Interpretation and Clinical Implications of the 2024 Italian Guidelines for the Management of Adult Individuals with Overweight and Obesity and Metabolic Comorbidities Resistant to Behavioral Treatment

ZHANG Peng¹, LIU Lidi¹, ZHANG Ying¹, YANG Ziyu¹, LIU Changming², TANG Yijun³, LIAO Xiaoyang¹, JIA Yu¹

¹General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China
²Department of General Practice, Xihanggang Community Health Service Center in Shuangliu District, Chengdu 610207, China
³Department of General Practice, Guixi Community Health Service Center in Chengdu High-tech Zone, Chengdu 610094, China

Corresponding authors: LIAO Xiaoyang, Professor/Doctoral Supervisor; E-mail: 625880796@qq.com
JIA Yu, Lecturer; E-mail: jiayu@wchscu.cn

[Abstract] Obesity is frequently accompanied by metabolism-related diseases, serving as a critical etiological factor or risk factor associated with adverse clinical outcomes. Effective weight reduction has been demonstrated to ameliorate or even alleviate these comorbidities. However, lifestyle interventions alone often yield suboptimal efficacy, and behavioral resistance is commonly observed. Currently, China lacks specific guidelines targeting patients with behavioral resistance. In 2024, the Italian Association of Clinical Endocrinologists released the Guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment, grounded in the latest evidence-based research. These guidelines primarily focus on pharmacological and surgical interventions for this patient population. This paper, in conjunction with Chinese guidelines, delves into the obesity evaluation and treatment strategies from the Italian guidelines, aiming to offer a reference for managing Chinese overweight or obese patients with behavioral resistance.

[Key words] Obesity management; Overweight; Metabolic comorbidities; Behavioral therapy resistance; Drug therapy; Metabolic-bariatric surgeries

Funding: Sichuan Provincial Department of Science and Technology Soft Science Project (2022JDR0325)

Citation: ZHANG P, LIU L D, ZHANG Y, et al. Interpretation and clinical implications of the 2024 Italian guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment[J]. Chinese General Practice, 2025. DOI:10.12114/j.issn.1007-9572.2025.0131. [Epub ahead of print].

1 Guideline Recommendations and Related Content

Obesity is not only a complex chronic disease but also a significant pathogenic factor for multiple chronic conditions, with its prevalence continuing to increase globally. According to the 2022 World Health Organization (WHO) European report, nearly 60% of adults are overweight or obese [1]. By Chinese standards, over half of adults and one-fifth of children are overweight or obese, making China the country with the largest number of overweight or obese individuals worldwide [2-3]. Obesity has become a major risk factor for mortality and disability in China [4], imposing a tremendous burden on the national healthcare system. The rising prevalence of obesity is associated with sedentary lifestyles and dietary habits [2]. Initial treatment for overweight or obese individuals should involve comprehensive lifestyle interventions, including diet, exercise, and behavioral modification [5]. However, for most obese patients, lifestyle changes alone are insufficient to achieve and maintain target weight, and behavioral resistance frequently occurs. Currently, China lacks guidelines specifically for such patients. In 2024, the Italian Association of Clinical Endocrinologists developed management guidelines for overweight or obese adult patients with metabolic complications who are resistant to lifestyle changes [6] (hereinafter referred to as "the guidelines"), using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. These guidelines focus on pharmacological and surgical interventions, categorizing evidence certainty into four levels (high, moderate, low, and very low) and recommendation strength as "strong" or "conditional" support/opposition based on the balance between effects, evidence certainty, patient values and preferences, economic resources, equity, acceptability, and feasibility.

Obesity is often complicated by metabolic comorbidities such as abnormal glucose metabolism, dyslipidemia, hypertension, nonalcoholic fatty liver disease (NAFLD), obstructive sleep apnea syndrome, polycystic ovary syndrome, and cardiovascular disease [7]. Obesity is not only an important etiological factor and/or risk factor for these comorbidities but is also closely associated with their poor prognosis [10-11]. Effective weight loss can improve and even alleviate these comorbidities [12-15]. The guidelines primarily provide recommendations for patients with metabolic comorbidities.

