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What is behind the surge of obesity worldwide, and how is Singapore fighting back?

What is behind the surge of obesity worldwide, and how is Singapore fighting back?

CNA18-07-2025
SINGAPORE: Obesity is not just a global problem, but one that is hitting Singapore hard.
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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Coroner's court: Man, 65, died after spinal surgery, no evidence COVID-19 vaccine implicated

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She's not a designer – but this public servant leads the charge to put Singapore design on the world stage
She's not a designer – but this public servant leads the charge to put Singapore design on the world stage

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time8 hours ago

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She's not a designer – but this public servant leads the charge to put Singapore design on the world stage

Long before she became the head of Singapore's national agency for design, DesignSingapore Council's Dawn Lim already experienced the cost of bad design – during the two decades she spent as a caregiver to her late parents. In a local hospital just last year, Lim had to collect a biopsy sample taken from her father. A biopsy is a medical procedure where a tiny portion of body tissue is taken to be examined in a lab. It's often used to check for diseases like cancer or better understand abnormal growths and conditions. The process, in theory, sounded simple: Go to the clinic, get the forms signed by his doctor, then let the hospital take over. In reality, the doctor told her to take the forms to the medical records office. 'I asked, 'Well, why can't you just send it over?' To me, that was the logical assumption, as (the staff) should know the hospital better than me,' the 43-year-old recalled. 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Though Lim isn't aware if the hospital's process has changed since, she believes it was likely designed for 'optimal efficiency' within the institution by allowing the requester, usually the patient or caregiver, to take full ownership of their request – but overlooked the very same patient or caregiver's journey. In the end, she got through to the clinic and they sorted it out. She didn't have to collect the slides – but the experience stuck with her. 'Generally with sickness, it's already a very stressful situation. To navigate an institution's bureaucracy adds even more stress. I'm English-speaking so I can ask the right questions and try to manoeuvre around – but what if somebody else isn't?' she said. 'That informed a lot of my personal conviction about why good design is so important to us as a society, especially with an increasingly ageing population.' THE GOOD AND BAD OF EVERYDAY DESIGN Good design targets decision making and removes 'cognitive load', Lim believes. It should make 'everyday lived experiences' feel easy and seamless. And perhaps it begins with first noticing what doesn't work and why. Bad design is 'very easy to spot', she said – such as in the inconvenience and frustration she suffered navigating a hospital's system as her late father's caregiver. One of her pet peeves is locked wheelchair-accessible toilets in shopping malls. It's a practice driven by a fear of misuse, which she understands, but it ends up excluding those who need it the most. 'If someone with incontinence cannot wait 10 minutes (for the mall's staff to unlock the toilets), it becomes an embarrassing situation for them. It removes their dignity in a really challenging situation that they may face daily,' she said. Another instance of lacking design is the bustling intersection of Orchard Road and Scotts Road, which she often frames in a thought experiment: How might an able-bodied person cross from Wheelock Place to Tang Plaza? And how would, say, a wheelchair user or a parent with a pram do the same? An able-bodied person may take the escalator from the ground floor of Wheelock Place to its basement – it links to Orchard MRT station, which has an exit leading up to Tang Plaza. For a wheelchair user or parent pushing a pram, however, 'it's not so straightforward', she said. They may have difficulty even locating the lift in Wheelock Place to start. 'This is just a small example of how we don't always realise many things that are in our everyday places and spaces are not fully inclusive or accessible.' Good design, on the other hand, is often invisible 'because you almost live through it smoothly', Lim said. 'We don't always notice or appreciate it.' The app – a 'genius idea' – that allows drivers to pay for parking with a mobile device is her personal favourite. 'If I'm (held up), I don't have to leave where I am to walk back to my car to put another coupon. I just go onto the app and extend (my parking duration),' she said. 'It makes it easier for the user to get on with life.' And she often points to Changi Airport's unparalleled efficiency – the fact that you could spend less than 10 minutes from plane to cab – as a tangible example to educate others that good design is everywhere. 