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Daifailluh al-Bugami was just a year old when his parents noticed that his lips turned blue as he slept at night. It was his weight, doctors said, putting pressure on his delicate airways.
德伊法伊拉・阿尔－布加米(Daifailluh al-Bugami)的父母注意到孩子晚上睡觉时嘴唇会变蓝的时候，他才一岁。医生说，这是因为他的体重给他脆弱的呼吸道带来了压力。
Now Daifailluh is 3, and at 61 pounds he is nearly double the typical weight of a child his age. So the Bugamis are planning the once unthinkable: To have their toddler undergo bariatric surgery to permanently remove part of his stomach in hopes of reducing his appetite and staving off a lifetime of health problems.
现在德伊法伊拉三岁了，体重61磅（约27.7公斤），几乎是一般同龄人体重的两倍。所以布加米夫妇打算采取之前从不敢想象的措施：让自己年幼的孩子接受减肥手术，永久切除一部分胃，希望降低他的食欲，让他以后免受健康问题的困扰。
That such a young child would be considered for weight-loss surgery -- something U.S. surgeons generally won't do -- underscores the growing health crisis here and elsewhere in the Middle East. Widespread access to unhealthy foods, coupled with sedentary behavior brought on by wealth and the absence of a dieting and exercise culture, have caused obesity levels in Saudi Arabia and many other Gulf states to approach or even exceed those in Western countries.
美国外科医生一般是不会给如此年幼的孩子进行减肥手术的。德伊法伊拉的父母做出这样的决定凸显了中东地区这种健康危机的加剧。大量接触不健康食品，加上富裕生活衍生的久坐行为，以及节食和锻炼文化的缺乏，导致沙特阿拉伯及许多其他海湾国家的肥胖水平接近甚至超过西方国家。
While solid national data are hard to come by, some experts say that obesity has turned into a serious health problem for Saudi children, with an estimated 9.3% of school-age youths meeting the World Health Organization's body-mass-index criteria for obesity, according to research published in 2013 in the Saudi Journal of Obesity. About 18% of school-age children in the U.S. were considered obese in 2010, according to the Centers for Disease Control and Prevention.
虽然很难获得可靠的全国性数据，但有专家说，肥胖症已经成为沙特儿童一个严重的健康问题。《沙特肥胖症期刊》(Saudi Journal of Obesity)在2013年公布的研究显示，约9.3%的学龄儿童达到了世界卫生组织(World Health Organization)身体质量指数(BMI)中的肥胖标准。据美国疾病控制与预防中心(U.S. Centers for Disease Control and Prevention)统计，2010年美国约18%的学龄儿童肥胖。
Daifailluh's doctor, Aayed Alqahtani, is a leading advocate of a radical approach to the problem. Patients travel to him from across the country and the Gulf region. Over the past seven years, he has performed bariatric surgery on nearly 100 children under the age of 14, which experts on the procedure believe is the largest number performed by one doctor on young children.
德伊法伊拉的医生Aayed Alqahtani是倡导用激进手段解决该问题的领军人物。沙特全国各地以及海湾地区很多病人都来找他看病。过去七年，他为近100个14岁以下儿童做过减肥手术，这方面的专家认为，没有哪一个医生做过这么多例儿童减肥手术。
Dr. Alqahtani's work is being watched amid a global debate about the appropriate age for bariatric surgery. In the U.S., the minimum is generally considered 14. The World Health Organization, in a 2012 report on pediatric bariatric surgery, concluded that there is a dearth of data available on the long-term outcomes of the procedure in children and that a 'conservative approach' is necessary until long-term studies are conducted.
全球各地对适宜做减肥手术的年龄存在争议，因此Alqahtani的工作备受关注。在美国，一般认为最小年龄是14岁。世界卫生组织在2012年的一份儿童减肥手术报告中总结道，目前有关减肥手术对儿童长期影响的数据相当匮乏，在进行长期研究之前需采用“保守治疗”。
Bariatric surgery has been embraced as an effective and relatively safe procedure for morbidly obese adults. The concern with children revolves mostly around nonsurgical risks, such as how the abrupt change in nutrition could affect long-term brain development and sexual maturation.
