Wang Lixiang and Wang Guiqiang: Weighing Your Weight on World Obesity Day - Part 2 of "Managing the "Desire to Become Weight" in Central Control

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 by the "Journal of Chinese Research Hospitals - Expert Consensus on Precision Health Communication in China", today's second article sharing is "Weight Control and "Desire to Gain" Management (Part 2)".

Centralized weight control "weight gain" management refers to the process of controlling overweight risk factors for individuals whose weight is within the normal range but who suffer from high-risk diseases such as hypertension, hyperuricemia, and hyperlipidemia. This article focuses on the high-risk factors that cause weight gain, emphasizes the word "control", and intervenes mainly from the three aspects of "physiology, psychology, and ethics".

1. Physiological “three machines”

1. Biological function: Function refers to the function and activity of the body's cells, tissues or organs. Common chronic diseases such as hypertension, hyperuricemia, hyperlipidemia and other high-risk diseases affect the health of the body on the one hand, and also cause obesity on the other hand. Obesity can also cause the occurrence and development of chronic diseases, and is prone to common chronic diseases such as hypertension, hyperuricemia, hyperlipidemia, etc.

2. Opportunities in life: Good exercise habits are a way to control weight through exercise. Long-term moderate-intensity aerobic exercise can keep an individual's energy intake and consumption in a negative balance, thereby burning excess fat accumulated in the body and completing the task of weight control. Although the positive effect of exercise on weight control is undoubted, there is no unique explanation for its mechanism. Some researchers believe that exercise can accelerate the decomposition of fat by increasing the release of adrenaline and reducing the secretion of insulin; other researchers have found that exercise can inhibit the accumulation and synthesis of fat by increasing the consumption rate of free fatty acids and glucose. Despite this, not all exercises are effective, so the following three issues must be paid attention to. (1) Setting the intensity of exercise: There is no consensus in the academic community on the setting of exercise intensity. Some studies have found that high-intensity exercise can achieve weight loss effects; but many researchers have also shown that moderate-intensity load (i.e., maximum oxygen consumption of about 55%) exercise has the best weight loss effect. If the intensity is too high (i.e., the maximum oxygen uptake exceeds 80%), it will inhibit the release of fatty acids in adipose tissue and reduce the ability of muscles to oxidize fat. At this time, energy consumption is mainly sugar; if the intensity is too low (i.e., the maximum oxygen uptake is less than 20%), the body's heat energy consumption is insufficient to reach a negative heat energy balance state, and it will also not have the effect of losing weight. Avoid intense and competitive exercise, especially for middle-aged and elderly people. The appropriate heart rate after exercise = 170-age. Aerobic exercise should be the main focus. Suitable exercises include swimming, Tai Chi, Ba Duan Jin, dancing, brisk walking, cycling, etc. Exercise should be done according to one's ability and persist. (2) Pay attention to the duration of exercise: Exercise must last for a period of time to consume fat, generally at least 20 minutes. Therefore, if you want to achieve the goal of burning fat, it is best to exercise for more than 30 minutes. Duration is a factor that is easily overlooked. This is one of the reasons why many people exercise every day but still have no significant effect. (3) Reasonable arrangement of exercise cycles: Many people expect that one exercise will bring about a significant change in weight due to laziness or busy work. However, exercise must be long-term and reach a certain stable frequency to bring about physical changes. (4) Diet and nutrition before and after exercise: Do not eat a lot before exercise, otherwise your breathing will be affected to a certain extent, increasing gastrointestinal digestion difficulties and easily causing abdominal pain, nausea, and vomiting. You need to rest after exercise and cannot eat immediately. You need to rest for 30 to 45 minutes after exercise before eating.

3. Chance of survival: Weight management is of great significance to both women and fetuses during pregnancy. Pregnant women not only need to take in the nutrients they need during pregnancy, but also need to accurately meet the nutritional needs of the newborn. For the management of weight during pregnancy, strict control is required. Medical staff should understand the weight of pregnant women before pregnancy and scientifically calculate the BMI of pregnant women based on their weight and height before pregnancy. For pregnant women with a pre-pregnancy BMI of less than 18.5 kg/m2, their weight gain during pregnancy is controlled to less than 13 kg. For pregnant women with a pre-pregnancy BMI of 18.5-25.0 kg/m2, their weight gain during pregnancy is controlled to 8-10 kg. For pregnant women with a pre-pregnancy BMI of 25.1-30.0 kg/m2, their weight gain during pregnancy is controlled to 5-7 kg. Those with a pre-pregnancy BMI of more than 30.0 kg/m2 need to consult a physician for individualized weight control. Weight gain should be controlled to 0.5-2 kg/week in early pregnancy, and to about 0.4 kg/week in mid- and late pregnancy. Pregnant women need to weigh themselves weekly and monitor their weight gain. In the early stage of pregnancy, that is, 1 to 12 weeks of pregnancy, it is only necessary to ensure that the daily diet structure of pregnant women is the same as before pregnancy; in the second trimester, that is, 13 to 27 weeks of pregnancy, when the fetus is in a rapid development stage, it is necessary to ensure that pregnant women get adequate nutritional support and ensure the intake of elements such as iron and calcium, and strictly limit the total amount of daily edible salt. The daily diet should be mainly based on fish, poultry, eggs, lean meat and milk, but it is still necessary to ensure balanced nutritional intake; in the third trimester, that is, 28 to 40 weeks, it is necessary to adjust the dietary structure according to the physical condition of the pregnant woman and the development of the fetus, and reasonably supplement unsaturated fatty acids, calcium, etc. to ensure normal weight gain. According to the gestational time and related indicators of the pregnant woman, and combined with the data of the nutrition analysis guidance system, the energy supply of the pregnant woman during pregnancy is adjusted to 30 to 38 kcal/(kg·d). Instruct pregnant women to exercise for about 1 hour every day, so as not to feel tired and sweat slightly. After the fetus is born, breastfeeding reduces the incidence of obesity compared with artificial feeding, and is more conducive to reducing the risk of overweight and obesity in the future.

