The National Health Commission recently released the "Dietary Guidelines for Adults with Obesity (2024 Edition)" and "Guidelines for Dietary Nutrition for Children and Adolescents with Obesity (2024 Edition)", which pointed out that the obesity rate of residents aged 18 and above in mainland China is on the rise, and obesity prevention and control is urgent.
The National Health Commission has decided to launch a three-year "Year of Weight Management" nationwide from 2024. At the same time, more and more people are joining the ranks of weight loss and declaring war on "obesity". A top-down, bottom-up nationwide action to "manage weight" is rapidly unfolding.
01
Trapped in obesity
In front of the outpatient building of Peking Union Medical College Hospital, Lu Bing, who was wearing a "5XL" skirt, held a hard-won medical registration slip and shouted "eggplant" at the camera.
The registration slip with the number "2" on it is "Chen Wei". Lu Bing, who was waiting for treatment, had a heroic spirit of "finally going to the battlefield", and also had a longing for victory, as if the 20 kilograms of meat that had soared in 3 years would soon be gone.
The World Health Organization stipulates that BMI is normal in the range of 18.5~25, 25~30 is overweight, and more than 30 is obese. In the mainland, a BMI of less than 18 is called low body weight, the normal range is 18~24, 24~28 is called overweight, and more than 28 is called obesity.
Lu Bing's physical examination data last year showed that she belonged to the "obesity group": 1.58 meters tall, 80 kilograms in weight, and BMI 32. For this reason, she came to Beijing from Baoding City, Hebei Province to lose weight.
On the mainland, there are many people like Lu Bing. According to the recently released "Dietary Guidelines for Adults with Obesity (2024 Edition)" and "Dietary Guidelines for Children and Adolescents with Obesity (2024 Edition)", the obesity rate of residents aged 18 and above in mainland China is 16.4%, the obesity rate of children under 6 years old is 3.6%, and the obesity rate of children and adolescents aged 6 to 17 years old is 7.9%. In 1982, the obesity rate among children and adolescents aged 7 to 17 was only 0.2 percent. The obesity rate among children and adolescents in urban areas is relatively high, while the obesity rate among children and adolescents in rural areas is increasing rapidly. Some studies predict that by 2030, the overweight and obesity rate of mainland adults will reach 65.3%.
Chen Wei is the chief physician of the Department of Clinical Nutrition, Peking Union Medical College Hospital. His department receives nearly 20,000 bariatric patients every year, and his experience of obesity is more intuitive. Once, 3 "fat friends" who weighed more than 150 kilograms appeared together, which made him feel "suffocation".
In 2016, The Lancet published the global epidemiological characteristics: for the first time, the number of "fat people" in the world surpassed that of "thin people", and the total number of obese people in China has surpassed that of the United States, ranking first in the world. At that time, there were an estimated 89.6 million obese people in China, of which 11.2 million were severely obese, and obesity has become a major challenge affecting the health of Chinese people. In this year, the State Council issued the "Healthy China 2030" Planning Outline, and proposed a healthy lifestyle for all people with "three reductions and three health".
Although governments at all levels, medical institutions and all walks of life are paying more and more attention to the prevention and treatment of obesity, and various obesity prevention and control books and weight-loss talent shows have emerged, however, what frustrates Chen Wei is that the obese people around him seem to be increasing rather than decreasing.
It was also in this year that Chen Wei shifted the focus of his work and research from treating "thin people" (i.e., solving the problem of malnutrition) to treating "fat people" (i.e., preventing and treating obesity).
What is the role of the doctor in the fight against obesity?
"Predict possible health problems in time to help lose weight and solve health problems at the same time." Chen Wei said that he found that although they are all fat, each fat person has their own story. For example, some people eat emotionally, some people have low metabolism, and some people have insulin resistance...... Therefore, it is necessary to formulate a weight-loss plan in a targeted manner in diagnosis and treatment, and to achieve safe and effective weight loss under medical supervision.
Lu Bing finally sat down beside Chen Wei. "Have you been busy lately?" "Tired or not?" "Did you sleep well?" "Are you emotionally stable?" The heart-to-heart consultation at the beginning made Lu Bing a little confused and a little moved. After battling obesity for more than two years, she has heard the most accusatory words. However, here, a few greeting-like opening words suddenly touched the softest and most sensitive place in her heart.
