Improved living standards and increasingly sedentary lifestyles mean China has the most fat people in the world - and the problem is just beginning

In November, when Bao Xin's weight soared to 120 kilograms, he decided to take steps. "That time my life was seriously disturbed by being so overweight. I couldn't even hold my 1-year-old baby for more than five minutes because I would be soaked in sweat," says the 34-year-old IT worker in Beijing.

According to China's National Health and Family Planning Commission, adults with a body mass index between 24 and 27.9 are classified as overweight, while those with a BMI of 28 or higher are classified as obese. Given his weight and height - 1.78 meters - Bao's was 38.

A person's BMI is an important factor in the risk of contracting many illnesses, such as cardiovascular disease, diabetes and cancer.

Bao eventually went on to lose 30 kg over four months by adhering to a strict diet and exercise plan, which was monitored by professional medics.

Experts say the number of obese people in China - already the largest in the world - is expected to continue to rise and pose an increased health risk, given the improved living standards and the prevalence of modern sedentary lifestyles.

"An obesity crisis is likely to happen in China in the next 20 years, and it is already being felt in big cities such as Beijing and Shanghai," says Chen Wei, a nutritionist at the Peking Union Medical College Hospital and deputy director of the Chinese Nutrition Society's clinical nutrition department. "The rising level of obesity is closely linked with the rise in a range of chronic diseases in China in recent years."

A growing problem

In 1975, 700,000 Chinese men were obese, which meant the country was ranked 13th in the world. In addition, there were 1.7 million obese women, making China the global No 10. The combined figure accounted for less than 2.5 percent of global obesity.

That picture has changed dramatically. In 2014, China overtook the United States to become the world's fattest nation for both men and women in terms of total numbers. The country was home to 43.2 million obese men (16.3 percent of the global total) and 46.4 million obese women (12.4 percent), according to research published in April by medical journal The Lancet.

The research, based on surveys of more than 19 million people in 186 countries, also showed China was moving higher in the global ranks of "serious" obesity.

In 1975, China's men occupied 60th place, while the women were in 41st place, but by 2014, both men and women were second in the global rankings.

In the past decade, the number of overweight or obese people in China has risen faster than in a large number of developed countries, according to the National Health and Family Planning Commission.

In 2012, nearly 12 percent of Chinese adults were obese, compared with 7.1 percent in 2002. Meanwhile, the figure for children and adolescents - ages 6 to 17 - was 6.4 percent, compared with 2.1 percent in 2002, The Lancet research says.

Yang Qinbing, director of nutrition at Beijing Tsinghua Changgung Hospital and a member of the Chinese Medical Doctors Association, believes China is facing an obesity time bomb.

"The prevalence of obesity has become a serious health problem, and it is one of the most dangerous health risks for the country in the near future," he says.

A rising rate of obesity is closely related to the surge in the incidence of many noninfectious diseases, which are now the primary health threat for China.

According to a report by the World Health Organization last month, the number of Chinese people with diabetes is estimated to be 110 million, about 10 percent of the adult population, but in 1980, the figure was less than 5 percent.

Being overweight and a low level of exercise were primary factors in developing the disease in patients with Type 2 diabetes, which accounts for 90 percent of those with the condition, the report says.

Moreover, the rapidly rising obesity rate among children increases the chances of them contracting chronic diseases such as diabetes, adds Yang Wenying, director of the China-Japan Friendship Hospital's Endocrine and Metabolic Diseases Center in Beijing.

"Clinicians have seen a fast rise in the number of children with diabetes. Most of these young patients are obese or overweight."

Those conditions have been major contributors to a rise in cardiovascular disease. About 290 million Chinese have heart disease, and the illness is now the primary cause of death in the country, according to a report last year by the National Center for Cardiovascular Diseases.

The incidence of hypertension among Chinese men aged 60 and older and with a waistline of 90 centimeters or larger was 78 percent, the center says.

Between 1980 and 2013, the number of cardiovascular patients being treated in China's hospitals rose by an average rate of 9.51 percent a year, higher than the number of patients with other chronic illnesses, it adds.

Rising living standards

Liang Xiaofeng, deputy director of the Chinese Centers for Disease Control and Prevention, says the rapid rise in living standards in recent decades has contributed to the spike in obesity and chronic diseases.

China has moved from a period of severe food shortages in the 1970s to a time of plenty, he explains.

Fundamental changes in lifestyles and working practices, such as the popularity of cars and computers, that result in lower levels of physical activity are also factors in the rise of severe illnesses.

In addition, Liang says, a shortage of sports facilities means students don't get enough physical exercise at school, which is leading to rising levels of obesity among students.

Chen, of the Chinese Nutrition Society, says that compared with some countries, obesity is a thornier problem in China: "It's rising fastest among people in suburban areas, and these people lack scientific guidance."

In addition, because healthcare resources in these areas are inadequate, compared with those in the cities, the rapid increase in obesity is posing more health risks to the rural population.

Moreover, physical exercise is promoted less in China than the United States and European countries, resulting in many people adopting a sedentary lifestyle, he adds.

In April, leading health associations including the Chinese Medical Doctor Association issued a guideline to promote standardized solutions that help people lose weight.

The guideline covers the principles and methods that should be adopted not only to help people to lose weight, but also to keep it off. It is designed to encourage clinical nutritionists and medical staff to provide patients with standard weight-loss services in accordance with the rules, explains Wang Qi, secretary-general of the China International Exchange and Promotive Association for Medical and Health Care.

Chen says there are a large number of commercial weight-loss treatments on the market, but many of them do not work and can even be harmful to health.

Although 5,000 to 10,000 weight-loss operations a year are performed in China, the actual number of obese people is far higher, he says. "Many obese people tend to stay at home and seldom go out. In this way, they become fatter and fatter."

As the problem grows, the demand for weight-loss therapies such as acupuncture and spa treatments will continue to rise, he adds.

According to the guideline, overweight people can slim down and maintain their proper weight by adhering to a few simple rules, such as eating a balanced diet and exercising properly, plus psychological intervention that can help maintain a positive mindset. It also notes that a healthy lifestyle is a long-term benefit.

Chen says the guideline has been introduced to major hospitals in Beijing and will be adopted by dozens of hospitals outside the capital by the end of July.

Leading experts from the China International Exchange and Promotive Association for Medical and Health Care are now providing training to doctors who offer weight-loss services in hospitals outside Beijing to ensure they follow the guideline and provide standardized treatment to patients most at risk.

"The program is aimed at seriously obese people. Their condition has caused noticeable damage to their health," Chen says.

Yu Linxin, a marketing manager at E-Jane, a healthcare services provider in Beijing, says: "We have conducted marketing surveys and found that 95 percent of obese or overweight people have never visited a hospital for treatment. Many of them don't know that there are such clinics in hospitals, and most of them do not regard obesity as a disease."

She urges obese people to visit hospitals for approved weight-loss treatments.

"Many methods used by service providers are not scientific. Some may help people lose weight temporarily - but they usually rebound quickly - and some may even cause health problems, such as malnutrition," she adds.

wangxiaodong@chinadaily.com.cn