obesity



Overview

Metabolic diseases caused by the accumulation of abnormal or excessive body fat that can damage health, with symptoms such as excess weight and increased waist circumference; moderate-to-severe obesity can be characterized by shortness of breath, arthralgia, anxiety, depression, etc. The causes of the disease include genetic factors, environmental factors, endocrine regulation abnormalities, etc. The main treatments are dietary control, scientific exercise, and complementary medications and surgical treatments.

Definition

Obesity is a chronic metabolic disease characterized by excessive accumulation of body fat and overweight, caused by the interaction of genetic and environmental factors.

Obesity is calculated based on the body mass index (BMI), i.e., BMI = weight/height2 (kg/m2). a BMI of 24-27.9 is considered overweight; a BMI ≥ 28 is considered obese.

Obesity is a risk factor and pathological basis for chronic non-communicable diseases such as hypertension, diabetes, cardiovascular and cerebrovascular diseases, and tumors.

WHO clearly recognized that obesity has been one of the largest chronic diseases in the world.

Typing

According to the pathogenesis and etiology

Primary obesity: also known as simple obesity, is the body’s intake of calories over the consumption of calories, resulting in excessive accumulation of fat components in the body and the formation of obesity.

Secondary obesity: is due to other health problems caused by obesity, obese people at the same time also suffers from another disease, when the disease caused by obesity is cured, secondary obesity can also be significantly reduced.

According to the fat accumulation site typing

Center-type obesity: also known as abdominal obesity, fat is mainly distributed in the abdomen, the most harmful to human health, can lead to metabolic diseases and cardiovascular diseases.

Peripheral obesity: also known as subcutaneous fat-type obesity, fat is mainly distributed in the periphery and buttocks, weight loss is more difficult.

Morbidity

The Global Burden of Disease study showed that as of 2016, a total of approximately 650 million adults (≥20 years of age) were obese and 41 million preschool children were overweight worldwide.

At least 2.8 million deaths per year are related to obesity, and globally overweight and obesity cause more deaths than normal weight.

As of 2014, China’s epidemiologic survey showed that among people aged 20 to 69 years, the overweight rate was 34.26% and the obesity rate was 10.98%.

Among those with normal weight, the detection rate of abdominal obesity is 22.46% to 33.53%.

In recent years, overweight and obesity in China have a significant upward trend, and the rate of obesity in children is higher than that of adults, and urban areas are higher than rural areas.

Causes

Causes

Simple obesity is the result of the interaction of genetic factors, environmental factors, abnormal endocrine regulation, inflammation, intestinal flora and other reasons.

Secondary obesity is caused by certain diseases, such as hypothyroidism, hypercortisolism, and so on.

Pathogenesis

Obesity occurs by the mechanism that energy intake exceeds energy expenditure.

Energy balance and body weight regulation

Energy balance and body weight regulation are regulated by both the nervous system and the endocrine system. Abnormalities in gastric acid secretion, gastrointestinal emptying rate, and heat production can lead to imbalances in energy intake and consumption.

Genetic factors

Obesity has a tendency of family aggregation, and the influence of genetic factors accounts for 40% to 70%.

Most of the primary obesity for polygenic inheritance, is a variety of genes role superimposed results.

Environmental factors

Environmental factors are the main reason for the increase in the prevalence of obesity, mainly due to the increase in calorie intake and the decrease in physical activity.

In addition, dietary structure also has a certain influence, often eat high-fat food is easy to cause fat accumulation.

Maternal malnutrition during fetal life or low birth weight children are prone to obesity in adulthood.

Abnormal endocrine regulation

Any abnormalities in neuro-endocrine regulation can lead to obesity. For example, the important hormones involved in the regulation of energy metabolism: leptin, lipocalin, insulin, gastric growth hormone, etc. are abnormal.

Inflammation

Obesity is a low-grade inflammatory response. Elevated inflammatory factors in serum and adipose tissue promote infiltration of inflammatory cells in the fat, causing insulin resistance (insufficient tissue response to normal concentrations of insulin), abnormal glucose metabolism and obesity.

