Let's Talk About Obesity

Living with obesity isn’t always easy; besides the health complications you may be experiencing, our society places an enormous stigma on individuals who are overweight. You may feel embarrassed or ashamed. But we at HealthCentral are here to tell you that you shouldn't have to feel that way. For starters, you’re not alone—far from it. Millions of other people living with this condition feel or have felt just like you do right now. We—and they—are here for you. On this page alone, you’ll discover the realities and challenges of obesity, along with the best treatments, helpful lifestyle changes, and all the crucial information to help you not just manage—but thrive. We’re sure you’ve got a lot of questions...and we’re here to answer them.

什么是肥胖，无论如何？

首先，让我们来谈谈肥胖不。这不是一个性格缺陷,懒惰的标志,or evidence of a lack of control. It’s not a reason to feel shamed or be made the punch line of a joke. Just liketype 1 diabetesor多发性硬化症，肥胖是一种疾病，以及难以控制一个，在那。

It’s a legitimate medical condition that occurs when your body accumulates and stores excess amounts of fat. Depending on one’s height and weight, obesity is divided into several categories, including Class 1, Class 2, and Class 3.

3类有时也称为“严重”或“极端”肥胖。（术语“病态肥胖”现在被认为是过时和过于诬蔑翻译：不要用它来形容自己或他人。）

Contrary to popular thought, people don’t choose to develop obesity; most people don’t wake up one morning and think, “Hey, today is a good day to become overweight to the point where it might damage my health and well-being.” Obesity is a result of a complex back-and-forth interplay of biological, psychological, and environmental triggers.

是的，营养和锻炼的事，但每过一年，研究人员揭示了越来越多的可能的影响因素，从缺乏睡眠对各种流行的药物，以肠道细菌，甚至儿时的耳部感染。

And while society as a whole seems to have no problem poking fun at those with obesity via memes and jokes, the truth is that obesity is now the norm in our country. According to new research published in theNew England Journal of Medicine, 40% of the U.S. population is currently living with obesity and that number is projected to rise to nearly half of the American population by the year 2030. Contributing to eight of the 10 leading causes of death in the U.S., obesity is a public health epidemic—and there's nothing funny about that.

What Causes Obesity in the First Place?

在最基本的层面，肥胖在热量摄入和支出不平衡的结果：当你消耗更多的热量比你消耗通过锻炼和日常生活活动，创建所谓的“正能量平衡” - 您的身体有在更多的燃料时间比它可以使用。如果继续下去，它可能会导致体重增加，可能还有肥胖。

但还有更多工作，不仅仅是这个充满挑战的情况下，“哎呀，我吃了太多的炸薯条。”也不能肥胖症遗传学完全归咎于，正如经常的情况。

专家认为，环境对我们身边每天都保持巨大支配着我们吃什么样的社会，经济，文化，甚至是物理因素，我们是多么的消费，如何迅速或低效我们燃烧它关闭。

Here are some of the most common culprits believed to be behind the obesity epidemic:

An Obesogenic Environment

专家认为，环境因素的星座可能是负责，部分信息，以提示我们不是需要每天吃更多的热量。总之，他们创造所谓的致胖，肥胖或促进，环境。其中一些功能包括：

• 对吃零食移位。Those calories tend to be in addition to our meals, meaning we don’t compensate for that 3 p.m. bag of chips by eating less at dinner.
• Mushrooming portion sizes。在20世纪50年代典型的快餐饮料是七盎司。今天的饮料往往42盎司。同时，汉堡包和鱼苗部分在尺寸上增加了两倍。
• Widespread availability of ultra-processed foods。We’re talking candy, cookies, chips, and soda—all of which somehow manage to be calorically high yet nutritionally devoid.
• 从家常菜渐行渐远。超过我们的卡路里一半来自家庭之外。这些菜肴往往是在脂肪和糖比自制熟食更高。
• 有针对性的营销。If you shop online for a certain less-than-healthy snack, targeted ads for similar products will start popping up on your social media feed. In another form of targeted marketing, companies that make fast food, soda, and other processed foods are known to concentrate their marketing efforts in black and Hispanic communities.
• Access to cars and public transportation。驾驶到处意味着没有必要走，和走路可以消耗热量。少热量的燃烧，同时进食同样数量的提高体重增加的几率。

