A
Don't control your weight with extreme dieting, fasting or induced vomiting; if you want to lose weight, do it from the exercise side
Value for cost Very high
In plain termsPeople with anorexia nervosa have about 5.9 times the probability of dying as people their age. For every 1000 people followed for a year, 5.1 die. Of those who die, one in five dies by suicide. And the way in is dieting: in a study that followed students at 44 secondary schools for three years, girls who dieted severely were 18 times as likely to develop an eating disorder as those who did not diet. If you want to control your weight, exercise more; don't eat so little that you go hungry.
- Cost
- No money. On the contrary, you save the money you would spend on weight-loss products.
No money
Done in passing
No willpower
Benefit size large
- Benefit
- 36 studies were pooled. The people with anorexia nervosa were followed for a cumulative 166,642 person-years (the number of years each person was followed, added up). Their standardized mortality ratio was 5.86, that is, a probability of death about 5.9 times that of people their age. There were 5.1 deaths per 1000 person-years, meaning 5.1 deaths when 1000 people are followed for one year. About 1/5 of those who died died by suicide. The standardized mortality ratio for bulimia was 1.93, and for other eating disorders 1.92, that is, each about 1.9 times that of people their age. Another study was done at 44 secondary schools in the state of Victoria, Australia, following students aged 14–15 for 3 years, with the same students surveyed in 6 waves over the three years. New eating disorders among girls occurred at 21.8/1000 person-years, that is, 21.8 new cases when 1000 girls are followed for one year. Girls who dieted severely had 18 times the risk of onset of those who did not diet, and moderate dieters 5 times. The analysis then adjusted for prior dieting and psychiatric symptoms, taking out the influence of “having dieted before” and “already having psychiatric symptoms.” After that, BMI (an index of fatness calculated as weight divided by height squared), amount of exercise and sex no longer predicted new eating disorders. The authors concluded that “among adolescents, controlling weight through exercise rather than food restriction appears to carry a lower risk of developing an eating disorder”
- Evidence grade
- A
- Notes
- “Severe dieting” here means keeping what you eat far below what your body needs over a long period, not skipping one meal or a late-night snack. If you already have induced vomiting, self-blame after binge eating, or repeated weighing you cannot stop, go to a psychiatry department or the clinical psychology department of a general hospital. This is an illness with standard treatments, not a question of willpower. For the relationship between BMI and mortality, see Section 2, Item 32; that item is about long-term weight ranges, not about ways of losing weight.
A
Before injections, thread lifts or surgery, check two things: whether the facility's license includes “medical cosmetology,” and whether the person doing it is an attending physician
Value for cost Very high
In plain termsAnything that uses needles, scalpels or medical devices and breaks the skin or goes into the body counts as medical treatment. It may only be done at a facility whose license says “medical cosmetology,” and the person doing it must be a registered licensed physician. Doing it in a beauty salon, a studio or a hotel room is illegal medical practice. The person doing it is sentenced to up to 3 years if the circumstances are serious, 3 to 10 years if someone is injured, and 10 years or more if someone dies.
- Cost
- No money. Checking these two certificates takes only a few minutes. The facility should hang its Medical Institution Practice License (医疗机构执业许可证) in the lobby. A doctor's qualifications can be verified through the health authorities' licensed-physician lookup.
