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Övervikt och fetma

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Sakkunnig:
Definition:
Övervikt definieras som BMI >25, fetma grad I som BMI >30, fetma grad II som BMI >35 och fetma grad III (extrem fetma) som BMI >40.
Förekomst:
Självrapporterad data insamlad under 2014 visar att 14 % av personer >15 år i Sverige har BMI >30, motsvarande definitionen för fetma.
Symtom:
Övervikt samt eventuella tilläggssymtom som sömnsvårigheter, dyspepsi och minskad livskvalitet.
Kliniska fynd:
Övervikt samt eventuella riskfaktorer för hjärt-kärlsjukdom som hypertoni, hyperlipidemi och diabetes typ 2.
Diagnostik:
TSH samt njur- och leverfunktionsprover. Blodfetter och HbA1c för bedömning av risk för hjärt-kärlsjukdom. 
Behandling:
Koständring ökad fysisk aktivitet och i undantagsfall läkemedelsbehandling. Kirurgi kan vara aktuellt vid fetma av grad III, eller vid grad II om tilläggssymtom finns.
  1. World Health Organization. Obesity. Preventing and managing the global epidemic. Report of a WHO consultation on obesity, Geneva, 3-5 June 1997. Genéve: WHO, 1997.
  2. Eckel RH. Nonsurgical management of obesity in adults. N Engl J Med 2008; 358: 1941-50. PubMed  
  3. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298: 2028-37. PMID: 17986696 PubMed  
  4. Shanshan L, Shin HJ, Ding EL, van Dam RM. Adiponectin levels and risk of type 2 diabetes. A systematic review and meta-analysis. JAMA 2009; 302: 179-88. PMID: 19584347 PubMed  
  5. Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis. Ann Intern Med 2013; 159: 758-69. PMID: 24297192 PubMed  
  6. Bennet WL, Gilson MM, Jamshidi R, et al. Impact of bariatric surgery on hypertensive disorders in pregnancy: restrospective analysis of insurance claims data. BMJ 2010; 340: c1662. BMJ (DOI)  
  7. Flynn AC, Dalrymple K, Barr S, et al. Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials. Nutr Rev. 2016 May;74(5):312-28. pmid: 27083868. PubMed  
  8. SOreg årsrapport 2017, del 1, hämtad 2019-02-07 www.ucr.uu.se  
  9. Folkhälsans utveckling – årsrapport 2022. Folkhälsomyndigheten www.folkhalsomyndigheten.se  
  10. Mårild S et al. Läkemedelsboken: Övervikt och fetma. : Läkemedelsverket, 2011. www.lakemedelsboken.se  
  11. Övervikt och fetma. Folkhälsomyndigheten. Hämtad 2019-06-25 www.folkhalsomyndigheten.se  
  12. Lissner L, Sohlström A, Sundblom E, Sjöberg A. Trends in overweight and obesity in Swedish schoolchildren 1999–2005: has the epidemic reached a plateau? . Obes Rev. 2010; 11 (8): 553-9. www.ncbi.nlm.nih.gov  
  13. Sjöberg A, Moraeus L, Yngve A, Poortvliet E, Al-Ansari U, Lissner L. Overweight and obesity in a representative sample of schoolchildren – exploring the urban– rural gradient in Sweden. Obes Rev 2011; 12 (5): 305-14. www.ncbi.nlm.nih.gov  
  14. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA 2016; 315: 2284-91. pmid:27272580 PubMed  
  15. Haslam DW, James WPT. Obesity. Lancet 2005; 366: 1197-209. PubMed  
  16. Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity . N Engl J Med 2003; 348: 2074-81. PubMed  
  17. Reilly JJ, Jackson DM, Montgomery C, Kelly LA, Slater C, Grant S, Paton JY . Total energy expenditure and physical activity in young Scottish children: mixed longitudinal study. Lancet 2004; 363: 211-2. PubMed  
  18. Maruyama K, Sato S, Ohira T. The joint impact on being overweight of self reported behaviours of eating quickly and eating until full: cross sectional survey. BMJ 2008; 337: a2002. BMJ (DOI)  
  19. Brandkvist M, Bjørngaard JH, Ødegård RA et al. Quantifying the impact of genes on body mass index during the obesity epidemic: longitudinal findings from the HUNT Study. BMJ. 2019 Jul 3;366:l4067. PMID: 31270083 PubMed  
  20. Kivimäki M, Lawlor DA, Singh-Manoux A, et al. Common mental disorder and obesity-insight from four repeat measures over 19 years: prospective Whitehall II cohort study. BMJ 2009; 339: b3765. BMJ (DOI)  
  21. Wedderkopp N, Andersen LB, Steen Hansen H, Froberg K. Fedme blant børn. Ugeskr Læger 2001; 163: 2907-12. PubMed  
  22. Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. N Engl J Med. 2017 Jan 19;376(3):254-266. PMID: 28099824.
