Gaining three pounds after the Spring Festival is actually not your fault

Obesity should be treated as a chronic condition. The idea that obesity can be reversed by making lifestyle changes contradicts existing scientific evidence. Conscious effort to lose weight may activate a powerful compensatory biological response, which often leads to long-term weight regain.

Written by | Zhang Chicheng

Another year of the Spring Festival, a rich reunion dinner, a comfortable long holiday, for people determined to lose weight, is undoubtedly a severe test. In this regard, some netizens made an oil poem ridicule: "Every festival fat three pounds, take a closer look at three kilograms." Weight loss desperately for half a year, before the achievement and the New Year. ”

More scientific data shows that "three pounds of weight every festival" is not just a joke on the Internet. As early as the beginning of this century, a study published in the New England Journal of Medicine showed that people gained significantly during the holiday period from mid-November to early/mid-January, with an average increase of 0.37±1.52 kg (p<0.001) [1]. Overweight/obese people have also been shown to gain more weight during the holidays than normal-weight people [2].

"It's a natural phenomenon." Professor Qu Shen, director of the Institute of Obesity of Tongji University School of Medicine, chief physician of the Endocrinology and Metabolism Center of Shanghai Tenth People's Hospital, and director of the Endocrinology and Metabolism Thyroid Center of Shanghai Tenth Hospital Alliance, told the "medical community" that due to the outbreak of the epidemic some time ago, there were fewer opportunities for everyone to go out for activities, and holidays such as New Year's Day, Christmas, and Spring Festival came one after another, so this period is "the most likely time of the year to gain weight".

"In autumn and winter, everyone is reluctant to move, and due to the influence of tradition, Chinese taboo to see a doctor before the Spring Festival, let alone go to the hospital because of obesity." It may be that after the Spring Festival, more and more obese patients will come to the hospital. Professor Qu Shen predicted.

Obesity is a disease,

Weight loss can't be done by willpower alone

"Many people think that the holiday 'fat three pounds' are all fat, in fact, in addition to dietary problems, irregular life and irregular sleep may cause weight gain or obesity." Professor Qu Shen pointed out, "Obesity is a disease, not only that, but it is also a disease with very complex etiology. For many years, the public's understanding of obesity has been misunderstood, thinking that obesity is only a matter of lifestyle or personal choice, and losing weight is 'controlling your mouth and opening your legs', and you don't need to go to the hospital. If we did a survey now and asked how obesity is caused, I think most people would answer 'eat more' or 'move less'. But this is a phenomenon, not a cause. What we need to figure out is, why do obese people eat more and move less? Why eat as much and exercise as much, some people are obese and some are not? This is the root cause of obesity. ”

Professor Qu emphasized that facing up to and acknowledging obesity as a disease can help reduce the stigma of obesity in society. In the past, obese patients were often accused of being "lazy and hungry" and "not self-disciplined enough", and were discriminated against and prejudiced in education, work and social interaction. On World Obesity Day 2020 (4 March), Nature Medicine, published a blockbuster international consensus statement[3], calling for an end to the stigmatization of obesity and making 13 recommendations, including "treating obesity as a chronic disease and treating it". The statement pointed out that weight regulation is not completely controlled by individual will, and biological, genetic and environmental factors all play a crucial role in obesity. The idea that obesity can be reversed completely/in the long term through conscious lifestyle changes (eating less and exercising more) also contradicts existing scientific evidence. Studies have shown that conscious effort to lose weight may activate powerful compensatory biological responses (e.g., increased appetite, decreased metabolism), which often lead to long-term weight regain.

"For obese patients, the really effective treatment is not only to lose weight, but also to maintain non-rebound for a long time." Professor Qu Shen believes that the control of obesity should start from the cause. In 2015, based on decades of clinical diagnosis and treatment experience, combined with the metabolic characteristics of obese patients in China, and drawing on the diagnosis and treatment experience of traditional medicine in the motherland, he proposed obesity classification based on metabolism. He used the four colors of white, yellow, red and black to describe the four different types of high metabolic obesity, metabolic normal obesity, low metabolic obesity and inflammatory metabolic obesity, which are not only vivid and vivid, but also easy to understand. In 2021, Professor Qu Shen's team also tried to use artificial intelligence to classify obesity. For different subtypes of obese patients, the treatment modality and focus are also very different.

Breakthroughs in drug discovery,

Indications for surgery are expanding

It has been more than two decades since the WHO first defined obesity as a disease in 1997. In recent years, the number of overweight and obese people in mainland China has increased rapidly, and the "Report on Nutrition and Chronic Diseases of Chinese Residents (2020)" pointed out that more than half of the adult residents of mainland China are overweight or obese, and obesity has become an important public health problem [4].

