GLP-1类药物与中年新陈代谢：Rocio Salas-Whalen博士解析减肥与更年期科学：第一部分

正是她发现了人体内的GLP-1。

And she's the one that discovered GLP-one in the human body.

那么，我们应该如何看待围绝经期和绝经期的GLP-1药物？

So, how should we think about GLP-1s in perimenopause and menopause?

我认为这是我们拥有的一个很好的选择，对吧？

I think it's a great option, right, that we have.

我认为现在正是女性中年生活的黄金时期，因为有激素疗法和GLP-1药物的可用性。

I think it's a great time to be a woman in midlife right now because of the availability of hormone therapy and GLP-one medication.

意味着不再接受低于100%的良好感受或健康状况。

Meaning no more accepting the less than 100% feeling good or having a good quality of health.

对。

Right.

没有借口，对吧？

There's no excuses, right?

我们可以讨论费用可及性，但它们确实存在，对吗？

We can talk about cost accessibility, but they are available, right?

那么对于青少年或更年轻的患者呢？

What about in adolescents or younger patients?

我们有足够的数据吗？

Do we have enough data?

是的。

Yes.

所以，它们实际上已经获批了。

So, they're actually approved.

因此，利拉鲁肽（商品名Victoza）这种每日注射的GLP-1类药物获批用于治疗2型糖尿病，适用于10岁及以上2型糖尿病患者。

So, liraglutide, which is Victoza, that's a medication, a GLP-one that is a daily injection approved for type two diabetes, is approved for 10 years and older with type two diabetes.

Saxenda（利拉鲁肽减肥版）作为减肥药物获批用于12岁及以上人群。

Saxenda, which is liraglutide for weight loss, branded for weight loss, is approved for 12 and above.

Wegovy（司美格鲁肽）同样获批用于12岁及以上人群。

Wegovy, which is semaglutide, also approved for twelve years and above.

所以快速减重——如果我们知道某人接受了胃绕道手术或严格热量限制，针对这些患者的研究显示会出现大量肌肉流失。

So, rapid weight loss, if we know if someone undergoes a gastric bypass or severe caloric restriction, the studies done on those patients show a lot of muscle loss.

这确实已成为社交媒体上的热门话题。

And this has become really a hot topic on social media.

你如何建议患者在治疗期间保护他们的瘦体重或肌肉质量，

How do you counsel your patients to protect their lean mass or their muscle mass while they're being treated with

GLP-1受体激动剂？

the GLP-one?

这一点甚至在我刚开始开具这些药物处方时也没有意识到。

And this is something that even me at the beginning when I started prescribing these medications, I wasn't aware of this.

这让我想到所有那些在减重手术后体重下降的患者，或者我们曾建议他们少吃、限制自己，然后回来时减掉了10磅的患者。

So, it makes me think all those patients that lost after bariatric surgery, or that we were recommending eat less, restrict yourself, and then coming and losing 10 pounds.

我们当时还非常自豪并安慰患者说，太好了，你减掉了体重。

And we were so proud and reassuring to the patient, Great, you lost the weight.

那可能减掉的大部分是肌肉，对吧？

It was probably a lot of muscle, right?

所以我们实际上弊大于利，但

So, we were doing more harm than better, but

我们-为什么失去肌肉是有害的？

we- Why is losing muscle harmful?

肌肉是我们最重要的代谢器官。

Muscle is our most important metabolic organ.

它实际上是一个内分泌器官。

It's actually an endocrine organ.

它会分泌一种叫做肌肉因子的激素。

It produces hormones called myokines.

所以，肌肉具有抗炎作用。

So, muscle is anti inflammatory.

肌肉能预防胰岛素抵抗性高胰岛素血症，对吧？

Muscle prevents insulin resistant hyperinsulinemia, right?

代谢综合征。

Metabolic syndrome.

肌肉在收缩时，会从血液中摄取葡萄糖并将其转化为能量。

Muscle, when it contracts, it subtracts glucose or takes glucose from the blood and converts it to energy.

肌肉通过燃烧脂肪来获取能量。

Muscle burns fat for energy.

所以，肌肉越多，就像你的卡路里燃烧机、脂肪燃烧机一样，对吧？

So, the more muscle you have, it's like your burning calorie machine, your burning fat machine, right?

肌肉越多，你的新陈代谢就越快。

The more muscle you have, the higher your metabolism is.

肌肉越少，你的新陈代谢就越慢，对吧？

The less muscle you have, the lower your metabolism is, right?

因此，肌肉是一个重要器官，我们谈论减肥时不能不讨论肌肉。

So, muscle is a vital organ that we cannot talk about weight loss without talking about muscle.

所以，在我们的诊所里，我们会为新开始GLP-1治疗的患者安排一小时的咨询。

So, in our clinic, we have an hour counseling visit for a new start GLP-one.

我们已经开始对他们进行激素治疗。

We've already started them on hormone therapy.

如果他们是合适的人选，他们会回来进行这次讨论。

If they're a good candidate, they're coming back for this discussion.

我们会花整整一小时讨论如何在减肥期间保护他们的肌肉质量。

And we take a whole hour to talk about ways to protect their lean mass while they're losing weight.

你具体会给患者提供哪些方面的建议？

What exact things do you counsel your patients about?

当然。

Definitely.

有没有什么药物可以帮助保持肌肉？

Is there a medication they can take to preserve muscle?

目前还没有。

Not yet.

暂时还没有。

Not yet.

我们得回到健身房器械训练上。

We have to go back to the gym rack.

所以这非常关键。

So, it's vital.

此外，在初次问诊时我会花一小时与患者沟通，因为必须向他们解释：治疗的三分之一是力量训练，另外三分之一是饮食中的蛋白质摄入。

And also, I spend one hour with my patients in their initial visit because it's vital to explain to them that one part, one third of their treatment will be strength training and another third part of their treatment will be protein in their diet.

最后三分之一则是GLP-1类药物。

And the other third will be a GLP-one.

这就是你的GPS治疗方案？

So that's your GPS?

这就是我的GPS方案。

That's my GPS.

所以让观众再听一遍，因为我觉得这非常重要。

So let the audience hear that again, because I think it's so important.

是的。

Yeah.

所以如果我能把它写成处方，我会的。

So if I could write it in a prescription, I would.

我称之为GPS，因为——

It's the GPS, I call it like that because-

等一下。

Wait a minute.

你认为我们应该能够把

Do you think we should be able to write

这个写成处方吗？

that as a prescription?

是的，应该。

Yes, should.

确实如此。

It is.

这就是健康。

It is health.

你认为保险应该涵盖私人教练的费用吗？

Do you think that insurance should cover personal trainers?

百分之百应该。

100%.

