"The Lancet" sub-issue cover report: How many "fat" factors have you gotten in?

Over the past 40 years, the proportion of overweight and obesity in the Chinese population has increased rapidly.

Overweight and obesity are related to the major non-communicable diseases and increased risk of premature death in the Chinese population.

The latest issue of "The Lancet-Diabetes and Endocrinology" published a series of articles on obesity in China.

The corresponding author of the study is Professor Pan An from the School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Dr.

Overweight and obesity standards suitable for Chinese

The World Health Organization (WHO) standard defines adult overweight as a body mass index (BMI) between 25.

The Chinese Obesity Working Group recommends that the BMI cut-off values ​​for overweight and obesity of the Chinese population be defined as 24.

▲BMI standards for overweight and obesity in Chinese school-age children and adolescents recommended by the China Obesity Working Group (picture source: reference [2])

In addition, waist circumference can reflect visceral fat, and the association between visceral fat and cardiovascular disease risk is independent of BMI.

There are more and more "fat people" in China, and the total number is among the "leading" in the world

Based on the China National Nutrition Survey (CNNS), China Chronic Diseases and Risk Factors Surveillance (CCDRFS) and other survey data, the average BMI and waist circumference of all age groups in China have shown a steady increase.

Taking CNNS data as an example, the average BMI of Chinese adults ≥18 years of age increased from 20.

▲Taking CCDRFS data as an example, the BMI distribution of Chinese men (A) and women (B) changed from 2004 to 2013; the overall BMI curve shifted to the right (fatter) (picture source: reference [1])

Regardless of whether Chinese standards or international standards are adopted, China's overweight and obesity rates are increasing rapidly.

The overweight and obesity of the Chinese population also shows the following demographic characteristics:

• In both urban and rural areas, boys and adolescents have a higher prevalence of overweight and obesity than girls.
  
  Health effects of overweight and obesity

  Overweight and obesity have become major risk factors for non-communicable diseases.

  
  

  Thick waist circumference is also related to the risk of these diseases and the risk of premature death.

  
  

  The three major influencing factors of overweight and obesity in China

  The three major influencing factors of overweight and obesity in China

  The article pointed out that obesity is not only a chronic, recurrent, and progressive disease, but also a difficult social problem.

  
  

  Among them, risk factors at the individual level are the key goal to solve obesity in clinical practice, and the two upstream factors cannot be ignored either.

  
  

  1.

  
  

  Economic development and technological progress: agricultural and food innovations have reduced food prices and promoted food consumption; automation has reduced the demand for physical activities at work.
  At the same time, more household equipment and electronic products have also increased family activities and leisure entertainment.
  The more "sedentary" becomes.
  In other words, it makes us eat more and move less.
  

  Cultural and conceptual influences: For example, older generations usually think that "large size" is healthier, especially among children, who are often mistaken for healthy growth.
  For example, the investment in children's cultural education has led to insufficient exercise for teenagers and children.
  For another example, pregnant women who eat more and do less exercise are mistaken as being good for their mothers and babies.
  In fact, they lead to overnutrition and lack of exercise for pregnant women, and the pregnant women themselves and their newborns are overweight.
  

  2.
  Environmental factors

  The influence of systemic factors is reflected in the three major environmental driving factors.
  

  Urbanization: In cities, restaurants, packaged food manufacturing, and modern retail make dining out more and more common, and expose people to large amounts of ultra-processed food and beverages.
  

  Urban planning and built environment: may pose a risk of obesity by affecting daily life, work, and entertainment.
  For example, on roads centered on motor vehicles, support for cycling and walking has declined, which has affected the development of sports activities and exercises.
  

  Data from the Chinese population shows that having a motor vehicle is closely related to the risk of obesity; high population density in the living environment is associated with an increased risk of overweight.
  This link may be caused by car ownership and insufficient exercise, while a higher level of community greening is associated with the risk of obesity Decrease related.
  

  Food system and environment: Fast food, packaged, and processed foods are increasing rapidly, but their nutritional value is not high.
  Supermarkets and online shopping make it more and more convenient for people to eat snacks.
  In addition, the way food is cooked is also quietly changing.
  The intake of steamed, roasted or boiled foods has decreased, and the intake of unhealthy fried foods has increased; take-out and dining out often bring more intake of high-fat, high-salt, and high-sugar foods.
  To increase total calorie intake.
  

  3.
  Personal risk factors

  These environmental changes have profoundly affected the daily lives of most people.
  

  Diet and nutrition: Data show that although the total calorie intake of the Chinese population decreased between 1982 and 2012 (from 2491.
  3 kcal per day to 2134.
  8 kcal per day), the percentage of fat energy supply increased from 18.
  4% to 31.
  5%, including The intake of edible oil has increased.
  

  Moreover, despite the reduction in total calorie intake, physical activity is also greatly reduced, ultimately resulting in excess calories.
  

