肥胖問題不能只看體重

Obesity should be defined by a person's health - not just by their weight, says a new Canadian clinical guideline.

加拿大的一份新臨床指南稱，肥胖與否應(yīng)該視健康狀況而定，而不只是體重。

The guideline, which was published in the Canadian Medical Association Journal on August 4, 2020, specifically admonished weight-related discrimination against patients in the health system. It also advises doctors to go beyond simply recommending diet and exercise. Instead, they should focus on the root causes of weight gain and take a holistic approach to health.

2020年8月4日發(fā)表在《加拿大醫(yī)學(xué)協(xié)會期刊》上的這一指南特別對醫(yī)療系統(tǒng)中針對肥胖癥患者的歧視發(fā)出了警告。該指南還建議醫(yī)生不僅僅就膳食和鍛煉方面給出醫(yī)囑，還應(yīng)該關(guān)注肥胖的根源，從整體的視角來看待健康問題。

Ximena· Ramos-Salas, the director of research and policy at Obesity Canada and one of the guideline's authors, said research shows many doctors discriminate against obese patients, and that can lead to worse health outcomes irrespective of their weight.

該指南的作者之一、加拿大肥胖組織的研究和政策主任西米娜·拉莫斯·薩拉斯稱，研究顯示許多醫(yī)生對肥胖癥患者存在歧視，而這種歧視會令患者的健康惡化，無論他們的體重是多少。

Although the latest advice still recommends using diagnostic criteria like the body mass index (BMI) and waist circumference, it also acknowledges their clinical limitations and says doctors should focus more on how weight impacts a person's health.

盡管該指南仍建議人們采用身體質(zhì)量指數(shù)和腰圍作為診斷標準，但它也承認了臨床治療的局限性，并表示醫(yī)生應(yīng)該更多地關(guān)注體重是如何影響一個人的健康的。

Small reductions in weight of about 3-5% can lead to health improvements, and an obese person's "best weight" might not be their "ideal weight" according to BMI, the guideline says. It emphasizes that obesity is a complex, chronic condition that needs lifelong management.

這份指南指出，體重微降大約3%到5%就可以改善健康，而且一個肥胖者的“最佳體重”可能不是他們根據(jù)身體質(zhì)量指數(shù)算出的“理想體重”。該指南也強調(diào)，肥胖是一個需要終生管理的復(fù)雜慢性病。

"For a long time we've associated obesity as a lifestyle behavior. It's always been with shame and blame," Ms. Ramos-Salas says. "But people living with obesity need supports like people living with any other chronic disease."

“長期以來，我們一直將肥胖與生活方式關(guān)聯(lián)在一起。肥胖也常常伴隨著恥辱和責備。”拉莫斯·薩拉斯女士稱，“但肥胖癥患者和其他慢性病患者一樣需要獲得支持。”

Weight off is often difficult because the brain will compensate by feeling hungrier, thus encouraging people to eat more. Many studies have shown that most people who lose weight on a diet gain it back. Physicians should work with the obesity patient to focus on health goals that matter to them, instead of just telling them to cut calories.

減肥通常很困難，因為大腦會通過饑餓感來補償自身，從而鼓勵人們吃更多東西。許多研究顯示，大多數(shù)通過節(jié)食來減肥的人后來體重又反彈了。因此，醫(yī)生應(yīng)該和肥胖癥患者一起關(guān)注對其有意義的健康目標，而不只僅僅是讓患者少吃。

So instead of simply advising patients to "eat less and move more", the guideline encourages doctors to provide supports such as psychological therapy, medication and bariatric surgery like gastric-bypass surgery. But the guideline doesn't completely abandon traditional weight-loss advice. "All individuals, regardless of body size or composition, would benefit from adopting a healthy, well-balanced eating pattern and engaging in regular physical activity," it says.

因此，這一指南并沒有簡單地建議肥胖患者“少吃多動”，而是鼓勵醫(yī)生提供心理治療、藥物治療和胃繞道手術(shù)等肥胖癥治療支持。不過該指南也沒有完全舍棄傳統(tǒng)的減肥建議。它指出：“所有個體，無論是什么體型或體質(zhì)，都能從健康平衡的飲食習(xí)慣和定期運動中獲益。”