与青少年肥胖抗争

与青少年肥胖抗争

An Action Plan to Combat Adolescent Obesity

营养：5条针对青少年的指导守则，帮他们获得健康的体魄

Nutrition： Use these 5 “rules” for coaching teens on better health。

Weight Watchers®公司在今年早些时候宣布为青少年开办免费的课程，掀起了轩然大波。

Weight Watchers® set off a furor early this year when it announced plans to launch a free program for teens。

青少年肥胖正在肆虐，不禁让人质疑：这个鼓励每周进行称重的Weight Watchers公司到底是不是有资格来帮助青少年改善健康？会不会使一些少年产生饮食障碍？这个课程会不会只是其发展新客户的套路？

As we are in the midst of a childhood obesity epidemic， critics pounced： Is a company named “Weight Watchers” that encourages weekly weigh-ins the proper vehicle for helping teens improves their health？ Will the company trigger the development of an eating disorder in some teens？ Is this just a ploy to lure new lifelong customers？

当然，青少年市场这么大，看准这个市场的并不是只有Weight Watchers公司这一家。像Medifast® 和 OPTIFAST®这类专注减重的公司，也开发了针对青少年的课程。比如卡路里控制课程，但是参加课程需要购买他们的奶昔或其他加工食品；还有一些减重营，持续2-12周，价格在5000美元到10000美元不等。虽然减重营声称能快速减重，但是这种方法并没有得到医学验证，我们也没有过看到长期效果。

Of course， Weight Watchers is not alone in going after the teen market。 Weight loss companies like Medifast® and OPTIFAST® have developed teen-focused programs with calorie-controlled meal plans that require purchases of shakes and other processed foods。 Weight loss camps—generally costing $5，000–$10，000 for programs of 2–12 weeks—promise teens rapid weight loss， often with little medical oversight or evidence of long-term effectiveness。

很多青少年和他们的家长只要听到有办法能帮助孩子减重，就会不顾一切地去尝试。因为他们知道，如果现在不开始进行控制，90%的“胖孩子”长大后就会成为“胖大人”，而且极有可能面临2型糖尿病（胰岛素抗性增加）、睡眠呼吸终止症、脂肪肝、高胆固醇血症、高血压、髋关节功能障碍以及多囊卵巢综合症等疾病的威胁。（Steinbeck et al。 2018）

Desperate for help， many teens and their families will try anything to lose weight。 Their feelings are justified： Without intensive intervention， 90% of teens with obesity will have overweight or obesity as adults。 They also face increased risk for type 2 diabetes and insulin resistance， sleep apnea， fatty-liver disease， high cholesterol， hypertension， hip dysfunction， and polycystic ovarian syndrome （in females） （Steinbeck et al。 2018）。

同样，青少年肥胖也和抑郁症、焦虑症、轻生、自卑、注意缺陷多动障碍、攻击性和破坏性行为、网络成瘾、暴饮暴食以及一些其他极端的情感展现有关。（Reinehr 2018）肥胖引起一系列情绪方面的问题，主要来自同龄人或媒体的霸凌和羞辱。（Van Geel， Vedder & Tanilon 2014）

Adolescent obesity has been linked， moreover， to depression， anxiety， suicidal thoughts， poor self-esteem， attention deficit hyperactivity disorder， aggressive and destructive behavior， internet addiction， binging and purging， and other severe emotional outcomes （Reinehr 2018）。 Emotional issues are often attributed to bullying and weight stigma， which frequently stem from peer and media influence （Van Geel， Vedder & Tanilon 2014）。

健身专业人士可以帮助少年们重获自信，重拾对生活的热爱，并且养成长期的健康习惯，最终克服因肥胖带来的各种不良后果。值得注意的是，青春期是人生中一个很敏感的时期，充斥着各种新的社会规则和压力。少年们的一时冲动、急于求成、对独立的渴望以及潜在的逆反心理都可能会对他们的健康造成不良影响。因此，一些Weight Watchers的批评者不禁提出了疑问：在不引起饮食失调或者不关注体重数字的前提下，怎样帮助青少年？

Health and fitness professionals can help teens gain the confidence， desire and ability to establish lasting healthy habits and avert the damage of obesity。 One thing to bear in mind， however， is that adolescence is a vulnerable life stage with unique new social norms and pressures。 Teens’ impulsive behavior， quick-fix outlook， growing independence and potential defiance can make any attempt to influence their health seem overwhelming and even perilous。 As some Weight Watchers critics wondered， how do we help teens without triggering disordered eating or a preoccupation with weight？

