减重代谢手术是治疗重度肥胖症及其代谢并发症的重要手段,但术后身体成分的不良改变———显著的瘦体组织流 失及随之而来的肌肉减少症风险,已成为影响患者远期健康结局的主要挑战。 本文旨在系统综述减重术后身体成分的动态 变化特征,并重点探讨以优化身体成分为核心目标的科学管理策略。 理想的术后管理应超越体重与代谢指标的短期改善,应 基于科学原则,在最大限度减少脂肪质量(尤其是内脏脂肪)的同时,竭力保留甚至增加瘦体组织。 实现这一目标的关键在于 实施多维度、个体化且长期坚持的综合干预方案。 该方案的核心包括:分阶段足量的蛋白质补充,以有效刺激肌肉蛋白质合 成、缓解瘦体组织流失;个体化运动处方,结合抗阻与有氧训练,协同促进肌肉合成代谢、改善胰岛素敏感性并防止体重反弹; 多学科协作的长期随访模式,整合营养、运动康复、内分泌及外科等多学科专业力量,为患者提供持续性支持与教育,确保治 疗依从性。 综上所述,以优化身体成分为导向的术后科学管理体系,是巩固减重手术远期疗效、提升患者生活质量和代谢健 康的核心保障。

Metabolic and bariatric surgery MBS is a pivotal intervention for severe obesity and its comorbidities. However the significant loss of lean body mass and the associated risk of sarcopenia following surgery present major challenges to long-term patient health. The review aims to systematically summarize the dynamic changes in body composition following MBS and to discuss scientific management strategies focused on optimizing body composition. Ideal postoperative management should go beyond short - term improvements in weight and metabolic parameters it should be based on scientific principles striving to minimize fat mass particularly visceral adipose tissue while preserving or even increasing lean body mass. Achieving this goal hinges on implementing a multidimensional personalized and sustained comprehensive intervention strategy. The core components of this strategy include phased and adequate protein supplementation to stimulate muscle protein synthesis and mitigate lean tissue loss personalized exercise prescriptions combining resistance and aerobic training to synergistically promote muscle anabolism improve insulin sensitivity and prevent weight regain and a long - term multidisciplinary follow - up model that integrates expertise from nutrition physical rehabilitation endocrinology and surgical team to provide continuous patient support and education thereby ensuring long - term adherence. In conclusion implementing this body composition-focused management framework is critical for consolidating the lasting benefits of surgery and enhancing overall metabolic health and quality of life.