研究指出，並非所有肥胖都代表健康不佳

作者：珍妮佛・瑞格比（Jennifer Rigby）By Jennifer Rigby

倫敦，11月11日（路透社）——一項新研究指出，目前被診斷為肥胖的人，只有約四分之一到三分之一應被視為健康狀況不佳。這項研究呼應了要求全面改革肥胖診斷方式的主張。LONDON, Nov 11 (Reuters) - Only between a quarter and a third of people currently diagnosed with obesity should be considered as in poor health, according to a new study that joins calls to overhaul how the condition is diagnosed.

這項週三發表於《自然》（Nature）的研究，延續了專家與醫療組織去年提出的建議：肥胖診斷不應只依據身體質量指數（BMI）——也就是以個人體重與身高為基礎的指標——而應納入體脂與更廣泛的健康狀況。The study, published in Nature on Wednesday, follows a proposal last year from experts and medical organizations to move obesity diagnosis beyond just body mass index (BMI), based on a person’s weight and height, to include body fat and broader health.

世界衛生組織（WHO）目前估計，全球有超過10億人受肥胖影響；這項研究試圖說明，這項新定義可能對肥胖的診斷人數、盛行率，以及最終的治療帶來什麼影響。The study attempts to show what this new definition could mean for diagnosis levels, prevalence, and ultimately, treatment, for a condition the World Health Organization currently estimates affects more than one billion people globally.

肥胖可能是第2型糖尿病、心血管疾病、肝腎疾病與癌症的風險因子。這項研究主張將肥胖定義為「臨床前」與「臨床」兩類：前者主要是風險因子，後者則已造成健康不佳。Obesity can be a risk factor for type 2 diabetes, cardiovascular disease, liver and kidney disease and cancer. The study suggests defining it as pre-clinical, when the condition is largely a risk factor, and clinical, when it is causing ill health.

研究指出，腰圍應納入肥胖診斷WAIST CIRCUMFERENCE SHOULD BE PART OF DIAGNOSIS, STUDY SAYS

這項研究使用來自中國、英國、美國與西班牙近85萬名成人的資料，估計在新架構下，若只以BMI定義為肥胖者，其中1%至3%將不再被歸為肥胖；另有5%至9%的人，例如體脂較高者，則會被診斷為肥胖。放在整體人口中，這可能影響數千萬人。Using data from almost 850,000 adults from China, Britain, the US and Spain, the study estimates that under the new framework, 1% to 3% of those defined as obese using BMI alone would not be, while another 5% to 9%, with higher body fat for example, would be diagnosed with the condition. Across a population, this could affect tens of millions of people.

研究資深作者、倫敦國王學院（King’s College London）代謝與減重手術教授兼主任法蘭切斯科・魯比諾（Francesco Rubino）表示，BMI測量不精確早已眾所周知。The study’s senior author Francesco Rubino, professor and chair of metabolic and bariatric surgery at King’s College London, said the inaccuracy of BMI measurements was well-known.

他說：「但到目前為止，我們還沒有一套更好的系統。」他補充說，新架構的目標正是如此，並表示這套架構可「提供對肥胖具有意義的臨床特徵描述，作為照護與政策的依據」。"But we haven't so far got a better system," he said. That is what the new framework aims to do, he added, saying it could "provide a meaningful clinical characterization of obesity that can inform care and policy."

新架構建議在診斷前，除了BMI，也應測量體脂，包括以腰圍衡量，並考量患者是否有與體重相關的器官功能異常，例如心臟或肝臟問題。The new framework proposes measuring body fat, including by waist circumference, as well as BMI, and considering if a patient has any organ dysfunction linked to weight, like heart or liver problems, before making a diagnosis.

這意味著，有些只有BMI偏高的人不會被歸類為肥胖。體脂與BMI都偏高者會被診斷為「臨床前肥胖」；若同時有器官功能異常，則屬於「臨床肥胖」——被視為一種活躍疾病，通常需要較緊急的治療。This means some people with high BMI alone would not be classed as having obesity. Those who have high body fat and high BMI would be diagnosed with "pre-clinical obesity", and those who also have organ dysfunction would have "clinical obesity" – considered an active disease that would usually require more urgent treatment.

這項研究估計，在這些標準下，4個受研究國家的肥胖者中，平均只有約27%屬於臨床肥胖，約占所有成人的8.5%。Under these criteria, only on average roughly 27% of people with obesity across the four studied countries have clinical obesity, the study estimated – representing around 8.5% of all adults.

研究發現，「臨床前肥胖」者多數並未發展為臨床肥胖；在4個受研究國家中，平均約82%未出現這種進展，不過中國與西班牙的進展率較高。The majority of those with "pre-clinical obesity" – around 82% on average across the four countries studied – did not progress to clinical obesity, although progression rates were higher in China and Spain, the study found.

（珍妮佛・瑞格比報導；亞歷山德拉・哈德森（Alexandra Hudson）編輯）(Reporting by Jennifer Rigby; Editing by Alexandra Hudson)