让我们来谈谈肥胖

生活与肥胖并不容易;除了health complications you may be experiencing, our society places an enormous stigma on individuals who are overweight and obese. You may feel embarrassed or ashamed. But we at HealthCentral are here to tell you that 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.

What Is Obesity, Anyway?

First, let’s talk about what obesityisn’t。这不是一个性格缺陷，懒惰的标志，或缺乏控制的证据。这不是一个理由感到羞愧或制成一个笑话的妙语。就像type 1 diabetesormultiple sclerosis, obesity is a disease—and a difficult-to-control one, at that.

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.

Class 3 is sometimes referred to as “severe” or “extreme” obesity. (The term “morbid obesity” is now considered archaic and overly stigmatizing. Translation: Don’t use it to describe yourself or others.)

与流行的想法，人们不选择开发肥胖;大多数人没有一天早晨醒来，并认为，“嘿，今天是个好日子，成为超重的地步，它可能会损害我的健康和福祉。”肥胖是生物，心理和环境诱因的复杂回往复相互影响的结果。

Yes, nutrition and exercise matter, but with every passing year, researchers are uncovering more and more possible contributing factors, from lack of sleep to various popular medications to gut bacteria, and even childhood ear infections.

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 the新英格兰医学杂志, 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.

是什么原因导致肥胖的发生吗？

At its most basic level, obesity is a result of an imbalance in caloric intake and expenditure: When you consume more calories than you burn through exercise and activities of daily living, you create what is called a “positive energy balance”—your body has taken in more fuel than it can use. If that continues unchecked, it can lead to weight gain and, possibly, obesity.

But there’s far more to this challenging condition than just, “Whoops, I ate too many fries.” Nor can obesity be blamed entirely on genetics, as has often been the case.

Experts now believe that environment—the social, economic, cultural, and even physical factors that surround us every day—hold enormous sway over what we eat, how much we consume, and how quickly or inefficiently we burn it off.

下面是一些最常见的罪魁祸首被认为是肥胖的流行背后：

一个致胖环境

Experts think a constellation of environmental factors may be responsible, in part, for prompting us to eat more calories in a day than needed. Together, they create what is called an obesogenic, or obesity-promoting, environment. Some of these features include:

• A shift towards snacking。这些热量往往是除了我们的饭菜，这意味着我们不能弥补那个下午3点通过在晚餐吃得少的芯片袋。
• 采蘑菇的份量。A typical fast food beverage in the 1950s was seven ounces. Today's drinks are often 42 ounces. Meanwhile, hamburgers and fry portions have tripled in size.
• 超加工食品普及。我们谈论的糖果，饼干，薯片，苏打 - 所有这些都以某种方式设法是calorically高但营养缺乏。
• Drifting away from home cooking。More than half of our calories come from outside the home. These dishes tend to be higher in fat and sugar than home-cooked food.
• Targeted marketing。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。Driving everywhere means there’s no need to walk, and walking burns calories. Less calorie-burn while eating the same amount of food raises the odds of weight gain.

卡路里质量

Not all calories are created equal. What we mean by that is that 100 calories of almonds don’t affect your weight in the same way as 100 calories of nachos. Your body has to work harder to digest foods that are rich in fiber and protein than it does to digest refined carbohydrates, such as white bread, pasta, and candy. Researchers call this the “thermic effect” of food.

在a study published in theAmerican Journal of Clinical Nutrition, subjects ate the same diet with the same number of calories for six weeks with one exception: when it came to grains, one group incorporated whole grains (brown rice, whole wheat bread, and oats) while the other ate refined grains like white bread. Those people in the whole grain group burned nearly 100 more calories per day, simply due to thermic effect.

遗传学

根据肥胖医学协会,创etics increase the odds of obesity by anywhere from 40% to 70%, and there are more than 200 genes known to be strongly associated with the disease. If you have one or more of these genes, it's important to understand that while they raise the risk of developing obesity, they by no means guarantee it. For the vast majority of people, when it comes to your weight, your fate is truly in your hands. Genes may also interact with the environment to increase or decrease one’s odds of gaining an unhealthy amount of weight.

药物

一箩筐的处方药en linked with weight gain, including steroids, antidepressants, hormonal contraceptives, medications for diabetes, bipolar disorder, insomnia, high blood pressure, seizures, epilepsy, and more.