Intestinal flora

The ratio of beneficial and harmful bacteria is imbalanced, which increases intestinal permeability, and the absorption of bacterial lipopolysaccharide into the blood can cause endotoxemia and aggravate the inflammatory response.

Predisposing factors

Age

Human weight increases with age because the number of muscles in the human body decreases with age, metabolism decreases, and energy consumption is lower than energy intake.

Prenatal environmental factors

Several studies have shown that adult men and women born small for gestational age are more likely to be overweight or obese than those born normal for gestational age. Maternal smoking and weight gain have also been associated with obesity in offspring.

Psychosomatic factors

Stress, anxiety, depression, or poor sleep can cause overeating and lead to weight gain.

Smoking cessation

Many ex-smokers gain 2 to 5 kg in the first 6 months after quitting, but the benefits of quitting far outweigh the harm caused by weight gain, so active quitting is encouraged.

Menopause

Women may gain 5.5 to 7 kilograms during menopause, which may be related to a decrease in estrogen in the body.

Pregnancy

Pregnancy can lead to weight gain and some women find it difficult to lose the weight gained during pregnancy.

Symptoms

Mild simple obesity

There are often no obvious symptoms, only weight gain, increase in waist circumference and increase in body fat percentage above normal.

Moderate and severe simple obesity

In addition to being overweight, it can cause the following symptoms.

Shortness of breath.

Chest tightness.

Abdominal distension.

Joint pain.

Muscle aches and pains.

Decreased physical activity.

Easy fatigue.

Anxiety, depression.

Severe obesity and secondary obesity

Patients with severe obesity may have mental problems such as low self-esteem, depression and poor social adjustment.

Often combined with dyslipidemia, fatty liver, hypertension, coronary heart disease, abnormal glucose tolerance or diabetes mellitus and other diseases, the corresponding symptoms.

It can also be accompanied or complicated by obstructive sleep apnea syndrome, gallbladder disease, hyperuricemia and gout, osteoarthropathy, venous thrombosis, impaired reproductive function (polycystic ovary syndrome in women, impotence in men, etc.).

Obese patients have an increased incidence of certain tumors (breast and endometrial cancer in women, prostate, colon and rectal cancer in men, etc.) and increased anesthetic or surgical complications.

Secondary obesity can have symptoms of the primary disease.

Complications

Obesity is a risk factor for a number of diseases and may lead to a variety of complications, such as obstructive sleep apnea syndrome, gallbladder disease, hyperuricemia and gout, osteoarthropathy, venous thrombosis, and impaired reproductive function (polycystic ovary syndrome in women, impotence in men, etc.).

Consultation

Department of Medicine

Endocrinology

If you are seriously overweight and cannot reach the target through lifestyle modification, or if you are overweight and experience symptoms such as shortness of breath, chest tightness, abdominal distension, joint pain, etc., it is recommended that you consult a doctor promptly.

Preparation for medical treatment

Preparation for medical consultation: registration, preparation of documents, FAQs

Tips for the doctor

It is recommended to keep a record of weight changes for the doctor’s reference.

Preparation Checklist

Symptom list

Pay special attention to the time of onset of symptoms, special manifestations, etc.

What is your height and weight?

Is there any shortness of breath or chest tightness after activity?

Medical history checklist

Is there a history of obesity in any blood relatives?

Are there any allergies to medications, foods, or other substances?

Is there a history of heavy eating and physical inactivity?

Are there any medical conditions such as diabetes, hypertension, hyperlipidemia, hypothyroidism, or hypercortisolism?

Checklist

Test results of the last six months, which can be brought to the doctor’s office

Laboratory tests: blood lipids, fasting blood sugar, kidney function, urine routine, blood routine, liver function, thyroid function, blood cortisol

Imaging Tests: Ultrasound of Liver, Gallbladder, Pancreas, Spleen and Kidneys, Ultrasound of Heart, Ultrasound of Thyroid, Magnetic Resonance of Pituitary Gland

Other tests: electrocardiogram

Medication List

Medication used in the last 3 months, if there is a box or package, you can bring it with you to the doctor’s office

Weight-loss medications: orlistat, lorcaserin, metformin, liraglutide

Glucocorticoids: hydrocortisone, prednisone acetate, methylprednisolone, dexamethasone

Diagnosis

Diagnosis is based on

Medical history

Obesity requires the patient to provide the doctor with a detailed medical history, which helps the doctor assess the condition and develop a detailed treatment plan.

