A 16-Year Retrospective of Weight Loss Clinics: Obesity Epidemiology and Changes in Diagnosis and Treatment

A 16-year review of a weight loss clinic

The weight loss clinic, which opened in 1985, has been operating for 16 years. Recently, it has been criticized by the medical community for its potential drug abuse. Five years ago, the Department of Health repeatedly prohibited medical staff from promoting meal replacements, but now it is repeating the same mistake, which is regrettable.

The glucose tolerance test conducted at Veterans General Hospital on Taiwanese people back then initially showed that Taiwanese people, despite not being particularly large, were already suffering from type 2 diabetes. This was consistent with my observation that Native Americans in the United States were also prone to diabetes. However, Native Americans were much larger and heavier than Taiwanese people. But in the case of the Pima tribe, their incidence rate was nearly 50%, almost to the point of extinction. Therefore, I compiled the patient self-care materials I learned in Germany and earnestly warned of the scourge of Westernization, which leads to obesity and then to diseases of civilization such as diabetes.

However, the book I published 14 years ago didn't sell particularly well, but another wave of dramatic changes has unfortunately come true, quietly taking place among children and teenagers: young people are becoming obese, and children are suffering from diseases common to the elderly. I have also published several papers based on community populations and outpatient data. When I published my outpatient visit data, it caused a sensation at the time, but we didn't do any sales promotions or solicit customers by distributing business cards. Instead, we looked at this issue from a humanistic perspective.

1. How many people in the community are obese?

2. How many young people suffer from eating disorders?

3. How many obese children are there in schools?

These issues were identified through independent research and data collection. Specifically: 1. Obesity continues to rise in the community, with adults gaining an average of 0.7 kg per year. By 1997, 40% of Taipei City's population aged 40-72 had a BMI exceeding 25. 2. Among young women aged 12-26 in the Greater Taipei area, 5% suffer from bulimia and 0.2% from anorexia. These individuals have become victims of various rudimentary weight-loss programs. 3. Among upper-grade school children, 25% of boys are obese, compared to 15% in junior high and 5% in senior high. Girls have half that rate. This is attributed to parental and societal expectations of women to be thinner, and this number continues to increase over the next five years.

Analyzing the past histories of over 12,000 people treated at our weight loss clinic over the past 16 years, almost everyone (99.8%) had tried to lose weight. Of these, 78% did so at work, while the remaining few lost weight on their own by reducing their food intake. When asked how long they maintained their weight, 94% regained or exceeded their original weight within two months, and 70% within one month. 40% of these individuals continued to diet several times, but 35% developed "eugenic syndrome," meaning their metabolic rate slowed down, making it difficult to achieve the target weight loss of 1 kg for every 7700 calories lost.

As for the complications that dieters often complain about, the following are common: rough skin (41%), sagging breasts or buttocks (23%), fatigue (62%), pale complexion (19%), anemia (8%), low mood (69%), frequent colds (23%), and decreased memory (17%).

Faced with these waves of problems, some may see them as business opportunities, but from a public health perspective, they are issues that warrant prior intervention.

1. There should be a simple and accurate nutrition education tool. Therefore, the Rice Yuan 80-calorie food exchange table was invented. It was made available to illiterate people and achieved good results, proving more effective than methods used in China, Japan, and the United States.

2. We should start with social work and pay attention to the nutrition of young students and infants. So I volunteered at the John Tung Foundation to promote the concept of children's weight loss and established a parent-child weight loss clinic.

3. We urge everyone not to be fixated on a single standard weight, but rather to aim for a reasonable and acceptable weight. Overemphasizing "standard weight" can trigger abnormal eating behavior, leading to problems such as "feeling guilty about eating, which is why I am overweight," "being able to vomit by pressing down on the back of the tongue with two fingers," and "people who are already thin but have a slightly larger frame still worrying about being heavier," which are common symptoms of binge eating disorder.

4. Screening each weight-loss patient in the outpatient clinic with 50 questions aims to identify long-term, undetected anorexia nervosa patients. This method was invited to be presented at Princeton University in the United States. Many unfortunate patients, influenced by television and movies, have absorbed exaggerated cultural factors from the US and Japan, excessively scrutinizing their weight and body shape, comparing themselves to celebrities and idols, leading to increased feelings of inferiority. This has caused a rise in the prevalence of anorexia worldwide since 1962. It quietly emerged in more aesthetically pleasing cities by 1970, and by 1980 it had gradually spread to all continents, no longer limited to young women in high society, but even affecting Black communities. Recently, I've found that bulimia accounts for 35% of my outpatient cases, and many more have subclinical symptoms approaching bulimia. 99% of these patients have had multiple experiences with weight gain, but have never successfully maintained it. This isn't a matter of insufficient willpower, but rather that they have already entered the bulimia nervosa phase, which doctors have simply failed to detect.

5. Weight loss clinics are not canneries where everyone consumes the same health foods or medications of unknown origin. Each patient has a different cultural, racial, family, occupational, and gender background. A comprehensive assessment is necessary to uncover the patient's true situation through outpatient visits, examinations, and questionnaires, leading to a diagnosis. Then, through open consultation, the patient should be gradually guided towards a less extreme weight loss approach. After all, everyone is different. Doctors should consult in a quiet, private setting, using minimally invasive methods such as nutritional guidance and behavioral correction to achieve weight loss without harming the body. When medication is truly necessary, drugs without central nervous system stimulation should be chosen to minimize side effects such as sudden death or rebound weight gain in the gastrointestinal tract. The role of medication should not be overemphasized; only by addressing the patient's actual problem can it be resolved. Otherwise, if doctors simply continue prescribing the same medications without anyone knowing what they are, it only creates more problems in the shadows, causing unfortunate complications for patients and increasing the burden on health insurance.