肥胖屬於疾病範疇的10大原因(下)

ity Impacts on the Proper Working of the Body

5.肥胖影響身體正常運轉

Ask a child what happens when you are sick or have a disease and the likelihood is that they will say that the disease stops 'some body part' working properly. Heart disease impacts the heart, lung disease the lungs etc. Obesity also impacts on the proper working of the body.

當你問小孩子生病會有什麼感覺時，他們很可能會說那種不適使“身體某些部位”不能正常工作了。心臟病會影響心臟，肺病會影響肺部，肥胖也會影響身體的正常運轉。

This impact on the body comes in two separate but connected ways. Firstly the increase in body mass can cause mechanical problems such as osteoarthritis, sleep apnoea and mobility problems. These will often be alleviated if the sufferer loses weight. Secondly the increase in the number of fat cells within the body can be the cause of a range of medical problems such as Heart Disease, Fatty Liver Disease, Infertility, High Blood Pressure etc. Such medical problems may not be easily reversed by a loss of weight.

肥胖對身體的影響主要有兩個方面，而它們既相互獨立又相互聯繫。第一，體重增加會導致機體問題，如骨關節炎、睡眠呼吸暫停和移動障礙。如果體重下降，那麼這些病症也常隨之減輕。第二，身體脂肪細胞數量的增加會導致一系列的健康問題，如心臟病、脂肪肝、不孕和高血壓等，而這類健康問題就不會隨體重的下降而得到緩解。

ity Works like Type II Diabetes

4.肥胖症的作用機理與2型糖尿病類同

When a person becomes obese their body starts to produce more of a hormone called Leptin than the bodies of people who are not. Leptin is responsible for telling the body when it is full in the same way that Insulin controls the body's response to Glucose. When a person produces too much Leptin they become resistant to it in the same way that someone with type II diabetes is resistant to Insulin.

一個人變得過於肥胖後，身體相較於正常人而言會產生更多稱之爲瘦蛋白（Leptin)的激素。這是一種傳達身體飽腹程度的激素，就像胰島素傳達體內葡萄糖含量一樣。當瘦蛋白過多，人會對其產生免疫作用，就跟二型糖尿病患者對胰島素產生抗體一樣。

As a person puts on weight their body secretes more Leptin – they are then no longer able to tell when they have eaten enough and so their body allows them to over-eat. Type II Diabetes is treated as a disease whether or not a person develops it as a result of genetic predisposition or as a result of a particular lifestyle. If this is true for Type II Diabetes then why not for obesity?

隨着人們體重上升，身體分泌出更多瘦蛋白，既而無法得知自己的飽腹水平，這樣一來就會過度飲食。不論二型糖尿病的病因是先天而來或是生活方式所致，人們都將其視作一種疾病來對待。所以，既然二型糖尿病受到了這種待遇，肥胖症又有何不可呢？

Body Adapts To a Specific 'Set Point'

3.肥胖影響“體重固定值”

Most people will have a stable 'set point weight' – the weight to which their body defaults. The scales may go up or down but they generally sit at or around this point. As a person puts on weight the body becomes used to a new normal – the set point changes and creeps up. When a person tries to lose weight the body will default back to its set point – it 'defends' the weight. This is why diets are often inefficient unless the person concerned is able to make a wholesale lifestyle change. Even then the body will often try to revert back if the person 'slips'. Not unlike an alcoholic who is never cured a person who does manage to lose weight is not able to give up on their new regime at any time.

大多數人都有一個穩定的“體重固定值”，這是身體默認的。平時的體重或高或低於這個數值，但通常都與其相差無幾。人的體重上升後，身體會適應一個新常態，這個固定值會緩慢上升。而當人們試圖減掉幾斤時，身體就自動想要回到那個“固定值”，捍衛原來的體重量。這也就解釋了爲什麼飲食調節對於減肥不太有效，除非減肥者可以顛覆原有的生活方式。不過即使是這樣，一旦減肥者稍有懈怠，身體就試圖故態復萌。恰恰就如一個不可治癒的酗酒者一樣，認真想要減肥的人也無法隨心所欲地拋棄自己的飲食起居習慣。

ity Meets the Definition of 'Disease'

2.肥胖符合疾病的定義

There is no single definition of disease but Webster's dictionary defines it as 'An alteration of the state of the body or some of its organs, interrupting or disturbing the performance of the vital functions and causing or threatening pain and weakness; malady; affection; illness; sickness; disorder…'

疾病的定義並不是單一的，其中《韋氏詞典》是這樣解釋的：一種身體和某些器官的變化；有礙於身體重要功能的發揮；導致疼痛、虛弱；身體失調；心情煩躁；身體不適；嘔吐；機能紊亂。

Obesity meets this definition in all respects. It alters the body– not only by increasing the size of the person suffering from the disease but by affecting the way in which the body produces or metabolises substances; by altering how efficiently some of the organs work or how well the person affected can move. It can cause the sufferer pain, discomfort, embarrassment. It exacerbates other underlying problems and is often, in its causes and effects beyond the control of the sufferer. Obesity has an effect on the physical and mental wellbeing of the sufferer and causes sickness or even death.

