Recently, Mr. Zhang, a Beijing resident who has been troubled by weight for years, heard that many tertiary hospitals have opened health weight management clinics and registered for treatment with a trial mentality. Mr. Zhang said, "For over a decade, my weight has always been above 200 pounds. I have tried to lose weight several times, but the results were not good. This time I went to the hospital to see an outpatient department, hoping to lose weight." According to him, at the hospital, doctors asked about his physical condition and conducted blood tests and other tests. "I always thought there was diabetes, but from the test results, the blood sugar value was within the normal range. The doctor prescribed medication and after taking it on time for a week, I lost 3 pounds and my mental state improved. ”He said happily. At the recent National Health Work Conference, the National Health Commission identified ten practical measures for serving the people throughout the system by 2026. One of them is that all tertiary public hospitals will provide outpatient services for healthy weight management to reduce the harm of chronic diseases to the health of the population. From the joint launch of the "Weight Management Year" by 16 departments in 2024, to the establishment of weight management clinics in many tertiary hospitals by 2025, and to the requirement for full coverage of tertiary public hospitals by 2026, weight has always been a hot topic of discussion among the public. The problem of obesity is not optimistic. In the opinion of Ms. Chen from Guangdong, it is necessary to go to the hospital's weight management clinic for registration and examination if overweight is detected. At the end of last year, I went to the nutrition and weight loss clinic of the hospital for examination. Because BMI (body mass index, calculated by dividing weight in kilograms by height in meters squared, is a commonly used international standard for measuring body fat and health) is relatively high, doctors used instruments to measure body fat and then developed a diet plan based on my lifestyle habits, recommending moderate exercise. After persisting for a month, I lost 5 pounds in weight. ”Ms. Chen said. In her opinion, going to the hospital to lose weight does not mean taking medication, injections, or even surgery. Instead, under the guidance of a doctor, one should have a better understanding of the body, including the causes of obesity, and based on this, carry out scientific weight loss. She said, "I only paid for the registration and examination fees, which add up to less than 100 yuan. It's worth noting that the obesity problem among Chinese residents is not optimistic. The "Report on Nutrition and Chronic Disease Status of Chinese Residents (2020)" released by the National Health Commission shows that the overweight and obesity rate among adult residents exceeds 50%, the overweight and obesity rate among children and adolescents aged 6 to 17 is nearly 20%, and the overweight and obesity rate among children under 6 years old reaches 10.4%. It is understood that hypertension, hyperlipidemia, and coronary heart disease are all related to obesity; Most patients with type 2 diabetes are overweight or obese, and long-term uncontrolled blood sugar may also cause damage to the kidneys, eyes, and even joints. For women, being overweight can easily lead to menstrual irregularities, polycystic ovary syndrome, and even affect fertility; Men may experience hormonal imbalances, which can affect their reproductive function. Moreover, the harm caused by obesity accumulates slowly, and there may be no sensation in the early stages. By the time symptoms actually appear, the situation is often already quite serious. According to the interviewed experts, weight management is a systematic project. Weight management clinics are usually composed of multidisciplinary teams such as doctors, nutritionists, and exercise instructors, acting more like a diagnostic and guidance center that can help overweight individuals scientifically assess their physical condition, identify the true cause of obesity, and provide personalized weight loss plans. The reporter noticed that although many hospitals have weight management clinics, specifically, the names of the clinics are different. Some are called TCM weight management clinics, which regulate body functions by identifying physique, using Chinese medicine, acupuncture and moxibustion and other means; Some are called endocrine weight management clinics. If you suspect that obesity is caused by thyroid or sex hormone problems, you can undergo examinations here; Some are called nutritional weight management clinics, where doctors customize recipes and nutritional supplementation plans through body composition analysis, metabolic rate measurement, and other methods. Mr. Liang, who is overweight and life-threatening in Guangzhou, Guangdong Province, gradually gained weight due to prolonged sitting, irregular diet and rest. Before the age of 40, his weight soared to 425 pounds and he was even unable to walk normally. Even so, Mr. Liang still felt that his problem was not significant at the time, he had just gained some weight. ”Zhu Mansheng, the chief physician of the Department of Gastroenterology at Sun Yat sen Memorial Hospital of Sun Yat sen University and the person in charge of weight loss at Sun Yat sen, introduced the experience of a patient to reporters. After preliminary examination, Mr. Liang had edema all over his body, and his BMI even reached 69.4kg/m2 (according to Chinese standards, a BMI greater than or equal to 24kg/m2 is considered overweight); When BMI is greater than or equal to 28kg/m2, it is considered obese. More seriously, Mr. Liang was diagnosed with respiratory failure. It was not until he saw his body measurements that Mr. Liang realized that his life was in danger. In order to reduce surgical risks, after multidisciplinary consultations, the hospital developed an individualized "medication+meal replacement" weight loss plan for him. After a month of weight loss, Mr. Liang lost 63 pounds, and his skin swelling and ulceration basically disappeared, allowing him to resume outdoor activities. After