The unbearable heaviness of being overweight, this time in China
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The combination of rising incomes and massive competition for everything means sitting at a desk for many hours while being able to eat lots of calorie-rich foods. The prevalence used to be much higher in urban areas than rural areas, but now the trend is actually reversing. The additional treatment cost would be equal to one-tenth of the current medical expenditure. That's a huge amount.

The Chat Lounge. Chat Lounge. Chat Lounge. The Chat Lounge unpacks views and opinions on hot issues in a more casual way. Once upon a time, fat people were believed to be more blessed. Now, they are urged to watch their weight.

Welcome to the chat lounge. I'm Tuyin. Joining our discussion on China's national weight management campaign are Dr. Lauren Johnston, an associate professor of the China Study Center, University of Sydney, Australia.

Dr. Julie Ju Shi, an associate professor of health economics in the School of Economics, Peking University, and Dr. Xiongfei Pan, professor of epidemiology and population health, West China Second University Hospital, Sichuan University. Thank you all for joining the chat. Welcome. Xiongfei, since you are the health expert here, would you first tell us the

the difference between being overweight and obese, please. Okay, sure. To answer the question, we just need to understand how obesity is normally defined. So obesity is defined by body mass index. We always say BMI. So it's calculated just as a weight in kilograms divided by height squared in meters. So a body mass index is

equal to or greater than 28 is believed to be obese and a VMI between 24 and 28 is just for overweight. Anyhow, the criteria for obesity and overweight could be very different between countries. For example, in the States and in Australia, the thresholds of 30 and 25 are used to define obesity and overweight.

And also, both overweight and obesity actually are detrimental to health in the long term because the current evidence is that the association between BMI and, for example, diabetes and cardiovascular disease is lenient. So it's kind of a lenient association that the higher the BMI, the higher risk if the diabetes or some other cardiovascular diseases.

Another caveat to note is that BMI is a very crude measure for obesity. In clinical practice, we also use some other anthropometric and also symptoms to define

we say clinical obesity for example we also use waist circumference and not other measures for example CT measured and the fat mass in the body just to understand whether the the obesity is clinical obesity which is

more detrimental than the obesity based on BMI. Right. And Lauren, Shunfei just mentioned, do you have any idea why Australia is a bit different when it comes to the standard of being overweight or obese, you know, the BMI index? I don't directly. I would guess that's just a deliberate effort to

try to instigate a healthy behavioral shift at an earlier phase in weight gain. It reminds me of the clothing size differences. I think in America, like a size 12 there, it might be a size 14 in other countries or even a size 16. So it's a perception difference. And

I guess that helps to promote healthier lifestyles by having a slightly stricter BMI obesity index measure. That's quite smart, actually. Yeah. Also, in Australia, we have a health system that is relatively public.

Probably. Yes, yes, totally.

money to be made where people are ill or need a drug to contain their appetite or so on. Those drugs would be subsidised much more in Australia by the taxpayer. So therefore, public authorities have a much more direct investment in reducing health problem incidents. Now, many poor people

Do you have a weight loss plan to get a ball rolling? I myself need to lose weight because the results of my latest medical examination showed I was overweight.

Luckily, I'm not obese yet, but it's really tough to get rid of even one kilogram. So, Zhongfei, can you go first since you're the only male guest here, which is quite rare for the show. You can choose to skip the question because it's a bit personal. Yeah, it's a bit personal, but I have to confess I do have a plan to reduce my weight because my BMI is quite close to 24, just to correct your idea, threshold for all the weights.

But you know, weight management is, it should be always a routine for everybody. I mean, so, you know, I do have the plan to reduce my weight since I'm almost overweight. But it's still, you're in the fit category, still quite fit, right? Right. And what about Julianne Lauren? Are you willing to reveal a little bit?

Well, as a female, under the East Asian culture, I think like, ladies always prefer to be thinner. Personally, I do have a plan to lose weight. I believe usually we will like have a loose weight plan in spring because it's just after our traditional Chinese New Year.

We'll eat more unhealthy food during the holiday and we'll feel that summer is coming. It's better for us to lose weight and be thinner in summer.

