One shouldn't be "trapped" in dieting for a lifetime.
Text by Hu Xiangyun
“I'm fat, but I'm not sick.” This is a deep - seated belief in the minds of many overweight or obese people.
So, what exactly counts as “fat”? According to the latest research in the authoritative medical journal The Lancet, it requires referring to multiple dimensions such as the Body Mass Index (BMI) and body shape measurement indicators (e.g., waist circumference, waist - hip ratio, waist - height ratio, etc.) for definition. According to the current domestic standards, a BMI between 24.0 kg/m² and 27.9 kg/m² already indicates being overweight, and a BMI exceeding 28.0 kg/m² means obesity.
In China, among the population aged 5 - 19 alone, there are nearly 100 million people with a high BMI (BMI ≥ 25 kg/m²), and some of them have already developed problems such as high blood pressure. For adult residents, the combined overweight and obesity rate has exceeded 50%.
As early as 1997, the World Health Organization had defined obesity as a disease. However, another sad fact is that although obesity has never been a niche topic and the clinically scientifically verified weight - loss methods have been increasingly abundant, few people truly regard obesity as a disease and seek medical help for health reasons until their bodies start to “send out alarms”.
People always prefer to believe in the weight - loss methods they figure out on their own. Even if these methods are unreliable and may even be harmful to health.
Today is another World Obesity Day, a day that calls on everyone to face up to obesity and lose weight scientifically. This time, we interviewed several long - time “fat friends” and clinical doctors engaged in weight - loss treatment to talk about people's psychological barriers regarding obesity. And in the doctors' view, how to manage weight scientifically.
We hope that everyone will no longer have to bear the “burden” of obesity alone.
The hospital is always the last choice
It took 17 years for this patient that Wang Chunchuan encountered to finally make up his mind to have weight - loss surgery. In the past, if calculated from the first time they learned about this treatment method, the average “hesitation” period was about 8 months - a number that is not short.
Wang Chunchuan is the leading expert in the Department of General Surgery and the Weight - Loss Center of the First Affiliated Hospital of Jinan University. He started treating obesity and metabolism - related diseases around 2000. In his experience, in few other departments do patients delay seeking medical treatment for so long. Only in the weight - loss outpatient department, unless serious health problems have occurred, the usual rule of “seeing a doctor when sick” does not apply.
Doctor Wang Chunchuan
In the 21st century, which can be regarded as “the most conducive to promoting obesity”, the growth and younger - age trend of the obese population are becoming more and more obvious, and it has gradually become a social problem. The 2024 edition of the “World Obesity Atlas” even directly points out that nearly 800,000 adults in China die each year from non - communicable diseases related to high BMI.
For a long time, the phenomenon that obese patients are reluctant to go to the hospital has been very common. In traditional perception, obesity is not a disease that needs intervention. It can be associated with many concepts such as “laziness”, “gluttony”, and “self - indulgence”, but it is never regarded as a “disease”.
So, losing weight is one's own business. Almost every “fat friend” has been advised like this.
However, it is actually very difficult to succeed in weight loss through simple lifestyle interventions. A review study found that most obese patients will regain about half of the weight they lost after 2 years of weight - loss through lifestyle interventions only. By the 5th year, this figure may reach more than 80% of the weight they lost.
A mainstream view in the medical community is that this is because there is a “weight set - point” in the human body. That is, the body will remember your weight level and maintain it within a stable range. In other words, even if you successfully lose weight through hard work, you will uncontrollably gain back the weight.
Abby is 32 years old this year. She is just over 160 cm tall and weighs about 95 kg. Her struggle with weight loss has almost spanned one - third of her life. In the past, she always “lost weight off and on for the sake of beauty”. She tried acupuncture and probiotics, and also believed in the popular “Beijing Dance Academy weight - loss diet” on the Internet. But except for losing 20 jin by insisting on running in college, she rarely had successful experiences.