further evaluation by a multidisciplinary team, Mr. Liang underwent laparoscopic sleeve gastrectomy and recovered smoothly after the surgery. We continued to follow up and help him with weight management. One year later, Mr. Liang lost about 160 pounds again. ”Zhu Mansheng introduced it. Zhu Mansheng was particularly impressed by a 14-year-old teenage patient who was 1.7 meters tall but weighed 250 pounds. The child experiences high academic pressure and irregular sleep patterns, leading to a gradual increase in weight. ”Zhu Mansheng said that at that time, a series of obesity related diseases were screened. It is unimaginable that the patient has Type 2 diabetes, which usually occurs in middle-aged and elderly people. After multidisciplinary consultation, the doctor determined that weight loss surgery would not have a significant impact on the patient's growth and development, and performed laparoscopic sleeve gastrectomy (minimally invasive surgery) on him. "After the operation, we followed him for a year and asked him to send relevant data on diet, blood sugar, weight and so on to the WeChat follow-up group every day. The patient's weight gradually dropped to normal and type 2 diabetes was cured. If the medical history is short and the degree is light, type 2 diabetes may be cured. It is necessary to carry out weight management in time. ”Zhu Mansheng said. During the interview, many people had misconceptions about obesity and did not fully recognize the harm it brings. Zhu Mansheng suggested that people with excessive BMI should go to the weight management clinic for evaluation. If BMI ≥ 24g/m2, there are also problems such as hypertension, type 2 diabetes, sleep apnea syndrome, and BMI ≥ 28g/m2, even those without the above problems should go to the health weight management clinic. The assessment indicators urgently need to be changed. The interviewed experts believe that there are still some problems that need to be solved in the process of promoting full coverage of health weight management outpatient clinics in tertiary public hospitals, especially the need to shift from disease centered assessment indicators to health centered assessment indicators, and achieve a priority transformation from "treating already sick" to "treating before sick" prevention. In the view of Professor Wang Yue from the School of Medical Humanities at Peking University, due to the lack of comprehensive assessment indicators, unclear fee standards for nutrition guidance, exercise intervention and other services, and difficulty in covering medical insurance, the enthusiasm of health weight management outpatient practitioners has been dampened, and the positioning of "prevention first" is sometimes distorted to be guided by "selling medicine". The health indicators of weight management should be included in the hospital assessment system to prevent the transformation of healthy weight management services into mere drug sales. Moreover, it is necessary to break through the policy bottleneck of the medical insurance department, improve relevant laws and regulations, and suggest that medical insurance expenses should not only be used for treating diseases, but also moderately included in relevant medical insurance policies for disease prevention. ”Wang Yue said. The reporter noticed that weight management involves multiple aspects and cannot be handled by a single department. It requires the cooperation of multiple departments such as endocrinology, nutrition, surgery, and psychology. In Wang Yue's view, there are still practical obstacles to the implementation of multidisciplinary collaboration models in most hospitals in China; Even the MDT diagnosis and treatment model that combines internal and external medicine (multidisciplinary collaborative diagnosis and treatment model) is still difficult to operate effectively in many medical institutions. The enthusiasm for promoting weight management in a single department is already low, and the feasibility of multi department collaboration is lacking, making it difficult to implement in the short term. Regarding this, Wang Yue suggested that in order to solve the problem of medical order in China's healthcare industry, first, second, and third level hospitals should form a division of labor cooperation. The vast majority of weight health management promotion should not only be carried out in tertiary hospitals, but also in community health service centers. The difficulty in seeking medical treatment in some regions of our country is actually due to the inertia of seeking medical treatment in large hospitals for both major and minor illnesses; If all diagnosis and treatment needs are undertaken by large hospitals for the first time, high-quality medical resources will be excessively consumed and it will be difficult to achieve practical results. Therefore, medical institutions at all levels need to perform their respective duties, collaborate and coordinate, and standardize the order of medical treatment. Services such as weight health management clinics should be extended to grassroots community health service centers and accompanied by incentive and assessment policies to promote their implementation and effectiveness. ”Wang Yue added. In the implementation of specific services, physicians' consultations, nutritionists' customized plans, and health management professionals' follow-up all require a lot of time and effort, but their core values are difficult to fully reflect in the current performance system. In Wang Yue's view, there are still certain structural problems in the performance incentive mechanism for medical staff in public hospitals. Although it is explicitly required at the policy level not to be directly linked to revenue generation, in practical operation, workload often still dominates, which is disconnected from the incentive of "preventive" services centered on health outcomes such as weight management, making it difficult to effectively mobilize the enthusiasm of relevant personnel. Therefore, it is necessary to fundamentally reform the performance evaluation method of public hospitals and promote the transformation from "quantity oriented" to "health value oriented". (New Society)