Weight Management

Obesity is a perpetual global health issue. According to the Ministry of Health’s annual National Population Health Survey, during the period of 2019 to 2020, 10.5% of Singapore residents were obese. In addition, fewer people engaged in at least 150 minutes of moderate-intensity physical activity per week - the recommended level by the World Health Organisation (WHO). 

Health risks of excess body fat

Obesity and high-risk BMI can potentially increase the risk of developing chronic diseases such as hypertension, high cholesterol and diabetes. These fall under an umbrella term known as metabolic syndrome. Other health risks include, but are not limited to:

• Heart disease

• Sleep apnea

• Cancer

• Depression

• Osteoarthritis

• Obese individuals have a mortality rate twice that of non-obese

The cold, hard truth about weight loss

In my practice, I often encounter patients who are seeking a quick and fuss-free way to lose weight. Unfortunately, the road to weight loss is not that easy. There is no magical pill you can take to slim you down automatically. Losing weight requires continued effort, commitment and dedication. Without them, even if you manage to lose some weight initially, you are likely to rebound and put it all back and more with time.

There is no way around it - a healthy lifestyle is the best long term Weight Management strategy to lose weight permanently and healthily.

Weight loss requires a calorie deficit

At the most basic level, Weight Management simply boils down to the calories you take in versus the calories you burn off. The three main body processes that burn calories are:

• Basal metabolism. Your body burns some calories to sustain basic functions such as your heartbeat.

• Digestion. Around 10-15% of your caloric intake is used to power digestion. This varies based on the foods you eat.

• Physical activity. This includes physical workouts and everyday tasks.

If you consume more calories than you burn, you gain weight. And if you eat fewer calories and burn more through physical activity, you lose weight. In general, if you reduce 500 to 1,000 calories a day from your typical diet, you will lose about 0.5 kg a week.

It sounds simple enough, but in reality it’s a little bit more complex because when you lose weight, you usually lose a combination of fat, lean tissue and water. Also, because of changes that occur in the body as a result of weight loss, you may need to decrease calories further to continue weight loss.

Aside from that, understand that not all calories are created equal when it comes to your health. Different foods can impact your hormones, hunger, feelings of fullness, and metabolism differently, regardless of the amount of calories they contain. For instance, fruits are much more nutrient-dense than potato chips. Calorie for calorie, fruit will provide a much larger dose of vitamins, minerals and beneficial plant compounds. So while it is important to reduce your caloric intake, it is even more crucial to eat the right type of foods while doing so.

Facts about dieting

Do a search on the Internet and you will find hundreds of different types of diets like the keto diet, Atkins diet, Paleo diet, South Beach diet, cabbage soup diet and grapefruit diet, just to name a few. Be advised however that many weight loss diets entail varying degrees of health risk, and some of these fad diets are widely considered to be ineffective.

The truth is, almost any diet will work if it helps you take in fewer calories, and the correct calories. A good diet is one which:

• Offers plenty of good tasting and healthy choices

• Does not contain highly processed foods

• Is well-balanced and does not lock in one macronutrient over another

• You are happy to live with for a long time

Get active

Exercise is the other key factor. You can start slow and gradually increase the intensity and frequency of your workouts, but eventually you should be aiming for 150 to 300 minutes of moderate-intensity aerobic activity per week. Aerobic exercise increases your breathing and heart rate, and helps with fat burning.

When you feel ready, you can start incorporating muscle-strengthening activities twice a week into your exercise routine. Strength-building exercises help not only with losing body fat, but also improving bone and muscle strength.

What can I expect on my visit?

Firstly, your doctor will enquire about your past medical history, exercise routine and eating habits. Physical examination includes measuring your blood pressure and heart rate, and a basic body assessment of waist, neck and arm circumference.

Your doctor may recommend the following blood tests to rule out underlying medical conditions that may cause weight gain:

• Blood glucose and cholesterol levels

• Thyroid function test

What about weight-loss medications?

Medications can help contribute to your weight loss goals. However, it is extremely important to note that they do not replace physical exercise or healthy eating practices as a solitary solution for weight loss. They are really only adjuncts, designed to aid you along the way.

Oral Medications

Injectable medications

Glucagon-like peptide-1 (GLP-1) Agonists are a relatively new class of medications used primarily to manage blood sugar levels in individuals with type 2 diabetes. They work by mimicking the actions of the GLP-1 hormone. This hormone is naturally produced in the intestines and regulates blood sugar levels by stimulating the release of insulin, thereby slowing down stomach emptying, reducing appetite, and inhibiting the release of glucagon (a hormone that raises blood sugar).

In addition to diabetes management, some GLP-1 agonists are approved and licensed for weight loss because of their powerful effect on appetite suppression and promoting a sense of fullness. Liraglutide is administered via subcutaneous injection once daily, whereas Semaglutide has a longer half-life, allowing for weekly dosing. Usually, the dosage of these medications is increased gradually to reduce the likelihood of side effects occurring. GLP-1 agonists may not be suitable for diabetic patients on insulin therapy. Possible side effects include dizziness, nausea and abdominal discomfort.