《IFSO关于临床肥胖患者在药物治疗诱导减重后的代谢减重手术声明》解读与思考

Interpretation and reflections on the IFSO statement on metabolic bariatric surgery after pharmacotherapy-induced weight loss in clinical obesity

摘要:

肥胖症已成为全球范围内的重要公共卫生挑战，可引发包括高血压、糖尿病在内的多种代谢性疾病。中国超过一半的成年居民存在超重或肥胖问题。随着减重药物（如GLP-1受体激动剂）和减重手术的快速发展，二者的协同治疗策略尚未明确，尤其是药物停用后手术准入原则存在争议，临床诊疗缺乏统一规范。国际肥胖与代谢病外科联盟于2025年7月发布全球首个聚焦“药物治疗诱导减重后代谢减重手术的声明”，明确肥胖的“慢性病”管理理念，阐明药物治疗与手术干预之间的协同关系。本文从治疗策略、手术准入原则及药物-手术协调策略等方面解读声明要点，为临床医生提供参考，推动肥胖治疗的规范化与个体化管理。

Abstract:

Obesity is a major global public health challenge and a leading cause of multiple metabolic disorders, including hypertension and diabetes. In China, more than half of the adult population is overweight or obese. While anti-obesity pharmacotherapies (such as GLP-1 receptor agonists) and bariatric surgery have both advanced rapidly, strategies for integrating these two modalities remain unclear. In particular, controversies persist regarding surgical eligibility after drug discontinuation, and standardized clinical guidelines are lacking. In July 2025, the International Federation for the Surgery of Obesity and Metabolic Disorders released the world's first statement focusing on "metabolic bariatric surgery after pharmacotherapy-induced weight loss", which emphasizes the chronic disease model of obesity management and clarifies the synergistic relationship between pharmacotherapy and surgery. This article interprets the statement from the perspectives of treatment strategies, surgical eligibility, and drug-surgery coordination, aiming to provide evidence-based reference for clinicians and to promote standardized, integrated obesity management.