2. The Three Psychological Needs

1. Individual behavior: Weight management is more about controlling individual behavior. Pay close attention to changes in your own weight, pay more attention to it, and adjust your weight control strategy in a timely manner. You can develop a specific and detailed weight management plan based on your weight. Establish a healthy dieting consciousness, do not eat too much at each meal, avoid overeating; chew slowly to extend the eating time, limit the amount of food you eat; choose fruits and vegetables with high fiber content to reduce the amount of food you eat. Changing eating behavior can help reduce the amount of food you eat and the feeling of not being full.

2. Mental behavior: Psychology is the subjective reaction of the brain to objective reality. Establish the correct concept and confidence of weight control, recognize the purpose of weight control, and understand that it is a long-term process of comprehensive action. Insist on controlling weight for a long time, maintain a positive mood, and avoid the adverse consequences of rebound (obesity again after weight loss). Many people hope to achieve the goal of losing weight in a short period of time by excessive exercise, but the effect of exercise on weight loss has always been questioned. Because of excessive exercise, the brain will give you instructions to reduce the amount of activity at other times, and the number of calories consumed in the end is not significantly different from usual. In addition, excessive exercise may overdraw willpower and cause other unhealthy lifestyles, such as being more prone to overeating, inability to concentrate, and more easily out of control of emotions, and even not having enough willpower to resist the temptation of delicious food, which is more likely to cause weight gain.

3. Social behavior: Regarding weight and fatness, which people are extremely concerned about, an advertisement published in an American magazine once wrote scathingly: "Your weight is a declaration of your social class." In the United States, obesity, which was once considered a sign of success, has now become a sign of the lower middle class. Most obesity is related to lifestyle. Improving public health awareness is the key to solving this problem. Promoting health education is a basic link. Understanding the relationship between overweight and many chronic diseases and the knowledge of weight management, knowing how to observe weight and control diet in daily life, etc., is of great significance for weight control. It is necessary to improve the public's health awareness and the recognition rate of scientific weight management goals, and create a healthy lifestyle environment. People who are on the verge of being overweight often cannot correctly assess their weight status and are prone to neglecting weight management, thus becoming overweight or even obese. The government should create convenient conditions for weight management, and by building sports facilities, let the public get close to sports facilities; improve supervision and management of the catering industry, create a healthy diet environment, limit the production and processing of unhealthy foods such as high calories and high cholesterol, and put warning stickers on food packaging to remind overweight people that eating too much calories can harm their health, so that the public can realize the importance of weight control.

3. “Three Beliefs” in Ethics

1. Moral beliefs: Over the past 30 years, the rapid growth of overweight people is mainly related to economic development and eating habits. High-energy, large-portion, nutritionally unbalanced diets, low physical activity and sedentary lifestyles are important risk factors for the development of obesity. Appropriate intervention by the national government, health publicity by the media, scientific guidance by experts, optimization and improvement of the social environment, and scientific updating of family concepts will ultimately affect the good development of individual behavior. Establish the concept of weight control, consciously accept moral education in the field of health, reduce the occurrence of diseases, and assume health responsibilities. As a social person, health is not only for individuals, but also for the entire family and the entire society. Maintaining and promoting health is a social responsibility that everyone must bear.

2. Credit of things: Strengthening social responsibility and rationally controlling weight can be regarded as the law of social development. Medical treatment for overweight or obesity is divided into symptomatic treatment (treating symptoms) and causal treatment (treating the root cause). The so-called symptomatic treatment is to remove excess fat, including surgical operations and drug methods. Treating symptoms instead of the root cause will cause a series of ethical issues, such as irreversible complications, overtreatment, etc. It is of great significance to choose the right way to control weight - change personal lifestyle and treat the problem of overweight and obesity from the source.

3. Belief in culture: At present, the "health" culture is increasingly valued and practiced. If a person blindly pursues "thinness" and loses his health, not only will it be difficult for him to fulfill the obligations he should have, but his work and career will also be affected. Therefore, we should correctly understand the meaning of health, develop a healthy lifestyle, and put an end to blind and unhealthy weight loss behaviors. As an academic organization specializing in the study of health culture in China, the Health Culture Committee of the China Health Management Association has been actively exploring the health field since its establishment, in order to guide the public to obtain health through culture. It has issued the "Ten-room Health Guidelines for Citizens to Prevent and Control Myocardial Infarction" and has received wide acclaim.

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.