好的，继续。

All right, keep going.

喜欢把它称为GPS，就像导航系统一样，因为使用GLP-1进行减肥之旅本身就是一段旅程，对吧？

Like to call it the GPS, like navigation system, because going on a GLP-one, going into a weight loss journey is a journey, right?

所以，这是一张路线图。

So, it's a roadmap.

因此，这个GPS由GLP-1组成。

So, the GPS consists of GLP-one.

好的。

Okay.

P代表你饮食中的蛋白质。

The P is for protein in your diet.

蛋白质。

Protein.

GLP-1蛋白质。

GLP-one protein.

S则代表力量训练。

And the S is strength training.

力量训练。

Strength training.

对。

Right.

所以我告诉患者，另外两项和GLP-1同样重要，必须坚持。

So, that has to go, I tell my patients, the other two is as important as the GLP one.

好的。

Okay.

这是在重新教育患者。

It's re educating the patient.

作为医生和医疗工作者，我们不仅要自我再教育，还必须重新教育患者理解减肥的概念，对吧？

As physicians, as healthcare, we are re educating ourselves, but also we have to re educate our patients of the concept of weight loss, right?

那么，这方法有效吗？

So, does it work?

百分之百有效。

A 100%.

所以那些你读到的标题说会流失30%肌肉的说法。

So, that idea or that headlines that you read, you're gonna lose 30% of muscle.

没错，你可能会流失30%肌肉，如果不做GPS训练就一定会发生，对吧？

Yes, you can lose 30% of muscle and it will definitely happen if you don't do your GPS, right?

当一个人减少热量摄入时，蛋白质摄入也会减少，对吧？

So, once a person decreases their caloric intake, we're decreasing our protein consumption, right?

这就是为什么会出现肌肉流失。

So, that's why there is muscle loss.

对。

Right.

快速或大幅减重不可能不伴随肌肉流失，对吧？

Rapid or significant weight loss is not free without muscle loss, right?

那么可接受的流失量是多少呢？

What's an acceptable amount then?

你的意思是，让我确认一下，任何减肥过程中都会流失肌肉，对吗？

What you're is, me make sure I get this right, with any weight loss, you are going to lose muscle, right?

是的。

Yes.

流失多少算过多？你的目标是什么？

How much is too much and what is your goal?

根据我的观察经验，我建议——因为我会在每次就诊时为每位患者进行体成分分析。

So I recommend of what I've seen, because I perform body compositions on every single patient on every single visit.

因此我能清楚了解患者饮食调整和力量训练带来的变化，以及我们观察到的体成分变化。

So I know what the changes and what the changes are we're making in the patient's diet and the strengthening, what changes we're seeing composition.

假设有位患者八周后来复诊，减掉了10磅体重。

Let's say a patient comes to me after eight weeks, they lost 10 pounds.

如果他们只流失1磅肌肉，意味着肌肉流失率10%，这不会影响减脂效果，对吧？

If they lose one pound of muscle, meaning 10% less, doesn't impact their fat loss, right?

包括他们的体脂率下降和内脏脂肪减少。

Their percentage body fat loss and their visceral fat.

如果流失超过这个比例——我有患者可能减重10磅中有3磅是肌肉，那就是30%的流失率，对吧？

If they're losing more than that, I have patients that maybe they lost three pounds out of the 10 pounds, or that's 30%, right?

这样的流失率就会影响或延缓体脂减少的速度。

So, that impacts or slows down the body fat loss.

为什么会这样呢？

And why is that?

这背后的原因是什么？

Why would that be?

因为你正在失去燃烧的基础代谢率。

Because you're losing your burning Basal metabolic rate.

机器，对吧？

Machine, right?

而你的基础代谢率正变得越来越慢。

And your basal metabolic rate is becoming even slower.

所以每当有人说，哦，当你减掉很多体重时，你的新陈代谢会变慢。

So whenever they said, oh, when you lose a lot of weight, your metabolism becomes slower.

嗯，这都是因为肌肉流失。所以，这种情况发生在

Well, it's because of all the muscle loss So, that happened with

我认为大多数听众不明白的是，什么是基础代谢率？

what I think most of our listeners don't understand is what is the basal metabolic rate?

它是

It's how

你在休息时燃烧的卡路里量，对吧？

many calories you burn at rest, right?

通过

By And

是什么器官决定了这个量？

what is the one organ that determines that amount?

肌肉量。

Muscle mass.

肌肉。

Muscle.

对。

Right.

肌肉量。

Muscle mass.

所以如果我取出你腿上的所有肌肉，也就是25%的肌肉量，那么你的卡路里消耗就会减少。我们从研究中得知，停用GLP-1类药物的患者会反弹约70%的体重。

So if I take all the muscle out of your leg, you know, 25% of your muscle mass, then you are not going to burn as many calories at We know from studies that patients who stop GLP-1s will regain about 70% of the weight.

关于这点争议很大。

So there's a big debate about that.

我的病人们都很害怕。

And I have patients frightened.

难道我这辈子都要靠这个药维持吗？

Am I gonna be on this for the rest So of my

我们必须退一步思考这个问题——无论是社会大众还是医疗界，都需要停止将减肥视为一种外在的审美追求。

we have to take a step back on this because the problem that we as a society, general society, and even healthcare, we need to stop viewing weight loss as something aesthetic, as something external.

所以如果有人是抱着改善外形的目的使用这些药物，那么长期服药确实显得很荒谬，对吧？

So, if somebody's going into these medications thinking of something external, it does seem completely crazy to be on a drug long term for it, right?

没错。

Right.

既然你已经达到理想体型，为什么还要继续用药呢？

You got there, you got to your size, you got where you look good, then why continue with this medication?

问题在于我们对减肥的认知方式。

The problem is how we are viewing weight loss.

我们应该如何看待体重问题？应该像对待疾病一样。

How should we be viewing weight Like a medical problem.

肥胖是一种慢性疾病，减肥是其治疗手段。

Obesity is a chronic disease that weight loss is a treatment.

GLP-1类药物是治疗慢性病症的方法。

GLP-1s are a treatment for a chronic condition.

为什么我们默认慢性病是无法治愈的？

And why do we understand by chronic conditions that they're not curable, right?

它们是慢性的。

They're chronic.

需要长期治疗。

They will require long term treatment.

假设有人开始服用降压药。

Let's say somebody goes on blood pressure medication.

他们的血压改善了。

They improve their blood pressure.

我们会怎么说？

What do we say?

‘哦，停用降压药吧，因为现在血压正常了’。

Oh, stop your blood pressure medication because now it's normal.

确实有人可以停用降压药。

Now there are people who can stop their blood pressure medication.

