In the weight loss clinic of Beijing Children’s Hospital affiliated to Capital Medical University, a child stands on a body composition analyzer with the help of a doctor. Photo by Tan Sijing/apprentice reporter of Youth Daily.
Dr. Yan Jie, Chief Physician of Clinical Nutrition Department of Beijing Children’s Hospital affiliated to Capital Medical University, has designed a weight loss nutrition plan for 14-year-old boy Li Zheyu. Photo by Tan Sijing/apprentice reporter of Youth Daily.
During the summer vacation, the weight loss clinic of Beijing Children’s Hospital affiliated to Capital Medical University was filled with “chubby” children and their parents seeking treatment.
Guided by a doctor, 10-year-old Qi Meng stands barefoot on the body composition analyzer, holding the instrument handles. The display shows weight, BMI (Body Mass Index), body fat percentage, visceral fat area, body shape assessment, and other information. After a series of tests, a weight loss nutrition plan tailored for Qi Meng is generated, specifying what foods to eat and how much of each type to consume daily. After fully communicating with the child and the parents about lifestyle habits, the doctor adjusts some contents of the diet, and Qi Meng starts implementing the weight loss plan.
“During the summer vacation, we customize dozens of such diets every day.” Dr. Yan Jie, the Chief Physician of the Clinical Nutrition Department of the hospital, told the Youth Daily reporter.
According to the “Chinese Residents’ Nutrition and Chronic Disease Status Report (2020)” released by the National Health Commission in 2020, the overweight and obesity rates of residents in urban and rural areas of China are continuously increasing, with the overweight and obesity rates among children and adolescents aged 6-17 approaching 20%, and below 6 years old reaching 10%. The report predicts that if not curbed, by 2030, the prevalence of overweight and obesity among school-aged children and adolescents will reach 31.8%, and among preschool children, it will reach 15.6%.
Professor Mi Jie, Director of the Children’s Chronic Disease Management Center at Beijing Children’s Hospital affiliated to Capital Medical University and Chairman of the Children and Adult Disease (Chronic Disease) Prevention and Control Committee of the Chinese Preventive Medicine Association, told reporters about the hazards of childhood obesity: “Childhood obesity increases the risk of many diseases, such as hypertension, abnormal blood lipids, high blood sugar, high uric acid, fatty liver, etc. In recent years, many ‘adult diseases’ have begun to appear at a younger age, and obesity is a factor that cannot be underestimated; secondly, childhood obesity can cause early puberty, precocious sexual development, regardless of boys or girls, excessive obesity can cause problems in sexual gland development; in addition, childhood obesity can also lead to abnormal secretion of sex hormones, advanced bone age, affecting height; obesity also affects children’s psychological health, obese children are often lacking in confidence, and some extreme cases may have social disorders.”
As the rates of overweight and obesity continue to rise, more and more hospitals are setting up weight loss clinics. “In the past, the endocrinology department of Beijing Children’s Hospital had a specialty in obesity, and in 2014, the nutrition department opened a weight loss clinic. The medical team consists of endocrinologists and nutritionists. There are 1-3 doctors on duty at each session,” Yan Jie said. “In recent years, public health awareness has gradually increased, and during summer and winter vacations, many children coming to the weight loss clinic for treatment.” The number of outpatients in the endocrinology department for weight loss is around 20-30 people on regular days, reaching more than 100 people during the summer vacation, and the Nutrition Department’s Weight Loss Clinic has increased from ten to over thirty people.”
“Chubby children” shuttling between weight loss clinics and endocrinology clinics
When reporters from Youth Daily followed up on interviews at the hospital, they often saw some “chubby children” transferred from the weight loss clinic to the endocrinology clinic, and similarly, children transferred from the endocrinology clinic to the weight loss clinic. Why are they, all being “chubby children,” transferred between different departments?