Calorie Quality

不是所有的热量都是一样的。我们的意思是说杏仁100个卡路里的热量不会影响你的体重以同样的方式为100个卡路里的玉米片的。你的身体必须更加努力地工作，以消化食物，含有丰富的纤维和蛋白质比它消化精制碳水化合物，如白面包，面条，和糖果。研究人员称这种食物的“热效应”。

In a study published in the美国临床营养学杂志，受试者吃同样的饮食与相同数量的卡路里六周有一个例外：当它来到谷物，一个组中包含全谷类（糙米，全麦面包和燕麦），而其他吃精制谷物，如白面包。整个中粮集团那些人烧毁了近100更多的热量，每天，只是由于热效应。

Genetics

根据肥胖医学会会长，遗传学增加肥胖的几率由任何地方从40％至70％，并有已知与疾病强烈相关的超过200个基因。如果这些基因不能正常工作，是要明白，虽然他们提高发展为肥胖的危险，他们决不保证是很重要的。对于绝大多数的人来说，当谈到你的体重，你的命运确实是在你的手中。基因也与交互环境，以增加或体重增加的不健康的量减少一个人的几率。

Medications

A laundry list of prescription medications have been linked with weight gain, including steroids, antidepressants, hormonal contraceptives, medications for diabetes, bipolar disorder, insomnia, high blood pressure, seizures, epilepsy, and more.

睡觉

嗡嗡代谢和均衡的饥饿荷尔蒙是的，当我们登录足够Zzzzs所发生的健康促进作用的一群之中。适当的睡眠有助于平衡，使我们感到饥饿或全（分别生长素和瘦素）激素。

Too little sleep and ghrelin soars, driving you to eat more. Not to mention, staying up later gives you more time to eat, which also contributes to weight gain. In the landmark Nurses’ Health Study, which followed 68,000 middle-age American women for up to 16 years, women who slept for five hours or less were 15% more likely to develop obesity compared with those who slept seven hours a night.

是否肥胖了我的风险的其他条件？

肥胖rarely occurs in a bubble. While some people may be obese and have no serious co-existing medical conditions, they are the exception. As the second leading cause of preventable death in the U.S., obesity is a serious public health concern with far-reaching implications and reams of studies have linked it with more than 200 chronic diseases. Here are a few:

心脏病

随身携带过量的体重可以把对心脏的压力，迫使它更加努力地工作，以整个身体的血液送。个人谁是超重或肥胖有也往往具有条件独立筹集的风险heart disease，例如升高的胆固醇和高血压。

Type 2 Diabetes

In this increasingly common condition, a person’s blood sugar levels become chronically elevated. Up to 90% of adults with2型糖尿病携带额外的重量或有肥胖，也许是因为多余的重量能使细胞变得一个叫做胰岛素的激素，这是负责运送糖从血液到肌肉和脂肪细胞，它可以用于能量的能力更强。与胰岛素抵抗，糖留在血液中的时间量不合适，造成炎症。高血糖并发症包括心脏疾病，中风，肾病，截肢和失明。

萧条

肥胖的心理影响可能有助于depression，特别是女性。在澳大利亚的一项研究中，研究人员比较了48000多名抑郁症患者与没有它的近30万数据的数据。他们发现，个人谁有肥胖率45％更容易患抑郁症与那些谁有一个健康的身体质量指数进行比较。（身体质量指数被定义为一个人的公斤由它们身高米的平方除以体重）的链接可能是由于遗传变异，携带额外的重量，或其他因素的社会耻辱。

Cancer

截至都达到了惊人的40％cancers与肥胖有关。医生们发现肥胖与这些癌症之间的连接：

• Colon and rectum
• Breast (specifically, in post-menopausal women)
• 食管
• 胆囊
• 肾
• 肝
• Ovarian
• 胰腺
• 甲状腺

Cancer happens when cells in a part of the body grow abnormally or in an out-of-control manner. We don’t know exactly why obesity—or even just carrying extra weight—seems to drive cancer rates, but one theory is that fat cells may release hormones that impact this abnormal cell growth. Poor eating habits and/or a lack of physical activity also fuels cancer risk.

英年早逝

据发表在最近的一项研究国际肥胖杂志, people who have obesity live 5.6 to 7.6 fewer years than healthy-weight people. Those who have severe obesity can expect to live 8.1 to 10.3 years less.

