Prevention and treatment of weight loss-related nutritional and metabolic complications: malnutrition, anemia, and hair loss.

Medical weight loss aims to help obese individuals achieve safe weight loss under medical supervision. Beyond achieving the desired weight loss, the most crucial aspect is ensuring the safety of obese individuals within a medical framework. On one hand, obese individuals are prone to chronic complications, so weight loss plans must consider various organ dysfunctions. On the other hand, a range of health problems that arise during weight loss, such as malnutrition, hair loss, insomnia, and constipation, often hinder the implementation of the weight loss plan. Therefore, appropriate treatment plans from various specialist perspectives are needed to prevent and intervene in potential health issues. I. Malnutrition

Overview: Malnutrition, also known as insufficient nutrition, refers to a state of energy or nutrient deficiency caused by inadequate intake or impaired utilization, leading to changes in body composition, decreased physiological and mental function, and adverse clinical outcomes. Malnutrition is a major cause of increased morbidity and mortality, decreased quality of life, increased hospitalizations and durations, and increased medical costs. There is currently no accurate data on malnutrition caused by poor weight loss.

Causes of malnutrition include an unbalanced diet, poor eating habits, and gender. Many people avoid meat and staple foods to lose weight, leading to malnutrition. Poor eating habits such as picky eating or unbalanced diets can result in insufficient intake of protein, vitamins, and minerals, causing malnutrition. Furthermore, some women's pursuit of a slim figure and excessive dieting also contribute to malnutrition.

Prevention and treatment measures: (1) Prevention measures: We should strengthen the publicity of the importance of nutrition to health and avoid malnutrition caused by poor weight loss; we should advocate a reasonable diet and scientific feeding. (2) Treatment measures: The principle of nutritional supplementation is to meet the body's target needs of 90% of fluids, 70%-90% of energy, and 100% of protein and micronutrients. Energy supplementation is generally based on the standard of 2025 kcal/(kg·d) at the beginning, and then adjusted individually; the target protein requirement is 1~2 g/(kg·d). Dietary supplementation + nutrition education: 20%~30% of total energy comes from fat (while limiting the intake of saturated fatty acids and trans fatty acids), 45%~60% from carbohydrates, and 15%~20% from protein. Nutritional support routes include enteral nutrition (EN), parenteral nutrition (PN), and combined enteral and parenteral nutrition support. Among them, enteral nutrition includes oral nutritional supplements (ONS) and tube feeding (TF). The preferred nutritional method for malnourished people is EN. When the patient's food intake is less than 80% of the target requirement, ONS is recommended. II. Anemia

Overview: Anemia refers to a decrease in the volume of red blood cells in the peripheral blood. When the volume falls below the lower limit of the normal range, the blood cannot adequately supply oxygen to tissues and organs, leading to a series of symptoms and even further organ damage. The diagnostic criteria for anemia in China are: at sea level, adult males with hemoglobin (Hb) <120 g/L; adult females (non-pregnant) with Hb <110 g/L; and pregnant women with Hb <100 g/L.

Causes: The main types of anemia associated with poor weight loss are iron deficiency anemia and megaloblastic anemia. Iron is an essential component of hemoglobin. Iron deficiency anemia occurs when dietary iron intake is insufficient (e.g., during dieting), or when excessive intake of phytates or phenolic compounds leads to malabsorption (e.g., long-term vegetarianism), or when iron loss exceeds iron intake (e.g., dieting during menstruation). Megaloblastic anemia is caused by vitamin B12 deficiency and/or folic acid deficiency; deficiencies in these nutrients can affect DNA synthesis, cell division, and erythrocyte production.

Prevention and treatment measures: (1) Nutritional therapy: Increase iron-rich foods, such as red meat, animal liver, fish, and poultry. Add vitamin C-rich fruits and vegetables (such as citrus fruits) to the diet to increase the absorption of non-heme iron. Avoid combining iron absorption inhibitors with iron-rich diets, such as drinking tea and coffee at different times than meals. (2) Drug therapy: The principle of iron deficiency anemia treatment is to identify the cause of iron deficiency and treat it according to the specific condition, including oral iron supplements, injectable iron supplements, and red blood cell transfusions. For oral iron supplementation, it is recommended to take iron supplements one hour before meals, along with vitamin C, to increase the absorption rate. For megaloblastic anemia caused by folic acid deficiency, take 10 mg of folic acid orally every day. Mecobalamin or intramuscular injection of vitamin B12 can improve the clinical symptoms of megaloblastic anemia. III. Hair loss

Overview: Pathological alopecia refers to abnormal hair loss caused by factors such as genetics, immunity, stress, certain medications, and endocrine disorders, resulting in thinning hair, with daily hair loss typically exceeding 100 strands. Pathological alopecia can cause a range of negative psychological effects on patients, including anxiety and low self-esteem.

Causes: Hair is mainly composed of keratin protein, and it is also rich in trace elements such as zinc, iron, and copper. Poor weight loss, due to reduced intake, leads to a deficiency in energy, protein, minerals, and/or vitamins. The scalp does not receive the necessary nutrition, causing hair loss due to severe malnutrition.

Prevention and treatment measures: (1) Prevention: Adopt scientific weight loss methods, avoid blindly dieting, and ensure adequate nutrition for the scalp by consuming a variety of nutrients. (2) Treatment: Supplementing with vitamin E can resist hair aging and promote cell division. Foods rich in vitamin E include vegetable oils, nuts, lean meat, dairy products, and eggs. Supplement with minerals, especially iron. Foods rich in iron include red meat, animal liver, and blood products. Increase protein intake while ensuring sufficient iron intake. Topical application of minoxidil (concentration of 2%~5%) and oral finasteride are commonly used drug treatment methods.