1.Obesity
Obesity (Obesity) refers to excessive accumulation of body fat and (or) distribution of abnormalities resulting in weight gain, is a multi-factorial chronic metabolic disease. Obesity has widespread prevalence in countries around the world, the global growth of rapid epidemiological characteristics. The latest data show that the total rate of overweight and obesity among adults in China is 42.6%, of which the rate of overweight is 30.6% and the rate of obesity is 12.0%.
Diagnosis of obesity
Body Mass Index (BMI) is the most commonly used method to evaluate the degree of obesity, BMI = weight/height2 (kg/m2). The BMI threshold value designated by the World Health Organization (WHO) is usually used internationally to classify the degree of obesity.
BMI (kg/m2) obesity classification (WHO 2004)
Classification
International standard
Asian population cut-off point*
Underweight
<< span="">18.5
<< span="">18.5
Normal
18.5-24.9
18.5-22.9
23.0-24.9
Pre-obese
25.0-29.9
25.0-27.4
27.5-29.9
Obesity stage I
30.0-34.9
30.0-32.4
32.5-34.9
Obesity Ⅱ stage
35.0-39.9
35.0-37.4
37.5-39.9
Obesity Ⅲ stage
≥40.0
≥40.0
*For the Asian population, the BMI classification is the same as the international classification, but the cut-off points for public health interventions are set at 23, 27.5, 32.5 and 37.5 kg?m2, respectively, which is 2.5 kg?m2 lower than the international standard.
Dangers of obesity
The danger of obesity lies in its associated diseases, and controlling obesity is a key factor in reducing the incidence and mortality of chronic diseases such as type 2 diabetes, coronary heart disease, hypertension, dyslipidemia, and metabolic syndrome.
Relative risk* of obesity-related diseases or symptoms in obese individuals
Risk is significantly higher
( relative risk greater than 3)
Moderately elevated risk
(relative risk 2-3)
Slightly increased risk
(relative risk 1C2)
Type 2 diabetes
Coronary heart disease
Postmenopausal breast cancer in women, endometrial cancer
Gallbladder disease
Hypertension
Prostate cancer, colorectal cancer in men
Dyslipidemia
Osteoarthrosis
Reproductive hormone abnormalities
Insulin resistance
Hyperuricemia and gout
Polycystic ovary syndrome
Obstructive apnea during sleep
Fatty liver
Impaired reproductive function
Shortness of breath
Lower back pain
Complications of anesthesia
* Relative risk refers to the prevalence of the above obesity-related diseases in obese people as a multiple of the prevalence of the disease in normal weight people
2.Diabetes mellitus
Diabetes is a group of metabolic disease group characterized by elevated plasma glucose (referred to as blood glucose) level, and obesity is closely related. China’s diabetic patients, type 2 diabetes accounted for more than 90.0%, type 1 diabetes accounted for about 5.0%, other types of diabetes accounted for only 0.7%. At present, there are more than 355 million T2DM patients worldwide, and the incidence is increasing year by year, and the number of patients is expected to exceed 560 million by 2030, with new patients mainly concentrated in China, India and other developing countries.
The latest domestic research results show that the prevalence of diabetes among adults in China has increased to 11.6%, with 12.1% for men and 11% for women, and the number of adults with diabetes is estimated to be over 100 million. In addition, about 70% of diabetics in China are unaware that they have the disease, and less than 40% of adults treated for diabetes have glycemic control.
Diagnosis of Diabetes
China currently adopts the WHO (1999) diagnostic criteria for diabetes and the glucose metabolic status classification.
Glucose metabolic status classification (WHO 1999)
Glucose metabolism classification
Intravenous plasma glucose (mmol/L)
Fasting blood glucose (FPG)
2 hours post-glucose load blood glucose (2hPPG)
Normoglycemia (NGR)
<6.1< span="">
<7.8< span="">
Impaired fasting glucose (IFG)
6.1 to <7.0< span="">
<7.8< span="">
Impaired glucose tolerance (IGT)
<7.0< span="">
7.8 to <11.1< span="">
Diabetes mellitus (DM)
≥7.0
≥11.1
Hazards of diabetes mellitus
Diabetes mellitus has a high incidence of complications and is extremely harmful. Its complications are mainly divided into microvascular complications and macrovascular complications, including cardiovascular disease, cerebrovascular disease, diabetic eye disease, diabetic nephropathy, diabetic foot, etc. The survey shows that the prevalence of complications in type 2 diabetic patients hospitalized in tertiary hospitals are 34.2% for hypertension, 12.6% for cerebrovascular disease, 17.1% for cardiovascular disease and 5.2% for lower limb vascular disease.