For my personal experience, I bought a gym membership two months ago and I found a gym instructor for me to train, to provide guidance on how to exercise more professionally with the purpose both to lose weight and to be more healthy, be more energetic.

Right. I guess you don't have such a concern then. What about Lauren? I guess you don't have such a concern either, right? I don't know my BMI, but I'm pretty sure it's probably in the overweight category. And

I would say in theory I always have a plan to lose weight. In practice, I only implement it when my clothes feel tight and I start to panic that, oh gosh, I must have put on weight if my clothes are getting tight. And then I lose it and then I just start eating food I like again. And so I tend to have a bit of a cyclical relationship. But understanding all these health metrics and so on. Right, I totally understand you. Just to talk about the –

what is attractive and so on. Even within Australia, I notice when I travel between Melbourne and Sydney, you know, in Sydney is sort of along the coast. Sydney is a very sort of fashionable, very outdoor, very kind of, I don't know, like a kind of a global supermodel culture, so to speak, whereas Melbourne's a bit more bookish, academic,

and indoors. And I really noticed the difference. Like, I feel like people in Sydney pay a bit more attention to being attractive, sort of to fit with that consciousness. And it's the same if you're in LA versus, you know, LA is so sort of outdoors and so conscious of how one looks versus other cities. So the environment definitely has a lot to

play in this cycle and who's around you for sure. Maybe it has something to do with the beaches there. Yeah, indeed. And the weather, you can be outside most of the year. Summers may be nicer, but actually winter's pretty nice too. Right. And then coming back to China, how many Chinese people need a weight loss plan? And according to today's survey, it seems to be

one in three, like a third of the population? Or it's even bigger than that? Well, just to answer your question, I think we just need to understand how many people are either obese or overweight. Here in China, I think at the moment,

the statistics indicate half Chinese adults are obese or overweight and 20 percent of children are either obese or overweight. So these figures are pretty high at the moment and that's also the background for our discussion today and I think there's kind of a misunderstanding for overweight and obesity and who needs to have a

As I mentioned earlier, because the association between BMI and major long-term communicable diseases are sort of linear. So the higher the BMI, the higher risk is for most long-term communicable diseases. So it's even very urgent for those who are overweight to reduce or control their weight. Yeah.

And those stay in the obese category, it's even more urgent for them to do so, right? Yeah, of course. Then you said it's a high rate. Actually, Lauren, are you a little bit surprised when you hear the number? It's

China, people wouldn't expect that, right? I don't think that's true. I think obesity rates rise as incomes rise. So obviously incomes have increased a lot, especially in urban China over the last few decades. As calorific intakes rise, obviously those two are correlated.

But perhaps the calorific intake of, for example, China's one child policy generation has been quite unique, like a sort of skyrocketing opportunity to increase living standards just for one cohort, especially the urban ones.

So I don't think it's that surprising. And then on top of that, you've still got kind of a traditional level of competition for getting into schools and getting into good universities. So the combination of rising incomes and massive competition for everything means sitting at a desk for many hours while being able to eat lots of calorie-rich foods, which is probably not a good combination for preventing cancer.

rising obesity. And I've definitely noticed, I mean, I first went to China in 1998 and

And I've been going irregularly and regularly ever since. And to be honest, it's got easier for me to buy clothes, not just because Chinese people have got taller, but also because they've got bigger. Much, much easier to buy clothes in China now. But we're still a developing country, you know. What's China's situation like, the rate compared to that of Australia or other developed countries like the U.S.?

I don't know all the rates comparatively off my head. Perhaps one of the other speakers who's a more specific obesity expert. Definitely the rates are not high compared to the US where the rates are the highest and even compared to Australia. And I guess they're not that high in places like rural China or poorer parts of China. It's more a question of, you know,

richer parts southern China Guangzhou Fujian and Beijing and Tianjin they would be the the candidates for even those places where people are more likely to own cars because they don't walk as much and they have desk-based jobs but I'm not

100% sure. Actually, one thing I would be really interested in is the rates of obesity among Chinese in different parts of China, but also Chinese overseas. China has an amazing pool of people all over the world who left China, and have they got

larger when they've gone to America? Have they got larger when they moved to Australia? There's a lot of chance to understand comparative lifestyles if you track even individual Chinese who've migrated from China.