肥胖完全符合疾病的定義。它不但能改變人們的身體，使患者的體型變大，還能影響體內物質的新陳代謝，影響器官的高效運作和患者的行動能力。肥胖會使人難受，侷促不安和尷尬。它也會引發潛在的疾病。通常情況下，患者無法控制其因果，影響患者身心健康，甚至造成疾病或是死亡等後果。

ity Is Like Alcoholism or Depression – Once Seen As Lifestyle Conditions but Now Accepted As a Disease

1.肥胖就像酒癮和憂鬱——過去被認爲是生活方式，現在被列入疾病範疇

One hundred years ago alcoholics were given very little support. Not much was known about the psychology, physiology and mechanics of addiction and it was seen as a lifestyle problem – an addiction gone wrong. In years gone by people suffering from mental health problems were stigmatised, marginalised and told to sort themselves out. In these, more enlightened times, we look back at such attitudes with horror and compassion. People suffering from alcoholism or mental health problems have access to a wide range of support networks and treatments to assist them in dealing with their disease.

一百年前，酒鬼是得不到任何幫助的。當時，人們對心理學、生理學以及酒癮都不太瞭解，都認爲酒癮屬於生活方式問題——形成了錯誤嗜好。過去，患有精神疾病是可恥的、被排斥的。在如今開明的時代，人們回想曾針對那些精神疾病患者的態度時，難免感到恐懼，併爲患者感到十分同情。現在，無論是精神病患者還是醉漢都能獲得廣泛的支持和治療以擺脫困擾。

There is no reason to view obesity in a different light. Even if obesity in a particular person is connected to lifestyle instead of genetic issues there is no reason not to treat it as a disease. Alcohol or cigarettes are optional – we do not need them to survive. All people need to eat; even those who are obese. It is difficult to change a relationship with something that is a fundamental constant in life. You can say no to a glass of wine or beer every day for the rest of your life – you cannot say no to breakfast, lunch and supper. Obesity, as opposed to just being a little overweight, is a condition that is often beyond the means of the sufferer to fix without assistance. It is a disease that has been with us as long as people have been on the planet. Obesity can be inherited from family – if your parents are obese the strong likelihood is that you will be too. While obesity can cause or exacerbate many other health conditions such as heart disease or diabetes it can also be caused by underlying health problems. Once an obese person's body gets used to the weight it will work against attempts to lose it – our bodies are designed to 'defend' the highest weight we reach. Obese bodies become resistant to the hormone that tells us when we are full, in much the same way that a person can become resistant to insulin. Obesity limits life and the sufferer will most likely need medical assistance to deal with the problem. If Alcoholism, Lung Cancer, Cirrhosis, Depression are all diseases then so is Obesity. Obesity is a growing problem worldwide it is a complex issue with many underlying causes that require complex, multi-party solutions. If obesity is considered a lifestyle choice, it can be palmed off as the personal responsibility of the sufferer. If it is a disease with a social and economic impact it becomes a wider problem. The medical establishment can legitimately look for new and innovative ways to treat this disease. Governments will have to make conditions favorable for investment in treatment and ensure that it is accessible and affordable for all. They will promote healthy living; make sure that the urban environment is exercise friendly. Society needs to stop victim blaming and stigmatizing sufferers. Categorizing obesity as a disease is the first step in making these solutions possible and available to all.

所以，我們沒有理由特殊對待肥胖。即使某些人的肥胖是因爲生活方式問題而不是遺傳問題，但我們沒有理由把肥胖排除在疾病之外。人們可以自由選擇是否抽菸喝酒，但所有人都需要吃飯，肥胖的人也不例外。改變我們和基本生活需求的關係是非常困難的。你可以在你的餘生每天少喝一杯酒，但是你卻沒法不吃早飯、中飯或者是晚飯。肥胖跟略微超重不一樣，如果沒有人幫助，將會是患者無法解決的問題。只要人們還居住在星球上，這個疾病就會一直存在。肥胖也可能從家族遺傳——如果你的父母肥胖，極有可能你也會肥胖。在肥胖會導致心臟病、糖尿病之類的疾病的同時，潛在的健康問題也會引發肥胖。一旦一個人長期處於肥胖狀態，他便會習慣這種狀態，他的身體會自動阻礙他減肥——因爲人們的身體天生就有“偏袒高體重”的傾向。肥胖的人對傳達腹飽程度的荷爾蒙已形成了抵抗性，就跟糖尿病患者對胰島素的反應一樣。肥胖限制了我們的生活，肥胖的人也需要醫療幫助才能解決這個問題。如果酒癮、肺癌、肝硬化和抑鬱症都屬於疾病，那麼肥胖也應該是一種病。在全球，肥胖已經是一個日益嚴重的問題。肥胖是一個複雜的問題，由很多潛在因素引發，解決方法複雜多樣。如果肥胖被認爲是一種生活方式上的選擇，那麼這就是患者個人的責任。而如果肥胖是一種影響經濟社會發展的疾病，那麼它涉及的範圍就更廣泛了。如此一來，醫療機構就可以研究各種新穎方法來治療肥胖了。政府必須爲治療肥胖創造一個良好的投資環境，以確保所有人都能接受治療並負擔得起治療費用。政府還要倡導健康生活，保證城市環境有利於人們做運動以鍛鍊身體。同時社會也要開始停止對患者的責怪和恥笑。爲了讓這些解決方案行之有效，首要任務就是把肥胖歸到疾病這一類。

審校：哈利 來源：前十網