Sleep

A humming metabolism and well-balanced hunger hormones are among the bevy of health-promoting effects that happen when we log enough Zzzzs. Proper sleep helps balance the hormones that make us feel hungry or full (ghrelin and leptin, respectively).

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 become obese compared with those who slept seven hours a night.

Does Obesity Put Me at Risk for Other Conditions?

肥胖很少发生在泡沫。虽然有些人可能是肥胖的，并没有严重共存的医疗条件，他们是例外。作为在美国可预防性死亡的第二大原因，肥胖是有深远的影响，并研究令纸已经有超过200种慢性疾病有关它一个严重的公共卫生问题。这里有几个：

Heart Disease

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者也往往具有条件独立筹集的风险heart disease, such as elevated cholesterol and high blood pressure.

Type 2 Diabetes

在这种越来越普遍的情况下，一个人的血糖水平成为慢性升高。截至成人的90％，type 2 diabetesare overweight or obese, perhaps because excess weight causes cells to become more resistant to a hormone called insulin, which is responsible for ferrying sugar from blood to the cells, where it can be used for energy. With insulin resistance, sugar remains in the blood for an inappropriate amount of time, creating inflammation. Complications of high blood sugar include heart disease, stroke, kidney disease, amputation, and blindness.

Depression

The psychological impact of obesity may contribute todepression, especially in women. In an Australian study, researchers compared the data of more than 48,000 people with depression with data of nearly 300,000 without it. They found that individuals who were obese were 45% more likely to develop depression compared with those who had a healthy Body Mass Index. (Body Mass Index is defined as a person’s weight in kilograms divided by the square of their height in meters.) The link may be due to genetic variations, the social stigma of being overweight, or other factors.

癌症

Up to a staggering 40% of all癌症are linked to obesity. Doctors have found connections between obesity and these cancers:

• Colon and rectum
• 乳房（特别是在绝经后的妇女）
• Esophagus
• Gall bladder
• Kidney
• Liver
• 卵巢
• Pancreas
• Thyroid

当癌症细胞在身体的一部分生长异常或外的控制的方式发生。我们并不确切地知道为什么肥胖甚至只是超重，似乎推动癌症发病率，但是一种理论是，脂肪细胞会释放荷尔蒙，影响这个异常细胞的生长。不良的饮食习惯和/或缺乏体力活动也助长癌症风险。

Premature Death

According to a recent study published in the在ternational Journal of Obesity人们谁是肥胖现场5.6至7.6近年来比正常体重的人少。这些谁是严重肥胖的预期寿命8.1至10.3年代少了。

…And More

Sleep disturbances and acid reflux, along with low back pain, arthritis, and other complications caused by excessive stress being placed on the bones and joints, are also caused by obesity.

How Do Doctors Diagnose Obesity?

在2013年，美国医学协会正式认可肥胖病。这是一个巨大的进步在很多医生和患者的眼睛，因为它担当了宣布国家，肥胖不是个人的选择，而是一个复杂的，合法的健康状况。

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.

如何计算BMI

When diagnosing, most doctors and medical organizations use a measure called Body Mass Index (BMI) to determine whether a person is obese or not. BMI is calculated via the following mathematic equation (Warning: You’ll likely need to use anonline conversion tool, as it utilizes European metrics):

Weight (in kilograms) / Height (in meters) squared = BMI

对于成年人...

• 25.0 BMI至29.9 =超重
• 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is further divided by class:

• Class 1 = BMI of 30.0 to 34.9
• 类2 = 35.0至39.9 BMI
• Class 3, or severe obesity = 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 as obese, 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 towherethey carry their fat.

People who carry their weight around the belly ("apple" body types), for instance, are at increased risk for cardiovascular disease over those who carry more weight around their hips ("pear" type), even if they have a medically acceptable BMI. Belly fat is more worrisome when it comes to the effects of obesity.

Some believe that a more progressive diagnostic tool would account for not just excess body fat, but the presence of adverse health effects caused by that body fat (see above).

What Are the Best Treatments for Obesity?

如果您认为肥胖似乎是一个复杂的疾病，其治疗方法也同样复杂。从生理上说，这是很难减肥的显著量和保持它关闭。“少吃多运动”是当你有10磅摆脱伟大的意见;少，所以当你需要卸载50个或更多。（事实上​​，虽然运动是维持体重至关重要的，研究表明，它在帮助人们失去大量的，除非你的工作了，在一个超级激烈的程度不太有效。）

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.