对严重肥胖的成年人来说，减肥手术被认为是一种有效并且相对安全的治疗方法。儿童的问题主要在于非手术操作风险，比如营养上的突然改变对大脑的长期发育和性成熟会带来何种影响。
Dr. Alqahtani says the decision to operate on Daifailluh is a difficult one because of his age. But after nearly two years of consultation with the clinic, Daifailluh's obesity-related medical problems haven't gotten any better. 'We should not deprive our patients from bariatric surgery based on their age alone,' the surgeon says. 'If they have [medical] conditions that threaten their lives, then we should not deny the bariatric surgery.'
Alqahtani说，由于德伊法伊拉的年龄小，所以给他做手术是一个艰难的决定。但在诊所经过近两年的会诊后，德伊法伊拉肥胖症带来的相关身体问题并无任何好转。Alqahtani说：“我们不应该只根据年龄而剥夺病人做减肥手术的权利。如果他们有威胁到生命的病症，我们就不应该拒绝实施减肥手术。”
The worsening obesity problem here also is manifesting itself in other ways. Some 20% of the Saudi adult population has Type 2 diabetes, a condition linked to obesity, according to the International Diabetes Federation, compared with 8.3% in the U.S., according to the CDC. The cost of diabetes treatment in Saudi Arabia is expected to rise to $2.4 billion in 2015, more than triple that spent in 2010, according to a recent study in the Journal of Family and Community Medicine.
中东地区肥胖症加剧的问题在其他方面也有体现。据国际糖尿病联合会(International Diabetes Federation)统计，沙特约20%的成年人患有2型糖尿病，这种病与肥胖有关。而据美国疾病控制与预防中心统计，美国成年人患2型糖尿病的比例仅为8.3%。《家庭及社区医学期刊》(Journal of Family and Community Medicine)最近的一项研究显示，沙特阿拉伯糖尿病的治疗费用预计将在2015年增至24亿美元，是2010年的三倍多。
Obesity, particularly among women, has become rampant across much of the Middle East, particularly in oil-rich Gulf nations. In Kuwait, almost half of adult women are considered obese, while 44% of Saudi women and 45% of Qatari women meet the criteria, according to the International Association of the Study of Obesity. Experts says Saudis, in particular, are more likely to carry certain genes linked to obesity.
肥胖症在中东很多地区都很猖獗，特别是在石油丰富的海湾国家，而且女性人群更为严重。 据国际肥胖研究学会(International Association of the Study of Obesity)统计，在科威特，近一半成年女性属于肥胖，沙特和卡塔尔肥胖女性比例分别为44%和45%。专家说，沙特人携带某些与肥胖有关基因的可能性尤其大。
Saudi lifestyle and parenting practices may exacerbate the problem, according to doctors at weight-loss clinics. Nannies or cooks are often employed, so parents may not know what their children are eating. Saudis often are coaxed to eat large quantities of food when visiting relatives and friends.
减肥诊所的医生们表示，沙特的生活方式和孩子的养育方式可能会使肥胖问题加剧。家里通常会雇佣保姆或厨师，所以父母不一定知道自己的孩子在吃什么。沙特人在亲戚朋友家做客时常会被劝说吃大量食物。
In Riyadh, physical activity is limited, particularly for girls, and high temperatures and few green spaces make walking difficult. School gym classes generally take place just once a week. Western-style fast food is abundant, particularly at the air-conditioned malls frequented by children and families.
在利雅得，体育活动是受到限制的，尤其是女孩子，高温和绿地的稀少也使得步行很困难。学校里一般每周只有一次体育课。西式快餐泛滥，特别是在儿童和家庭经常光顾的带空调的商场。
Bariatric surgery has become an accepted treatment among obese Saudi adults and is paid for by the government. An estimated 11,000 bariatric surgeries were performed on Saudis in 2012, according to Dr. Alqahtani.
