Health x Wellness

Dealing with obesity and weight management

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We discuss some of the management options available for weight management, the role of medication as an adjunct in weight loss, and how these options may be helpful to your weight loss journey.  

Obesity causes a significant increase in both morbidity and mortality and is associated with an increased rate of death from causes like cardiovascular disease, as well as an increased risk of metabolic diseases (e.g., diabetes mellitus and high cholesterol), certain cancers (e.g., kidney, breast, stomach, colon, pancreatic cancers etc.) and in recent years, an observational data link with increased adverse outcomes and death from COVID-19. Therefore, tackling the issue of obesity is of paramount importance.

Obesity is an increasingly prevalent health problem worldwide. In 2021, the World Health Organisation (WHO) reported that worldwide obesity has nearly tripled since 1975. Locally, according to the 2020 National Population Health Survey, approximately 10.5 percent of Singaporean residents aged 18 to 74 years were obese, while 20.7 percent were in the high-risk Body Mass Index (BMI) category for the Asian population. 

The WHO defines obesity as a BMI of ≥ 30kg/m2.  However, as the risk for developing cardiovascular disease starts from a lower BMI in an Asian population, the WHO recommends a lower cut-off of ≥ 27.5kg/m2 for Asian individuals as having “high risk BMI”. 

A multi-disciplinary approach should be adopted in the management of individuals looking to achieve and sustain weight loss.

Prior to undertaking any measures to facilitate weight loss, clearly defined weight loss targets should be laid out. More importantly, these goals should be realistic and safe.  A commonly used target would be weight loss not exceeding 0.5-1.0kg/week, and an overall initial weight loss goal of about 5-10% over 6 months.  

Dietary modification and physical activity are the cornerstones of any weight loss journey. Nutritional counseling should be performed to instill and reiterate the importance of a reduced calorie diet, as maintaining a negative energy balance, where calories expended exceed caloric intake, is essential to achieving sustainable weight loss.

weight management

The importance of physical activity and regular exercise cannot be understated as well. Individuals looking to lose weight should aim to engage in at least 150-300 minutes of moderate-intensity aerobic activity per week.  

Medications can also be considered as adjunct in support of weight management

While lifestyle modification and behavioural change is the key management strategy for weight loss, medications can also be considered as adjunct in addition to dietary changes and regular physical activity.  In line with Clinical Practice Guidelines from the Ministry of Health, medications can be considered when BMI is ≥ 30kg/m2, or when BMI is 27.5-29.9kg/m2 in individuals who have complications stemming from obesity (e.g. diabetes mellitus, high blood pressure etc.).  

Locally, there are 3 different types of medications that can be considered as an adjunct to lifestyle modification for weight loss; these are medications that act on the central nervous system (namely Phentermine), causing a stimulant and appetite suppressant effect; medications that block the absorption of ingested fat (namely Orlistat); and more recently, a daily injectable medication known as Liraglutide (often referred to by its brand name, Saxenda) that was originally developed as a diabetes medication. All these medications act on different pathways within the body and can be useful in suitable individuals to help them achieve sustainable weight loss goals. 

While both Phentermine and Orlistat have established efficacy for weight loss, the use of these medications is often limited by their side effect profiles.  As an alternative, where appropriate, individuals may wish to consider Saxenda instead.

In a study published in the New England Journal of Medicine (NEJM) in 2015, when used as an adjunct to diet and exercise, Liraglutide at the maximum dose of 3.0mg/day was associated with reduced body weight and improved metabolic control.  The study found that weight loss with Liraglutide was maintained over 56 weeks, and patients treated in the Liraglutide group lost an average of 8.0kg. Overall, approximately 92 percent of patients who received Liraglutide lost weight. From our experience, Liraglutide has a potent appetite suppressive effect, and can be particularly useful to help curb food-related cravings.  Additionally, on top of the weight loss benefits, Liraglutide treatment was also associated with improvements in blood pressure, fasting cholesterol levels, inflammatory markers, blood sugar and health-related quality of life. Therefore, this medication can have a plethora of potential health benefits that extend beyond the number on the weighing scale. 

Obesity is a growing global epidemic that can cause a multitude of negative repercussions on an individual’s health. Weight loss through a combination of lifestyle modification and medications, can improve or even prevent many obesity-related risk factors for cardiovascular disease. Please speak to your physician if you are keen to explore some of the treatment options available for weight management to see if they may be suitable for you.

Article attributed to Dr. Jonathan Chong, DTAP Clinic. Established in 2005, DTAP (Dr. Tan & Partners) clinics, a pioneer of the GP plus, or “General Practice with Special Interest” model in Singapore, provides holistic and comprehensive medical care for everyone. DTAP clinics are located in Singapore and Malaysia, and DTAP Express is the first clinic in Singapore with express self-testing kits for  STD“DTAP to Home” is an extension of DTAP Teleconsult and DTAP Delivery for medications, supplements and health aid services.

Photos by Diana Polekhina on Unsplash and by Towfiqu barbhuiya on Unsplash