  23. Korner J, Leibel RL. To eat or not to eat - how the gut talks to the brain. N Engl J Med 2003; 349: 926-8. PubMed  
  24. NICE Guidance. Obesity: identification, assessment and management. Last updated 08 September 2022. www.nice.org.uk  
  25. Jacobs EJ, Newton CC, Wang Y, et al. Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med 2010; 170: 1293-301. PubMed  
  26. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012 Mar;13(3):275-86. doi: 10.1111/j.1467-789X.2011.00952.x. Epub 2011 Nov 23. PMID: 22106927 PubMed  
  27. Grief SN, Miranda RLF. Weight loss maintenance. Am Fam Physician 2010; 82: 630-34. PMID: 20842990 PubMed  
  28. Shikora SA, Saltzmann E. Revisiting Obesity: Current Treatment strategies. Review. Hospital Medicine 1998; 34(8):41-44, 47-50
  29. Potter MB, Vu JD, Croughan-Minihane M. Weight management: What patients want from their primary care physicians. J Fam Pract 2001; 50: 513-8. PMID: 11401737 PubMed  
  30. Wadden TA, Butryn ML, Hong PS, et al. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014 Nov 5;312(17):1779- 91. doi: 10.1001/jama.2014.14173. DOI  
  31. Madigan CD, Graham HE, Sturgiss E, et al. Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ 2022; 377: e069719. pmid:35636762 PubMed  
  32. Johnson F, Cooke L, Croke H, Wardle J . Changing perceptions of weight in Great Britain: comparison of two population surveys . BMJ 2008; 337: a494. PubMed  
  33. Motiverande samtal för att förändra mat- eller motionsvanor. SBU-kommentar (2014-04-02).
  34. Shaw K, Gennat H, O'Rourke P et al. Exercise for overweight or obesity. Cochrane Database of Systematic Reviews, issue 4, 2007. The Cochrane Library  
  35. Svendsen OL, Toubro S, Bruun JM, Linnet JP, Kroustrup JP. Retningslinjer for behandling af overvægt/fedme anno 2006. Ugeskr Læger 2006; 168: 180-2. PubMed  
  36. Garrow JS, Summerbell CD. Meta-analysis: effect of exercise with or without dieting, on body composition of overweight subjects. Eur J Clin Nutr 1995; 49: 1-10. PubMed  
  37. Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360: 859-73. New England Journal of Medicine  
  38. Liu D, Huang Y, Huang C, et al. Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N Engl J Med 2022; 386: 1495-1504. pmid:35443107 PubMed  
  39. Lowe DA, Wu N, Rohdin-Bibby L, et al. Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity: The TREAT Randomized Clinical Trial. JAMA Intern Med 2020; 180: 1491-99. pmid:32986097 PubMed  
  40. Jamshed H, Steger FL, Bryan DR, Richman JS, Warriner AH, Hanick CJ, Martin CK, Salvy SJ, Peterson CM. Effectiveness of Early Time-Restricted Eating for Weight Loss, Fat Loss, and Cardiometabolic Health in Adults With Obesity: A Randomized Clinical Trial. JAMA Intern Med. 2022 Sep 1;182(9):953-962. doi: 10.1001/jamainternmed.2022.3050. PMID: 35939311 PubMed  
  41. Johnston BC, Kanters S, Bandayrel K, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA 2014; 312: 923-33. pmid:25182101 PubMed  
  42. Astrup A, Larsen TM, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for wieght loss?. Lancet 2004; 364: 897-99. PubMed  
  43. Foster GD, Wyatt HR, Hill JO. Weight ant meetabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 2010; 153: 147-57. Annals of Internal Medicine  
  44. Larsen TM, Dalskov S-M, van Baak M, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med 2010; 363: 2102-13. New England Journal of Medicine  
  45. Pittler MH, Ernst E. Dietary supplements for body-weight reduction: a systematic review. Am J Clin Nutr 2004; 79: 529-36. PubMed  
  46. Boutelle KN, Kirschenbaum DS. Further support for consistent self-monitoring as a vital component of successful weight control. Obes Res 1998; 6: 219-24. PubMed  
  47. Kayman S, Bruvold W, Stern JS. Maintenance and relapse after weight loss in women: behavioral aspects. Am J Clin Nutr 1990; 52:800-7. PubMed  
  48. Nationella riktlinjer för vård vid obesitas. Socialstyrelsen (hämtad 2022-05-09) www.socialstyrelsen.se  