与10年前相比，现在青少年的肥胖比例为17%，6%严重肥胖，比例整整翻了一倍，急需有效的方案来改善健康状况。（Reinehr 2018）虽然调查人员分别研究了强制干预法、药物法和减肥手术的有效性，但现在仍然不能确定哪一种对青少年是最有效的。按照下面的5条规则来安排青少年的计划，能对他们的训练产生积极的影响，并且减少受伤的风险：

With 17% of teens affected by obesity and 6% of teens by extreme obesity—rates having doubled in the past decade—this population needs quality programs to improve health （Reinehr 2018）。 While researchers are exploring the effectiveness of intensive lifestyle interventions， medications and bariatric surgery， we’re still unsure of the most effective weight loss interventions for teens。 Nevertheless， health and fitness professionals who work with adolescents can drive positive outcomes and minimize the risk of harm by following these five “rules” for coaching teens to better health：

1。关注行为，而不是体重

1. Focus on Behavior， Not Weight

怎么让青少年把注意力从减重或者控制能量摄入上转移走呢？重新建立好的习惯是个不错的选择，鼓励青少年养成以下习惯：

Zeroing in on healthy habits takes the emphasis off weight loss and/or restricting calories。 Encourage teens to adopt these behaviors：

• 多吃蔬菜水果或者全麦食物，而不是包装类或者精加工的食物。

Eat “real foods” like vegetables， fruits and whole grains rather than packaged or highly processed foods。

• 每天都去参加一些有趣的活动。

Incorporate enjoyable activity into each day。

• 睡眠要充足。

Get adequate sleep。

• 少做低头族，每天都适量地远离电子产品。

“Unplug” from screens and devices for part of the day。

• 培养有效的抗压能力。

Cope with stress more effectively。

这些习惯能帮助青少年去学会选择健康的食物、提高睡眠的质量、处理压力以及进行体力活动，这些都与体重的控制有关。另外，还能教会青少年设立切实可行的目标。一个饮食或节食计划刚刚开始或结束时，总会伴随体重的起起伏伏。如果青少年能适应饮食安排，那他就不太会出现这种体重的波动。有证据表明，如果只把注意力放在控制饮食上，会增加饮食失调和自卑的风险。（Golden et al。 2016）

The goal is to help teens learn about healthy food options and ways to improve habits pertaining to sleep， stress management and physical activity， all of which affect weight。 Focusing on healthy habits helps teens set goals based on things they can control。 Moreover， teens who do not feel confined to a strict diet are less likely to yo-yo between weight loss and gain， which often occurs when people start and stop a new diet or restrictive nutrition plan。 Evidence also suggests that focusing on dieting increases the risk of disordered eating and low self-esteem （Golden et al。 2016）。

青少年们一般只关注当下，而不怎么放眼未来。应当使用一些效果立竿见影的方法手段，提升他们的动力。例如让他们精力充沛、改善其心情、增强其在自己最喜欢的体育项目的中运动能力或进行一组长距离步行、慢跑或骑行。

Remember， though， that adolescents tend to focus on the present and not so much on improving health for their future。 Thus， a focus on health should include goals with immediate benefits—such as increased energy and mood， or the ability to play a favorite sport or go a set distance by walking， biking or jogging。

2。注意用词

2. Choose Words Carefully

要特别注意的是，不要使用有标签性质的词。美国儿科学会（APP）建议使用一些中性词，比如用“体重增加”或者“BMI升高”来代替“肥胖”或者“超重”这样的词。同样，把注意力放在健康习惯的养成而不是体重的减轻上。

Adults must be careful to avoid stigmatizing language。 The American Academy of Pediatrics （AAP） advises using neutral words like “increased weight” and “elevated body mass index” versus “obese” or “overweight。” This includes， as discussed， de-emphasizing weight loss altogether to focus on developing healthy habits before addressing weight。

根据美国儿科学会（APP）的调查，人们通常觉得羞辱能激发别人减肥的动力。因此，我们经常听到像“你真胖”这类明显带有羞辱意味的话。（Pont et al。 2017）事实并非如此，羞辱更可能导致体重增加、活动量下降、暴食、社交孤立以及对自身健康问题的逃避。（Pont et al。 2017； Brewis & Bruening 2018）

