Behavioral assessment and genetic factors: Habit correction and the thrift gene theory in obesity management

III. Behavioral Assessment and Recommendations for Obesity Weight loss requires the joint efforts of both doctors and patients; it cannot be decided unilaterally by medical staff. The patient's psychological changes and attitudes are crucial. If the patient is not proactive or cooperative, treatment often fails. Therefore, medical staff should assist obese patients in developing a plan and support and guide the implementation of weight loss measures. Medical staff need to understand the obese patient's obesity history, previous treatments, setbacks encountered during weight loss, existing problems, and the impact of obesity on their life. They should explain the potential health risks of obesity to obese patients, establish a partnership to jointly overcome obesity, and gain the patient's trust psychologically, enabling them to take a proactive and positive attitude in developing a plan and goals for behavioral change. Behavioral therapy includes recommendations for appropriate diet and lifestyle habits, as well as psychoeducation and teaching patients how to self-monitor and self-adjust their weight loss plan. Dietary recommendations include: cultivating a conscious awareness of portion control and avoiding overeating at each meal; minimizing the frequency and extent of binge eating; choosing low-fat foods; chewing slowly to prolong eating time, allowing the brain to receive satiety signals before the meal is finished, which helps reduce food intake; using smaller utensils to make moderate portions appear more substantial; planning meals by portioning food into portions beforehand to limit food intake to about 70% fullness, which can also prevent overeating at the next meal if a meal is missed; and having fruit after meals to satisfy cravings. When developing an activity plan, weight loss goals should be specific and achievable. For example, when setting physical activity goals, use "walk 30 minutes or 5000 steps a day" instead of vague suggestions like "more activity every day." Establish a series of short-term goals, such as starting by increasing walking time by 30 minutes each day, gradually increasing to 45 minutes, and then to 60 minutes. Psychological education for obese patients requires doctors to treat them fairly and equally, sharing numerous examples of successful weight loss to build their confidence. Simultaneously, it's essential to explain the dangers of obesity and the benefits of weight loss, highlighting the positive impact of good health on life, family, and society. This helps patients envision a bright future and a happy life after successful weight loss, making the treatment plan more acceptable. Monitoring patients during treatment helps evaluate their progress and provides information on how to achieve further goals based on previous results. Maintaining regular contact with patients and offering care and support is crucial. Furthermore, teaching obese patients self-monitoring is equally important. First, patients should be instructed to observe and record certain behaviors daily, such as the type, amount, and time of food intake, exercise, medications used, and the results of behavioral changes. Second, patients should be reminded to weigh themselves regularly, ideally at similar times of day and wearing the same clothing as the previous measurement. Self-monitoring often guides patients towards their desired goals. While some patients may find self-monitoring tedious, it is extremely useful. In 1948, the WHO included obesity in its disease classification list, and in 1997, it first defined obesity as a disease. Obesity is a chronic metabolic disease caused by multiple factors, characterized by excessive accumulation of body fat and excessive weight, resulting from the interaction of genetic, environmental, and other factors. Over the past 30 years, overweight and obesity rates among Chinese residents have shown a significant upward trend, with urban areas higher than rural areas, and decreasing sequentially in the eastern, central, and western regions. Obesity is a risk factor and pathological basis for chronic diseases such as hypertension, diabetes, cardiovascular and cerebrovascular diseases, and tumors. The WHO has clearly recognized obesity as the most prevalent chronic disease globally. The mechanism of obesity is that energy intake exceeds energy expenditure. Obesity is the result of the interaction of multiple factors, including genetic factors, environmental factors, endocrine disorders, and gut microbiota. 1. Constitution and Genetic Factors: Constitution is a comprehensive and relatively stable characteristic of the human body, based on heredity and acquisition, encompassing morphological structure, physiological function, psychological factors, physical fitness, and athletic ability. Human health depends on a good living environment; only a healthy ecosystem can ensure healthy human survival. Statistics show that among individuals with slender bones, only 3% of men and 5% of women are overweight; while among those with broad bones, 37% of men and 67% of women are overweight. Obesity has a familial aggregation tendency, with 40%–70% of the difference in body mass index (BMI) between individuals attributed to genetic factors. Statistics indicate that if both parents are obese, their children have approximately a 70% chance of being obese; if one parent is obese, their children have approximately a 40% chance; and if both parents are thin, their children have only a 10% chance of being obese. Currently, over 50 genetic loci associated with obesity have been identified in European populations, and some loci have been validated in Asian populations, such as the FTO (Fat Mass and Obesity-Related Gene) and the melanocortin-4-receptor gene (MC4R). The "thrifty gene theory" is currently considered an important mechanism in the development of obesity. Thrifty genes enable efficient energy utilization for survival in situations of food scarcity, but can lead to (abdominal) obesity and insulin resistance in situations of food abundance. Frugality genes (also known as "abdominal obesity susceptibility genes") include genes for β₃ adrenergic receptors, hormone-sensitive lipases, peroxisome proliferation-activating receptor-γ (PPAR-γ), prohormone-converting enzyme-1 (PC-1), insulin receptor substrate-1 (IRS-1), and glycogen synthase. Most cases of primary obesity are polygenic, resulting from the combined effects of multiple minor genes. Some obesity is caused by single-gene mutations, such as classic genetic syndromes like Laurence-Moon-Biedl syndrome and Prader-Wili syndrome. Recently, several single-gene mutations causing obesity have been discovered, including genes for leptin (OB), leptin receptor (LEPR), proopiomelanocortin (POMC), melanocorticotropic hormone receptor 4 (MC4R), PC1, and PPAR hormone.