Rising standards of living and increasingly sedentary lifestyles have resulted in China becoming the fattest country in the world, and the problem is just beginning. Wang Xiaodong reports.

In November, when Bao Xin's weight soared to 120 kilograms, he decided to take steps. "At 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," said the 34-year-old IT employee 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 BMI was 38, which put him firmly in the obese category.

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

Unlike his previous attempts which always ended in failure, Bao's efforts to lose weight paid dividends; he lost 30 kilograms in four months by adhering to a strict diet and exercise plan, which was monitored by medical staff.

Experts say that 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 rising 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," said Chen Wei, a nutritionist at the Peking Union Medical College Hospital who is also deputy director of the clinical nutrition department at the Chinese Nutrition Society.

"The rising level of obesity is closely linked with the rise in a range of chronic diseases in China in recent years," he said.

A growing problem

In 1975, 0.7 million 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. The country was home to 43.2 million obese men - accounting for 16.3 percent of the global total - and 46.4 million obese women, or 12.4 percent of obese females across the world, according to research published in April by The Lancet, a medical journal.

The research, based on surveys of more than 19 million people in 186 countries, also showed that 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 report said.

Yang Qinbing, director of the nutrition department at Beijing Tsinghua Changgung Hospital, and a member of the Chinese Medical Doctors Association, said the country faces an obesity time bomb: "The prevalence of obesity has become a serious health problem in China, and it is one of the most dangerous health risks for the country in the near future."

Chronic diseases soar

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

According to a report released 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 the main causes of the disease in patients with Type-2 diabetes, which accounts for 90 percent of those with the condition, the report said.

Moreover, the rapidly rising obesity rate among children increases the chances of them contracting chronic diseases such as diabetes, said Yang Wenying, director of the Endocrine and Metabolic Diseases Center at the China-Japan Friendship Hospital 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 people have heart disease and the illness is now the primary cause of death in the country, according to a report released last year by the National Center for Cardiovascular Diseases.

The incidence of hypertension among Chinese men age 60 and older and with a waistline of 90 cm or larger was 78 percent, the report said.

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, according to the report.

Rising living standards

Liang Xiaofeng, deputy director of the Chinese Center for Disease Control and Prevention, said the rapid rise in living standards in the past few decades has contributed to the spike in both obesity and chronic diseases.

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

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, he said.

In addition, a shortage of facilities means students don't get enough physical exercise at school, which is leading to rising levels of obesity among school-age children, he said.

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

In addition, because healthcare resources in these areas are inadequate, when compared with those in 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 said.

Standardized solutions

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, said Wang Qi, secretary-general of the China International Exchange and Promotive Association for Medical and Health Care.

Chen said 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 are performed in China every year, the actual number of obese people is far higher, according to Chen.

"Many obese people tend to stay at home and seldom go out," he said. "In this way they become fatter and fatter."

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

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 said the guideline has been promoted 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 a number of 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 said.

Yu Linxin, a marketing manager at E-Jane, a healthcare services provider in Beijing, said: "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 urged 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."

Contact the writer at wangxiaodong@chinadaily.com.cn