探索GLP-1类药物对心理健康的影响，Rachel Goldman博士主讲

过去几年间，以诺和泰（Ozempic）和维格威（Wegovy）为代表的GLP-1类药物兴起，彻底改变了美国社会关于体重与肥胖问题的讨论方向。

Over the past several years, the rise of GLP-one drugs such as Ozempic and Wegovy has changed the conversation around weight and obesity in The US.

这类原本用于治疗糖尿病的GLP-1药物，如今已得到广泛应用。

Once reserved for treating diabetes, GLP-1s are now widely available.

最新调查显示，12%的美国成年人曾服用过GLP-1类药物，另有14%表示有意尝试。

One recent survey found that twelve percent of American adults have taken a GLP-one medication, and another fourteen percent are interested in doing so.

对许多人而言，这些药物带来了颠覆性的改变。

For many people, the drugs have been life changing.

但伴随生理变化的，是使用者需要面对的心理健康、情绪波动及人际关系等新挑战。

But along with physical changes, people taking GLP-1s often need to navigate new mental health, emotional, and relationship concerns.

当前心理健康专家正在研究如何为这些人群提供最佳支持。

Now mental health professionals are thinking about how best to support people through these challenges.

那么GLP-1类药物的作用机制是怎样的？

So how do GLP-one drugs work?

人们在决定是否使用时需要考虑哪些因素？

What should people consider when they're deciding whether or not to take them?

这些药物可能对心理健康产生哪些积极或消极影响？

What effects, both positive and negative, might these medications have on mental health?

体重减轻会如何影响人们与家人、朋友及伴侣的关系？

How does weight loss affect people's relationships with their family, friends, and partners?

为何GLP-1类药物仍面临使用污名化？

Why is there still stigma around the use of GLP-1s?

患者应如何应对并避免这种污名化的伤害？

And how can patients navigate and protect themselves from that stigma?

欢迎收听《心理学访谈》——美国心理学会旗舰播客节目，探索心理科学与日常生活的深刻联系。

Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life.

我是主持人金·米尔斯。

I'm Kim Mills.

今天我的嘉宾是博士。

My guest today is Doctor.

雷切尔·戈德曼，纽约市执业心理学家，同时担任纽约大学精神病学系临床助理教授。

Rachel Goldman, a licensed psychologist in private practice in New York City and a clinical assistant professor in the Department of Psychiatry at NYU.

她的临床实践专注于压力管理、饮食行为、肥胖治疗和健康行为改变。

Her practice focuses on stress management, eating behaviors, obesity treatment and health behavior change.

2011年至2016年间，她曾担任贝尔维尤医院肥胖与体重管理中心的高级心理学家。

From 2011 to 2016, she served as senior psychologist at the Center for Obesity and Weight Management at Bellevue Hospital.

除了临床工作外，博士。

In addition to her clinical work, Doctor.

戈德曼博士经常作为健康专家出现在媒体上，包括担任奥普拉专家小组成员，以及在《纽约时报》《时代》和《今日美国》等出版物上发表观点。

Goldman is frequently featured as a health expert in the media, including as an expert panelist with Oprah and in publications including The New York Times, Time and USA Today.

博士。

Doctor.

戈德曼博士，感谢您今天接受我的采访。

Goldman, thank you for joining me today.

非常感谢。

Thank you so much.

今天能在这里与您交流，特别是讨论这个话题，我感到非常兴奋。

I'm so excited to be here with you today and especially talking about this topic.

所以谢谢您。

So thank you.

那么，让我们从一个基本问题开始。

Well, let's start with a basic question.

这些GLP-1类药物是如何起作用的？

How do these GLP-one drugs work?

当人们服用这些药物时，大脑和身体会发生什么变化？

What's happening in the brain and the body when people take these medications?

是啊，这个问题问得真好。

Yeah, such a great question.

GLP-1类药物实际上是模拟一种名为GLP-1的天然激素，它能帮助调节血糖水平并促进减重。

So GLP ones actually mimic a natural hormone called GLP one, which helps regulate blood sugar levels and promotes weight loss.

用更通俗的话来说，根据我的客户反馈，这类药物能让人更快产生饱腹感，同时减少'食物噪音'——这是近几年来出现的新术语，但这种现象其实你我可能早就见识过，只是现在才有了正式名称。

So now to kind of take that to easier terms, so to say, what I always hear with my clients is that it helps them feel full faster and it also decreases food noise, which is a new term that we've been hearing for the past few years now, but it's something that probably you and I have known about or seen in individuals for many years, but now we have a name for it.

GLP-1类药物的实际效果是：使用者能更快获得饱腹感，减少对食物的渴望，这种'食物噪音'的降低使他们进食量减少，从而促进减重并有助于糖尿病治疗。

So really what we're seeing with GLP-1s is that individuals are getting full faster, they're decreasing cravings and this food noise allowing them to eat less food, and that is promoting weight loss as well as helping with diabetes.

最新研究还发现它对心脏病等其他疾病也有益处。

There's also new research out related to heart disease and other things as well.

那么这些药物会对人的心理产生什么影响呢？

And what's happening to people mentally as a result of taking these drugs?

是的。

Yeah.

我是说，心理层面确实会产生很多变化。

So I mean, lot of things are happening mentally.

首先我想说明，这些药物并非对所有人都有效。

And and I think first, you know, I want to just mention that these medications don't work for everybody.

今天我们讨论的主要是最常见的反馈情况。

So the things that we're going to be talking about today is kind of like what we hear most of.

但有些客户反映效果不太理想，或者出现了严重副作用。

But I have clients that it's not really working so well for them or they have really bad side effects.

所以希望大家能记住这点。

So, you know, kind of just keeping that in mind.

我注意到，对于那些长期受健康问题和体重困扰的人来说，这些药物在他们绝望时重燃了希望。

What I have really noticed with my clients and with individuals that have really been struggling with their health and their weight for years is that these medications are giving them hope when they have lost hope.

具体来说，这些患者多年来一直受'少吃多动'这种说法的困扰。

And really what I mean by that is individuals that have been struggling with these messages that we've been told for years, eat less, move more.

突然间，当他们可能吃得少一点、动得多一点时，他们看到了变化。

All of a sudden now when they are maybe eating less and moving a little more, they're seeing change.

而在此之前，我认为许多患有肥胖症的人都在努力改变健康行为，非常拼命，但却没有看到结果——我不想妄加揣测，但可能是像你或我这样的人会看到的结果。

Whereas before, I think a lot of individuals that have the disease of obesity would be doing those health behavior change and trying really hard, but not seeing the results that maybe I don't want to assume, but maybe somebody like you or I would.

对吧？

Right?

所以对一些人来说，少吃一点、多动一点确实能让他们更健康或减轻体重。

So for some people eating a little less and moving a little more works for them to get healthier and or to lose weight.

但对另一些人来说，这并不奏效。

And for some people that doesn't do it.

他们大脑中有某种信号在告诉他们仍然饥饿，或者真的在抵抗体重变化或抵抗这种阻力。

There's something in their brain that's telling them you're still hungry or is really fighting that weight change or fighting the resistance.

而药物正在消除这部分障碍。

And the medications are taking that of that piece away.

所以我喜欢这样说：它让那些一直在挣扎的人与从未真正挣扎过的人站在了同一起跑线上，也许去健身房多一点，他们就能看到成功和改变。

So I like to say it's putting individuals that have struggled on an even playing field with people that really haven't struggled and that maybe going to the gym a little bit more, they're able to see that success and that change.

所以我认为我们都知道减肥有一些积极的影响，特别是如果你长期努力减肥的话。

So I think we know that there are some positive aspects to losing weight, especially if you've been trying to do so for a long time.

然后你服用其中一种药物，看到效果发生，感觉会更好。

And then you take one of these drugs and you see it happening and you you feel better.

但对人们的心理有哪些负面影响呢？

But what are some of the negative effects on people's psyche?

是的。

Yeah.

我很喜欢你提出这个问题的方式，因为你知道，有些人在较大的体型中也非常快乐，这并不意味着他们必须减肥，对吧？

So and I'm glad the way you phrased that question also because, you know, some individuals are also very happy in a larger body, and that doesn't mean that they have to lose weight, right?

所以有些人患有肥胖症或一直在挣扎，这是他们的目标之一，而且我们知道过多的体脂并不健康，长期来看还可能导致其他疾病。

So some individuals have the disease of obesity or have struggled, and this is a goal of theirs, and we know excess body fat is not healthy and can lead to other diseases down the road as well.

但有些人确实需要注意他们的减重情况。

But some individuals, they have to be mindful of their weight loss.

我们不希望人们减重过多，或者他们本就不需要减重且身体健康，却为了服用这些药物而进一步减重。

And we don't want individuals to lose too much weight, or maybe they don't need to lose weight and they're healthy and they're trying to get on these medications and losing more weight.

所以这真的因人而异。

So it really depends.

我想提醒大家，每个人都是独特的个体，都有自己的故事和挣扎。

I like to remind people, everybody is a unique individual and everyone has their stories and their struggles.

有些人可能已经情绪低落，心理健康状况较差，可能有抑郁、焦虑等问题。

So some individuals may already be feeling kind of low and have lower mental health, maybe have depression, anxiety, things like that.

而这些药物并不一定能消除这些问题，甚至可能适得其反，对吧？

And these medications aren't necessarily going to just make that go away and or could be the opposite, right?

比如你目前生活中正面临什么状况？

Like what is going on in your life right now?

现阶段把减重纳入考虑范围是否合适？

Is weight loss a good thing to add to the equation or not right now?

对吧？

Right?

所以这就像权衡利弊，同时考虑一个人的心理状态和身体健康状况。

So it's kind of like weighing the pros and cons and thinking where somebody is mentally and with their physical health conditions.

因此这确实取决于具体情况。

So it really depends.

根据我的观察，大多数服用这些药物的人在心理和生理上都开始感觉好转。

Most individuals that I've seen, again, I would say that they are starting to feel better mentally and physically on these medications.

再次强调，我不能代表所有人，但多数人在减重变健康、看到努力见效后，会获得更强的自我价值感、自尊心和身体形象认同。

Most, again, I can't speak to everybody, but most people as they're losing weight and they're getting healthier and they're seeing that what they're doing is working, they get a sense of increased self worth, increased self esteem, increased body image.

很多人如果之前有社交孤立的情况，这时候往往会开始增加社交活动，但反之也有可能。

A lot of times people start to socialize more if they were isolating before things like that, but it could work in the other direction as well.

所以有些人可能会害怕外出社交或去餐厅吃饭，因为他们现在可能只吃很少量的食物，而且不想和别人分享这一点，对吧？

So some individuals might be fearful to go out and socialize and go out to dinner because maybe they're only eating such a small amount of food now, and maybe they don't want to share that with others, right?

或者他们还没准备好和别人分享这件事。

Or they're not ready to share that with others.

所以我认为这真的取决于个人的情况和他们的目标。

So again, I think it really depends where individuals are and what their goals are.

但两种情况都有可能，这就是为什么我总说，在理想情况下，每个使用GLP-1药物的人都应该咨询营养师和心理健康专家，来帮助他们应对生活中这种重大变化。

But it can go either way, which is why I always say, in a perfect world, everybody on a GLP-one would be seeing a dietitian and a mental health professional to help guide them and navigate this kind of really big change that's happening in their life.

嗯，这个观点很有意思，也引出了人们该如何思考这些药物是否适合他们的问题。

Well, that's an interesting point, and it raises a question of how people can think through whether these medications are right for them.

那么人们在开始使用这些药物前，应该问自己或医疗保健提供者什么问题？如果医生愿意开处方的话？

So what are the questions that people should ask themselves or their health care providers before they start on one of these drugs and if their doctor will even prescribe?

是的。

Yeah.

我认为第一个问题是：你目前或过去是否在健康或体重方面遇到困扰？

So I think the first question is, are you or have you been struggling with your health and or your weight?

对吧？

Right?

我喜欢从整体角度提出这个问题，因为体型较大并不一定意味着你不健康。

And I and I like to put that overall again because just being a larger body doesn't mean that you're necessarily unhealthy.

所以这是第一个问题。

So that's the first question.

你有这方面的困扰吗？

Are you struggling?

我经常说的另一件事是：如果有这个念头，就像我常说的心理治疗一样——

Another thing I always say is if the thought is there, it's the same as I say about therapy actually.

如果你一直在考虑是否要接受心理治疗，这可能就是个寻求帮助的信号。

If you've been thinking about maybe going for therapy, it's probably a sign seek it out.

对吧？

Right?

去咨询一下心理健康专家。

Ask, you know, get a mental health professional.

也许你可以先做个咨询。

Maybe you have a consult.

也许你会觉得这不适合你。

Maybe you decide it's not for you.

如果你在想：这适合我吗？

If you're thinking, is this right for me?

这是我应该尝试的吗？

Is it something I should try?

这应该是个信号，提醒你该和医疗专业人员谈谈这件事。

That should be a signal to talk to your health care professional about it.

打个电话预约吧，我一直在想这事是否适合我，和你的医生好好聊聊。

You know, make the phone call make the appointment, it's been on my mind, is this right for me, and talk that through with your doctor.

因为这确实取决于你的病史，取决于很多因素，只有你和医疗专业人员共同才能做出最佳决定。

Because really, it depends on your medical history, it depends on so many things that really just you and your healthcare professional together can make the best decision.

我还想提醒的是，如果有人曾有饮食失调史，若他们决定使用GLP-1类药物，我会特别要求密切监测。

Things I also like to keep in mind though is if somebody has a history of an eating disorder, I would actually really want to be closely monitoring that person if they decide to go on a GLP one.

再次强调，用药后食欲会减弱，这说明药物在起作用，但我们也不希望效果过强。

Again, there is this lesser appetite that comes along with it, which means it's working, but we don't want it to work too well either.

所以如果你有饮食失调史，我强烈建议不仅要咨询医疗专业人员，还要找心理治疗师——希望你已经有一位能帮你度过这个阶段的治疗师。

So, you know, if you do have a history of an eating disorder, I would really recommend not only speaking to your health care professional, but also getting a therapist or hopefully you have a therapist that can help guide you through this as well.

我认为这些是首要事项，能让你迈出第一步去和医疗专业人员沟通。

I would say those are the main things to first get you in the door to talk to your healthcare professional about.

就像我说的，最终决定权在于你和你的医生。

And then like I said, it's really the decision is yours and your doctor's.

我特别强调'你和你的医生'这一点，因为外界有太多信息了。

And I really emphasize the yours and your doctor's because there's a lot of messages out there.

外界有太多观点了，除了你和你的医生讨论外，没人知道什么最适合你和你的健康状况。

There's a lot of opinions out there, and nobody knows what is right for you and your body and your health besides you and talking with your doctor about it.

我知道我们接下来还会谈到羞耻感和评判的问题，但这就是为什么我要强调这一点。

So and I know we're gonna get to the shame and the judgments in our conversation as well, but that's why I like to emphasize that.

因为如果你一直在与这个问题抗争，这是一种可用的治疗方案，而且对很多人都有效。

Because if this is something that you've been struggling with, this is a treatment option that is available, and it works for for many people.

再次说明，虽然很多人会有一些不良副作用等问题，但它对很多人确实有效。

Again, a lot of people have some bad side effects and things, but it works for many people.

这是你完全可以考虑也应该考虑的一个选项。

And it's something that you could totally consider and should be considered.

现在你在诊所里会见到正在使用GLP-1类药物或想要使用的人。

Now you see people in in your practice who are on GLP one or would like to be on a GLP-one.

如果医生说'我认为你不适合'而病人仍坚持要使用，确实有些渠道可以获得这类药物？

Now, if the physician says, I don't think you're a candidate and the patient says, I still want it, and there are places where you can get it?

你会对这些患者说什么？

What do you say to those folks?

是否存在更安全的供应商？有些渠道比其他更好吗？

Are there safer distributors than there are some better than others?

当然。

Sure.

这个问题很棘手，因为并非所有医生都真正了解GLP-1类药物的科学研究和最新进展。

And and that's that's a tough one because, you know, I I don't think all physicians are really up on the science and the research and what's going on with GLP ones.

所以我认为有些医生会直接拒绝说'不行'。

So I think some individuals or some physicians right away are just like, no.

我认为你不适合使用。

I don't think you're a candidate.

我不想让你用这个药。

I don't want you on it.

如果是这种情况，如果你觉得你的医生可能因为不完全理解而不支持，我实际上会建议你去寻找一位肥胖医学专家，或者看一位专门研究这个领域的内分泌学家，因为不是所有初级保健医生都会放心开这种处方。

And if that's the case, if you feel like your physician may just not be on board because they don't fully understand, I would actually say to seek out an obesity medicine specialist and or see an endocrinologist that really specializes in this area because not every primary care physician is going to be comfortable prescribing this.

当然，还有一些人我认为并不真正符合标准，但仍然想要用药。

And then, of course, you have the individuals that I would say don't really meet criteria and still want it right.

所以，是的，不幸的是有些地方你可以拿到药，但我还是希望人们能真正去看一位在这个领域受过培训、知道如何开处方的医疗专业人士。

So, yes, there's places out there unfortunately that you can get it but again, I would want individuals to be really seeing a healthcare professional who is trained in this area and knows what they're doing with the prescriptions.

有些人剂量增加得太快，然后就会有更严重的副作用。

Some people kind of go up too quickly in the dosages and then they have worse side effects.

而且任何药物都要经过所有的临床试验。

And also with any medication, they are tested through all the clinical trials.

已经有相关研究了。

There's research out there.

它们是经过FDA批准的，有特定适应症，而且Erbesan有特定的使用标准。

They're FDA approved and indicated for something, and there are certain criteria for Erbesan.

所以每当我们听到这些关于这种或那种副作用的消息时，我的问题总是：如果用药的人是药物针对的人群，你可能就不会有那些其他副作用了。

So whenever we hear these things of, Oh, this side effect or that side effect, my question is always, well, if the people that are on the medications are ones that the medication is made for, you might not be having some of those other side effects.

所以要特别注意这一点。

So to just be extra mindful of that.

是的，我们每天都在了解更多关于GLP-1受体激动剂的信息。

And yes, we are learning more about GLP-1s every day.

有更多研究正在发表。

More research is coming out.

甚至就在我们说话的时候，还有更多药物正在研发中。

More medications are even being developed as we speak.

目前它们是一周注射一次的药物。

Right now, they're once a week injectables.

很快就会有每日服用的片剂上市。

There's going to be daily tablets pretty soon.

还会有每周服用的片剂。

There's going be weekly tablets.

所有这些产品都在研发中即将面世。

There's all these things in the works coming out.

所以我们每天也在了解更多新进展。

So we're learning more every day also.

但我真心希望听众能咨询专业医疗人员，他们熟悉相关研究并接受过专业培训，可能需要内分泌学家或肥胖医学专家的诊疗。

But I would really want individuals listening to go to a health care professional that is up in the research and is trained in this area, and that might need seeing an endocrinologist or an obesity medicine specialist.

我们将短暂休息一下。

We're going to take a short break.

回来后，我将与Goldman医生讨论为何GLP-1类药物仍存在污名化，以及患者如何应对并保护自己免受其影响。

When we return, I'll talk to doctor Goldman about why there's still a stigma around GLP one use and how patients can navigate and protect themselves from that.

我们来谈谈污名化问题。

Let's talk about stigma.

你知道，我们之前一直避而不谈这个话题。

You know, we've been sort of dancing around that.

长期以来我们的社会存在体重歧视，现在人们又面临GLP-1类药物的污名。

There's long been weight stigma in our society, and now people are facing stigma around the GLP one drugs.

比如有种观点认为使用者是在作弊，没有通过正确方式减肥。

Like, there's an idea that people are somehow cheating and not losing weight the right way.

人们该如何应对来自他人甚至自我的这些评判？

How can people deal with these judgments from others and even from themselves?

是的。

Yeah.

这非常不幸，因为我认为患者在未接受治疗时就已经承受了污名和羞耻。

It's it's so unfortunate because I think individuals experienced stigma and shame when they weren't getting treatment.

对吧？

Right?

而现在他们在得不到治疗时还要遭受污名和羞耻。

And now they're experiencing stigma and shame when they aren't getting treatment.

这几乎就像是一个无解的困境，真的很糟糕。

So it's almost like it's a it's a no win situation, which really sucks.

我真的非常...你知道...我特别为我的客户们感到难过。

And I and I really, you know, I I hate that for my clients.

我为那些正在经历这些的听众感到痛心，因为不幸的是，我们生活在一个充满评判的世界。

I hate that for for people listening and that are experiencing that because, unfortunately, we live in a world that judges.

作为人类，我们就是会评判他人。

As humans, we judge.

不幸的是，我们确实如此。

Unfortunately, again, we we do.

但我们生活的这个世界确实在污名化大体型人群，或者说他们'选择了轻松出路'。

But we live in a world that really stigmatizes individuals and larger bodies and or now, quote, taking the easy way out.

我不认为事实如此，正因如此我才说'但这确实非常困难'。

I don't believe that that's the case, which is why I said, quote, but so it's very difficult.

我不想坐在这里说'别理会那些'，因为这确实很难，人们会内化这些负面信息，进而产生羞耻感和污名感。

And I and I don't wanna sit here saying just ignore that because it's difficult and and people internalize those messages and then experience, you know, their own shame and stigma around it as well.

关于这点我想说几点：首先，我们确实不幸地生活在一个崇尚瘦弱的社会。

So a few things I wanna say about that is first, yes, we live in a society, unfortunately, that I think has glorified or thrived on thinness.

我认为这某种程度上就是问题的起源和部分症结所在。

And I think that's, of course, kind of where this begins and part of the problem.

多年来，我们都在杂志、媒体上看到各种'减肥、减肥、再减肥'的内容。

For years, we've all seen the magazines, the media, and and all of this about lose weight, lose weight, lose weight.

情况就是这样。

So there's that.

正因如此，人们已经内化了这种观念，认为瘦就是更好。

And because of that, individuals have internalized that and think that being thin is better.

这未必是事实。

That's not necessarily the truth.

要知道，体型瘦小的人可能并不健康，正如体型较大的人可能健康或不健康一样。

You know, individuals can be in a thin or smaller body and not be healthy, just like individuals can be in a larger body and healthy or not healthy.

这同样需要你和你的医疗团队共同决定。

Again, a decision for you and your health care team.

但我想说的是，无论你对自己的健康和身体做出什么决定，你都没有义务告诉任何你不想告知的人。

But what I will say is, a, you don't need to tell whoever you don't want to tell, whatever you decide to do when it comes to your health and your body.

就像我们不会到处宣扬自己正在服用这种或那种药物治疗其他疾病。

So we are not all out there blurting if we're on this medication or that medication when it comes to any other health condition.

那么为什么在体重问题或整体健康话题上，我们就必须向他人汇报呢？

So why do we have to be telling people what we're doing when it comes to our weight or, again, overall theme of health?

这就是我要说的第一点。

So that's one thing I'm gonna say.

可悲的是，虽然我经常这么说，但确实如此——我们的额头上并没有贴着便签向全世界宣告我们正在经历什么。

And the unfortunate part is, I often say this, but it's so true, we don't have post it notes on our forehead telling the world what we're struggling with.

对吧？

Right?

但不幸的是，如果我们原本体型较大突然瘦了，或者无论什么体型的人瘦了，人们总会注意到。

But unfortunately, if we live in a larger body and all of a sudden lose weight or whatever body we live in and we lose weight, unfortunately, people notice.

对吧？

Right?

这是我们必然会注意到的一件事。

That is one thing we notice.

如果我染了头发，肯定会有人注意到并发表评论。

If I colored my hair, someone's gonna notice and make a comment.

对吧？

Right?

这是我们能看到的东西。

That's something that we see.

这是我们的外表。

We it's our appearance.

但就是没人问我们穿多大码的鞋。

But, like, nobody's asking what our shoe size is.

对吧？

Right?

这是我们的鞋码。

It's our shoe size.

它不会改变。

It doesn't change.

好吧，有时候会变。

Well, sometimes it does.

但一般来说不会变。

But in general, it doesn't.

所以当涉及他人体型和身材时，请保持沉默。

So let's be quiet when it comes to people's body shape and size.

对吧？

Right?

不要对他人的体型和身材评头论足。

Don't comment on people's body shape and size.

我们不知道别人正在经历什么。

We don't know what people are going through.

特别声明一下，因为这是个心理学播客，所以我还要说这个。

Especially because this is a psychology podcast, I'm gonna say this also.

有时当你评论他人的体型和身材时，你可能在强化一种负面行为。

Sometimes when you comment on people's body shape and size, you could be reinforcing a negative behavior.

意思是某人可能在采取不健康的方式，而你却称赞说'哇，你看起来棒极了'。

Meaning somebody could be doing something unhealthy and you're like, wow, you look amazing.

这会直接触发那个人的心理反应。

And that then triggers to that person.

'哦，我要继续这样做，因为我得到了这么多赞美，感觉很好'——但这可能非常有害且不健康。

Oh, I'm gonna keep doing what I'm doing because I'm getting all these compliments and that feels really good, but it could be really harmful and unhealthy.

所以首要原则就是不要评论他人的体型身材，因为我们不知道他们正在经历什么。

So first role is just don't comment on people's body shape and size because we don't know what they're doing.

其次要提醒自己：如果不想说，你完全不必告诉别人。

And then I would say remind yourself that you don't have to tell people if you don't want to.

但我建议尝试找到一个小群体，你可以向他们倾诉或寻求支持，因为这件事你肯定不想完全独自面对。

But I would say to try to get a select group of people that you can confide in or you can get support in because it's also something that you don't want to be fully doing alone.

你需要能和你爱的人、支持你的朋友讨论这些事情。

You want to be able to talk through some of these things, with loved ones, supportive friends.

你生活中也需要有人为你能掌控健康、为困扰已久的问题寻求治疗而感到高兴。

You want to have that in your life also to be happy for you that you are taking your health in your control and seeking treatment for something that maybe you've really been struggling with.

但这很难。

But it's hard.

我从客户那里经常听到这种反馈。

I I hear this from from clients.

我在媒体上也经常讨论这个问题——比如有人因为减肥使用GLP-1类药物，要应对随之而来的各种情况可能相当具有挑战性。

I I comment on it a lot in media related to, you know, this one must be on this because they're losing weight and, like, you know, how to deal with all of that can be quite challenging.

我想更深入讨论一些心理影响。

So I want to talk a little more about some of the psychological effects.

关于GLP-1类药物与抑郁症的关联性，现有研究结论存在矛盾。

There have been conflicting studies about links to depression and patients on GLP-1s.

目前关于这方面的研究进展如何？

Where's the research on this now?

是的。

Yeah.

所以我认为，与此相关的新研究一直在不断涌现。

So again, I think there's more research coming out all the time related to this.

而我始终想问的是，他们之前经历了什么？

And my question always goes back to, well, what were they experiencing before?

对吧？

Right?

就像，我们不能仅因为他们正在使用GLP-1类药物且抑郁程度高就假设这两者存在关联，对吧？

Like, we can't make the assumption that just because they're on a GLP one and they're having high levels of depression that that's the link, right?

我们并不清楚真正的原因。

We don't know what the cause is.

很多时候可能存在相关性，或者症状被加重了，也可能没有，但我们并不确定。

Many times there could be a correlation or maybe it's exacerbated or not, but we don't really know.

随着GLP-1类药物兴起已有三四年甚至五年时间，人们使用这些药物的时间更长，相关研究也正在不断深入。

So more research is coming out on that and now that people have been on these medications for a little bit longer because the rise of GLP-1s I think was maybe three, four, even five, a few years ago at this point.

所以我们确实不清楚，这也正是为什么你必须咨询医疗专业人员——这个治疗方案是否适合我。

So we really don't know and again this is why it's so important that you talk to your healthcare professional about this is this right for me.

如果你目前正深陷抑郁困扰。

If you are somebody that's really struggling with depression right now.

而抑郁与你的体重和社交生活相关，或许你因体重问题而自我封闭，那么在医疗团队监督下尝试这类药物可能是个不错的选择。

And the depression is related to your weight and your social life, and maybe you're isolating because of your weight, then maybe a job you want might be a good option for you under supervision with your healthcare team.

但如果你正饱受抑郁折磨，且这与体重无关，与社交生活等因素无关，或许你应该先采取其他措施控制并妥善管理抑郁症状，再考虑添加可能加重或改善抑郁的新药物。

But if you are somebody that's really struggling with depression, and it's not related to your we not related to your social life and these other things, maybe there's other things you should be doing first to get your depression under control and well managed before you add another medication that could worsen or better the depressive symptoms.

对吗？

Right?

这确实是个独特的个人选择，需要你和你的医疗团队共同决定。

So it's really a unique individual choice, again, with you and your health care team to figure that out.

你知道，最近也有关于'奥赞皮克离婚'的新闻报道。

You know, there have also been news articles recently about Ozempic divorce.

这是真实存在的现象吗？

Is that something real?

我是说，GLP-1类药物和更广泛的减肥如何影响人们与伴侣、家人朋友的关系？

I mean, how do GLP ones and weight loss more broadly affect people's relationships with their partners and their family and friends?

是的。

Yeah.

你知道吗，这些标题非常有趣，我记得几年前——现在可能已经好几年了——就有过类似关于减重手术的标题。

I you know, it it's so interesting, those headlines, because I remember it was a few years ago, could have even been several years ago at this point, that there was a similar headline with bariatric surgery.

我深入研究了一下，因为记得当时就这个话题接受过采访。

And I digged into the research a little bit more because I remember being interviewed about it.

确实，这个标题某种程度上是真的，但某种程度上又不是。

And yes, the headline was like kind of true, but kind of not true.

我的意思是，我忘了美国现在的离婚率具体是多少，但不管怎样，基数本来就不大，而减重手术后这个数字翻倍了。

And what I mean by that is like, maybe the I forget what the divorce rate in America is right now, but whatever it was, it's like a you know, not a huge number, and it was double that, like, for bariatrics are right.

但这是个很小的数字翻倍。

But it was a small number, doubled.

可标题却写成'减重手术后离婚率翻倍'。

But, like, the headline was, post bariatric surgery doubles divorce rate.

没错，但有点误导性。

Yes, but a little misleading.

首先我想提醒大家，请阅读完整文章并查看研究数据。

First I just want to remind people, please read the articles and look at the research.

不要只看标题，因为我们的大脑会立即联想到：天啊，这会发生在我身上吗？

Don't just read the headlines because our brain wants to jump to, oh my god, is that gonna happen to me?

在完全不明白发生了什么的情况下。

Without really understanding what's going on.

但话虽如此，任何改变。

But with that being said, any change.

这个改变可能是我决定多去健身房，这样我就不会和伴侣一起坐在家里看电视了。

Now the change could be I decide to go to the gym more, so I'm not going to be sitting at home with my partner watching TV.

这个改变可能是我们要做出改变，在家吃得更健康，也许我的伴侣支持，也许不支持。

The change could be we're making a change and we're going to eat healthier at home and maybe my partner's on board or maybe my partner's not on board.

对吧？

Right?

所以这些伴随着GLP-1药物或减重手术而来的变化，也意味着你生活中的其他改变。

So these what comes along with either being on a GLP one or bariatric surgery also mean other changes in your life.

你不仅仅是接受手术或服用药物。

You're not just getting surgery or you're not just taking a medication.

希望你也正在做出这些行为生活方式的改变。

Hopefully you're making those behavior lifestyle changes as well.

而这些改变本身就可能影响人际关系，甚至无需真正进行手术或使用GLP-1药物。

And that could impact relationships simply by just making those changes without even introducing the actual surgery or GLP-one medication.

那么我是否见过有人开始这些治疗方案或减重后，关系出现问题的？

So have I seen relationships struggle after starting one of these treatment options or after weight loss?

是的。

Yes.

我想说的是，我的建议是提前和你的伴侣谈谈这件事。

And what I would say is my recommendation is talk to your partner about this ahead of time.

他们支持你这样做吗？

Are they supportive of you doing this?

我并不是说如果他们不支持你就不该做，因为这是你的健康和你的身体。

I'm not saying not to do it if they're not supportive because it's your health and your body.

但要讨论这个问题，讨论可能出现的状况，对吧？

But talk about this and talk about things that might arise, right?

比如，你的伴侣是否能接受你为家里准备不同的餐食？

Like, is your partner going to be on board that maybe you're going to make a different meal for the household?

或者也许你会想在晚餐后去散散步。

Or maybe you are gonna wanna go on evening walks after dinner.

你知道，我经常用这个例子，但你必须和伴侣建立新的仪式感。

You know, I I kind of always use this example, but you have to create new rituals with your partner.

如果旧仪式无法适应你正试图融入的新生活方式。

If old rituals aren't going to fit in to this new lifestyle that you're trying to incorporate into your life.

意思是，如果你们过去习惯每晚一起坐在沙发上吃冰淇淋，这本身没什么问题。

Meaning, if you used to sit on the couch and eat ice cream after dinner every night together, there's nothing wrong with that.

但你们可能决定不再这样做，或者你不再渴望吃冰淇淋了。

But you might decide that you don't wanna do that anymore, or you might not crave ice cream anymore.

我经常听到使用GLP药物的人这么说。

I hear this often with people on GLP ones.

你可能决定想去散步或去健身房。

You might decide I wanna go take a walk or I wanna go to the gym.

那么，这会影响你和伴侣的关系吗？

Well, is that going to impact your relationship with your partner?

也许你的伴侣仍然想保持旧习惯。

Maybe your partner is still gonna wanna do that.

这对你们的关系动态意味着什么？会如何改变？

What is that gonna mean for the dynamic of the relationship and how is that gonna shift?

这不一定意味着离婚，对吧？

It does not have to mean divorce, right?

我们不必急着下结论。

We don't need to jump to that.

这仅仅意味着更好的沟通，获得支持并找到适合双方的新习惯。

It just means better communication, getting the support and finding new rituals that work for both of you.

而且

And

我还看过一些关于所谓'奥泽米克人格'的文章，指的是一系列心理健康问题，包括焦虑加剧、抑郁，以及对曾经喜欢的活动失去兴趣。

I've also seen articles about something that they're calling Ozempic personality, which refers to a cluster of mental health issues, including increased anxiety, depression, and a lack of interest in some of the, activities you used to enjoy.

这是另一个需要在此澄清的误解吗？

Is that another myth that needs to be busted right here?

我认为是的。

I think so.

没错。

Yes.

再说一次，我们可以用这个理论解释任何情况。

And again, we could say that about anything.

再次强调（虽然不想重复），对于这种药物，希望人们在用药时能配合生活方式和行为改变。

Again, not to repeat myself, but kind of to repeat myself with this medication, hopefully people are doing the lifestyle and behavior changes with that other things change.

我采用一种叫CBT认知行为疗法的治疗方式。

So I do a type of therapy called CBT cognitive behavior therapy.

为不了解的听众解释一下。

For anyone listening that doesn't know what that is.

它的基本前提是我们的思想、情绪和行为都是相互关联的。

The basic premise of it is our thoughts, emotions, and behaviors are all linked.

以GLP-1药物为例，如果你通过服药改变行为，继而改变其他行为，这会改变你的思维方式，进而改变你的感受方式。

So if we use GLP one medication for a moment as an example, if you change the behavior by taking a medication and then you change other behaviors, that's going to change the way you're gonna think about things, and that's gonna change the way you're feeling about things.

所以这些都是相互关联的。

So it's all related.

那么你的所谓'人格'会发生变化吗？

So could things change in your, quote personality?

既是也不是。

Yes and no.

对吧？

Right?

就像你的性格不会改变，但你可能不会再那么感兴趣了——我也不知道为什么我总用冰淇淋来举例。

Like your personality isn't gonna change, but you might not be as interested in again, I don't know why I'm using ice cream as an example for everything.

但你可能不会那么想和朋友出去吃冰淇淋了。

But you might not be as interested in going out for ice cream with your friends.

你可能会说，嘿，我们不如散散步聊聊天，而不是今晚一起吃甜点。

You may instead be like, hey, let's go on a walk and talk and meet up instead of grabbing dessert together tonight.

对吧？

Right?

你可能想改变现有的生活方式。

You might want to change the way that you're living your life.

这未必是件坏事。

And that's not a bad thing necessarily.

再次强调，无论你是否在使用GLP-1类药物，如果进食不足，那种'饿怒'感是真实存在的，明白吗？

And again, and or I will say also, and this goes for anybody if you're on a GLP-one or not, if you're not eating enough food, there's realness to being hangry, right?

当你饥饿时会变得易怒和烦躁。

When you're hungry and you're angry and you get irritable.

这些正是我注意到使用GLP-1类药物却未规律进食人群的表现。

So these are things that I am noticing with people that are on GLP ones that aren't getting enough food or eating regularly.

重申一下，GLP-1类药物通过加速饱腹感和限制进食量发挥作用。

So again, GLP ones are working by also making you fall faster and limiting the amount of food you're eating.

今天早些时候就有个客户说，她刚增加剂量后就完全没食欲了。

I just had a client earlier today that was like, she just upped her dose and was like, I have zero appetite.

我当时就说：这可是个问题。

And I was like, that's a problem.

对吧？

Right?

就是说，我们需要你开始，我们需要确保你规律饮食。

Like, we we need you to start we we need to make sure you're eating regularly.

所以对某些人来说，这多少需要强迫自己吃点儿东西。

So for some people, it's a little bit forcing yourself to eat a little bit something.

如果我们中任何人限制饮食或跳过正餐，就会变得易怒。

If any of us restrict what we're eating or we're skipping meals, we're going to get irritable.

我们会变得暴躁。

We're gonna get angry.

可能会抑郁，可能对某些事物失去兴趣。

We might get depressed, we might lose joy in certain things.

所以重申一下，我认为很多这类标题都在做大幅跳跃，忽略了中间发生的过程。

So again, you know, I think a lot of these headlines are making a big jumps and missing what's happening in the in between.

这再次说明为什么必须由真正受过专业训练的人员来跟进患者——他们知道该问什么问题。

And again, this is why it's so important that people are being followed by individuals that are really trained in this to to know what questions to ask.

对吧？

Right?

比如，我也指导精神科住院医师，有天他们中有人问我：'我有个使用GLP-1类药物的客户——或者说患者——但恶心反应很严重'

Like like, I I supervise psychiatry residents also, and one of them had asked me one day, you know, I have a client that's or a patient that's on a GLP one, but they're getting really nauseous.

'我该直接让他们找医生调低剂量吗？'

Should I just tell them to talk to their doctor about lowering their dosage?

我当时说：'我们先深入了解一下情况，好吗？'

And I was like, well, let's explore it a little bit, right?

比如：'他们几点服药？'

Like, what time are they taking the medication?

'是空腹还是饱腹时服药？'

Are they taking the medication on an empty stomach, on a full stomach?

他们喝够水了吗？

Did they drink enough water?

他们睡眠充足吗？

Did they get enough sleep?

就像我们无法立即断定这只是剂量问题或仅仅是GLP-1的问题

Like we can't make this immediate connection that it's just the dosage or it's just the GLP one.

有些行为表现是我们可以关注的

There's some behaviors that we can be looking at.

作为心理健康专业人士，我虽然不是处方医生，但可以帮助客户理清这些情况，然后建议他们：现在我希望你回去找你的处方医生，告诉他们你感到非常恶心，但同时你也意识到自己是在空腹服药

And as a mental health professional, I'm not the prescribing physician, but I can help my clients navigate that and then say, now I want you to go back to your prescribing doctor and let them know I'm getting really nauseous, but I also realized I'm taking the medication on an empty stomach.

让我们在减少剂量前先试试这个方法，好吗？

Let me try this before we lower the dose, right?

而不是直接跳到调整剂量那一步

As opposed to just jumping to that.

这就是为什么我认为这次对话如此重要——心理健康服务者可以带着这种探索精神，与客户一起进行调查和引导工作，并指导他们如何与处方医生进行这类沟通

And that's where I think this conversation is so important that mental health providers can be doing this kind of curiosity and investigative and navigation work with our clients and guide them in then having these conversations with their prescribing doctors as well.

对于那些达到目标体重后决定停药的人怎么办？

What about people who reach their goal weight and then decide that they want to stop taking the medications?

他们可能会遇到什么问题？需要哪些支持？

What issues might come up for them and what kinds of support might they need?

是的

Yeah.

这个问题提得非常好

Such a great question.

我们最近经常听到这类问题：当我达到目标体重后，可以停药吗？

We've been kind of hearing about this for a while now, this question of when I get my goal weight or when I meet my goal weight, can I stop the medication?

这确实是个比较难回答的问题

And it's it's kind of a difficult question to answer.

但我倾向于这样回答：如果你患有肥胖症，这是一种需要终身管理的疾病。

But the way that I like to answer it is if you have the disease of obesity, it is a disease that has to be managed for the rest of your life.

对大多数人来说，你需要持续接受某种治疗。

So for most people, you have to have some treatment that you are using.

我模糊地说，你需要某种终身使用的治疗方式来控制它。

And I say that vaguely some treatment that you're using for the rest of your life to manage it.

对某些人而言，这可能仅意味着生活方式的改变。

That could mean just lifestyle behavior change for some.

对另一些人来说，可能意味着降低药物剂量。

It could mean a lower dose of the medication for others.

我们无法确定。

We don't know.

但如果你正在服用降压药，而血压突然恢复正常范围，大多数人不会直接停药，对吧？

But if you are on a medication for hypertension and you all of a sudden your blood pressure is in the normal range for most people, they're not just going to stop the medication, right?

正是因为服药才使病情得到控制。

Like it's working because you're on the medication.

所以我认为这一点非常重要，大家需要明白。

So I think that's really important for people to hear.

重申一下，如果你正与肥胖症抗争，仅为了减肥而服药，且并非基于适应症原因，那么我本次谈话的对象并不包括这类人群。

Again, if you're struggling with the disease of obesity, if you're on the medication just for weight loss and maybe didn't really get it for the reasons it's indicated for, I'm not speaking to that person in this conversation.

但这同样需要你与医生进行深入沟通。

But again, that's a conversation that needs to happen with you and your doctors.

有些人会尝试减少剂量，看看是否更适合维持治疗。

For some people, they're going down a dosage to see maybe it's more like a maintenance dose.