No money
Done in passing
No willpower
Benefit size large
- Benefit
- Article 2 of the Measures for the Administration of Medical Cosmetology Services (医疗美容服务管理办法) defines medical cosmetology. The original text is “the repair and reshaping of a person's appearance and the form of each part of the human body by means of surgery, drugs, medical devices and other traumatic or invasive medical techniques.” Put simply, anything that breaks the skin, puts in a needle or goes into the body counts as medical treatment. Articles 8 and 24 require first obtaining a Medical Institution Practice License (医疗机构执业许可证) and having the medical cosmetology treatment specialty approved by the registration authority before such services may be offered. If the license does not list “medical cosmetology,” it may not be done. Article 11 requires the attending physician (the doctor who does the procedure) to hold a physician's qualification and to be registered. Cosmetic surgery also requires 6 years or more of clinical work experience in a related specialty, cosmetic dentistry 5 years or more, and cosmetic traditional Chinese medicine and cosmetic dermatology 3 years or more each. Article 20 requires that, before the procedure, the indications, contraindications (when it is suitable and when it must not be done), medical risks and precautions be disclosed in writing, and signed consent be obtained. Article 336 of the Criminal Law (刑法) governs illegal medical practice. Illegal medical practice means a person without a physician's practice qualification giving people injections, operating on them or treating them. Where the circumstances are serious, the punishment is fixed-term imprisonment of not more than 3 years, short-term criminal detention or public surveillance, with a fine imposed in addition or alone. Where it seriously harms the patient's health, the punishment is fixed-term imprisonment of not less than 3 years and not more than 10 years, plus a fine. Where it causes the patient's death, the punishment is fixed-term imprisonment of not less than 10 years, plus a fine
- Evidence grade
- A
- Notes
- Article 16 of the same Measures also provides that medical cosmetology procedures may only be done in cosmetic medical institutions, or in hospitals or clinics that have set up a medical cosmetology department. So injections given in your home, or done privately in a studio, are already noncompliant on location alone. Article 20 states that when a minor or another person who cannot yet decide for themselves is to have a medical cosmetology procedure, the guardian's consent is required, and a parent must sign. Facials, massage and manicures are lifestyle beauty services and are not covered by these rules. But as soon as needles or scalpels are involved, it counts as medical cosmetology.
B
For facial fillers, avoid the bridge of the nose, the area between the eyebrows and the forehead, and above all don't go for unlicensed injections to save money
Value for cost Very high
In plain termsAmong people who went blind after filler injections, more than half had been injected in the nose, followed by the area between the eyebrows, the forehead and the nasolabial folds, and over 80% had hyaluronic acid. Of those who lost their sight, only about 20% fully recovered their vision, over 10% partially recovered, and nearly 20% also had damage to the brain. At present there is no rescue method that reliably works; the only option is to avoid these areas in advance.
- Cost
- No money. You just have a different area injected, or don't do it.
No money
Done in passing
No willpower
Benefit size large
- Benefit
- Cases reported in journals worldwide were pooled. From January 2015 to September 2018 there were 48 new cases of partial or complete vision loss after filler injection. The most common site was the nose, at 56.3%. Next came the glabella (between the eyebrows) at 27.1%, the forehead at 18.8%, and the nasolabial fold (the groove of the smile lines) at 14.6%. In 81.3% of cases the filler was hyaluronic acid (玻尿酸, its everyday name). 43.8% had skin changes. 18.8% had central nervous system complications (something went wrong in the brain). 10 cases (20.8%) fully recovered their vision, 8 cases (16.7%) partially recovered, and the rest did not recover. The authors concluded that the ways the complication is managed differ widely, and no treatment has been shown to work consistently
- Evidence grade
- B
- Notes
- These numbers come from counting, one by one, the cases reported in journals. They include only the number of people harmed, not the total number of people injected. So you cannot calculate “the probability of going blind from one injection”; you can only see which sites have the most incidents, and that afterward the damage can basically not be undone. That is also why the evidence is graded B. The ways licensed facilities lower the risk are already routine: first find out how the blood vessels run under the spot to be injected, use a blunt cannula rather than a sharp needle, inject small amounts while withdrawing the needle, and have hyaluronidase ready in advance. Each of these requires the person doing it to be a trained doctor, which is also the reason not to go through unlicensed channels. Before having it done, first check against Item 2 of this section (check the facility's license and the attending physician).
- Sources
- Beleznay K et al. (2019). Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J. https://doi.org/10.1093/asj/sjz053
A
Don't buy weight-loss pills, weight-loss coffee, slimming candy or enzyme plums (plums claimed to have been soaked in enzymes) that promise “fast slimming”
Value for cost High
In plain termsThe ingredient most often found secretly added to these products is sibutramine, which used to be a weight-loss drug and was stopped in China in 2010. Overweight people with heart disease or diabetes who took it for more than three years had about 30% more nonfatal heart attacks and about 36% more strokes. Their weight went down by only 1.7 kg more. By the time a spot check finds it, you have already swallowed it.