Age at which obesity occurs, rate of progression, etc.

Past history: whether there is a secondary history of obesity-related diseases, such as cortisolism, hypothyroidism and so on.

History of drug use: antipsychotics, hormonal drugs (corticosteroids, birth control pills), insulin and sulfonylurea hypoglycemic drugs, certain α and β receptor blocking antihypertensive drugs.

Reproductive history: whether the mother’s weight was normal during pregnancy, whether the child’s weight was normal at birth, etc.

Lifestyle: personal diet, habits, physical activity, smoking, alcohol consumption, etc.

Family history: whether first-degree relatives (father, mother) are obese.

Clinical manifestations

Mild obesity is mostly asymptomatic. Moderate to severe obesity may cause shortness of breath, joint pain, muscle aches and pains, decreased physical activity, as well as anxiety and depression.

Laboratory Tests

Blood biochemistry

Triglycerides, total cholesterol, LDL cholesterol, etc. are checked. Clarify the presence of dyslipidemia and other conditions.

Elevated triglycerides, elevated total cholesterol, and elevated LDL cholesterol may be present. It is one of the main methods of examination for this disease.

Precautions: Fasting must be maintained before the examination, i.e., fasting for 6 hours and 4 hours without water. If the test is performed in the morning, no food should be consumed after dinner the day before.

Diagnostic Criteria

There is a lack of uniform diagnostic criteria for obesity, which can be assessed based on indicators such as body mass index, ideal body weight, waist circumference and waist/hip ratio.

Body Mass Index (BMI)

It can measure the degree of body obesity, BMI (kg/m2) = weight (kg) / [height (m)]2.

Note: BMI does not accurately describe the distribution of body fat and cannot differentiate between fat and muscle content, so muscular people are easily misclassified.

Overweight

24～27.9

Underweight

<18.5

Normal Ideal Weight ± 10%

Normal

Ideal body weight ± 10%

Overweight Ideal weight 10.0% to 19.9

Overweight

10.0%～19.9% of ideal body weight

Obese more than 20.0% of ideal body weight

Obese

Over 20.0% of ideal body weight

Waist circumference

Subjects were placed in a standing position with feet 25 to 30 centimeters apart so that the weight was evenly distributed.

Classification Male waist circumference (cm) Female waist circumference (cm)

Pre-centered obesity 85～89.980～84.9

Pre-centered obesity

85～89.9

80～84.9

Central obesity ≥90≥85

Central obesity

≥90

≥85

Waist/hip ratio

Hip circumference measurement is the circumference of the most prominent point of the pelvis surrounding the hips. A diagnosis of central obesity was made at >0.9 in men and >0.85 in women.

Other tests

CT or MRI: It can calculate the thickness of subcutaneous fat or the amount of visceral fat, and is the most accurate method of assessing the distribution of fat in the body, but is not used as a routine test.

Body densitometry, bioelectrical impedance measurement, and dual-energy X-ray (DEXA) absorptiometry can measure total body fat.

Other laboratory tests help to diagnose which diseases are comorbid with obesity and the etiology of secondary obesity, such as thyroid function tests, glucose tolerance tests, and sex hormone tests.

Differential Diagnosis

Cortisolism (Cushing’s syndrome)

Similarities: obesity.

Differences: may have centripetal obesity, full moon face, purple lines on the skin, acne, hypertension, osteoporosis. Measurement of blood and urine cortisol, adrenal ultrasound and CT can be used for further diagnosis.

Hypothyroidism

Similarities: obesity.

Differences: chills, edema, fatigue, drowsiness, memory loss, weight gain, constipation. It is often accompanied by a significant decrease in basal metabolic rate, and the weight gain is mostly moderate, which can be differentiated by thyroid function measurement.