It wasn't until she crossed the threshold of 30 years old that she realized that obesity is also a disease that requires medical intervention. When she saw many abnormal indicators on her physical examination report and was stunned by the doctor's recitation of terms such as pre - diabetes, fatty liver, endocrine disorders, and polycystic ovary syndrome, she said, “I need to succeed in losing weight once and for all, instead of being trapped in the cycle of weight loss for a lifetime.”
In Beijing Yide Hospital where Sun Mingxiao works, most obese patients who seek help have tried all kinds of weight - loss methods outside the hospital. “I once received a 18 - year - old boy who weighed 119 kg. He already had symptoms of high blood pressure, high uric acid, and insulin resistance. His parents had spent more than 400,000 yuan trying to help him lose weight. They were so desperate that they finally sent him to the hospital.”
Sun Mingxiao understands these overweight or obese people who resist seeing doctors. In the early years, the development of the weight - loss discipline in China was not perfect. There were problems such as unclear division of responsibilities and inconsistent treatment methods among different departments in the treatment of obesity. Coupled with the mixed information on the Internet, even when facing doctors, patients often don't know how to choose.
On the other hand, the “stigma of illness” still deeply troubles the obese group. Sun Mingxiao mentioned that almost all the patients who come to the outpatient department, whether they are children brought by their parents or husbands accompanied by their wives, are under great psychological pressure and may even be in a state of depression.
Wang Chunchuan also has the same experience. He even once encountered a patient who was told by his leader not to go out for business entertainment because of his obesity and poor image. The leader said, “What if people think we are corrupt because you are so fat?”
Since childhood, Yaya has felt that she was “a relatively big - sized child in the class”. Due to the high study pressure, her family never paid much attention to her weight. They only thought that “a child who is not picky about food is healthy”. She is just over 160 cm tall, and her weight once reached 165 jin.
“In kindergarten, some people called me 'fat woman'. Later, when I grew up and went to middle school, people seemed to learn to be more euphemistic. 'Fat woman' became 'Maybe you should eat less'. Sometimes when I was just getting my normal meal, they would ask if anyone had advised me to lose weight. This is even worse than scolding me with malice. It seems to be for my own good, but every word stings my heart.”
In this situation, since they are already discriminated against because of their weight, going to see a doctor seems to not only announce to the world that “I'm fat” but also requires extra money, time, and the risk of unsuccessful treatment.
“It's really hard to take this step,” Sun Mingxiao said. “Sometimes, as soon as the family members leave, the patients start to cry to me, saying that they are often blamed for being gluttonous, lazy, and lacking willpower. But I know that they have tried hard; they just can't control themselves. So for every patient who comes to see me, I will recognize their efforts, even if it's just the thought of trying.”
“I can lose weight healthily”
Abby's weight - loss journey finally took a turn for the better after she went to the weight - loss outpatient department of a public hospital at the end of 2022. On the doctor's advice, she started to try a prescription drug for weight loss in the GLP - 1 (glucagon - like peptide - 1, a substance secreted by the intestine that can stimulate insulin secretion, lower blood sugar, and stimulate satiety) class.
In Abby's view, this weight - loss experience was very different from the previous ones. There was not only a detailed inquiry about her physical condition but also relevant examinations. Only after it was confirmed that she met the medication indications did she get her first GLP - 1 drug. A companion of hers was even refused by the doctor because her BMI was less than 27. “If it was in a weight - loss center before, they would accept almost anyone as a trainee.”
After taking the medicine for a month, Abby lost nearly 10 jin. “Although I didn't visually notice a change in my body shape, the number on the scale kept going down every day. It was a really amazing feeling. I also checked the side - effect issues before taking the medicine, but they hardly occurred to me.”
With extensive real - world data accumulated at home and abroad, GLP - 1 drugs have been regarded as “miracle weight - loss drugs” in the past two years.
If we look back at the path of how this kind of drug became popular in China, different from many weight - loss products that first became popular on social media, its initial audience was actually professional groups in the medical circle such as pharmaceutical companies and hospitals.