"I really wanted to cry at the time, tears were rolling in my eyes, and Dr. Chan must have seen it." Lu Bing said that at that moment, he seemed to forget the anxiety of not being able to register before, and the helplessness of hiding in an underground hotel in Beijing and crying secretly the night before.
Five years ago, when she was just in her early 40s, she was pushed to the bottom by unemployment and forced marriage, so she ate with revenge, and the consequence was that her weight was out of control. When dozens of arrows appeared on the physical examination form at the same time, Lu Bing panicked. Losing weight immediately became her top priority.
As a former programmer in a large factory, she took out the rigor of writing code, and formulated a strict diet and exercise plan. Swimming, running, light eating, skipping dinner...... The rigorous exercise plan and diet list went well in the first week, and the weight dropped quickly, but in the days when the "big aunt" came, the hormone level changed, and Lu Bing collapsed, "I ate a big bucket of fried chicken in one go, poured Coke hard, and began to blame myself after eating."
In the struggle against 20 kilograms of fat, Lu Bing tasted victory, but it was short-lived. However, she has a character that does not admit defeat. After her mood calmed down, she began a "new journey": to suppress her appetite. After using prescription drugs and health care products, she spent tens of thousands of dollars on miscellaneous items, and she lost 15 kilograms of weight. However, as soon as the drug stopped, not only did he gain weight, but he also gained three or four pounds.
"Why can't it be reduced? Why do you lose more weight and gain weight? There must be some hidden factors, and only by solving these problems can we embark on the road to health. Conversely, it is difficult to change behavior without addressing psychological problems. Chen Wei said.
Every time he has a consultation, Chen Wei will spend a little more time talking to patients about seemingly ordinary things, with the aim of quickly entering their lives and hearts. And this is also the reason why everyone likes him - not only has superb medical skills, but also the ability to empathize.
In order to gain valuable "chat" time, Chen Wei has a doctor's assistant who specializes in understanding the patient's relevant information, and there is also a medical housekeeper at the door who helps the patient do a physical test in advance.
The treatment of obesity is different from taking medicine and injections for ordinary diseases, and it is a protracted battle. Chen Wei found that as long as you want to lose weight and your willpower is strong enough, no matter what method you use in the short term, you will definitely lose weight. However, such a practice can only be reduced for a while, and then it may be faced with a situation where it cannot be reduced, reduced to a plateau, and reduced to a collapse.
The scientific research project that Chen Wei and his team are carrying out is a clinical study on the prevention and treatment of "weight circulation": mainly for those who have been "repeatedly defeated", to find the physiological factors and inducing factors of weight regain. At the same time, Chen Wei carried out "group management" for patients, and let everyone supervise each other through peer education and individualized remote management.
At the door of the clinic, in addition to helping patients with physical testing, the medical housekeeper will also help make an appointment for the next outpatient time, and take the trouble to advise everyone on medical weight loss precautions, and send the blessing of "early graduation". In Peking Union Medical College Hospital, which is known for its difficulty in registration, this wave of operations has warmed the hearts of patients.
Lu Bing also enjoyed this perk: a month later, on Wednesday, she will be here again, "the kind with appointments".
02
Cautious surgery
Near 12 noon, Zhang Peng, chief physician of the bariatric and metabolic surgery department of Beijing Friendship Hospital affiliated to Capital Medical University, came out of the operating room. The subject of the operation was 38-year-old Liu Min, who was 1.63 meters tall and weighed 95 kilograms, with a history of diabetes for two years, combined with a hiatal hernia, and when he reached the stage of steatohepatitis, he slept and snored.
Last year, Beijing Friendship Hospital performed a total of 445 bariatric surgeries. The bariatric and metabolic surgery ward where Peng Zhang is located has a total of 13 wards and 37 beds. "Before moving to Tongzhou, bariatric and metabolic surgery was part of the gastroenterology department. In 2018, the Department of Bariatric Surgery established an independent department, the Department of General Surgery, with an independent ward. Zhang Peng introduced that Beijing Friendship Hospital is the first hospital in China to establish a bariatric specialty, and it is also the hospital with the largest number of bariatric beds in China.
