今年全國兩會上，國家衛健委主任雷海潮關於加強體重管理的一段講話火爆全網，“國家喊你減肥”衝上熱搜。從今年起，國家衛健委啟動實施“體重管理年”活動，並引導醫療衛生機構設立體重門診。北京眾多醫院積極回應，加速推動體重管理門診落地。此前，本市提供減重診療服務的醫院已有不少，3月份以來，各醫院打造的體重管理門診有何不同？近日，北京青年報記者前往多家醫院探訪發現，隨著體重管理門診遍地開花，無論是人們的健康理念還是醫院的多學科聯合診療方式，無不在推動科學體重管理成為全民健康新趨勢。
Change 1: Health awareness awakening, outpatient pursuit, weight managers increase
4月9日一早，北京世紀壇醫院門診樓四層的體重管理門診，已有不少患者和家屬將走廊外的座椅佔滿。9點，家住西城的程怡（化名）敲開了診室的門，迎接她的是該醫院肥胖與代謝病中心副主任廉東波。
Cheng Yi is 28 years old this year, 0 cm tall, wearing a loose sweatshirt and black jeans, and at first glance her figure is no different from a normal person. But when she stood on the body composition analyzer, she measured a weight of 0 kg and a BMI (Body Mass Index) of 0.0. "According to the weight criteria for adults in China, she is already overweight. If this value exceeds 0, you are obese. Lian Dongbo said.
"After giving birth, the baby weighs 20 pounds more than the original, and I am busy with work and have to take the baby, so I have no time to lose weight. When I heard that the weight management clinic here was open, I came to Dr. Lian to try it out, wanting to restore my body to its original appearance and wear beautiful clothes. "Cheng Yi's purpose is very clear.
Measurements showed that she had normal skeletal muscle content but excess body fat. Combined with her work, life and diet, Lian Dongbo tailored a fat loss and muscle gain program for her through a combination of medication and dietary intervention. He also assigned Cheng Yi a "homework": reduce the daily staple food by one-third, and record everything that is eaten and put into his mouth every day, from three meals a day, extra meals, drinking water, to daily activities and exercises. When she comes back for a follow-up visit a month later, Lian Dongbo will make targeted corrections based on her records.
走進廉東波門診的人群中，像程怡這樣的不在少數。自從3月“國家喊你減肥”的號召發出後，廉東波明顯感受到，最近大半個月，門診中追求體重管理的人多了不少。“以前來的大多是因肥胖產生併發症的患者，如今，許多未出現嚴重併發症的超重人群也主動就診，甚至體重正常但體脂率稍高的人也來尋求指導。”
Yang Qinbing, director of the clinical nutrition department at Tsinghua Chang Gung Hospital in Beijing, feels the same way. "In the past half a month, many people have not reached overweight or obesity in BMI, and they have also come to the hospital to seek weight management, which shows that the country's call is indeed effective, and it also reflects the improvement of public health awareness."
Change 2: Diagnosis and treatment model innovation: from a single person to a multidisciplinary combination
A reporter from Beiqing Daily visited and found that many hospitals in the city have been providing weight loss services many years ago, with endocrinology and gastrointestinal surgery as the main departments, and mainly through drugs or surgery for medical weight loss.
