Why Your Body Fights Weight Loss | Katherine Saunders | TED

譯者: Lilian Chiu 審譯者: 麗玲 辛

I'm going to tell you something that's going to surprise you.

我等下要告訴各位的事， 會讓各位很驚訝。

It might be upsetting.

可能會感到不安。

And for some of you, it might explain a lot.

對在座某些人來說， 它可能解答了很多問題。

And maybe I can convince you that it's liberating.

也許我還能說服各位這是種解脫。

Your body is evolutionarily conditioned to gain weight,

在演化上，為了適應環境， 我們的身體很自然就會傾向增重，

which means that your body is also evolutionarily conditioned

意即，各位的身體已經演化成

not to lose weight —

天生就不想減重——

and definitely not to keep weight off.

且肯定不會想要保持體重不變。

According to one explanation called “the thrifty gene hypothesis,”

根據一個稱為「節儉 基因假說」的理論，

when we were hunter gatherers,

當我們以前還是狩獵採集者時，

our body's powerful anti-starvation responses helped us survive.

我們身體強大的抗飢餓反應 幫助我們生存下來。

We had to find our food and sometimes we couldn't,

我們必須覓食，但有時就是找不到，

so our bodies stored calories to keep us alive.

因此身體會儲存熱量 來維持我們的生命。

The better we stored calories, the better our chance of survival.

熱量儲存得越好， 生存的機會就越高。

So what changed?

那，發生了什麼改變？

Nowadays, if we can afford food,

現今，如果我們買得起食物，

there's plenty of it, everywhere.

食物其實非常充足，到處都能取得。

We don't have to hunt.

我們不必狩獵，

Even the gathering is easy.

就連採集也很容易。

We can order food to be delivered directly to our sofa,

我們可以訂購食物， 在家坐著等就會送上門，

與二十年前相比， 現今食物的份量也相當大。

and portions are huge compared to even 20 years ago.

And a lot of food is tasty, but not so great for us.

且很多食物都很好吃， 只是對我們不是那麼健康。

We're living in what obesity doctors like me

對肥胖專科醫生， 像我，我們現在生活在

call an obesogenic environment:

所謂的肥胖促成環境中：

limited need for any kind of physical activity,

不太需要任何形式的身體活動，

and easy access to inexpensive,

且很容易取得不昂貴、

calorie-rich, nutrient-poor food

高熱量、低營養的食物 或類似食物的物質。

or food-like substances.

Our bodies, primed to keep us alive,

我們的身體天生的設計 就是要維持生命，

have gone into overdrive

但現在身體得加倍努力，

to store all these calories from all of that food,

把所有攝取的食物熱量 通通儲存起來，

just in case.

只為了預防萬一。

And this is one of the reasons why we have an obesity epidemic

這就是美國肥胖症盛行的原因之一。

in the United States,

where 42 percent of adults have obesity,

42% 的成人有肥胖症，

and when we take a look at overweight and obesity combined,

如果把過重和肥胖一起計算，

that number goes up to 74 percent.

比例就高達 74％。

Let's go back to the biology part of the equation because it gets worse.

咱們回來談談 這個問題的生物學部分，

因為這部分更糟嚴重。

For example,

比如，

a high-fat diet damages nerve cells

高脂飲食會損害神經細胞，

in the area of our brain called the hypothalamus,

且是大腦下視丘區域的神經細胞，

which is like a thermostat,

下視丘就像溫度計，

regulating how hungry we are

調節我們的飢餓程度，

and how we use energy.

以及要如何運用能量。

When these nerve cells or neurons become inflamed,

當這些神經細胞或神經元發炎時，

feedback signals from our guts, our digestive system,

來自腸道、消化系統， 和脂肪細胞的反饋訊號

and our fat cells

can't get through to our brain

就無法送到大腦，

to tell us to stop eating when we're full,

無法在已經吃飽時， 告訴我們該停止進食了，

and to stop storing calories when we're not at risk of starvation.

