Lifestyle interventions are science
Preferred and foundational measures for weight loss
Article 1
Overweight Obesity is the excessive total fat content of the body caused by excessive calorie intake and consumption, or the increase and abnormal distribution of local fat content.
Interpretation:Overweight Obesity is the intake of more calories than consumption, so that calories accumulate in the body in the form of fat, resulting in excessive total fat content or local fat content and abnormal distribution. The current body mass index (BMI) in China is 240kg m2 and BMI 280kg m2 as a diagnostic criterion for overweight and obesity in adults;Take the male waist circumference 900cm, women's waist circumference 850 cm as a criterion for diagnosing ** central obesity (Annex 1). The health hazards of central obesity are greater than those of systemic obesity.
The definition of overweight and obesity in children and adolescents is different from that of adults, and China has established an age-sex BMI reference cut-off value (Annex 2).
Article 2
Unhealthy lifestyle is a major risk factor for overweight and obesity, and a holistic lifestyle management can help to lose weight effectively.
Interpretation:Overweight Obesity is mainly caused by high-calorie diets such as high-fat and high-sugar diets, low-fiber dietary habits, irregular diets, lack of physical activity and other lifestyles, as well as other genetic, psychological, economic, cultural and other factors. Whole lifestyle management refers to the simultaneous implementation of multi-dimensional lifestyle interventions for overweight and obese patients, which mainly includes three elements: diet, exercise and behavioral intervention.
Whole lifestyle management is superior to dietary or exercise interventions alone and can lead to multiple health effects. Overweight Obese people can achieve effective weight loss and long-term weight control by strengthening weight monitoring, setting lifestyle improvement goals, adhering to a healthy lifestyle, and obtaining social support.
Reasonable diet is the foundation of scientific weight loss
Article 3
On the basis of controlling total calories, adhering to a balanced dietary pattern based on cereals is beneficial for weight loss;The daily diet should include cereals and potatoes, vegetables and fruits, livestock, poultry, fish, eggs, milk and legumes, and reduce the intake of oil, salt and sugar.
Interpretation:A balanced eating pattern that controls total calories is the foundation of weight loss. A diet based on vegetables and fruits, fish, whole grains, legumes and olive oil is also known as the Mediterranean diet. The Mediterranean diet is often referred to as a healthy, varied, and nutritious eating pattern. The Mediterranean diet is associated with weight improvement, cardiovascular disease (CVD), and a reduced risk of metabolic disease. Globally, there are also different dietary patterns such as Deshu Diet, Nordic Diet, and Chinese Jiangnan Diet (Oriental Healthy Diet).
Jiangnan diet is a long-term eating habit formed by residents in the middle and lower reaches of the Yangtze River in China, which can be used as a representative of China's healthy dietary pattern, characterized by a rich variety of ingredientsHigh intake of fruits and vegetables;The intake of white meat such as aquatic products and poultry is higher than that of red meat such as pigs, cattle and sheep;Less oil and salt intake;The taste is lighter;There is little cooking oil, mainly vegetable oil;The cooking methods are mainly steaming and boiling. This diet may be beneficial for weight control and reduce the risk of chronic disease. Choosing a science-based dietary pattern that works for you and sticking to it over the long term is a key to successful weight loss and maintaining a healthy weight.
Article 4
Dietary increases in milk and its products can help with weight loss.
Interpretation:Studies have shown that cow's milk may have a potential ameliorating effect on overweight, obesity, T2DM disease, and CVD. Milk and dairy products provide high-quality protein, which is the best dietary calcium**, and can also provide a variety of essential nutrients. The Dietary Guidelines for Chinese Residents (2022) recommends a daily intake of 300 500g of liquid milk or equivalent dairy products per person. Proper consumption of milk and milk products may be beneficial for people of all ages, with the exception of special groups such as lactose intolerance or cow's milk protein allergy.
Article 5
Total calorie control, alteration of the ratio of the three major energy nutrients, and intermittent fasting can help with short-term weight loss, but there is a lack of evidence to support the long-term effect.
