04 “Obesity” is an epidemic! — Comments on hepatogenic secondary obesity (Part I) (one of the common symptoms of “deficiency of blood and weakness of qi”

Preface

In 1997, WHO listed “obesity” as the third chronic killer after smoking and AIDS.  Modern people are afraid of “obesity” and become particularly sensitive to the increase of body weight and change of figure.  It is especially so in females, and for the purpose of keeping fit, they try by every possible means to “reduce fat”.  But what is the result?  Most of them ended in disappointment.  The chief reason is that the real cause of producing obesity and the correct method of treating it are not found out.

The current “obesity epidemic” is spreading over the whole world

“Obesity” is an epidemic, this is an undeniable fact, and in many places, numerous statistical data prove this tendency.  In the middle of May this year, the annual meeting of WHO issued its newest research material: “Obesity is not only an ‘epidemic’ of developed countries, but also a disease with the acknowledged characteristics of “wealthy society”, spreading to the developing countries.  It is estimated that there are about 300 million people suffering from obesity and about 750 million are over weight.  In some countries, 30% of the children belong to the fat group and about 22 million children under five years old are overweight or too fat.  For example, in Africa, to our surprise, the number of fat children is four times of the undernourished…..”.

Statistics in America indicated that from the sixth decade onwards, obesity patients increased by more than a double.  The “abnormally fat” population increased from 13% to 22.5% in 1994, and in 1999 to 27%, while the age of the patients becoming younger and younger.  In America, there are about 100 million people (97 million adults) over weight or abnormally fat, occupying 55% of the total population.  The investigation of North Carolina University in America showed that more than 1/4 of the American population suffered from obesity (male 20%, female 28%).

•           Countries of European Union have 1/3 of their population overweight and there is one obese person in every ten.
•           Reports from British Audit Bureau indicated that obesity patients increased two times in the recent 20 years.  At present, there are 20% of the population too fat, in which 1/5 are listed as obesity and in every five adults one has a body weight reaching risk level.
•           In Greece, 1/4 of the population is fat and 2% of them belong to morbid fatness, that is over weight 40% or above 45 kg.
•           In Singapore, 3 out of 10 persons are obese.  The obese population increased fivefold as compared with that of 3 years ago.
•           In China, there 70 million fat people.  In Beijing, one out of 5 persons is fat, and in females, fat individuals occupy 52%, in which about 70% are middle or old age.  In Guangzhou, over weight people have increased twofold as compared with that of the 1980’s in which one eighth were considered obese.

From these scattered and incomplete statistical materials, we can still see that “obesity” is really a problem of the whole world.  Specialists consider that morbid fatness is an epidemic in the field of public health and the number of victims is up rising.  In fact, one would be reluctant to accept that he is fat.  Besides, fatness also affects seriously human health.  It is unsatisfactory to explain by saying that obesity is simply due to “lack of physical exercise” and to “over nutrition” in modern life or that “the conventional diet habit tends to be substituted by taking high fat instant food or the daily life limited in a small area with insufficient physical exercise”.

Differentiate “simply obesity” and “secondary obesity”

Hepatogenic secondary “obesity” is due to infection by “hepatophilic virus”.  We can not consider obesity as “disease of the rich”.  When the calories taken are more than those consumed, the remaining nutritional materials are transformed into fat, which is stored in various tissues and also under the skin and then “obesity” is formed.  From the medical point of view, obesity includes “simple obesity” and “secondary obesity”.

“Simple obesity” is obesity caused by simple over nutrition.  In this kind of obesity, the distribution of fat is even without showing any significant anatomic or formational changes in nervous or endocrine system.  Therefore, individuals with mild or moderate obesity usually have their skin delicate and full of luster, abdominal circumference larger but still preserving a loin curvature, umbilicus deeply mined, fat pads protruding around the central umbilicus and curving depression seen at the outer side of sheath of rectus abdominal muscle, causing the fat pad to be more prominent.  These individuals have full breasts and buttocks, normal mental condition and good health.  The correct method for them to reduce fat is to control food intake adequately, reduce high lipid and glucose diet, do some physical work or exercise and cut down extra-dietary food and calorie intake.  Fat reduction method is only effective for simple obesity.

