肥胖問題不能只看體重！加拿大新臨牀指南對醫生髮出警告
一直以來，大家都認爲減肥就是“少吃多運動”，但是加拿大新發布的臨牀指南指出，治療肥胖更應該關注肥胖的根源，尤其要杜絕對肥胖者的歧視。
Obesity should be defined by a person's health - not just their weight, says a new Canadian clinical guideline.
加拿大的一份新臨牀指南稱，肥胖與否應該視健康狀況而定，而不只是體重。
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.
該指南還建議醫生不要只是就膳食和鍛鍊給出醫囑，而應該關注肥胖的根源，從整體的視角來看待健康問題。
The guideline, which was published in the Canadian Medical Association Journal on Tuesday, specifically admonished weight-related stigma against patients in the health system.
8月4日發表在《加拿大醫學協會期刊》上的這一指南特別對醫療系統中針對肥胖症患者的歧視發出了警告。
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，研究顯示許多醫生都歧視肥胖症患者，而這種歧視會令健康惡化，無論患者體重多少。
"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."
她告訴BBC說：“體重歧視不僅是對肥胖有誤解，實際上還會對保健醫師的行爲產生影響。”
The rate of obesity has tripled over the past three decades in Canada, and now about one in four Canadians is obese according to Statistics Canada.
過去三十年間，加拿大的肥胖率上升了兩倍，根據加拿大統計局的數據，現在約有四分之一的加拿大人是肥胖者。
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 person's health.
儘管最新指南仍建議人們採用身體質量指數和腰圍來作爲診斷標準，但指南承認了臨牀治療的侷限性，並表示醫生應該更多地關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.
指南指出，體重微降（大約3%到5%）可以改善健康，而且一個肥胖者的“最佳體重”可能不是他們根據身體質量指數算出的“理想體重”。
It emphasises that obesity is a complex, chronic condition that needs lifelong management.
指南強調，肥胖是一個需要終生管理的複雜的慢性病。
"For a long time we've associated obesity as a lifestyle behaviour... It's been a lot of shame and blame before," Ms Ramos-Salas says.
拉莫斯-薩拉斯女士稱：“長時間以來我們一直將肥胖與生活方式關聯在一起……肥胖在過去伴隨着許多恥辱和責備。”
"People living with obesity need support like people living with any other chronic disease."
“患有肥胖症的人需要和患有其他慢性病的人一樣的支持。”
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.
這一指南沒有簡單地建議肥胖患者“少吃多動”，而是鼓勵醫生提供心理治療、藥物治療和胃分流術等減肥手術這樣的支持。
The guideline doesn't completely do away with standard weight-loss advice.
不過該指南也沒有完全捨棄標準的減肥建議。
"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.
指南稱：“所有個體，無論是什麼體型或體質，都會從健康平衡的飲食習慣和定期運動中獲益。”
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.
但是，它指出，減肥通常很困難，因爲大腦會通過飢餓感來補償，從而鼓勵人們吃更多東西。
Many studies have shown that most people who lose weight on a diet gain it back.
許多研究都顯示，大多數通過節食來減肥的人後來體重又反彈了。
"Diets don't work," Ms Ramos-Salas says.
拉莫斯-薩拉斯女士稱：“節食沒有用。”
Physicians should also ask permission before discussing a patient's weight, and work with them to focus on health goals that matter to them, instead of just telling them to cut calories.
醫生應該先徵得允許才能討論患者的體重，並和患者一起關注對其有意義的健康目標，而不只是讓他們少吃。