You must be able to learn a lot. Yeah, it may have a lot to do with what their daily diet is. If they already change that to the American style or the Australian style or German style, maybe they can get bigger. The Chat Lounge. The Chat Lounge unpacks views and opinions on hot issues in a more casual way.

Julie, I understand you lived in the States for quite some years, right? And study there. And do you have any findings there or, you know, compare China with the States, the obesity rate? I'm happy to. The one point is

What I like to read is that in general, I think the over rate and the rate of diabetes are much higher than that we have in China. Even like 10 years ago, if I remember correctly, like two thirds of the population in the US are overweight. Like one third of them experience problem of like diabetes or not. That's something in my mind.

And I like to share something about the prevalence of overweight and the path of the development of the country. It's not usually the linear trends. We will see it's like nonlinear trend where there is a turning point. So in the very first stage,

When the country is very poor, there is the problem of famine. That's the hunger. People are like hunger for food. Like what we experienced maybe 50, 60 years ago in China. People would be like thin, just like Lauren mentioned. They may be like short and thin. But as income increased,

There are more food, better food, where more calories are taken, they will become stronger, and the overweight problem emerges. However, as the income continues to increase, people will gradually realize that the problem of overweight and try different methods to control the way to pursue a more healthy lifestyle. And

And China is in the second to the third stage. That's the turning point. Right. Lauren and Julie both mentioned the differences between different groups, like where they live or whether they are wealthy or poor. A decisive factor, probably, to some extent, I should say, to whether a person could become overweight or obese.

But, Shunfei, can you tell us a little bit more gender-wise or age-wise what's the characteristics of the overweight and obese population in China? Okay, so there are a lot of research studies actually on the disparities between different sexes and age groups in China. Now, the prevalence of

slightly higher in men than women, which was different actually 10 years ago. And also the prevalence of obesity and overweight is higher in middle-aged adults than younger adults and the elderly adults. And also geographically, Thich Nhat Hanh also mentioned the possible disparities here in China. But the reality is the prevalence is much lower in coastal areas, particularly, for example, Guangdong or Anhui.

And it's higher in more afferent provinces like Shanghai or Beijing. If we divide China into North or South China, then it's generally much higher in North China than in South China. In the southwestern part of the country, then the rate is also lower. But anyhow, the geographic differences or variations may reflect

reflect a sort of a compilation effect if lifestyles, even physical constitution, economic development, or even cultural background, I think. So it's pretty sort of complex question actually to explain the geographical differences. And also, if we compare the rural, the rates in rural and urban areas, you know, there's very interesting trend. The prevalence used to be higher

much higher in urban areas than rural areas. But now the trend is actually reversing. It's kind of narrowing and, you know, both in rural and urban areas, the prevalence is high. So that's a very surprising finding from the latest in the national surveys in the past few years.

And that's also we need to note actually in policymaking. Then have you tried to find the reasons behind this kind of surprising result? Well, I think it could be partly due to the rising, you know, disposable incomes in rural areas. Most rural families, they can afford or have better access to foods or even calorie-rich foods. And also I think the

they are less aware of the detrimental effects of certain foods. That could be one of the two major reasons, or there could be other reasons. For example, the infrastructure or wireless infrastructure in rural parts of the country is less developed.

developed, I think at the moment. It could also be other reasons, but we're trying to understand this. But globally, the rural-urban gap is diminishing in most countries, even in rich countries or less developed countries. So that's the global trends we are seeing from the beta.

Has the traditional mindset of being fat as more blessed played any role here, actually, in China, in rural areas like you just mentioned? Yeah, that could be one of the reasons. That's been all the way to obese people.

could be a symbol of affluence as believed by a lot of older generation Chinese. Even in urban areas, we still have this kind of mindset. So that's what we say the sort of the psychosocial factor playing a major role in the risk of obesity. But now, actually, the government wants to change that kind of a mindset.

and the country launched the nationwide weight management campaign about half a year ago. So, Julie, why do you think the National Health Commission has intensified the three-year campaign actually now? For short answer, because...

