HowToLiveWorse

CHAPTER 28 · 9 SOURCE ENTRIES

Appearance vs. Health

别为了外形把身体搞坏

[← 回总目录](../README.md) 本节说的是「为了改变外形而对身体动手」的几种做法：饿肚子、吃药、打针、开刀。这几件事，决定多半是和别人比较之后做的，代价却全落在自己身上，而且相当一部分改不回来。 本节不评价任何人想把自己变成什么样子，那是各人自己的事。同一个目标，可以找「有处方、有资质、有复查」的，也可以「网购、美容院、自己加量」，本节只比这两种做法的风险差多少。算账主要看身体上实际出了什么事，比如失明、住院、死亡。医美那两条还涉及非法行医的刑事责任。

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28-001
Evidence AlifespanSource-sensitive

Do not use extreme dieting, fasting, or self-induced vomiting to control weight; if you want to lose weight, focus on exercise instead.

不要用极端节食、断食或催吐来控制体重，要减就从运动那一侧减

People with anorexia nervosa have a mortality rate roughly 5.9 times higher than their peers. Over a period of one year, 5.1 out of every 1,000 individuals in this group die. One in five of those who die commit suicide. The root cause of this is dieting: a three-year study of students at 44 secondary schools found that girls who engaged in severe dieting were 18 times more likely to develop eating disorders than those who did not diet. If you want to manage your weight, increase physical activity rather than cutting food intake to the point of hunger.

Open the low-ROI detour

Move “Do not use extreme dieting, fasting, or self-induced vomiting to control weight; if you want to lose weight, focus on exercise instead.” to Future Me's calendar

The routine already works until the day the source says it may not.

Today I keep a few minutes and avoid interrupting my default routine.

Read the source and trade-off
28-002
Evidence AlifespanSource-sensitive

Two things to check before getting injections, thread lifts, or surgery: does the facility’s license list “medical aesthetics,” and is the practitioner a licensed attending physician?

打针、埋线、开刀之前查两样：机构许可证上有没有「医疗美容」，动手的人是不是主诊医师

Any procedure that involves needles, surgery, or medical devices — meaning anything that breaks the skin or enters the body — is considered medical treatment. Such procedures may only be performed at facilities whose licenses explicitly list “medical aesthetics,” and only by registered attending physicians. Performing them in beauty salons, private studios, or hotel rooms is illegal medical practice: in serious cases, offenders face up to three years in prison; if they cause injury, three to ten years; if they result in death, more than ten years.

Open the low-ROI detour

Move “Two things to check before getting injections, thread lifts, or surgery: does the facility’s license list “medical aesthetics,” and is the practitioner a licensed attending physician?” to Future Me's calendar

There is no immediate alarm, so the sensible choice can wait for a less busy week.

Today I keep a few minutes and avoid interrupting my default routine.

Read the source and trade-off
28-003
Evidence BlifespanSource-sensitive

Facial fillers should avoid the bridge of the nose, glabellar area, and forehead — and never opt for unregulated clinics just to save money.

面部填充避开鼻背、眉间、额头这几个部位，更别为省钱找非正规注射

Between 2015 and 2018, 48 new cases of partial or total vision loss following filler injections were reported worldwide. The nose was the most common site of complications, accounting for 56.3% of cases; followed by the glabellar area at 27.1%, the forehead at 18.8%, and the nasolabial fold at 14.6%. Hyaluronic acid was used in over 80% of these cases. Only 20.8% of patients regained full vision, while 16.7% saw partial recovery; the rest remained visually impaired. Nearly 20% also developed complications affecting the central nervous system. Currently, no single treatment has been proven consistently effective for reversing these effects, so prevention remains the only reliable option.

Open the low-ROI detour

Move “Facial fillers should avoid the bridge of the nose, glabellar area, and forehead — and never opt for unregulated clinics just to save money.” to Future Me's calendar

Future Me has a clearer calendar, more patience, and apparently the same responsibilities.

Today I keep a few minutes and avoid interrupting my default routine.

Read the source and trade-off
28-004
Evidence AlifespanSource-sensitive

Don’t buy weight‑loss pills, coffee, candies, or “enzymatic plums” that promise rapid results

不要买承诺「快速瘦」的减肥药、减肥咖啡、瘦身糖果和酵素梅（号称泡过酵素的梅子）

The illegal ingredient most often found in these products is sibutramine. Originally a legitimate weight‑loss medication, it was banned in China in 2010. In a multi-year randomized clinical trial, individuals taking the drug experienced a roughly 30% higher risk of non‑fatal heart attacks and a 36% higher risk of non‑fatal strokes; the overall adverse‑event rate was 11.4% versus 10.0%. Over three years, the drug only produced an extra 1.7 kg of weight loss. By the time tests detect the substance, you’ve already consumed it.

Open the low-ROI detour

Move “Don’t buy weight‑loss pills, coffee, candies, or “enzymatic plums” that promise rapid results” to Future Me's calendar

If I do not open the notes, no new task has technically appeared.

Today I keep a few minutes, a bit of persistence and avoid interrupting my default routine.