在沙特，减肥手术已经成为肥胖成年人普遍接受的一种治疗手段，并且费用由政府支付。Alqahtani表示，2012年，沙特人所做的减肥手术约有1.1万例。
The surgery, of which there are several types, generally reduces the size of the stomach and, with some techniques, rearranges the digestive path to bypass much of the intestines. Some types are reversible but generally considered less effective. After the surgery, patients must eat very small meals -- ideally for the rest of their lives. Many studies have shown that adults, on average, lose over 50% of their body weight after surgery.
减肥手术共有好几种，一般都是缩胃，和通过某些技术重组消化路径，让食物绕开大部分肠道消化。有些手术是可逆的，但一般认为效果比较差。手术后，患者三餐的摄入量必须非常少――最好是一辈子都保持。许多研究显示，通常情况下成年人做完手术体重都会减掉50%。
Increasingly, youngsters are heading to the operating room here, where parents see no other options. These days, Dr. Alqahtani performs surgery on three to four youths a week.
在中东，越来越多的儿童开始走向手术室，因为父母看不到其他的选择。目前Alqahtani医生每周都会为三到四个青少年做手术。
'I have seen in my clinic patients who cannot sleep lying down -- they sleep sitting -- because of sleep apnea, and their age is 10 years, sometimes 5 years,' says Dr. Alqahtani, a professor in the college of medicine and an obesity specialist at King Saud University.
身为沙特国王大学(King Saud University)医学院教授以及肥胖症专家的Alqahtani说：“我的很多临床病人都没法躺着睡觉，而是坐着睡觉，因为他们有睡眠窒息症，他们才10岁，有些才5岁。”
Pediatric surgeons in the U.S. say they also are facing demands from families to operate on younger patients. Thomas Inge, surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children's Hospital, says he will be operating on a 12-year-old later this month. He says that as younger and younger children are referred for consideration of surgery, care teams will need to carefully weigh the pros and cons.
美国的儿科外科医生说，他们也面临许多家庭希望为年幼患者做手术的需求。辛辛那提儿童医院(Cincinnati Children's Hospital)青少年手术减肥项目(Surgical Weight Loss Program for Teens)外科主任托马斯・英格(Thomas Inge)说，这个月月底他要给一个12岁的孩子做手术。他说，随着被推荐过来做手术的孩子年龄越来越小，医疗团队需要仔细权衡利弊。
Many doctors say they aren't ready to follow Dr. Alqahtani yet. Kirk Reichard, chairman of the pediatric-surgery committee for the American Society for Metabolic and Bariatric Surgery, notes that there are no data to show that surgery doesn't affect young children's long-term sexual maturation or cognitive functioning. The brain, particularly in growing children, is sensitive to nutrition and needs enough energy to mature properly. Nutrition also has the potential to affect hormones linked to sexual maturation.
许多医生表示他们还没有准备好跟随Alqahtani的步伐。美国代谢与减肥手术学会(American Society for Metabolic and Bariatric Surgery)儿科手术委员会主席科克・理查德(Kirk Reichard)指出，没有数据显示手术不会影响年幼儿童的长期性成熟发育或认知机能。大脑对营养很敏感，需要足够的能量才能正常发育成熟，对成长中的孩子来说尤其如此。营养也有可能影响与性成熟有关的荷尔蒙水平。
Dr. Alqahtani says he has seen evidence of normal growth following the procedure in his under-14 patients, many of whom are now four years postsurgery.
Alqahtani说，在他的病人中，很多14岁以下儿童做完手术后发育都很正常，很多人现在做完手术已经四年了。
'We will certainly use his experience to inform us in some ways, but [Dr. Alqahtani's work] won't take the place of trials,' says Dr. Reichard.
理查德说：“我们肯定会借鉴他的经验，但他的成果不会替代临床试验。”
One of the main criticisms from some weight-loss experts about performing the surgery on those under 14 is that changes in diet and exercise can prevent further weight gain. In addition, says Dr. Reichard, 'there are a lot of other therapies short of surgery that can be helpful in managing' related medical conditions.