Yan Jie explained, “Many parents do not consider their children’s obesity as a disease. They bring their children to the endocrinology clinic for more examination of small reproductive organs, rapid growth and development, or various abnormal physical indicators, which appear to be other conditions, but most are actually caused by obesity. To treat the condition, the children need to lose weight first, so they are transferred from the endocrinology clinic to the weight loss clinic. Some parents are aware of their children’s obesity problem, and take them to the weight loss clinic; after a checkup, if conditions like diabetes and fatty liver are already present, they have to be transferred from the weight loss clinic to specialized departments such as endocrinology for professional treatment.”
“Many parents don’t see childhood obesity as a disease,” Yan Jie sighed.
Qi Meng was transferred from the endocrinology clinic to the weight loss clinic. Initially, his mother brought him for treatment of advanced bone age issues. The doctor judged that the child’s advanced bone age and rapid growth were caused by excessive obesity, so he recommended him to seek treatment at the weight loss clinic.
When Qi Meng’s mother adjusted the diet plan with the doctor, the reporter asked Qi Meng if he was confident about losing weight. Qi Meng said he didn’t have much confidence, “I don’t want to lose weight, I’m just here with my mom today because I’m ‘forced to’.”
Yan Jie told the Youth Daily reporter, “Many children are in a period of growth and development, they love to eat and play, and they are resistant to weight loss suggestions. This is when parental awareness is very important. “Children whose parents pay attention to weight loss can almost always succeed in losing weight”.
Before the annual exams, many parents go to the hospital to get a medical excuse for physical education classes. Whenever this happens, Yan Jie will remind them that they can get the form, but they should make time to bring their children to the weight loss clinic, as obesity should not be ignored.
“Many parents have misconceptions about childhood obesity, thinking that chubby kids are healthier. Children are in a period of growth and development; gaining weight can lead to growth spurts, and they will naturally lose weight during adolescence; when they hear that their child’s illness is caused by obesity, they don’t think much of it, believing that losing weight will solve the problem. Little do they know that obesity can disrupt the body’s metabolism. If not corrected in a timely manner, children will develop high blood pressure, diabetes, gout, and other diseases, just like adults,” Yan Jie said.
“Children’s unbalanced nutrition is mainly due to the family’s improper dietary structure. These families have the following dietary problems: skipping breakfast, irregular meals, excessive consumption of high-energy density foods such as meat, sugary drinks, fried foods, insufficient variety in the diet, and insufficient intake of vegetables,” Yan Jie said. “Some parents themselves have beer bellies and dictate weight loss to their children, but don’t practice what they preach, so it’s difficult for their children to lose weight.”
Childhood weight loss is different from adult weight loss; children need parental guidance and the support of the entire family. Therefore, the focal point of childhood weight loss lies in parents having the correct awareness of obesity and its dangers.
The Dilemma Troubling Parents: Where to Learn Scientific Weight Loss Knowledge
Xia Lulu, a chief physician in the Clinical Nutrition Department of Beijing Children’s Hospital affiliated with Capital Medical University, is on duty at the weight loss clinic irregularly during the summer vacation. She told the Youth Daily reporter that among the obese children they encounter at the clinic, 95% are cases of simple obesity (obesity caused by the interaction of genetic and environmental factors, with environmental factors including imbalanced diet, lack of exercise, insufficient sleep, and emotional neglect). Excessive energy intake and an unbalanced diet are important causes of overweight and obesity in children. “After being diagnosed with obesity, many parents will think that their children are eating too much and too well, resulting in excess nutrition. The children are indeed obese due to overeating, but not because they eat well; on the contrary, it is because they have poor eating habits and nutritional imbalance,” Xia Lulu said.
Helping children lose weight requires a correct understanding as a premise and the need for scientific weight loss knowledge. This is also a dilemma for many parents – where can they learn scientific weight loss knowledge?
14-year-old boy Li Zheyu from Inner Mongolia, less than 1.7 meters tall, weighing 91.6 kilograms, traveled with his mother all the way to Beijing Children’s Hospital for obesity treatment. After six months of treatment, his weight has now dropped to 81 kilograms.
