What is behind the surge of obesity worldwide, and how is Singapore fighting back?
According to the latest Ministry of Health data from 2022, nearly 12 out of every 100 adults aged 18 to 74 in Singapore were obese - double the rate from 30 years ago.
However, obesity is not a flaw or a simple lifestyle choice, but a complex, chronic disease that is often misunderstood and unfairly judged, according to healthcare experts.
WHAT IS OBESITY?
Dr Tham Kwang Wei, president of the Singapore Association for the Study of Obesity, noted a gradual rise in obesity prevalence in the population.
'Between 2010 and 2022 … we've hovered around anywhere from 10 plus per cent to currently 11.6 per cent … but I think if the measures had not been put in, we could have seen a larger rise,' said the Woodlands Health senior consultant.
She noted these public health measures implemented by the government included public infrastructure that encourage physical activity as well as campaigns that encourage a healthier lifestyle and earlier health screenings.
The World Health Organisation defines obesity as a Body Mass Index (BMI) of 30 or above.
However, with regards to Singapore's population, Dr Tham said the health risks from obesity for Asians begin from a BMI of 27.5.
Apart from looks or waistlines, doctors are also concerned about how obesity can lead to excess fat inside a person's body, causing health problems.
'When we have excess energy … that energy has to be stored somewhere … in the fat (cells). When the fat cells start to extend and are unable to tolerate more fat storage, then the fat needs to also flow somewhere else,' said Dr Tham.
The excess fat could end up around a person's liver, heart or even in the muscles, she added.
HEALTH RISKS FROM OBESITY
Dr Tham noted that the fat surrounding vital organs can cause inflammatory responses and ill health. This can lead to an increased risk of heart disease, stroke, Type 2 diabetes, or fatty liver disease.
Obesity is associated with more than 230 medical conditions, she added, with 77 per cent of patients with obesity seeking treatment at Woodlands Health hospital having at least three obesity-related complications (ORC) while 52 per cent have at least four such ORCs.
Dr Tham said the most common ORC was musculoskeletal complaints, followed by obstructive sleep apnoea and metabolic-dysfunction associated steatotic liver disease, commonly known as fatty liver.
She noted that many often do not view it as seriously as a chronic disease.
'They know it's serious, but they often seek help on their own. I don't think everybody needs to see a doctor, but they need to (see) obesity can lead to many serious, chronic diseases,' added Dr Tham.
TREATMENT FOR OBESITY
Lifestyle factors can lead to obesity, she said.
These include stress, lack of physical activity and sleep issues like lack of adequate sleep or routines and environments that hinder proper restful sleep.
Childhood obesity is another risk factor for adult obesity, added Dr Tham.
She noted that children who enjoy processed, energy-dense food and snacks will have an increased risk of weight gain when they grow up, as they will consume such food as adults.
The effects of obesity are not just medical but also deeply personal, affecting patients' daily lives, she said.
'Up to 80 per cent (of our patients) … are impacted by their weight, whether it's at home doing housework … at work or in public places,' said Dr Tham.
While exercise and diet may help some in their weight loss journey, some may have their bodies working against them, she added.
'Energy regulation is disrupted by obesity. You may see that people say, 'I really don't eat much but I'm still putting on weight', and it's true in quite a number of people … (Their body's) metabolism has changed when they have obesity,' said Dr Tham.
For those whose bodies are genetically rewired to store fat and resist weight loss, medical help is available, including ultra-low calorie diets, medication or metabolic and bariatric surgery options, according to experts.
In tougher cases, patients may need help from a full medical team - a physician, dietitian, physiotherapist and psychologist.
'If a person with obesity has tried many, many times, it's really a signal for us to add on something beyond diet and lifestyle therapies … We may … introduce things like medications and even intensive diet, dietary interventions,' Dr Tham added.
Surgery is another step for even more serious cases. Doctors may use shrink a patient's stomach through surgical procedures to make it smaller, or filling part of it using a gastric balloon so it holds less and induces a feeling of fullness in the patient.
PREVENTION IS BETTER THAN CURE
While treatments and therapies are available to manage obesity, national efforts to promote healthy living and fitness are being made to help people stay healthy and reduce weight gain before it starts.
Dr Tham said the HealthierSG initiative has also helped to encourage people to visit their doctors and go for health screenings where they can do weight assessments.
'The environment is very, very important. And I think as a whole … our government has done a very good job,' she noted.
'We've seen a lot of infrastructure built around the environment, making healthcare very close to where we live, and making the environment very liveable,' she said, noting how people can easily access public exercise corners and fitness classes through ActiveSG.
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The first thing the chief medical officer asked: 'How are you doing as a caregiver?' 'Nobody in the entire journey of 18 months had ever asked how I – as the primary caregiver – was doing. And wow, that just changed the entire conversation,' she said. 'It wasn't about providing information. It was just someone acknowledging, 'Actually, it's hard on you, we know. We'll take care of you. We'll take care of your father.''