1.1 Definition, Classification, and Comorbidities of Obesity

The WHO defines obesity as a chronic, complex disease of abnormal or excessive fat accumulation that impairs health [8]. In recent years, some academic organizations have proposed defining obesity as "adiposity-based chronic disease" (ABCD) [9]. There are certain differences in obesity classification between domestic and international standards. The guidelines classify obesity into Grade I, II, and III based on body mass index (BMI) (see [TABLE:1]). Considering the characteristics of the Chinese population, Chinese guidelines use different BMI cut-off values and classify obesity into mild, moderate, severe, and very severe categories (see [TABLE:1]). Obesity frequently coexists with metabolic diseases and is an important cause and/or risk factor for these conditions.

[TABLE:1]

Obesity is not only an important cause and/or risk factor for these comorbidities but is also closely associated with their poor prognosis [10-11]. Effective weight loss can improve and even alleviate these comorbidities [12-15]. The guidelines primarily provide recommendations for patients with metabolic comorbidities.

1.2 Obesity Assessment

Regarding obesity assessment, Chinese guidelines share many similarities with the Italian guidelines but also have some differences. The Italian guidelines emphasize the integration of comprehensive information, while Chinese guidelines provide more detailed lists of specific assessment methods and examination items. Both emphasize etiological investigation, psychological assessment, physical examination, laboratory tests, obesity comorbidities, and functional assessments. Additionally, Chinese guidelines mention body fat content and visceral fat measurement, family and social resource support assessment, and weight loss motivation and expected goals. The Italian guidelines highlight the critical role of clinical history, which should consider weight gain trends over time, potential triggers, previous weight loss attempts (methods and outcomes), medication history (drugs that may cause weight gain), lifestyle, and family history. Furthermore, the need for specialized psychological evaluation should be assessed.

Chinese guidelines recommend initial psychological screening to identify potential mental health issues and list commonly used screening scales [7], such as the 9-item Patient Health Questionnaire for depressive symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the Eating Disorder Inventory for eating disorders. BMI alone does not provide information on body fat distribution and should be combined with waist circumference measurement. Attention should also be paid to signs of obesity-related diseases or conditions causing secondary obesity, such as acanthosis nigricans, moon face, and goiter [7]. Laboratory and imaging evaluations should be conducted to understand obesity comorbidities including glucose and lipid metabolism, uric acid metabolism, and liver and kidney function, as well as to assess secondary causes. For example, serum TSH should be tested to exclude hypothyroidism. Both male and female patients should be clinically evaluated for symptoms and signs of hypogonadism [6], while specific hormone tests should only be performed in symptomatic patients [16]. Chinese guidelines also emphasize screening for Cushing's syndrome or hypogonadism when clinically suspected [7].

By integrating information on comorbidities, physical and psychological symptoms, and functional limitations, obesity stage can be determined using the Edmonton Obesity Staging System (EOSS). Chinese guidelines also list two other obesity staging systems: cardiometabolic disease staging and adiposity-based chronic disease staging (ABCD), which aim to more precisely diagnose and manage obesity patients through an "obesity-related disease-centered" approach [7].

1.3 Obesity Treatment

The guidelines clearly state that multidisciplinary obesity treatment should focus on weight reduction and comorbidity prevention as core objectives. Lifestyle modification is the first step. Nutritional therapy should be personalized and combined with other treatments. Combining nutritional therapy with physical activity is crucial for treating overweight and obese populations and reducing morbidity and mortality. Since lifestyle intervention is not the focus of these guidelines, they concisely provide timeframes, dietary goals, dietary approaches, exercise time targets, and exercise modalities to facilitate goal management and self-monitoring for patients and physicians. The dietary goal is to achieve 5% weight loss within 3-6 months by reducing daily caloric intake by 600-1,000 kcal while maintaining protein intake and limiting carbohydrates to 60% of total calories. To achieve weight loss goals of 2.0-3.0 kg or 5.0-7.5 kg within 4-6 months, aerobic exercise should be increased to 150-225 min/week and 250-420 min/week, respectively [6]. With appropriate exercise modalities, aerobic exercise appears more effective than resistance exercise. Chinese guidelines also emphasize the importance of multidisciplinary treatment, nutritional and exercise counseling, and psychological guidance, providing more detailed clinical applications of various dietary and exercise methods [7] that are suitable for clinical practice. Using both guidelines together can provide more comprehensive and personalized treatment plans for obese patients.