…And More

睡眠障碍和反酸，腰痛，关节炎，和引起的过大的应力等并发症一起被放置在骨骼和关节，也由肥胖引起的。

怎么做医生诊断肥胖？

In 2013, the American Medical Association officially recognized obesity as a disease. This was a huge step forward in the eyes of many doctors and patients, as it served as an announcement to the nation that obesity is not a personal choice, but a complex, legitimate health condition.

Recognizing obesity as a disease is also important because it means that, like cancer, Crohn’s disease, and other widely-accepted medical conditions, health care providers can write prescriptions for treatment.

How to Calculate BMI

When diagnosing, most doctors and medical organizations use a measure called Body Mass Index (BMI) to determine whether a person has obesity or not. BMI is calculated via the following mathematic equation (Warning: You’ll likely need to use an在线转换工具，因为它们使用的国际单位制）：

体重（公斤）/身高（米）的平方= BMI

For adults…

• BMI of 25.0 to 29.9 = overweight
• BMI of 30 or more = obese

To put that in perspective, a woman who is 5’4” and weighs 175 is considered obese (BMI of 30). The same goes for a 5’9” man who weighs 204 pounds (BMI of 30.3).

肥胖是由类进一步划分：

• 类1 = 30.0 34.9 BMI
• Class 2 = BMI of 35.0 to 39.9
• 第3类，或重度肥胖= BMI≥40.0

赞成和反对使用BMI作为诊断工具都存在。那些赞成使用它的理解实际上它是一种快速，简便，无成本计算，并说它提供了一个人的风险的一个快速而可靠的快照。

Opponents feel it may be a misleading measurement, either incorrectly categorizing some people having obesity, as it doesn’t take muscle mass or body frame into account (in athletic individuals or those with highly muscular builds, for instance) or, more dangerously, classifying some people as healthy simply because they have a "normal" BMI, when in fact they may be at risk for weight-related health conditions due to哪里they carry their fat.

谁携带自己的体重周围的腹部（“苹果”身材类型），例如人，是在心血管疾病比那些谁携带他们的臀部（“梨”型）更多的重量增加的风险，即使他们有一个医学上可接受的BMI。腹部脂肪更令人担忧的，当谈到肥胖的效果。

有些人认为，一个更进步的诊断工具大概占身体不只是多余的脂肪，但引起的体脂不良健康效应的存在（见上文）。

什么是肥胖最好的治疗？

If you think obesity seems like a complicated disease, its treatments are equally complex. Physiologically speaking, it’s difficult to lose a significant amount of weight and keep it off. “Eat less and move more” is great advice when you have 10 pounds to shed; less so when you need to unload 50 or more. (In fact, while exercise is vital for weight maintenance, research suggests it's less effective in helping people to lose large amounts, unless you're work out at a super-intense level.)

So yes, the struggle is real. Ready for some encouraging news? Losing just 3% to 5% of your weight—and maintaining that loss—has the power to bring about important improvements in health. You can stabilize your blood sugar levels, lower your risk of developing type 2 diabetes, and more. Dropping more than that helps improve heart health and may be enough to reduce the dose of medication you take for various related chronic diseases.

考虑到这一点，检查出的治疗策略专家目前采用以帮助人们对抗肥胖，他们的成功几率。

Lifestyle Modification

这一类通常包括旨在帮助人们减肥的努力消耗更少的热量和增加体力活动。如果你与医疗服务提供者的工作，他或她可能会建议增加来帮助你留在轨道改变行为的工具，如设置具体的，可实现的目标;保持食物和锻炼杂志;和深挖掘，了解环境线索提示你不健康的方式吃。

％的人谁将会使用生活方式的改变达到他们的减肥目标：2％至5％

处方营养干预

A step beyond lifestyle medication, this category involves specific, prescribed behavioral modifications tailored to the individual’s unique environmental and genetic risk factors, with the goal of creating some sort of weight-loss advantage. Possibilities include (but are not limited to):

• 素食者的饮食
• 治疗碳水化合物减少（也称为酮饮食）

％的人谁将会使用规范的营养干预达到自己的减肥目标：5％至10％

药物治疗

The Food and Drug Administration has approved several medications for weight loss and chronic weight management. You need a BMI greater than 30 to qualify for a prescription, though those with a BMI greater than 27 as well as a weight-related health complication are eligible as well, even though they’re not technically obese.