- Cost
- No money. On the contrary, you save the money you would spend on these products. The hard part is accepting that there is no such thing as “losing a few jin (斤) in a week.”
No money
Done in passing
Some willpower
Benefit size large
- Benefit
- The SCOUT trial enrolled 9,804 people. All of them were 55 or older, overweight or obese, and had cardiovascular disease or type 2 diabetes. They were randomly assigned to a group that took the drug and a group that did not, with an average treatment period of 3.4 years. The primary endpoint was a set of bad events decided in advance to be counted: nonfatal heart attack, nonfatal stroke, being resuscitated after cardiac arrest, and cardiovascular death. These events occurred in 11.4% vs 10.0%. HR 1.16 (95% CI 1.03–1.31, P=0.02): people taking the drug had about a 16% higher probability of an event. The true value lies roughly between 3% higher and 31% higher. Nonfatal heart attack 4.1% vs 3.2%, HR 1.28 (1.04–1.57), about 30% higher. Nonfatal stroke 2.6% vs 1.9%, HR 1.36 (1.04–1.77), about 36% higher. Cardiovascular death and all-cause mortality did not increase; all-cause means deaths from every cause added together. After randomization, the sibutramine group lost on average 1.7 kg more. The former State Food and Drug Administration, based on a safety assessment, concluded that “the risks of weight-loss treatment outweigh the benefits,” and in October 2010 issued a notice stopping the production, sale and use of sibutramine preparations and the active pharmaceutical ingredient. Sibutramine and phenolphthalein are both banned as additives in food, health foods included
- Evidence grade
- A
- Notes
- SCOUT enrolled a high-risk group who already had heart disease or diabetes. The trial did not show that healthy young people who take it would have the same problems. But precisely because there is no way to tell who is high-risk, regulators simply took it off the market. Another ingredient often secretly added is phenolphthalein, which was originally a laxative; taking too much of it over a long time disrupts the body's electrolytes and triggers arrhythmias. How to tell: genuine weight-loss drugs are prescription drugs, and their approval numbers can be looked up at pharmacies and hospitals. Products sold under the banner of “coffee,” “candy,” “plums” or “meal replacements” that also promise a few jin off in a week should by definition have no drug effect; if they do have a drug effect, that shows something has been added. The original text of Guoshiyaojianban [2010] No. 432 is on the National Medical Products Administration website, but opening it on this machine kept returning a 412 error, so a restatement page from a provincial-level regulator is cited instead. The two phrases “the risks outweigh the benefits” and “stopping production, sale and use in October 2010” can be checked word for word there.
A
Don't use anabolic steroids (“muscle-building shots,” “oral pills”) to build muscle
Contested Value for cost High
In plain termsMen who tested positive in gym doping tests had 3 times the risk of death of people their age, and went to the hospital more than twice as often each year. Acne, breast development in men, and erectile dysfunction each hit at least one in ten users. In China these drugs are prescription drugs; any channel that can sell them to you is itself breaking the law.
- Cost
- No money, and you save the cost of the drugs. The hard part is accepting that muscle grows slowly.
