The “China Obesity Metabolic Surgery Database: 2023 Annual Report” shows that the national number of weight loss surgeries reached over 37,000 in 2023, an increase of over 10,000 compared to 2022.
Obesity is not just about beauty, it’s also a disease. In 1997, the World Health Organization (WHO) first defined obesity as a disease. Increasing evidence indicates that being overweight or obese is a significant risk factor for cardiovascular diseases, diabetes, various cancers, and other chronic illnesses.
Recently, Dr. Gu Yan, Director of General Surgery at Fudan University Affiliated Huadong Hospital, stated in an interview with The Paper (www.thepaper.cn) that in recent years, the number of weight loss metabolic surgeries nationwide has been increasing. People are paying more attention to the dangers of obesity, but not everyone needs surgical treatment. In outpatient clinics, doctors often have to reject irrational surgical requests.
Weight loss metabolic surgery has strict indications, with Body Mass Index (BMI) being an important measure of obesity and its severity. BMI ≥ 37.5 suggests active surgery; 32.5 ≤ BMI < 37.5 recommends surgery; BMI ≥ 27.5, when lifestyle changes and internal medicine treatments are ineffective in control, and there are at least two components of metabolic syndrome or the presence of complications, surgical treatment may be considered after a comprehensive evaluation.
On August 14, at Fudan University Affiliated Huadong Hospital’s Obesity and Metabolic Disease MDT Clinic, a preoperative discussion was held with a patient from Jiangsu. All images in this article are provided by Huadong Hospital.
Surgery “is not something you can do just because you want to.”
The indications for weight loss surgery are clear, and doctors will firmly reject unsuitable patients.
Dr. Gu Yan mentioned a case where a young woman in her early twenties, weighing 58 kilograms, with a height of 162 centimeters and a BMI of 22.1, visited the clinic demanding surgery because she was not satisfied with her body shape after browsing information online. She was rejected by the doctor.
Such cases are common, mostly involving young people. There was also a university student with a BMI just reaching 28, who directly requested weight loss surgery after coming to Dr. Gu Yan’s clinic, but was ultimately turned down.
Dr. Gu Yan emphasized that while weight loss has become a common societal phenomenon, blindly undergoing weight loss surgery carries risks. He encountered a patient who did not meet the necessary surgical indications and underwent weight loss surgery at a private hospital, experiencing adverse reactions post-surgery, requiring urgent treatment at Huadong Hospital.
“Weight loss surgery is a surgical treatment with strict indications; it is not something you can do just because you want to,” emphasized Dr. Gu Yan.
To better assist patients in resolving obesity issues, Huadong Hospital recently established an Obesity and Metabolic Disease MDT (multidisciplinary) Clinic. Dr. Gu Yan, along with the hospital’s Director of Anesthesiology Gu Weidong, Director of Endocrinology Lu Bin, and Director of Nutrition Wu Jiang, collectively provide individualized diagnosis and treatment.
Dr. Gu Yan mentioned that for safe and effective weight reduction surgery, it requires the combined efforts of multidisciplinary experts to conduct preoperative evaluations, analyze nutrition, endocrine indicators, etc., and provide different treatment plans for various patients, including surgical and medical treatments, as well as nutritional and lifestyle guidance.
“Obesity is a disease,” said Dr. Gu Yan. The “Report on the Nutrition and Chronic Disease Status of Chinese Residents (2020)” indicated that the situation of overweight and obesity among Chinese residents is severe, with overweight and obesity rates of 34.3% and 16.4% among adult residents.
In clinical practice, attitudes towards obesity among patients often vary drastically. Some completely disregard it, believing a “ruddy complexion” is a sign of health, when it could actually be facial flushing due to high blood pressure; while others excessively focus on it, leading to body image anxiety.
There are many criteria for classifying obesity, with common classifications being “simple obesity” and “secondary obesity” based on causation. Dr. Gu Yan explained that “simple obesity” mostly results from overeating, with the improvement in living standards leading to excessive eating habits and emotional overeating, making it easy to become obese. On the other hand, “secondary obesity” is mainly due to endocrine, hypothalamus, genetic, and medication-related factors.
Obesity poses various risks, causing physiological issues such as type 2 diabetes, fatty liver, cardiovascular diseases, and metabolism-related diseases, while also easily triggering anxiety and depression psychologically.
For different types of obesity, different weight reduction treatment plans need to be adopted. In the case of severe obesity, simply altering lifestyle habits often fails to achieve effective weight loss. Patients with severe obesity undergo evaluation by specialist physicians and multidisciplinary consultations to meet the surgical indications criteria and may undergo surgical treatment.
Weight loss metabolic surgery has been applied clinically in China for over 20 years. The mainstream surgical methods include laparoscopic sleeve gastrectomy, single-anastomosis gastric bypass surgery, Roux-en-Y gastric bypass surgery, with laparoscopic sleeve gastrectomy accounting for over 80%.
“With technological advancements, surgeries are now minimally invasive, and there are even day surgeries where patients are discharged on the same day as the operation. Most patients are discharged one or two days post-surgery,” noted Dr. Gu Yan; for instance, at Huadong Hospital, over 400 weight loss surgeries are performed annually, all minimally invasive procedures.
Dr. Gu Yan’s team at Fudan University Affiliated Huadong Hospital performing weight loss surgery for patients.
Dr. Gu Yan stated that while the safety and effectiveness of weight loss surgery have been validated, patients undergoing such procedures still require nutrition, exercise management, and guidance, as well as timely follow-up. More importantly, “control your diet and stay active” in daily life, adopt a healthy lifestyle, and mitigate the occurrence of obesity and related complications through prevention.