  In addition, China’s traditional plant-based diet based on coarse grains and vegetables has gradually been transformed into a Western->Among them, the intake of animal food increased from 60.
  7 grams per day in 1982 to 162.
  4 grams per day in 2012.
  

  The intake of processed and packaged foods and beverages is also rising.
  Between 2012 and 2016, the consumption of ultra-processed food and beverages in China increased by 2-3 times, from 11.
  0kg and 11.
  8kg per capita to 23.
  6kg and 39.
  9kg per year.
  

  Reduced physical activity: From 1991 to 2011, the average work and home physical exercise time for adults dropped from 427.
  8 MET-h per week to 246.
  0 MET-h (MET refers to metabolic equivalent, 1 MET is energy expenditure rate at rest, 4 MET means 4 times the energy consumed during rest), and the daily sedentary time for adults has increased from 3.
  7 hours to 4.
  0 hours.
  From 2004 to 2011, the energy consumed by men's and women's leisure sports decreased by 36% and 44%, respectively, and the sedentary time increased by 14% and 12%, respectively.
  

  The phenomenon of lack of exercise and sedentary is also common among Chinese children and adolescents.
  In 2017, a survey of more than 130,000 7-19 year-old students showed that 2/3 did not meet the WHO recommendation (at least 60 minutes of medium to high-intensity exercise per day), and 1/3 did not meet the recommendation of watching the screen <2h every day.
  

  Genetic susceptibility: Aiming at the genetic factors related to obesity in East Asian populations, a total of 26 genetic variants related to BMI were identified based on three important meta-analysis of the large-scale genome-wide association study (GWAS).
  Data from the Chinese GWAS study shows that among young (18-35 years old) and middle-aged (35-45 years old) adults, polygenic risk scores are closely related to BMI, while BMI in late adulthood (45-65 years old) is closely related to that in early adulthood.
  BMI is indirectly related.
  

  It is worth noting that in East Asians, all 26 genetic variants identified can only explain 1.
  5% of the change in BMI, which shows that the interaction between genetic factors and lifestyle factors may be more than simple genetic susceptibility.
  important.
  

  Social and psychological factors: Psychological stress can also lead to abnormal eating behaviors and sedentary lifestyles, which in turn increases the risk of obesity.
  

  It is worth noting that lack of sleep is also a risk factor for obesity in the Chinese population.
  In 2011, more than 55% of children and adolescents aged 3-17 did not get enough sleep; 5.
  5% of adults aged 18-44 and 11.
  9% of adults aged 45-59 had an average of less than 7 hours of sleep.
  A prospective study of Chinese adults followed up for 8 years showed that people who sleep 6 hours a day or less have a higher risk of weight gain (≥5 kg) and central obesity than those who sleep about 7 hours a day.
  

  ▲Insufficient sleep is also a risk factor for obesity in the Chinese population (data source: reference [1]; tabulation: new medical perspectives)

  ▲Insufficient sleep is also a risk factor for obesity in the Chinese population (data source: reference [1]; tabulation: new medical perspectives)

  Other exposure factors: Some endocrine disrupting chemicals can also affect the risk of human obesity.
  For example, exposure to bisphenol A (BPA) and phthalates is associated with an increased risk of obesity in children and adults.
  Monosodium glutamate (sodium glutamate) is also potentially obesity-causing.
  A study of more than 10,000 healthy Chinese adults shows that the 20% of people with the highest intake of sodium glutamate are overweight or overweight compared to the 20% with the lowest intake.
  The risk of obesity increased by 33%.
  

  Early development: Some exposures early in life can also affect the risk of overweight and obesity.
  For example, in children under 3 years of age in China, a large fetus (weight ≥4000g) is associated with an increased risk of overweight and obesity in the future.
  The obesity rate of pregnant women in China increased from 5.
  0% in 2005 to 8.
  2% in 2014, and the overweight rate increased from 20.
  8% to 24.
  9%.
  

  Note: The original text has been deleted

  Reference

  Reference

  [1] Xiong-Fei Pan, Limin Wang, An Pan.
  (2021).
  Epidemiology and determinants of obesity in China.
  The Lancet Diabetes & Endocrinology, DOI: 10.
  1016/S0140-6736(18)31928-7

  [1] Xiong-Fei Pan, Limin Wang, An Pan.
  (2021).
  Epidemiology and determinants of obesity in China.
  The Lancet Diabetes & Endocrinology, DOI: 10.
  1016/S0140-6736(18)31928-7

  [2] Working Group on Obesity in China.
  Classification criteria for body mass index values ​​for screening of overweight and obesity in Chinese school-age children and adolescents [J].
  Chinese Journal of Epidemiology, 2004, 25 (02 ): 97-102.
  

  [2] Working Group on Obesity in China.
  Classification criteria for body mass index values ​​for screening of overweight and obesity in Chinese school-age children and adolescents [J].
  Chinese Journal of Epidemiology, 2004, 25 (02 ): 97-102.