Health management is a very important thing for the country. The National Health Commission has finally realized it. All right. That's the short answer. Let me tell you a little bit about the background of the commission. In 2008, our country experienced institutional reform at the nation level.

Before that, you may be aware, the National Health Commission was named the National Health and Family Planning Commission. So they have both tasks. And in English, it mentions the National Health Commission. However, in Chinese, it's the Weisheng Jiankang Wei. It's both health care and health, not just the health.

So due to the historical reason, this commission has not been put too much effort on our healthcare system instead of promoting population health. I'm not saying that's incorrect.

Because healthcare system is as important as other government tasks. But gradually, at the national level, the Commission realized that besides the healthcare system, that health management is as important as, or in some sense, more important than just improving the healthcare system. So in old times, we just think that, okay, when people are getting sick, I will

we will provide good access to the patients, make them affordable for healthcare, etc. But gradually, the government realized that it's much better or it's more cost-effective to help people to maintain a health status and to avoid to get catastrophic illness in the future for their medical treatments.

in order to avoid catastrophic medical spending for the population. The national network experiment is such a mind-changing. So that's the background for implementing such a high-level loose weight plan. Indeed, it's like the philosophy of traditional Chinese medicine, right? Prevention is better than cure. And Shunfei, what's your interpretation here? Yeah, I think it has...

to do also with the high prevalence were absolute lambdas. Obviously cases, as we discussed earlier. So China is already the number one in the league table in terms of obesity and overweight burden. So that's a major issue now for China. And what sort of projections of further increase of obesity and overweight, you know, are not positive, you know.

Also, you mentioned earlier, it's probably much easier to prevent than to reduce overweight. And another very important thing we need to realize is that here we have the Healthy China 2030 goal. So let's say 2030 is a very important time for us.

to achieve a sort of the goal of a harmonious society or a healthy country. So as we mentioned, obesity is related to most non-communicable diseases like diabetes, cardiovascular disease, and a few cancers, for example, breast cancer.

So to tackle the non-communicable diseases, to achieve the goal for a healthy China by 2030, we have to deal with the obesity issue in this country. So I think that's why the director, Lei Haichao, just

discussed the obesity issue for over five minutes during the press conference at the 14th National People's Congress. So it is a major issue now for us. Yeah, it's only five years to go. To Lauren, is there such a similar campaign in your country? You know, a lot of people are asking, it's kind of a personal issue, right, being overweight or obese. It's my problem. Why do the authorities care that much about it?

I think the authorities care because

It costs a lot of money when people are overweight because of those comorbidity issues. So the comorbidity factor tends to undermine labor productivity. But I think actually the key reason now it's become important in China is as a population ages, the average tendency to seek medical treatment shifts from a sort of a contagious type one to a chronic

chronic illness one. And chronic illness is fostered by obesity, as was said, from diabetes to backaches and other issues. And so now that China's population has aged quite rapidly, not only will there be a lot more old people facing these

chronic illnesses which will be so exaggerated by obesity and therefore the cost will be exaggerated to the health system but it also makes the labor productivity and health

of the smaller, younger labour force more important. So it's even more important that they can be productive than it was before. So you have that sort of double importance economically of reducing the burden of the large older populations' health issues and also enabling them to have a healthier older age.

and enabling a much higher per capita or per worker productivity of the younger generation. So it's both, you know, to foster each of those things. So that's why I don't see it as weird at all. I see it as a consequence of that shift. This has been The Chat Lounge. When we come back, we'll discuss the challenges and opportunities that may arise during the process. Stay with us.

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Welcome back to the chat lounge. We continue our discussion on China's national weight management campaign. Lauren, is there a similar campaign in your country, in Australia? I guess it's not as explicit now. I would say it's always ongoing. Maybe it's more subtle, as was noted by the BMI index, being 25 measuring obesity in Australia versus 30 in the U.S.,

And possibly GPs, for example, might be prompted to work with their patients on these related issues. So I think that the government has indirect ways as well as direct ways to try to foster healthy lifestyles simply because when people are overweight, it really weighs on the whole national economy and it costs a lot of money to fund people.

all the health needs of people when they're overweight. So it's definitely in the government's and the collective interest to keep people healthy and even more so when the population is older. Indeed. And Julie, like Lauren just mentioned, it's

The cost could be huge if this issue is not being solved in a timely manner. So economically, how big a burden would it be to the nation? As an economist, do you have any evaluation or calculation there?