也無法在沒有挨餓的風險時， 告訴身體該停止儲存熱量了。

It literally becomes harder to tell how full we are after eating,

因此就更難在進食後， 分辨出我們到底吃多飽，

and how much fat our bodies really need

以及身體究竟需要多少脂肪來維生。

to keep us alive.

如果沒有準確的調節感測器，

Without an accurate thermostat sensor,

our bodies store more calories as fat,

身體會將更多的熱量 以脂肪的形式儲存起來，

and we're more prone to what we call food noise

而我們也會更容易受到 所謂食物噪音的影響，

or persistent thoughts of food,

或者說會一直想著食物，

often leading to maladaptive eating behavior.

這通常會導致適應不良的飲食行為。

And this is how weight gain leads to weight gain.

這就是為什麼體重增加後， 就會繼續增加下去。

It's a vicious cycle.

這是個惡性循環。

And there are other factors that compound the situation.

還有其他因素讓情況變得更複雜。

Some people are even more genetically susceptible to obesity

有些人的基因就是比較容易肥胖，

or develop health complications like sleep apnea,

或者會出現影響健康的併發症， 如睡眠呼吸中止症，

that can worsen obesity and other health outcomes.

那可能會導致肥胖及其他 健康問題都變得更加嚴重。

Many people have even less access and ability to afford healthy food,

許多人可能很不容易取得 或負擔不起健康的食物。

罪魁禍首之一可能是藥物，

and medications can be a huge culprit,

因為許多常見的處方藥

with so many common prescriptions

and over-the-counter drugs that are weight-promoting.

和非處方藥都會促成體重增加。

And people with obesity are extremely,

而肥胖的人非常非常可能

extremely likely to experience weight bias, stigma and discrimination,

會遇到與體重相關的偏見、 汙名，和歧視的情況，

which can worsen obesity.

可能會讓肥胖變得更嚴重。

And I can go on and on about factors

除了吃太多和運動太少之外，

other than eating too much and exercising too little

會導致體重增加的因素 太多了，說也說不完。

that lead to weight gain.

Oh wait, there's one more thing.

哦，等等，還有一點。

When people with obesity try to lose weight,

當肥胖的人試圖減重時，

their bodies freak out and think they're starving.

他們的身體會很驚慌， 以為他們在挨餓。

The hunger hormone, ghrelin, increases

飢餓荷爾蒙，即飢餓素，會增加，

and the fullness hormones decrease.

飽足荷爾蒙則會減少。

It's not your imagination.

這不是你在幻想。

Every time you diet, your body holds on to calories.

你每次節食時，

你的身體會緊抓著熱量不放。

Your metabolic rate slows down

你的新陳代謝速度會減慢，

身體的運作如同挨餓時的反應。

and your bodies behave as if you're starving.

This metabolic adaptation is fantastic

這種新陳代謝的調適很厲害，

if, say, you find yourself on a deserted island

假設你淪落到無人的荒島上，

with nothing but papaya and tree bark to eat.

能吃的東西就只有木瓜 和樹皮時，就需要這個機制。

But if your coworker has a bottomless candy bowl,

但如果你同事有 一大碗吃不完的糖果，

it makes life rough.

這機制會讓你生活更加煎熬。

So have I convinced you

現在，各位是否相信

that obesity isn't just a lack of willpower?

肥胖並不只是缺乏意志力的問題？

We know all of this from tons of medical research

許多資料來源都支持這個說法， 包括大量的醫學研究

and rigorously designed scientific studies,

及嚴謹設計的科學研究，

but also from the TV show "The Biggest Loser."

還有電視節目《減肥達人》。

If you haven't watched it,

如果各位沒看過 《減肥達人》這個節目，

"The Biggest Loser" is a show

where people with obesity compete to lose weight.

它是個讓肥胖者比賽減重的節目。

What happens in the show, and what we've seen in other studies,

節目中發生的狀況以及我們 在其他研究中看到的發現，

is that the weight comes back eventually for most people.

