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英爵醫美診所皮膚專科 紀俊麟主任醫師

「為什麼網路的新聞說,疫情期間除了做好防疫措施之外,也要注意體重管理?」
一個朋友很好奇背後的邏輯到底通不通,而傳訊息來問我。

確實!許多醫學研究已證實,肥胖的人更容易感染新冠病毒,且病情的進展也更加快速、死亡率更高。

從最宏觀的角度來看,BMC公衛期刊在2021年底發表了一項大規模的研究,針對190個國家、共七千七百萬感染COVID-19的個案做統計分析,發現身體質量質數(BMI)及膽固醇較高的國家,有較高的感染率和較高的死亡率。此外、美國疾病管制暨預防中心(CDC) 的調查也顯示,61%感染新冠肺炎住院的青少年族群,都患有肥胖。這些證據都讓「體重管理」成為疫情期間一個非常值得重視的議題。

肥胖會增加染疫風險

有數篇醫學統合分析的研究指出,肥胖透過好幾個機轉,造成染疫的風險上昇,以及讓病情惡化的速度加快。

1.肥胖造成免疫系統失調:
大家都知道肥胖會引發新陳代謝的問題,例如腰圍和三酸甘油脂超標等等。但其實更進一步地,肥胖會造成身體處於慢性發炎狀態,這直接影響了免疫系統的平衡,讓身體失去抵禦病毒入侵的能力。

2.肥胖的人易有慢性病:
肥胖易造成「三高」(高血壓、高血糖、高血脂)、以及心血管疾病。這些疾病的患者,染疫後的嚴重度都明顯提高。

3.肥胖的人維生素D容易缺乏:
許多研究發現,維生素D缺乏的問題在超過一半的肥胖患者身上出現,而維生素D的缺乏,讓免疫系統不健全,進而讓病情的嚴重度、住院率增加。

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疫情期間體重持續上升? 這不全是你的錯

「我也很想好好控制我的體重,但疫情期間真的很難做到!!」

有不少客戶無奈地告訴我他們的心聲!其實這不是大家「不夠認真」,而是,真的很困難! 研究顯示,在疫情期間有三大挑戰,影響了體重管理的成效。

1.運動變少了:
疫情期間大家減少外出,取消原本的運動聚會,避免去健身房…等等,讓原本的運動習慣無法維持,熱量的燃燒減少了,體重就容易增加。

2.情緒更緊繃、更低落:
人們在疫情期間的心理健康遇到極大的挑戰,壓力、焦慮、憂鬱的盛行比率,都超過三成。低落的情緒除了影響免疫力之外,也被證實與肥胖有因果關係。

3.難以維持原本的健康飲食習慣:
研究發現有高達八成的民眾覺得在疫情期間很難「吃得健康」。我有幾位原本很自律的客戶,在疫情期間壓力爆表,只好用「吃」來排解心中的壓力和苦悶。過度的飲食及糖份的攝取、動的少坐的多,體重真的就直線上升,一去不回頭!

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良好的體重管理,增強自身免疫力

我知道體重管理很重要,那應該要怎麼做呢?綜合上述的研究結果,我們給出幾點務實的建議,讓大家可以從知道、變成做到!

1. 正視體重過重所帶來的健康危害:
許多病患其實知道肥胖對健康有害,但一直找不到動機去改變。我們希望透過這些研究的發現和臨床的實際經驗,能夠讓大家更了解肥胖對免疫力、抵抗力的影響,期望可以增加大家改變的動力。

2. 生活習慣反著做:
既然我們知道,疫情會讓我們動的少、吃的差,那我們就更應該多找機會動起來、好好吃。例如把握好天氣的時候,多到空曠的戶外走走;多攝取蔬果並減少低糖飲食,來提昇自己的抗疫能力。

3.與專業人士討論體重管理的最新方法:
最新的GLP-1 類升糖素胜肽(善纖達減重筆),已被許多研究證實可以抑制食慾、控制體重,同時可改善因肥胖帶來的心血管負擔、慢性疾病等併發症,降低內臟脂肪及皮下脂肪。
另外增肌儀療程則可刺激肌肉收縮運動、增加肌肉量、輔助減少脂肪及提高代謝率,躺著就可以輕鬆訓練!

增加自己的抗疫能力,從今天開始做起

每個人都想要有良好的體重和輕盈的體態。但忙碌的現今社會,再加上疫情的挑戰,讓許多人停留在「知道」,但「很難做到」。在實際臨床經驗中,我們會與客戶溝通許多生活的細節,找出體重控制的關鍵因素。看見客戶在接受治療的過程,自己也變得更有動力去調整生活習慣、注意飲食內容、增加運動,提早睡眠時間。這些努力加總起來,換來了健康、自信、以及更好的免疫力。真的,非常值得!!

引用文獻
GLP-1 與 COVID

Preadmission use of antidiabetic medications and mortality among patients with COVID-19 having type 2 diabetes: A meta-analysis
Metformin, GLP-1RA, and SGLT-2i were associated with lower mortality rate in patients with COVID-19 having type 2 diabetes. DPP-4i and insulin were linked to increased mortality

Pre-admission glucagon-like peptide-1 receptor agonist (GLP-1RA) and mortality from coronavirus disease 2019 (Covid-19): A systematic review, meta-analysis, and meta-regression
Our study suggests that pre-admission use of GLP-1RA may offer beneficial effects on Covid-19 mortality in patients with diabetes mellitus. However, more randomized clinical trials are required to confirm this conclusion.

Use of Novel Antidiabetic Agents in Patients with Type 2 Diabetes and COVID-19: A Critical Review


中立
肥胖與COVID

COVID-19, body mass index and cholesterol: an ecological study using global data (bmc public health)
Conclusion: Countries with higher BMI or cholesterol at aggregate levels had a higher ratios of COVID-19 incidence and mortality. The aggregated level of cholesterol and BMI are important risk factors for COVID-19 major outcomes, especially in developing countries with younger populations. We recommend monitoring and promotion of health indicices to better prevent morbidity and mortality of COVID-19.

Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review (bmj)
Sixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions.

COVID-19 infection, progression, and vaccination: Focus on obesity and related metabolic disturbances
Annemarie J. F. Westheim,Albert V. Bitorina,Jan Theys,Ronit Shiri-Sverdlov
OBESITY REVIEW 16 July 2021

心理健康與COVID

COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health (lancet)

Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis (J of affective disorders)
The overall pooled prevalence of depression, anxiety, distress, and insomnia was 31.4%, 31.9%, 41.1% and 37.9%, respectively.

Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis (NATURE)
The global prevalence estimate was 28.0% for depression; 26.9% for anxiety; 24.1% for post-traumatic stress symptoms; 36.5% for stress; 50.0% for psychological distress;
and 27.6% for sleep problems.

 關於英爵【健康】門診時間表

1. 2.3.4.5.

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