But to be honest, technically it would be hard to accurately predict the burden as it would depend on many factors like the price of healthcare services, population income, etc. However, we could do a very rough calculation or prediction if we do not make any

like intervention on this overweight pattern, the number of patients with chronic diseases related to overweight will experience a rapid and large-scale increase in the future. Let's just assume that, for example, in the maybe coming 10 years, there will be like 100 million additional patients suffering from cardiovascular diseases and diabetes and other overweight-related diseases.

the annual treatment cost for each patient would be like 10,000 yuan. The total treatment cost would be like 1 trillion yuan. That's a huge amount. It's equal to 0.7% of our country's GDP. Just to give you a reference number that currently our healthcare expenditure as a percentage of our GDP is only 7%, much lower than Western countries.

So the additional treatment cost would be equal to one-tenth of the current medical expenditure. So that's a huge amount. And this is only the medical or clinical cost in treating these diseases per year without counting other costs such as nursing experience and nursing expenses and losses due to the work absence. So I totally agree with Lauren that

Helping people to keep from overweight is not just an individual issue, it's also an issue at the country level. It would save a lot of cost or resources for the country. It makes every sense for the authorities to carry out this campaign. Can I possibly just add?

One point. Sure, go ahead, please. Another subtle or like, it's not so subtle, actually, but for example, in The Economist in the last year or so, they've had this kind of feature and it's targeted at women. It's not targeted at men, but maybe it's an overall thing that economic research shows that women especially have

a faster track career and better career success when they're very thin. Sort of creating a mindset for staying thin, like to communicate this will not just benefit your health, it even benefits your income. So there are different ways of planting seeds and that might be one way seeds are being planted. That's a very good point. Now let's take a look at the details of the National Health Commission's Weight Management Initiative.

An essential part is about healthy diets. And we see Olympic champions like star sprinter Su Bingtian and the swimmer Zhang Yufei having been enlisted as advocates. And the strategy actually offers dietary advice tailored to different regions and considering obviously local food preferences and nutritional needs.

So I'm not sure if you've read the manuscript, I should say. Which one is your favorite? I know, Lauren, it's all in Chinese. But my favorite one is one of the autumn dietary for East China. They have, you know, different advice for different regions. I like that because it's...

it contains a lot of seafood and freshwater food so I'm not sure if you got your own pick. Lauren, did you look through that? Actually, well I can read Chinese but I wasn't able to download the document unfortunately. Oh sorry, sorry about that. Then what about Julie?

Of course I can read it. My favorite one is not the food, but be aware of the hazards of being overweight. Give more knowledge to the population. Make them aware of the potential problems for being overweight.

Okay, so it's about the whole management initiative strategy. And what about Xiongfei? Yeah, the guidelines are pretty unique in terms of its contents. The previous ones from other Chinese expert organizations, for the first time, it contains specific recipes

for different reasons of the country. And also for the first time, it provides prescriptions from the traditional medicine. So these two firsts,

actually make the guidelines pretty unique and pretty practical. And it's very easy actually for normal, ordinary Chinese to follow the guidelines instead of consult the health experts. Right. You're saying it's quite practical, but from my perspective, you know, I'm giving you an example. It advises the energy supply ratios of the three major macronutrients

are fat 20% to 30%, protein 15% to 20%, and carbohydrates 50% to 60%. And the recommended energy supply ratio for breakfast, lunch, and dinner is 3 for 3. But how can we manage to do that? You can't, you know, take a scale everywhere you could go, right?

Yeah, of course. It's difficult actually to measure the intake of macronutrients by ourselves. I think the good thing is that there are quite a few different values attached to this guide map. Right. And I also find it difficult to follow because it outlines recommended food and medicine for different types of obesity in adults based on a person's

TCM syndrome type like, you know, spleen-yarn deficiency syndrome or blood stagnation syndrome. You have to identify which type you are first, but how can we do that by ourselves? Yeah, that's a good question. You know, for these prescriptions, I think we have to, you know, consult the traditional Chinese experts or traditional Chinese professionals. So,

So I think that's the part that's difficult for us to follow. Otherwise, the different recipes or menus provided for people or residents in different parts of the country are pretty practical. And they are also customized to the dietary habits and different regions. That's why I say that's the uniqueness of these guidelines.