都顯示大部分減重的人 體重最後還是會回復。

We know that within two years,

我們知道，在兩年內，

half of the weight is regained,

減掉的重量有一半會增加回來，

and within five years, 80 percent can be regained.

五年內，八成會復重。

這並不表示《減肥達人》的 勝利者就是輸家。

This doesn't mean that "The Biggest Loser" winners are losers.

This means that weight loss itself is often a losing battle.

這表示減重本身通常 就是一場打不贏的仗。

In 2017,

2017 年，

有位叫做芭芭拉的病人 走進我的辦公室。

a patient named Barbara walked into my office.

She had given up.

她已經放棄了。

She had a lifetime of struggle with her weight.

她一輩子都為體重所苦，

I mean, just some awful, awful treatments and experiences.

盡是些很糟糕很糟糕的治療和經驗。

Barbara's pediatrician started her on stimulant medications

芭芭拉的小兒科醫生 要她開始服用興奮劑，

when she was just seven years old,

那時她才七歲，

and by the age of ten her parents had enrolled her in Weight Watchers.

她十歲時，她的父母幫她 報名參加體重監察員計畫。

Throughout her life,

芭芭拉一輩子就是不斷減掉一百磅，

Barbara would lose 100 pounds,

regain them and lose 100 pounds again.

又增加一百磅， 接著再次減掉一百磅。

And while her weight went up and down,

雖然她的體重會上上下下，

her shame remained constant.

她感到的羞恥卻始終如一。

Barbara ultimately underwent a gastric bypass surgery,

芭芭拉最終接受了胃繞道手術，

but after the initial weight loss,

起初體重確實有下降，但之後，

the pounds just crept back.

體重又回復了。

It felt like Barbara's body was conspiring against her

感覺就好像芭芭拉的身體 在秘謀策對抗她，

because it was.

的確如此。

And this is when Barbara was referred to me.

此時，芭芭拉就被轉介給我。

芭芭拉表現出完全絕望的樣子，

Barbara presented completely hopeless

and blaming her lack of willpower.

且怪罪自己缺乏意志力。

What else could it be?

不然還會有什麼原因？

I did two things that day

那天，我做了兩件事，

that completely transformed Barbara's life.

完全改變了芭芭拉的人生。

第一，我告訴她： 「這不是你的錯。」

One, I told her, "This is not your fault,"

and two,

第二，

I gave her hope that I knew exactly what was going on with her body,

我給了她希望，因為我很清楚 她的身體是怎麼回事，

and we had the tools to treat her disease effectively.

且我們有辦法 可以有效治療她的疾病。

Barbara had been made to feel her whole life

芭芭拉一生中，別人都讓她覺得

like her weight was her fault,

她的體重是她的錯，

when in reality she has a disease.

但實情是，她生病了。

Obesity is a disease,

肥胖是一種疾病，

and for those who have it,

對於肥胖的人來說，

for their complex set of individual reasons,

每個人都有許多複雜的個人原因，

it can be extremely, extremely hard to treat.

讓肥胖變得非常非常難治療。

Does anyone believe it

有人會相信寫著「均碼， 適合所有人」的服飾標籤嗎？

when a clothing label reads "one size fits all?"

No, no, right?

不會吧？

Especially when it comes to obesity,

談到肥胖時更是如此，

of course not, one size fits none.

當然不可能有適合 所有人的解決方案。

For some fortunate folks, diet and exercise work.

有些人很幸運，靠飲食 和運動可以有效改善。

For others, surgery works.

其他人則可以靠手術來達成。

But for most people with obesity,

但對於大部分肥胖的人來說，

effective treatment requires a combination,

有效的治療

是將多種治療方法

a personalized combination,

of more than one treatment approach

做個人化的組合，

delivered by a trained care team.