With that in mind, check out the treatment strategies experts currently employ to help people fight obesity, and their odds of success.

Lifestyle Modification

This category typically includes weight loss efforts designed to help people consume fewer calories and increase physical activity. If you’re working with a healthcare provider, she or he may recommend adding behavior change tools to help you stay on track, such as setting specific, attainable goals; keeping a food and exercise journal; and digging deep to learn about the environmental cues that prompt you to eat in unhealthy ways.

Percent of people who will reach their weight-loss goal using lifestyle modifications: 2% to 5%

Prescriptive Nutritional Interventions

超越的生活方式药物的一步，这一类涉及个体化的独特环境和遗传危险因素具体，规定的行为的修改，与创建某种减肥优势的目标。可能性包括（但不限于）：

• vegetarian or vegan eating
• 间歇性禁食
• therapeutic carbohydrate reduction (a.k.a. the Keto diet)

Percent of people who will reach their weight-loss goal using prescriptive nutritional interventions: 5% to 10%

Pharmacotherapy

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.

药物的几个例子包括：

• 阿利（奥利司他）- This drug works by blocking the absorption of dietary fat. When taken, about 30% less fat is absorbed from food and eliminated in the stool.
• Ozempic (Semaglutide)- Already used to treat diabetes, this drug is expected to be available for obesity by 2021. It belongs to a class of drugs called GLP-1 receptor agonists, and studies suggest it can help some people lose as much as 20% of their weight.
• Suprenza（芬特明）- This stimulant targets neurotransmitters in the brain that dampen appetite.

药物治疗需要医疗监督，结合使用营养和生活方式的改变。

Percent of people who will reach their weight-loss goal using pharmacotherapy: 5% to 20%

内镜手术

The term “endoscopic” means a doctor uses a tiny, flexible instrument to enter your gut through your mouth. Once inside, one of a number of approaches may be used to help reduce food intake. These include anintragastric balloon，而这正是它听起来是这样的：气球在胃中，在那里它占用的空间来降低食欲和鼓励病人消耗较小的部分膨胀。在endoscopic suturing, tiny stitches are sewn into the inside of the stomach, making a person feel fuller on less food.

On the upside, endoscopic procedures are done on a same-day, outpatient basis, and are less invasive than surgery (meaning fewer risks). On the downside, they are not yet covered by insurance, so you can expect to pay $5,000 to $8,000 out of pocket.

％的人谁将会使用这些方法内镜达到他们的减肥目标：10％至20％

Metabolic Surgery (a.k.a. bariatric surgery)

This is the treatment category with the most risk but also greatest success rate. Surgery is usually reserved for people with a BMI higher than 40, or a BMI over 35 along with an obesity-related health condition. It has the potential to not just drastically reduce your weight, but to also help manage, improve or even reverse more than 40 obesity-related conditions, including heart disease, sleep apnea, high cholesterol, certain cancers, and more. In some trials, 70% of patients who undergo surgery show remission of type 2 diabetes within a few days.

A few types of metabolic surgery include:

• 胃旁路手术- 外科医生，创建了一种新的，更小的胃，然后直接将其连接到小肠。第一步骤减少，可以（在一个时间约二至六个盎司）被舒适地消耗的食物的量，和所述第二步骤防止主体从吸收如，因为它会否则多少卡路里。
• Gastric Sleeve (a.k.a. Vertical Sleeve Gastrectomy)——就像胃旁路手术,这限制了多少心on can eat. Unlike gastric bypass, about 80% of the stomach is removed. “The Sleeve” also has a strong effect on appetite-regulating hormones, so people generally just feel less hungry after the procedure.

保险公司一般docover metabolic surgery, so long as you meet the proper criteria.

Percent of people who will reach their weight-loss goal using bariatric surgical methods: 20% to 40%

What’s Life Like for People with Obesity?

在dividuals 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.

The effects of being treated as unworthy of respect or love can be emotionally haunting and physically and psychologically dangerous. Poor self-esteem, depression, and even suicidal thoughts have all been widely reported in individuals affected by obesity.

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.

Ironically, some of the more successful forms of treatment, such as surgery, are themselves stigmatized. No one would ever fault a woman with breast cancer for needing a mastectomy, yet that’s a common response to hearing of someone electing to undergo metabolic surgery. (“Wow, what a failure. She couldn’t lose it on her own.”)

