Article 122: Preventing Fatty Liver in Middle-Aged Obese Individuals and Preventing Obesity in the Elderly

Fatty liver is a pathological condition characterized by liver cells filled with fat droplets, resulting in an enlarged, yellowish, and oily appearance of the entire liver. Clinically, patients with fatty liver may experience symptoms such as abdominal distension, discomfort or pain in the liver area, a feeling of oiliness when pressing on the liver, and steatorrhea. Physical examination may reveal an enlarged liver, and liver function may be abnormal to varying degrees. A definitive diagnosis can be made through ultrasound or CT scans.

Fatty liver disease has a relatively high incidence rate in the population. A survey of 3,250 people in my country showed an incidence rate of 19.21%. The 40-59 age group accounted for about 50% of all cases, meaning that fatty liver disease is common in middle-aged people. Further analysis shows that overweight/obese individuals, heavy drinkers, and diabetics are the most prevalent groups, forming the majority of fatty liver disease patients.

Middle-aged obese individuals are prone to fatty liver disease for several reasons. Firstly, obesity can cause liver fat to accumulate, leading to fatty liver. In obese individuals, enlarged fat cells are less sensitive to insulin, reducing the body's ability to break down and utilize sugars and fats. This results in excessive fat accumulation and its transfer to the liver, causing fatty liver. Secondly, middle-aged obesity is also an independent risk factor for diabetes. If diabetes is present, insufficient insulin secretion and lipid metabolism disorders can also cause excessive fat to enter the liver, leading to fatty liver. Thirdly, middle-aged people are often in their career peak, with frequent social engagements, making it easier for alcohol and fat intake to accumulate, thus increasing the risk of fatty liver. Fourthly, middle-aged people are often busy with work and lack exercise, reducing the conversion of fat into energy and increasing fat accumulation, thus raising the incidence of fatty liver.

In conclusion, middle-aged people should pay attention to preventing fatty liver, especially obese individuals who should take proactive measures. Regarding the reasons mentioned above: First, maintain a normal weight or gradually reduce excess weight through dietary control (low sugar, low calories) and regular exercise (at least 5 times per week); second, abstain from alcohol, or at least avoid excessive drinking, and carefully control alcohol intake when socializing (no more than 50 grams of spirits, no more than one bottle of beer, and no more than 250 grams of wine) to prevent alcohol from accelerating the formation of fatty liver; third, after middle age, regularly check blood sugar and urine sugar, especially for obese middle-aged individuals, who should be tested at least every six months. If diabetes is already diagnosed, actively pursue blood sugar-lowering treatment to maintain satisfactory blood sugar levels. Doing this will help reduce the incidence of fatty liver.

Generally speaking, fatty liver does not represent a true disease, but rather a pathological change. Therefore, once fatty liver is diagnosed, a comprehensive analysis is necessary. If it is only mild to moderate fatty liver, no special drug treatment is required. A combination of dietary and exercise therapies, along with abstinence from alcohol, control of diabetes, and weight loss, can achieve the desired therapeutic effect. If it is severe, with fat content accounting for 40% to 50% of liver weight, then lipid-lowering or lipid-regulating drugs are needed, along with appropriate liver-protective medications. Among the above prevention and treatment measures, abstinence from alcohol is crucial because research data confirms that alcoholic fatty liver presents with more common symptoms, significantly abnormal liver function, and is prone to developing into cirrhosis; conversely, non-alcoholic fatty liver rarely leads to cirrhosis and has a relatively better prognosis.

Prevention of obesity in the elderly should begin in youth, cultivating good habits such as not smoking and not drinking alcohol from a young age. Regular physical exercise is essential to maintain good physical health from childhood. Some cases of obesity in the elderly occur after middle age; therefore, it is important to pay attention to preventing and treating diseases that can lead to obesity, such as fatty liver and hyperlipidemia, during middle age.

Obesity in some elderly people is often related to the inappropriate use of hormones. Therefore, middle-aged people with a tendency to become obese should be advised to avoid using hormones as much as possible when ill. If hormones are necessary for treatment, the dosage should be adjusted regularly, and once the condition improves, the dosage should be reduced until hormone use is discontinued. For elderly women with menstrual irregularities, menstruation should be regulated promptly to facilitate safe menopause and avoid obesity caused by endocrine disorders.

To avoid obesity, people should consciously receive medical education on obesity and take preventative measures.

The number of obese people in my country has exceeded 70 million. The incidence of obesity is even higher in economically developed regions. In major cities like Beijing, Shanghai, and Guangzhou, nearly one-third of the population is overweight, making them high-incidence areas for obesity. Obesity not only affects a person's appearance and causes numerous inconveniences in daily life, but it also leads to various diseases such as diabetes, hypertension, hyperlipidemia, and coronary heart disease. Due to traditional misconceptions about health, obesity has not received sufficient attention. Many people still view obesity as a symbol of wealth and health, ignoring this potential threat. Conversely, many people of normal weight resort to various methods to lose weight, hoping to achieve a slim figure. Many patients with severe obesity who need to lose weight are unaware of the necessity of weight loss. Obese patients with diabetes and hypertension who do not seek medical attention continue to adhere to unhealthy eating habits and rarely participate in exercise. Many of them do not realize that it is precisely obesity that makes their diabetes and hypertension so stubborn and resistant to treatment. After weight loss treatment, blood sugar and blood pressure in these patients will significantly decrease, with weight loss even achieving effects that cannot be achieved by medications for lowering blood sugar and blood pressure.

Many obese patients are unaware of how to use medication. Centrally acting drugs work on the brain, suppressing appetite to achieve weight loss. Non-centrally acting drugs are fat inhibitors, reducing fat absorption and using daily life to burn excess body fat to achieve weight loss. Because these drugs generally do not enter the bloodstream, they are relatively safe. Non-centrally acting drugs work by inhibiting gastrointestinal lipases, directly blocking up to 30% of dietary fat absorption in the gastrointestinal tract. By blocking the source of fat, the body must consume existing body fat to provide the energy it needs each day, thus fundamentally preventing excessive fat accumulation with virtually no systemic adverse reactions. Many obese patients are unaware that weight-loss drugs should be used under the guidance of a doctor. Everyone should choose a suitable weight-loss drug for themselves, rather than blindly buying weight-loss health products with unclear mechanisms of action from stores. They do not understand that rapid weight loss is harmful to health, nor do they understand that there is no such thing as a weight-loss drug that allows you to "live like royalty every day." A common misconception in the market is that "taking weight-loss drugs will make you lose weight quickly" or "you'll become thin overnight." In fact, no single drug can independently and completely achieve a weight-loss plan. Only by combining appropriate exercise and dietary control can one truly achieve effective and healthy weight loss through a three-pronged approach. Similarly, only by developing good lifestyle habits can one thoroughly control their weight and maintain their weight loss achievements. This possibility is greatly increased when guided by professionals such as doctors and nutritionists.