A few examples of medications include:

• Alli (Orlistat)- 这种药物通过阻断食物中脂肪的吸收。当食用时减少约30％的脂肪，从食物吸收，在大便消除。
• Ozempic (Semaglutide)- 到2021年已被用于治疗糖尿病，这种药物有望成为适用于肥胖，属于一类药物GLP-1受体激动剂，并研究表明，它可以帮助一些人失去了重量高达20％。
• Suprenza (Phentermine)- 在大脑中食欲浸湿，这刺激神经递质的目标。

药物治疗requires medical supervision and is used in combination with nutrition and lifestyle changes.

％的人谁将会使用药物治疗达到他们的减肥目标：5％至20％

Endoscopic Procedures

术语“内窥镜”是指医生使用一个小的，灵活的仪器通过你的嘴，进入你的肠道。一旦进入，许多方法中的一个可以用来帮助减少食物的摄入。这些措施包括intragastric balloon, which is exactly what it sounds like: a balloon is inflated in the stomach, where it takes up space to lower your appetite and encourage the patient to consume smaller portions. In内镜缝合，细针脚缝到胃里面，使上较少的食物的人产生饱腹感。

从正面看，内窥镜程序在同一天，门诊的基础上进行，而且比手术（意味着更少的风险），创伤更小。不利的一面，他们还没有投保，所以你可以期待支付$ 5,000到$ 8,000个的口袋里。

Percent of people who will reach their weight-loss goal using these endoscopic methods: 10% to 20%

代谢手术（又名减肥手术）

这是治疗类最危险也是最伟大的成功率。手术通常是预留给人们提供了BMI大于40，或与肥胖相关的疾病以及身体质量指数超过35。它不只是大大减少你的体重的潜力，而且还可以帮助管理，改善甚至逆转超过40肥胖相关疾病，包括心脏疾病，睡眠呼吸暂停，高胆固醇血症，某些癌症，等等。在一些试验中，谁接受手术的患者70％表现型的缓解在几天内2型糖尿病。

几类代谢手术包括：

• 胃绕道- A surgeon essentially creates a new, much smaller stomach, then connects it directly to the small intestine. The first step reduces the amount of food that can be comfortably consumed (about two to six ounces at a time), and the second step prevents the body from absorbing as many calories as it otherwise would.
• 胃套（又名垂直胃切除术）- 像胃绕道手术，这限制多少人可以吃。不同于胃旁路，胃的约80％被除去。“套筒”，也有调节食欲的激素有很大的影响，所以人们一般只是觉得手术后那么饿了。

Insurance companies typically做涵盖代谢手术，只要你符合正确的标准。

％的人谁将会使用减肥手术的方法达到自己的减肥目标：20％至40％

What’s Life Like for People with Obesity?

Individuals affected by excess weight and obesity are on the receiving end of unwarranted disapproval and shaming by others in the workplace, in the dating world, at their doctor’s office, when dining out, at the gym, or just at the corner store, as other customers assess and judge their purchases. Studies have concluded that weight stigma is as pervasive as racial stigma.

被视为不值得尊重和热爱的影响可能是情绪困扰的和身体上和心理上的危险。可怜的自尊，抑郁，甚至轻生的念头都被广泛报道，受到肥胖的人。

Weight bias also impacts how and whether a person chooses to access health care. For example, studies have shown that women with obesity tend to skip preventive care appointments and routine gynecologic cancer screenings. Reasons include wanting to avoid interacting with providers who had previously expressed a negative attitude towards their weight or given unsolicited weight loss advice; fearing being asked to wear a too-small gown or sit on a too-small examining table; not wanting to be weighed; you get the point. The result is a supremely unhelpful catch-22, causing those who need medical help the most to avoid it.

讽刺的是，一些治疗比较成功的形式，如手术，本身就是耻辱。没有人会指责患有乳腺癌的女人需要一个乳房切除术，然而这对选举的人接受手术代谢听力共同应对。（“哇，什么是失败的。她不能在她自己失去它。”）

尽管如此，社会正慢慢向前的理解，肥胖是一种疾病，而不是一种生活方式的选择移动。用恭敬的语言（“person with obesity“ 代替 ”肥胖的人”)是一个主要的正确方向的一步,和exciting work is being done with regards to public health policy and treatment innovation.

