肥胖问题不能只看体重

Obesity is not just a matter of weight

林晓洁 供稿

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

加拿大的一份新临床指南称，肥胖与否应该视健康状况而定，而不只是体重。

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日发表在《加拿大医学协会期刊》上的这一指南特别对医疗系统中针对肥胖症患者的歧视发出了警告。该指南还建议医生不仅仅就膳食和锻炼方面给出医嘱，还应该关注肥胖的根源，从整体的视角来看待健康问题。

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.  

该指南的作者之一、加拿大肥胖组织的研究和政策主任西米娜·拉莫斯·萨拉斯称，研究显示许多医生对肥胖症患者存在歧视，而这种歧视会令患者的健康恶化，无论他们的体重是多少。

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.

尽管该指南仍建议人们采用身体质量指数和腰围作为诊断标准，但它也承认了临床治疗的局限性，并表示医生应该更多地关注体重是如何影响一个人的健康的。

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.

这份指南指出，体重微降大约3%到5%就可以改善健康，而且一个肥胖者的“最佳体重”可能不是他们根据身体质量指数算出的“理想体重”。该指南也强调，肥胖是一个需要终生管理的复杂慢性病。

"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."

“长期以来，我们一直将肥胖与生活方式关联在一起。肥胖也常常伴随着耻辱和责备。”拉莫斯·萨拉斯女士称，“但肥胖症患者和其他慢性病患者一样需要获得支持。”

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.

减肥通常很困难，因为大脑会通过饥饿感来补偿自身，从而鼓励人们吃更多东西。许多研究显示，大多数通过节食来减肥的人后来体重又反弹了。因此，医生应该和肥胖症患者一起关注对其有意义的健康目标，而不只仅仅是让患者少吃。

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，这一指南并没有简单地建议肥胖患者“少吃多动”，而是鼓励医生提供心理治疗、药物治疗和胃绕道手术等肥胖症治疗支持。不过该指南也没有完全舍弃传统的减肥建议。它指出：“所有个体，无论是什么体型或体质，都能从健康平衡的饮食习惯和定期运动中获益。”

【VOCABULARY】

1. admonish v. 警告  

2. discrimination n. 歧视

3. holistic adj. 整体的

4. diagnostic adj. 诊断的

5. bariatric adj. 肥胖症治疗的

6. gastric-bypass n. 胃绕道手术

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