摘要

肥胖是一種由過多脂肪組織引起的慢性疾病。與其他族群相比，臺灣人在較低體重下罹患肥胖相關共病的風險較高，因此BMI (body mass index) ≥ 27 kg/m2 即定義為肥胖。病理機制包括能量攝取超過消耗、腸腦軸失衡、以及內臟脂肪堆積引起慢性發炎，進而增加心血管疾病與糖尿病風險。減重策略首選行為干預及飲食控制，其次為藥物治療，最後才是手術介入。減重藥物會考量病人是否合併第二型糖尿病、能否接受注射劑型藥物，以及經濟能力進行選擇。對於無糖尿病共病症的肥胖病人，tirzepatide 為目前最有效的減重藥物，72 週體重降低20.9%，其次為semaglutide，68 週體重降低14.9%，但停藥後體重容易回升。其他藥物如naltrexone-bupropion 與orlistat，因副作用風險較高且效果有限，僅適用於特定族群。自從GLP-1 受體促效劑問世，這類藥物以不同商品名獲得糖尿病與減重適應症，但減重適應症核准較晚，導致部分人將糖尿病藥物用於減重，影響糖尿病患者用藥權益，此外，市場上偽藥問題日益嚴重，政府已發布警訊，提醒民眾透過正規管道取得藥物。對於BMI ≥ 32.5 kg/m2 且合併高風險併發症者，手術治療最有效，可減輕15 ~ 25% 體重。成功減重關鍵包括個人化治療計畫、持續監測體重與規律回診追蹤。本文統整具實證依據的減重策略，期望為藥師提供專業參考，並協助患者達成長期減重目標。

 

ABSTRACT

Obesity is a chronic disease caused by excessive fat accumulation. Compared to other populations, Taiwanese individuals have a higher risk of obesity-related comorbidities at lower body weights, leading to the definition of obesity as a body mass index (BMI) ≥ 27 kg/m2. Its pathophysiology involves excessive energy intake, gut-brain axis imbalance, and chronic inflammation from visceral fat accumulation, increasing cardiovascular disease and diabetes risks. The primary weight loss strategies include behavioral interventions and dietary control, followed by pharmacological treatment and surgical intervention. Weight-loss medication selection depends on type 2 diabetes status, ability to tolerate injectables, and financial considerations. Among non-diabetic patients, tirzepatide is the most effective, reducing body weight by 20.9% over 72 weeks, followed by semaglutide with a 14.9% reduction over 68 weeks, though weight regain is common after discontinuation. Other medications, such as naltrexone-bupropion and orlistat, have higher risks and limited efficacy. Glucagonlike peptide-1 receptor agonists have different brand names for diabetes and weight loss, but weight-loss indications are approved later, leading to off-label use and affecting diabetes patients’ medication access. The rise of counterfeit drugs has also raised concerns, prompting government warnings. For patients with BMI ≥ 32.5 kg/m2 and high-risk complications, surgery is the most effective, reducing weight by 15 ~ 25%. Key factors for successful weight loss include personalized treatment plans, regular weight monitoring, and follow-up visits. This article provides evidence-based weight loss strategies to support pharmacists in helping patients achieve long-term weight management.

 

 

Submitted for publication: 2024.10.21; Accepted for publication: 2025.3.1