The guidelines define lifestyle intervention resistance as overweight or obese patients who have received standardized lifestyle intervention (including diet and exercise) for 6 months but have not achieved at least 5% weight loss [6]. At this point, other treatment options should be considered (see [TABLE:2]). Chinese guidelines only state that weight-loss drugs may be combined when lifestyle interventions fail to achieve weight loss goals. The Italian guidelines explicitly define the threshold for lifestyle intervention resistance, providing an actionable efficacy evaluation time point that helps Chinese clinicians more accurately identify and manage obese patients who do not respond to lifestyle interventions.

[TABLE:2]

1.3.1 Pharmacotherapy

The guidelines state that pharmacotherapy, as part of a comprehensive plan, is indicated for patients with BMI ≥30 kg/m² or BMI ≥27 kg/m² with overweight-related risk factors who are resistant to lifestyle intervention [6]. Chinese guidelines have similar indications for weight-loss drugs (see [TABLE:1]), but note that the Italian guidelines use BMI ≥27 kg/m² rather than the BMI ≥25 kg/m² overweight threshold, likely based on evidence from available literature and resource optimization. The guidelines list four long-term obesity treatment drugs approved by the European Medicines Agency and the Italian Medicines Agency, along with their research evidence: orlistat, naltrexone/bupropion combination, liraglutide, and semaglutide [6]. Their applications and recommendation strengths are detailed in [TABLE:2].

Currently, five drugs are approved for adult primary obesity in China: orlistat, liraglutide, beinaglutide, semaglutide, and tirzepatide [7]. Drugs for hereditary obesity have not been approved. Combining the Italian and Chinese guidelines, the mechanisms of action, weight-loss effects, adverse effects, and contraindications of these drugs are summarized in [TABLE:3]. Additionally, these weight-loss drugs can improve metabolic indicators such as waist circumference, fasting glucose, glycated hemoglobin, and triglycerides. Except for orlistat, the other drugs also improve quality of life. The clinical value of weight-loss drugs lies not only in metabolic benefits (weight reduction and comorbidity improvement) but also in reducing psychological resistance to behavioral change, making it easier to establish a positive cycle of "negative energy balance → metabolic improvement → behavioral reinforcement." However, weight regain occurs after discontinuation of weight-loss drugs. Furthermore, caution is needed when using weight-loss drugs in patients with sarcopenic obesity, as evidence regarding their efficacy and potential risks in this population is lacking, and they may exacerbate sarcopenia [7].

[TABLE:3]

1.3.2 Surgical Treatment

Metabolic and bariatric surgery reduces body weight by decreasing gastric volume and/or shortening the effective length of the small intestine to limit food intake and/or reduce nutrient absorption [7]. Such surgery not only effectively improves or even alleviates obesity-related comorbidities but also works through mechanisms independent of weight loss, hence the term "metabolic and bariatric surgery" [7]. The guidelines classify these procedures into three categories based on mechanism: "restrictive," "malabsorptive," and "mixed." They outline various surgical procedures and their evolution, including laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB) and its variant one-anastomosis gastric bypass (OAGB), adjustable gastric banding (AGB), biliopancreatic diversion (BPD) and its modified procedures [such as biliopancreatic diversion with duodenal switch (BPD-DS)]. The guidelines analyze the technical characteristics (such as gastric pouch volume, limb length, anastomosis methods) and development trends of each procedure (for example, LSG and RYGB, the two most commonly performed procedures globally from 2014-2018, have similar weight-loss and complication outcomes; OAGB has become more popular due to improved weight-loss effects; AGB has decreased in use due to complications and poor efficacy [24]; technical improvements have driven the optimization of malabsorptive procedures). They focus on research evidence for SG, RYGB, AGB, and OAGB, emphasizing the importance of thorough preoperative evaluation and postoperative care (such as dietary and medication adjustment education).

Chinese guidelines classify surgical procedures into three categories based on mechanism: primarily restricting food intake, primarily reducing nutrient absorption, and balancing both approaches. They recommend procedures including SG, RYGB, OAGB, and BPD-DS [7], and provide detailed surgical indications (see [TABLE:4]), contraindications, preoperative preparation, discharge criteria, postoperative nutritional management, and follow-up [7]. Chinese guidelines for surgical treatment of obesity and metabolic diseases provide detailed discussions of the characteristics and selection of recommended procedures in China [25]. In comparison, Chinese guidelines are more comprehensive but lack detailed evidence summaries for procedures. The Italian guidelines provide evidence-based support for procedure selection in China, helping to optimize surgical strategies and improve treatment efficacy and safety.

