Wang Lixiang and Wang Guiqiang: Weighing Your Weight on World Obesity Day - "Lowering Your Weight: Managing Your Existing Weight, Part 2"

Obesity is a common metabolic syndrome. The WHO has long included obesity in the list of diseases and believes that it is the world's largest chronic health problem for adults and a risk factor for major chronic diseases such as cardiovascular and cerebrovascular diseases. The number of people who die from obesity each year is as high as 4 million, so how to manage weight scientifically is particularly important. The "Chinese Expert Consensus on Precision Health Communication" points out: "Faced with the in-depth development of today's medical science and the growing health needs, it is difficult for health communication workers to generalize; faced with the complexity of today's diversified information and health media, it is difficult for the general public to obtain accurate information and feel at a loss; faced with the unpredictable changes in today's ecological environment, it is difficult for social and human health to adapt and speed up the update." Therefore, the communication of weight management also needs to start with precision health communication, that is, to accurately locate the weight management goals in terms of spatial position, time perception, and changes in the world, focus on the targets of body physiology, mental psychology, and social ethics, and carry out the content of deepening health communication resources, carefully cultivating health communication channels, and infecting health communication audiences, and establish a weight health management communication system that covers the entire life process, all aspects, the entire cycle, and a three-dimensional and full-chain. Extracted from the Citizen Weight Management Guidelines published in the "Journal of Chinese Research Hospitals - Expert Consensus on Precision Health Communication in China", today's final sharing is "Lowering the Weight, Part 2 of Management of "Already Overweight"".

"Downward adjustment" mainly involves timely intervention in overweight management. "Already overweight" means BMI ≥ 24.0 kg/m2, with or without obesity-related diseases. In particular, BMI ≥ 28 kg/m2 with obesity-related diseases is in urgent need of intervention. As mentioned above, weight management involves multiple aspects, multiple links, and multiple factors. In the implementation process, a standardized, diversified, and individualized approach should be adopted.

1. Standard “three parties”

According to the WHO definition, healthy weight loss methods must follow three principles: ① Mainly reduce fat to avoid water loss and muscle loss; ② Increase muscle mass, improve its firmness and elasticity, and prevent skin and muscle relaxation after weight loss; ③ Enhance the function of the main internal organs, rather than just insignificantly harming the body. Therefore, the goal of healthy weight loss is to reduce weight by 0.5 to 1 kg per week. Rapid weight loss will cause harm to the body. Among them, improving the nutritional content of the diet and moderately increasing physical activity are the cornerstones of weight management and should be regarded as standardized methods. Weight loss is a systematic project that requires three aspects: ① Comprehensive intelligent monitoring system for detection, evaluation and tracking; ② Professional guidance from weight management experts; ③ A team of healthy weight experts, including experts in medicine, health management, nutrition, psychology, sports and physical fitness.

1. Evaluate and set a plan: Before losing weight, you need to complete a 23-item obesity questionnaire and contraindication selection, fill in your medical history, family history, weight loss history, and medication history; use a body fat scale to measure and obtain basic personal data such as weight, BMI, and metabolic assessment; share your physical examination report with a weight management coach for analysis. The weight management coach analyzes and evaluates the patient's physical data, such as physical health and disease status, obesity level, and appropriate weight loss techniques; formulates a weight loss plan (the health manager needs to fill in the basis for the plan before formulating a weight loss plan). Usually, before formulating a weight loss plan, the patient needs to undergo a physical examination at a regular medical institution and provide a physical examination report. Different plans are customized for different patient conditions.

2. Intervention methods: The weight loss process is mainly divided into three stages, namely the weight loss period, the plateau period, and the transition period. There will be targeted intervention measures in different periods.

3. Service strategy: Since the reform and opening up, with the improvement of people's living standards and changes in lifestyle, the incidence of obesity has continued to rise, becoming a major killer threatening human health. It is reported that in 40 years, the number of obese people in the world has increased from 105 million to 641 million, and obesity among adolescents is on the rise.

Therefore, healthy weight should be aimed at managing weight, starting from the perspective of human metabolism and based on the concept of health. Weight management coaches use the theories, techniques and methods of related disciplines such as medicine and health management to monitor and record human body composition, food intake, water and exercise in real time, and test and evaluate the relevant biochemical indicators (triglycerides, cholesterol, plasma lipoproteins, blood glucose, insulin, etc.) involved in body fat metabolism of lipids, sugars, proteins, and inorganic salt metabolism, dynamically monitor lipid metabolites (urine ketones), provide guidance and intervention in diet, nutrition, exercise, psychology, sleep, etc., combine artificial intelligence technology, use big data analysis to generate body fat metabolism management plans, and formulate reasonable, feasible, individualized intervention and metabolic regulation plans for metabolic status to promote the body's metabolic balance.