Liu Min's choice of gastric reduction surgery is one of the many bariatric surgeries, namely laparoscopic sleeve gastrectomy. Bariatric metabolic surgery reduces body weight from a morbid state to an overweight or normal state in a relatively short period of time by reducing the volume of the stomach, Zhang said. This type of surgery includes laparoscopic sleeve gastrectomy and laparoscopic gastric bypass, which is more common in mainland China. Once the body weight is lost by 10%~15%, obesity-related diseases such as type 2 diabetes, fatty liver, and sleep apnea syndrome will also be significantly alleviated.
"Bariatric surgery is strictly indicated, and surgery should only be considered if exercise, diet, and medical intervention are not satisfactory." Zhang Peng said.
Bariatric surgery was first seen internationally in 1954. It wasn't until 2000 that the first bariatric surgery was performed on the mainland. Before 2012, there were less than 500 bariatric surgeries performed in mainland China. However, in 2012, it reached about 700 cases, and in 2019, the number of surgeries nationwide exceeded 10,000, and in 2022, it exceeded 30,000. According to incomplete statistics, more than 35,000 bariatric metabolic surgeries will be performed in mainland China in 2023.
In addition to the rapid increase in the number of surgeries, the bariatric and metabolic surgery department of Beijing Friendship Hospital has also innovated surgical methods. Zhang Peng introduced that the current surgical methods of bariatric and metabolic surgery in mainland China are different from those in the world, which is manifested in the fact that the proportion of gastric sleeve resection with the largest number of gastric sleeve resections performed in the world is too high in the mainland, and the number of gastric sleeve resection combined with jejuno-jejunal bypass, which is rarely performed abroad, ranks second in the mainland. Due to the later development of bariatric and metabolic surgery in mainland China than in Western countries, the high-level clinical evidence accumulated in the whole discipline is still limited, and gastric sleeve resection and Roux-en-Y gastric bypass are still recommended as the standard at this stage.
Whether or not to do bariatric surgery and what kind of surgery to do is not up to the doctor to decide, but requires a joint decision between the doctor and the patient. Liu Min insisted on choosing gastric reduction surgery. In view of the history of diabetes and other comprehensive considerations, Zhang Peng's recommendation was an alternative surgical procedure.
"As a doctor, I will recommend the appropriate surgical method based on my clinical experience and clinical evidence, but the choice is still in the hands of the patient, and what we need to do is to make the reason clear." Zhang Peng said that there is usually a "bargain" between doctors and patients, and then they jointly decide which surgery to perform.
Zhang Peng divided the patient's mental journey to bariatric surgery into four stages: first, the impulsive period, which is generally 2~3 days; This is followed by a period of resistance, fear of surgery; This is followed by a hesitation period; Finally, there is the rational period. "We prefer patients to undergo surgery in a rational period." Zhang Peng said.
Unlike Liu Min, who took the initiative to ask for surgery, most of the patients who came to bariatric and metabolic surgery were transferred from other departments. There are many patients from the Department of Obstetrics and Gynecology, and women of childbearing age are prone to obesity, polycystic ovary syndrome, no ovulation, and no fertility. There are people who are transferred from orthopedics, because the lumbar spine and knee joints are not good due to obesity, and the orthopedic surgeon will say that "the weight is too heavy, the pressure is too great, and it is useless to do it, lose weight first and then do orthopedic surgery". There are also many people from urology, and patients with high uric acid and kidney stones are more common in obese people. There are also diabetics from endocrinology, mainly obese patients. There are also people from the cardiovascular department, and the hypertension of fat people cannot be lowered with medication, which is also called refractory hypertension......
