Surgical interpretation of “Guidelines for the Diagnosis and Treatment of Obesity (2024 Edition)”_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Danlu , WAN Qianyi , ZHAO Rui , HOU Dongsheng , ZHANG Guixiang , CHENG Zhong ,  CHEN Yi

Division of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHEN Yi, Email: toddy@scu.edu.cn

Keywords：

obesity; diagnosis; treatment; guideline interpretation

DOI：

10.7507/1007-9424.202504067

Video：

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[Abstract] The “Guidelines for the Diagnosis and Treatment of Obesity (2024 Edition)” was formulated by the National Health Commission in cooperation with multidisciplinary experts nationwide, and was formally released on October 17, 2024. As China’s first authoritative guideline for obesity, it comprehensively covers the etiology, epidemiology, diagnosis, classification, staging, and related diseases of obesity. The guideline emphasizes the high risk of obesity-related diseases, and for the first time puts forward a standardized diagnosis and treatment pathway, sorting out various treatment options including lifestyle interventions, pharmacotherapy, metabolic/bariatric procedures, and traditional Chinese medicine treatments. At the same time, the guideline advocates the multi-disciplinary treatment model, which integrates expertise and methodologies from various disciplines to develop personalized treatments for patients. We interpreted and discussed the diagnostic assessment and multimodal management of obesity, so as to enhance readers’ understanding of the guideline and promote the standardization of evidence-based practices in obesity care.

1.	GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet, 2025, 405(10481): 813-838.
2.	国家卫生健康委员会肥胖症诊疗指南编写委员会. 肥胖症诊疗指南 (2024年版). 中国循环杂志, 2025, 40(1): 6-30.
3.	国家卫生健康委员会. 《中国居民营养与慢性病状况报告 (2020年)》. (2020-12-23) [2024-12-08]. http://www.gov.cn/xinwen/2020-12/24/content_5572983.htm.
4.	Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021, 398(10294): 53-63.
5.	Chen K, Shen Z, Gu W, et al. Prevalence of obesity and associated complications in China: a cross-sectional, real-world study in 15. 8 million adults. Diabetes Obes Metab, 2023, 25(11): 3390-3399.
6.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
7.	World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization Technical Report Series, 2000, 894: i-xii, 1-253.
8.	Mechanick JI, Hurley DL, Garvey WT. Adiposity-based chronic disease as a new diagnostic term: the american association of clinical endocrinologists and american college of endocrinology position statement. Endocr Pract, 2017, 23(3): 372-378.
9.	Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol, 2025, 13(3): 221-262.
10.	李鲁, 王红妹, 沈毅. SF-36健康调查量表中文版的研制及其性能测试. 中华预防医学杂志, 2002, 36(2): 109-113.
11.	Kolotkin RL, Crosby RD, Kosloski KD, et al. Development of a brief measure to assess quality of life in obesity. Obes Res, 2001, 9(2): 102-111.
12.	Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest, 2016, 149(3): 631-638.
13.	Sockalingam S, Leung SE, Ma C, et al. Efficacy of telephone-based cognitive behavioral therapy for weight loss, disordered eating, and psychological distress after bariatric surgery: a randomized clinical trial. JAMA Netw Open, 2023, 6(8): e2327099.
14.	Moraes ADS, Padovani RDC, La Scala Teixeira CV, et al. Cognitive behavioral approach to treat obesity: a randomized clinical trial. Front Nutr, 2021, 8: 611217.