Yeah, but on the other hand that makes this you know professional clinics or weight management clinics quite imperative right and very necessary so the strategy also highlights the establishment of medical weight management clinics and raising awareness at schools and workplaces fully embracing traditional Chinese medicine accelerating the transformation of food

food, processing and so on. So, which one do you deem as the most pivotal point then, Lauren? I guess they're all important.

One of the issues I think in the United States is that unhealthy food is much, much cheaper than healthy food, as well as being a bit more accessible. And so I think it's important to ensure that healthy food is affordable and accessible, other than all those income scale effects and so on, just as a general benchmark to make sure healthy food is always readily affordable. I think that's

a fundamental issue. And maybe one thing China has going for it in this obesity campaign is at least, maybe it doesn't exist as much, but older Chinese at least, and some younger Chinese in my experience, have a sort of openness of telling somebody their facts, like in a way that doesn't exist in many other places. There's a kind of a

a Chinese comfort with saying, you know, nìu yí diàn pàng, or, you know, you're, that's just a sort of a norm in China. And if that openness, if that descriptiveness can be combined in a more sensitive way into this healthy China and obesity campaign, maybe China can turn that direct element of traditional culture into something more

favorable into something that helps to reduce obesity. But which part is more important? I mean, probably changes by generation, by workplace, by region, by income level. It's very hard to say. Right. Quite enlightening, actually. It's a new way to look at the, you know, telling people you're fat. All right. And Julie, your pick.

I just now asked which one is the most important one. I'm saying it's the reason awareness for the population. So that would be like reason awareness at the schools and workplaces, let people to know the potential harm for being overweight.

And our health expert here, Xiongfei. Yeah, I actually like all the points you mentioned. Combining them together reflects the government's will to use multisectoral efforts or multidisciplinary efforts to combat the problem. As you mentioned, sort of the medical weight management clinics or the raising awareness at schools. So these actually are efforts from different sectors.

from the health sector, the education sector, and even as you mentioned the food processing issue, that's actually the effort from the commercial sector side. So I guess these sort of a multi-sector efforts are super important to tackle, as we mentioned, the up-level determinants or risk factors for obesity in a country.

We repeat it again and again, obesity is not a personal problem, it is a national problem, it is a national challenge. So we need sort of much extra efforts, you know, from different levels of the governments to put all our efforts together to jointly address the issue. That's important and that reflects the initiative. The Chat Lounge. The Chat Lounge unpacks views and opinions on hot issues in a more casual way.

And let's talk a little bit about the challenges and opportunities during this campaign. Actually, the three-year campaign aims to promote healthy lifestyles, strengthen chronic disease prevention and treatment, and enhance the public's awareness and skills in weight management, like you all mentioned. But it doesn't have quantified goals. So what effect can we expect by late 2027, Shunfei?

Well, that's a good question. Yes, actually we don't see the accurate goals for the campaign, but actually there are some goals in other guidelines from the National Health Commission or the national governments. The goals I can find for childhood obesity and overweight is to reduce the growth rate by

about 70% by 2030. So that's the goal for children, you know, childhood obesity. For adults, obviously, I don't have the statistics

But I think the issue is very difficult to set a goal for obesity control. It's difficult. Even for the current goals, we can see from earlier the Chinese documents or guidelines just for reducing the growth rate of obesity instead of the rate of obesity. These are two different issues. So basically means it's difficult to reverse the trend in the short term.

there's some possibility to control or to reduce the growth rate instead of the prevalence and there's actually some projections from experts in china and for the future prevalence obesity if we don't do anything by 2030 i think it's projected that 60 percent of chinese adults and

30% of Chinese children will be obese or obese by 2030 if we don't do anything. But for 2027, I don't have any exact projections at the moment. I have to notice it will take very long time to reverse the trend. And globally, very few countries so far

have reversed the trend of obesity, but there is some hope. For example, in Italy, I think there is an indication of obesity reduction in childhood, basically in children and adolescents. Here in East Asia, in Singapore, Japan, the prevalence rates are pretty stable in the past few years, and also they are low. So there are good examples there.