In 2016, the American Clinical Endocrine Association first proposed to rename "obesity" to "obesity-related chronic diseases", conceptualizing obesity as a chronic disease state and leading to a variety of concurrent diseases characterized by obesity, including a specific medical diagnostic term, reflecting the pathophysiological process of obesity-based diseases including cardiovascular diseases, endocrine and metabolic diseases, tumors, and other diseases. In the same year, the International Agency for Research on Cancer (IARC) found enough evidence to support the association of excess body fat with 13 of the 24 sites of cancer, including esophageal (adeno), gastric cardia, colon, liver, gallbladder, pancreas, postmenopausal breast, endometrium, ovarian, kidney, meningioma, thyroid and multiple myeloma.
The inextricable relationship between obesity and a variety of diseases is directly manifested in medical institutions: doctors who see weight loss have any specialty. Zhang Peng introduced that from the beginning of surgery, nutrition, endocrinology, etc., it has now expanded to traditional Chinese medicine, rehabilitation, otolaryngology, hepatology, etc. At the same time, bariatric surgeons are often transformed from gastrointestinal surgery, hepatobiliary surgery or other surgeons, although such doctors have certain basic medical knowledge and superb surgical skills, but have not undergone systematic obesity medical education, lack of systematic learning and integration of basic theoretical knowledge related to obesity, more or less affect clinical work, and the degree of standardized and standardized treatment is relatively low.
In this regard, Zhang Peng suggested that the medical school should build a clinical course on obesity and a training system for specialized chemical physicians, including the training of bariatric nurses, and improve the academic literacy of practitioners through national academic organizations.
The quality of surgery is what Zhang Peng and his peers value the most. Zhang Peng is also the director of the Beijing Bariatric and Metabolic Surgery Quality Control and Improvement Center. He and other experts spent more than half a year last year inspecting more than 20 hospitals in Beijing that perform bariatric surgery. At the same time, in his own department, Zhang Peng attaches great importance to the whole process management of patients, and has established a specialist follow-up team to inform patients how to eat, how to exercise, and when to return to the clinic through direct education and manual publicity. Among them, the department has added a specialized nursing consultation clinic for bariatric treatment of metabolic diseases to help triage patients for initial consultation, and at the same time undertake postoperative patient guidance, follow-up, and re-education after drug treatment.
03
Diverse accompaniment
Some people say that losing weight is a lonely and long practice. On this arduous road, Chen Wei and Zhang Peng are not only companions of the "fat friends", but also firm long-term companions.
Chen Wei has co-sponsored the "Weight Loss of 10,000 catties" plan with many medical institutions across the country. At that time, many people were curious to see how long it would take to complete this task. "As a result, more than 10 institutions completed this feat in the outpatient department in just three months." Chen Wei said that next, his wish is to accompany the 10 million "fat friends" across the country to lose weight.
Chen Wei set an upper limit on the time limit for "successful weight loss" for obese patients: 6 years. He was referring to a set of international data.
In 1993, Dr. James Hill and Dr. Rainer Wing of the United States established the National Weight Control Registry and established a database of obese people who have been managing their weight for a long time and voluntarily undergoing follow-up management, aiming to collect data on those who have successfully lost weight, and hope to study the long-term maintenance of successful weight loss. The database requires that weight loss must be maintained for at least one year before it can be registered in the database, and that enrolled members are required to fill out a questionnaire once a year to ensure that the weight loss effect is well maintained. In the 30 years since the database was built, only nearly 10,000 people who have successfully lost weight have registered.
In Chen Wei's view, long-term weight loss without rebound is achievable, and with the extension of time (more than 6 years), it will become natural, and it will become easier for obese patients to maintain weight. "Of course, in this process, it takes the joint efforts of doctors, patients, families, and society, and long-term changes in behavior and lifestyle, so that the dream can become a reality." Chen Wei said.
No matter which patient he is, Zhang Peng will give him his contact information so that he can consult when he has any questions. Peng Zhang and his team are working on a database of weight-loss concerns. He believes that the accumulation of data can dynamically reflect the progress of the diagnosis and treatment of various obesity-related diseases, which is convenient for clinicians to make medical decisions. In the future, more high-quality international studies can be made based on the weight loss data accumulated in China to promote the overall development of bariatric and metabolic surgery in China.