No money
Done in passing
Some willpower
Benefit size large
- Benefit
- In Denmark, researchers went back through records and matched each user with controls of the same age. The users were 545 men who tested positive for androgenic steroids in gym doping tests between 2006-01-03 and 2018-03-01, matched with 5,450 controls. The results were also checked again using 644 people who refused testing and 6,440 controls. Results: users' mortality was 3 times that of controls, HR 3.0 (95% CI 1.3–7.0); the true multiple is roughly between 1.3 and 7. The median number of hospital admissions or visits per year was 0.81 vs 0.36 (P<0.0001). The median is the number that half of people are above and half are below. This P value means the difference is almost impossible to be due to chance. Acne, breast development in men and erectile dysfunction each affected more than 10% of users, that is, at least one in ten users, all clearly more than in controls (P<0.0001). The results of the recheck group were consistent. Article 7 of the Anti-Doping Regulations (反兴奋剂条例): the state applies strict control to the prohibited substances on the doping list, and no unit or individual may illegally produce, sell, import or export them. The same Regulations provide that anabolic agents and peptide hormones are managed as prescription drugs, meaning they can only be bought with a doctor's prescription; anabolic agents (蛋白同化制剂) is the regulations' name for this class of drugs
- Evidence grade
- A
- Notes
- Contested: this is a study that followed a group of people to see what happened, not a randomized trial. The people who use the drugs may also take more risks in other ways, so the figure of 3 times cannot be attributed entirely to the drugs. The true multiple could be as low as 1.3 or as high as 7.0; the range is very wide. But “acne, breast development in men and erectile dysfunction each hitting more than one in ten users” are side effects you can see with your own eyes, and they are less affected by this kind of bias. In the regulations these drugs are written as anabolic agents (蛋白同化制剂); when you see these four characters, this is what is meant. Ordinary protein powder and creatine are not covered by this item. The trouble is that products “claiming especially fast muscle gain” may have ingredients secretly added. The way to judge is the same as in the item on weight-loss products (Item 4, don't buy weight-loss pills that promise fast slimming): genuine drugs are prescription drugs with an approval number you can look up. If something sold under the name of “muscle-building powder” or “nutritional supplement” promises results within a few weeks and really works, something has been added.
B
If you are going to take weight-loss medication, get a prescription at a hospital; don't buy from online shops that ship without a prescription
Value for cost Standard
In plain termsPrescription drugs must be sold only with a prescription, and online sales must also have a genuine prescription and use real-name registration. A shop that doesn't consult you, doesn't ask for a prescription and ships as soon as you order is either not selling the drug it says it is, or is breaking the rules. If something goes wrong, no one takes responsibility for your dose and contraindications. For a registration fee of a few dozen yuan, you have a doctor guard this gate for you.
- Cost
- One registration fee, plus one round trip. A few dozen yuan and half a day.
A little money
A few hours
No willpower
Benefit size medium
- Benefit
- The Measures for the Supervision and Administration of Drug Distribution and Use Quality (药品经营和使用质量监督管理办法) provide that drug retail businesses must comply with the system of classified management of prescription and non-prescription drugs. This system divides drugs into two classes: one must be bought with a doctor's prescription, and the other you can buy yourself. Pharmacies must sell prescription drugs against a prescription as required, and keep prescriptions for not less than five years. When the pharmacist or other pharmaceutical technical staff are not on duty, a sign should say so, and prescription drugs must not be sold without their review. Prescription drugs must not be sold on open shelves; they cannot be put on the shelves for customers to take themselves. Article 9 of the Measures for the Supervision and Administration of Online Drug Sales (药品网络销售监督管理办法) provides that anyone selling prescription drugs to individuals online must ensure that the source of the prescription is genuine and reliable, and must apply real-name registration. Article 10 requires risk warning information to be displayed prominently on every drug display page. Before the prescription passes review, the package insert must not be displayed and purchase services must not be provided; if the prescription has not been reviewed, the page should not even offer a buy button. Article 8 provides that drugs under special state control must not be sold online. These include vaccines, blood products, narcotic drugs, psychotropic drugs, toxic drugs for medical use, radioactive drugs, and drug-type precursor chemicals
- Evidence grade
- B
- Notes
- The articles of law can be checked word for word, but no one has done a study quantifying “how many fewer problems you have taking it on prescription than buying it and taking it yourself,” so it is graded B as “hard to quantify.” The steroids and sex hormones covered in Items 5 and 7 of this section follow the same rules. If you really have reached the point where you should rely on medication to lose weight, the doctor will first look at your body mass index, whether you have other illnesses, and whether there is any reason you cannot use the drug, and then decide whether to take one and which one. That judgment cannot be bought.