Correspondingly, the only drug approved for long-term weight loss in mainland China is orlistat, which is difficult to meet a wide range of clinical needs, and its adverse reaction risk also limits the application of the drug. "In the past, we didn't have good weight loss drugs, and obesity treatment has been faltering." Professor Qu Shen said, "In the past two years, we have begun to pay attention to obesity, not only because of the increase in patients, but also because obesity treatment has made great progress. This is mainly due to advances in basic research. ”

A variety of basic studies have shown that in addition to changes in endocrine metabolism and central regulation, changes in gastrointestinal flora also play an important role in the mechanism of dieting rebound [5]. "Now obesity treatment is gradually shifting to the center, to the intestine." Professor Qu Shin introduced.

In January 2023, Nature published an article entitled ""Breakthrough" diet drugs that shocked researchers", introducing the development history of diet drugs and the research results of a new generation of diet drugs such as semeglutide and Tirzepatide [6]. The article mentioned that the weight loss of obese patients after treatment with GIPR/GLP-1R dual agonists is close to the level of metabolic surgery. This was "impossible" in the past.

"The weight-loss drugs we used in the past were not large and difficult to maintain for a long time. But now a new generation of weight-loss drugs act on the central system, the weight loss effect is significant, and the side effects are relatively small, and patients can use it for a long time. Everyone has seen the light, and many hospitals have opened obesity clinics. Professor Qu Shen introduced, "In addition, we have also made great breakthroughs in bariatric surgery. In the past, it was believed that surgery could reduce weight because stomach capacity was reduced and food intake was reduced - this is a relatively superficial understanding. Now, 40 years of clinical evidence suggests that metabolic surgery is a very effective way to lose weight without rebounding through communication with the brain. It not only reduces weight loss, but also reduces the risk of death from many obesity complications, such as cardiovascular disease, diabetes, tumors, etc. ”

Professor Qu Shen pointed out that the current treatment of obesity is still mostly "independent combat", but the effect of monotherapy is often unsatisfactory. Therefore, centralized treatment will become the general trend in the future. The establishment of the obesity diagnosis and treatment center can cover multiple disciplines such as internal medicine, nutrition, sports, traditional Chinese medicine, surgery and psychology, and combine a variety of treatment methods to provide patients with more personalized and reasonable solutions.

"Lifestyle interventions are the basis of all obesity treatments, but lifestyle interventions are not effective for all patients, such as many obese patients with hyperinsulinemia, and if they are restricted from eating, hypoglycemia may occur. In the process of weight loss, sports injuries are also common, which requires scientific guidance. Professor Qu Shen emphasized, "Drug treatment is adjunct, and patients with severe obesity, metabolic abnormalities or other diseases can consider surgical treatment." For example, some obese patients with polycystic ovary syndrome will have normal menstruation immediately after surgery. This is not only related to weight loss, but may also regulate the patient's endocrine metabolism. In the past, patients who met the indications for surgery may account for only 2%~5% of obese patients, but now the indications for surgery have been relaxed. In the past, obesity patients could only undergo surgery at the age of 18, but now the age has been relaxed to 16; In the past, the upper age limit for metabolic surgery was 65 years, but now the average life expectancy is extended, and we have also operated on patients in their 70s, and the results after surgery are very good. Metabolic surgery itself is not complicated, but perioperative management is very important and requires professional surgeons to judge and deal with it. It's all a matter of science. ”

"So we are now going to great lengths to promote that obesity is a disease and that obesity should be treated under scientific guidance, not for everyone." Professor Qu Shen said, "In fact, the treatment of obesity is much more complicated than diabetes and high blood pressure. ”

Bibliography:

[1] Yanovski JA,Yanovski SZ,Sovik KN,et al. A prospective study of holiday weight gain. N Engl J Med.2000 Mar 23;342(12):861-7.

[2] Díaz-Zavala RG,Castro-CantúMF,Valencia ME,et al. Effect of the Holiday Season on Weight Gain:A Narrative Review.J Obes.2017;2017:2085136.

[3] Rubino F,Puhl RM,Cummings DE,et al. Joint international consensus statement for ending stigma of obesity. Nat Med.2020 Apr;26(4):485-497.

[4] Report on Nutrition and Chronic Diseases of Chinese Residents (2020)[J].Journal of Nutrition, Vol. 42, No. 6, 521 pages, ISTIC PKU CSCD CA,2021.

[5] Zhong W,Wang H,Yang Y,et al. High-protein diet prevents fat mass increase after dieting by counteracting Lactobacillus-enhanced lipid absorption. Nat Metab.2022 Dec;4(12):1713-1731.

[6] Prillaman M.The'breakthrough'obesity drugs that have stunned researchers. Nature.2023 Jan;613(7942):16-18.

Source: Medical community

Responsible editor: Wang Hang

Proofreader: Zang Hengjia

Editor: Zhao Jing