Interviewee: Yuan Zhenfang, Chief Physician of Endocrinology in the Bariatric Outpatient Department of Peking University First Hospital
Global Times health client reporter Niu Yulei
May 11 is World Obesity Day, and this year's theme is "Obesity and Obesity, Refuse to Carry Weight". According to the latest "2024 Global Obesity Map" released by the World Obesity Association, 34.8% of people in China are currently overweight, that is, BMI (body mass index BMI = weight ÷ height squared) greater than or equal to 24 and less than 28; 14.1% had a more severe form of obesity, i.e. a BMI of 28 or greater. At present, the total number of obese people in mainland China has reached 184 million, surpassing the United States and becoming the country with the most fat people in the world!
In life, everyone has more or less family and friends around them who live under the "burden". Guoguo, who is just 28 years old this year, said that after working for 3 years, her weight soared from 55 kg to 68 kg, which she didn't think was a big deal, but the changes in her body made her extremely troubled: "Suddenly one day I slept and snored, and I was often awakened, and my mouth was dry and my throat hurt." "During last year's physical examination, she was found to have mild fatty liver and was determined to lose weight, but after a short period of exercise, she gasped and coughed, and it was difficult to persist in half an hour of moderate aerobics; In terms of diet, as soon as the meal arrives, I am "panicked", my mood is at a low point, and I can't do anything, "which especially affects my work and life." 30-year-old Nana gained weight during pregnancy, and her biggest feeling is: "When you sit down, you have to lean on something, and when you bend over, your stomach is uncomfortable, and you can only be comfortable when you are paralyzed on your back." I thought that I would lose weight after giving birth, but the result was not as expected: "Before pregnancy, I would lie on my desk at noon on weekdays for a while, but after returning to work half a year after giving birth, the meat on my stomach was uncomfortable. ”
Overweight and obesity have never been just an "aesthetic proposition", but also a "health proposition". Yuan Zhenfang, chief endocrinology physician of the bariatric clinic of Peking University First Hospital, told the "Global Times Health Client" reporter that obesity will increase the risk of more than 200 diseases, affecting the health of the whole body from top to bottom. It can be said that no fat person can live completely healthy all the time.
Diseases of the respiratory system. Yuan Zhenfang introduced that if the fat of obese people accumulates in the respiratory system, it will lead to hypertrophy of the pharyngeal wall, hypertrophy of the soft palate, and narrowing of the pharyngeal cavity, inducing sleep apnea syndrome. Studies have also found that obesity can increase the severity of asthma, affect the efficiency of drug control, and in severe cases, lead to abnormal lung function. A study published in the American Journal of Respiratory and Critical Care Medicine showed that BMI can predict the incidence of asthma events, that is, the higher the BMI, the more likely asthma will occur.
Cardiovascular disease. "Obese people have higher lipids in their blood, and thick blood can lead to plaque, atherosclerosis, reduce the elasticity of blood vessels, and induce high blood pressure and heart disease." Yuan Zhenfang said that obese people have a higher weight and a larger heart load than normal, which increases the risk of cardiovascular disease. Previously, a study conducted by the University of Gothenburg in Sweden on more than 1.38 million women of childbearing age (18~45 years old) said that compared with women with a BMI between 20~22.5, more than 35 severely obese women have a nearly 5-fold higher risk of developing dilated cardiomyopathy.
Formation of fatty liver. Obese fat accumulates in the abdomen, and a large amount of excess fat cannot be metabolized and transported out through the liver, so it will be hoarded, resulting in the formation of fatty liver. A 2018 global study reported that fatty liver disease accounts for about 25% of the general population; The proportion of obese people can reach 60%~90%.
Type 2 diabetes. As fat cells grow in size, they become insulin resistant, leading to an imbalance in the blood sugar regulation process, which increases the risk of diabetes. Previously, a Danish study published in Diabetology, the journal of the European Association for the Study of Diabetes, said that obesity increases the risk of type 2 diabetes by at least 6 times.
Abnormal kidney function. Most obese patients are accompanied by hyperinsulinemia, which can increase glomerular plasma flow and filtration rate, resulting in glomerular hypertrophy and affecting kidney structure and function. A study published in the Chinese Journal of Epidemiology that included more than 500,000 residents aged 30~79 in China showed that the risk of abnormal kidney function increased by 19% and 27% respectively in people with total obesity and central obesity compared with healthy people.
Reproductive health. In men, obesity leads to a decrease in androgens and an increase in estrogen, resulting in the stunted and phagocytosis of mature sperm cells and a decrease in sperm count. Data show that about 1/5 of men with clinical fertility difficulties are obese. In women, obesity can hinder the development of the placenta, resulting in a decrease in the vascular density and surface area of the placenta, reducing the efficiency of nutrient exchange between the mother and the fetus, and affecting hormone levels, resulting in abnormal placental function. A South African study found that obesity during pregnancy can seriously affect the structure and function of the placenta in pregnant women, increasing the health risks for both mother and baby. In addition, obesity can also affect sexual desire between couples, induce sexual dysfunction and other problems, and indirectly affect fertility.
Injury to limb joints. Obese patients bear more weight on the knee joints and ankle joints than ordinary people, so the problem of joint wear and tear is serious, and they are more prone to osteoarthritis. Data from a study in March showed that the incidence of osteoarthritis in obese patients was as high as 12 to 43 percent.
Increased incidence of cancer. Obese people often have an unbalanced diet, long-term overload of the digestive system, and less physical activity will lead to fat accumulation, which will make the body in a state of chronic inflammation for a long time, reduce immune function, and induce the occurrence and development of cancer. A joint survey of more than 14 million people in 175 countries and regions by the Centre for Environment and Health of the School of Public Health at Imperial College London found that obesity causes 3.9% (about 544,300) of cancers.
Yuan Zhenfang said that judging from many studies at home and abroad, the saying that "one fat gives birth to a hundred diseases" is very reasonable. She called on people who are overweight or obese to actively do the following three things.
1. Conduct obesity diagnosis and risk assessment.
Before losing weight, you can go to the hospital to see a doctor to understand your physical condition. If there are related diseases, it is necessary to do a good job in the treatment and conditioning of the diseases first; If you are in good condition, you can talk to your doctor about the best way to lose weight, including lifestyle modifications, medical medications and surgical treatments.
2. "Keep your mouth shut": Pay attention to calories and nutrition
If you want to lose weight, you must first understand how to eat scientifically. Here are two recommended dietary methods: a high-protein dietary pattern, that is, increase the proportion of protein supply in the diet to more than 20%, eat more lean meat, eggs, poultry, fish, etc.; An energy-restricted balanced dietary pattern, in which the intake of each nutrient is reduced while maintaining a balanced diet. A high-protein diet is generally recommended for people with obesity, and a balanced diet with energy restriction can be used for patients with kidney disease. The above two modes can be used intermittently.
3. "Step out of the way": take into account efficiency and safety
Before formulating an exercise plan, obese people should first evaluate the underlying diseases, body fat distribution, muscle strength, exercise endurance and flexibility, and develop an exercise method suitable for them under the condition of ensuring safety. For ordinary overweight and obese people, it is best to combine anaerobic exercise and aerobic exercise, do at least 4~5 times a week, and train every day. For each training, you can use 15 minutes to 20 minutes to do anaerobic, such as crunches, supine leg presses, etc., to consume excess sugar in the body; After half an hour to 40 minutes of aerobic work, such as brisk walking, cycling, swimming, etc., to further burn body fat. In addition, it is necessary to warm up fully before exercising, pay attention to safety during exercise, and do soothing tidying up after exercise. ▲