'Then, people get it. Raising awareness of our daily lived experience and how design shows up in the most innocuous ways tells a lot of the story itself,' she said. More recently, Singaporean designers showcased a spectrum of possible everyday design applications at Milan Design Week in April from furniture to medical technology, she added. A highlight was the 'digital twin' – a virtual replica of a real-world entity – of Changi General Hospital's (CGH) emergency department. It was designed by CGH and Singaporean companies, multi-disciplinary design agency Farm and cross-technology company Vouse, to enable the hospital to rethink operations and improve patient experience. Through simulations, the hospital would be able to see how people move around, how staff make decisions and how to deploy resources, among other scenarios. This makes it easier to find better ways to deliver care. 'Many people have the misconception that design equates to nice things, but nice things also need to work nicely. You can have both – it is not mutually exclusive,' Lim said. 'Let Singapore surprise you. We have more to offer than you would expect.' TAKING SINGAPORE DESIGN GLOBAL Unlike three of her four predecessors who were architects, and the fourth who worked briefly in a global design consultancy, Lim had no formal background in design. What she had was over a decade of experience in EDB – DesignSingapore's parent organisation and the lead government agency responsible for enhancing Singapore's position as a global business centre. While her role at DesignSingapore now requires her to dive deep into design knowledge, her prior stint at EDB taught her complementary skills by thinking about innovation 'very broadly'. This included how design was applied across research and development, product, and service areas among other functions. Her scope at EDB, including overseeing the independent execution of the agency's strategy and operations in Europe, taught to see the big picture to ensure Singapore was always 'internationally competitive'. 'That mindset is probably something quite embedded that I took with me into this role: What is Singapore design's competitive edge in the world? And what can we stand out for?' she said. FINDING THE COURAGE TO BE CREATIVE Putting Singapore design on the global stage, however, requires a fundamental mindset change involving creative confidence, competence and courage. 'Many people like to say Singaporeans are not creative … but we are very competent creatively. The fact that this country makes so many things work is creative,' Lim said. Singaporeans do have 'small 'c' creativity', she added. 'It's actually there every day. You look at these ground-up initiatives like Repair Kopitiam.' The community-driven programme encourages repair culture by getting people to first consider fixing their broken item before throwing it away. As for 'big 'C' creativity', she pointed to the NEWater process, which recycles Singapore's treated used water into ultra-clean, high-grade reclaimed water. 'So we have both ends of the spectrum of creativity. It's not that we're not creative, but we also must know how to recognise it exists in many different forms.' This starts with understanding what we mean when we talk about 'creativity', Lim noted. On one hand, there is the 'Silicon Valley type, where every day there's a startup that's invented and you hope that one of them becomes the next Facebook or Google'. On the other, there is 'creativity in terms of making changes to the everyday', she added. 'And I think there's space for both.' The issue is that Singaporeans often 'don't have enough courage to try', she believes. 'But the very definition of creativity means you must try and take risks. And when you don't practise it, you cannot build confidence. Then it becomes a cycle.' So she's convinced the 'crux of creativity' lies in not knowing the outcome but trying anyway – and knowing it is okay to get it wrong many times before finally getting it right. Importantly, this mindset shift starts from as early as primary school. The organisation's Learning By Design initiative brings together students, educators and sometimes parents to tackle a challenge within the school or wider community. In 2023, St Joseph's Institution students noticed 'quite a lot of elderly men lounging by themselves alone at kopitiams (coffee shops)' in Toa Payoh, and set out to create a 'community space' to address their social isolation. As with any discipline, there are professional qualifications and training in design, but there's also the aspect that's about encouraging 'a mindset of creative thinking that everybody can exercise', Lim explained. For when it works, good design makes all the difference. In healthcare, for example, it would involve training practitioners to deliver the human touch at critical points in the caregiver's journey, she added, speaking from experience. Eighteen months into her late father's treatment, she was referred to a palliative care institution. 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.''

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