Novo Nordisk (China) Pharmaceuticals Co., Ltd.

Over the past 40 years of reform and opening-up, China has achieved great economic and social development and made tremendous achievements. At the same time, the lifestyle changes brought by economic development have also resulted in a continuous rise in the incidence of chronic diseases. In October 2016, the Central Committee of the Communist Party of China (CPC) and the State Council released the "Healthy China 2030" Planning Outline, which elevated chronic disease prevention and treatment planning to a national strategic level priority. 

In August 2016, General Secretary Xi Jinping stressed at the National Healthcare Conference that people's health should be put high on the development strategy, and efforts should be made to ensure people's health in all directions and in the whole cycle. In October 2017, the 19th National Congress of the CPC also made major decisions and arrangements in “Healthy China strategy implementation”, stressing the importance of prevention and control of major diseases. In July 2019, The State Council has established a Healthy China Initiative Promotion Committee, issued the Healthy China Initiative (2019-2030) and the corresponding assessment plan, and the impact of being overweight and obesity has been highlighted in various special prevention and control actions. Addressing overweight and obesity is of great significance to reducing the burden of disease, supporting Healthy China 2030 and achieving common prosperity. 

Obesity, one of the independent diseases of chronic diseases, is defined by the World Health Organization (WHO) as a chronic metabolic disease caused by abnormal or excessive fat accumulation that presents a risk to health, resulting from multiple genetic and environmental factors. Globally there is increasing prevalence yearly, causing huge disease and economic burden to the world. According to the WHO, more than 1.9 billion adults worldwide were overweight and more than 650 million were classified as obese, with adult overweight and obesity rates as high as 39% and 13%. More than 340 million children and adolescents aged 5-19 were overweight or obese in 2016. Previous findings indicate that obesity had a negative impact in the 23 EU and G20 countries, with a reduction in GDP of 3.3% and 3.5% respectively. International organizations and a number of countries such as the United Kingdom and Australia have made obesity prevention and treatment a national priority, formulating national systemic policies to assist in national obesity management. 

Meanwhile, obesity has also become a major public health issue in China in recent years. According to Monitoring Results of Chronic Diseases and Nutrition of Chinese Residents released by the National Health Commission of the People’s Republic of China in 2020, over 50% of adult residents in China were overweight and obese, approximately 20% of children and adolescents aged 6-17 were overweight and obese, and 10% of children under 6 years old were overweight and obese. As per WHO standards (body mass index (BMI) ≥ 30 kg/m2), China ranks first in the world in terms of the number of children with obesity, and second in terms of the number of adults with obesity, second only to the United States. According to Chinese standards (body mass index (BMI) ≥28 kg/m2), China ranks first in the world in terms of the number of obese adults.  Presently, the overweight and obesity-related health expenditure in China is RMB 24.35 billion/year and is expected to reach RMB 418 billion in 2030, accounting for about 22% of the country's total medical expenditure. Therefore, it is of great significance to elevate the prevention and treatment of obesity as an independent chronic disease and also an important causative factors of many other chronic diseases to the level of national strategy for building a healthy China. 

Therefore, the following issues need urgent attention and improvement in prevention and control, diagnosis and treatment and management of overweight and obesity in China: 

1. Obesity has not been the focus of prevention and control, diagnosis and treatment and management as an independent chronic disease, and patients have poor disease awareness and treatment willingness. 

2. Obesity and overweight must be viewed as a systematic, societal problem because of profound social attributes, which requires joint efforts from the government, experts, society, educational circles and individual residents. 

3. Despite the consensus guidelines for the management, nutrition, and treatment of overweight and obesity, there is little coordination among them, which results in inadequate clinical implementation. 

4. No recognized program for overweight and obesity lifestyle intervention is available. 

5. There is a lack of drugs to treat obesity. 

The UK is one of the countries with the highest concern about the obesity problem. The UK government has reduced the negative impact of obesity on national public health by developing relevant policies. The policies range from prohibition of advertising and promotion of non-healthy foods, increased funding for weight management services, the founding of special clinics for children with obesity. An Office of Obesity Prevention and Control has also been established to have a more systematic and comprehensive approach. 

In view of above problems and international experience, the following three suggestions are proposed to address the current obesity in China:Firstly, it is recommended that obesity should be officially recognized as an independent chronic disease and included as a key chronic disease in China’s Medium-to-Long Term Plan for Prevention and Treatment of Chronic Diseases and the Healthy China Initiative. The government takes the lead in organizing relevant interdisciplinary experts to formulate China's medium and long-term obesity prevention and control plans, lifestyle intervention programs, clinical diagnosis and treatment and management guidelines or expert consensus, etc. so as to strengthen the systemic and coordinated efforts and enhance government input in obesity prevention and control. 

Furthermore, it is recommended that Office of the National Patriotic Health Campaign Committee (ONPHCC) should give full play to its leading role to include overweight and obesity prevention and control into the focus of the first batch of pilot cities for building healthy cities nationwide, and guide the implementation of overweight and obesity prevention and control work at the grassroots level. Also, it is suggested to hold a conference on overweight and obesity prevention and control around World Obesity Day (March 4) and World Obesity Prevention and Control Day (May 11) to carry out overweight and obesity health popularization, improve public awareness of overweight and obesity diseases, and increase treatment willingness. 

Thirdly, it is recommended that qualified medical institutions at all levels set up overweight and obesity clinics to improve their abilities in prevention, control, diagnosis, treatment and management of overweight and obesity, and promote the development of the discipline. Moreover, the R&D and registration of anti-obesity drugs should be encouraged and supported to make safe and effective drugs be available for the vast number of patients.Novo Nordisk, a leading global biopharmaceutical company specialized in diabetes, obesity and other serious chronic diseases, is willing to leverage our rich global resources and experience to deepen partnership with the Chinese government continuously, actively share international experience in the disease prevention and treatment. and provide support for relevant public cooperation projects to jointly boost the early realization of the Healthy China 2030.

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