“Secondary obesity” is basically different from simple obesity.  The main cause, in most patients, is disease in the body leading to accumulation of fat.  Secondary obesity is often associated with some other diseases; it may be secondary to certain primary disease in the body and may also be the result of development of certain disease, e.g. hepatogenic obesity (肝源性肥胖), diencephalon obesity (間腦性肥胖), pituitary obesity (垂體性肥胖), (induced by various encephalitis, meningitis, brain injury, brain tumors causing damage to diencephalon and pituitary) sex gland dysfunctional obesity, adrenocortical hyperfunction obesity (腎上腺皮質機能亢進性肥胖), hypothyroidism obesity (甲狀腺機能過低性肥胖), insulin obesity or improper use of drugs (such as abuse of adrenocortical hormones leading to adverse effects like full moon face, sodium retention or prolonged use of sex hormones).  The above endocrine disorders all can produce secondary obesity.

Recent clinical observation reveals that increasing incidence of secondary obesity is found to occur in the acute hepatitis convalescence stage and during chronic active hepatitis.  Some cases can be confirmed as “fatty liver” and some are in the stage of “nutritional disorder” produced by metabolic disturbances after infection by “hepatophilic virus” and by prolonged suffering from chronic hepatitis resulting in diseases of various systems.  Abnormality of liver function can also cause endocrine disorders which may produce “hepatogenic secondary obesity”.

When the human body is infected by hepatophilic virus, the immunologic reaction can cause the liver to develop acute or chronic inflammation.  We have mentioned that “hepatophilic virus disease” means that the patient has abnormal margin of hepatic dullness, clinical persistent & repeated, alternating and multiple systemic symptoms of chronic hepatitis and various diseases and complications induced by acute or chronic liver function damage.  The disease includes defect in absorption of nutritional material, leading to malnutrition, prolonged anemia, hypoproteinemia (低旦白血症), bleeding from abnormality of clotting mechanism and all these conditions can cause ischemia of pituitary (垂體缺血) and subsequent endocrine disorder.  Protective function of the body can lead to over production and retention of adipose tissue which forms hepatic edema, fatty liver and secondary obesity.  So, it is doubtless that fatty liver, hepatogenic secondary obesity and hepatic edema are common complications and sequalae of hepatophilic virus disease.

In addition, most of the patients with secondary obesity have still a dysfunction liver when first seen by physician.  If there is no provision of effective systemic TCM therapy, the chronic hepatitis may persist and gradually complications of heart, blood vessels, apoplexy and diabetes may appear.  Obesity can also induce respiratory diseases, muscular and dermal problems, infertility, hypertension and hormone related cancer complications, leading to dysfunction of heart, lung and kidney.  Although “abnormal obesity” can induce many complications, but these complications together with “abnormal obesity” are in fact the result of the persistence of chronic “liver disease”.

“Epidemic”— characteristics of hepatogenic secondary obesity

•          Hepatogenic secondary obesity patients often have a history of acute liver disease and are frequently diagnosed as “fatty liver”.
•          The above mentioned patients usually have abnormal plasma examination results, e.g. abnormal results of various hepatitis virus antigens, antibodies or even liver function.  But patients with abnormal liver function level who cannot be confirmed the type of virus, are usually diagnosed as non-type A, non-type B or non-type C hepatitis.
•           The above mentioned patients often have typical manifestations of TCM forms of chronic liver disease and also have signs of hypochondriac anomaly, lip and tongue signs, pitting edema over pretibial region and abnormal margin of hepatic dullness.  But, it is too common that many hepatophilic virus disease patients with no abnormal serum reactions are not possible to be diagnosed as hepatitis.
•           The age of the above mentioned patients differentiates into two extremities:
  It is not surprising to find that fatty liver and hepatogenic obesity appear in childhood, because infancy and childhood are the important periods of primary infection of hepatophilic virus.
  According to reports, 15% – 20% of American children have over weight.  In Greece, children considered as too fat, accounted for 77%, and in the range of 6-11 years, fat children occupied 54%; and in the 12-17 year group, the proportion of fat children reached 40%.  Can it be said that it is not related to virus infection?  There is a Chinese idiom: “Fatness of good fortune at middle age “.  In fact, this is chronic hepatitis persisting to middle age, causing damage of liver function and evoking endocrine disorder with the result of hepatic edema and secondary obesity after middle and old age.
•           Hepatogenic secondary obesity often shows regional and familial characteristics:
  It commonly occurs in liver disease epidemic areas; it has significant population or family predilection tendency.  Recent seminar articles from WHO meeting held in Singapore pointed out that the susceptibility of abnormal obesity in Asians is related to the spread of type B hepatitis in Asia.  Hepatophilic virus disseminating through close contact under regional or familial conditions may mislead one to think that abnormal obesity is related to heredity.