Hypothalamic obesity

Similarity: obesity.

Differences: fat distribution is prominent in the face, neck and trunk, tender skin, thin fingers, often accompanied by mental retardation, gonadal hypoplasia, uremia, thyroid and adrenocortical insufficiency. Measurement of endocrine function, cranial CT or magnetic resonance examination can help to clarify the diagnosis.

Hypogonadism

Similarities: obesity, hypogonadism, scanty menstruation, amenorrhea, infertility in women, breast development in men.

Differences: Hypogonadism can be differentiated by sex hormone tests, ultrasound, etc. Sex hormone abnormalities are seen.

Sexual infantile-low muscle tone syndrome

Similarity: Obesity.

Difference: Sexual infantile-low muscle tone syndrome, also known as Prader-Willi syndrome, is an autosomal dominant disease, which starts at the age of 1~3 years old, and is characterized by peripheral obesity, short stature, mental retardation, small hands and feet, low muscle tone, and hypoplasia of the external genitalia, which is often associated with diabetes mellitus at puberty.

Treatment

Treatment goal

To prevent and treat obesity-related complications through weight loss and to improve the patient’s health status.

Lifestyle and Behavioral Treatment

The main part of the treatment is to reduce calorie intake and increase calorie consumption.

Medical Nutritional Therapy

It is necessary to improve the dietary pattern, focusing on low energy, low fat and moderate protein diet to ensure that the calorie intake is less than the consumption. Caloric intake needs to be assessed under the guidance of a professional dietitian to determine the appropriate nutrient partitioning.

Determining Caloric Intake

Total daily calorie requirement = ideal body weight (kg) x calories per kg of body weight (kcal/kg).

For overweight or obese people, the calorie requirement per kg of body weight is 15 kcal for bedridden people, 20-25 kcal for light work, 30 kcal for medium work and 35 kcal for heavy work.

Nutrient Ratio

Principle of distribution: protein accounts for 15% to 20% of the total calories, fat accounts for <30%, and carbohydrates account for 50% to 55%.

Protein should be mainly high quality protein (≥50%), such as eggs, milk, meat, fish and soy protein (1 egg per day for adults and about a palmful of lean meat).

Consume adequate fresh vegetables (400-500 g/day) and fruits (100-200 g/day).

Avoid fried foods, convenience foods, fast foods, chocolates and snacks.

Increase dietary fiber, non-absorbent foods (e.g. konjac, etc.) and water as appropriate to satisfy satiety.

Weight Loss Diet

Commonly used weight loss diets mainly include calorie-restricted balanced diets, low-calorie diets, very-low-calorie diets, high-protein diets and light fasting diets, etc. However, recipes should be formulated by professional doctors and strictly followed.

Calorie-restricted balanced diet.

Applicable to all those who need weight control. Restriction of energy intake while ensuring basic nutritional requirements, the structure should have a reasonable proportion of nutrient distribution.

There are 3 methods: ① reduce the target intake by a certain percentage (30%～50%); ② reduce the target intake by 500 kcal per day; ③ supply 1000～1500 kcal per day.

Low-calorie diet.

Also known as a calorie-restricted diet, the intake of fat and carbohydrates is reduced moderately on the basis of protein, vitamins, minerals, dietary fiber and water.

Adults should consume no less than 1,000 kcal per day.

Very low calorie diet.

Daily intake of 400-800 kcal, mainly from protein, with strict restriction of fat and carbohydrate intake.

This method is not suitable for pregnant and lactating women and adolescents during growth and development.

High protein diet.

Daily protein intake accounts for 20% to 30% of total calories or 1.5 to 2.0 g/kg (body weight).

This method helps to improve simple obesity with dyslipidemia and is suitable for patients with simple obesity.

Light fasting diet.

It refers to the dietary pattern of eating normally for 5 days in 1 week and consuming 1/4 of the weekday calories (500 kcal/day for women and 600 kcal/day for men) on the other 2 (non-consecutive) days, also known as the 5:2 pattern of intermittent fasting.

This method is suitable for obese patients with diabetes, hyperlipidemia and hypertension.