自2015年起，北京清華長庚醫院臨床營養科就開設了醫學減重門診，後續聯合內分泌與代謝科、胃腸減重外科、中醫科等科室共同提供服務。該醫院醫務管理部部長林思勇介紹，今年4月初，體重管理聯合門診正式上線，各科室攜手將發揮“1+1＞2”的效果。“聯合門診有五個主力科室，分別是臨床營養科、內分泌與代謝科、中醫科、心理科、胃腸減重外科；同時還會輻射婦產、耳鼻喉、呼吸等相關科室，如果患者因肥胖同時伴發相關併發症，都可以找到相關專家就診。”
How does the Combined Weight Management Clinic work? Lin Siyong said that some obese patients have complex conditions and need to run multiple departments, such as obesity with diabetes and anxiety, etc., and the hospital will set the joint outpatient time for weight management to Wednesday morning according to the "greatest common divisor" of the time of experts in each department. In other words, all five departments related to weight management have doctors on Wednesday morning, and if patients need to be assisted by other departments, they can be easily referred to the joint outpatient physician without rescheduling appointments. In addition, the hospital optimizes the layout of the clinic around the joint outpatient clinic, and the scientific flow line is set to minimize the "errands" of patients. Lin Siyong said that for some obese patients who are severely overweight and have multiple organ function impairment, the hospital will further introduce multidisciplinary MDT diagnosis and treatment, so that "doctors run around the patient" and help patients in need to formulate the "best" diagnosis and treatment plan.
In Beijing Jishuitan Hospital, the joint outpatient clinic for weight management has also started trial operation, which is also a multidisciplinary joint "one-stop" service. Yu Feng, assistant to the president of the hospital and director of the medical department, told the reporter of Beiqing Daily that unlike in the past, Jishuitan Hospital opened a joint outpatient clinic for weight management this time, giving more prominence to active screening, and the leading department in the health management center found people with abnormal weight in advance through health examinations, and carried out classified management and early intervention.
"Most people who are mildly overweight can lose weight only through diet, exercise and lifestyle modifications, and we advise them and prescribe exercise and diet; For patients with severe or disease-induced obesity, it is recommended to visit the appropriate department or initiate a multidisciplinary joint consultation to provide a personalized weight loss plan. Some overweight and obese patients may have osteoarthropathy, and we will also give full play to the advantages of the orthopedic department of the hospital to make treatment and weight loss 'two-pronged'. Yu Feng said.
Change 3: The service concept is upgraded to open the whole life cycle and the whole process management
Lian Dongbo told a reporter from Beiqing Daily that the concept of "weight management" is actually quite meaningful, in the past, it was only about weight loss, focusing on patients with complications and using medical means to lose weight, but now it has risen to the level of "management", which is a whole population, the whole life cycle, and the whole process, breaking through the previous "treatment" category.
"For example, we emphasize starting from pregnant women, controlling pregnancy weight to prevent 'macrosomia', for children and adolescents, establish healthy eating and exercise habits to avoid becoming 'chubby', for middle-aged and elderly groups, pay attention to muscle loss and metabolic decline, prevent obesity and pay attention to sarcopenia, and people with normal weight should not relax their vigilance, and need to regularly monitor and pay attention to body fat percentage, muscle mass and other indicators. Weight management is not only about 'losing weight', but also about maintaining a healthy state through science. Lian Dongbo said.
北青報記者梳理髮現，本市各醫院開設的減重門診可以說覆蓋了全生命週期、全人群。今年3月18日，首都兒科研究所成立醫學體重管理中心，針對小胖墩們提供多學科綜合服務；4月初，北京婦產醫院開設體重與營養代謝門診，重點針對女性備孕、孕期、產後、更年期等關鍵階段，實施科學的體重管理；北大醫院也早已“出手”，老年醫學、婦產生殖醫學中心、兒童醫學中心等科室都有成熟的體重管理特色門診……
From the perspective of patient categories, how can the weight management clinic cover the treatment needs of "fat friends" with different degrees of obesity? At present, all hospitals basically adopt the mode of classified management to "prescribe the right medicine".
For example, in Beijing Tsinghua Chang Gung Hospital, Lin Siyong introduced that the first thing is to "move the threshold forward" of weight management: for people with normal BMI but worried about the risk of obesity, through health education, diet and lifestyle guidance to prevent overweight, that is, "cure the disease". Secondly, for patients with "simple obesity", nutritional metabolism assessment was carried out, and scientific intervention programs were formulated, including dietary and nutritional intervention, lifestyle intervention, drug treatment, etc. For patients with obesity and other systemic complications, such as obesity with diabetes mellitus, affecting reproductive health, etc., multidisciplinary joint outpatient management is required; Finally, a small number of patients may have serious complications due to obesity, such as severe diabetes, cardiovascular and cerebrovascular diseases, etc., and it is necessary to initiate multidisciplinary MDT comprehensive diagnosis and treatment, and in addition to nutritional intervention, develop more active treatment plans, including drugs, minimally invasive bariatric surgery, etc.