这取决于每个人需要用药的个人经历，对吧？

It will depend on the individual personal story that took them to the place of needing a medication, right?

比如我有个60岁的病人，从八九岁就开始与体重作斗争，这是终生的抗争，那么他们很可能需要长期服药。

So, if I have a 60 year old patient that started struggling with their weight at eight years old, nine years old, that it's been a lifelong struggle, then most likely they will require the medication long term.

对吧？

Right?

而我总是喜欢换个角度说，这并不是坏事。

And I always like to flip it and say, it is not a bad thing.

因为这是历史上首次，我们拥有了不仅能帮助减重，还能维持减重效果的方案，对吧？

Because for the first time in history, we have something that is going to help not just with the weight loss, but maintaining the weight loss, right?

任何节食方法都会让人失去力量。

Any diet It's people people lose lose strength.

是的，你会瘦下来，但要保持住却变得不可能。

Yeah, you will lose it, but to stay there is what becomes impossible.

但现在通过药物在正确监督下，可以长期使用。

But now using a drug with the correct supervision, it can be used long term.

它长期使用是安全的，而且设计就是为长期使用。

It is safe to be used long term and it's designed to be used long term.

我可以给你举个例子，我自己的例子。

I can give you the example, my example.

我从未为体重困扰过。

I never struggled with weight.

我在三十多岁后期怀孕，四十出头生下第一个孩子。

I got pregnant in my late thirties, had my first kids in my early forties.

我进入了围绝经期。

I hit perimenopause.

我胖了30磅。

I gained 30 pounds.

我的糖化血红蛋白升高了，对吧？

My A1C went up, right?

我有两个学步期的孩子。

I had two toddlers.

我使用了六个月的司美格鲁肽，之后就能停用了。

I used semaglutide for six months and I was able to stay off of it.

但我一生都在进行力量训练，所以没有体重困扰，对吧？

But I strength training all my life and I didn't struggle with weight, right?

所以在这种情况下，是有可能的，对吧？

So in those situations, there's a possibility, right?

我总是告诉患者，你长期不依赖这种药物的最大赌注就是你的肌肉状况

I always tell my patients, your biggest bet on not depending on this drug long term is what happens to your muscle

你的肌肉量

mass Your muscle in mass.

对于那些出于短期原因想使用这类药物的患者呢？比如为了某个活动、婚礼，他们使用这些药物是出于

The What about patients who come in wanting to use them for short term reasons, like for an event, for a wedding, they're using them for

美容原因？

cosmetic reasons?

再次强调，这种情况不应该使用这类药物，对吧？

Well, again, they should not be used in that scenario, right?

但我学会了不去做任何假设，对吧？

But I've learned to not to assume anything, right?

我不知道这个人是否因为限制饮食来维持体重，而无法降到更低的体重。

And I don't know if this person is restrictive to maintain a weight and cannot get to a lower weight.

那么详细跟我说说这个情况。

So walk me through that.

我之前听你讲过这个，我觉得这对我们的听众非常重要。

I've heard you talk about this before, and I think it's so important for our listeners.

有人体重相对健康，却来咨询这种药物。

Someone comes in with a relatively healthy weight and they are asking about this medication.

这不是一个自动的否定答案。

It's not an automatic no.

这不是一个自动的否定答案。

It is not an automatic no.

这不是一个为什么？

It's not an Why?

自动

Automatic

因为互联网上的人会在这里跟你争论。

Because the internet will argue with you here.

是啊。

Yeah.

即便是我治疗过数千名患者，当看到一个人走进我办公室时，我也无法仅凭外表判断他们的内脏脂肪含量、体脂率或肌肉量。

Even me that I've treated thousands of patients, when I see somebody externally when they walk in my office, I cannot say what's their visceral fat, what's their percentage body fat, what's their muscle mass.

他们可能看起来很苗条，但那可能是因为肌肉量极少而体脂率和内脏脂肪很高，对吧？

They may look slim, but maybe it's because they have very low amount of muscle and high percentage body fat and high visceral fat, right?

这就是我们所说的瘦胖子或肌肉减少性肥胖。

It's what we call skinny fat or sarcopenic acidity.

好的。

Okay.

所以当他们来就诊时，你做了全身扫描，看起来一切正常。

So, but they come in, you do the body scan and everything kind of looks okay.

是啊。

Yeah.

你还是在说不行。

You're still saying no.

不行。

No.

然后我会说，跟我详细说说你的日常生活，对吧？

And then I go, Walk me through your day to day, right?

比如，你平时吃什么？

Like, what is it that you eat?

你做哪些运动？

What is it that you exercise?

对很多患者来说，要保持那个体重需要过一种限制性的生活方式。

And for many patients, it's a restrictive lifestyle to maintain that weight.

限制性的生活方式是什么意思？

What does restrictive lifestyle mean?

就是不可持续的事情，对吧？

Something that is not sustainable, right?

就是让你脱离日常生活的事情，对吧？

Something that is removing you from your daily life, right?

那么，有人在计算卡路里，称量食物，还有人每周锻炼七天，对吧？

So, somebody who is counting calories, who is weighing their food, somebody who is exercising seven days a week, right?

他们无法享受这个过程，这就像一份全职工作。

That they cannot enjoy the process, that it's a full time job.

维持那种状态

To maintain that

体重。

weight.

维持。

Maintain.

你在这些患者身上看到了什么？

And what do you see with those patients?

他们可能会从药物治疗中受益，对吧？

That they may benefit from the medication, right?

我们可以帮他们解脱出来。

We can relieve them from that.

不仅仅是给你开药，不用等待，而是要进行再教育。

And it's not just here's the drug, you don't have to wait, but then it becomes a reeducation.

然后你要讨论肌肉建设，肌肉力量训练。

Then you talk about muscle building, muscle strength training.

看，这些患者可能是心肺运动狂人，对吧？

See, these patients may be cardio queens, right?

每天骑动感单车，跑步，做各种有氧运动。

Doing spinning every day, they're running, they're doing all the cardio.

然后你重新教育他们如何锻炼。

Then you reeducate them on how to exercise.

但一旦消除了脚步声和负重噪音，他们就能专注于为健康而锻炼。

But once you remove that foot noise, that weight noise, then they can concentrate on exercising for health.

所以，当你消除了对某人减肥的压力——或者保持体重。

So, when you remove the pressure of weight loss to somebody- Or maintaining your weight.

或者说保持体重，这对许多患者来说变得愉快了，对吧？

Or maintaining your weight, it becomes enjoyable for many patients, right?

它变得更易适应且易于长期维持，因为这不是解决方案，对吧？

It becomes more adaptable and easy to maintain long term, because that's not the solution, right?

这不是减肥的解决方案。

That is not the solution for the weight loss.

