The Chinese became "the fattest in the world"!

*It is only for medical professionals to read and refer to the current situation of overweight and obesity in my country: the rising speed is fast, the prevalence level is high, and the whole population is affected! Summary of this article 1.
In the past 30 years, Chinese people are gaining weight quickly! 2.
Data overview: Who is not in control of their fat? 3.
Chinese obesity is by no means a simple biological problem! 4.
Obesity management in China: Break down the 4 major pain points! According to the latest "Report on Nutrition and Chronic Disease Status of Chinese Residents (2020)" [1], overweight and obesity have become one of the prominent nutritional problems of Chinese people.

According to my country's standards, the rates of overweight and obesity among adults (≥18 years of age) are 34.
3% and 16.
4%, respectively.
Overweight/obese adults are more than half.

Overweight and obesity are closely related to a variety of chronic non-communicable diseases (such as cardiovascular disease, type 2 diabetes and some tumors), and are the sixth leading risk factor for death/disability in my country [2].
Therefore, the problem of obesity can be solved For the health of the Chinese population and reduce the burden of related diseases [3].

Not long ago, the top medical journal "The Lancet" adopted an article written by a Chinese scholar on the issue of obesity in my country, and summarized it into an album, which was published in the June sub-issue of "The Lancet-Diabetes and Endocrinology" .

Figure 1 The cover of the June issue of The Lancet-Diabetes and Endocrinology.
This album summarizes the obesity trend and related disease burden in China in the past 40 years, analyzes related risk factors in detail, and summarizes the existing obesity treatment and clinical management And analysis.

01In the past 30 years, there has been a surge in obesity in China! According to the latest survey report (2015-2019) data, according to Chinese standards, the overweight/obesity rate of children under 6 years old is 6.
8% and 3.
6%, respectively; the overweight/obesity rate of children and adolescents 6-17 years old is 11.
1%, 7.
9%; adult overweight/obesity rates were 34.
3% and 16.
4% [3].

Based on the national survey data in the past 40 years, it can be seen that the obesity population in China is increasing rapidly, and this increase covers all age groups.

Table 1: Summary of some national survey results.
It is worth mentioning that the above data are based on the "Overweight/Obesity Standards" [Note 1] established by the China Obesity Working Group, which can truly reflect the current status of overweight/obesity of Chinese residents.

The author of the album and Professor Pan An of the School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, said in an interview with The Lancet that based on the absolute population, there are already 600 million people in the country who are overweight and obese.
This number is global In the first place.

At the same time, this is the first time that a large proportion of more than 1/2 appears in a national survey report in my country [4].

02Data overview: Who hasn't controlled their fat? Judging from the available data, the distribution of overweight/obesity is slightly different among people of different gender, age, geographic location, race, and socioeconomic status.

Figure 2 The trend of overweight/obesity in China over the past 30 years [4] Among children and adolescents, the rates of overweight and obesity in boys were significantly higher than those in girls; among adults, the rate of overweight/obesity in men was once lower than in women, but in recent years this This difference began to shrink and even reversed; overall, the prevalence of overweight and obesity increased with age, and decreased slightly in old age.

The epidemiological survey in my country also found that the prevalence of overweight and obesity in urban areas is higher than that in rural areas.
The prevalence rate in northern areas is generally higher than that in southern areas.
There are clusters of overweight/obesity in North China, Northeast China, and Bohai Rim.
The prevalence rate in Beijing is national highest.

Economic status also has a non-negligible effect on the prevalence of overweight/obesity.

The higher the socioeconomic status, the higher the prevalence of overweight/obesity in all age groups.

In addition, the higher the education level of men, the higher the prevalence rate, and the opposite is true for women.

There is currently no comprehensive data showing the difference in obesity and overweight prevalence between ethnic minorities and Han ethnic groups, but scattered research data shows that adult males among Uyghur, Hui, Yi, Mongolian, and Manchus, as well as Korean, Mongolian, The prevalence of overweight/obesity among minors of Tujia and Kazakhs is higher than that of Han Chinese of the same age.

In summary: Although men living in cities and with high economic status are more likely to accumulate fat than others and become a member of the overweight/obesity "army"[4], the problem of overweight/obesity among Chinese residents is already in the entire population.
Highlight.

What is it that makes all the men, women and children in China scrambling to gain weight? 03 Chinese obesity is by no means a simple biological problem! It is true that in the past 40 years, the life>
Animal-derived foods, refined grains, and deep-processed foods are gradually increasing in the proportion of Chinese people’s menus.
At the same time, people’s sedentary time is continuously increasing and physical activity is drastically reduced.

These are all factors influencing Chinese people's gaining weight.

But, not all.
.
.
Overweight/obesity is a progressive disease state.
From a biological perspective, it can be understood as a collection of all the above-mentioned influencing factors.
However, Professor Pan An believes that overweight and obesity have profound meanings.
The social attributes of, should be regarded as a systemic problem of the whole society [3].