[TABLE:4]

Patients who meet surgical indications without contraindications should be actively considered for surgery, with comprehensive preoperative evaluation of obesity and related diseases and surgical safety, and proactive management of related issues. The Italian guidelines mention that preoperative weight loss of 5%-10% can improve surgical outcomes and reduce postoperative complications. Chinese guidelines do not require preoperative weight loss for all patients, but for severe and above obesity, especially those with severe fatty liver disease, preoperative weight loss of 5%-10% can help reduce surgical difficulty and perioperative complications [7]. Both the volume and quality of metabolic and bariatric surgery in China have improved, with the three most common procedures in 2023 being SG, OAGB, and RYGB [26].

2 Summary and Implications

Obesity is a global health challenge with continuously rising prevalence, and the situation is particularly severe in China [2], yet subsequent management measures lag behind [27]. To address this, China has issued a series of obesity-related policies and guidelines [7,25,28] to standardize obesity diagnosis and treatment. Obesity treatment includes psychological intervention, lifestyle intervention, pharmacotherapy, surgical treatment, and other modalities, with lifestyle intervention as the cornerstone [7]. However, most obese patients struggle to adhere long-term and achieve or maintain ideal results, and behavioral resistance is common, while China currently lacks specific guidelines for such patients. Building upon lifestyle interventions, adjunctive pharmacotherapy and surgical treatment can achieve more significant and durable weight loss and improve various obesity-related health issues. In fact, pharmacotherapy and surgical treatment are already widely used internationally, but their application in China is limited by factors such as drug availability, surgical techniques, and economics [29].

The 2024 evidence-based guidelines from the Italian Association of Clinical Endocrinologists provide detailed recommendations for pharmacological and surgical treatment in overweight or obese adult patients with metabolic complications who are resistant to lifestyle intervention. Therefore, this article analyzes the core content of these guidelines in combination with China's national conditions and existing guidelines, aiming to provide references for managing overweight or obese Chinese patients with behavioral resistance.

Weight loss goals for obesity should be stratified based on obesity severity and comorbidity risk and severity [6,28], with stage-specific goals established (such as intensive treatment and maintenance phases [28]), and time-efficacy dual-dimension criteria to avoid treatment delays due to lack of quantitative indicators. The intensive treatment phase runs from treatment initiation to approaching individual optimal weight and can be divided into multiple short-term stages based on individual circumstances, with specific goals set for each stage (such as changes in body weight and waist circumference), typically lasting 3-6 months [28]. For example, most overweight and mildly obese patients are recommended to reduce body weight by 5%-15% within 3-6 months and maintain it; moderately to severely obese patients may set higher weight loss goals to improve metabolic abnormalities and clinical outcomes [28]. For younger patients with few or no complications, the initial stage goal can be set at 10%-15% weight loss within 3-6 months; for older patients with multiple complications, a more moderate goal such as 5%-10% weight loss within 3-6 months may be set to ensure safety [28]. Weight loss rate should be appropriate for obesity severity and treatment method, with close monitoring for dehydration, sarcopenia, and endocrine system changes. Weight loss efficacy and metabolic indicators should be evaluated every 3-6 months, with the next goal set after achieving each stage goal, gradually reaching and maintaining individual optimal weight [28]. Earlier intervention in weight management yields greater benefits; management should begin when weight starts to increase rather than waiting for obesity or complications to develop [28].

Obesity treatment requires comprehensive multimodal approaches. Lifestyle intervention remains the foundation, but most patients achieve suboptimal results with this approach alone and experience rebound, necessitating combination with other treatments. Pharmacotherapy can be applied, and metabolic and bariatric surgery performed when necessary. When using pharmacotherapy, factors such as drug mechanism, weight-loss efficacy, and adverse effects should be comprehensively considered to develop personalized regimens, while being vigilant about risks in special populations. Metabolic and bariatric surgery demonstrates significant efficacy; surgical indications and contraindications should be strictly followed, and eligible patients without contraindications should be actively considered for surgery, with enhanced preoperative evaluation and postoperative care and promotion of preoperative weight loss strategies. The long-term and comprehensive nature of obesity management must be recognized, as scientific comprehensive lifestyle intervention and/or pharmacotherapy remains necessary even after pharmacotherapy or surgery. Additionally, traditional Chinese medicine and acupuncture therapy with Chinese characteristics may be considered, including dietary therapy based on syndrome differentiation, Daoyin exercises (physical activity), "mindfulness intervention," and acupuncture-related therapies [7].