2. Multiple “three adjustments”

Weight management involves the interweaving of various factors. Standardized methods of improving diet and increasing physical activity are often difficult to implement, let alone achieve the goal. As a result, a variety of weight loss methods have been developed, which is called a diversified approach. For example, low-energy meal replacements, dietary supplements, low-sugar diets, low-salt and low-fat diets, vegetarian (low-fat and high-carbohydrate) diets, etc. There are also energy-restricted diet methods such as intermittent fasting and Bigu (traditional Chinese medicine) [45]. Increasing physical activity includes weight loss training camps, weight loss clubs, and walking groups. Some researchers believe that overweight and obese people should engage in a variety of sports activities because different types of activities have different effects on health. For example, aerobic exercise is not only good for the heart and lungs, but also helps reduce the risk of various non-communicable diseases.

1. Self-adjustment: For people who want to lose weight, it is necessary to make appropriate adjustments to some nutrient ratios and food choices in the "Balanced Diet Guidelines for Chinese Residents". To achieve the goal of weight loss, it is necessary to combine diet and exercise to form a reasonable calorie surplus and deficit, that is, calorie intake is less than calorie consumption. On the premise of meeting the calorie restriction, nutritional intake is carried out. Usually, the energy distribution ratio of the three meals is 30% for breakfast, 40% for lunch, and 30% for dinner, that is, 3:4:3. For obese people, especially those with moderate obesity, it is recommended to adjust the ratio to 4:4:2 or 4:5:1. Semi-starvation therapy can be used for dinner, with an energy intake of 150-200 kcal.

2. Family adjustment: Family support plays an important role in whether obese people can successfully lose weight. Families can use strategic influence methods for psychological intervention on dieters, that is, using methods and techniques of behavior correction to solve psychological problems and regulate behavior. Obese people will encounter different psychological problems such as hesitation, anxiety, worry, and giving up at different stages of weight loss. If family members pay attention to and intervene in their psychological state in a timely manner, it will achieve twice the result with half the effort (Figure 1).

Figure 1 Flow chart of psychological intervention

3. Social regulation: Overweight and obesity, once considered to be limited to high-income countries, are now on a sharp rise in low- and middle-income countries, especially in cities. The sharp increase in the number of people with abnormal weight has led to the vast majority of people being in a sub-healthy or unhealthy state, and the health level of the whole society has declined significantly. Therefore, weight management requires the support of the social environment. The impact of the social environment on weight is reflected in all aspects of life, such as health, agriculture, transportation, urban planning, living environment, food processing, ecology, market, education, etc. ① In terms of transportation, especially in cities, reasonable layout of bicycle lanes and pedestrian streets should be guaranteed to ensure people's freedom to ride bicycles and walk when commuting and going out, increase physical activity, and facilitate weight management; ② In terms of food processing, the food production process should not be too refined and too fine, and the content of fat, sugar and salt in processed foods should be minimized; all dining points should ensure the supply of healthy food; ③ In the work area, the community should encourage the construction and creation of a fitness environment.

3. Three Changes of Individuals

1. Adapt to the season: Obesity has certain seasonal manifestations. Weight management methods should also be formulated according to the season. Humans are warm-blooded animals. When it is cold outside, the human body can ensure a constant body temperature by increasing fat burning and raising the basal metabolic rate. Therefore, it is more beneficial to lose weight in winter, which is a good season for removing fat. In spring, everything revives, and the functions of various tissues and organs of the human body are active, requiring a large amount of vitamins and minerals to supply the body. Therefore, weight management should choose fresh fruits and vegetables with a low or medium glycemic index. On the one hand, it reduces the rate of blood sugar rise and reduces insulin secretion; on the other hand, it ensures the stable operation of the metabolic system, does not cause weight gain, and promotes detoxification.

2. Change according to local conditions: People in different regions have different lifestyles and eating habits. Weight management must correspond to specific regional eating habits and social culture, and a targeted weight management plan must be formulated.

3. Transformation based on individual needs: Individual weight management needs to take into account personal, family, social and other factors, and needs to provide a personalized comprehensive plan that varies from person to person and adapts to local conditions, which is called an individualized approach. This includes personalized guidance, psychological intervention, drug therapy, surgical treatment, etc. Weight intervention for overweight or obese patients should be carried out according to their physical conditions and with the professional guidance of health managers. Not all patients are suitable for weight loss, and the intervention methods adopted by patients with special diseases are also different.

author:

Wang Guiqiang is the director of the Department of Infectious Disease Control at Peking University, professor, and doctoral supervisor. He is a national health science popularization expert and the editor-in-chief of "Immunity is a Good Doctor", which won the 2020 "China Good Book" Award.

Wang Lixiang is the former director of the emergency department of the Third Medical Center of the General Hospital of the People's Liberation Army, professor, and doctoral supervisor. He is a national health science popularization expert and co-editor of "Immunity is a Good Doctor", which won the 2020 "China Good Book" Award.