肥胖問(wèn)題不能只看體重

Obesity should be defined by a persons health—not just their weight， says a new Canadian clinical guideline.

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.

The guideline， which was published in the Canadian Medical Association Journal， specifically admonished weight-related stigma against patients in the health system.

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

“Weight bias is not just about believing the wrong thing about obesity，” she told the BBC. “Weight bias actually has an effect on the behaviour of healthcare practitioners.”

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

Small reductions in weight， of about 3%—5%， can lead to health improvements and an obese persons “best weight” might not be their “ideal weight” according to BMI， the guideline says.

It emphasises that obesity is a complex， chronic condition that needs lifelong management.

“For a long time weve associated obesity as a lifestyle behaviour... Its been a lot of shame and blame before，” Ms Ramos-Salas says.

“People living with obesity need support like people living with any other chronic disease.”

But instead of simply advising patients to “eat less， move more”， the guideline encourages doctors to provide supports along the lines of psychological therapy， medication and bariatric surgery like gastric-bypass surgery.

The guideline doesnt completely do away with standard 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.

However， it notes that keeping the weight off is often difficult because the brain will compensate by feeling more hungry， thus encouraging people to eat more.

Many studies have shown that most people who lose weight on a diet gain it back.

“Diets dont work，” Ms Ramos-Salas says.

Physicians should also ask permission before discussing a patients weight， and work with them to focus on health goals that matter to them， instead of just telling them to cut calories.

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。

該指南還建議醫(yī)生不要只是就膳食和鍛煉給出醫(yī)囑，而應(yīng)該關(guān)注肥胖的根源，從整體的視角來(lái)看待健康問(wèn)題。

發(fā)表在《加拿大醫(yī)學(xué)協(xié)會(huì)期刊》上的這一指南特別對(duì)醫(yī)療系統(tǒng)中針對(duì)與肥胖相關(guān)的歧視發(fā)出了警告。

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)生都歧視肥胖癥患者，而這種歧視會(huì)令健康惡化，無(wú)論患者體重多少。

她在接受BBC采訪時(shí)說(shuō)道：“體重歧視不僅是對(duì)肥胖有誤解，實(shí)際上還會(huì)對(duì)保健醫(yī)師的行為產(chǎn)生影響。”

盡管最新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(biāo)準(zhǔn)，但指南承認(rèn)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(gè)人的健康的。

指南指出，體重微降（大約3%到5%）可以改善健康，并且一個(gè)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”。

指南強(qiáng)調(diào)，肥胖是一個(gè)需要終生管理的復(fù)雜慢性病。

拉莫斯-薩拉斯女士稱：“長(zhǎng)時(shí)間以來(lái)我們一直將肥胖與生活方式關(guān)聯(lián)在一起……肥胖在過(guò)去伴隨著許多羞恥和

責(zé)備。”

“患有肥胖癥的人需要和患有其他慢性病的人一樣的

支持。”

這一指南沒(méi)有簡(jiǎn)單地建議肥胖癥患者“少吃，多動(dòng)”，而是鼓勵(lì)醫(yī)生提供心理治療、藥物治療和胃分流術(shù)等減肥手術(shù)這樣的支持。

不過(guò)該指南也沒(méi)有完全舍棄標(biāo)準(zhǔn)的減肥建議。

指南稱：“所有個(gè)體，無(wú)論是什么體型或體質(zhì)，都會(huì)從健康平衡的飲食習(xí)慣和定期運(yùn)動(dòng)中獲益。”

然而，指南指出，減肥通常很困難，因?yàn)榇竽X會(huì)通過(guò)更多饑餓感來(lái)補(bǔ)償，從而鼓勵(lì)人們吃更多東西。

許多研究都顯示，大多數(shù)通過(guò)節(jié)食來(lái)減肥的人后來(lái)體重又反彈了。

拉莫斯-薩拉斯女士稱：“節(jié)食沒(méi)有用。”

醫(yī)生應(yīng)該先征得允許才能討論患者的體重，并和患者一起關(guān)注對(duì)其有意義的健康目標(biāo)，而不只是讓他們減少卡路里的攝入。

Word Study

discriminate /d?'skr?m?ne?t/ v. 歧視;區(qū)別對(duì)待

They believe the law discriminates against women.

therapy /'θer?pi/ n. 治療;療法

Since Ive been in therapy， Ive grown to be a better husband and father.

compensate /'k?mpense?t/ v. 補(bǔ)償;彌補(bǔ)

Nothing can compensate for the loss of a loved one.