Weight loss strategies should involve充分 communication with patients to understand their motivation, needs, concerns, expected goals, and family/social resources, with shared decision-making to develop the most reasonable individualized weight loss plan and guide its implementation, monitoring, and follow-up. With technological development, digital health tools such as wearable devices, mobile health applications, and remote monitoring equipment show promising prospects in obesity management, enabling real-time patient data monitoring, personalized recommendations, behavioral interventions, and remote interaction between patients and healthcare providers to improve treatment adherence and self-management capabilities. Obesity is a complex chronic disease requiring multidisciplinary integration; a multidisciplinary collaborative diagnosis and treatment model should be advocated, encouraging participation from physicians of multiple specialties (such as general practice, endocrinology, cardiology, psychiatry, rehabilitation, surgery, traditional Chinese medicine), dietitians, nurses, and others in obesity management. Continuous attention to the latest clinical advances in related fields will provide patients with standardized, comprehensive, personalized, and continuous services based on evidence-based medicine [29], effectively curbing the epidemic of obesity and related comorbidities and achieving long-term goals and benefits. Furthermore, integrating obesity management into the public health system is recommended through policy guidance and health education to increase public awareness and attention to obesity, increasing medical resource investment, and improving primary care physicians' obesity diagnosis and treatment capabilities through training and telemedicine to enhance the accessibility and equity of obesity treatment.

Author Contributions: ZHANG Peng was responsible for conceptualization and design, data collection and analysis, manuscript writing and revision, and overall responsibility for the article; LIU Lidi, ZHANG Ying, YANG Ziyu, LIU Changming, and TANG Yijun contributed to manuscript revision; LIAO Xiaoyang and JIA Yu conducted feasibility analysis, participated in manuscript revision, supervised the project, and were responsible for quality control and final review.

Conflict of Interest: The authors declare no conflicts of interest.

ORCID IDs:
ZHANG Peng https://orcid.org/0009-0005-8323-3460
LIAO Xiaoyang https://orcid.org/0000-0003-4409-9674
JIA Yu https://orcid.org/0000-0002-0073-1685

