):171–72.
  28. 佳佳DB,Mentore JL,许M等人。Antipsychoticinduced体重增加:一个全面的综合研究。牛J精神病学1999; 156(11):1686至1696年。
  29. De懂得M, Detraux J,凡温克尔R,于W,雷尔CU. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat Rev Endocrinol 2011;8(2):114–26.
  30. Lett TA, Wallace TJ, Chowdhury NI, Tiwari AK, Kennedy JL, Muller DJ. Pharmacogenetics of antipsychotic-induced weight gain: Review and clinical implications. Mol Psychiatry 2012;17(3):242–66.
  31. Serretti A, Mandelli L. Antidepressants and body weight: A comprehensive review and meta-analysis. J Clin Psychiatry 2010;71(10):1259–72.
  32. Harris MF, Zwar NA. Care of patients with chronic disease: The challenge for general practice. Med J Aust 2007;187(2):104–07.
  33. 扬森S,Desbrow B,球L.肥胖管理科医师:不可避免的必要性。奥斯特J主控健康2015; 21(4):366-68。
  34. Sturgiss EA,面包车的Weel C,球L,扬森S,道格拉斯K.肥胖管理在澳大利亚的初级保健:哪里有全科医生到哪里去了?奥斯特J主控健康2016; 22(6):473-76。
  35. King L, Gill T, Allender S, Swinburn B. Best practice principles for community-based obesity prevention: Development, content and application. Obes Rev 2011;12(5):329–38.
  36. Allender S,欧文B,Kuhlberg J,等。基于社区系统图的肥胖原因。公共科学图书馆一2015; 10(7):e0129683。
  37. Malakellis M, Hoare E, Sanigorski A, et al. School-based systems change for obesity prevention in adolescents: Outcomes of the Australian Capital Territory ‘It’s Your Move!’. Aust N Z J Public Health 2017;41(5):490–96.
  38. Bray G, Kim KK, Wilding J. Obesity: A chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev 2017;18(7):715–23.
  39. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 2011;365(17):1597–604.
  40. 穆迪R,Stuckler d,蒙泰罗C,等人。利润和流行病:预防烟,酒和过度加工食品和饮料行业的有害影响。柳叶刀2013; 381(9867):670-79。
  41. Sturgiss E, Jay M, Campbell-Scherer D, van Weel C. Challenging assumptions in obesity research. BMJ 2017;359:j5303.
  42. Wolfenden L, Wyse R, Nichols M, Allender S, Millar L, McElduff P. A systematic review and meta-analysis of whole of community interventions to prevent excessive population weight gain. Prev Med 2014;62:193–200.


Obesity prevention and management(PDF 581 KB)