You’ve tried and tried to lose weight, but it just doesn’t happen. Or you lose a bit, then gain it back with a vengeance. Sound familiar?
一次又一次地试着减肥，就是没有效果。好不容易体重轻了一点，过不了多久又反弹回来了。是不是觉得这种情况很熟悉？
Recently, while reporting a story on 3 new supplements studied for weight loss, I had the opportunity to speak with nationally known obesity expert Louis Aronne, M.D., Director of the Comprehensive Weight-Control Program at New York-Presbyterian Hospital
最近，我在报道三种研究中的新的减肥补充剂时，借机采访了全国知名肥胖症专家、医学博士路易·阿龙内（Louis Aronne）。阿龙内是纽约-长老会医院/威尔·康奈尔医疗中心（New York-Presbyterian Hospital /Weill Cornell Medical Center）“综合体重控制项目”（Comprehensive Weight-Control Program）的负责人。
According to Aronne, scientists are finally finding answers to the mystery that has stumped them for so long: Why do some people seem to find it impossible to lose weight, despite numerous serious attempts to get slim using diets and exercise?
为什么有些人又节食、又锻炼，使尽了浑身解数，体重就是减不下来？这是困扰科学家多年的问题。阿龙内表示，如今这一问题终于快要找到答案了。
And what they’ve discovered might surprise you: Years of eating – and overeating – the typical American diet actually changes the brain. More specifically, it damages the signaling pathways in the hypothalamus, the part of the brain that regulates metabolism.
科学家的发现或许会让你大吃一惊：长年的饮食习惯——以及过度饱食——典型的美国式饮食习惯实际上改变了大脑。具体说来，它使下丘脑的信号通路受损，而下丘脑是大脑调节新陈代谢的中枢。
“The evidence is quite convincing – eating fattening foods causes inflammatory cells to go into the hypothalamus, ” explains Aronne. “This overloads the neurons and causes neurological damage.”
“这个理论的证据非常有力——摄入能增肥的食品会使炎症细胞进入下丘脑，”阿龙内表示。“这使神经元负荷过大，导致神经损伤。”
A groundbreaking study in the British Journal of Nutrition published in February, 2013 is one example of the kind of high-quality, on-target research that’s proving the theory of hypothalamic damage and thus paving the way to new weight loss strategies, Aronne says.
据阿龙内说，今年2月，《英国营养学杂志》（British Journal of Nutrition）发布了一项开创性的研究，这是一项典型的、具有针对性的高质量研究，证明了下丘脑损伤理论，为减肥新策略的诞生铺平了道路。
A team of scientists at the University of Liverpool analyzed a body of research that included studies of different weight loss diets. What they found was that a diet high in saturated fat and simple carbohydrates sets in motion a chain reaction of “metabolic dysfunction” involving the appetite regulating hormones leptin and ghrelin. (Leptin’s job is to suppress appetite, ghrelin’s to increases it.) In addition, a fatty high-carb diet resulted in “alterations in structural plasticity” – i.e. brain changes.
利物浦大学（University of Liverpool）的一个科学家团队分析了一系列对减肥食谱的研究。他们发现，饱和脂肪和简单碳水化合物含量高的饮食会导致“代谢功能障碍”的连锁反应，其中涉及到两种食欲调节激素的活动，这两种激素分别是瘦素（leptin）和胃饥饿素（ghrelin）。（瘦素的作用是抑制食欲，胃饥饿素则刺激食欲）除此之外，高脂肪、高碳水化合物的饮食还会导致“结构塑性的改变”——也就是大脑结构的变化。
Over time, consuming too many calories from fat and simple sugars damages the nerves that conduct signals through the hypothalamus, affecting the function of leptin and ghrelin, and thus the body’s ability to regulate weight and metabolism, says Aronne. “Because of this damage, the signals don’t get through about how much fat is stored.”