A
Use sex hormone drugs only when a doctor prescribes them and you have regular follow-up checks; don't buy them online and don't raise the dose yourself
Value for cost Standard
In plain termsThis item does not discuss whether to use them, only how to use them. Transgender women who use estrogen get blood clots in their blood vessels noticeably more often than people their age: per thousand people, about 4 more over two years and about 17 more over eight years. This kind of risk has to be watched through regular follow-up checks; if you buy drugs online and adjust the dose yourself, no one checks for you.
- Cost
- Regular registration fees, plus blood tests at follow-ups. A few hundred yuan a year, and a few half-days.
A little money
A few hours
No willpower
Benefit size medium
- Benefit
- The researchers followed a group of people through the electronic health records of the health care group Kaiser Permanente. Among them were 2,842 transgender women and 2,118 transgender men, followed on average for 4.0 and 3.6 years. Each person was matched by year of birth, race, care site and time of entry with about 10 times as many cisgender controls, a total of 48,686 cisgender men and 48,775 cisgender women. Transgender women had more venous thromboembolism (a blood clot forming in a vessel and blocking it) than controls. Compared with cisgender men, at 2 years it was 4.1 cases per 1000 people (95% CI 1.6–6.7). At 8 years it was 16.7 cases (6.4–27.5). Worked out, that is 4.1 extra cases among 1000 people over two years and 16.7 extra over eight years. Compared with cisgender women, these two numbers were 3.4 (1.1–5.6) and 13.7 (4.1–22.7). Ischemic stroke (the kind of stroke where a blood vessel is blocked) and myocardial infarction were broadly similar across groups overall. But among transgender women who started hormone therapy only during the follow-up period, the differences in venous thrombosis and ischemic stroke were more pronounced. The evidence for transgender men was insufficient to draw conclusions. The authors concluded that “these results may suggest the need for long-term vigilance regarding the vascular side effects of estrogen in cross-sex hormone therapy”
- Evidence grade
- A
- Notes
- The researchers themselves stated this study's weakness: they could not see how many people bought drugs themselves outside the health system, so the line of “using the drug or not” could not be drawn cleanly to begin with. That is all the more reason to put drug use under regular follow-up. This study looked only at whether something went wrong in the blood vessels; it does not answer whether hormone therapy should be used or what benefits it brings, which is a separate body of evidence. The same applies wherever sex hormones are used, including birth control pills, menopausal hormone therapy and testosterone supplementation. Whenever someone buys online themselves, adjusts the dose following online posts, and never checks for blood clots or liver and kidney markers, the risk lies in the stretch where “no one is watching,” and has nothing to do with why the drug is used. The regular route in China is to go to the endocrinology department or the relevant specialty at a licensed medical institution for assessment, a prescription and follow-up checks.
B
If “feeling ugly” has reached the point of checking the mirror over and over and repeatedly wanting to change something, get a body image assessment before talking about surgery
Value for cost Standard
In plain termsAbout 15% of people who go for plastic surgery have body dysmorphic disorder, which means magnifying a flaw that others can barely see until it affects their life. Among people who go to dermatology for cosmetic reasons it is about 13%, and in both groups over 70% are women. People like this finish one area and then fixate on the next, and surgery cannot solve it. First book one appointment to see whether this applies to you, then decide whether to have surgery.
- Cost
- One registration at a psychiatry or clinical psychology department, a few dozen yuan. The hard part is going there once before booking the surgery.