所以，回答你的问题，这取决于具体情况，取决于它如何消耗他们的生活，取决于他们的身体成分。

So, to answer your question, it depends on the story, it depends how it's consuming their life, it depends on their body composition.

那么，FDA并未批准用于肥胖症以外的用途，对吧？

So, is not FDA approved for outside of obesity, right?

它被批准用于减肥和治疗肥胖症。

It's approved for weight loss and obesity.

但在这种情况下，我们并没有获得FDA的批准。

But in this situation, we don't have an FDA approval for this.

但根据你的临床经验，你觉得是的。

But in your clinical experience, you feel Yeah.

所以，

So,

当我们讨论适应症时，目前是针对BMI超过27的患者，即使是超重患者，对吧？

when we're talking about the indications, currently it's indicated for a BMI greater than twenty seven, so that even on overweight patients, right?

但你看，我们只是在治疗数字。

But see, we're treating numbers.

对。

Right.

对吧？

Right?

我们只是在治疗数字。

We're treating numbers.

我们并没有治疗病人。

We're not treating the patient.

我们必须根据患者的实际情况来治疗。

And we have to meet patients where they are.

而且我

And I've

之前听你说过这个。

heard you said this before.

必须了解他们所处的生命阶段和年龄。

Have to see where they are in their life, in their age.

有时候我们对病人要求太多，却得不到相应的效果。

We ask too much from patients sometimes without getting their results.

我认为我们不应该把持一种可能有益的药物——不仅对身体有益，对患者心理也有帮助的药物，这不公平。

I don't think it's fair for us to gatekeep a medication that can be beneficial, not just physically, but mentally also on a patient.

确实，我会拒绝一些病人的请求。

Now, I do say no to some patients.

如果有病人来找我说想减肥，但他们的肌肉量很好，体脂率也很理想，我就会拒绝说：'你不需要用药。'

So if a patient comes to me and they tell me, I wanna lose weight, but their muscle mass is great, their percentage of body fat is great, then I say no, You don't need the medication.

所以，这反而更让人安心。

So, it's more reassuring.

保持现状就好。

Doing what you're doing.

因为如果有人来找我时体脂率很低而肌肉量很高，我就知道他们的生活方式很健康。

Because if somebody comes to me and their percentage body fat is low and their muscle mass is high, I already know that their lifestyle is healthy.

是的。

Yeah.

我已经能猜到他们的饮食状况了，对吧？

I already know what their nutrition is, right?

我知道他们肯定在坚持锻炼。

I already know that they're working out.

我能预见到他们的血液检测结果会很好，对吧？

I can see their blood work is gonna be good, right?

他们的血压也很正常。

Their blood pressure is good.

所以，这些指标和身体成分是相互印证的。

So, the parameters go with the body composition.

我最喜欢的就诊经历就是遇到一位自认为超重甚至终生肥胖的女性，而她从未做过身体成分扫描。

That's my favorite visit is someone who's felt she was overweight or even obese her whole life, and she's never had a body scan.

我们让她躺在扫描仪上，我正看着你身上这些漂亮的肌肉。

And we get her on the scanner and I'm look at this gorgeous muscle that you have.

你的体脂非常少。

You have such little body fat.

你没有内脏脂肪。

You have no visceral fat.

你只是拥有基因和上天赐予的几道曲线。

You just have a few curves that your genetics and God gave you.

她的化验结果看起来很棒。

Her labs look great.

她的血压非常完美。

Her blood pressure's perfect.

她因此感到非常安心，因为由于BMI这个荒谬指标，她一直觉得自己终身都有体重问题。

And she's so reassured because she has felt, because of this BMI ridiculousness, that she has had a weight problem her whole life.

是啊。

Yeah.

这也在教育患者——这需要时间，可能需要几代人——让他们明白体重不等于健康。

And it's also teaching patients, and this is gonna take time, few generations, is to understand that their weight doesn't equal their health.

体重秤上的数字并不能说明全部情况，对吧？

The number and the scale is not telling us all the picture in there, right?

关键是你的身体成分。

It's your body composition.

尽管指南已经改变，但他们仍然从临床医生那里听到'你体重超标，BMI太高'这样的说法。

They're still hearing this from their clinicians and their doctors that your weight is too high, your BMI is too high, even though the guidelines have changed.

你觉得要多久

How long do you

才能让所有人都接受？

think it's gonna take before everyone gets on board?

我想可能需要等到新一代医学院学生成长起来，对吧？

I think it's gonna take probably the new incoming generation of medical school students, right?

所以大概在未来五到十年内，我认为会得到更广泛的认可。

So, probably in the next five years, ten years, I think it's going to be more broadly accepted.

关注心理健康可能会让人感到孤独。

Taking care of your mental health can feel isolating.

有时候在网上浏览建议并不能满足你的需求。

There are days when scrolling through advice online just doesn't give you what you need.

说实话：寻求支持可能会让人不知所措。

And let's be honest: Reaching out for support can be overwhelming.

很难知道该从哪里开始。

It can be hard to know where to start.

但这就是Alma发挥作用的地方。

But that's where Alma comes in.

Alma拥有全美超过20,000名多元化的持证治疗师网络，其中99%接受保险，让寻找合适的治疗变得简单且经济实惠。

With a nationwide network of over 20,000 diverse, licensed therapists, 99% of whom accept insurance, Alma makes finding the right care simple and affordable.

你无需注册即可搜索，然后根据性别、种族或治疗方法等重要因素筛选，甚至可以使用免费的保险估算器预先查看咨询费用。

You can search without creating an account, then filter by what matters most, like gender, race, or therapeutic approach, and even see the session costs upfront with their free insurance estimator.

平均而言，使用Alma的人能节省80%的咨询费用。

On average, people using Alma save 80% on their sessions.

Alma最突出的特点在于，它不提供速效方案或泛泛建议。

What stands out most about Alma is that this isn't about quick fixes or generic advice.

它专注于真正的人际连接，这意味着你可以根据需要安排与多位治疗师的15分钟免费咨询，直到找到真正符合你目标的那一位。

It's about real human connection, which means you can schedule free fifteen minute consultations with as many therapists as needed to find one who truly fits your goals.

随着时间的推移建立有意义的关系能带来更好的心理健康结果，而Alma让这个过程比以往任何时候都更容易。

Building a meaningful relationship over time leads to better mental health outcomes, and Alma makes that easier than ever.

与人相处更融洽，与Alma相伴更美好。

Better with people, better with Alma.

访问helloalma.com/unpaused立即开始，今天就预约免费咨询。

Visit helloalma.com/unpaused to get started and schedule a free consultation today.

网址是helloalma.com/unpaused。

That's helloalma.com/unpaused.

