With the rapid development of modern social economy and the improvement of people's living standards, lifestyles have also undergone major changes, and the problem of obesity is becoming increasingly prominent. Research shows that the prevalence of overweight and obesity is 28.1% and 5.2% [1], and it is showing a continuous upward trend. It is related to the increased risk of a variety of chronic diseases, such as cardiovascular disease, diabetes , and some cancers, and has become a public health issue that my country is focusing on. It is very necessary to understand the scientific and effective prevention and treatment methods of obesity and is the basis for achieving the goal of " Healthy China 2030". Recently, the Obesity Prevention and Control Branch of the Chinese Nutrition Society, the Clinical Nutrition Branch of the Chinese Nutrition Society, the Behavioral Health Branch of the Chinese Preventive Medicine Society, and the Sports and Health Branch of the Chinese Preventive Medicine Society released the "Expert Consensus on Obesity Prevention and Control of Chinese Residents" [2]. This article summarizes the diagnosis and prevention of obesity in adults for your learning and reference.
1. Diagnostic standards for obesity
Common diagnostic methods include body mass index (body mass index, BMI), waist circumference, skin fold thickness, dual energy X-ray absorption method and bioelectric impedance analysis method. Among them, the body mass index is body mass (kg)/height square (m2), which can be used to indirectly evaluate the body's fat composition. It is the most widely used indicator for measuring and diagnosing overweight and obesity in the past 30 years. China currently recommends that adults: 24.0 kg/m2≤BMI28.0 kg/m2 are diagnosed as overweight, and BMI≥28.0 kg/m2 are diagnosed as obesity; adult central obesity is diagnosed by waist circumference of men and women≥85.0 cm.
2. Preventive measures for obesity
1. Self-monitoring
Regular monitoring of body mass changes is one of the important measures to prevent obesity. The overall body mass growth in adulthood is best controlled within 5 kg, and if it exceeds 10 kg, the risk of related diseases will increase. Individuals who are already overweight/obese should control their body mass growth or reduce their body mass. Research shows that reducing body mass by 5% to 15% or more is the goal of body mass management, which is conducive to reducing the risk of a variety of obesity-related diseases [3].
2. Reasonable diet
From the diversified and balanced diet as the core, different groups of people should design balanced diets according to the daily energy needs, on the premise of controlling total energy intake, and gradually achieve a fat energy supply ratio of 20% to 30%, protein energy supply ratio of 10% to 20%, and carbohydrate energy supply ratio as much as possible to control 50% to 65%.
3, physical activity
Residents should adhere to daily physical activities and reduce the time of sitting for a long time. " Chinese Adult Physical Activities Guide " recommends that ordinary adults perform at least 150 min of moderate-intensity exercise (such as jogging, swimming, cycling, etc.) or 75 min of high-intensity exercise (such as fast running, basketball, badminton, etc.); active physical activity reaches at least 6,000 steps per day.
3. Treatment of obesity
1, lifestyle intervention
(1) Nutritional intervention: It is recommended to give 85% and 80% balanced energy intake standards respectively to achieve negative energy balance, and at the same time, it can meet the basic needs of energy intake higher than the human body's basal metabolic rate. It is recommended to reduce daily energy intake by an average of 30% to 50% or reduce 500 kcal, or limit the daily energy intake to 1000 to 1500 kcal.
(2) Exercise intervention: It is recommended that patients formulate exercise plans under the guidance of professional doctors, and adopt aerobic exercise combined with resistance exercise based on the principle of personalization and the principle of gradual progression. Adults recommend moderate-intensity aerobic exercise for at least 150 min every week, preferably for 30 to 90 minutes a day, for 3 to 7 days a week, for a total of 200 to 300 min/week; resistance training is 2 to 3 times per week, and the next day. It is recommended for the elderly to perform appropriate moderate and low-intensity aerobic exercise for at least 150 min every week, 3 to 5 days a week; 2 resistance exercises per week, and the next day to strengthen balanced exercise.
(3) Cognitive and behavioral intervention: Change patients' views and knowledge on obesity and quality control, establish beliefs, and take behavioral measures to effectively reduce and maintain healthy body quality. Under the guidance of professionals, self-management methods such as diet diaries, nutrition education APPs or mini programs can be adopted to gradually learn to identify the characteristics of food, select healthy food, conduct scientific diet matching, strengthen cognitive skills, control the meal process, etc.
2, drug treatment
021 edition of the "China Overweight/Obacteria Medical Nutritional Treatment Guidelines" recommends that adults should have risk factors such as BMI ≥28 kg/m2 or BMI ≥24 kg/m2 and combine with risk factors such as hyperglycemia , hypertension , dyslipidemia , dyslipidemia , dyslipidemia , and dyslipidemia . After comprehensive evaluation, drugs can be selected under the guidance of a doctor. Currently, only orlistat has been approved as an over-the-counter drug and can be used for obesity treatment and needs to be used under the guidance of a doctor. For example, GLP-1 receptor agonist, sodium-glucose cotransporter 2 inhibitors are recommended for obese/overweight diabetic patients.