A little money
A few hours
Some willpower
Benefit size medium
- Benefit
- Following systematic methods, 33 studies were gathered in full and then pooled. Among plastic surgery patients, the prevalence of body dysmorphic disorder (magnifying a flaw that others can barely see until it affects one's life) was 15.04%, ranging from 2.21% to 56.67% across studies. In terms of people, about 15 out of every 100 people who go for plastic surgery meet the criteria; looking at individual studies, it ranges from 2 to 57. This group's mean age was 34.54±12.41 years (the second number is how far it varies up or down), and 74.38% were women. Among dermatology patients it was 12.65%, ranging from 4.52% to 35.16% across studies, with a mean age of 27.79±9.03 years and 76.09% women. The authors recommend that plastic surgeons and dermatologists actively assess patients, identify those at high risk, and arrange for several departments to manage them together
- Evidence grade
- B
- Notes
- The proportions measured by different studies run from 2.21% all the way to 56.67%, an enormous spread. The reason is that the questionnaires used and the populations surveyed all differ. So all you can read from it is that “this proportion is not low, and it is worth screening once first”; you cannot treat 15.04% as a precise figure, which is also why it is graded B. The vast majority of people who want cosmetic medical procedures have no psychological problem. This item is aimed at the small group for whom it is “repeated, persistent, and already affecting work and social life”; surgery cannot solve their problem. The clues to look for are these: spending a long time each day checking or hiding a certain body part, avoiding social situations or photos because of it, and fixating on the next area as soon as one is done.
- Sources
- Ribeiro RVE (2017). Prevalence of Body Dysmorphic Disorder in Plastic Surgery and Dermatology Patients: A Systematic Review with Meta-Analysis. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-017-0869-0
C
To straighten your teeth, have a doctor qualified in orthodontics examine you in person and go to follow-ups on time; don't buy aligners online and wear them at home on your own
Value for cost Standard
In plain termsIn China, clear aligners are Class II medical devices, and their instructions require them to be worn under the guidance of a doctor qualified in orthodontics, with regular follow-ups. The US drug regulator says it has not authorized aligners sold directly to individuals without a dentist's prescription. Without an in-person examination, your bite may go crooked, teeth may move to the wrong position, you may have pain, or you may even lose teeth.
- Cost
- Compared with buying online, you pay extra for registration and follow-ups, and you have to go to the clinic every so often. The hard part is that treatment often takes a year or two, and you have to keep going to follow-ups.
A little money
A few hours
Some willpower
Benefit size small
- Benefit
- The 2022 Guidelines for the Registration Review of Bracketless Orthodontic Appliances (无托槽矫治器注册审查指导原则) from the Center for Medical Device Evaluation of the National Medical Products Administration say that these aligners have a “management class of Class II.” They require the instructions to state that “during treatment they must be worn under the guidance of a physician with professional orthodontic qualifications,” and also to state “the requirements for eating, brushing teeth and regular follow-up visits.” For the product name, “conceptual names that are empty or hypothetical, such as ‘invisible,’ are not recommended.” The U.S. Food and Drug Administration (FDA) says: “The FDA has not authorized clear aligners that are sold directly to consumers without a prescription and supervision by a dentist or orthodontist,” meaning that it has never approved a single clear aligner sold directly to individuals without a dentist's prescription and supervision. The FDA also says: “In-person examination by a dentist or orthodontist can help lower the risks of uneven bite, unintended tooth movement, pain, and tooth loss,” that is, an in-person examination by a dentist can lower the risks of a misaligned bite, teeth shifting, pain and tooth loss. Only regular in-person follow-ups after you start wearing them can confirm that the teeth are moving safely as planned. Both of these are regulatory documents and give no rates of harm
- Evidence grade
- C
- Notes
- The size of the benefit is rated small because no rates of harm were found, so it can only be judged by the consequences. No risk warnings from drug regulators or health authorities in China specifically about “buying aligners online and wearing them at home on your own” were found, so this item relies mainly on the registration requirements and the FDA's statements. Orthodontics is medical treatment; for tooth straightening of a medical cosmetology nature, the facility's license must include the corresponding specialty and the doctor doing it must be qualified; for how to check, see Item 2 of this section (facility license, attending physician). A 2023 notice on oral health care from four departments also specifically calls for severe punishment of unlicensed facilities and of hiring people who are not health technicians to treat teeth. Orthodontics is not reimbursed by medical insurance (医保); see Section 24, Item 12 (ask for the all-inclusive price before getting implants)