你们听我谈论过更年期护理缺口的问题。

You've heard me talk about the care gap in menopause.

女性的症状经常被忽视或得不到治疗。

How women's symptoms are often dismissed or left untreated.

我在执业过程中屡见不鲜。

I see it all the time in my practice.

许多女性苦苦寻求答案却不知该求助何处，往往得不到所需的支持。

There are many women struggling for answers, unsure where to turn, and too often not getting the support they need.

这就是为什么我如此兴奋地向你们介绍MidiHealth。

That's why I'm so excited to tell you about MidiHealth.

MidiHealth是一家专门服务于中年女性的远程医疗诊所。

MidiHealth is a telehealth clinic focused exclusively on women in midlife.

在值得信赖的医疗领导和临床医生的带领下，团队致力于基于证据的全人护理。

Led by trusted medical leaders and clinicians, the team is committed to evidence based whole person care.

他们还是全国唯一由主要保险公司承保的女性健康远程诊所，让专业护理变得触手可及且价格合理。

They're also the only national women's health tele clinic covered by major insurance, making expert care accessible and affordable.

当你与Middie合作时，你会获得一个个性化计划，可能包括激素治疗、营养指导、体重管理和生活方式支持。

When you work with Middie, you get a personalized plan that can include hormone therapy, nutrition guidance, weight management, and lifestyle support.

这种护理设计不仅是为了让你今天感觉更好，更是为了保护你未来的心脏、骨骼和大脑健康。

It's care designed not just to help you feel better today, but to protect your heart, bone, and brain health for the future.

这真是个激动人心的时刻。

This is such an exciting moment.

更年期护理终于发展成了应有的样子：易于获取且以女性真实需求为中心。

Menopause care is finally evolving into what it should be: accessible and centered on women's real needs.

看到MIDI取得的进步令人振奋，他们帮助女性真正感受到被倾听和支持。

It's inspiring to see the progress MIDI is making, helping women feel truly heard and supported.

你值得拥有既能支持你现在又能保护你长期健康的护理。

You deserve care that supports you now and protects your long term health.

访问joinmiddie.com与Middie临床医生会面，开始为未来几年做最好的自己。

Visit joinmiddie.com to meet with a Middie clinician and start feeling your best for the years ahead.

在这个节日季，送礼不应意味着在质量或清洁成分上妥协。

This holiday season, gift giving shouldn't mean compromising on quality or clean ingredients.

Primal Pure让这一切变得简单，他们提供无毒小批量套装，包装精美且真正有效。

Primal Pure makes it easy with toxin free small batch bundles that are ready to wrap and designed to actually work.

在寻找一款无毒除臭剂和既奢华又纯净的身体黄油吗？

Looking for a non toxic deodorant and a body butter that feels both luxurious and clean?

他们的天然竹炭除臭剂富含维生素的生物活性成分，不仅能有效中和体味，还能帮助减少毒素积累。

Their charcoal natural deodorant is made with vitamin rich bioavailable ingredients that work with the body not only to effectively neutralize odor, but to help minimize toxic buildup.

你也可以试试他们最畅销的杏仁香草身体乳，不仅保湿滋润，而且无添加毒素，是沐浴后的完美选择。

You may also want to try their best selling almond and vanilla body butter, which is not only moisturizing, but free of toxins and perfect after a shower or bath.

需要准备节日女主人礼物吗？

Need a Hostess gift for the holidays?

试试他们新推出的限量款，比如我最爱的温馨香草薄荷身体护理系列或蔓越莓红润唇膏。

Try their new limited edition picks, like the Cozy Vanilla Mint Body Care or Cranberry Red Lip Balm that are at the top of my list.

好消息是Primally Pure不仅是份礼物。

The good news is that Primally Pure isn't just a gift.

它是对清洁生活和用心自我护理的邀请。

It's an invitation to clean living and mindful self care.

他们的畅销产品都是奢华无毒的必备品，人人都会喜欢。

Their best sellers are luxurious, non toxic staples that everyone will appreciate.

使用优惠码UNPAUSED可享受Primally Pure购物85折。

Use code UNPAUSED to get 15% off your Primarily Pure purchase.

官网是www.primallypure.com。

That's www.primallypure.com.

结账时别忘了使用优惠码UNPAUSED享受85折优惠。

And don't forget to use code UNPAUSED at checkout for 15% off your order.

最近网上很多人讨论微量服用。

Hear a lot on the internet about microdosing.

那是什么，你

What is that and do you

推荐吗？

recommend it?

微量给药是指使用微量或低于治疗剂量的剂量。

So, microdosing is when you use a micro amount or a smaller amount than the therapeutic doses.

微量给药是指某人想使用低于治疗剂量的剂量来获得减肥以外的益处，对吗？

Microdosing is when somebody wants to use a smaller dose than the to therapeutic get benefits outside of weight loss, right?

因为我们知道要达到减肥效果，你需要治疗剂量。

Because we know that to reach weight loss, you need the therapeutic doses.

剂量。

Dosing.

现在，关于微量给药的概念，根据我见过最多的情况，人们主要是为了抗炎特性——我是否错过了什么？

Now, the concept of microdosing is by people, and this is what I've seen the most, is that for the anti inflammatory properties, am I missing out?

我是否错过了那些正在减肥的人从GLP-1中获得的所有健康益处？

Am I missing on the all healthy benefits of GLP-one that people that are losing weight are getting?

我在网上随处可见这种现象。

I see it all over the internet.

每个健康领域的网红都在谈论微量给药，但是，

Every wellness influencer talks about microdosing and But,

在这些情况下有两件事需要注意。

so there's two things in those scenarios.

第一，可能是那些拥有完美体脂比例的人，对吧？

One, it could be somebody who has a perfect body composition, right?

低体脂率、高肌肉量、低内脏脂肪——我可以向他们保证，你已经获得了别人通过GLP-1能获得的所有积极益处，对吗？

Low percentage body fat, high muscle mass, low visceral fat, that I reassure them, you already are getting all the positive benefits that somebody's going to get from a GLP-one, right?

你有肌肉量，你的肌肉正在燃烧卡路里，你很强壮，体脂率低，没有内脏脂肪。

You have muscle mass, you are burning calories with your muscle, you're strong, you have a low percentage body fat, you don't have visceral fat.

所以你患病的风险非常低。

So you have a very low risk of disease.

GLP-1类药物不会给你带来额外的好处。

There's nothing extra that you're gonna get from a GLP-one.

这是问题的一个方面。

Now, that's one side of it.

另一方面是那些认为自己不需要减肥的人，对吧？

The other side is somebody who thinks who doesn't need to lose weight, right?

