Obesity¹ should be defined by a person's health - not just their weight, says a new Canadian clinical guideline.

加拿大的一份新临床指南称，肥胖与否应该视健康状况而定，而不只是体重。

It also advises doctors to go beyond simply recommending diet and exercise. Instead, they should focus on the root causes of weight gain and take a holistic² approach to health.

该指南还建议医生不要只是就膳食和锻炼给出医嘱，而应该关注肥胖的根源，从整体的视角来看待健康问题。

The guideline, which was published in the Canadian Medical Association Journal on Tuesday, specifically admonished³ weight-related stigma⁴ against patients in the health system.

8月4日发表在《加拿大医学协会期刊》上的这一指南特别对医疗系统中针对肥胖症患者的歧视发出了警告。

Ximena Ramos-Salas, the director of research and policy at Obesity Canada and one of the guideline's authors, said research shows many doctors discriminate⁵ against obese⁶ patients, and that can lead to worse health outcomes irrespective of their weight.

该指南的作者之一、加拿大肥胖组织的研究和政策主任西米娜·拉莫斯-萨拉斯称，研究显示许多医生都歧视肥胖症患者，而这种歧视会令健康恶化，无论患者体重多少。

"Weight bias⁷ is not just about believing the wrong thing about obesity," she told the BBC. "Weight bias actually has an effect on the behaviour of healthcare practitioners⁸."她告诉BBC说：“体重歧视不仅是对肥胖有误解，实际上还会对保健医师的行为产生影响。”

The rate of obesity has tripled over the past three decades in Canada, and now about one in four Canadians is obese according to Statistics Canada.

过去三十年间，加拿大的肥胖率上升了两倍，根据加拿大统计局的数据，现在约有四分之一的加拿大人是肥胖者。

Although the latest advice still recommends using diagnostic criteria⁹ like the body mass index (BMI) and waist circumference¹⁰, it acknowledges their clinical limitations and says doctors should focus more on how weight impacts a person's health.

尽管最新指南仍建议人们采用身体质量指数和腰围来作为诊断标准，但指南承认了临床治疗的局限性，并表示医生应该更多地关注体重是如何影响一个人的健康的。

Small reductions in weight, of about 3-5%, can lead to health improvements and an obese person's "best weight" might not be their "ideal weight" according to BMI, the guideline says.

指南指出，体重微降（大约3%到5%）可以改善健康，而且一个肥胖者的“最佳体重”可能不是他们根据身体质量指数算出的“理想体重”。

It emphasises that obesity is a complex, chronic¹¹ condition that needs lifelong management.

指南强调，肥胖是一个需要终生管理的复杂的慢性病。

"For a long time we've associated obesity as a lifestyle behaviour... It's been a lot of shame and blame before," Ms Ramos-Salas says.

拉莫斯-萨拉斯女士称：“长时间以来我们一直将肥胖与生活方式关联在一起……肥胖在过去伴随着许多耻辱和责备。”

"People living with obesity need support like people living with any other chronic disease."“患有肥胖症的人需要和患有其他慢性病的人一样的支持。”

But instead of simply advising patients to "eat less, move more", the guideline encourages doctors to provide supports along the lines of psychological therapy, medication and bariatric surgery like gastric-bypass surgery.

这一指南没有简单地建议肥胖患者“少吃多动”，而是鼓励医生提供心理治疗、药物治疗和胃分流术等减肥手术这样的支持。

The guideline doesn't completely do away with standard weight-loss advice.

不过该指南也没有完全舍弃标准的减肥建议。

"All individuals, regardless of body size or composition, would benefit from adopting a healthy, well-balanced eating pattern and engaging in regular physical activity," it says.

指南称：“所有个体，无论是什么体型或体质，都会从健康平衡的饮食习惯和定期运动中获益。”

However, it notes that keeping the weight off is often difficult because the brain will compensate¹² by feeling more hungry, thus encouraging people to eat more.

但是，它指出，减肥通常很困难，因为大脑会通过饥饿感来补偿，从而鼓励人们吃更多东西。

Many studies have shown that most people who lose weight on a diet gain it back.

许多研究都显示，大多数通过节食来减肥的人后来体重又反弹了。

"Diets don't work," Ms Ramos-Salas says.

拉莫斯-萨拉斯女士称：“节食没有用。”

Physicians should also ask permission before discussing a patient's weight, and work with them to focus on health goals that matter to them, instead of just telling them to cut calories.

医生应该先征得允许才能讨论患者的体重，并和患者一起关注对其有意义的健康目标，而不只是让他们少吃。