It is not suitable for patients at risk of hypoglycemia, hypotension, and frailty.

Prolonged use may lead to malnutrition or ketosis.

Exercise

Exercise in combination with medical nutrition therapy and long-term adherence may prevent obesity or result in weight loss in obese patients. Exercise therapy needs to be carried out under the supervision of a physician after assessment of cardiorespiratory and exercise function.

Exercise program

According to the patient’s interests, age, complications and physical ability to choose.

Perform aerobic exercises such as brisk walking, swimming, cycling, playing badminton and tai chi.

Perform strength training 2 days a week, lifting weights or using resistance bands, etc.

Exercise time

The amount and intensity of exercise needs to be gradually increased, with the ultimate goal of exercising 3 to 5 times a week for 30 minutes at a time.

If it is not possible to exercise for 30 minutes at a time, short bursts of exercise (e.g., 10 minutes) accumulating 30 minutes can be beneficial.

Exercise intensity

Moderate intensity: 50% to 70% of maximum heart rate (220-for-age), exercising a little harder, heart rate and breathing faster but not rapid.

Behavioral Interventions

Dietitians, doctors, nurses, sports coaches, and counselors need to be involved to help patients with self-management, goal-setting, and cognitive adjustment to increase adherence to weight loss.

Medication

Drug indications

Strong appetite, unbearable hunger before meals, eating more at each meal.

Combination of high blood sugar, high blood pressure, dyslipidemia and fatty liver.

Combined weight-bearing joint pain.

Obesity-induced dyspnea or obstructive sleep apnea syndrome.

BMI ≥24 with the above comorbid conditions.

BMI ≥ 28, regardless of whether there are comorbidities or not, after 3 to 6 months of simple diet control and increased activity can not lose 5% of weight, or even the weight still has a tendency to rise.

It is not suitable to apply weight reduction drugs

Children.

Pregnant and lactating women.

Those who have adverse reactions to this kind of drugs.

Those who are taking other selective serotonin reuptake inhibitors.

Weight Reducing Drugs

Orlistat

Dosage: Usually taken before meals, the recommended dose is 120 mg three times a day.

Efficacy and action: a gastrointestinal pancreatic lipase and gastric lipase inhibitor that reduces fat absorption.

Adverse effects: In the early stage of treatment, there are mild digestive adverse effects, such as intestinal flatulence, increased frequency of stools and fatty stools, etc.; as the duration of administration increases, headache, back pain, lower limb pain, respiratory infections, etc.; in severe cases, it may affect the absorption of fat-soluble vitamins, and cause serious hepatic and renal damage, such as hepatic failure, renal calculi, renal failure, etc.

Appetite suppressant

Commonly used drugs: Chlorocarbazone. This drug was approved for marketing in June 2012 by the U.S. FDA. It has not been approved for marketing in China.

Effects: It has the effect of suppressing appetite, increasing satiety and reducing food intake.

Adverse effects: headache, dizziness, nausea, dry mouth, fatigue, constipation, etc.

Glucose-lowering drugs with weight-loss effects

Metformin: It can promote the uptake of glucose by tissues, increase insulin sensitivity, and have some weight loss effect, effective for patients with diabetes and polycystic ovary syndrome. It can cause gastrointestinal reactions and lactic acidosis. However, it has not been approved for the treatment of obesity.

Liraglutide: It can play a role in weight reduction by suppressing appetite, reducing gastric emptying and promoting the browning of white fat.

Surgical treatment

The pros and cons of surgery need to be weighed comprehensively and objectively under the guidance of doctors in regular medical institutions. Surgery does not mean that obesity can be cured. Regular follow-up is needed to strengthen diet control and exercise.

Surgical Procedures

Liposuction, liposuction, and various types of surgeries to reduce food absorption (gastric diversion, jejuno-ileal bypass, vertical sleeve gastrectomy, gastric banding and gastric pouch surgery).

Indications for surgery

Indications for surgery for people between the ages of 16 and 65

Surgical treatment may be considered if one of the first three of the following conditions is present, and the last four are also present.