However, the mother and son had a setback on the weight loss journey before. Half a year before starting the weight loss treatment, Li Zheyu was found to have high uric acid, fatty liver, and black knoll skin through a physical examination, prompting the mother and son to decide to lose weight together at home. Following the misguided guidance of an online weight loss blogger, they ate large amounts of vegetables every day, only had one meal of beef or fish per week, which not only led to unsatisfactory weight loss results but also both were diagnosed with anemia.
Li Zheyu’s mother told the Youth Daily reporter that the weight loss knowledge online is all over the place, sometimes making her dizzy. She also tried to follow the “Chinese Residents’ Dietary Guidelines (2022)” to cook for her child, but due to the child’s health conditions, some recommended foods couldn’t be eaten carelessly, and she didn’t know what to replace them with. “How to help my child lose weight scientifically is a big challenge for me,” Li Zheyu’s mother said.
Heard that Beijing Children’s Hospital has a weight loss clinic, Li Zheyu and his mother took a twenty-plus-hour train journey to Beijing. Based on Li Zheyu’s physical condition, Yan Jie has developed a specialized weight loss diet for him and worked with Chinese medicine to provide an additional prescription for supplementary Chinese medicine.
Yan Jie told the Youth Daily reporter, “Obese children have a too monotonous dietary structure, so they need to adjust their dietary structure and balance their nutrition. We tailor a specific diet for them based on their physical condition. For example, if a child has high uric acid, they need to eat less soy products and seafood, and we replace these types of foods with other nutrient-rich foods. Combined with Chinese medicine to control the child’s chronic diseases, Chinese medicine has unique value in weight loss. Generally, the bodies of obese children contain a lot of moisture, so we use Chinese medicine to strengthen their spleen and eliminate dampness according to their physical constitution.”
“This time, it was much easier to stick to the weight loss compared to before. My mom bought a food scale, cooks meals for me according to the diet every day, it’s rich and satisfying, and I lost weight without feeling hungry,” Li Zheyu said. During the monthly follow-up visits, Li Zheyu has gradually lost weight, feeling lighter and more agile.
Before the high school entrance exam, due to excessive academic pressure, Li Zheyu’s weight did not rebound, but some indicators showed a small rebound. During the summer vacation, Li Zheyu’s mother asked Yan Jie, “Although my child has lost 20 pounds, he still looks weak and his skin seems looser. What’s going on?”
Yan Jie explained, “This is a common issue for many people trying to lose weight – focusing only on controlling diet while neglecting scientific exercise. As weight decreases, the distribution of fat and muscles changes; muscle mass decreases, and body fat percentage increases.”
According to Xia Lulu, assessing childhood obesity should consider three factors: BMI (Body Mass Index), waist-to-height ratio, and body fat percentage.
The formula for calculating BMI is weight (kg) / height^2 (m^2). If BMI is higher than the 95th percentile for children of the same age and sex, it is considered obesity. For children aged 6 and above, the ideal waist circumference (cm) / height (cm) ratio should be less than 0.46. For boys and girls under 12 years old, the body fat percentage should be less than 20%, and for girls over 12 years old, it should be less than 25%. Exceeding these ranges indicates obesity.
Yan Jie said, “The goal of weight loss should be to fully restore normal body indicators, not just focus on weight loss. So once weight loss reaches a certain stage, while combined with dietary control, it is necessary to incorporate scientific exercise (a combination of aerobic and anaerobic exercises). This is also the pain point of the weight loss clinic.”
Children’s weight loss clinics are missing a “prescription for exercise”
When it comes to weight loss, it involves both managing diet and exercising. The weight loss clinic provides detailed diet plans for children, specifying what to eat, how much to eat, and when to eat. However, when it comes to exercise, the doctors in the weight loss clinic can only give children and parents very vague advice to “exercise continuously for at least 30 minutes.”