Interpretation:Studies have shown that the dietary pattern of controlling total calories and changing the ratio of the three major energy-providing nutrients (low-carb, low-fat, high-protein, etc.) has a short-term weight loss effect, but the long-term effect is not obvious, and long-term use is not recommended. For example, very low and low calorie diets can reduce body weight by 2% to 15% in the short term, control blood glucose, and improve lipid metabolism, but there is no evidence of long-term effects.
Intermittent fasting, also known as "light fasting", is a dietary pattern that alternates between normal calorie restriction and calorie restriction (or complete fasting) that has some weight loss effects, but there is no evidence of long-term effects.
Article 6
Low-carbohydrate diets are beneficial for short- to medium-term weight control, but there is insufficient evidence for their long-term safety and efficacy. Weight loss on the ketogenic diet should be done under the guidance of a doctor.
Interpretation:A low-carbohydrate diet generally refers to a dietary pattern in which the carbohydrate-to-energy ratio is reduced from 55% to 65% to 40%, the energy supply ratio of fat is 30%, and the protein intake is relatively increased. A very low carbohydrate diet (carbohydrate energy ratio of 10%), that is, an intake of 30 50g d carbohydrates, correspondingly increases the energy supply ratio of fat and protein to carbohydrates 3 1 4 1, also known as the ketogenic diet, has an ameliorating effect on overweight and obesity.
Mechanisms by which the ketogenic diet produces weight loss effects may include a lack of carbohydrates in the diet that leads to decreased insulin secretion, inhibits fat production and accumulation, and promotes lipolysis;A high-protein diet creates feelings of fullness and affects appetite control hormones (such as leptin and appetite-stimulating hormone), insulin secretion, and ketone production.
Studies have shown significant weight loss with short-term low-carbohydrate diets, but the safety and benefits of long-term use are unclear.
Article 7
Eating at night and skipping breakfast increases the risk of obesity and is not conducive to weight loss.
Interpretation:The role of eating time in contributing to obesity and influencing weight loss is increasingly being emphasized. Skipping breakfast and eating at night has been linked to weight gain and even lead to obesity. Studies have shown that skipping breakfast increases hunger, increases the amount of lunch and dinner eaten, and worsens insulin resistance.
Eating breakfast is beneficial to maintain blood sugar stability, increase the body's insulin sensitivity, and avoid hyperphagia caused by the increase in ghrelin concentration caused by prolonged fasting. The quality and nutritional profile of food consumed at night may negatively affect the metabolism and circadian rhythms required for optimal health.
Article 8
Eating at a lower rate can help you recover and maintain a healthy weight.
Interpretation:Studies have shown that eating too fast is associated with obesity, especially abdominal and visceral obesity. Possible mechanisms by which decreasing the rate of eating is beneficial for weight loss are: reduced caloric intake, decreased ghrelin secretion, and reduced hunger;Increases the secretion of satiety hormones such as neuropeptide Y and glucagon-like peptide-1 (GLP-1) and increases satiety. It is recommended that adults eat 20min at each meal.
Article 9
There is no clear scientific evidence for the weight loss effects of natural dietary supplements and should be used with caution.
Interpretation:Natural dietary supplements include carnitine, white kidney bean extract, chitosan, hydroxycitric acid, capsaicin, chromium picolinate , conjugated linoleic acid, glucomannan , chromium, guar gum, pyruvate, caffeine and more. There is insufficient evidence for the weight loss effects of natural dietary supplements in obese people.
To date, most of the studies have problems such as methodological shortcomings, insufficient sample size, lack of long-term follow-up data, and even different studies have reached opposite conclusions.
Therefore, there is currently a lack of sufficient evidence to demonstrate the efficacy and safety of the dietary supplements described above. Some studies have shown that individual dietary supplements may have intestinal adverse reactions and even cause liver and kidney damage, so caution is recommended for use.
Exercise interventions are at the heart of scientific weight loss
Article 10
Aerobic, resistance, and high-intensity interval exercise can all be effective in weight loss.
Interpretation:Aerobic exercise refers to the exercise based on aerobic metabolism and energy, which is characterized by low exercise intensity, such as: brisk walking, long-distance running, square dancing, long-distance cycling, etc.
Aerobic exercise can last for a longer period of time, and the total amount of calories and fat burned is high;Long-term regular aerobic exercise is good for fat loss. Resistance exercise is a form of exercise that causes muscles to contract by resisting resistance. Resistance exercise may prevent the loss of muscle mass during weight loss by restricting calories.