According to the AAP， “Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight” （Pont et al。 2017）。 However， there is no evidence that shaming a person motivates them to lose weight。 Indeed， shaming is more likely to result in more weight gain， less physical activity， binge eating， social isolation and avoidance of health care （Pont et al。 2017； Brewis & Bruening 2018）。

健身专业人士应该如何帮助青少年更好地坚持计划呢？我们要散发正能量，避免负能量，注重青少年客户的长处而不是短处。（Reinehr 2018）

Health and fitness professionals can improve a teen’s adherence to a program by showing a positive attitude， avoiding blame and focusing on the teen’s strengths， as opposed to failures （Reinehr 2018）。

3。鼓励家长成为榜样

3. Encourage Adults to Model Healthy Behaviors

发挥家长的榜样作用，可以让青少年更好地遵守计划安排。后文中的“家长小贴士：该做的和不该做的”会给大家一些有用的建议。

In addition to following this guidance themselves， health and fitness professionals can encourage parents to model healthy habits。 See “Modeling Dos and Don’ts： Tips for Parents” on page 47 for some practical ideas。

研究表明，强迫孩子节食可能会得不偿失。“被父母鼓励节食的青少年，在15年后有更大概率超重或肥胖、节食、暴食、养成一些不良的饮食习惯，并且对自己的身体不满意”。（Berge et al。 2018）家长们应该以身作则，给孩子提供健康的食物。

Research has found that parents who urge a child to diet may do more harm than good： “Experiencing parent encouragement to diet as an adolescent was significantly associated with a higher risk of overweight or obesity， dieting， binge eating， engaging in unhealthy weight-control behaviors， and lower body satisfaction 15 years later” （Berge et al。 2018）。 Instead， parents can help by modeling healthy habits and a healthy relationship with food for the whole family。

4。让青少年做好选择

4. Empower Teens to Make Better Choices

要给予青少年足够的自主权，让他们对健康做出自己的选择。教他们用SMART原则（Specific具体的、Measurable可量化的， Attainable可实现的， Relevant相关的、Time-bound有时限的）去制定目标。告诉他们注重生活习惯的改变（每餐都吃水果蔬菜或者零食）远比注重减肥更有效。这些策略会使青少年获得短期的成功，进而激励他们坚持下去。

Giving teens autonomy and the tools to make healthy choices is powerful。 Teach SMART （Specific， Measurable， Attainable， Relevant and Time-bound） goal-setting and create habit-based goals （e.g。， “I will eat a fruit or vegetable with each meal or snack”） rather than weight loss goals。 These tactics set teens up for the quick wins that will keep them motivated。

当青少年完成SMART目标后，要鼓励他们去学些新技能。比如学会读营养表、知道怎么控制食量、明白饥饿感和饱腹感、参与制定饮食计划等等。这些技能都能帮助青少年更好地完成目标。

Once teens develop SMART goals， encourage them to learn new skills like reading nutrition labels， understanding serving sizes， noting hunger and fullness cues， and helping with meal planning。 These skills can keep teens involved， empowered and likely to achieve their goals。

另一种向青少年赋予自主权的方法，是让他们在没有父母陪伴的情况下自己去参加健身活动。只有与家长一起合作，让家长了解正在进行的计划是什么后，才能让青少年更好地实现目标。

Another way to empower teens is to let them attend health or fitness appointments on their own， without a parent。 As a health or fitness professional， make sure you tell a teen’s parents about any action plan you and the teen agree on。 That helps nurture a home environment that encourages the teen to achieve goals。

5。采用多学科方法解决问题

5. Use a Multidisciplinary Approach

根据调查，那些成功减掉体重和改善健康的青少年，是在全家积极的参与配合、广泛的支持保障以及多学科团队合作等多方面因素的作用下取得成功的。这对那些严重肥胖或健康“亮起红灯”的青少年尤其重要，出现的健康问题表现为：

There is strong evidence to suggest teens who succeed the most at improving weight and health do it by engaging their families， an extended support network and a multidisciplinary team。 This is especially important for teens with severe obesity or with “red flags” such as

• 过量的运动、体重减少，使用减肥药或泻药；

excessive exercise， weight loss or use of dieting pills or laxatives；

• 催吐、暴饮暴食或者严格控制饮食；

induced vomiting， bingeing or severe diet restriction；

• 社交孤立；

social isolation；

• 一些临床症状如头疼、髋关节疼；

clinical problems such as severe headaches or hip pain； and

• 一些并发症如糖尿病、抑郁症或饮食障碍。

comorbidities such as diabetes， depression or an eating disorder。

如果你的社区没有相应的青少年而体重管理项目及团队，可以通过专业的网络途径来把客户转介绍给儿科医师、心理医生或者注册营养师。

While not every community has easy access to a robust adolescent weight management program， you can develop a professional network so you can refer a client to a pediatrician， mental health professional and/or registered dietitian， for example， if needed。