对给14以下儿童做这种手术持批评态度的减肥专家的一个主要观点是，饮食和锻炼上的变化会阻止进一步的体重增长。此外，理查德说，“还有其他很多不用手术的疗法可以有助于控制”相关的症状。
Saudi Arabia's Dr. Alqahtani says he requires his child patients to enroll in a weight-loss program for at least six months because patients able to lose even a bit tend to have better outcomes after surgery. But he says that by the time families come to him, their children have such substantial health problems it is generally too late for diet and exercise alone.
沙特阿拉伯的Alqahtani说，他要求儿童患者至少参加六个月的减肥项目，因为即使只能减掉一点点体重的患者在术后的情况都会更好。但他说，到家里人来找他的时候，孩子的健康问题已经很严重了，一般仅靠节食和锻炼已经太晚了。
Dr. Alqahtani was trained as a surgeon at McGill University in Montreal and at a minimally invasive surgery center in Denver. When he returned home to Riyadh in 2002, he says, he was inundated with pediatric patients so obese they were suffering from advanced stages fatty liver disease, diabetes and sleep apnea, a disorder in which patients repeatedly stop breathing for short periods during sleep -- all diseases typically not seen until middle age.
Alqahtani毕业于蒙特利尔麦吉尔大学(McGill University)医学专业，并在丹佛一家微创手术中心工作过。他说，2002年回到利雅得时，他接待了大量儿科患者，他们由于太过肥胖而遭受着晚期脂肪肝、糖尿病和睡眠窒息症的折磨――这些病一般情况下只有到中年才会出现。患睡眠窒息症的人在睡觉时会不断地短暂停止呼吸。
The procedure Dr. Alqahtani performs is called the gastric sleeve, which slices off a portion of the stomach but leaves the rest of the digestive tract intact. It is gaining in popularity because of its good weight-loss results and minimal side effects. The operation, conducted through tiny incisions in the abdomen, takes him just 30 minutes.
Alqahtani所做的手术名叫袖状胃切除，一部分胃会被切除，但消化道其他部分不受影响。这种手术越来越受欢迎，因为减肥效果很好，而且副作用最小。该手术会在腹部切开微小切口，30分钟就能完成。
One recent morning, he operated on a 20-year-old, two 17-year-olds, a 12-year-old, then Abdullah, who was then 10.
最近的一个早晨，他给一个20岁的病人、两个17岁的病人、一个12岁的病人、还有当时10岁的阿卜杜拉(Abdullah)做了手术。
Complications can include bleeding in about 10% of cases, and leaking and blood clots in 1% to 2%. Dr. Alqahtani says he has had only two leaks in 1,700 cases, neither in children.
可能产生的并发症包括流血、吻合口裂开和血块，约10%的病例会出现流血，后两种情况的几率为1%到2%。Alqahtani说，他在1,700例手术中只出现过两例吻合口裂开的情况，而且都不是儿童患者。
Dr. Alqahtani says each of his pediatric patients has lost at least some weight, and nearly three-quarters have lost more than 50% of their initial body weight. Abdullah has lost close to 50 pounds since his surgery about two months ago, according to his 29-year-old brother, Ahmad.
Alqahtani说，他的每一个儿科患者至少体重都有一定的下降，近四分之三的患者减重超过50%。阿卜杜拉29岁的哥哥艾哈迈德(Ahmad)说，阿卜杜拉从约两个月前做完手术以来减了近50磅。
Dr. Alqahtani says about 90% of his patients have seen medical conditions such as diabetes and hypertension clear up, according to a paper scheduled for publication in the journal Surgery for Obesity and Related Diseases. He published outcomes on 108 children in the peer-reviewed Annals of Surgery journal in 2012.
Alqahtani在一篇论文中说，约90%的患者以前的糖尿病和高血压等病症都有所好转。该论文将发表在《肥胖及相关疾病手术》(Surgery for Obesity and Related Diseases)期刊上。2012年，他在同行评审期刊《外科学年鉴》(Annals of Surgery)上发表了对108名儿童的研究成果。
Recovery involves a six-week transition diet starting with clear liquids and pureed food. Patients eventually can resume solid foods at much-reduced quantities. At first, patients feel full after just 1 to 2 spoonfuls of food, though they gradually can eat more as their stomachs stretch.
