The Paper chief reporter Chen Sisi
"Lose 20 pounds in 15 days", "Lose 10 pounds in 7 days, fasting is a real cow", "The trick to losing weight is to be hungry"...... In the social context of "thinness is beauty", various social platforms are always full of "experience posts" with weight loss as the topic, are these reliable?
What kind of people need to lose weight? Why do obese people get fat when they drink boiled water? When you are older, your metabolism is slow, so you have to eat less to not get fat, is this true? Who needs "gastric reduction surgery"? "Intermittent fasting" and "Internet celebrity diet pills", are they really that effective?
"In recent years, more and more young people have come to our obesity clinic, and women always come to see me more than men, and they will always consult me about 'how to lose weight', 'how to make myself thinner', and some are even very obsessed with 'why I am old and can't get back to the previous 100 pounds'. In fact, there are always some patients who don't need to lose weight at all, I am always dissuading them, and the various weight loss methods on the Internet are also testing people's will, and how many people can really lose weight and continue to maintain a healthy state? ! Professor Qu Shen, director of the Institute of Obesity at Tongji University School of Medicine and chief physician of the Department of Endocrinology of Shanghai Tenth People's Hospital, said.
May 11 is World Obesity Day, and The Paper reporter talked to Qu Shen to learn about the weight loss stories of men and women in his bariatric clinic. When he saw the doctor, he often thought: "Why don't we see what we should see, why we insist on reducing when we shouldn't, maybe our cognitive bias about obesity is too big." ”
Professor Qu Shen, Director of the Institute of Obesity, Tongji University School of Medicine, and Chief Physician of the Department of Endocrinology, Shanghai Tenth People's Hospital. Photo courtesy of the interviewee
What you think is fat is really fat?
"I'm over 100 pounds, I'm too fat", "As I get older, I'm getting fatter and fatter, how can I lose weight"...... This is a topic that is often asked by patients in the bariatric clinic of Qushen.
"People often come to my clinic to say that they want to lose weight, especially many young women, in fact, they can't reach the normal weight standard, but they want to lose weight, which is unscientific, and you can't just use the naked eye judgment and subjective feelings, or weigh yourself to judge whether you are fat." Qu Shen said that now, body mass index (BMI) is usually used worldwide to assess whether obesity is imperfect, but it is also a relatively scientific diagnostic standard for judging obesity, BMI is the square of weight (kg) divided by height (m). According to the criteria set by the China Obesity Working Group for the Chinese population, an adult BMI between 24.0 and 27.9 is defined as overweight, while a BMI greater than 28.0 is considered obese.
Qu Shen said that the BMI standard set by the WHO (World Health Organization) is different from the standard set by the mainland, because Chinese and Europeans are different, and the standard set by the WHO is 25.0 and above is overweight, and more than 30.0 is obese.
"In the diagnosis of obesity, professional doctors should consider the following situations in addition to referring to the BMI diagnosis in the mainland, first, to see whether they are fat or not, and second, to see whether they are fat or not, if there are complications such as fatty liver, diabetes, and hypertension related to metabolic disorders and obesity, or if the waist circumference of women is more than 85 cm and the waist circumference of men is 90 cm, it is also called obesity, even if the weight is normal, it should be paid attention to." Qu Shen said.
Based on his long-term clinical treatment experience and patients' clinical manifestations, he divided obese patients into four types according to their metabolic status: red, white, black and yellow, and this research result was published in the authoritative Chinese Journal of Endocrinology and Metabolism in 2015.
Specifically, red fat people (high metabolism) are generally able to eat, drink, and be easily excited, and are most likely to get high blood pressure. Black fat people (inflammatory obesity) are generally energetic, like Lu Zhishen, they can eat and move, and they have more muscle and fat. Nowadays, there are more young black and fat people, most of whom are manifested as black necks, abnormal menstruation and increased hair in girls. Yellow fat people are generally rare, mostly in older people, manifested as a fat belly, weak qi, may appear hypothyroidism, anterior pituitary hypofunction, metabolic rate reduction and other endocrine dysfunction; Although the body mass index is exceeded, the white fat person has good skin elasticity, normal waist-to-hip ratio, and no metabolic abnormalities.