我不需要减肥，只想用药，但当我们用'真相机器'（我喜欢称之为身体成分分析仪）检测时，结果发现他们肌肉不足，内脏脂肪高，体脂率高。

I don't need to lose weight and I just wanna use the medication, but surprise, surprise, when we put them on the machine of truth, I like to call that the body composition, then you realize they're under muscle, they have high visceral fat, they have high percentage body fat.

所以，你不需要微剂量。

So, you don't need the microdose.

你需要常规的标准剂量。

You need the regular real dose.

剂量。

Dose.

那么，是什么导致我们体内发炎呢？

So, what is that causes inflammation in our body?

内脏脂肪是促炎性的，对吧？

Visceral fat is pro inflammatory, right?

内脏脂肪会增加胰岛素抵抗和高胰岛素血症，这本身也是促炎性的。

And visceral fat increases insulin resistance, hyperinsulinemia, which also in itself is pro inflammatory.

许多肥胖患者可能肌肉量较低。

And then many patients with obesity may have low muscle mass.

所以这是炎症的三重打击，对吧？

So, it's a triple whammy in inflammation, right?

当某人开始使用GLP-1药物并减少内脏脂肪时，他们的炎症指标会下降。

So, when somebody goes on a GLP-one and they start losing visceral fat, their inflammatory markers go down.

如果他们开始增肌，炎症指标会进一步降低，对吧？

And if they start building muscle, then their inflammatory markers go even lower, right?

这就是为什么我们看到自身免疫性疾病有所改善，对吧？

That's why we see improvement in autoimmune diseases, right?

因为现在免疫系统能正常运作，保护身体，减少感染和生病的机会。

Because now the immune system can do its job, can protect the body, less infections, less getting sick because of that effect.

但为什么这属于药物治疗呢？

But why is it in the medication?

首先，它会减少进食，对吧？

One, that you're gonna decrease eating, right?

你的热量摄入会降低。

Your caloric intake is lower.

这怎么会减轻炎症呢？

And how would that lower inflammation?

因为你正在减少内脏脂肪。

Because you're dropping visceral fat.

其次，这种药物的作用在于它能抑制饥饿激素并增加饱腹感激素。

Second, is because the effect of this medication that it decreases, suppresses your hunger hormones and increases your satiety hormones.

饱腹感就是当你吃饱时的感觉。

Satiety is when you're full.

所以，这些药物会增加你的饱腹激素。

So, these drugs increase your fullness hormones.

因此，你只需吃平时一半的量就会感到饱足。

So, you feel fuller with half of what you normally would eat.

然后它会在两餐之间抑制你的饥饿激素。

And then it suppresses your hunger hormones in between meals.

好的。

Okay.

所以，患者只需吃平时一半的量，在两餐之间也不会感到饥饿或渴望进食。

So, patients eat half of what they normally eat without feeling hungry or craving in between meals.

通过立即将摄入量减少到平时的三分之一、三分之二或一半，你也减少了促炎性食物的摄入。

So, by cutting us already immediately to one third, to two thirds or half of what you normally would consume, you're also decreases pro inflammatory food.

这种药物还会抑制或阻断他们对食物产生的奖赏感。

This medication also suppresses their reward or blocks their reward from food.

那么，对许多患者来说，食物的奖赏是什么？

So, what is the reward of food for many patients?

要么是淀粉类、甜食或咸食。

Either starches, sweets, salts.

那些是高

Those are high

奖赏食物？

reward foods?

可能是高回报食物，同时也是促炎性食品。

Can be high reward foods, And that's pro inflammatory food.

你认为肥胖问题是否属于流行病的一部分，你觉得这是种流行病吗？

Do you feel that part of the obesity epidemic, do you feel like it's an epidemic?

是的，没错，

Yes, Yeah,

我们都知道事实如此。

we know it is.

好的。

Okay.

是由于

Is due to

食品工业。

the food industry.

很大程度上确实如此。

In big part, yes.

我们国家的食品生产方式对健康并不最有利，对吧？

The way that our food is made in this country is not the best for our health, right?

我认为食品工业终将——希望在不远的将来——要为我们面临的肥胖流行病负责，在食品生产上我们重数量轻质量，对吧？

We concentrate on quantity and not quality when it comes to I do feel like the food industry at one point, hopefully in the not too far away future, will be held accountable for the obesity epidemic that we have, right?

食品可及性方面，优质健康食品往往价格更高。你不能要求一个六口之家用月薪购买草饲肉类或有机水果。

Food accessibility, the good, healthy food tends to be more expensive than none, And you cannot argue with a family of six that they're making it month by month on their paycheck to buy grass fed meat or organic fruit.

对吧？

Right?

对。

Right.

所以，食品可及性也必须改变。

So, food accessibility has to also change.

但还有我们的环境，对吧？

But also our environment, right?

我们居住的地方。

Where we live.

我们生活的城市不再提倡步行，也不再鼓励步行。

We live in cities where walking is not promoted, is not encouraged anymore.

是啊。

Yeah.

我们到哪儿都开车。

We take the car everywhere.

现在我们甚至可以在客厅里工作。

Also now we can work from our living room.

我们生活的环境让我们暴露在久坐不动的状态中。

We live in an environment that expose us or makes us be sedentary.

我听说这叫致胖环境。

I've heard it called an obesogenic.

环境。

Environment.

环境。

Environment.

此外，我们可以讨论致胖环境中的内分泌干扰化学物质，对吧？

Also, we can talk about endocrine disrupting chemicals in the obesogenic environment, right?

塑料、双酚A、永久性化学物质、水中的污染物、墙上的涂料，对吧？

Plastics, BPA, the forever chemicals, what's in our water, the paint in our walls, right?

所以，这些也会助长肥胖。

So, that also can promote obesity.

当我们谈论肥胖时，甚至可以追溯到几代人之前。

And when we talk about obesity, we can go even generations before us.

这就是我们要讨论为某人消除内疚感的地方，对吧？

And this is where we talk about removing the guilt for someone, right?

我可以给你举个例子，关于我接诊一位新患者的经历。

And I can give you the example of an appointment that I had with a new patient.

那是一位14岁的女孩，由她的父母带来就诊。

It was a 14 year old girl that was brought by her mom and her dad.

他们带她来是因为肥胖问题。

And they were bringing her for obesity.

当时父母都在场，我总是想了解家族病史。

And I had both parents there and I always wanna know what's the family history.

我追溯了两代人，发现她的父母都曾与肥胖抗争。

I go two generations behind that your parents struggle with obesity.

在这个案例中，她当时14岁。

In this case, she was a 14 year old.

她的父母在场，所以我能够直接与双方父母交谈。

Her parents were there, so I was able to talk directly to both parents.

父亲也曾与肥胖症抗争。

The father also struggled with obesity.

