An epidemiological survey covering 100,000 people showed that among adults aged 18 and above, 30.6% were overweight and 12% were obese. The prevalence of obesity was positively correlated with economic development.
In the past, the medical community divided obesity into two categories: simple obesity and pathological obesity. With deeper understanding, obesity can now be classified into four types based on symptoms and physical signs, each with characteristic pathological changes and corresponding medical interventions.
- Simple Obesity Without Metabolic Abnormalities
People in this category have a BMI ≥ 28 but no accompanying metabolic disorders, such as hyperlipidemia, hyperinsulinemia, insulin resistance, hyperuricemia, thyroid dysfunction, or sexual dysfunction. They usually have a uniform body shape and relatively good health.
The key to weight control is lifestyle modification, including a balanced diet and increased physical activity. Special drug intervention is generally not required. - Obesity with Hypertension, Hyperhidrosis, Heat Intolerance and High Metabolism
This type has distinct clinical features: Irritable temperament
Flushing of the face or whole body with sweating when agitated
High blood pressure
High energy levels, but no obvious weight loss despite frequent activity
In addition to lifestyle interventions (diet control and exercise), active drug treatment for hypertension and other complications is needed.The goal is not only weight and waist circumference reduction but also stable blood pressure control below 135/85 mmHg to protect the heart, brain, kidneys, and other vital organs.
- Obesity with Lethargy and Low Metabolic Rate
Patients in this group often appear “lazy,” but this is physiological rather than psychological.Low levels of hormones such as thyroid and gonadal hormones lead to persistent fatigue, weakness, and even drowsiness day and night.
Although their food intake is similar to that of normal people, low metabolism and reduced energy consumption result in fat accumulation.For suspected cases, blood tests for various endocrine hormones should be performed promptly for a clear diagnosis. - Obesity with Metabolic Disorders and Insulin Resistance
Patients show pigmentation and thickening of the skin in areas such as the neck, armpits, groin, perianal region, and umbilical fossa. The skin looks dirty but cannot be cleaned, a condition known as acanthosis nigricans.
These skin changes reflect underlying severe insulin resistance, hyperuricemia, elevated free fatty acids, and inflammatory factors. This is the most complex type; without timely intervention, patients are highly likely to develop diabetes.
Medical intervention should focus not only on weight and waist circumference but also on comprehensive testing: Fasting blood glucose
Glucose tolerance
C-peptide
Glycated hemoglobin (HbA1c)
Satisfactory outcomes require simultaneous intervention on body fat and blood glucose.