References
[1] World Health Organization. Regional Office for Europe. WHO European Regional Obesity Report 2022[EB/OL]. (2022-05-03)[2025-01-26]. https://iris.who.int/handle/10665/353747.
[2] PAN X F, WANG L, PAN A. Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392. DOI:10.1016/S2213-8587(21)00045-0.
[3] WANG Y, ZHAO L, GAO L, et al. Health policy and public health implications of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9(7): 446-461. DOI:10.1016/S2213-8587(21)00118-2.
[4] Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020, 396(10258): 1223-1249. DOI:10.1016/s0140-6736(20)30752-2.
[5] YANOVSKI S Z, YANOVSKI J A. Approach to obesity treatment in primary care: a review[J]. JAMA Intern Med, 2024, 184(7): 818-829. DOI:10.1001/jamainternmed.2023.8526.
[6] CHIANELLI M, BUSETTO L, VETTOR R, et al. Italian guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment[J]. J Endocrinol Invest, 2024, 47(6): 1361-1371. DOI:10.1007/s40618-024-02361-y.
[7] 中华人民共和国国家卫生健康委员会医政司. 肥胖症诊疗指南(2024年版)[J]. 中华消化外科杂志, 2024, 23(10): 1237-1260. DOI:10.3760/cma.j.cn115610-20241017-00455.
[8] World Health Organization. Obesity and overweight[EB/OL]. (2024-3-1)[2025-02-17]. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
[9] MECHANICK J I, HURLEY D L, GARVEY W T. Adiposity-based chronic disease as a new diagnostic term: the American association of clinical endocrinologists and American college of endocrinology position statement[J]. Endocr Pract, 2017, 23(3): 372-378. DOI:10.4158/EP161688.PS.
[10] KIVIMÄKI M, KUOSMA E, FERRIE J E, et al. Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe[J]. Lancet Public Health, 2017, 2(6): e277-285. DOI:10.1016/S2468-2667(17)30074-3.
[11] NDUMELE C E, NEELAND I J, TUTTLE K R, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American heart association[J]. Circulation, 2023, 148(20): 1636-1664. DOI:10.1161/CIR.0000000000001186.
[12] LEAN M E, LESLIE W S, BARNES A C, et al. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study[J]. Lancet Diabetes Endocrinol, 2024, 12(4): 233-246. DOI:10.1016/S2213-8587(23)00385-6.
[13] KENNEDY C, HAYES P, SALAMA S, et al. The effect of semaglutide on blood pressure in patients without diabetes: a systematic review and meta-analysis[J]. J Clin Med, 2023, 12(3): 772. DOI:10.3390/jcm12030772.
[14] LINGVAY I, MOSENZON O, BROWN K, et al. Systolic blood pressure reduction with tirzepatide in patients with type 2 diabetes: insights from SURPASS clinical program[J]. Cardiovasc Diabetol, 2023, 22(1): 66. DOI:10.1186/s12933-023-01802-7.
[15] NEWSOME P N, BUCHHOLTZ K, CUSI K, et al. A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis[J]. N Engl J Med, 2021, 384(12): 1113-1124. DOI:10.1056/NEJMoa2028395.
[16] BUSETTO L, CARBONELLI M G, CARETTO A, et al. Updating obesity management strategies: an audit of Italian specialists[J]. Eat Weight Disord, 2022, 27(7): 2653-2663. DOI:10.1007/s40519-022-01402-w.
[17] SHI Q, WANG Y, HAO Q, 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): e21-31. DOI:10.1016/S0140-6736(24)00351-9.
[18] HENDERSON K, LEWIS, SLOAN C E, et al. Effectiveness and safety of drugs for obesity[J]. BMJ, 2024, 384: e072686. DOI:10.1136/bmj-2022-072686.
[19] CHEN K, CHEN L, SHAN Z, et al. Beinaglutide for weight management in Chinese individuals with overweight or obesity: a phase 3 randomized controlled clinical study[J]. Diabetes Obes Metab, 2024, 26(2): 690-698. DOI:10.1111/dom.15360.
[20] KADOWAKI T, ISENDAHL J, KHALID U, et al. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an East Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial[J]. Lancet Diabetes Endocrinol, 2022, 10(3): 193-206. DOI:10.1016/S2213-8587(22)00008-0.
[21] MU Y, BAO X, ELIASCHEWITZ F G, et al. Efficacy and safety of once weekly semaglutide 2·4 Mg for weight management in a predominantly East Asian population with overweight or obesity (STEP 7): a double-blind, multicentre, randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2024, 12(3): 184-195. DOI:10.1016/S2213-8587(23)00388-1.
[22] JASTREBOFF A M, ARONNE L J, AHMAD N N, et al. Tirzepatide once weekly for the treatment of obesity[J]. N Engl J Med, 2022, 387(3): 205-216. DOI:10.1056/NEJMoa2206038.
[23] GREENWAY F L, FUJIOKA K, PLODKOWSKI R A, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2010, 376(9741): 595-605. DOI:10.1016/S0140-6736(10)60888-4.
[24] FURBETTA N, CERVELLI R, FURBETTA F. Laparoscopic adjustable gastric banding, the past, the present and the future[J]. Ann Transl Med, 2020, 8(Suppl 1): S4. DOI:10.21037/atm.2019.09.17.
[25] 王勇, 梁辉, 张频, 等. 中国肥胖及代谢疾病外科治疗指南(2024版)[J]. 中国实用外科杂志, 2024, 44(8): 841-849. DOI:10.19538/j.cjps.issn1005-2208.2024.08.01.
[26] 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2023年度报告[J]. 中华肥胖与代谢病电子杂志, 2024, 10(2): 73-83. DOI:10.3877/cma.j.issn.2095-9605.2024.02.001.
[27] ZENG Q, LI N, PAN X F, et al. Clinical management and treatment of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9(6): 393-405. DOI:10.1016/S2213-8587(21)00045-0.
[28] 中华医学会内分泌学分会. 肥胖患者的长期体重管理及药物临床应用指南(2024版)[J]. 中华内分泌代谢杂志, 2024, 40(7): 545-564. DOI:10.3760/cma.j.cn311282-20240412-00149.
[29] 何心, 魏炜, 刘莎, 等. 国内外肥胖管理指南防治要点差异介绍[J]. 中华心血管病杂志, 2024, 52(11): 1266-1271.

(Received: March 10, 2025; Revised: June 15, 2025)
(Editor: ZHAO Yuecui)