Presence of diseases related to simple fat excess, such as type 2 diabetes mellitus, cardiovascular disease, fatty liver, lipid metabolism disorder, and obstructive sleep apnea syndrome.

Waist circumference ≥90 cm for men and ≥80 cm for women.

Stable weight gain for more than 5 consecutive years, BMI ≥ 32.

Age 16～65 years old.

Unsuccessful or intolerable with non-surgical treatment.

No alcohol or drug dependence, no serious mental disorder, intellectual disability.

Fully informed consent and able to actively cooperate with postoperative follow-up.

Minimum indications for surgery for people aged 2 to 18 years

BMI>32.5 with at least 2 obesity-related organic comorbidities; or BMI>37.5 with at least 1 obesity-related comorbidities (e.g. obstructive sleep apnea syndrome, type 2 diabetes mellitus, progressive non-alcoholic steatohepatitis, hypertension, dyslipidemia, weight-related arthropathy, gastro-esophageal reflux disease, and serious psychological disorders, etc.).

Patients who have failed to achieve significant weight loss through dietary modification, adherence to exercise, and formal medication.

Age between 2 and 18 years old; the younger the patient, the more cautious the surgery needs to be.

After psychological assessment, the patients themselves are compliant, or their families are capable of strictly cooperating with the postoperative dietary management.

Contraindications to surgery

Presence of severe psychosomatic disorders that prevent adherence to the postoperative diet, physical activity and nutrient supplementation program.

Currently pregnant or planning to become pregnant within 12 to 18 months after surgery.

Inability of the patient or her parents to understand the risks and benefits of surgery.

Surgical Complications

Recent postoperative complications

Infection of the incision.

Bowel obstruction.

Anastomotic leakage.

Pulmonary embolism.

Deep vein thrombosis.

Respiratory complications.

Postoperative long-term complications

Digestive disorders such as cholelithiasis and dumping syndrome.

Malnutrition.

Postoperative care

Postoperative diet.

Diet Postoperative dietary guidance: an important part of ensuring the efficacy of surgical treatment, avoiding postoperative long-term complications and improving various postoperative discomforts.

Purpose: to form new dietary habits to promote and maintain the improvement of glucose metabolism, and at the same time to supplement the necessary nutrients to avoid discomfort.

It takes about 6 weeks to start with a liquid diet, gradually transition to a semi-liquid diet, and finally to a normal diet.

Activity.

If laparoscopic surgery is performed, you should be able to complete most of your regular activities within 2 to 4 weeks.

If open surgery is performed, it may take up to 12 weeks.

Other.

For women of childbearing age undergoing bariatric surgery, pregnancy should be avoided for 1 year after surgery if possible.

If pregnancy occurs, nutritional status should be monitored to prevent postoperative malnutrition.

Traditional Chinese Medicine (TCM) treatment

There is a lack of evidence-based medical support for TCM treatment of obesity, and it is currently believed that traditional Chinese medicine (TCM), acupuncture, and tuina have some effect on weight reduction.

It is necessary to go to a regular medical institution to be treated by a TCM doctor for evidence-based treatment. Don’t be superstitious of partial prescriptions, local remedies and so on.

Cutting-edge treatments

Some cutting-edge treatments have not yet been applied to clinical treatment in China and are subject to further research.

In 2014, the U.S. Food and Drug Administration approved (FDA) a new device for treating obesity by way of vagus nerve blocking therapy, which is an intermittent blockage of the vagus nerve by implanting a rechargeable device into the patient’s chest wall to reduce hunger and increase satiety.

Prognosis

Cure

Obesity is a chronic condition that may return to normal weight in most people with weight loss treatment, but requires lifelong management.

Mildly obese people generally take diet control, physical exercise and so on mostly can achieve the purpose of weight loss.

Moderate and severe obesity combined with other diseases, it is necessary to actively reduce weight and control the accompanying disease can also achieve better results.

Part of the obesity caused by type 2 diabetes, fatty liver, hypertension, etc. After weight loss treatment may return to normal.

How long can obese people live is related to a variety of factors, such as whether there are accompanying diseases, complications, etc., generally active control, can obtain the same life expectancy as normal people.