如果你是肥胖的生活，找了一个多学科的减肥团队（他们往往附属于大学）可以帮助你想出一个策略，把你的身体的控制权。通过这些球队之一，你将有机会获得医生，心理学家，营养学家，健身专家和其他专家谁希望能帮助你，免判定。

在哪里可以找到我的肥胖社区？

人多势众，对不对？随着40％的美国人目前正与肥胖的生活，这个社区的人谁是正确的与你同在不乏其人。这个社区找到一种方式来相互鼓励 -will对方 - 为健康的未来。作为这个世界的一部分，似乎现在望而生畏，但这些影响力和单位部门会帮助你来与刻度上的一些术语，并通过自己的行程，鼓励你开始你自己的。

Top Obesity-Related Instagrammers

• Stella,@stellaisstriving

遵循这是因为：她开始在567磅，她已经失去了重量的43％以上。不开刀，只是食物的变化和运动。没有特效药，只是纯粹的决心。她有挫折？当然，她的人。可是，她老是推，她每天分享每英镑丢失，一口棚的每一个汗，她每次进字令人鼓舞。

• 香农·泰勒，@shannons_story

遵循这是因为：Like most people who set off on a weight-loss journey, Shannon’s did not stick the first time around... or even the fifth. It wasn’t until he met his medical match — his gastric sleeve surgeon — that it finally clicked. He’s the epitome of the saying, if it doesn’t work the first time, try, try again. He’s now on the road to completing an Ironman, but will never forget where he came from, so he shares the inspiration for how he got from there, to here, on his feed.

• Nichole,@pretty.n.sleeved

遵循这是因为：有一个在她的袖子比赛没有羞耻。其中关于她的饲料最好的报价不能响更真实：“减肥手术并不讨巧，因为如果你做了手术才有效。”有减肥手术还是有自己艰辛的主机，它并不适合所有人。她南瓜手术是从肥胖的替罪羊的烙印，同时不断重新点燃她的自我问责坚持下去。

• Mike "Gormy” Gorman,@gormy_goes_keto

遵循这是因为：He’s not going to sugarcoat it. It’s hard work and tough choices, every single day. But for someone who ate his way down (yes, ate his way down) from 540lbs to 205lbs, he’ll tell you it’s worth it. Gormy shares his keto lifestyle, while also spilling some life lessons about living with obesity—including the mental “weight” on your shoulders that comes along with this condition.

Top Obesity-Related Podcasts

• 肥佬论坛。Gormy的再次回来 - 这一次与播客，不仅记载了他300磅的重量损失，也照在其他男人有惊人的减肥旅程的焦点。他们来自每个POV生活，听他们的战术各界你会在几个小时吸（或天...）。
• 肥胖Panacea Podcast。两博士候选人肥胖和减肥主机这个播客中，该产品采用了减肥新产品评论，看好节目，和趋势的迷恋。他们带来的高手潜入肥胖的选择，同时也围绕这种疾病的心理和社会规范。
• 该播客燃烧脂肪。如果播客的名字没有告诉不够......这个播客的目的是帮助你吃干净，找出最适合你，最终，燃烧脂肪的锻炼。通过主机洛瑞Shemek博士和健康教练奥马尔·康伯巴奇的支持，这是当你需要有关获取健康的知识，你听播客and在鼓励每天推。

前肥胖有关的单位和支持团体

• 肥胖协会。This nonprofit organization believes there’s a science behind obesity — it’s not just about your environment and life choices, it’s chemical, it’s inside you. While helping you understand that, they also do the work to create science-based treatments to change your life.
• 肥胖Action Coalition。需要为您的旅程肥胖供应商？他们得到了你。感到这将是最好的在这个过程中社区？他们有一个。想参加的脸对脸或虚拟会议，让你重新振作？下来吧。这家非盈利有你需要的实际上是成功的在你的减肥之旅的一切。
• LEAD for Rare Obesity。这个令人难以置信的团队支持那些与肥胖的遗传性疾病，如POMC，LEPR，鲜红斑痣，和其他人，你可能只知道，如果你是其中的一个影响。作为该集团的一部分（也有许多support groups to choose from within LEAD) makes you feel like — maybe for the first time in your life — that you’re understood.