母亲患有多囊卵巢综合征。

The mother had PCOS.

他的母亲患有肥胖症，他的姨妈们也都有肥胖问题。

His mother struggled with obesity and his maternal aunts also struggled with obesity.

他的兄弟也有肥胖困扰。

His brother struggled with obesity.

所以，你可以看到我的病人家族中三代人都患有肥胖症。

So, you can see three generations to my patient with obesity.

因此，肥胖具有代际传递性。

So, obesity is transgenerational.

是的。

Yeah.

更有趣的是，有研究数据表明代际创伤也是导致肥胖的原因之一。

There's even data, it's so interesting, there's even research showing that transgenerational trauma is a cause of obesity also.

我记得住院医师期间读过一项妇产科研究，讲的是基因印记改变的问题。

So, there was a study I remember reading about in residency, an OBGYN, and it was talking about imprinting, of changing our genetics.

这项研究特别关注二战期间德国占领比利时等欧洲国家时，当地孕妇的处境。由于占领期间食物匮乏，她们遭受了严重的卡路里限制。

And this was specifically on women who were in Germany had This is World War II, and they had occupied maybe Belgium or, you know, one of the European And women who were pregnant during the occupation, they were severely calorically restricted because they didn't have access to food during the occupation.

她们每天只能吃几个土豆或任何能找到的食物。

So, they were just eating a few potatoes a day or whatever they could get their hands on.

在这次占领期间，营养不良和饥饿现象极为普遍。

But malnutrition and starvation was huge during this occupation.

之后她们继续分娩。

They then go on to deliver their babies.

那些婴儿出生时全都体重不足，这很正常，因为不给胎儿提供营养，它就无法生长。

Those babies were all born underweight, okay, which is normal when you don't feed a fetus, it doesn't grow.

绝大多数父母非肥胖的儿童长大后却成了肥胖者。

An overwhelming majority of those children who had non obese parents grew up to be obese.

当时的观点认为，我们改变了他们的基因——当这些胚胎在严重受限的子宫环境中形成时。

And the thought process was we had changed their genetics while they were, you know, embryos and forming in the uterus from this severely restricted environment.

是的。

Yeah.

所以，跨代创伤是导致肥胖的原因之一，对吗？

So, transgenerational trauma is a cause of obesity, right?

大量研究表明，经历创伤的儿童——即使没有家族肥胖史——也比童年未受创伤者更容易肥胖，对吧？

There's so many studies that children that go through trauma, even without having family history of obesity, tend to have obesity more than those that were not exposed to trauma in early childhood, Right?

如果把所有因素都考虑进去，肥胖者真正能掌控的又有多少呢？

So, there's so many factors that if you put them all together, how many does a person with obesity actually have control of?

而终其一生都被告知'这是你的错，你缺乏意志力'，我认为这对患者同样是一种创伤。

And being told your whole life, this is your fault and you don't have willpower, I think that that's traumatic for patients as well.

非常具有创伤性，极其创伤。

Very traumatic, very traumatic.

这也是他们不再信任的原因，对吧？

And that's the reason that also they don't trust, right?

于是他们选择沉默。

And they stop talking about it.

但我告诉患者们，甚至在你们出生前，可能就已经存在患肥胖症的风险。

But when I tell patients, even before you were born, you might already had the risk of having obesity.

因为我们知道遗传因素，我说的是表观遗传学，对吧？

Because we know that genetics, and I'm talking about epigenetics, right?

有多个基因会影响那一个特定基因。

That there's multiple genes affecting that one single gene.

所以，我们知道父母双方在孕前的体重都会影响后代的体重，

So, we know that both parents weight at preconception will impact the weight of their offspring,

太神奇了。

their Amazing.

甚至高达50%到70%。

Even 50 to 70%.

回到我的患者案例，那个14岁的孩子对父亲说：看吧，我患肥胖症是你的错。

Going back to my patient, the fourteen year old says to the dad, oh, so see, it's your fault that I develop obesity.

这并非要责怪谁，因为他母亲也有肥胖症，对吧？

And it was not to blame because his mom had obesity too, right?

母亲不知道，父亲也不知道，但现在我们知道了，对吗？

She didn't know, the father didn't know, but now we know, right?

所以现在这个14岁的孩子接受治疗后，将打破这种跨代肥胖的循环。

So, this 14 year old that we can treat now will break that cycle of transgenerational obesity.

这是我经常遇到的情况——当我的育龄患者告诉我：我计划六个月后怀孕。

And this is something that I always, I have when I have my reproductive age patients that they tell me, Oh, I wanna get pregnant in six months.

而她们本身患有肥胖症或超重。

And they have obesity or overweight.

我向他们解释：看，你的体重和父亲的体重——不仅仅是母亲的，而是父母双方的体重——都会影响你子女和孙辈的体重。

I explain to them, Look, what your weight is and the father's weight, this is not just the mother, both parents' weight, is going to impact the weight of your children and your grandchildren.

因此，凭借我们掌握的这些信息，我们可以打破这种跨代肥胖的模式。

So, with this information that we have, we can break that transgenerational obesity pattern.

现在为您带来由MediHealth赞助的《更年期健康》节目。

Now for A Medipause, sponsored by MediHealth.

对女性健康最简单有效的营养素之一就是维生素D。

One of the simplest, most powerful nutrients for women's health is vitamin D.

维生素D实际上是一种激素，几乎影响身体的每个系统，包括免疫功能、情绪、新陈代谢甚至肌肉力量。

Vitamin D is actually a hormone that affects nearly every system in the body, from our immune function, our mood, metabolism, and even muscle strength.

然而，超过42%的美国人缺乏维生素D，而对于更年期女性，这个比例可能高达85%。

Yet, over forty two percent of Americans are deficient in vitamin D, and this number can approach eighty five percent for women in menopause.

以下是这为何重要。

Here's why that matters.

在围绝经期和绝经期，随着雌激素水平下降，我们患骨质疏松、肌肉流失甚至情绪低落的风险都会增加。

During perimenopause and menopause, our risk for osteoporosis, muscle loss, and even low mood increases as estrogen declines.

维生素D帮助我们的身体吸收钙和磷，这两种矿物质对保持骨骼强健和预防骨折至关重要。

Vitamin D helps our bodies absorb calcium and phosphorus, two minerals essential for keeping bones strong and preventing fractures.

但它还能支持免疫健康，减少炎症，并与更好的情绪调节和认知功能相关。

But it also supports immune health, reduces inflammation, and has been linked to better mood regulation and cognitive function.

挑战是什么？

The challenge?

仅靠饮食很难获取足够的维生素D。

It's hard to get enough vitamin D from food alone.