阿龙内表示，从高脂肪、高单糖的饮食中摄入过多的热量，长此以往，会损伤下丘脑中传递信号的神经，影响瘦素和胃饥饿素的功能，从而影响人体调节体重和新陈代谢的能力。“由于神经损伤，关于身体脂肪储量的信号将无法有效传递。”
In other words, your brain has gone haywire and you can no longer trust the messages it’s sending you about appetite, hunger, and fullness. “It’s like your gas gauge points to empty all the time, whether or not the tank is full, ” says Aronne. “So you keep stopping for gas, and then eventually you start filling up gas cans and storing them in the back of your car because you’re so convinced you could run out of gas at any moment.”
换句话说，大脑已经一片混乱，它给你发送的任何关于食欲、空腹感和饱腹感的信号都无足采信。“好比你的汽油表指针一直莫名其妙地指向零，不管油箱是不是满的，”阿龙内表示。“于是你总是停下车来加油，结果到了最后，你干脆把油桶注满，并在后备箱里屯一些，因为你觉得油箱里的油随时都会耗完。”
So What Does Work for Weight Loss?
那么，怎样做才能有效减肥呢？
Change your diet, and change it fast. “It’s about biology, ” Aronne is fond of saying. While some damage to the hypothalamus may be permanent, it’s possible to reverse much of it. “If less fatty food comes in, it reduces the rate of damage, ” he explains, noting that it doesn’t matter so much which specific diet you follow, as long as it’s one that cuts calories, reduces fat, and reduces simple carbohydrates.
改变饮食习惯，而且要迅速行动。“这涉及到生物学理论，”阿龙内总是把这句话挂在嘴边。虽然下丘脑受到的损伤有些可能是永久性的，但很大一部分损伤还是有可能复原。“只要减少脂肪的摄入，就能减缓大脑受损的速度，”阿龙内解释道。他还指出，遵守什么样的食谱并不是特别的重要，重要的是你所遵守的食谱要有助于减少热量、脂肪和简单碳水化合物的摄入。
Of course, there are lots of trendy diets, such as the Fast Diet currently making headlines. And there’s no reason not to try a new approach and see if it works better for you than the ones you’ve tried in the past. But work with your body, not against it, Aronne says, and the weight will come off much faster.
当然，现在有很多时兴的食谱可以参考，比如日前登上头条的快速减肥食谱（Fast Diet）。再说，有了新的方法，没有理由不去试一试，说不定会比以前的方法更适合自己。不过，要结合自身的状况量力而行，不要跟自己的身体过不去，这是阿龙内的忠告，只有这样，减肥才会收效更快。
But wait, there’s more. Retooling your diet to be rich in health-promoting foods can stop and even reverse the damage done by an unhealthy one. In the above-mentioned study at the University of Liverpool, the researchers also looked at the impact of omega-3 fatty acids, known to be beneficial to brain health. And sure enough, fish oil appears to modulate some of the negative effects of the saturated fats and carbs.
不过且慢，还有更多的好消息等着你。只要改变饮食习惯，多摄入有益健康的食物，就可以抑制甚至扭转不健康饮食造成的大脑损伤。在上文提到的利物浦大学开展的研究中，研究人员还探讨了欧米茄-3（omega-3）脂肪酸——一种有益于大脑健康的不饱和脂肪酸——在饮食中发挥的影响。而且不出所料的是，鱼油似乎可以减轻饱和脂肪和碳水化合物造成的某些不良影响。
What that means, in effect, is that switching to a healthy diet can heal the hypothalamic damage that’s playing havoc with your hunger and satiety cues. Not surprisingly, Aronne has authored his own diet book (with coauthor Alisa Bowman), The Skinny: The Ultimate Guide to Weight Loss Success (2010). It features lean meat, plenty of seafood, lots of vegetables and fruit, and unprocessed grains. There’s also more information on Aronne and his views on brain signaling and weight loss available on the Weill Cornell Medical College website.
事实上，这就意味着，只要改变不良的饮食习惯，采取健康的饮食结构，就可以治愈扰乱饥饿感和饱腹感的下丘脑损伤。毫不意外，阿龙内近日推出了他自己的食谱书——合著者为艾丽莎·鲍曼（Alisa Bowman），书名为《变身骨感美人：减肥成功的终极指南》（The Skinny: The Ultimate Guide to Weight Loss Success）（2010年出版）。书中提倡的饮食结构包含瘦肉、未经加工的谷类，很多海产品和蔬菜、水果。此外，登录威尔·康奈尔大学医学院（Weill Cornell Medical College）的网站，你也可以找到更多阿龙内就大脑信号和减肥问题发表的观点。
But here’s secret number two: Permanent weight loss takes time. Aronne is quick to point out that many of those who’ve dropped massive amounts of weight on The Biggest Loser have gained most of it back again within a year or two. Once again, science suggests the problem is that it takes time for the brain’s metabolic messaging system to heal.