Read the source and trade-off
28-005
Evidence AlifespanSource-sensitive

Do not use anabolic steroids (“muscle‑building injections” or “oral pills”) to build muscle

不要用合成代谢类固醇（「增肌针」「口服药」）来长肌肉

A Danish study followed 545 men who tested positive for anabolic steroids and compared them with 5,450 age‑matched controls. Users had a three‑fold higher risk of death, and the median number of hospital visits per year was 0.81 versus 0.36 for controls. More than 10 % of steroid users developed acne, gynecomastia, or erectile dysfunction. In China these drugs are prescription‑only, and any source selling them illegally is breaking the law.

Open the low-ROI detour

Move “Do not use anabolic steroids (“muscle‑building injections” or “oral pills”) to build muscle” to Future Me's calendar

One more exception feels free because the bill arrives outside the current scene.

Today I keep a few minutes, a bit of persistence and avoid interrupting my default routine.

Read the source and trade-off
28-006
Evidence BlifespanSource-sensitive

If you need weight-loss medication, get a prescription from a doctor — don’t buy it from online shops that ship it without one.

要吃减肥药就去医院拿处方，别在不用处方就发货的网店买

By regulation, prescription drugs must be sold only with a valid prescription, and pharmacies must keep that prescription on file for at least five years. Online sellers of prescription drugs must also have a genuine prescription and verify the buyer’s identity. So when you see an online shop that doesn’t require a consultation or a prescription and ships the product right away, there are only two possibilities: either the product isn’t actually the drug it claims to be, or the shop is breaking the law. In either case, no one can be held responsible for dosage or contraindications if something goes wrong. Those few dozen yuan you spend on a doctor’s visit buys you exactly this protection.

Open the low-ROI detour

Move “If you need weight-loss medication, get a prescription from a doctor — don’t buy it from online shops that ship it without one.” to Future Me's calendar

I can spend longer deciding whether to start than the small action would take.

Today I keep a little money, a few minutes and avoid interrupting my default routine.

Read the source and trade-off
28-007
Evidence AlifespanSource-sensitive

Sex hormone therapy should only be used when prescribed by a doctor and with regular follow‑up; do not buy it online and do not adjust the dose on your own.

性激素类药只在医生开方并定期复查的前提下用，不要网购、不要自己加量

This section does not discuss whether hormone therapy is appropriate, only how to use it safely. A study followed transgender individuals for about four years. Transgender women taking estrogen had a noticeably higher rate of venous thrombosis than age‑matched controls — 4.1 extra cases per 1,000 people in two years and 16.7 extra cases per 1,000 in eight years. Such risks must be monitored through long‑term follow‑up, and that monitoring only happens when a clinician checks you regularly. When people buy hormones online and adjust doses themselves, there is no one to provide that oversight.

Open the low-ROI detour

Move “Sex hormone therapy should only be used when prescribed by a doctor and with regular follow‑up; do not buy it online and do not adjust the dose on your own.” to Future Me's calendar

The routine already works until the day the source says it may not.

Today I keep a little money, a few minutes and avoid interrupting my default routine.

Read the source and trade-off
28-008
Evidence BlifespanSource-sensitive

If the feeling of “being unattractive” has reached the point where you constantly check your reflection and obsess over changes, get a body image assessment before considering surgery.

如果「觉得自己丑」已经到反复照镜子、反复想改的程度，先做一次体像评估再谈手术

When we combine data from 33 studies, we find that 15.04% of people seeking cosmetic surgery meet the criteria for body dysmorphic disorder — a condition where a flaw barely noticeable to others becomes a major source of distress. Among dermatology patients seeking cosmetic treatments, the rate is 12.65%. In both groups, over 70% are women. Surgery can alter facial features, but it cannot break the cycle of constant self‑scrutiny and dissatisfaction; this often leads to repeated operations. Spending a modest amount on an initial evaluation can help determine whether you fall into this category, guiding your decision about surgery.

Open the low-ROI detour

Move “If the feeling of “being unattractive” has reached the point where you constantly check your reflection and obsess over changes, get a body image assessment before considering surgery.” to Future Me's calendar

There is no immediate alarm, so the sensible choice can wait for a less busy week.

Today I keep a little money, a few minutes, a bit of persistence and avoid interrupting my default routine.

Read the source and trade-off
28-009
Evidence ClifespanSource-sensitive

Use an orthodontist for an in-person exam and follow-up; do not self-treat with mail-order aligners

矫正牙齿要找有正畸资质的医生当面检查、按时复诊，别网购牙套自己在家戴

Chinese device guidance calls for an orthodontist's supervision and regular review. The US FDA says it has not authorized clear aligners sold directly without a prescription and dental supervision.

Open the low-ROI detour

Move “Use an orthodontist for an in-person exam and follow-up; do not self-treat with mail-order aligners” to Future Me's calendar

Future Me has a clearer calendar, more patience, and apparently the same responsibilities.

Today I keep a little money, a few minutes, a bit of persistence and avoid interrupting my default routine.

Read the source and trade-off

Source snapshot: a994b6a0c90598b0fe15cb837343f438dbf7b95d. Every original stays available in Chinese alongside the English edition.