Abstract: Childhood obesity has become a major global public health issue. Conventional prevention and treatment strategies usually have poor long-term outcomes. The studies in recent years have shown that the gut microbiota is a key mediator between the environment and the host metabolism，and the composition and dysbiosis of gut microbiota contribute to childhood obesity， affecting energy harvest，dietary metabolism，low-grade inflammation，insulin sensitivity，and appetite regulation. Microbiota-targeted interventions，such as specific diets and pre/probiotics，have shown promise as adjuncts to lifestyle changes，but the clinical use is hampered by the microbiota’s complexity，individual variability，uncertain causality，and limited technological efficacy and insufficient data of long-term safety. Fecal microbiota transplantation requires extreme caution in the treatment of pediatric obesity due to unclear risk-benefit. Clinicians should take a rational perspective on gut microbiota intervention，and consider healthy lifestyles as the cornerstone of management. Optimizing diet with high-fiber and diversity remains the most fundamental，safe and effective strategy for modulation of gut microbiota and prevention and treatment of obesity. Future research on gut microbiota should focus on causal mechanisms，developing multi-omics-guided personalized interventions and exploring preciser and safer microecological agents.

Key words: obesity, gut microbiota, short-chain fatty acids, probiotics, dietary intervention

摘要： 儿童肥胖已成为全球重大公共卫生问题，传统防治策略面临长期效果不佳的挑战。近年研究表明，肠道菌群是环境与宿主代谢的关键中介，其组成和功能紊乱与儿童肥胖发生发展有关，影响能量提取、膳食成分代谢、低度炎症、胰岛素敏感性及食欲调控。尽管菌群靶向干预（如特定饮食、益生元 / 益生菌）展现出潜力，尤其是可作为生活方式干预的补充，但其临床应用面临菌群复杂性、个体差异大、因果关系确立困难、现有技术效果有限和长期安全性数据不足等挑战。粪便微生物移植在儿童肥胖治疗中风险收益比不明，应极其谨慎。临床实践中应理性看待菌群干预，将健康生活方式作为防治肥胖的核心，优化饮食结构（高纤维、多样化）是最基础、安全且有效的调节菌群和防治肥胖的策略。未来肠道菌群研究方向应聚焦于解析因果机制、发展基于多组学的个体化干预以及探索更精准安全的微生态制剂。

关键词: 肥胖, 肠道菌群, 短链脂肪酸, 益生菌, 饮食干预