Figure 3: Group-level determinants and individual-level risk factors of obesity in China.
The rapid development of society and economy is one of the driving factors for overweight/obesity.
While improving food security and living environment, it has also changed the nutritional intake structure of residents.
Lead to a universal energy surplus.

On the other hand, deep-rooted social concepts are also contributing to the epidemic of obesity in China.
The older generation in China regards physical fitness as a symbol of wealth and health, "fat fat" is considered a symbol of children’s health, and obesity is my country is not an independent chronic disease, and patients are lacking in willingness to treat.
.
.
[4]04 Obesity Management in China: Break down the 4 major pain points! Overweight/obesity is a chronic and progressive disease state.
It is difficult to reverse the obesity problem of Chinese people in the short term.
Therefore, clinical management of obesity is particularly important.
However, at this stage, obesity management in China faces 4 major pain points [5]: 1) Although there is a consensus on the guidelines, the clinical implementation is not enough.
China's obesity management guidelines have undergone important changes and developments in the past 20 years-the medical community has generally recognized the necessity of obesity intervention and is no longer limited to weight loss itself , And focus on the management of complications and the improvement of overall health.

However, the guidelines lack sufficient local information for guidance, so the clinical application is not satisfactory.

At the same time, since obesity has not been officially recognized as a chronic disease in China, clinicians and patients are not willing to treat it.

2) The lack of a recognized plan for life>
The US advance guidelines recommend at least 14 on-site weight loss-related high-intensity comprehensive life>
Because of the lack of clinical life>
3) There are too few drugs available for obesity treatment! In the US and European guidelines, drug therapy is considered to be another treatment option when life>
However, the use of obesity drugs in China is conservative.

In 2018, the consensus of Chinese weight management experts adopted the strategy of “focusing on obesity-related complications”-if life>
In fact, the only weight loss drug approved for long-term use in my country is orlistat, which is difficult to meet a wide range of clinical needs.
At the same time, orlistat has adverse gastrointestinal reactions (such as oily stools and urgency of stool), Users need to take daily multivitamin preparations to improve the absorption of fat-soluble vitamins and the unclear cardiovascular risk of long-term use, which limits the widespread use of the drug.

Table 2 Major adult weight-loss drugs approved for long-term use in the United States, the European Union and China 4) There is still a lack of long-term outcome data for bariatric surgery.
Globally, four major bariatric surgery procedures have definite curative effects: laparoscopy can be used.
Adjusted gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliary-pancreatic bypass with or without duodenal transposition.

The latest Chinese bariatric surgery guidelines released in 2019 suggest: aggressive surgery when BMI≥37.
5 kg/m²; surgical treatment is recommended when 32.
5≤BMI<37.
5 kg/m²; 27.
5≤BMI<32.
5 kg/m², through life>
For patients with central obesity (waist circumference ≥90 cm in men or ≥85 cm in women), surgery may also be considered based on the evaluation of the Multidisciplinary Comprehensive Treatment Team (MDT).

This guideline uses the lower BMI cut-off value recommended by the International Diabetes Federation (IDF) for Asian populations, but whether this cut-off value is the best cut-off point for recommended bariatric surgery in terms of the benefit-risk characteristics of Chinese patients remains to be determined.

At the same time, research on bariatric surgery in my country has great limitations.
Most of the research subjects are less than 50 (only one study in Hong Kong has a sample size of more than 100), and the follow-up period is within 24 months, so there is a lack of corrective measures.
The long-term assessment of the risk of major cardiovascular events and the risk of death.

05Faced with this situation, what can clinicians do? The overweight/obesity epidemic in China is a foregone conclusion, and it will be difficult to reverse in the next few years.
The clinical management of obesity will become a new challenge in the medical field.

At this stage, although the obesity management idea of ​​"focusing on obesity-related complications" is gradually taking shape, the current clinical work is facing obstacles due to the official failure to recognize obesity as a disease.

There are very few effective life>
Clinicians need to conduct more high-quality weight loss-related clinical trials, and conduct more high-quality implementation studies on the real-world practice of obesity treatment models to improve the evidence base of clinical practice, so as to form a basis for obesity/overweight patients in China.
Management mode.

Note 1: Adult overweight/obesity: BMI value of overweight, 24.
0-27.
9 kg/m²; BMI value of obesity ≥28.
0 kg/m².

Obesity in children and adolescents: For children and adolescents aged 7-18, BMI greater than 85% of the national gender and age-specific BMI value reference standard is considered overweight, and 95% is considered obese (the threshold value corresponding to the percentile).

References: [1]http:// 2019 Risk Factors Collaborators.
Global burden of 87 risk factors in 204 countries and territories, 1990– 2019: a systematic analysis for the Global Burden of Disease Study 2019.
Lancet 2020; 396: 1223-49[3]B, Xiong Fei Pan A, PLW C, and PAP A.
"Epidemiology and determinants of obesity in China.
" ( 2021).
[4]https://mp.
weixin.
qq.
com/s/OGBHp2mB9tlMWEJRV1b9gQ[5]A, Prof Qiang Zeng, et al.
"Clinical management and treatment of obesity in China.
" (2021)