Harmfulness

Overweight and obesity have a much greater risk of developing a variety of serious diseases compared to people of normal weight, both in adults and children. The diseases that may be caused are:

High blood pressure

More common in obese adults.

Hypercholesterolemia

Lipid tests in overweight people often show hypercholesterolemia. Hypercholesterolemia is strongly associated with the development of cardiovascular disease.

Type 2 Diabetes

Being overweight and obese doubles the chance of developing type 2 diabetes.

Arthritis

The risk of developing arthritis increases by 9 to 13% for every 0.91 kg of weight gain.

Respiratory Diseases

Asthma and obstructive sleep apnea are more common in obese people.

Cancer

Obesity may increase the risk of endometrial, breast, prostate, kidney, esophageal and colon cancers.

Pregnancy complications

Obesity increases the risk of pregnancy, preeclampsia, delivery complications and diabetes. Obese women have ten times the risk of developing high blood pressure during pregnancy as they do during non-pregnancy. Obese pregnant women and their babies have an increased risk of dying during pregnancy.

Depression

Obesity affects a person’s ability to get around, may affect self-esteem and even discrimination, and can lead to depression and eating disorders.

Other

Obesity has also been linked to heart failure, back pain, bladder problems, gallstones, kidney stones, liver disease, gout, post-surgical complications, infections, and menstrual irregularities and infertility in women.

Daily

Daily Management

Dietary management

Adjust your diet so that caloric intake is lower than consumption and stick to the recipes developed by your doctor or dietitian.

Don’t eat too much at each meal, you can eat smaller and more frequent meals.

Steam and boil should be the main cooking method, and avoid oil stir-frying and deep-frying as much as possible.

Eat more fresh fruits and vegetables, and consume high quality protein, such as poultry, fish, eggs and low-fat milk.

Avoid high-sugar and high-fat foods, such as chocolate, pastries and fried foods.

Avoid eating when you are very hungry, you can drink water before eating.

Exercise Management

Avoid being sedentary and stick to exercises that interest you.

Exercise should be 150 minutes per week, 3 to 5 times per week.

Work and rest management

Ensure sufficient and quality sleep, avoid staying up late and have a regular routine.

Keep a food and exercise diary to record your diet and exercise time.

Psychological Management

Focus on your mental health during the weight loss period. Consult a professional counselor if you have depression or anxiety.

Review

You should pay close attention to your physical condition and have regular review as directed by your doctor.

If symptoms such as fatigue and weakness, coldness and mental depression occur, consult a doctor at any time.

Warm Tips

Dieting to lose weight does not maintain weight in the long run. If you stop dieting it will lead to weight rebound and it will lead to some psychological problems, so you should lose weight scientifically.

Drugs and surgical treatments cannot be used as a regular means of weight loss and will have some adverse effects, so long-term diet control and physical exercise should be strengthened.

Prevention

Children

Diet

Breastfeeding is recommended for infants.

Learn about age-appropriate dietary portions to ensure that your child gets enough nutrition without overdoing it.

Do not skip meals, especially breakfast.

Choose foods that are high in fiber and low in salt and sugar, such as fruits, vegetables, whole grains, and beans.

Encourage your child to drink plenty of water and avoid carbonated drinks, soda and sports drinks.

Limit fried foods such as French fries, onion rings and other fried snacks.

Avoid snacks with sugar as the main ingredient.

Avoid daily desserts such as cakes, cookies and ice cream.

Exercise

Ensure that children have daily opportunities for healthy physical activity.

Encourage children to play during their free time, such as running, biking and participating in sports.

Exercise two to three times a week for 30 to 45 minutes of moderate-intensity exercise.

Lifestyle Habits

Do not watch TV while eating.

Children should not watch TV for more than 2 hours a day.

Avoid sitting or lying down to watch TV, play games, etc. after meals.

Should go to bed before 10:00 p.m. to ensure sufficient sleep, not less than 10 hours a day.

Regularly visit the pediatric health clinic to receive systematic nutritional monitoring and guidance.