  49. Rucker D, Padwal R, Li SK, et al. Long term pharmacotherapy for obesity and overweight: updateed metaanlysis. BMJ 2007; 335: 1194-9. British Medical Journal  
  50. Lindgarde F, on behalf of the Orlistat Swedish Multimorbidity Study Group. The effect of orlistat on body weight and coronary heart disease risk profile in obese patients: The Swedish Multimorbidity Study. J Intern Med 2000; 248: 245-54. PubMed  
  51. Dombrowski SU, Knittle K, Avenell A, et al. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014 May 14;348:g2646. doi: 10.1136/bmj.g2646. DOI  
  52. Greenway FL, Fujioka K, Plodkowski RA, 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. Lancet 2010; 376: 595-605. PubMed  
  53. Apovian CM, Aronne L, Rubino D et al; COR-II Study Group. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity 2013; 21: 935-43. pmid:23408728 PubMed  
  54. Wadden TA, Foreyt JP, Foster GD et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity 2011; 19: 110-20. pmid:20559296 PubMed  
  55. Hollander P, Gupta AK, Plodkowski R, et al; COR-Diabetes Study Group. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes. Diabetes Care 2013; 36: 4022-29. pmid:24144653 PubMed  
  56. Isaacs D, Prasad-Reddy L, Srivastava SB. Role of glucagon-like peptide 1 receptor agonists in management of obesity. Am J Health Syst Pharm. 2016 Oct 1;73(19):1493-507. PMID: 27521241. PubMed  
  57. Astrup A, Rössner S, Van Gaal L, et al. Effects of luraglitide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet 2009; 374: DOI:10.1016/S0140-6736(09)61375-1. DOI  
  58. Wilding J, Batterham R, Calanna S et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med 2021; 384:989-1002 New England Journal of Medicine  
  59. 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. Lancet 2021. pmid:34895470 PubMed  
  60. Weghuber D, Barrett T, Barrientos-Pérez M, et al. Once-Weekly Semaglutide in Adolescents with Obesity. N Engl J Med 2022. pmid:36322838 PubMed  
  61. Curioni C, André C. Rimonabant for overweight or obesity. Cochrane Database of Systematic Reviews, issue 2, 2007. The Cochrane Library  
  62. Courcoulas AP, Yanovski SZ, Bonds D, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. BMJ. 2015 Jan 5;350:g6380. PMID: 25271405. PubMed  
  63. Ollendorf DA, Cameron CG, Pearson SD. Effectiveness and Value of Treatment Options for Obesity-A Report for the California Technology Assessment Forum. JAMA Intern Med. 2016 Feb;176(2):247-8. doi: 10.1001/jamainternmed.2015.7189. PMID: 26746682 PubMed  
  64. Ikramuddin S, Korner J, Lee WJ, et al. Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. JAMA 2018; 319: 266-78. pmid:29340678 PubMed  
  65. Reges O, Greenland P, Dicker D, et al. Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality. JAMA 2018; 319: 279-90. pmid:29340677 PubMed  
  66. Merlotti C, Morabito A, Pontiroli AE. Prevention of type 2 diabetes: a systematic review and meta-analysis of different intervention strategies. Diabetes Obes Metab 2014; 16: 719-27. pmid:24476122 PubMed  
  67. Jakobsen GS, Småstuen MC, Sandbu R, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA 2018; 319: 291-301. pmid:29340680 PubMed  
  68. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial. JAMA 2018; 319: 255-65. pmid:29340679 PubMed  
  69. Salminen O, Helmiö M, Ovaska J, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA 2018; 319: 241-54. pmid:29340676 PubMed  
  70. Giske L, Stoinska-Schneider A, Arentz-HansenA et al. Fedmekirurgi ved diabetes type 2 og kroppsmasseindeks under 35. Rapport - 2018. Oslo: Folkehelseinstituttet; 2018. www.fhi.no  
  71. O'Brien PE, Dixon JB, Laurie C et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 2006; 144: 625-33. PMID: 16670131 PubMed  
  72. Trus TL, Pope GD, Finlayson SR. National trends in utilization and outcomes of bariatric surgery. Surg Endosc 2005; 19: 616–20.