不过，这里还有第二个秘诀：永久减肥需要时间。阿龙内很快指出，真人秀节目《超级减肥王》（The Biggest Loser）上，很多短时间内狂瘦下来的人都在一、两年内几乎完全反弹。科学家表示，其中的问题依然在于，大脑新陈代谢信号系统的复苏需要时间。
Weight Loss Medications May Help
减肥药或许有效
If you’re in the group of people who’ve tried (really tried) controlling your weight with diet and exercise, Aronne says it’s worth considering taking a prescription weight loss medication. Doing so can reset your brain to begin healing the hypothalamic damage. The two new diet drugs that just entered the market, Qsymia (formerly Qnexa) and Belviq, have the potential to do this, Aronne says.
如果你尝试过节食减肥和运动减肥（而且真的扎扎实实努力过），那么阿龙内的建议是，可以考虑服用处方减肥药。这样做可以“重置”大脑，开启治愈下丘脑损伤的进程。据阿龙内说，新上市的两种新型减肥药——Qsymia（即原来的Qnexa）和Belviq有做到这一点的潜力。
“Qsymia supports neuropeptide Y, amplifying the signals that come from the hypothalamus, ” Aronne says, adding that Belviq (lorcaserin) and the migraine drug Topamax also have a beneficial effect on brain signaling. In other words, these drugs at least partially fix the broken gas gauge.
“Qsymia能增强神经肽Y的作用，放大下丘脑发出的信号，”阿龙内表示。他还指出，Belviq（lorcaserin，绿卡色林）和偏头痛药物妥泰（Topamax）也有益于大脑信号的传递。换句话说，这些药物至少可以部分修复损坏的“汽油表”。
Along with being overweight comes insulin and leptin resistance, Aronne says. “When inflammatory cells go into the hypothalamus, they prevents leptin – which signals to the brain that the stomach is full from getting in, ” Aronne says. Among other things, Belviq stimulates the effect of leptin, Aronne says. “We don’t know exactly how it works, but it’s possible the mechanisms are hypothalamic. Belviq appears to amplify signals that go to the critical area of injury.”
阿龙内称，人一旦肥胖，随之而来的是胰岛素抵抗和瘦素抵抗。“炎症细胞进入下丘脑后，将阻止瘦素的进入，而瘦素可以传递饱腹感信号，”阿龙内表示。他指出，Belviq的作用之一，就是刺激瘦素的效果。“我们不清楚它具体是怎么发挥作用的，但是它的机理可能与下丘脑有关。Belviq似乎可以把发送到关键受损部位的神经信号放大。”
Now I know I’ve reported in the past on concerns about side effects from Qsymia and Belviq. Qsymia has been looked at for potential heart valve damage because phentermine, one of the two drugs in the combination, was part of the notorious Fen Phen diet drug combo that caused serious heart valve damage in the 1980s and early 90s.
现在我想起来自己曾经报道过人们对Qsymia和Belviq副作用的担忧。Qsymia曾由于可能造成心瓣膜损伤而被检测，因为组合中的两种药物之一——苯丁胺是臭名昭著的芬芬（Fen Phen）减肥药组合的成分之一，芬芬从上世纪80年代到90年代初曾给服用者造成严重的心瓣膜损伤。
But from Aronne’s perspective, the drugs have been studied very thoroughly and these concerns are unfounded. And more importantly, the seriousness of the health problems – and the increased risk of death – associated with obesity outweigh the risks of the drugs.
但是阿龙内认为，上市的药物都已经过彻底研究，人们的担忧毫无根据。而且更重要的是，肥胖症会引起严重的健康问题，导致死亡风险增加。服用减肥药的风险与之相比，只是小巫见大巫。
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