High-intensity interval exercise refers to a type of exercise that is performed multiple times, for short periods of time, at high intensity, and between high-intensity exercises, low-intensity exercise or rest ranging from a few seconds to a few minutes, and is performed in cycles. High-intensity interval exercise can increase excess oxygen expenditure after exercise and enhance fat loss efficiency.
Article 11
Maintaining moderate-intensity exercise for 250 minutes for weeks can help with weight loss, and the weight loss is more pronounced with higher-intensity exercise.
Interpretation:Moderate weight loss can be achieved by maintaining moderate-intensity exercise (150 to 250 min weeks);250min week, can achieve significant weight loss and maintenance results. According to the percentage of heart rate reserve, 40% to 60% is recommended for moderate intensity exercise and 60% to 80% for high-intensity exercise. Exercise intensity estimation method: target heart rate = resting heart rate + (maximum heart rate resting heart rate) exercise intensity percentage, maximum heart rate = 220 age.
Overweight and obese patients with underlying medical conditions, such as T2DM, hypertension, cardiovascular and cerebrovascular diseases, should be professionally assessed and confirmed to be safe before engaging in higher-intensity exercise. Care should be taken to monitor for changes in disease-related biomarkers, symptoms, and signs during and after exercise.
Good sleep and active health
Mindset helps to lose weight
Article 12
Sleeping 6 hours a day increases the risk of obesity, and 7 hours is conducive to weight loss, especially to prevent abdominal obesity.
Interpretation:Epidemiological studies have shown that 6 hours of sleep per day is associated with obesity, T2DM, CVD, risk of metabolic diseases, and increased risk of accidents. Long-term sleep disturbances can lead to chronic stress, which keeps the body's "hypothalamic-pituitary-adrenal axis" functionally active for long periods of time, increases glucocorticoid secretion, and in turn leads to insulin resistance and weight gain. At the same time, sleep disturbances can also affect calorie expenditure by increasing anxiety and depression, reducing physical activity.
Article 13
Long-term and persistent psychological stress can increase the risk of obesity, and maintaining a good mental and emotional health can help maintain a healthy weight.
Interpretation:Long-term and persistent psychological stress can interfere with a person's cognitive functions, such as executive function and self-regulation. Chronic stress can increase additional caloric intake by inducing overeating and intake of high-calorie foods such as high fat or sugar, while reducing physical activity and sleep time and allowing body fat to accumulate.
Chronic stress may also promote the intake of "self-rewarding" high-calorie foods (fats and sweets) by affecting the body's "hypothalamic-pituitary-adrenal axis", affecting the intestinal microecological environment and the secretion of peptide hormones (such as leptin, appetite stimulating hormone and neuropeptide Y), leading to obesity.
Article 14
Mindfulness and looking in the mirror can help you regain a healthy weight.
Interpretation:Psychological approaches to weight management can help improve weight loss motivation and self-control in obese patients, and limit eating urges and inappropriate food intake. As an adjunctive and self-directed psychological intervention, mindfulness can improve the effectiveness of the program by improving eating behavior disorders and reinforcing self-motivation and self-control, and the effect is better when combined with other psychological methods.
Medications and surgeries** are clinical
An important means of weight loss
Article 15
Acupuncture** is supplemented with lifestyle management to help with weight loss.
Interpretation:Acupuncture affects appetite, intestinal motility and metabolism, reduces stress, regulates mood, etc. Acupuncture has the effect of weight loss by altering central neurotransmitters, regulating hunger and satiety, increasing enkephalins, endorphins and serotonin levels in plasma and brain tissue, reducing appetite. Methods such as auricular acupuncture, acupuncture, and acupuncture thread embedding may help people with overweight and obesity lose weight, but more evidence is needed for their long-term effects.
Article 16
Overweight Patients with obesity and complications of "three highs" who are unable to lose weight effectively after 3 to 6 months of lifestyle intervention may be considered for medication**.