"The treatment of these four types of obese patients needs to be targeted and not one-size-fits-all." Qu Shen explained that taking the yellow fat man as an example, this kind of people don't eat much, and if he is allowed to keep his mouth shut and open his legs, it will not solve the problem, but to help him increase his hormone level, the metabolic rate is high, and he will naturally lose weight, and it is more difficult for black fat people to lose weight, and they need to reduce the insulin level in their body. The red fat person has a higher metabolic rate, increased cortisol, purple striae and high blood pressure, and is also prone to liver and kidney dysfunction. Excessive and rapid weight loss often leads to other health problems, such as irregular menstruation, decreased physical strength, and lack of energy, but it is also necessary to prevent the trend of continuous obesity.
"Everyone often thinks that if a person wants to lose weight and doesn't want to be obese, he just needs to keep his mouth shut and open his legs, but in fact, we have to start from the cause of obesity for treatment, and not everyone can control their mouths and open their legs." Experts say.
A fasting method shared on a social platform. Screenshot of the phone
Why do some people get fat when they eat, and some people can't get fat when they don't eat at all?
In the outpatient clinic, many patients often ask whether their physique is easy to gain weight, is it natural? Is it related to genes?
It's true, Qu said, that genetics determine the type of metabolism in the body, which affects weight and body shape. "The size of a person depends 40%-70% on genetics and congenital conditions, just like the height of a person is difficult to change. However, in addition to congenital factors, the influence of acquired and social environmental factors, such as long-term sedentary work, as well as unhealthy lifestyle habits and environmental factors, all contribute to the occurrence of obesity. Stress-led psychological factors and the use of certain medications can also lead to weight gain. ”
Why are some people prone to gaining weight, and some people not getting fat no matter how much they eat? Qu Shen especially said that some people love to eat, and some people can never eat enough, and they can't stop eating, which is related to the metabolic characteristics and central regulation of our human body. "We are now studying the central regulation of obesity, and everyone has a 'set-up point' in their brain from birth that determines how much you weigh. For example, some people need to be fat to 100 kilograms before their brain thinks it is "enough", and some people are affected by human factors and do not eat when they are young, but the people around them force them to eat, and their weight will continue to increase. ”
As a weight-loss expert, Qu Shen has developed a good habit: he has to weigh himself every day, just like eating every day, and the formation of this habit has also allowed him to realize in time when it is time to exercise and when to eat less, which is much easier than losing weight when it is out of control.
In response to the ketogenic diet, "16+8 diet", "low-calorie diet", "time-limited diet", "no meals at night" and other online weight loss "experience stickers", Qu Shen believes: "Although these methods are effective, they cannot last, weight loss is not fashionable, maybe some methods can bring short-term and rapid weight loss, but you can do it for a month, two months, and persist for half a year, you will feel very strenuous, these lifestyles that do not conform to physiological habits are difficult for people to stick to for a lifetime." ”
In his opinion, for obesity, nutrition therapy is the first step to lose weight, but only nutrition therapy, no other methods of cooperation is also unscientific, no muscles are not enough, "just hungry, eat less is not advisable, not the thinner the healthier." ”
"A lower BMI is not always better." Qu Shen said frankly that some epidemiological studies have confirmed that the all-cause mortality rate of people with a BMI of less than 18.5 is much higher than that of people with a BMI of 25-30, "so we advocate that we must not lose too much weight, and what should not be lost can not be lost indiscriminately, for example, for menopausal women, there is often an increase in waist circumference, which is related to physiological aging. ”
Qu Shen particularly emphasized that most of the current weight loss behaviors will lead to the loss of muscle and fat at the same time, and what we expect is fat loss (especially visceral fat) and muscle gain, "Our requirement is that exercise and diet control must be carried out at the same time to maintain a healthy state of the body, so measures such as strengthening bones and muscles, supplementing corresponding nutrients and minerals are particularly important." ”
A fasting method shared on a social platform. Screenshot of the phone
Do influencer diet pills really work?
Who needs to have gastric reduction surgery?
