Obesity is a chronic disease! Famous psychiatrist Yang Congcai: Improving obesity requires consideration of both physiological and psychological environments

The World Health Organization points out that "obesity is a chronic disease" and calls for attention to the harm of obesity to health. Compared with people with a healthy weight, obese people have more than three times the risk of developing diabetes, metabolic syndrome and dyslipidemia, and twice the risk of developing hypertension, cardiovascular disease, knee arthritis and gout. Studies have confirmed that when obese people lose more than 5% of their body weight (for example, an adult weighing 90 kg loses 5 kg), it can bring many health benefits, and obesity-related diseases such as hypertension and diabetes will be improved.

The World Health Organization points out that "obesity is a chronic disease" and calls for attention to the harm of obesity to health.

Body mass index (BMI) or waist circumference is commonly used internationally as an indicator to assess obesity. In China, BMI ≥ 24 is considered overweight, ≥ 27 is considered mildly obese, > 30 is considered moderately obese, and above 35 is considered severely obese.

Obesity is caused by excessive calorie intake and too little calorie consumption, which leads to calorie accumulation and accumulation in the body in the form of fat, causing obesity. The factors that cause obesity are diverse, and they must be evaluated and treated from a multi-pronged perspective of physiology, psychology, and environment in order to treat both the symptoms and the root cause and avoid the recurrence of the problem of weight gain.

A = Physiological factors

A- Congenital genetic factors

Simply put, if mom and dad are fat, their children will also be fat. The formation of an obese family is mainly related to genetics. Of course, it is closely related to the family’s eating patterns and habits. There is increasing evidence that genetic inheritance is one of the main causes of obesity. The discovery of the obesity gene (Ob gene) in 1995 provided the best evidence. Leptin, a fat-derived hormone transcribed by the Ob gene, can be produced by fat cells and transmitted to the brain through the blood circulation to regulate food intake and increase energy consumption.

Therefore, in addition to lifestyle and eating habits, the normal function of leptin is also important in the cause of obesity in the family. Because when the concentration of leptin in the blood is low or the receptors that bind to leptin in the brain are abnormal, it is easy to cause overeating, body fat accumulation, reduced energy consumption, and finally weight gain and obesity. Another study pointed out that the weight of a group of adults who were adopted at an early age was closer to the body shape of their biological parents. Therefore, for obese families, genetic factors are more important than environmental factors in obesity. There is no good treatment for this part.

B- A few diseases may also cause obesity

A few diseases may also lead to obesity, including hypothyroidism, Cushing's syndrome and some neurological diseases. Taking certain medications such as steroids can also cause obesity. This part requires finding out the cause of the disease and treating it to improve it.

C- Obesity is caused by excessive calorie intake and insufficient energy expenditure

Obesity is caused by excessive calorie intake and too little calorie consumption, which leads to calorie accumulation and accumulation in the body in the form of fat, causing obesity. So the content of food is very important.

Obesity and depression have a causal relationship. Obese people may suffer from depression due to psychological stress and metabolic disorders. On the other hand, depressed patients may become obese due to changes in diet and lifestyle habits, such as overeating and lack of exercise.

B = Psychological factors

Psychological factors also play a role in influencing eating behavior. Therefore, abnormal overeating is often a way to vent emotions such as emptiness, anger and sadness. According to statistics, about 30% of obesity is caused by psychological factors. In the case of overeating, patients usually cannot control their eating emotions, and then they will induce vomiting, forming a vicious cycle. This symptom is usually called bulimia. This type of obese patient usually has difficulty maintaining or losing weight and therefore requires assistance from a psychiatrist or psychotherapist.

There are also mood disorders. When people encounter setbacks or unpleasant things, they will inevitably feel low and lose motivation to do anything. However, if they indulge in negative emotions for a long time, are always distracted, sometimes cry for no reason, or even have suicidal thoughts, they may be suffering from depression. Many documents show that obese people are much more likely to suffer from depression and anxiety than other people. Some studies have shown that obese people have a 20% increased risk of depression, and women with a BMI of 30 or above have a more than 50% increased risk of depression.

It is currently believed that obesity and depression have a causal relationship. Obese people may suffer from depression symptoms due to psychological stress and metabolic disorders. On the other hand, patients with depression may become obese due to overeating and lack of exercise due to changes in diet and lifestyle habits.

C = Lifestyle and social environment factors

The environment is also one of the main causes of obesity. Environmental factors include lifestyle and dietary behavior. Take Americans as an example. When it comes to food choices, they tend to choose high-calorie foods, and taste and convenience are often considered more important than nutritional value. In addition, modern people generally do not exercise enough, so the accumulated calories cannot be consumed and naturally accumulate as fat, causing the weight to increase day by day.

D = Taiwan's new weight loss drug

Contrave® (bupropion/naltrexone) is a combination preparation approved for marketing by the U.S. Food and Drug Administration (FDA) in 2014. Bupropion is an antidepressant that can increase the activity of dopamine and norepinephrine, thereby suppressing appetite and increasing energy expenditure. Naltrexone is an opioid antagonist that can suppress appetite. Contraindications to its use include patients with uncontrolled hypertension, epilepsy, long-term use of opioids, and those who have used monoamine oxidase inhibitors (MAOIs) within 14 days.

E = Adjust your diet and exercise lifestyle

To change cardiovascular risk factors, you can make corrections by adjusting your lifestyle. Diet control and increased physical activity are the core principles of weight loss. You must implement diet control and physical activity in your life through self-management, lifestyle adjustments and behavioral changes to achieve the goal of weight loss. This method can help you lose about 3-5% of your weight in a year. Taking 90 kg as an example, it is about 3-5 kg. Be careful not to use inappropriate methods to lose weight, which may result in a yo-yo effect where you lose weight and gain weight again.

(1) Healthy eating:

Three mores and three lesses - drink more boiled water, eat more fruits and vegetables, more whole grains, less oil, less salt, and less sugar. Reducing your daily calorie intake by 500 calories, or reducing your food intake by 300 calories and increasing your physical activity by 200 calories more, can help you lose about 0.5 kg per week. And when controlling your weight, you should pay attention to not less than 1200 calories per day.

(2) Happy Movement:

At least 10 minutes each time and 150 minutes accumulated per week of moderate-intensity physical activity can only maintain body posture and basic physical fitness. If you want to lose weight or improve physical fitness, you must accumulate more than 300 minutes of moderate-intensity physical activity per week. If you can add high-intensity aerobic exercise or high- and low-intensity interval exercise, it will be easier to achieve weight loss and health promotion effects. In addition, you should do at least two days of strength training for large muscle groups, which can not only increase muscle mass, but also increase insulin sensitivity and reduce the risk of metabolic syndrome.

(3) Weigh yourself every day:

You can always remind yourself to maintain a healthy weight.

= Maintain a healthy diet and exercise lifestyle, and follow a weight loss plan as recommended by your doctor:

Maintain an adjusted lifestyle and seek help from professionals including physicians, psychologists, nurses, sports instructors, nutritionists, etc., to plan and design individualized exercise prescriptions and low-calorie diets based on personal conditions to help lose weight. This method can help you lose about 5-10% of your weight in a year. Taking 90 kg as an example, it is about 5-9 kg.

Health is one, everything else is zero. Obesity, a modern civilization disease, is something that requires a long-term battle. Let’s work together!

Yeung Chung Choi Clinic