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, Department of General 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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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.

Citation： LIU Danlu, WAN Qianyi, ZHAO Rui, HOU Dongsheng, ZHANG Guixiang, CHENG Zhong, CHEN Yi. Surgical interpretation of “Guidelines for the Diagnosis and Treatment of Obesity (2024 Edition)”. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(6): 738-744. doi: 10.7507/1007-9424.202504067 Copy

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.	國家衛生健康委員會肥胖癥診療指南編寫委員會. 肥胖癥診療指南 (2024年版). 中國循環雜志, 2025, 40(1): 6-30.
3.	國家衛生健康委員會. 《中國居民營養與慢性病狀況報告 (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 Organ Tech Rep Ser, 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.	李魯, 王紅妹, 沈毅. SF-36健康調查量表中文版的研制及其性能測試. 中華預防醫學雜志, 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. doi: 10.1001/jamanetworkopen.2023.27099.
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. doi: 10.3389/fnut.2021.611217.
15.	Lopez P, Taaffe DR, Galv?o 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. doi: 10.1111/obr.13428.
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.	中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和代謝病外科專家工作組. 中國肥胖及代謝疾病外科治療指南 (2024版). 中國實用外科雜志, 2024, 44(8): 841-849.
26.	楊華, 張鵬, 董志勇, 等. 中國肥胖代謝外科手術方式推薦立場聲明. 中華肥胖與代謝病電子雜志, 2021, 7(1): 8-12.
27.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會 (CSMBS). 精準肥胖代謝外科手術中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(10): 841-851.
28.	Peterli R, W?lnerhanssen 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.	楊珵璨, 王文越, 馬帥, 等. 腹腔鏡下Roux-en-Y胃旁路術: 從術式發展到精準規范. 中國普外基礎與臨床雜志, 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-Zu?iga 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. doi: 10.3390/nu15030742.
33.	姚立彬, 王鍵, 朱孝成. 袖狀胃切除術聯合雙通道術的前景與思考. 中國普外基礎與臨床雜志, 2024, 31(4): 398-402.
34.	梁輝, 李聰, 沈佳佳. 胃袖狀切除術附加手術術式選擇及難點. 中國實用外科雜志, 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.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 肥胖代謝外科修正手術東亞專家共識 (2018). 中華肥胖與代謝病電子雜志, 2018, 4(1): 1-4.
37.	中華中醫藥學會《中醫體重管理臨床指南》專家組, 廣東省針灸學會肥胖專病聯盟. 肥胖癥中醫診療方案專家共識. 北京中醫藥大學學報, 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. doi: 10.1186/s12966-014-0160-6.
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. 國家衛生健康委員會肥胖癥診療指南編寫委員會. 肥胖癥診療指南 (2024年版). 中國循環雜志, 2025, 40(1): 6-30.
3. 國家衛生健康委員會. 《中國居民營養與慢性病狀況報告 (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 Organ Tech Rep Ser, 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. 李魯, 王紅妹, 沈毅. SF-36健康調查量表中文版的研制及其性能測試. 中華預防醫學雜志, 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. doi: 10.1001/jamanetworkopen.2023.27099.
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. doi: 10.3389/fnut.2021.611217.
15. Lopez P, Taaffe DR, Galv?o 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. doi: 10.1111/obr.13428.
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. 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和代謝病外科專家工作組. 中國肥胖及代謝疾病外科治療指南 (2024版). 中國實用外科雜志, 2024, 44(8): 841-849.
26. 楊華, 張鵬, 董志勇, 等. 中國肥胖代謝外科手術方式推薦立場聲明. 中華肥胖與代謝病電子雜志, 2021, 7(1): 8-12.
27. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會 (CSMBS). 精準肥胖代謝外科手術中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(10): 841-851.
28. Peterli R, W?lnerhanssen 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. 楊珵璨, 王文越, 馬帥, 等. 腹腔鏡下Roux-en-Y胃旁路術: 從術式發展到精準規范. 中國普外基礎與臨床雜志, 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-Zu?iga 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. doi: 10.3390/nu15030742.
33. 姚立彬, 王鍵, 朱孝成. 袖狀胃切除術聯合雙通道術的前景與思考. 中國普外基礎與臨床雜志, 2024, 31(4): 398-402.
34. 梁輝, 李聰, 沈佳佳. 胃袖狀切除術附加手術術式選擇及難點. 中國實用外科雜志, 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. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 肥胖代謝外科修正手術東亞專家共識 (2018). 中華肥胖與代謝病電子雜志, 2018, 4(1): 1-4.
37. 中華中醫藥學會《中醫體重管理臨床指南》專家組, 廣東省針灸學會肥胖專病聯盟. 肥胖癥中醫診療方案專家共識. 北京中醫藥大學學報, 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. doi: 10.1186/s12966-014-0160-6.
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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical interpretation of “Guidelines for the Diagnosis and Treatment of Obesity (2024 Edition)”

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