Still, society is slowly moving forward with an understanding that obesity is a disease and not a lifestyle choice. Using respectful language (“人与肥胖” instead of “obese person”) is a major step in the right direction, and exciting work is being done with regards to public health policy and treatment innovation.

If you are living with obesity, finding a multidisciplinary weight loss team (they’re often affiliated with a university) can help you come up with a strategy to take control of your health. Through one of these teams, you’ll have access to physicians, psychologists, nutritionists, exercise specialists, and other experts who want to help you, judgement-free.

Where Can I Find My Obesity Communities?

Power in numbers, right? With 40% of Americans currently living with obesity, this community has no shortage of people who are right there with you. This community finds a way to encourage each other —willeach other — into a healthier future. Being a part of this world may seem daunting right now, but these influencers and orgs will help you come to terms with the number on the scale, and through their own journeys, encourage you to start your own.

前肥胖有关的Instagrammers

• 斯特拉，@stellaisstriving

Follow because:She started at 567 lbs and she has lost over 43% of that weight. No surgery, just food changes and exercise. No miracle drug, just pure determination. Does she have setbacks? Of course—she’s human. But she keeps pushing, and she shares every pound lost, every sweat of morsel shed, and every encouraging word on her feed, daily.

• Shannon Taylor,@shannons_story

Follow because:喜欢谁掀起减肥旅程大多数人而言，香农没有坚持在第一时间周围...甚至第五。但直到他遇到了他的医疗比赛 - 他的胃套外科医生 - 它最后点击。他是说的缩影，如果它不工作的第一次，尝试，再尝试。他现在的道路上完成了铁人三项，但永远不会忘记他来自何方，所以他分享了他从那里得到怎样，在这里，他进了灵感。

• 蔻，@ pretty.n.sleeved

Follow because:There is NO shame in her sleeve game. One of the best quotes on her feed could not ring more true: “Weight-loss surgery is NOT the easy way out because the surgery only works if YOU do.” Having weight-loss surgery still has its own host of hardships, and it’s not for everyone. She squashes the stigma of surgery being the scapegoat from obesity, while constantly reigniting her self-accountability to keep going.

• Mike "Gormy” Gorman,@gormy_goes_keto

Follow because:他不会去粉饰它。它的辛勤工作和艰难的抉择，每一天。但有人谁吃了他一路下滑（是的，吃了他的方式向下）从540lbs到205lbs，他会告诉你这是值得的。Gormy分享他酮的生活方式的同时，也洒关于与肥胖，包括你的肩膀上的精神“权重”，用该条件走来住一些生活的经验教训。

前肥胖有关的播客

• The Fat Guy Forum。Gormy’s back again — and this time with a podcast that not only chronicles his 300lb weight loss, but also shines the spotlight on other men with phenomenal weight loss journeys. They come from all walks of life and hearing their tactics from each POV will suck you in for hours (or days...).
• 肥胖Panacea Podcast。Two Ph.D. candidates with a fascination for obesity and weight-loss host this podcast, which feature reviews on new products, promising programs, and trends for weight-loss. They bring in the experts to dive into options for obesity, but also the mental and social norms around this disease.
• This Podcast Burns Fat。在case the name of the podcast wasn’t telling enough... this podcast aims to help you eat clean, find the workouts that are right for you, and ultimately, burn fat. Backed by hosts Dr. Lori Shemek, and health coach Omar Cumberbatch, this is the podcast you listen to when you need the knowledge about getting healthyandthe encouraging daily push.

Top Obesity-Related Orgs and Support Groups

• The Obesity Society。这个非盈利性组织认为有肥胖背后一门科学 - 这不只是你的环境和生活的选择，它的化学，它是你内心。同时帮助您理解的是，他们也做了工作，创造科学为基础的治疗，以改变你的生活。
• 肥胖行动联盟。Need a provider for your obesity journey? They got you. Feeling like it would be best to be in a community for this process? They have one. Want to attend face-to-face or virtual conference to keep you reinvigorated? Come on down. This nonprofit has everything you need to actually be successful on your weight-loss journey.
• LEAD珍稀肥胖。This incredible group supports those with genetic disorders of obesity, like POMC, LEPR, PWS, and others that you likely only know if you are affected by one of them. Being a part of this group (and there aremanysupport groups to choose from within LEAD) makes you feel like — maybe for the first time in your life — that you’re understood.