We can follow and we should be optimistic. It may mean that this campaign will have to be renewed after 2027. Then what kind of challenges do you think may emerge for individuals and the authorities while carrying out the initiative for us to...

get our weight under control or get the nation's weight under control? It's also a very difficult question, actually. You know, obesity is not an individual problem. It can be related to a lot of up-level determinants, as we mentioned, social determinants, you know, economic development and other factors such as urban design or urban planning or food system. So these actually are very, very

factors we can address in the short term. For example, we say commercial determinants for obesity. So the food industry obviously is very interested to reduce the cost of food, possibly by processing the foods in a large scale.

And, you know, ultra-precious foods, for example, have been a major issue globally and also in China. And there are commercial interests in producing processed or ultra-precious foods. So it's difficult to keep a balance between economic developments and addressing, you

medical issues. So that's number one challenge. Number two challenge could be specific fragments of the population. You know, for them, it's difficult to change their behaviors. For example, we have a large number of right-hand drivers. These drivers, they work in their car for long hours. It's very difficult to change their lifestyle. Their lifestyle is just sedentary.

And for some other people, for example, the food delivery workers, you know, it's difficult actually for them to...

have healthy food because they are working pretty hard and they don't have much time to cook healthy food to eat healthy. So these are the two of the major challenges that I think we are facing at the moment. Right. Maybe it's like Lauren mentioned in the beginning of the show, that's because of the fierce competition and maybe the authorities need to improve the work environment as well.

But to me, personally, I think it's self-discipline and perseverance in this regard. But Lauren, do you...

In some places, there's campaigns to encourage people to take the stairs. And that doesn't mean the stairs up like 10 flights, but just the stairs in and out of a train station. Or, you know, if you're only going to the third floor, take the stairs or something like this. And I guess that's another reason obesity has changed in China. You know, when I was first there in 1998, you know, you had all those six-story apartment buildings in Beijing and everyone has to take the stairs.

Yeah, and the same in the subway. There wasn't really an elevator. You had to take a lot of stairs.

And in parts of Berlin, especially East Berlin, they still have a lot of places where you literally still have stairs. I spent some time living in Berlin. And for a period, I lived in exactly that type of building, which was I was on the sixth floor or the fifth floor, and there was no lift. And lifts haven't been put in these old buildings in Berlin. The old building remains. And so there's this whole...

healthy culture around literally climbing to the stairs. And so even the delivery people in Berlin are actually perversely, they're the fittest people because many of those delivery guys, they don't just drive to the destination, but they have to climb all the way to the fifth or sixth floor in those buildings to actually deliver the good. So they're almost one of the fittest people in the city. So I guess,

finding creative ways that don't force people to be fit. But that might mean like encouraging the delivery companies to provide a gym somehow, even if it's at where the people park their cars or somehow if there's a way to,

foster the companies that have workers who live that lifestyle to somehow provide a way that fits into their income and that lifestyle that also enables them to stay fit, which surely would actually work for labor productivity in any case. So I think that's just embedding it somehow and making it part of a

cost-effective culture both for individuals and for companies. Right, quite illuminating advice. And like they say, amid every crisis or difficulty lies great opportunity. So let's talk a little bit about the business opportunities here. This question goes to Julie. What kind of business opportunities do you envision that may emerge during this campaign? Well,

Maybe like nutritionists, we will also see maybe more like fitness centers, more fitness instructor and also the manufacturer of healthy food, like the drinks without the sugar. They may have like better market opportunities than those traditional manufacturers. Lauren? Is European drug Ozempic?

Oh, yeah, the weight control drug pills. A weight loss wonder drug. Yeah, yeah. A period last year where the most valued company on the stock market in the whole of Europe was the company making Ozempic. And it's, was it such a, it's a drug that's like being used in America and Australia and all over Europe. Was it recommended by Elon Musk or? I don't know who's recommended it. It's a Danish company called Novo...

Something. I can't remember. Oh, well, this...