Lin Siyong said that weight management is not "overnight, overnight", from the early stage of health education, advocating a healthy lifestyle, to dietary and nutritional intervention, drug treatment, bariatric surgery, and postoperative rehabilitation, the hospital will implement the whole process and full cycle of closed-loop management for patients.
·Breakthrough·
Doctors have a number of tips for making weight management sustainable
Weight management is not an easy task. Regarding weight loss, some people can successfully lose weight by "keeping their mouths shut and opening their legs", some people even lose more and more weight, and some people end up hastily because of the long time and painful process of weight loss. Yang Qinbing said that on the road to weight loss, "fat friends" mainly face two major "obstacles": one is afraid of starvation, and the other is afraid of being affected by exercise. The hardest thing to lose weight is to persevere, how to break through? After battling obesity for many years, doctors have accumulated a lot of skills.
4月10日，36歲的陳鑫（化名）來到北京清華長庚醫院臨床營養科就診，身高一米八的他體重達到了99公斤，BMI為30.56，屬於肥胖。楊勤兵建議採取飲食調整+運動的方式減重，並給陳鑫出具了一份飲食指導方案。
The plan indicates the amount of food to be consumed, as well as information on food options, careful food selection, cooking methods, precautions for eating, and appropriate exercise. A reporter from Beiqing Daily noticed that Chen Xin's food choices involve eight categories of common foods such as staple foods, vegetables, meat, eggs, and milk, which seem to be very rich, and the total daily intake can not exceed 2.0 servings. "Let me only eat one or two things to lose weight, I will definitely not be able to stand it, all kinds of food together, weight loss will not be too painful." With the blessing of the doctor, Chen Xin is full of confidence for the "long road to weight loss".
"This will allow the 'fat friends' to lose weight without starving. If he is allowed to eat boiled vegetables every day, or if he is not allowed to eat staple foods purely by starvation, he will definitely not last for a few days. For each patient, we developed a 'food exchange table', which included eight common food groups, and measured the total daily calorie intake of the target body weight for them, and then allocated these calories evenly to the eight food groups and converted into daily intake. Through scientific allocation, it can not only control calories, but also allow patients to eat as much food as possible, and the nutrition is balanced, which is more conducive to long-term persistence. Yang Qinbing said.
At Beijing Shijitan Hospital, Lian Dongbo follows a "stepwise approach", suggesting that patients slowly reduce their intake, eating one-third less than usual at each meal, so that the body can have a smooth transition. For people who are really "difficult to start", such as those with a large base and no time to exercise, appropriate drug assistance will be given according to the patient's physical condition, so that the patient can see the weight loss and slowly build self-confidence, which will help long-term perseverance.
For many "fat friends", it is a big challenge to be afraid of exercising and getting tired. In this regard, Yang Qinbing said that the scientific movement is the key. "In order to avoid the patient's body aches and affect his motivation to exercise, we recommend that he stretch enough after exercise to reduce the discomfort after exercise. Some people do have a fast pace of life and work and have no time to exercise, so it is recommended to integrate exercise time into daily life, such as cycling, brisk walking, etc. for commuting, and use these fragmented exercises to lower the threshold for execution and increase physical consumption. ”
What should I do if I lose weight halfway? "Weight stewards" came to help, and hospitals have established follow-up systems to "supervise" them regularly. It is worth mentioning that Beijing Tsinghua Chang Gung Hospital also plans to introduce a case manager system, where a dedicated person with a medical background is responsible for the establishment of health records, regular follow-up and personalized guidance, and urges people to do a good job of self-management. "With the introduction of artificial intelligence technology, we will also rely on the perfect smart medical system in the hospital to provide comprehensive dynamic health consultation and diagnosis and treatment services in the future, making weight management more convenient and easy." Lin Siyong said.