In response to the fact that "semaglutide injection" has been used by many people to control weight in the past two years, Qu Shen said that in the outpatient clinic, some patients often come to consult whether they can get an injection?
He said: "Semaglutide injection currently on the market in China is only approved for the indication of adult type 2 diabetes, and semaglutide injection is actually a new long-acting glucagon-like peptide-1 (GLP-1) analog, which should be used scientifically and rationally under the guidance and monitoring of doctors as a prescription drug. Semaglutide injection 2.4mg is currently used for long-term weight management, but it has not been approved in the mainland. ”
Who needs to have bariatric surgery? Qu Shen said that compared with foreign countries, the recognition of bariatric surgery in China is not high, "In Europe and the United States, there are now 300,000 bariatric surgeries a year. In China, we have been implementing it for more than ten years, and in 2023, we will just reach 30,000 surgeries a year. From the current point of view, there are still 90% of obese patients who need surgery, do not accept or are afraid of surgery, bariatric doctors will strictly grasp the indications of bariatric surgery, so as to achieve the ideal surgical effect. ”
Qu Shen admitted that in his outpatient clinic, he has even encountered people who weigh up to 500 pounds, with a BIM index as high as 60, this kind of obesity is called fatal obesity, and only surgery can solve the problem and save the life of these patients.
"Obesity will bring many metabolic abnormalities, such as diabetes, fatty liver, high blood pressure, hyperlipidemia, as well as mental and psychological problems, and even lead to organ dysfunction, such as liver and kidney fibrosis and heart failure and lung dysfunction, especially for children and adolescents, their growth and development, and fertility in adulthood will also be affected by obesity, and this must be recognized as early as possible." Qu Shen also met a young patient weighing more than 400 pounds, heart failure once a month, each time he had to go to the ICU for rescue, after losing 25 kilograms, he did not have heart failure within a year, but long-term obesity made him lose the opportunity for surgery, and finally died because of a heart accident caused by obesity, which is very regrettable.
"Severe obesity often leads to obese heart disease, and such patients can die at any time due to sudden arrhythmias and heart failure." Qu Shen emphasized that the earlier the intervention in the treatment of overweight patients, the better the effect.
He pointed out that in clinical practice, bariatric surgery for severely obese patients has high technical requirements and corresponding risks, including anesthesia and perioperative treatment, which require experienced teamwork, not just a simple stomach cut, "even if there is a slight opportunity, we will find a way to help them save it, therefore, multidisciplinary cooperation is extremely important, before the operation, we will also help them lose weight, so that their cardiopulmonary function recovers, and carry out bariatric surgery at the most appropriate time." ”
In response to the misunderstanding of weight loss, Qu Shen also has one more point to appeal to the public: "Don't pursue short-term weight loss, quick results, in fact, short-term weight loss, repeated weight loss will have great harm to the human body, such as liver fibrosis, induce gout and physical decline." Our principle is to go multi-headed, nutritionally balanced, eat and move together, start losing weight a little faster, then slowly slow down, and finally return to a balanced diet, regular exercise and return to a normal and long-lasting life, which is scientific. ”
So, who should visit an obesity clinic?
Qu Shen specially introduced that first, people who gain weight rapidly, people who have no health problems, if they gain 10 kilograms or 20 kilograms in a year, and they can't lose it, it may be that there is a problem with endocrine metabolism and they need to go to the hospital for diagnosis to find the cause; Second, people who continue to gain weight year by year may be accompanied by various reasons for weight gain; The third is people with a larger and larger belly, which is a manifestation of aging, and may also have problems such as abnormal metabolism or abnormal liver function; Fourth, hereditary obese people, who have been fat since childhood, and their parents are also fat, such people should not wait for problems in adulthood to lose weight, and need to control their weight as soon as possible to prevent the occurrence of metabolic abnormalities in adulthood.
"The problem of obesity is becoming more and more serious, and medical intervention has a long way to go, and I hope that with the popularization of scientific weight loss knowledge, we can eliminate some misunderstandings about weight loss." Qu Shen finally said.
Editor of this issue: Zou Shan