A Liang works in the biomedical industry. He has many business entertainments and little exercise on weekdays. He gained nearly 10 jin in his first year of work, and his weight continued to increase by about 10 jin in the following 7 or 8 years. He also tried to eat only salads and exercise more, but he found that he couldn't resist carbohydrates at all.
Later, the name GLP - 1 began to gain popularity in a small circle in the medical industry. For this reason, A Liang almost read all the clinical research data of GLP - 1 products on the market. After the relevant new products for weight management were officially launched in China at the end of last year, he decided to restart his weight - loss plan.
He Yu's father's experience with the medication was similar. She and her family are all involved in the medical industry. They knew about GLP - 1 drugs as soon as they were approved overseas.
“My father is a doctor himself. He is very busy at work. Moreover, he is almost 60 years old, has a large weight base, and has underlying diseases. It is very difficult for him to lose weight through regular exercise, so this matter has been delayed for many years. Later, when he went to see a leg problem, the doctor advised him to lose weight to relieve the pressure on his legs, so we decided to try the medicine.”
Looking back, the common characteristics of the early users of these GLP - 1 drugs are that they mostly have a good educational background, “believe in science” and care about the impact of obesity on health. At the same time, compared with achieving rapid weight - loss results, they hope that they or their family members can lose weight healthily.
In the doctors' view, this is already a good start. In the early years, professional doctors had few “weapons” to fight obesity: surgery was effective but invasive, and most people were reluctant to choose it; lifestyle interventions were easy to accept but difficult to stick to; drugs were the most common, but there were many problems. Products such as sibutramine, fenfluramine, and mazindol were once “popular” one after another and then delisted due to safety and other issues. Before 2023, there were only a few weight - loss drugs available for clinical use in China, such as orlistat.
In other words, in the previous mass market, there had never been a weight - loss product that closely connected doctors, obese patients, and treatment drugs. Now, with the popularization of GLP - 1 prescription drugs for weight loss, which have a “popular base”, it drives the change of obese patients' medical treatment habits. They “begin to be willing to go to the hospital”, and the existing obesity treatment pattern may also be standardized accordingly.
“It's like opening a window for patients to understand the treatment of obesity in regular hospitals.” Wang Chunchuan summarized the significance of GLP - 1 drugs in the treatment of obesity in this way. “Comparing with surgery, weight - loss surgery has been around for about 70 years, and the number of people who undergo the surgery globally each year is only about one million. But drugs can quickly cover a larger population and help more people.”
Long - term management, not “taking a shot only when you remember”
Since starting to take the medicine at the end of last year, A Liang has achieved some success in his weight - loss journey. “I can clearly feel that my belly has become smaller.”
At the beginning of taking the medicine, as a professional in the medical industry, he also had a “pitfall” experience. A Liang admitted that he “was a bit excited and didn't think much”. He didn't follow the doctor's advice and started taking the medicine directly when he still had the flu. “During the first week of taking the shot, I had serious side - effects and felt very uncomfortable.”
Actually, both professional doctors and the general public have more or less implicitly noticed this unreasonable use phenomenon. He Yu also mentioned that there are many friends around her who are fat but not serious enough to need the medicine. They often stop taking the medicine after using it for a while, and then start taking it again when they gain weight back.
In the long run, this is not a reasonable weight - loss method. A Liang mentioned that the popularization of prescription weight - loss drugs, while improving the weight - loss effect, has certain threshold requirements for pre - medication testing and evaluation, dose escalation during medication, etc. It needs to be used reasonably under the doctor's guidance. At the same time, this procedure “can also ensure its use within the reasonable indication population and reduce the problem of abuse”.
After entering college, Yaya left her former acquaintance circle. The new campus environment is very friendly, and her friends always support what she wants to do. She also began to have time to systematically learn about obesity - related knowledge and understand the mechanism behind the disease. In November last year, she started using GLP - 1 drugs on the doctor's advice.