·Misunderstanding·
Obesity is not actually a disease? Don't wait until you have complications to see a doctor
Some people believe that obesity is just bad shape. In fact, the World Health Organization has long defined obesity as a chronic disease and has warned the world that obesity will become the world's leading health problem.
Lian Dongbo said that medical research has confirmed that obesity is closely related to the occurrence of more than 40 diseases, the most common are metabolic problems (such as diabetes, hyperlipidemia), cardiovascular and cerebrovascular diseases (such as coronary heart disease, stroke), respiratory problems (such as sleep apnea, blood oxygen saturation is as low as 0% in severe cases), as well as osteoarthritis, polycystic ovary syndrome and so on. In addition, obese people may also have psychological problems such as low self-esteem and depression, and social, employment, and emotional problems may also be affected.
Yu Feng also paid attention to the fact that there are more and more obese people, but only a small part of them go to the hospital, and the awareness of "fat friends" to take the initiative to seek medical treatment is still weak. "Many people seek medical treatment because of complications, such as diabetes, high blood pressure, joint pain, etc., which may be closely related to obesity and need to be vigilant."
Is it okay to be "flexible fat"? Physical indicators will change from quantitative to qualitative
Nowadays, there are many overweight people active on various social platforms, some can dance enchanting dances to the camera, some can perform well on the sports field, and their talents even exceed ordinary people, many people call themselves "flexible fat people"; Some people also think that "fat friends" look happy and attractive.
Lian Dongbo reminded, "In fact, in a strict sense, there is no healthy fat person in the world, and obesity is inevitably accompanied by potential risks, but the various indicators of the body have not yet crossed from quantitative to qualitative changes." For example, the flexibility of the 'fat friend' has not yet decreased the mobility of the joints of the body, but if the weight remains high, the exercise ability will inevitably be impaired. As long as you are overweight and obese, you must manage your weight. ”
Does a weight loss artifact work? Anything that deviates from the laws of science is pseudoscience
In the market, weight loss products and methods are emerging in an endless stream. Lian Dongbo reminded that weight loss cannot escape the physical law of "energy gap" - intake is less than consumption to lose weight, and all products that are out of scientific law are pseudoscience. Some slimming shower gels, fat burning creams, etc., are essentially gimmicks created by merchants to seize the psychology of consumers who are eager to achieve results.
There are also "fat friends" who will follow the sports anchor to exercise blindly, and their weight has not changed after running for half a year, and their knees are wasted first. There are also people who rely on home remedies, such as blind ketogenic diet or extreme fasting, which is easy to hurt their body. Lian Dongbo suggested that everyone should manage their weight scientifically, and if they are not sure, they can go to the hospital to seek a professional plan.
The thinner the body, the more beautiful you are? Lean people also need weight management
At present, many young women pursue the aesthetic of "white and thin", believing that the thinner and slimmer the better, but they are too thin or hide health problems. Lian Dongbo said that "weight management" is not only to lose weight, but also to pay attention to the situation of underweight. People with a BMI of less than 5.0 should be aware that there may be a risk of malnutrition. Weight management is a two-way street, and it is necessary to pursue a "healthy body" rather than blindly thin.
Yang Qinbing reminded that even people with a BMI within the normal range should pay attention to weight management and be wary of hidden obesity with too high body fat percentage. At the same time, a good weight should also be maintained, especially when the metabolism declines at the age of forty or fifty, people are easy to gain weight, and weight management needs to be done in advance. "Weight management should never be seen as a phased task, but as a long-term, healthy lifestyle."
This edition is also photographed by reporter Jiang Ruojing
Basemap/Visual China