Interpretation:Lifestyle interventions are the basis for overweight and obesity**. When overweight and obesity are combined with the "three highs" (i.e., hypertension, hyperglycemia and hyperlipidemia), and lifestyle changes are ineffective, appropriate drugs can be considered. Medications** help increase adherence to behaviour and have a more significant weight loss effect.
At present, the only over-the-counter weight-loss drug approved for use in China is orlistat, which is an intestinal pancreatic lipase inhibitor that can reduce the absorption rate of dietary fat, but does not affect the absorption of protein and carbohydrates. Common adverse reactions of medication include: **Oily spots, increased gastrointestinal gas, stool urgency, oily stool and fecal incontinence, etc.;It can also lead to reduced absorption of fat-soluble vitamins (especially vitamin D), which should be supplemented during medication.
Patients with T2DM and obesity can choose hypoglycemic drugs such as metformin, GLP-1 receptor agonists, and sodium-glucose cotransporter 2 (SGLT-2) inhibitors, which are more conducive to weight control. These drugs have the effect of suppressing appetite, slowing the rate of gastric emptying, and increasing glucose excretion in the body. The most common adverse reactions of metformin and GLP-1 receptor agonists are gastrointestinal events.
Article 17
Surgery** Obesity is effective and is indicated for patients with severe obesity who do not respond to lifestyle interventions.
Interpretation:Severe obesity (BMI 37.)5kg m2 or BMI 325 kg m2 with complications) may be considered for aggressive measures including intensive whole-life interventions, medications**, and bariatric surgery. Although bariatric surgery is the most effective way to reduce and maintain weight loss, and to improve comorbidities and mortality risk, lifestyle modification is recommended as a cornerstone of weight loss and prevention and control of related comorbidities.
The most common types of bariatric surgery are gastric sleeve resection and roux-en-y gastric bypass, which can reduce body weight by 27% to 69% at 10 years postoperatively. In obese patients with T2DM, the 10-year postoperative T2DM remission rate was 25% to 62%. But surgery can lead to complications such as vitamin deficiencies, gastroesophageal reflux, and dumping syndrome.
Obese patients should undergo bariatric surgery at a surgical bariatric medical center with extensive experience**. A thorough medical evaluation of the indications and safety of the procedure should be performed preoperatively. Postoperative follow-up and nutritional management should be undertaken.
Obesity life-cycle prevention and treatment
Focus on childhood obesity
Article 18
Overweight The goal of weight interventions for obese children is to maintain no weight gain or a slower rate of growth to achieve a healthy weight, rather than having to lose absolute weight. Lifestyle interventions are the first to be approached, and the involvement of parents and families is crucial.
Interpretation:The goal of weight intervention for overweight and obese children is to achieve a healthy weight, rather than having to reduce absolute weight, while maintaining a steady increase in height, without or slowing the rate of gain.
Lifestyle intervention refers to the implementation of a variety of lifestyle strategies for overweight and obese children, including diet, exercise, and behavioral interventions. Lifestyle interventions for obese children should be targeted at the whole family and promote family-centered lifestyle changes (diet, physical activity, etc.) to achieve the goal of promoting a reasonable reduction in BMI in obese children.
Article 19
Overweight Obese children should focus on dietary adjustment, reduce eating out, and control the pace of eating, snacks, and sugary drinks.
Interpretation:Overweight The weight-loss diet of obese children should adhere to the principles of controlling the total amount of food, adjusting the dietary structure and eating behavior, reducing the consumption of fast food and snacks, avoiding the intake of sugary drinks, and eating more fruits and vegetablesEnsure that you drink at least 300ml of milk or equivalent milk products per dayReduce the frequency of eating out, the eating speed should not be too fast, and the time of each meal should be controlled at 20 30min.
Article 20
Overweight and obese children should do at least 150 minutes of moderate-to-high-intensity aerobic exercise and resistance training per week, reduce sedentary times, and use electronic devices for no more than 2 hours a day.
Interpretation:For overweight and obese children, it is recommended to do moderate-to-high-intensity, whole-body aerobic exercise for 30 to 60 minutes (such as jogging, skating, swimming, etc.) every day, 4 days a week, for 150 minutesDo resistance training 3 to 4 times a week (e.g., pull-ups, sit-ups, leg raises, etc.), preferably every other day. Exercise requires long-term persistence while reducing sedentary behavior.