富含脂肪的鱼类、蛋黄和强化乳制品有助于补充，但阳光是我们最主要的来源。

Fatty fish, egg yolks, and fortified dairy help, but sunlight is our biggest source.

根据你居住的地区、肤色以及室内活动时间的长短，仅靠这些可能还不够。

And depending on where you live, your skin tone, and how much time you spend indoors, that might not be enough.

大多数女性每日补充1000至2000国际单位的维生素D3会受益，这是人体吸收效果最佳的形式。

Most women benefit from supplementing with one thousand to two thousand international units per day of vitamin D3, which is the form your body absorbs best.

我建议通过简单的血液检测来检查你的维生素D水平，并在临床医生的指导下调整剂量。

I recommend getting your levels checked with a simple blood test and adjusting your dose under your clinician's guidance.

因为当你的维生素D水平达到最佳状态时，你的骨骼、肌肉、免疫系统甚至情绪都会因此受益。

Because when your vitamin D is optimized, your bones, muscles, immune system, and even your mood may thank you.

请记住，在开始任何新的营养补充剂前，务必咨询临床医生。

And remember, always to consult a clinician before introducing any new nutritional supplement.

你在候诊名单中提到，某些被开具GLP-1类药物的患者可能因用药不当而面临治疗失败？

You say in wait lists that some patients who are given GLP-1s are being set up to fail by being offered these medications?

遗憾的是，现在人人都能轻易获得这些药物的处方。

Well, unfortunately, everybody's prescribing these medications for everybody.

每个人都是如此。

Everybody.

我可以开化疗药物处方。

I can prescribe chemo drugs.

但我不这么做，因为会造成伤害，对吧？

I don't because I'm gonna create harm, right?

虽然我有这个权限，但我选择不开。

But I could, but I don't.

所以，GLP-1药物应该被视为同一种东西，对吧？

So, GLP-one medication should be seen as the same thing, right?

这是针对慢性病的医疗手段。

It's a medical treatment for a chronic condition.

它们不是为了让病人开心而采取的肤浅、表面的东西。

They're not something superficial, external to make the patient happy.

我是说，曾有神经科医生、眼科医生问我该怎么开这种药。

I mean, I've had neurologists, ophthalmologists asking me, how do I prescribe this?

我的回答是：你根本不该开。

And I'm like, you just shouldn't.

目前我认为，每个专科都会因为各种原因接诊肥胖患者，或者他们看到的是肥胖引发的并发症。

For now, I do think that every specialty gets a patient with obesity for whatever reason, or that they're seeing the patient form a complication from obesity.

但在我们因开具这些药物而弊大于利之前，我们必须先接受肥胖症相关的教育。

But before we do more harm than good by prescribing these medications, we have to educate ourselves in obesity.

每位准备开具这种药物的医生，或者任何要开这种药的人，办公室里都应该配备体成分分析仪。

And every doctor who's going to prescribe or anybody who's gonna prescribe this medication should have a body composition in their office.

你需要负责任地使用它。

You need to do it responsibly.

是的。

Yeah.

因为否则我们造成的伤害将大于健康收益。

Because otherwise we are creating more damage than health.

患者可能确实减掉了40磅体重，但其中有20磅是肌肉。

You're making the patient maybe, yes, they lost 40 pounds, but they lost 20 of muscle.

对。

Right.

对吗？

Right?

而且他们的体脂率下降得并不多。

And their percentage body fat didn't drop that much.

所以，表面上看起来他们有所改善，但实际上你可能让他们比来时更不健康了。

So, yeah, outside they look like they improved, but you might've made them less healthy that they came in.

73%的20岁以上美国人患有肥胖症或超重。

Seventy three percent of Americans over the age of 20 have obesity or are overweight.

那相当于1.8亿人。

That's one hundred and eighty million people.

为什么？

Why?

再次强调，因为我们过去对肥胖成因的认识并不完全正确，对吧？

Again, because our knowledge of what caused obesity was not completely understood, right?

就像我们现在知道的那样。

As we know now.

即使有了现在的信息，也需要几代人才能实现改变。

And even with the information that we have now, it's going to take several generations to make the changes.

所以，即使今天食品行业停止并改变他们的生产方式，也需要两代人时间，对吧？

So, even if today the food industry is stopped and changes the way that they produce food, it's gonna take two generations, right?

三代人之后我们才能看到效果。

Three generations for us to see the impact.

所以，这就是我们当前处境的原因——食品工业、工业化进程、环境问题，对吧？

So, that's why where we are because food industry, industrialization, environment, right?

正因为所有这些因素，我们才陷入了现在这样的疫情局面。

Because of all of that is why we are in an epidemic as we are.

慧俪轻体、Noom等最初为激素疗法开发的远程医疗公司，现在正转型平台并增加这些药物服务。

Weight Watchers, Noom, telemedicine companies developed originally for hormone therapy are now shifting platforms and adding these medications.

现在我甚至看到新的远程医疗平台正在开发中。

And now I've even seen new telemedicine platforms being developed.

而现在这需要处方才能获取。

And now this is a prescription.

必须持有州内执业医师执照才能开具这些处方。

You must be a licensed practitioner in a state in order to prescribe these.

所以你不能直接去沃尔玛自取，明白吗？

So you can't go to Walmart and pick it up, you know, for yourself.

因此，这些都需要持证临床医师操作。

So, these are all licensed clinicians.

但对于患者可获得的这类新选择浪潮，你怎么看？

But how do you feel about this kind of wave of new options available to patients?

嗯，我认为减肥行业一直是个利润丰厚的

Well, I think weight loss has always been a very lucrative

市场。

market.

这可是笔大生意。

It's big business.

一直以来，甚至在GLP-1药物问世前就是如此，对吧？

Always, even before we had GLP-one medication, right?

所以，每个人都想分一杯羹。

So, everybody's gonna want a piece of the pie.

我担心的是如果他们缺乏正确监督，不使用GPS追踪，我们知道他们会出现肌肉流失。

My problem with that is if they're not doing the right supervision, if they're not doing the GPS, we know that they're gonna lose muscle.

我们知道这会增加代谢性疾病的风险。

We know that that increases the risk for metabolic disease.

因此，我们不能只关注数字和体重秤，不能只为了让患者开心，只看体重下降或BMI数值。

So, we cannot just concentrate on the number and the scale, on making the patient happy, on seeing a number drop or a BMI.

如果他们正在进行身体重组，向患者解释身体成分概念，做DEXA扫描，那当然是多多益善，对吧？

So, if they're doing body recomposition, explaining the patients have a body composition, doing DEXA scans, the more the merrier, right?

毕竟我只是一个人。

Because I'm only one.

真正有经验、有专业知识的人非常少。

People that are experienced, that have expertise are very few.