Yeah, Novodisc. And literally, Novodisc had the highest stock market value of any European company just because of an obesity drug. So that tells you the kind of what a distorted market has been created by this whole obesity phenomenon. Right. So those drug companies, they can find a, you know, profitable market there. Yeah. And because it is so hard to change your habits, you know, it's just easier to take a drug once you get fat. But

But isn't that unhealthy to some extent? Yes, it is. It's not the best solution. It's such a... That's Europe's most successful company. Right. We can take it as a short-term solution. But for the long term, let's pursue the healthy way. All right. Bye.

Before we sign off, could each of you please share a tip for losing weight? Shall we begin with Julie? Share a tip for losing weight? Can't think of any? I think it's very hard.

Personally, I think the key thing or the challenges for the individuals to lose weight is to change their eating and exercise habits. So if there is something that I like to share is to have a good rest and keep a strong mind. That supports your mind to change the style that you usually feel comfortable.

Okay. Eating healthy. That's quite fundamental, actually. And what about Shufi? Yeah, it's difficult to lose weight for anybody. And it means to change the current lifestyle and establish a new routine. So in this case, it's very important, actually, for those who want to lose weight or to reduce the weight and to be in a peer group, to encourage each other,

for the lifestyle change. And the second point is very important to niche into expert views. And a lot of times we think it's very easy to lose weight just by changing the lifestyle or eat healthy or be more physically active. But that's the principle. We know everybody knows that. But it's difficult. We just need to have some guidance from experts.

And third one is that we need to have to realize that we should have a customized plan for each other. It's starting, you know, not all the people should use the same plan for reduced weight. For example, for those who have severe obesity, you know, the lifestyle change or modification started is not feasible at all.

So in that case, probably we need, for example, bariatric surgery or some, you know, just anti-obesity medication. And so we just need to realize how serious the problem is and have to individualize the plan and, you know, just follow the plan and be encouraged by the others who are in the same situation. And, you know, it's not always as easy as we mentioned. It's just a lifestyle change problem. It's

It's not. It's more than that. Okay, that's quite academic. And last but not least, Lauren, please. I would definitely say the same about peer groups and that it's never easy. You know, people say, and it's probably true that

Even just making sure you eat dinner before 7 p.m. and all these sort of behavioral shifts or not drinking too many calories. Like these tend to drink lots of coffees, you know, or hot chocolates or these type of drinks or, you know, soft drinks.

And that drinking lots of calories is just a waste of calories. So that at least when you're consuming calories, don't waste them. Like use your calories wisely, you know, use them on good food.

Sorry to interrupt you, can I add one more point about the challenges? I do have some ideas. For the challenges, I think, just now I mentioned, it's very difficult for people to change their eating habits, especially for the middle-aged population in our society. They often face great work pressure and family burdens, and usually those high-fat and high-sugar foods is just a way for them to relax themselves.

But the overweight problem would be the most severe for the middle-aged population because they still have a longer time to live. So I hope the government should pay special attention to those middle-aged population. Maybe like reduce the evolution, provide a better working environment for them. That's for the individual challenge. And for the authorities,

Just now we mentioned that the government would start the weight loss clinics in the hospitals to help the patients to lose their weight. This is great, but these clinics will only help the patients who have already realized that they face the problem.

there is still an even larger population who are not aware that they are in an overweight state or face the risk of being overweight. So I think the government should put the most effort, again, on health education and publicity. The authorities need to do what they need to do. But personally or individually, I think, like Lauren just mentioned, maybe just

get one of your colleagues to watch her back and remind you when it's time to do some exercises and so that we can fit ourselves into the clothes we want. On that note, we wrap up this episode of Chat Lounge. Many thanks to Dr. Lauren Johnston, an associate professor of the China Study Center, University of Sydney, Australia. Dr. Xiong Fei-Pan, professor

professor of epidemiology and population health, West China Second University Hospital, Sichuan University, and Dr. Zhu Yizhu, an associate professor of health economics in the School of Economics, Peking University. The show is available on all major podcast platforms. Please email us your comments at radio at cgtn.com. I'm Tian Yun. Thank you for listening. Joining us for more chat at the chat lounge next week. ♪

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