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美国今昔最大的变化是什么？ 今年二月去纽约的时候，我和大学时代的两个同学一起吃了顿非常愉快的晚餐。像我这样背井离乡，远离母校，住在地球的另一半，坏处之一就是很少能有机会和亲朋好友欢聚一堂，所以我知道这样的机会来之不易。 我大学的前室友如今在纽约当医生，他还是名律师，并且获得了公众健康管理学硕士。晚餐时他问我，从上世纪７０年代中期我搬到香港迄今为止，美国让我印象深刻的一个最大变化是什么？ 我回答说，虽然变化和不同多如牛毛，但最显著的就是美国社会的极端肥胖案例越来越多，程度也愈演愈烈，每次回国都能引起我的注意，而且情况比二、三十年前要严重得多；我的这种观察也得到了公众健康数据的证实。 我说的不是一般的肥胖人群（我自己也该算是这类人），我说的是在购物中心和娱乐场所可以看见的大批“庞然大物”。如果你去迪斯尼乐园或者其他游乐园，你会遇到许多非常非常胖的人，数量之多真的会让你惊掉下巴。 据专家称，身高5英尺9英寸（1.75米）的人如果体重达到169至202磅（76.66至91.63公斤）之间就属于超重。如果比这还要重，就算是肥胖。 有些人发胖是因为得了慢性病，但大多数人都是由于生活习惯所致：比如节食和锻炼，或者缺乏饮食控制和运动。餐饮和食品加工行业也没起什么好作用，要么餐厅里供应的单人份菜量多得足够两个人吃，要么就无穷无尽地开发高卡路里、低营养的新垃圾食品。 这和美国人普遍提高的对健康风险和健康问题的意识是背道而驰的。美国人现在重视健康问题，比如美国烟民的数量在过去二十年已经急剧下降。很多人认为，人们之所以选择这种更加健康的生活方式，是由于政府实施了禁止发布香烟广告的法令，强令烟盒包装必须印有吸烟有害健康的警示，还提高了烟草税，使消费者的吸烟成本有所增加（现在纽约的香烟已经卖到了11美元一包）。 而肥胖在美国各社会经济阶层的发生率并不平均，以中等和中等以下收入群体为最多。如果按人口比例计算，虽然南方最为严重，但全美50个州的形势都相当严峻。 我的这位医生同学还说——而且也有文献记载——一直以来，不断高发的糖尿病、心脏病、中风和其他疾病是导致美国人肥胖的直接原因。肥胖是美国第二大可预防的死亡原因。过去25年，美国人的普遍肥胖已经增加了四倍。 虽然，造成肥胖的各种原因流传甚广，但是，可避免的肥胖既不是好事，也有损健康，更何况这对社会医疗成本和资源也造成了不利的影响。 美国政府曾有很多年都对吸烟采取了怀柔政策。在50年代描绘美国生活方式的电影里，男男女女喷云吐雾不分场合：无论在家里、办公室、餐厅，还是在汽车、火车、飞机上，总是烟不离手。当时的香烟广告居然还出现了身穿白大褂的医生抽烟，甚至代言某种香烟品牌的情况。 最终，吸烟有害健康的科学证据占了上风，一系列严苛的政策和税负得以出台，目的就是抑制吸烟恶习，并似乎取得了一定成效。批评人士可能会说，每个人都有吸烟的权利。事实的确如此，就象美国有些地方有的人也会用同样的理由说每个人都有持枪的权利一样。但无论烟枪还是手枪，关键在于要对这些权利加以哪些细致的限制和疏导。 那么，未来美国的肥胖状况会怎么发展呢？政府会不会公布极端的法令，要求在高脂食品上贴注标签、减少餐厅菜品的菜量、提高垃圾食品的税收，或者对苗条人士减税吗？还是实行新的机票订价方式，按乘客和行李的总重收费？ 抑或是消费者不断加强意识，最终带来生活方式的转变？我宁愿是后者，因为这对大家都有好处。 |
What's The Biggest Difference Between America Then and Now? During my visit to New York in February, I had a very enjoyable dinner with two of my schoolmates from university days. One downside of living on the other side of the planet from your home town and alma mater is that you get fewer opportunities to relax with old friends and family, so you learn not to take such opportunities for granted. My former college roommate is now a physician practicing in New York. He is also a lawyer and has a masters in public health administration. Over dinner, he asked me what is the single biggest difference that strikes me between the U.S. today and at the time when I moved to Hong Kong in the mid-1970s. I responded that although there are a multitude of changes and differences, the most dramatic one is the increase in the incidence and degree of extreme obesity in American society. It is very noticeable each time I return, to a far greater extent than 20 or 30 years ago; and this observation is confirmed by public health statistics. I'm not talking about moderately overweight people (a group I would include myself in), but the super jumbo sized folks you see in vast numbers in shopping malls and entertainment venues. A trip to Disneyland or any other amusement park is really shocking by virtue of the number of really, really super-sized people you see there. According to the experts, someone who is 5 feet 9 inches tall and weighs between 169 to 202 pounds is considered overweight. Heavier than that would be considered obese. Some people become obese due to chronic health issues, but for most it's more a result of lifestyle. choices: diet and exercise, or lack of it. The foodservice and food processing industry doesn't help by serving food portions in restaurants which are large enough for two people rather than one, and creating endless new variations of junk food high in calories and low in nutritional value. This runs counter to the generally increased awareness of health risks and issues in America, as evidenced, for example, by the sharp drop in the number of cigarette smokers during the past twenty years. Most would argue that this healthier living trend is due to regulations prohibiting the advertising of cigarettes, and requiring explicit health warnings to be placed on cigarette packaging, not to mention sharply increased taxes which raised the cost of cigarettes to consumers (a pack in New York now costs about US$11). Obesity does not occur evenly across all socio-economic strata in the U.S.; it is far more prevalent in middle to lower income groups. In terms of percentage of the population, it is most extreme in America's southern states, but it's serious in every one of the 50 states. My doctor classmate said -- as is well documented -- there has been an enormous increase in the incidence of diabetes, heart attacks, strokes and other illnesses among Americans which are directly attributable to obesity. Obesity is considered the #2 preventable cause of death in America. The prevalence of obesity among American boys and girls has quadrupled over the past 25 years. There are all kinds of reasons that widespread, avoidable obesity is neither a good nor healthy thing, not least of which the impact on a society's health care costs and resources. For many years the U.S. government took a relaxed approach which enabled the popularity of cigarette smoking. In films which depict the American way of life in the 1950s, men and women are smoking everywhere: at home, in the office, in restaurants, cars, trains, airplanes, etc. Cigarette advertising of that era depicts doctors in white medical gowns smoking, and even endorsing particular brands of cigarettes. Finally the scientific evidence about the negative impact of smoking on health became overwhelming, eventually resulting in restrictive policies and higher taxes intended to curtail the habit. It seems to have worked. Critics may say that individuals have a right to smoke. That's true, although it's also true that in many parts of the U.S., the same can be said about the right to own a gun. In both cases, the devil is in the detail of what restrictions and guidelines should apply to those rights. So, what of the future of obesity in America? Will it take extreme new laws aimed at more explicit labeling of fattening foods, curtailing food portions, raising taxes on junk food, or offering tax breaks for slim people? Or perhaps a new airline passenger ticket pricing policy based on the combined weight of the passenger and his or her luggage? Or will increased consumer awareness eventually result in a change in lifestyle? I hope it's the latter, for everyone's sake. |