Yan Jie expressed helplessness: “Comprehensive reduction in body indicators requires exercise. Currently, hospitals can provide detailed dietary guidance, but lack specific intervention methods for exercise, and the doctors in weight loss clinics do not have the qualifications to prescribe exercise.”*
What is an exercise prescription? In simple terms, it is a scientifically designed personalized fitness program in the form of a prescription based on the results of physical tests of participants, such as age, sex, personal health information, medical examination results, sports experience, and cardiovascular endurance, etc. This aims to develop a systematic and personalized scientific fitness regimen. Exercise prescriptions aim to change the incorrect habit of excessive reliance on medications and surgeries for medical intervention, neglecting the body’s ability to repair itself, and foster a lifestyle of promoting health through exercise. It is an effective method for preventing and treating chronic diseases, sports injuries, and many sub-health issues.
Journalists learned that in 2023, the “Expert Consensus on Exercise Prescription in China (2023)”, which was formed by the National Sports Administration Sports Medicine Research Institute and the Chinese Exercise Rehabilitation Medicine Training Project, was officially released. The expert consensus divided exercise prescriptions into fitness exercise prescriptions and medical exercise prescriptions. Fitness prescriptions mainly serve healthy people and those at risk of chronic diseases, while medical exercise prescriptions mainly serve people with chronic diseases, sports injuries, and those in the perioperative period. It specifies that exercise prescription developers must be qualified exercise prescription technicians, and implementers must be qualified rehabilitation therapists, exercise rehabilitation therapists, exercise health therapists, or fitness coaches, etc.
Yan Jie explained, “Different exercises should be prescribed for obesity-induced chronic diseases. For example, hypertension patients must ramp up their exercise gradually; they shouldn’t start doing weightlifting like others but should pay attention to exercise intensity and avoid high-intensity strength training because sudden exertion can lead to a rapid rise in blood pressure and potentially cause cardiovascular problems. And for diabetes patients, they are more suited to aerobic exercises. It should be noted that diabetes patients are prone to have low blood sugar, so they should avoid exercising within one hour after meals, and morning fasting exercises are also taboo. Diabetic patients need to pay special attention to their choice of exercise time.”
“Currently, the General Administration of Sport has been training personnel with exercise prescription qualifications. However, they cannot enter hospitals and collaborate with doctors to serve patients with chronic diseases. Most doctors can only give patients exercise ‘suggestions,’ rather than scientific ‘exercise prescriptions’,” Yan Jie told reporters. Fitness workers from the sports sector and staff in sports and fitness institutions do not have medical knowledge about chronic diseases. Doctors often advise patients to exercise, but due to a lack of professional knowledge on exercise prescriptions and scientific fitness skills and experience, they cannot tailor exercise prescriptions to patients’ conditions; gym instructors can teach how to run but are unaware of what exercise is suitable for individuals with health problems.”
Yan Jie said, “Children’s weight loss requires the joint cooperation of family, school, medical, and sports sectors. Currently, ‘integration of medical and physical education’ as a national strategy has been included in the “Healthy China 2030” plan. The “14th Five-Year Plan for National Economic and Social Development of the People’s Republic of China and the Long-Range Objectives for 2035″ has prioritized ‘advancing the health frontier, deepening sports-medical integration’ in building a healthy China and strengthening the country’s sports sector. ‘Medical and physical integration’ represents a new trend in health promotion philosophy. Jiangsu Province has already implemented sports-medicine integration services for chronic disease patients in community hospitals, yielding significant results. However, for weight loss clinics, to unleash the full potential of 1 + 1 > 2 integration, it requires further exploration.”
And this is what Yan Jie is currently working on. “We are collaborating with multiple industry experts to apply for the industry standard – the standardized system construction for the integration of medical and physical education in children and adolescents’ weight loss clinics.”
Yan Jie expressed hope for future collaboration with the sports sector to jointly advance the implementation of exercise prescriptions in clinical settings. At that time, when the “chubby children” enter the weight loss clinic, they will receive customized weight loss meal plans and exercise prescriptions all in one go, achieving the goal of ‘managing diet and exercising.’
The “State Council’s Opinions on Implementing the Healthy China Action” proposed the implementation of 15 major special actions to promote the shift from disease-centered to people-centered health. Among these actions is the promotion of the integration of sports and medicine in disease management and health services. By 2030, the proportion of urban and