  73. DuPree CE, Blair K, Steele SR, Martin MJ. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease. JAMA Surg 2014 PMID: 24500799 PubMed  
  74. Andreasson K, Videhult P. Gastrisk bypass eller sleeve-gastrektomi – vilken är bäst? Läkartidningen. 2017;114:ER3H lakartidningen.se  
  75. Søvik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch. Ann Intern Med 2011; 155: 281-91. Annals of Internal Medicine  
  76. Pedersen SB, Møller D, Funch-Jensen PM. Kirurgisk behandling af svær fedme. Ugeskr Læger 2005; 167: 1942-5. PubMed  
  77. Nguyen NT, Slone JA, Nguyen XM, Hartman JS, Hoyt DB. A Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding for the Treatment of Morbid Obesity: Outcomes, Quality of Life, and Costs. Ann Surg 2009; 250: 631. PubMed  
  78. Dayyeh BKA, Maselli DB, Rapaka B, et al. Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial. Lancet 2021. pmid:34793746 PubMed  
  79. Crossan K, Sheer AJ. Intragastric Balloon. 2022 Jun 9. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 35201712 PubMed  
  80. Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet. 2022;400(10350):441-451. doi:10.1016/S0140-6736(22)01280-6. PMID: 35908555 PubMed  
  81. Schiavon CA, Bersch-Ferreira AC, Santucci EV. Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). Circulation 2017. pmid:29133606 PubMed  
  82. Murphy R, Plank LD, Clarke MG, et al . Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial.. Diabetes Care 2022; 45: 1503-11. pmid:35554515 PubMed  
  83. Sjostrom L, Narbro K, Sjostrom CD, et al, for the Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741-52. New England Journal of Medicine  
  84. O'Brien PE, Sawyer SM, Laurie C, et al. laparoscopic adjustable gastric banding in severely obese adolescents. JAMA 2010; 303: 519-26. PMID: 20145228 PubMed  
  85. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: An updated systematic review and meta-analysis, 2003-2012. JAMA Surg 2013. PMID: 24352617 PubMed  
  86. ArterburnDE, Olsen MK, Smith VA, et al. Association between bariatric surgery and longterm survival. JAMA 2015; 313: 62-70. PMID: 25562267 PubMed  
  87. Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: A one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants.. Lancet 2021; 397: 1830. pmid:33965067 PubMed  
  88. Rask E, Peters H, Jansson S. Hypoglykemi – problematisk komplikation av överviktskirurgi Hypoglycemia following gastric bypass surgery - a case, causes and coping. Lakartidningen. 2019;116:FHFP. Published 2019 Feb 19.PMID: 31192390 PubMed  
  89. Scarpellini E, Arts J, Karamanolis G, et al. International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol. 2020;16(8):448-466. doi:10.1038/s41574-020-0357-5PMID: 32457534 PubMed  
  90. Buksmärtor vanliga efter fetmakirurgi. Janusinfo. Region Stockholm. Hämtad 20201201 janusinfo.se  
  91. Fisher SA, Stetson BT, Kominiarek MA. Pregnancy After Bariatric Surgery. JAMA. 2023 Feb 10. Epub ahead of print. PMID: 36763352 PubMed  
  92. Följ upp läkemedel efter fetmakirurgi. Janusinfo. Region Stockholm. Hämtad 2020-12-01 janusinfo.se  
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet