节食的终结

今天的《今日解说》是重播节目，但我们更新了一些新闻内容。

Today's episode of Today Explained is a rerun, but we have updated it with some news.

也许你看到特朗普总统最近宣布与两家制药公司达成协议，这将导致减肥药价格大幅下降。

Perhaps you saw president Trump recently announced a deal with two drug companies that's gonna result in much cheaper weight loss drugs.

也许你还看到他随后透露了政府中哪些人在服用这些药物。

Perhaps you saw that he then revealed who in his administration is taking them.

史蒂夫在哪？史蒂夫来了吗？

And we have Steve where's Steve here?

白宫公关主管？

Head of public relations for the White House?

他正在服用。

He's taking it.

经典。

Classic.

也许你看到有人在那次发布会期间晕倒在椭圆形办公室。

Perhaps you saw someone then fainted in the Oval Office during that announcement.

媒体

Press

现在。

now.

媒体。

Press.

别。

Don't.

经典。

Classic.

事情是这样的。

Here's the thing.

这些药物似乎正在发挥作用。

These drugs appear to be working.

美国的肥胖率正在下降，但仍存在未知因素。

Obesity rates in The US are declining, but there are still unknowns.

饮食、体重与健康之间的关系看似应该很清晰了，但实际上并非如此。

The relationship between diet, weight, and health seems like it should be clear by this point, but it's really not.

接下来在《今日解读》节目中，我们将探讨为何减肥指南总在不断更新，以及药物如何为这一领域增添了全新篇章。

Coming up on Today Explained, why the gospel on weight loss is always being rewritten and how medications have added a brand new chapter.

你上一次感觉完全掌控企业财务状况是什么时候？

When was the last time you felt in control of your business finances?

支出有记录、发票已发送、税务准备就绪。

Expenses tracked, invoices sent, taxes ready.

这正是FOUND的用武之地。

That's where FOUND comes in.

FOUND将银行业务、簿记、开票和税务整合到一个简单应用中。

FOUND brings your banking, bookkeeping, invoicing, and taxes together in one simple app.

管理支出、给客户开发票、发送付款、税务筹备——所有这些都可以在你的银行账户里完成。

Manage expenses, invoice clients, send payments, and prep for tax time right where you bank.

加入已通过Found简化财务流程的数十万用户行列。

Join the hundreds of thousands who have already streamlined their finances with Found.

免费在found.com开设Found账户。

Open a Found account for free at found.com.

网址是f0und.com。

That's f0und.com.

是一家金融科技公司，并非银行机构。

Is a financial technology company, not a bank.

银行服务由FDIC成员银行Lead Bank提供。

Banking services provided by lead bank member FDIC.

本节目由家得宝赞助播出。

Support for this show comes from The Home Depot.

这个假期，您可以在家得宝享受各类顶级智能家居安防产品的节日优惠，所有品牌都值得信赖。

This holiday season, you can take advantage of holiday savings on a wide selection of top smart home security products from the brands you trust, and you can do it at The Home Depot.

家得宝提供您所需的一切，让您的家通过最新技术和产品变得更智能，实现家居控制和自动化。

The Home Depot has everything you need to make your home smarter with the latest technology and products that let you control and automate your home.

这样无论您外出还是在家，都能安心度过这个季节。

So you can protect your peace of mind whether you're away or at home this season.

家得宝。

The Home Depot.

智能家居，从这里开始。

Smart homes start here.

您正在收听的是《今日解说》。

You're listening to today explained.

苏米达·慕克吉是一位作家兼编辑，2018年她被聘为《Teen Vogue》执行主编时感到非常焦虑。

Sumida Mukhopadhyay is a writer and editor who was very anxious when she was hired as the executive editor of Teen Vogue back in 2018.

和其他人一样，苏米达看过《穿普拉达的女王》，她知道时尚行业是残酷无情的。

Like everyone else, Sumida had seen The Devil Wears Prada, and she knew that the fashion industry was unforgiving.

但入职不久后，她就意识到事情正在发生变化。

But not long after she started there, she realized that things were changing.

要知道，我进入时尚行业时正值一个非常独特的时期，那时人们对大码时尚的兴趣正在增长。

You know, I entered the fashion industry at a really unique moment where there was an increased interest in plus fashion.

明白吗？

You know?

所以当我得到《Teen Vogue》的工作后，开始有各种时尚品牌主动联系我，他们都很兴奋。

And so when I got the job at Teen Vogue, I started having all these fashion brands reaching out to me to be like, wow.

我们太激动了。

We're so excited.

我们即将推出一个加大码系列。

We're launching a plus collection.

我们非常希望能和你聊聊这个系列。

We'd love to, like, talk to you about it.

我们很乐意把它寄给你。

We'd love to send it to you.

作为一名大码时尚编辑是什么感觉？

How does it feel to be a fat fashion editor?

那时候我算是刚胖起来不久。

And at the time, I had kind of newly gained the weight.

所以我还没有完全接纳这个状态。

And so I wasn't totally embracing it.

那种感觉并不让人充满力量。

I was I wasn't I didn't it didn't feel empowering.

当时感觉像是突然意识到：等等，我变胖了？

It was almost felt like something that was happening to me where I was like, oh, wait.

我胖了？

I'm fat?

就像需要先跨过心理障碍，才能自信地说出'我光彩照人'。

Like, you know, where I had to kinda get over that first step before being like, I'm fabulous.

我喜欢做个胖子。

I love being fat.

好的。

Okay.

所以你正处在《Teen Vogue》变得更包容的时期。

So you're in a period where Teen Vogue has become more accepting.

拥有丰腴体型是完全可以接受的。

It is okay to be a person in a larger body.

事实上，甚至有一种倡导或行动主义围绕着存在不止一种体型这一事实展开。

And in fact, there's even some sort of advocacy or activism around the fact that there is more than one body type.

然后你听到一些消息，再次改变了你对这一切的看法和体验。

And then you get some news that, again, changes how you see and experience all of this.

发生了什么？

What happened?

当我在《Teen Vogue》工作期间以及即将离职时，我接连遭遇了一系列与家庭相关的压力事件。

While I was at Teen Vogue and kind of as I was leaving Teen Vogue, I had had a series of stressful family related things happen.

我父亲因糖尿病并发症去世了。

My father passed away of diabetes related complications.

我母亲被诊断出患有乳腺癌。

My mother was diagnosed with breast cancer.

我从事着这份异常忙碌的工作，同时还要处理所有这些事情。

I had this really hectic job, and I was managing all of it.

而我的应激反应就是暴饮暴食——而且不仅仅是吃东西那么简单。

And my stress response was eating, and it was and not just eating.

从根本上说，这其实是一种彻底的自暴自弃。

It was, like, really not taking care of myself ultimately.

对吧？

Right?

比如频繁叫优步打车。

It was taking Ubers.

顿顿吃外卖。

It was getting takeout.

几乎抽不出时间照顾自己，这确实导致我体重不受控制地增加，并开始出现行动不便的问题。

It was kind of not really having a lot of time for myself, and that did lead to some unwanted weight gain on my part, and I was having some mobility issues.

我连地铁站上下楼梯都感到吃力——当时我以为只是太疲惫的缘故，毕竟以前从没有过这种情况。

I was having trouble kind of I I I just thought it was because I was exhausted because I had never had these experiences, but I was having trouble getting up and down the stairs on the subway.

我就把原因归结为，哦，我太忙了。

And I would just chalk it up to, like, oh, I'm just so busy.

你懂吗？

You know?

比如，我不得不叫优步，因为我实在太忙太累了。

Like, I have to take Ubers because I'm, like, busy and I'm exhausted.

我走路跟不上节奏，睡眠也出现了问题。

And I was having trouble keeping up on walks, and I was having trouble sleeping.

我感觉身体不适。

I wasn't feeling well.

而且，最糟的是，我的衣服都穿不下了。

And, you know, on top of that, my clothes weren't fitting.

于是我去了医院，那时我已经离开《Teen Vogue》，差不多是疫情结束后，我决定开始弄清楚自己是否健康，以及能做些什么，因为我知道节食没有用。

And so I went to the doctor, and, you this know, is after I had left Teen Vogue, and and, like, kind of after the pandemic, I decided to start the process of, you know, figuring out if I was okay and also, you know, what I could do because and I understood that diets don't work.

对吧？

Right?

我知道可以控制饮食，但最终体重还是会反弹。

Like, I knew I could restrict what I was eating, but eventually, I'd gain the weight back.

我真心想要一个更有效的策略。

And I really wanted something I really wanted a strategy that would be more effective.

我去做了血液检查，几乎所有指标都偏高。

And so I went in and got my blood work done and, you know, pretty much every indicator was elevated.

我已经处于糖尿病前期。

So I was had become prediabetic.

胆固醇也偏高。

My cholesterol was elevated.

这些结果吓到我了。

And so those scared me.

对吧？

Right?

就像，我父亲刚刚因我验血报告上显示的同样问题去世。

Like, I had just lost my father to exactly the things that I'm now looking at in my blood report.

所以我就想，是时候认真对待这件事，制定一个前进的策略了。

And so I was like, you know, I think it's finally time for me to really take this seriously and figure out, you know, a strategy to move forward.

她建议我试试Mounjaro。

And she suggested Mounjaro.

这是一种需要每周注射一次的药剂。

It is a injectable that you take weekly.

它的工作原理主要是减缓消化速度。

It slows your digestion, basically, is how it works.

通过这种方式，它能降低你的进食速度和饥饿感。

And in doing so, it reduces the rate at which you can eat and how hungry you get.

于是，我决定开始使用它。

And so, you know, I decided to go on it.

这对你意味着什么？

What did that mean for you?

比如，开始用药后会发生什么？

Like, once you start taking it, what happens?

你是指情感上还是生理上？

Do you mean emotionally or physically?

都有。

Both.

都有。

Both.

完全是指两方面。

Entirely, I mean both.

谢谢你的关心。

Thank you for asking.

是啊。

Yeah.

是啊。

Yeah.

确实。

For sure.

我的意思是，从情感上来说，做出开始用药的决定真的非常艰难。

I mean, emotionally, it was really hard to make the decision to go on it.

我当时看到了两个方面。

I saw it as two things.

一方面，我觉得这是对我所信奉的身体自爱和女性主义的背叛——那种无论体型如何都要爱自己、不依赖药物干预的理念。

I saw it as a betrayal to the kind of body positivity and feminism that I had ascribed to of loving yourself at any size and not trusting pharmaceutical interventions.

另一方面，我内心还有个声音在说：情况已经糟糕到这种程度了，姑娘。

And also, there was another voice inside me that was like, this is how bad it's gotten, girl.

就像，你已经无法控制这个局面，现在不得不靠药物了。

Like, you couldn't control this and now you have to take a drug.

这正说明你的状况有多糟糕。

That's how that's how not well you are.

所以这个用药决定伴随着大量的自我批判和羞耻感。

And so a lot of self judgment, a lot of shame came out with the decision to go on the medication.

从身体反应来说，这个过程并不平坦。

Physically, it is a bumpy road.

至少对我来说是这样。

It was for me.

我个人就经历了非常严重的恶心反应。

For me, I struggled with very intense nausea.

所以，你知道，它的作用机制之一是通过减缓消化速度，如果你吃得过多，就会感到非常不适。

So you, you know, one of the ways that it works is since it slows your digestion, if you overeat, you are, you feel very sick.

然后，还会引发很多消化问题。

And then, a lot of digestive issues.

服用期间上厕所会非常困难。

It is very hard to go to the bathroom when you're on it.

你不得不服用各种泻药。

You have to take all kinds of laxatives.

现在他们又开了额外的处方药。

They now have additional prescriptions.

他们让服用这种药的人同时服用其他药物，以帮助维持正常排便。

They put people on that are taking it to help support with, you know, regular bowel movements.

所以这并非最佳的身体体验。

And so it was not the best physical experience.

后来，在某个阶段我逐渐适应了，但与其说是适应，不如说是习惯了应对这些副作用。

And then, you know, at a certain point, I got used to it, but I think it was more that I just got used to managing the side effects.

这些副作用对我来说从未真正消失过。

They never really went away for me.

有趣的是，你把服用Mounjaro描述得如此可怕，但我很感激你能坦诚地谈论这些副作用，因为平时很少听到这方面的讨论。

You have made, interestingly enough, being on Mounjaro sound absolutely horrible, but I appreciate you I appreciate you being honest about the side effects because I don't hear talk about the side effects very often.

那它有什么好处呢？

What was the good in this?

是什么让你坚持服用？

What kept you on it?

它确实有效果。

It does something.

我认为这是生理层面的作用，医生可以更专业地解释——它会触发大脑中某种激素的分泌，让你产生饱腹感。

And I think it's it's physiological and a doctor can speak more eloquently to this, but it does trigger something in your brain, a hormone that suggests that you're satiated.

对吧？

Right?

于是它开始帮助我对更少的食物感到满足。

And so it started to help me feel satisfied with less.

我的一个行为习惯是晚上会强迫性进食，无论是出于压力、娱乐、无聊还是追剧时，总之各种原因都可能。

One of my behaviors is I tend to compulsively eat in the evening, whether it's stress or just fun or boredom or binge watching TV, whatever it might be.

我会坐下来面前摆满各种零食，然后无意识地吃，经常不记得吃了多少，吃的也未必是有营养的食物。

I will sit down with, like, an array of snacks and kind of eat mindlessly, not always keeping track of how much I'm eating, not necessarily food that had good nutritional value.

当我使用Mounjaro期间，吃完晚餐后晚上基本不会感到生理性饥饿，胃里也没有空间再吃其他东西。

When I was on Mounjaro, I would finish dinner, and I pretty much would not physically be hungry in the evening, and I just wouldn't have space to eat anything else.

如果突然想吃零食，我会选择更健康的食物，因为我发现这些更容易消化。

And if I got the munchies, I started to reach for healthier snacks because I noticed that I digested them easier.

比如吃个苹果或葡萄——天知道我吃了多少葡萄——或者一把胡萝卜之类的。

And so if I just, like, ate an apple or some grapes, you know, like, I ate so many freaking grapes, or, you know, a handful of carrots or whatever that might be.

就像我们常对自己说的：这是健康的选择。

All the things we tell ourselves, we were like, this is the healthy choice.

让我们做出健康的选择。

Let's make the healthy choice.

突然间，选择健康食物变得容易多了。

The healthy choice all of a sudden became easier.

嗯。

Mhmm.

这也是我坚持用药的部分原因，它真正让我从长期存在的渴望中解脱出来，做决定时毫不纠结。

And so that was part of why I stayed on it, that it really gave me this release from this yearning that I always had where and it wasn't a challenging decision.

我完全没有感到压力。

I didn't feel a lot of strain around it.

而过去当我因夜间进食自责时，总觉得根本停不下来。

Whereas, historically, when I would beat myself up for eating at night, I never felt like I could stop.

通过这种药物干预，我终于能够停下来了。

And with the kind of pharmaceutical intervention, I was able to stop.

好的。

Okay.

凡事都有利弊。

So there are pros, there are cons.

最近怎么样？

How is it going?

我记得Mounjaro刚上市时，他们给早期用药者提供了制造商优惠券。

I guess when Mounjaro hit the market, they had given a manufacturer's coupon to early people that to people that had first started taking the drug.

诺艾尔，你知道的，我从不看那些细则。

And, you know, I don't read the fine print, Noelle.

就是，我也不清楚。

Like, I don't know.

就像

Like

没人会看的，姐妹。

No one does, girl.

我还以为是医保报销的。

I thought that was my insurance covering it.

我当时不明白价格这么高是因为优惠券，而不是医保。

Like, I didn't understand that, like, the reason it cost that much was a coupon and not my insurance.

现在优惠券被取消了。

And so the coupon is rescinded.

一夜之间药价就涨到了600到800美元一个月。

And overnight, the drug becomes 6 to $800 a month.

我记得好像是800美元。

I think it was like I think it was 800.

然后他们说，我们可以提供另一种优惠券，能帮你降到600左右。

And they were like, we can do this other coupon that will get you to like 600.

我当时就觉得，虽然这些不是确切数字，但我想说的是，那金额简直离谱，我都惊呆了。

Like, I'm kind of like, these aren't the exact numbers, but all I'm saying is like, was an insane amount of money that I was, like, what?

要知道，我住在纽约市。

Like, I live in New York City.

怎么可能随便再承担一笔那样的支出？

You can't just take on another payment like that?

那真是

That's

太疯狂了。

crazy.

是啊。

Yeah.

没错。

Exactly.

确实如此。

Exactly.

我觉得是费用和副作用双重因素，而且我当时已经减了很多体重。

I think the combination of the cost and the side effects and I had lost a lot of weight.

大概减了50磅左右。

Like, think I lost 50 pounds about.

哦，天啊。

Oh, wow.

我当时感觉棒极了。

And I was feeling great.

于是我就想，要不干脆试试停用会怎样。

And I was like, you know, let me just try without it.

让我逐渐戒掉它。

Let me phase out of it.

于是在2023年我停用了药物，而且可以说我保持了相当长时间的减重效果。

And so I I came off the drug at the 2023, and, you know, I will say, like, maintained the loss for quite a bit of time.

大概两三个月内我的体重反弹了10到15磅。

I probably gained, like, 10 to 15 pounds within, like, two or three months.

那段心理体验确实很糟糕。

And that was definitely not a great mental experience.

我又回到了那种失控的感觉——天啊，我快要失控了。

Like, I definitely came back to that feeling of control of, like, oh my god, I'm losing control.

我快要失控了。

I'm losing control.

不过我还是很振奋，因为我坚持了一些生活方式的改变，这感觉像是个非常积极的转变。

And, you know, but I was excited because I had made some lifestyle changes that I was maintaining, and that felt like a really positive intervention.

这是我半年来第一次接受关于这个话题的采访。

Now, this is like the first interview I'm doing about this in like six months.

所以我要说过去六个月对我来说压力很大。

And so I will say the last six months have been really stressful for me.

我出版了一本书。

I launched a book.

我结婚了。

I got married.

能听到吗？谢谢。

Can you hear Thank you.

没有什么比在婚礼前发福更糟心了。

Nothing like gaining weight for your wedding.

但我开始放弃了一些坚持的习惯，比如做饭、保证每日步数等等，这些都有所松懈。

But I started, you know, some of the things that I had been committing to, like cooking and getting enough, you know, my steps every day and all of that, like, fell to the wayside a little bit.

于是体重开始一点点、一点点地增加。

And so the weight started to creep on and creep on and creep on.

现在我可能已经反弹了大约60%到70%减掉的体重，这真的很难接受。

And now I've probably gauged back, like, 60 or 70% of what I lost, which has been really hard.

你知道，这很艰难，而且感觉像是在强迫我真正面对自己与健康和身体的关系。我明白现有的选择，但这些选择很有限。

You know, it's hard, and it's also feels like it's forcing me to really face my relationship with my health and my own body and to like, it's like I understand the options that are out there, but the options are limited.

我甚至不认为自己会重新选择那种方式，因为只要一想到它，我就又感到反胃。

I wouldn't even say that I would necessarily go back on it because when I think about it, I just get sick to my stomach again.

我就是...唉，真的不确定自己能否再经历一次那种过程。

I'm just like, ugh, I just don't know if I can go through that again.

但你知道，这就像坐过山车一样——从'体重减轻了'的兴奋高点，又跌回'仿佛回到原点'的低谷，尽管我心里清楚自己其实并没有真的回到原点。

But the you know, it's been a roller coaster emotional roller coaster having the kind of high of, like, oh, like, the the weight came off and then to, like, be feel like I'm back to square one, even though I know in my mind and my heart and my spirit, I am not.

苏米达·慕克吉，作家兼编辑。

Sumida Mukhopadhyay, writer and editor.

接下来请听：节食与运动的时代是否已经结束？

Coming up, is the age of diet and exercise over?

本期节目由Indeed赞助播出。

Support for today's explain comes from Indeed.

Indeed表示：如果您正在招聘，使用'赞助职位'功能可以让您的招聘信息获得最佳曝光机会。

Indeed says if you're looking to hire, you can give your job posting the best chance to be seen with Indeed Sponsored Jobs.

通过'赞助职位'，Indeed会提升您发布的职位信息使其获得更高可见度。

With Sponsored Jobs, Indeed boosts your post so that it is more visible.

数据显示这种方式非常有效。

Their data shows it's effective.

Indeed研究表明：直接发布在平台上的赞助职位，获得高申请量的概率比非赞助职位高出90%，因为能触达更广泛的求职者群体。

According to Indeed, sponsored jobs posted directly on Indeed are 90% more likely to report higher than those non sponsored jobs because you reach a bigger pool of people.

目前已有160万家企业通过Indeed发布赞助职位。

1,600,000 companies sponsored jobs with Indeed.

现在通过Indeed赞助职位，您可以花更多时间面试候选人，减少压力，节省时间，获得更好成果。

You can spend more time interviewing candidates, less stress, less time, more results now with Indeed sponsored jobs.

本节目听众可获得75美元赞助职位信用额度，帮助您在Indeed.com/todayexplained获得应得的高级职位状态。

Listeners of this show get a $75 sponsored job credit to help your job get the premium status it deserves at Indeed dot com slash Today Explained.

Indeed.com/todayexplained

Indeed.com/today Explained.

支持我们的节目，只需告知您是通过本播客《今日解说》了解到Indeed。

Support our show by saying you've heard about Indeed on this podcast, Today Explained.

Indeed.com/todayexplained

Indeed.com/today Explained.

请注意适用条款和条件。

Terms and conditions do apply, guys.

招聘。

Hiring.

用Indeed正确开展招聘。

Do it the right way with Indeed.

《今日解说》由Bombas赞助播出。

Support for Today Explained comes from Bombas.

Bombas表示，穿上一双新袜子能立即带来焕新感受——尤其是Bombas袜子。

Putting on a new pair of socks can instantly feel refreshing according to Bombas, especially according to Bombas if they're Bombas socks.

Bombas为各种活动设计专用袜子。

Bombas make socks for just about any activity.

保暖美利奴羊毛袜、舒适压力袜、缓震跑步袜等丰富品类。

Your warm merino wools, your comfortable compressions, your cushioned running socks, and so much more.

高品质拖鞋、T恤、木丹鞋等产品。

High quality slippers, T shirts, moudans.

Nisha Chital试穿了Bombas。

Nisha Chital tried Bombas.

这是她的想法。

Here's what she thinks.

Bombas的儿童袜很棒。

Bombas has great kid socks.

我有个三岁的孩子。

I have a three year old.

她经常穿着袜子在家里跑来跑去，经常在硬木地板上打滑。

She runs around a lot indoors in her socks, and she's often slipping on the hardwood floors.

但Bambas儿童袜底部有防滑设计，能有效防止在硬木或瓷砖地板上打滑。

But Bambas kid socks have grips on the bottom, and they're really great to prevent that slipping around on hardwood or or tile floors.

所以我们很喜欢给她穿这个。

So we love those for her.

这绝对是我们首选的袜子

They're definitely our preferred socks

给我们女儿的。

for our daughter.

Bombas表示每购买一双Bombas袜子，他们就会捐赠一双给无家可归者。

Bombas says that for every pair of Bombas you buy, they donate one to someone facing homelessness.

每当你获得温暖时，也有人能同样感受温暖。

Anytime you get something cozy, someone else can too.

据Bombas所说，可访问bombas.com/explain并使用优惠码explain享受8折优惠。

According to Bombas, can go to bombas.com/explain and use code explain for 20% off.

首次购买请访问b0mbas.com/explain，结账时输入优惠码explain。

Your first purchase, that's b0mbas.com/explain, code explain at checkout.

本期节目由Chime赞助播出。

Support for today explained comes from Chime.

什么是Chime？

What's Chime?

与众不同。

Is different.

Chime是一家金融科技公司，希望您在设置直接存款时珍惜每一美元。

Chime is a financial technology company that wants you to embrace each and every dollar when you set up direct deposit with Chime.

您可以享受免手续费功能，如透支保护，据说还能提前两天拿到工资，甚至更多福利。

You can get access to fee free features like overdraft protection, or they say you can get paid up to two days early and even more.

说到免手续费，Chime表示开通支票账户后，无需支付月费和维护费。

Speaking of no fees, Chime says that when you open a checking account, then there are no monthly fees and no maintenance fees.

符合资格的直接存款用户，可享受最高200美元的借记卡消费和取现免息透支额度。

And with qualifying direct deposits, you can be eligible for free overdraft up to $200 on debit card purchases and cash withdrawals.

更不用说（虽然我要提一下）47,000台免手续费ATM机。

Not to mention, although I will, 47,000 fee free ATMs.

您今天就可以通过Chime实现财务目标。

You can work on your financial goals through Chime today.

两分钟即可在chime.com/explain开通账户。

You can open an account in two minutes at chime.com/explain.

网址是chime.com/explain。

That's chime.com/explain.

Chime让进步触手可及。

Chime feels like progress.

Chime是金融科技公司，非银行机构。

Chime is a financial technology company, not a bank.

银行服务和借记卡由The Bank或Bank NA或Stripe Bank NA提供。

Banking services and debit card provided by the Bank or Bank NA or Stripe Bank NA.

会员由FDIC承保。

Members FDIC.

需满足特定资格要求，透支限额适用。

Spotting eligibility requirements, overdraft limits apply.

时间取决于支付文件的提交情况。

Timing depends on submission of payment file.

非本行ATM机取款将收取手续费。

Fees apply it out of network ATMs.

根据《美国新闻与世界报道》2023年排名显示的银行等级及ATM机数量。

Bank ranking and number of ATMs according to US News and World Report 2023.

需开通Chime支票账户。

Chime checking account required.

您正在收听《今日解说》节目。

You're listening to Today Explained.

我是丹·贝西森，医学博士实习生，内分泌科医生。

I'm Dan Bessison, I'm an MD by trainee, I'm an endocrinologist.

我在丹佛的科罗拉多大学工作，既在丹佛健康县医院从事临床护理，也在医学院进行科研工作。

I'm here at the University of Colorado in Denver and I do clinical work taking care of patients at our county hospital Denver Health and I do research here at the medical school.

同时我还是安舒茨健康与 wellness 中心的主任。

I'm also the director of this building called the Anschutz Health and Wellness Center.

丹，你身兼47份工作啊老兄。

Dan, you have 47 jobs, man.

好吧。

Alright.

我们来聊聊这种对肥胖的文化和医学关注是如何兴起的。

Let's let's talk about the beginnings of this sort of cultural and medical interest in obesity.

医生从什么时候开始将肥胖视为需要矫正、需要医疗干预的问题？

When did doctors start thinking of obesity as something that needed to be fixed, something that needed medical attention?

我认为一直都有体重过高的人群让医生觉得这是个健康问题。

I think there's always been people with really high weights that doctors thought, well, that's probably a health problem.

但我觉得直到80年代末到90年代中期，这个问题才真正进入公众视野。

But I don't think it entered the general public consciousness until sort of the late eighties to the mid nineties.

这种疾病是肥胖症。

The disease is obesity.

但肥胖只是我们这个国家面临的真正问题的症状。

But obesity is just a symptom of the real problem we as a nation face.

弗朗西斯，你从记事起就超重了吗？

Francis, you've been overweight since you can remember?

从小就是。

Since a child.

大概十几岁开始。

About, early teens.

美国人吃得太多。

Americans overeat.

我们对食物着迷，这种痴迷正在要我们的命。

We are obsessed with food and it's an obsession that's killing us.

而格蕾塔一岁时体重就达到了一百磅。

And when Greta was one year old, she weighed a hundred pounds.

将近一百磅。

Almost a hundred.

将近一百磅。

Almost a hundred.

那可不少。

That's a lot.

我觉得当时人们环顾四周都会想，这是怎么回事？

I think there were people looked around and thought, what's going on here?

似乎有越来越多的人体重超标。

There seems to be more and more people at higher weights.

美国国立卫生研究院曾召集专家小组用BMI指数来定义肥胖。

NIH had an expert panel that defined obesity using BMI.

BMI指标存在一定争议，但当时我们采用这个公认标准后不久，CDC分析了他们的数据并问道：肥胖问题发生了什么变化？

BMI is sort of controversial but that was the point at which we had this accepted standard and shortly after that the CDC looked at data they had and said, What's been happening with obesity?

我想他们震惊地发现肥胖人口数量出现了急剧增长。

And I think they were sort of shocked to find there was just a dramatic increase in the number of people with obesity.

于是在1999年，他们发布了这些CDC肥胖地图。

And so in 1999, they published these maps, these CDC obesity maps.

可能有些人见过那些图表。

Maybe some people have seen those.

这些数据确实引起了人们对这场看似流行病的广泛关注。

And they really brought a lot of attention to what really looked like an epidemic.

如果这些数字反映的是艾滋病或癌症，人们会非常担忧，当时大家都说天啊，这情况不对劲。

If you had looked at those numbers and it was HIV or cancer, people would be quite worried, and people said, gosh, something is happening here.

我们必须对此采取行动。

We should do something about this.

那么医生们决定采取什么措施呢？

And what was the something that doctors decided they should do?

是的。

Yeah.

我认为NIH专家组考虑过体重分级，治疗方案应根据问题严重程度而定。

I think that the, NIH panel had thought about levels of weight and that treatment or what intervention somebody did should be based on how serious the problem was.

体重轻微超标的人可能需要调整饮食和增加运动。

So, people with a modest increase in their weight might change their diet and increase their physical activity.

中度肥胖者可能需要服药，而重度肥胖者可能适合手术。

People with a more severe weight problem might take a medication, and those at the highest weight might benefit from surgery.

对大多数美国人而言，当时建议的是改变生活方式——那时我们对体重调节的生物学基础认识还很初步。

For most Americans, lifestyle is what was suggested and I think at that point, we were still early in understanding the biologic basis of weight regulation.

毕竟我们都要吃饭、都要活动，这些看似都是自主选择。

And we all eat, we all move, and it seems like we choose those things.

所以显而易见的第一步是：也许人们只是不知道该吃什么。

So the obvious first step was to say, Maybe people just don't know what to eat.

如果他们多思考一下，少吃多动，这个问题或许就能解决。

And if they just thought about it some more and ate less and moved more, that this problem might go away.

这就是最初的想法。

So that was the first thought.

卫生局局长曾呼吁采取行动。

And the Surgeon General had a call to action.

肥胖是一个自1990年以来急剧恶化的主要问题。

Obesity, a major problem that has increased dramatically since 1990.

基于肥胖率不断上升的数据，指出人们应该多运动并保持健康饮食。

Based on these numbers rising of obesity saying, you know, people ought to move more and eat a healthier diet.

在缺乏运动、肥胖和糖尿病问题上，事实是我们正在朝错误的方向发展。

When it comes to physical inactivity, obesity, diabetes, factor of matter is we're moving in the wrong direction in terms of of these areas.

这个建议看起来显而易见。

The advice seems obvious.

改变饮食习惯并增加运动量。

Change what you eat and move more.

节食和锻炼真的有效吗？

Do diet and exercise prove to work?

我认为可以从几个角度来看这个问题。

I think there's a couple ways to look at that.

大约在同一时期，有一项名为'糖尿病预防计划'的研究发表，他们发现适度的体重减轻（5%）能将患二型糖尿病的风险降低一半。

One is around this same time, there was a study published, the diabetes prevention Program, and what they found was that a modest weight loss, a 5% weight loss, could reduce the risk of developing type two diabetes by half.

这是一项非常惊人的研究。

It was a really dramatic study.

正是基于此，人们认为这个目标是可以实现的，而且5%的减重具有明确的健康效益。

And so it was really based on that that people said, gosh, this is achievable, and it has clear health benefits of 5% weight loss.

我只是在脑子里算算数。

I'm just doing the math in my head.

如果你体重两百磅，那就减去十磅。

If you weigh two hundred pounds, that's take 10 pounds off.

是啊。

Yeah.

三百磅的话，就减去十五磅。

Three hundred pounds, take 15 pounds off.

感觉没什么变化。

That feels like nothing.

虽然体重变化不大，却带来了显著的健康改善。

It seems like a small change in weight, and yet it had dramatic benefits.

说实话，我在诊所见过很多病人，二十年来我一直在宣传减重5%的好处。

I gotta tell you, I mean, I see people in clinic, and so I've spent twenty years trying to sell the benefits of a 5% weight loss.

大多数人并不买账，他们想要更大幅度的减重。

Most people don't buy it, most people want more weight loss than that.

这种程度的减重通常不会让人在镜子里看出变化，朋友也注意不到，但它确实对健康有明显益处，已成为临床显著减重的基准。

It's not a weight loss that most people see in the mirror or that their friends are going to notice, but it has clear health benefits and has become a benchmark of what a clinically significant weight loss is.

稍微减重就有帮助。

A little bit of weight loss helps.

那么这些减重5%后健康状况改善的研究对象，在研究结束后情况如何？

So what happened after the study was over with these folks who lost 5% of their weight and then saw their health improve?

他们保持住减重成果了吗？

Did they keep the weight off?

多数生活方式研究表明，大部分人都会反弹大部分体重。

Most lifestyle studies show that most people regain much of the weight.

虽然不是所有人都会完全反弹，但大部分减掉的体重都会重新长回来。

It's not like everybody regains all of the weight, but much of the weight is regained.

过去二十五年间，我们对体重调控背后生物学原理的理解发生了真正的爆炸性突破。

What has happened over the last twenty five years is a real explosion in our understanding of the biology that underlies weight regulation.

我认为现在我们把体重看作类似于血压或血糖——身体对于理想体重有着复杂的生物学调控机制。

I think now we think of weight much like we think about blood pressure or glucose, that there's complex biology that the body's got its own idea about what it wants to weigh.

身体似乎不是围绕某个固定值进行调节，而是倾向于在人生轨迹中保持体重逐渐上升的趋势。

And what it seems like the body wants to do, it doesn't regulate around a set point, it regulates around a trajectory of gradual weight gain across the life.

因此，体重的生物学特性实际上会抵制我们改变饮食的努力。

So, the biology of weight really pushes back against efforts to change our diet.

这就是为什么人们会复胖——当体重下降时，身体会认为这不对劲。

And so that's why people regain the weight is when they lose weight, the body goes, this is not good.

人们会变得更饥饿，能量消耗下降，这些因素都会促使体重反弹到原先水平。

And the people become more hungry, their energy expenditure goes down, and these things tend to push the weight back up to where it was before.

您提到医生治疗肥胖的另外两种方式：药物和手术。

Were there you mentioned two other ways that doctors saw of treating obesity, medications and surgeries.

医生有多大可能会对患者说：先生/女士，您需要药物治疗？

How common was it for a doctor to say, you, sir or madam, you're gonna need medication.

您需要接受手术治疗。

You're gonna need surgery.

我不太记得二十年前有这么普遍的做法。

I I don't remember so much of that, like, twenty years ago.

当时只有1-2%的人会进行这类谈话或获得药物治疗，这背后有多重原因。

Only maybe one or two percent of people ever had that conversation, ever got that medication, and there are a number of reasons for that.

一是旧款药物存在某些副作用。

One is the older medicines had some side effects.