並由受過訓練的照護團隊來執行。

People with obesity should be treated like individuals with any other disease,

肥胖症者受到的對待方式， 應該和任何其他疾病的病人一樣，

any other complex chronic disease.

和所有複雜慢性疾病的病人一樣。

An empathetic, reasonable, thoughtful,

要由一位有同情心、理性而周到、

trained provider assesses each individual patient one by one,

訓練有素的照護提供者

逐一評估每一位病人，

understands their version of the disease

了解疾病在他們身上的反應，

and comes up with a very personalized,

再提出非常個人化的

long-term treatment approach.

長期治療方法。

Obesity medications have absolutely transformed our field.

肥胖藥物徹底改變了我們的領域。

When I started practicing obesity medicine,

當我開始從事肥胖醫學時，

the most effective medications we had

我們最有效的藥物

were associated with five to 10 percent total body weight loss,

大約能協助減輕 總體重 5% 到 10% 的重量，

which was still a lot.

這算是很多。

But now we can help our patients lose even more weight

但現今，我們可以 幫助病患減掉更多體重，

and more importantly,

更重要的是，

much, much more importantly,

更加重要的是，

keep that weight off long-term.

能長期維持那個體重。

This new frontier is absolutely astonishing

這種新的進展讓人感到驚艷，

and transformative to our field and to our patients' lives.

且能夠轉變我們的領域 以及病人的生活。

But we don't want to fall into a pharmacologic craze

但我們不能陷入藥物狂熱，

and think that the only way to treat obesity is with medication.

認定肥胖就只能靠藥物來治療。

We have an entire armamentarium of lifestyle interventions,

我們有一整套的解決方案，

包含生活方式的干預調整、

other medications, and other treatment approaches.

其他藥物，以及其他治療方法。

Treatment, in fact, in whatever form it takes,

事實上，不論是哪種形式的治療，

should be the last step in the process.

都應該是整個過程中的最後一步。

The first, and maybe the most critical

第一步，也許也是最重要的一步，

is to finally put an end to the stigma

是希望最終能消除

與肥胖相關的汙名、 羞恥感、責怪，及評斷。

and the shame and the blame

and the judgment surrounding obesity.

Understanding obesity as the complex chronic disease that it is,

了解肥胖本身就是複雜的慢性疾病，

is essential to liberate individuals

這是解放病人的關鍵，

and to help them actually get the care that they need.

也能協助他們取得所需的照護。

Plus, when we accurately appreciate the reality of obesity,

此外，當我們能正確地 認識肥胖的真實樣貌時，

this will lead to more innovation and to more treatments.

就能促成更多的創新和更多治療。

我們已經不再是狩獵採集者了。

We're not hunter-gatherers anymore.

Well, except we are.

嗯，除了事實上，我們就是。

Think about the buffet line.

想想自助餐的排隊人潮。

Think about the "all you can eat" food,

想想「吃到飽」的食物，

all the "grab and go" food at your grocery store.

想想超商的「輕便即食」食物。

Think about the endless snacks in office environments.

想想辦公環境中吃不完的零食。

Our biology drives our brain, our bodies

我們的生物特性會驅動我們的大腦、

我們的身體，和行為，

and our behavior to act as if we're still gathering

當作我們仍然在飽食與飢荒交替的 環境中採集，來採取相應行動。

in a feast or famine environment.

Medications are not a quick fix,

藥物並非速效的解決方案，

nor are they the easy way out.

也不是輕鬆的捷徑。

Medications are a tool

藥物是工具，

to help our bodies adapt

能協助我們的身體適應

to our 21st century obesogenic environment.

二十一世紀的肥胖促成環境。

They help quiet the food noise

藥物能協助降低食物噪音，

so we can make better food choices,

讓我們能做出更好的食物選擇，

and they give us a fighting chance

並提供我們一搏的機會，

to take on this terrible adversary once and for all.

迎戰這個可怕的對手，

一勞永逸解決它。

Thank you.

謝謝。

(Applause)

（掌聲）