15.	Lopez P, Taaffe DR, Galvão DA, et al. Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: a systematic review and meta-analysis. Obes Rev, 2022, 23(5): e13428.
16.	Berge J, Hjelmesaeth J, Hertel JK, et al. Effect of aerobic exercise intensity on energy expenditure and weight loss in severe obesity-a randomized controlled trial. Obesity (Silver Spring), 2021, 29(2): 359-369.
17.	le Roux CW, Steen O, Lucas KJ, et al. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial. Lancet Diabetes Endocrinol, 2024, 12(3): 162-173.
18.	Jastreboff AM, Kaplan LM, Frías JP, et al. Triple-hormone-receptor agonist retatrutide for obesity - a phase 2 trial. N Engl J Med, 2023, 389(6): 514-526.
19.	Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 Randomized Clinical Trial. JAMA, 2021, 325(14): 1414-1425.
20.	Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab, 2022, 24(8): 1553-1564.
21.	Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 Randomized Clinical Trial. JAMA, 2024, 331(1): 38-48.
22.	Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly semaglutide in adults with overweight or obesity. N Engl J Med, 2021, 384(11): 989-1002.
23.	Donini LM, Busetto L, Bischoff SC, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr, 2022, 41(4): 990-1000.
24.	Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg, 2023, 33(1): 3-14.
25.	中华医学会外科学分会甲状腺及代谢外科学组, 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. 中国肥胖及代谢疾病外科治疗指南 (2024版). 中国实用外科杂志, 2024, 44(8): 841-849.
26.	杨华, 张鹏, 董志勇, 等. 中国肥胖代谢外科手术方式推荐立场声明. 中华肥胖与代谢病电子杂志, 2021, 7(1): 8-12.
27.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会 (CSMBS). 精准肥胖代谢外科手术中国专家共识(2022版). 中华胃肠外科杂志, 2022, 25(10): 841-851.
28.	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(3): 255-265.
29.	杨珵璨, 王文越, 马帅, 等. 腹腔镜下Roux-en-Y胃旁路术: 从术式发展到精准规范. 中国普外基础与临床杂志, 2024, 31(4): 394-397.
30.	Singh B, Saikaustubh Y, Singla V, et al. One anastomosis gastric bypass (OAGB) vs Roux en Y gastric bypass (RYGB) for remission of T2DM in patients with morbid obesity: a randomized controlled trial. Obes Surg, 2023, 33(4): 1218-1227.
31.	Ortiz-Zuñiga AM, Costa Forner P, Cirera de Tudela A, et al. The impact of the length of the common intestinal loop on metabolic and nutritional outcomes of patients with severe obesity who undergo of single anastomosis duodeno-ileal bypass with sleeve gastrectomy: 5-year follow-up. J Laparoendosc Adv Surg Tech A, 2022, 32(9): 955-961.
32.	Marincola G, Velluti V, Voloudakis N, et al. Medium-term nutritional and metabolic outcome of single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Nutrients, 2023, 15(3): 742.
33.	姚立彬, 王键, 朱孝成. 袖状胃切除术联合双通道术的前景与思考. 中国普外基础与临床杂志, 2024, 31(4): 398-402.
34.	梁辉, 李聪, 沈佳佳. 胃袖状切除术附加手术术式选择及难点. 中国实用外科杂志, 2023, 43(5): 529-533.
35.	Firkins SA, Chittajallu V, Flora B, et al. Utilization of anti-obesity medications after bariatric surgery: analysis of a large national database. Obes Surg, 2024, 34(5): 1415-1424.
36.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 肥胖代谢外科修正手术东亚专家共识 (2018). 中华肥胖与代谢病电子杂志, 2018, 4(1): 1-4.
37.	中华中医药学会《中医体重管理临床指南》专家组, 广东省针灸学会肥胖专病联盟. 肥胖症中医诊疗方案专家共识. 北京中医药大学学报, 2022, 45(8): 786-794.
38.	Gillison F, Stathi A, Reddy P, et al. Processes of behavior change and weight loss in a theory-based weight loss intervention program: a test of the process model for lifestyle behavior change. Int J Behav Nutr Phys Act, 2015, 12: 2.
39.	Yu B, Chen Y, Qin H, et al. Using multi-disciplinary teams to treat obese patients helps improve clinical efficacy: the general practitioner's perspective. Am J Transl Res, 2021, 13(4): 2571-2580.

1. GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet, 2025, 405(10481): 813-838.
2. 国家卫生健康委员会肥胖症诊疗指南编写委员会. 肥胖症诊疗指南 (2024年版). 中国循环杂志, 2025, 40(1): 6-30.
3. 国家卫生健康委员会. 《中国居民营养与慢性病状况报告 (2020年)》. (2020-12-23) [2024-12-08]. http://www.gov.cn/xinwen/2020-12/24/content_5572983.htm.
4. Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021, 398(10294): 53-63.
5. Chen K, Shen Z, Gu W, et al. Prevalence of obesity and associated complications in China: a cross-sectional, real-world study in 15. 8 million adults. Diabetes Obes Metab, 2023, 25(11): 3390-3399.
6. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
7. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization Technical Report Series, 2000, 894: i-xii, 1-253.
8. Mechanick JI, Hurley DL, Garvey WT. Adiposity-based chronic disease as a new diagnostic term: the american association of clinical endocrinologists and american college of endocrinology position statement. Endocr Pract, 2017, 23(3): 372-378.
9. Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol, 2025, 13(3): 221-262.
10. 李鲁, 王红妹, 沈毅. SF-36健康调查量表中文版的研制及其性能测试. 中华预防医学杂志, 2002, 36(2): 109-113.
11. Kolotkin RL, Crosby RD, Kosloski KD, et al. Development of a brief measure to assess quality of life in obesity. Obes Res, 2001, 9(2): 102-111.
12. Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest, 2016, 149(3): 631-638.
13. Sockalingam S, Leung SE, Ma C, et al. Efficacy of telephone-based cognitive behavioral therapy for weight loss, disordered eating, and psychological distress after bariatric surgery: a randomized clinical trial. JAMA Netw Open, 2023, 6(8): e2327099.
14. Moraes ADS, Padovani RDC, La Scala Teixeira CV, et al. Cognitive behavioral approach to treat obesity: a randomized clinical trial. Front Nutr, 2021, 8: 611217.
15. Lopez P, Taaffe DR, Galvão DA, et al. Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: a systematic review and meta-analysis. Obes Rev, 2022, 23(5): e13428.
16. Berge J, Hjelmesaeth J, Hertel JK, et al. Effect of aerobic exercise intensity on energy expenditure and weight loss in severe obesity-a randomized controlled trial. Obesity (Silver Spring), 2021, 29(2): 359-369.
17. le Roux CW, Steen O, Lucas KJ, et al. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial. Lancet Diabetes Endocrinol, 2024, 12(3): 162-173.
18. Jastreboff AM, Kaplan LM, Frías JP, et al. Triple-hormone-receptor agonist retatrutide for obesity - a phase 2 trial. N Engl J Med, 2023, 389(6): 514-526.
19. Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 Randomized Clinical Trial. JAMA, 2021, 325(14): 1414-1425.
20. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab, 2022, 24(8): 1553-1564.
21. Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 Randomized Clinical Trial. JAMA, 2024, 331(1): 38-48.
22. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly semaglutide in adults with overweight or obesity. N Engl J Med, 2021, 384(11): 989-1002.
23. Donini LM, Busetto L, Bischoff SC, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr, 2022, 41(4): 990-1000.
24. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg, 2023, 33(1): 3-14.
25. 中华医学会外科学分会甲状腺及代谢外科学组, 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. 中国肥胖及代谢疾病外科治疗指南 (2024版). 中国实用外科杂志, 2024, 44(8): 841-849.
26. 杨华, 张鹏, 董志勇, 等. 中国肥胖代谢外科手术方式推荐立场声明. 中华肥胖与代谢病电子杂志, 2021, 7(1): 8-12.
27. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会 (CSMBS). 精准肥胖代谢外科手术中国专家共识(2022版). 中华胃肠外科杂志, 2022, 25(10): 841-851.
28. 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(3): 255-265.
29. 杨珵璨, 王文越, 马帅, 等. 腹腔镜下Roux-en-Y胃旁路术: 从术式发展到精准规范. 中国普外基础与临床杂志, 2024, 31(4): 394-397.
30. Singh B, Saikaustubh Y, Singla V, et al. One anastomosis gastric bypass (OAGB) vs Roux en Y gastric bypass (RYGB) for remission of T2DM in patients with morbid obesity: a randomized controlled trial. Obes Surg, 2023, 33(4): 1218-1227.
31. Ortiz-Zuñiga AM, Costa Forner P, Cirera de Tudela A, et al. The impact of the length of the common intestinal loop on metabolic and nutritional outcomes of patients with severe obesity who undergo of single anastomosis duodeno-ileal bypass with sleeve gastrectomy: 5-year follow-up. J Laparoendosc Adv Surg Tech A, 2022, 32(9): 955-961.
32. Marincola G, Velluti V, Voloudakis N, et al. Medium-term nutritional and metabolic outcome of single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Nutrients, 2023, 15(3): 742.
33. 姚立彬, 王键, 朱孝成. 袖状胃切除术联合双通道术的前景与思考. 中国普外基础与临床杂志, 2024, 31(4): 398-402.
34. 梁辉, 李聪, 沈佳佳. 胃袖状切除术附加手术术式选择及难点. 中国实用外科杂志, 2023, 43(5): 529-533.
35. Firkins SA, Chittajallu V, Flora B, et al. Utilization of anti-obesity medications after bariatric surgery: analysis of a large national database. Obes Surg, 2024, 34(5): 1415-1424.
36. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 肥胖代谢外科修正手术东亚专家共识 (2018). 中华肥胖与代谢病电子杂志, 2018, 4(1): 1-4.
37. 中华中医药学会《中医体重管理临床指南》专家组, 广东省针灸学会肥胖专病联盟. 肥胖症中医诊疗方案专家共识. 北京中医药大学学报, 2022, 45(8): 786-794.
38. Gillison F, Stathi A, Reddy P, et al. Processes of behavior change and weight loss in a theory-based weight loss intervention program: a test of the process model for lifestyle behavior change. Int J Behav Nutr Phys Act, 2015, 12: 2.
39. Yu B, Chen Y, Qin H, et al. Using multi-disciplinary teams to treat obese patients helps improve clinical efficacy: the general practitioner's perspective. Am J Transl Res, 2021, 13(4): 2571-2580.

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