Were you able to lose weight in a healthy manner?

Obesity is a rising epidemic. The prevalence of obesity among adult Singaporeans aged 18 to 59 years was 8.9%. According to MOH guideline, BMI ≥27.5 is considered obesity for Singaporeans. With lifestyle modification, an initial goal of at least 5% weight loss by 6 months is reasonable. The optimal weight management requires a combination of diet (ie, a reduction in caloric intake), exercise, and behavioural modification.

Obesity is a “rising epidemic”

Based on the 2017 National Population Health Survey, the prevalence of obesity among adult Singaporeans aged 18 to 59 years was 8.9%, among seniors aged 60 to 74 years was 6.9%. It’s not good news for our children either – 13% of children aged 6 to 18 years are already obese.

What is the definition of obesity?

The World Health Organisation (WHO) defines obesity based on Body Mass Index (BMI). BMI is calculated from the weight and square of the height as follows:

BMI = body weight (in kg) ÷ height (in meters) squared

Here is the BMI based classification according to WHO and MOH guidelines:

BMI （ kg/m2）	Singapore	WHO
Underweight	<18.5	<18.5
Normal	18.5-22.9	18.5-24.9
Overweight	23-27.4	25-29.9
Obesity	≥27.5	≥30

 

Why are we concerned of obesity?

Obesity is associated with a significant increase in morbidity (including diabetes mellitus, hypertension, dyslipidaemia, heart disease, stroke, sleep apnea, and cancer) and mortality. Obesity is now the fifth leading risk for global deaths. Weight loss is associated with a reduction in obesity-associated morbidity. So if you are overweight or obese, it might be time to adopt some lifestyle changes and see the improvements to your physical and mental health. Maintaining a healthy BMI for your height and weight is the best medical advice you can get for free.

How to lose weight?

1. Goal of treatment

The goal of therapy is to prevent, treat, or reverse the complications of obesity and improve quality of life. Health benefits have been reported with weight loss of only 5% of body weight. With lifestyle measures only, an initial weight loss goal of 5 to 7 % of body weight is more typical. Typically, we set an initial goal of at least 5% weight loss by 6 months.

2. Comprehensive approach

The optimal management of overweight and obese patients requires a combination of diet (ie, a reduction in caloric intake), exercise, and behavioural modification.

Diet therapy:

Commonly seen diets are as below:

• Balanced low-calorie diets and low-calorie versions of healthy diets (eg, Mediterranean and Dietary Approaches to Stop Hypertension [DASH] diets)
• Low-fat diets
• Low-carbohydrate and low glycemic index diets
• High-protein diets
• Very low-calorie diets

The goal of dietary therapy is to reduce the total number of calories consumed. You are advised to choose a dietary pattern of healthful foods, such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-style diet, rather than focusing on a specific nutrient. Diets which emphasize reductions in refined carbohydrates, processed meats, and foods high in sodium and trans-fat; moderation in unprocessed red meats, poultry, eggs, and milk; and high intakes of fruits, nuts, fish, vegetables, vegetable oils, minimally processed whole grains, legumes, and yogurt are preferred.

Dietary adherence is an important predictor of weight loss, irrespective of the type of diet. Although many individuals have success losing weight with diet, most subsequently regain much or all of the lost weight. Long-term adherence to a weight-maintaining diet is probably the most important determinant of success.

Exercise/Physical Therapy

Coupled with dietary changes, exercise offers the most effective approach for weight loss. For weight loss, the goal is to increase energy expenditure by 1000 to 1200 calories per week, or slightly more than 150 calories per day. Combined aerobic and resistance training is preferred.

Adding exercise to diet may have other important benefits independent of weight loss. Exercise improves blood glucose, cholesterol, blood pressure and reduce coronary disease and death.

Behaviour Modification

Lifestyle changes play an important role in the fight against obesity. There are many behavioural approaches that can achieve weight loss goals, including face to face (individual or group), internet-based, and mobile applications. There are weight management programs available in Singapore. Please do not hesitate to check with your doctor if you need any help during your weight loss process.

Medical Therapy

Drug therapy may be considered when BMI is ≥ 30, or when BMI is 27.5–29.9 in Asians with comorbidities or complications of obesity such as hypertension, Type 2 diabetes mellitus, who have not met weight-loss goals with a comprehensive lifestyle intervention alone. Check with your doctor if you have difficulties achieving your weight goal.

Surgery

Individuals with a BMI greater than 32.5 are advised to consider surgery for obesity (also referred as “Bariatric Surgery”) when all other treatment options have been unsuccessful. Surgery enables you to successfully lose weight and treat obesity-related diseases

References
1. Obesity in Singapore: It’s Not a Small World, https://www.healthhub.sg/live-healthy/764/its-not-a-small-world-after-all

2. Obesity in adults: Prevalence, screening, and evaluation, www.uptodate.com
3. Obesity in adults: Dietary therapy, www.uptodate.com
4. Obesity in adults: Role of physical activity and exercise, www.uptodate.com
5. Obesity in adults: Behavioral therapy, www.uptodate.com
6. Obesity in adults: Drug therapy, www.uptodate.com
7. Weight management, https://www.healthhub.sg/live-healthy/340/weight_management_nuhs