青少年和我们不一样

Teens Are Not Like the Rest of Us

青少年并不是成年人的缩小版。他们的健康计划和减肥计划，需要考虑年龄、生长期、个人喜好和期望等多方面因素。计划的设计及实施要由专业团队协作完成。

Adolescents are not young versions of adults。 Thus， optimizing health and treating obesity in teens means tailoring programs to their age， developmental stage， personal preferences and aspirations。 Moreover， this work must be done by a caring team of medical and health professionals who understand adolescents。

想让青少年吃得更好、动得更多、睡得更长、减少花在移动设备上的时间并进行更好的压力管理，要有健身专业人士的参与。为了帮助青少年改善生理与心理的健康，应当对他们目标达成进行奖励。

We desperately need health and fitness professionals who meet these requisites so we can help teens eat better， move more， sleep longer， spend less time on screens and devices， and better manage stress。 Teens must be able to experience the rewards， including improved mental and physical health and well-being， that result from these behavior changes。

家长小贴士：该做的和不该做的

MODELING DOS AND DON’TS： TIPS FOR PARENTS

该做

DO

• 多在家自己做饭；

make family meals a priority；

• 鼓励孩子饿的时候吃，饱的时候停；

encourage a child to eat when hungry and stop when full；

• 吃的食物要丰富；

eat a wide variety of nutrient-dense foods；

• 随时准备新鲜的水果和蔬菜；

provide ready access to fresh fruits and vegetables；

• 家里不放不健康的食物，比如冰淇淋、薯片和含糖饮料；

remove unhealthful “trigger” foods such as ice cream， potato chips and sugary drinks from the home environment；

• 全家一起改变；

make healthful changes for the whole family；

• 每天都进行体育运动；

incorporate physical activity into everyday routines；

• 每天准时睡觉，保证充足睡眠；

get adequate sleep and enforce bedtime routines； and

• 全家总动员，规定使用电子设备的时间，比如用餐时间不使用，睡前使用1小时等（可以在org/mediauseplan查看更多细节）

set screen time rules for the whole family， such as no screens during mealtimes or within 1 hour of going to bed （check out the AAP’s family media-use plan at healthychildren.org/mediauseplan）。

不该做

DON’T

• 节食；

diet；

• 把食物妖魔化；

demonize foods；

• 如果孩子不吃饭就惩罚他们（强迫他们运动）；

punish teens for “poor” nutrition decisions （with exercise or otherwise）；

• 用食物进行奖励（比如吃了蔬菜就奖励零食，或者表现好就奖励冰淇淋）；

use food as a reward （such as eating your vegetables to get dessert or celebrating a good report card with ice cream）；

• 只让一个人进行计划而不是全家总动员；

single out an individual family member；

• 情绪化进食（压力，焦虑等）；

eat for emotional reasons （stress， anxiety， etc。）；

• 对孩子或自己的身材进行负面的评价；

make negative comments about a child’s body or your own； or

• 拿体重开玩笑；

tease about weight。

青少年的健康风险

Health Risks for Teens

青少年健康话题的的要点

POTENTIAL TALKING POINTS WHEN SPEAKING WITH TEENS

青少年超重或肥胖会增加以下疾病的风险：

Overweight and obesity increase teens’ risk of these illnesses and conditions：

• 2型糖尿病以及胰岛素耐受性

type 2 diabetes and insulin resistance

• 睡眠呼吸终止症

sleep apnea

• 脂肪肝

fatty-liver disease

• 高胆固醇血症

high cholesterol

• 高血压

hypertension

• 髋关节功能障碍

hip dysfunction

• 多囊卵巢综合症（女性）

polycystic ovarian syndrome （in females）

• 抑郁症、焦虑症、轻生、自卑

depression， anxiety， suicidal thoughts， low self-esteem

• 注意缺陷多动障碍

attention deficit hyperactivity disorder

• 攻击性和破坏性行为

aggressive and destructive behavior

• 网瘾

internet addiction

• 饮食障碍，如暴饮暴食

eating disorders like bingeing and purging

作者：Natalie Digate Muth， MD， MPH， RDN， FAAP and Cassandra Padgett， MS 

译者：戴佳希