术后恢复需要六个星期的过渡饮食，从流质和泥状食物开始。患者最后都会恢复固体食物，但量会减掉很多。最开始患者吃一两勺东西就会有饱腹感，不过随着胃的伸展，逐渐会吃的越来越多。
Some bariatric-surgery experts have raised questions about whether children are capable of maintaining the restrictive lifetime diet after surgery or whether they will sabotage the procedure when they become teenagers and have a greater autonomy to eat what they want. Some experts question whether parents should make such a drastic and permanent decision for a child.
有些减肥手术专家提出了质疑，比如儿童是否有能力在术后一直保持限制性的饮食，是否会在十几岁对自己想吃的东西有更大自主权的时候破坏手术成果。有些专家质疑父母是否应该为孩子做出如此极端的永久决定。
The decision has been excruciating for the family of Daifailluh, the toddler from Ta'if. Daifailluh was referred to Dr. Alqahtani's clinic about two years ago after difficulty breathing sent him to the intensive-care unit at a hospital in his hometown. Doctors there determined the toddler was seriously overweight. His mother, Hessa Salem al-Bugami, says she tried to improve his diet but didn't have good guidance until she came to Dr. Alqahtani's clinic, a trip of nearly 500 miles from Ta'if. 'I feel like I failed,' she says.
对来自塔伊夫(Ta'if)的德伊法伊拉家庭来说，这个决定非常折磨人。德伊法伊拉是两年前左右被推荐到Alqahtani医生的诊所的，之前他因为呼吸困难被送到家乡一所医院的特护病房。诊所的医生诊断孩子严重超重。他的母亲赫萨・萨勒姆・阿尔－布加米(Hessa Salem al-Bugami)说，她努力改善孩子的饮食，但在来Alqahtani医生诊所前没有得到过很好的指导。从塔伊夫到利雅得有近500英里的路程。她说：“我觉得自己很失败。”
At first, the family wanted Daifailluh to lose weight without the operation. Ms. Bugami says her son has always had an 'open appetite' and never refuses food. She says she feeds him brown bread and boiled chicken and rice, and limits his portions, hiding the rest of the food. But his obesity hasn't improved, she says.
最初家里人希望德伊法伊拉能够不做手术减肥。布加米太太说，她的儿子总是胃口很好，从不会拒绝食物。她说她给他吃黑面包和水煮鸡肉米饭，限制他的饭量，把剩下的食物藏起来，但他的肥胖并没有改善。
Daifailluh will cry and sometimes throw temper tantrums when he wants food, she says. She has tried distracting him with toys, locking the two of them in a room to play for so long she ended up missing her own meal.
她说，德伊法伊拉会哭，想吃的时候有时会发脾气。她尝试过用玩具分散他的注意力，把自己和儿子关在屋子里玩儿，最后时间太长了，连她自己都想吃了。
'When he starts crying, it's hard not to give him any of the food, to make the crying stop,' she says. 'I feel like I work really hard, but it's just too much on me.'
她说：“在他开始哭的时候，不给他任何食物是很难哄他不哭的。我觉得自己很努力，但压力太大了。”
Daifailluh, who was hospitalized again for pulmonary problems, is waiting for a surgery date, which will come if he gets final medical clearance from Dr. Alqahtani.
德伊法伊拉后来又因为肺部问题住过院。现在他正在等待手术日期，如果获得Alqahtani最后的体检合格结果，医生就会给他安排手术。
The entire family is worried about the surgery, particularly the effects of anesthesia and whether the surgery will reduce his appetite too much. Ms. Bugami also worries that her son will regain the weight when he leaves the house eventually and is no longer under her watch. But that is a concern for another day. 'Right now is the most scary situation,' she says.
德伊法伊拉的家里人都很担心这次手术，尤其是麻醉的副作用，以及手术是否会把他的胃口减得太多。布加米太太还担心儿子最后离家不再受到自己监护后会再度增重，但这是以后的问题。她说：“现在是最可怕的情形。”