Zhang Peng and many other experts are doing one more thing: developing standardized guidelines for the diagnosis and treatment of obesity. "At present, there are many guidelines for obesity, but there are surgical departments, nutrition departments and Chinese medicine departments...... Basically, each specialty formulates guidelines from its own point of view, the standards are not uniform, the treatment methods are different, and the treatment plan is highly arbitrary. The level of obesity specialist diagnosis and treatment needs to be improved. Zhang Peng revealed that multidisciplinary experts are being organized at the national level to formulate guidelines for the diagnosis and treatment of obesity, which is of great significance for the diagnosis and treatment of weight loss.
"Zhang Peng" is also communicating with the medical insurance department. "Purely for the sake of physical weight loss, it is understandable that medical insurance does not reimburse. However, some people have other diseases because of obesity, and whether the diagnosis and treatment of these patients can be covered by medical insurance is still a relatively vague area. Zhang Peng said that he had communicated many times, held several meetings, and he also submitted some relevant reports from the doctor's point of view.
"Obesity is something that needs to be managed. Studies have shown that many symptoms can be improved as long as fat people lose 5% of their body weight; A 10% drop would result in significant remission. Chen Wei said frankly that 15%~20% of outpatients will not come because of poor weight loss. In particular, patients who have high blood pressure and high blood lipids have stopped losing weight, which makes Chen Wei feel very sorry.
Obesity not only harms human health, but also causes a considerable economic burden. According to public information, China's overweight and obesity-related health expenditure is 24.35 billion yuan per year, and it is expected to reach 418 billion yuan in 2030, accounting for about 22% of the country's total medical expenditure.
Chen Wei said that if obesity is managed according to chronic diseases and calculated as a big account, it can save medical insurance funds, and more importantly, it is of great significance to change the chronic disease map in the future.
Now, Chen Wei has also walked out of the clinic and spread a more intimate channel with "fat friends". From 2011 to 2023, Chen Wei wrote a lot of books on obesity, some for doctors, and more for his "fat friends".
On April 22 this year, the day before World Book Day, the sales volume of Chen Wei's "Medical Weight Loss Guide for Chinese People" exceeded 30,000 copies. At the book's readers' sharing event, Chen Wei once again told everyone how to achieve weight loss. Readers feel intimate with the home weight loss life scene created in the book, and at the same time, the thousands of doubts on the long road to weight loss can also be answered in this interesting book.
The reason why Chen Wei can be favored by readers is mostly due to his accurate communication. "You must know who it is written for and who it is for, popular science is not like a scientific paper, the important thing is to let the people understand and be able to operate." Chen Wei said.
At the beginning of 2020, Chen Wei started to do self-media, focusing on scientific weight loss, and it became popular all of a sudden - the number of fans on a single new media platform jumped to more than 1 million in 3 months, and then slowly grew to more than 3 million. At the same time, multiple platforms converged and made efforts, and more and more people knew Chen Wei.
However, the ensuing troubles also gave Chen Wei a headache, "facing the problem of cracking down on counterfeiting every day". Some self-media will intercept Chen Wei's text or video, and then add some products to take them out of context. "Doctors also need protection, and the cost of correcting deviations by themselves is too high, and they have to find a team and someone to keep an eye on them." Chen Wei said that the cost of violating the law is very low, but the cost of cracking down on counterfeiting is very high.
And with the development of self-media, people are sometimes easy to listen to and believe, and prefer to believe that a magic method can solve the problem of weight loss. It is precisely because of this that in the process of disseminating knowledge, Chen Wei has become more and more cautious, "sometimes I am afraid that a certain sentence will make people misunderstand."
"Ordinary people want to give them a clear conclusion, and we spread more ideas." Chen Wei said that because of the aura of Peking Union Medical College Hospital, he no longer needs to establish authority from scratch, but he still has to use scientific theories to defend authority.
At present, many self-media people who do science popularization are not doctors, and their main goal is to transform content to attract attention. And Chen Wei spared no effort to insist on using paper books, paper media, new media and other integrated media methods, the only purpose is to "let people in weight loss life no longer be lonely, when they need help the most, when they can't persevere, accompany, supervise, and encourage".
Text: Yao Changfang, chief reporter of Health News
Editor: Qin Mingrui
Proofreading: Ma Yang
Review: Guan Zhongyao, Xu Bingnan