朱莉·埃斯特利克

For many of us, the beginning of a new year brings enthusiasm for a fresh start. If you’ve struggled with weight issues and you’re ready to make a change in 2019, forget fad diets and extreme workouts, 当地专家说.

对你的饮食模式做一个诚实的评估，建立健康的饮食和锻炼习惯，这对你来说是可持续的，会带来更好的结果. When it comes to achieving a healthy weight, the stakes are often higher than just fitting into a new pair of jeans. A person who is overweight is at an increased risk for heart disease, 中风, 2型糖尿病, 某些癌症, 更差的心理健康状况.

肥胖在临床上的定义是根据你的体重来估计你的脂肪储存, 体格, 和高度. 身体质量指数(BMI)是用来定义一个人是否超重或肥胖的一种衡量标准. (见下图)

世界卫生组织和国际医学界和科学界现在承认肥胖是一种慢性疾病, progressive disease resulting from many diverse factors. It’s no longer considered a cosmetic issue, but a health hazard.

Currently, Colorado has the lowest prevalence of adult obesity in the nation at 22.6 percent, compared to a high of 38 percent in West Virginia. 然而, 自2001年以来，拉里默县和全州肥胖居民的比例持续上升, based on self-reported data from the Behavioral Risk Factor Surveillance System, 这是疾病预防控制中心和州卫生部门正在进行的一项调查.

肥胖的复杂性

解决肥胖问题, seek help from a specialist who understands the complexities of the disease, 比如注册营养师(RDN)或专门研究肥胖医学的医生.

“There is rarely one issue that is behind obesity—a lack of time, your work and home environment, 社会影响是所有会使健康饮食之旅变得非常紧张的因素,谢尔比·考克斯说, interim director of Kendall Reagan Nutrition Center at Colorado State University. 考克斯是注册营养师，也是肥胖和体重管理方面的认证专家，并为许多超重和肥胖患者提供咨询.

A successful weight-loss strategy is about a lot more than simply reducing calorie intake. It starts with understanding what motivates a person’s eating habits and food choices.

例如, 许多人说，他们在处理焦虑或抑郁等心理健康问题时，会把食物作为治疗方法. Stress can drive us to seek comfort foods that are salty, 含糖的, 而且脂肪含量高, 比如薯片, 巧克力, 还有通心粉和奶酪. Often referred to as “emotional eating,“食用这些高热量的食物可以让人暂时感到情绪振奋，不那么沮丧, 但它并不能有效地解决潜在的问题，还会给体重管理带来额外的挑战, 考克斯指出.

她建议那些担心情绪化进食的客户除了咨询营养师或肥胖医生外，还应咨询心理健康专家. 事实上, Cox emphasizes that taking the stress out of eating is key, 因为“在已经很复杂的情况下增加应激激素会让减肥变得越来越困难。.”

开始减肥之旅的一种方法是提出一个人可以做出的现实改变，并在开始时获得动力, such as including more vegetables at dinner, 或者不不吃饭. 另一种方法是计划和准备更多的自制饭菜，以取代不太健康的餐馆饭菜.

不需要痛苦

A big problem with many weight-loss diets is that they are too restrictive. Then, when a person stops following the plan, the weight returns. 研究表明，负重上下骑行对健康有害.

So, 忘记那些“为了变瘦而忍受痛苦”的日常生活吧，因为有规律的体育锻炼加上健康的饮食是保持健康体重的更好方法, and also prevents the development of chronic diseases and other health conditions.

“A combination of cardio and strength training is recommended, because each plays a different but important role in weight loss,考克斯说. “You want to find fitness that feels good, 不是惩罚, but a celebration of what your body can do.”

向你的医生咨询医疗许可，然后找一个有资格的运动专家, which is someone who has a combination of education and training, to provide exercise guidance as part of your weight-loss team.

手术的选择

对于有肥胖并发症的人来说，单靠改变生活方式无法降低风险, 指南建议将处方减肥药物甚至手术添加到他们的整体健康计划中. 体重的大幅增加会导致神经通路的物理变化，使其难以恢复, 专家说, meaning that eating less can’t change the body’s physiology. That’s where medication comes in.

大多数fda批准的减肥药都能降低食欲，增加进食后的饱腹感. 本质上, the medications mimic more food coming in and stimulate more nerves, which give more of a signal to your brain that you’re full. 还有一种药物可以通过阻断分解脂肪的酶来抑制脂肪的吸收.   

美国临床内分泌学家协会和美国内分泌学会的指导方针指出，对于体重指数超过27的人，甚至有一种轻中度肥胖并发症, weight-loss medications should be considered along with lifestyle changes. Examples of complications include 2型糖尿病, 高血压, nonalcoholic fatty liver disease, or obstructive sleep apnea. If you are living with a severe obesity complication and have a BMI over 27, weight-loss medication is recommended together with lifestyle therapy. 体重指数大于35且至少有一种严重并发症的患者应考虑进行减肥手术, according to the guidelines. 

重要的是要找一位在肥胖医学方面有认证的医生，他可以根据你的病史帮助你选择合适的药物. Only a professional can help you manage the risks and benefits of different drugs.

然而, 如果你已经尝试了不同的减肥药，并排除了其他可能导致减肥效果不佳的原因, 包括生活习惯, barriers to proper exercise and 营养, and any prescriptions that cause weight gain, surgery might be an option for you.

柯林斯堡外科医生. 罗伯特·奎德(Robert Quaid)是落基山脉健康减肥中心的医疗主任，他与许多肥胖患者打交道, 这是北科罗拉多外科协会和uhealth Poudre Valley医院的一个共享项目. 他看到减肥手术帮助病人达到减肥和改善健康的目标.

“减肥手术, such as gastric bypass and gastric sleeve, reduces the size of the stomach, limiting the amount of food that the body can take in at one time,奎德解释道. “导致身体将自身调节到较低体重水平的代谢变化是手术更重要的影响. 幸运的是, 这两种变化共同作用，使我们的病人即使不能吃很多东西也不会感到饥饿.”

大多数保险公司要求患者在手术前完成一段特定时间的医疗监督饮食, 他指出. 他们必须与注册营养师进行一对一的饮食咨询，了解手术后的饮食情况，并参加分享健康生活方式信息的课程.

Shrinking the stomach is just one step on the weight-loss journey, which also demands a lifetime commitment to good diet, 营养, and regular exercise to maintain the benefits. “减肥手术是一种用来达到健康体重和减少慢性疾病的工具,奎德说。. “In order to sustain their weight loss, patients need to continue to incorporate healthy lifestyle changes and habits.”

最后，虽然减肥目标很重要，但它们必须是现实的、可实现的，考克斯说. “Achieving 5 to 10 percent weight loss in six months may not seem like a lot, but it can lower your blood pressure, lower your risk for diabetes, 让你更健康.”