Diabetes is an important concomitant disease of coronary heart disease, and the prevalence of abnormal glucose metabolism in Chinese patients with coronary heart disease is about 80%, and diabetes increases the mortality rate of cardiovascular disease by 2-4 times. Among diabetic patients over 50 years of age in China, the prevalence of lower limb arteriopathy is as high as 19.47% to 23.80%, and the relative risk of lower limb amputation in diabetic patients is 40 times that of non-diabetic patients. Diabetic retinopathy is the main cause of adult blindness. The prevalence of type 2 diabetic retinopathy increases with disease duration and age, and among adult patients with type 2 diabetes, 20% to 40% develop retinopathy and 8% lose vision. Diabetic nephropathy is the most common cause of chronic renal failure, resulting in about 40% new onset end-stage renal disease. 60% to 90% of patients have varying degrees of neuropathy, of which 30% to 40% are asymptomatic.
3, the traditional treatment of obesity and diabetes
Traditional treatment of obesity
The treatment of obesity mainly includes weight reduction and maintenance, the treatment of associated diseases and complications. Specific treatment measures to improve weight include medical nutrition therapy, physical activity, cognitive behavioral intervention, drug therapy and surgery. Among them, medical nutrition therapy, physical activity and cognitive-behavioral therapy are the basis of obesity management, and specific patients should be actively treated with medication or surgery.
Obesity medication treatment criteria.
High appetite, unbearable hunger before meals and high volume of food intake at each meal.
Comorbid hyperglycemia, hypertension, dyslipidemia and fatty liver.
Comorbid weight-bearing joint pain.
Obesity causing dyspnea or with obstructive sleep apnea syndrome.
BMI ≥ 24kg/m2 with the above-mentioned complications, or BMI ≥ 28kg/m2 regardless of whether there are complications, after 3 to 6 months of simple control of diet and increased activity treatment still can not lose 5% of weight, or even weight still has a tendency to rise, can be considered with drug-assisted treatment.
Traditional treatment of diabetes mellitus
Patients with type 2 diabetes are often combined with clinical manifestations of one or more components of the metabolic syndrome, such as hypertension, dyslipidemia, and obesity. As blood glucose, blood pressure and lipid levels increase and body weight increases, the risk of developing complications of type 2 diabetes, the rate of progression, and its harms will increase significantly. Therefore, a scientific, rational and evidence-based comprehensive treatment strategy should be adopted for patients with type 2 diabetes, including glucose lowering, blood pressure lowering, lipid regulation, anticoagulation, weight control and lifestyle improvement. Among them, glucose-lowering treatment includes diet control, reasonable exercise, blood sugar monitoring, diabetes self-management education and the application of glucose-lowering drugs and other comprehensive treatment measures.
4.Surgical treatment of obesity and diabetes mellitus
For heavy obese patients, diet and drug treatment are difficult to achieve the ideal weight loss effect, and maintain long-term stability is more difficult than weight loss. And obesity with type 2 diabetes non-surgical weight reduction therapy such as control diet, exercise, drug therapy can improve blood sugar and other metabolic indicators in the short term, but these measures in some patients on long-term weight loss and maintain good control of blood sugar is not ideal. In addition, some glucose-lowering medications (e.g., sulfonylureas, glinides, TZDs, and insulin) can increase body weight. Clinical evidence shows that surgical treatment is an effective means of maintaining long-term weight stability and improving concomitant disease and quality of life. Surgical treatment can significantly improve glycemic control in obese patients with type 2 diabetes and can result in complete remission of diabetes in some diabetic patients, with remission rates as high as 80%. In addition, non-diabetic obese patients have a significantly reduced risk of developing diabetes after surgical treatment.
Advantages of surgical treatment of obesity and diabetes
Long-lasting weight loss, rapid and durable remission of diabetes, and high remission rates
Reduced incidence of diabetes and reduced risk of cardiovascular disease in obese patients
Improved quality of life for patients, free from long-term medication and diet control
Lower overall treatment costs
Surgical treatment of obesity and diabetes has become the consensus of experts in China and abroad
In 1991, the International Health Organization established guidelines for the surgical treatment of morbid obesity, stating that bariatric surgery can be used to treat obese patients with a BMI ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 and with important complications such as T2DM.
In 2009, the American Diabetes Association (ADA) officially listed bariatric surgery (metabolic surgery) as one of the measures to treat obesity with type 2 diabetes in its guidelines for the treatment of type 2 diabetes.
In 2011, the International Diabetes Federation (IDF) also issued a statement officially recognizing metabolic surgery as a treatment for type 2 diabetes with obesity.
In 2011, the Chinese Diabetes Society (CDS) and the Chinese Society of Surgery also reached a consensus on metabolic surgery for the treatment of type 2 diabetes, recognizing metabolic surgery as a treatment for type 2 diabetes with obesity and encouraging medical-surgical cooperation in the management of patients with type 2 diabetes who undergo metabolic surgery. In 2007 and 2010, the Endocrine Surgery Group and the Laparoscopic and Endoscopic Surgery Group of the Chinese Medical Association published the “Guidelines for the Surgical Treatment of Obesity in China” and the “Expert Guidelines for the Surgical Treatment of Diabetes in China”, respectively.