3, surgical treatment
The "China Weight Loss Surgery Guidelines" (for adult patients) released in 2019 recommends surgery when BMI is ≥37.5 kg/m2, surgery is recommended when (32.5≤BMI <37.5)> diabetes relief.
4, TCM treatment
Traditional TCM therapy is used as a supplementary therapy for weight loss. In terms of diet, dialectical diet can be carried out. Dialectical diet refers to determining the corresponding dietary therapy plan based on factors such as the patient's physical condition, traditional Chinese medicine syndrome, seasonal conditions, geographical environment, etc. If the body is phlegm and damp, you should eat less fat, sweet, oily, sticky (greasy) foods, and you should choose foods that strengthen the spleen and help the movement, remove dampness and eliminate phlegm; if the body is phlegm and heat, you should eat less warm, spicy, and warm and tonic products, and you should choose foods that clear heat and remove dampness. For patients with spleen deficiency and dampness symptoms, please use the following: white lentil , jujube, yam , longan meat , pyrophyllum , tangerine peel, lotus seed, coix seed ; for patients with gastrointestinal fever symptoms, please use the following: Cassia seed , kumbu , fat sea , lotus leaves, and pueraria root; for patients with liver depression and qi stagnation symptoms, please use the following: Buddha hand , orange peel, mint, white radish; for patients with spleen and kidney yang deficiency, please use the following: grove kelp , yam, poria, cinnamon , ginger.
It is recommended to use traditional Chinese medicine exercise therapy ( Baduan Jin , Yijin Jing) for weight management in terms of exercise. Acupuncture therapy can also be used, and acupuncture points such as Zhongwan, Tianshu , Daheng , Qihai, Guanyuan, Zusanli , Sanyinjiao and other acupoints to strengthen the spleen, remove dampness and eliminate phlegm [3].
5, Mental-Psychological Support
Overweight, obesity and other experiences will cause negative psychology such as inferiority and self-blame, which can easily induce mental abnormalities such as anxiety and depression disorders, and will further aggravate the patient's excessive eating behavior. Therefore, psychological counseling and support should be included in obesity treatment and targeted treatment of related mental illnesses (such as anxiety, depression, etc.).
China is the country with the largest number of overweight and obese people in the world, and obesity has become a serious public health problem. People have a full understanding of the diagnosis and prevention methods of obesity, actively conduct self-monitoring, and establish good diet, exercise and other living habits, which will help weight management. When lifestyle interventions are not effective, they should seek medical treatment in a timely manner for further treatment.
References:
[1] Zhang X, Zhang M, Zhao Z, et al. Geographic Variation in Prevalence of Adult Obesity in China: Results From the 2013-2014 National Chronic Disease and Risk Factor Surveillance[J]. Ann Intern Med, 2020, 172(4):291-293.
[2] Obesity prevention and control branch of the Chinese Nutrition Society, Clinical Nutrition Branch of the Chinese Nutrition Society, Behavioral Health Branch of the Chinese Preventive Medicine Society, etc. Expert consensus on obesity prevention and control among Chinese residents [J]. Chinese Journal of Preventive Medicine, 2022, 23(05):321-339.
[3] Expert consensus on traditional Chinese medicine diagnosis and treatment plan for obesity [J]. Journal of Beijing University of Traditional Chinese Medicine, 2022, 45(08):786-794.
Written by: Jia Jundi Xu Hao
Essential editor: Wang Tongxin
This headline account has enabled the automatic reply function of entering keywords for private message. welcomes to enter keywords in the private message dialog box to view past exciting content or related prompt information.
Note: Inquiry about specific medical conditions. Because it involves detailed information such as medical history, symptoms, examination, medication, diagnosis and treatment, etc., it cannot be replied here. Please search Director Xu Hao of Xiyuan Hospital in Haodafu and upload relevant medical records before consultation. Thank you for your understanding!
Follow "Doctor Xu Hao" today's headlines to learn more about health science popularization!
Expert Introduction
Xu Hao, PhD, Chief Physician, Professor, Doctoral Supervisor, is currently the vice president and secretary-general of the Cardiovascular Professional Committee of the World Federation of Traditional Chinese Medicine, chairman of the blood circulation and stasis removal professional committee of the Chinese Society of Integrated Traditional Chinese and Western Medicine, and vice chairman of the Evidence-Based Medicine Professional Committee. He was selected as the third batch of outstanding clinical talents in traditional Chinese medicine in the country, won the honorary titles of 100 million talents, leading talents in the scientific and technological innovation of the Ministry of Science and Technology, famous traditional Chinese medicine in the capital, etc., and enjoyed special government subsidies of the State Council.
is good at: combining traditional Chinese and Western medicine to treat coronary heart disease, hypertension, heart failure, premature beat, bradycardia, paroxysmal atrial fibrillation, sequelae of myocarditis, hyperlipidemia, arteriosclerosis plaques, cardiac neurosis, etc.; insomnia, headache, dizziness, cough and asthma, stomach pain, constipation, spontaneous sweating and night sweating and other Chinese medicine conditioning.
Discovery time: Xiyuan Hospital, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences,
- Expert clinic: Tuesday morning,
- Special clinic: Sunday afternoon,
(Note: Special clinic can be searched through the Haodafu online website, Director Xu Hao applies for an appointment plus number)