The above mentioned patients may not easily obtain fat reducing results through ordinary fat reducing measures.  But the application of “effective systemic TCM therapy” can give clinical cure in chronic hepatitis.  Further more, it may be able to correct hepatic edema and hepatic obesity, terminate the progression of chronic hepatitis and make the liver function normal and can eventually avoid the development of complications of obesity.

Liver disease is regarded as an infections disease and the fact that induces hepatogenic secondary obesity and that the saying “hepatogenic secondary obesity is epidemic” is not at all irrational.  Patients with obesity have increased rapidly in recent years.  It is closely related to the recent development of science, frequent communications among people in all corners of the world and the increased chance of hepatophilic virus infection.  Data from many places indicate that in the world patients with obesity are increasing every year and their age are becoming younger.  If these cases are “hepatogenic secondary obesity”, it indicates that “hepatophilic virus” is silently disseminating in the human community with a high speed.

Nowadays, people gradually understand that we must not neglect the harmful effects of “hepatophilic virus” upon human health and the above statement about the cause of hepatogenic edema (or secondary obesity) by chronic hepatitis is an undoubted evidence.  The only method to cope with this situation is to take preventive measures at the very beginning, that is to say, detect and treat “chronic hepatophilic virus disease” at an early stage.  This is the best way to reduce fat and prevent secondary obesity.  It we still use the erroneous old method of reduction of food in take, food preference, or increase exercise blindly, or improper administration of fat reducing drugs, the result will be squander of money or even serious impairment of health.

According to standard body weight, over 10% of standard body weight is regarded as over weight while over 20% of standard body weight is regarded as obesity.

•           Standard body weight = normal body weight +10% to 20%
•           Normal body weight (kg) = Height (cm) – (105 to 110)

The body mass is measured by the Body Mass Index (“BMI”), i.e. body weight (kg) in proportion to body height (M²):

Body Mass Index (BMI) = Body weight (kg)/body height ² (M²)

Chinese adult standard of obesity

Recently, a report was given by Prof. Chou Bei Fan of Epidemic Disease Research Institute, Fou Wai Cardiovascular Disease Hospital, Chinese Academy of Medical Sciences, stated that the Chinese obesity working team, according to the data collected during the ninth decade of 20^th century, made an analysis which first suggested a standard of obesity suitable for Chinese adults:

•           Body weight index:obesity ≧ 28
• over weight ≧ 24
•           Abdomen obesity standard :female ≧ 80 cm
• male circumference ≧ 85 cm

Introduction of cases

Case 1

Shu (code number 2612), female, age 32 years.

Her first visit was in August 2001, with the complaint of suffering from hemorrhoids two years ago.  From time to time, she experienced poor appetite, abdominal pain and distention, constipation, hematochezia and she had an increase of 10 lbs of body weight.  She was hospitalized once because of insomnia, palpitation, dim eyesight and vertigo.  Her height was 1.57 meter, weight 65 kg, BMI 25.39.

Physical examination: marked swelling of lip mucosa, hepatomegaly of 1.5 cm with percussion tenderness, (+) pitting edema over pretibial region.  The TCM diagnosis was wetness-heat vaporization, blockage of channels and blood stasis and secondary obesity.  After taking 3 parcels of TCM drugs, the liver returned to normal.  Through systemic TCM therapy, the body weight reduced to 50 kg, BMI 18.86.  She lost about 33 lbs and the abdominal circumference was 73 cm, buttocks circumference reduced from 40 inches to 34 inches.  She was now receiving premenstrual TCM therapy.

Published on 25th July 2002

Translated by Professor Zheng in January 2005