Latest news with #GLP-1s
The Hindu
a day ago
- Health
- The Hindu
How do GLP-1 drugs work? This book answers all your questions
Dresses are shrinking. Menus are shifting. Supermarkets are changing. Ozempic, or the 'fat shot' medication, as United States President Donald Trump calls it, is transforming the way America eats, dresses and shops. Alexandra Sowa, who just released 'The Ozempic Revolution: A Doctor's Proven Plan for Success to Help You Reverse Obesity, End Yo-Yo Dieting, and Protect Yourself from Disease'(published by HarperCollins) says that as a doctor specialising in obesity, GLP-1s are the most effective tool she has to treat patients today. She adds that one in eight Americans use the medication at this point, leading to huge cultural shifts in the country. 'It has changed how people buy clothes and how they shop at the grocery store. There is a reduction in the sale of junk food. When you are on it, your tastebuds change, you want healthier food,' she says, over a Zoom call from New York, where she runs SoWell, a clinic and brand tailored to support GLP-1 users. GLP-1s are Glucagon-like peptide-1 agonist drugs that include Ozempic, Wegovy, Mounjaro and Zepbound. There is still a lot of confusion about the medication, which is why Dr. Sowa, who is a dual board-certified physician in internal and obesity medicine with more than 10 years of experience working with GLP-1, says she felt the need to write the book. 'I was one of the first doctors using this in the US, so this is the first comprehensive user guide out in the market. People have so many questions: how does it work, how you eat, how do you think, how do you move… I try to answer all that.' She adds, 'You see people on social media talking about 'Ozempic face' and 'Ozempic hands', but those are headlines wrapped around the fear people have of these medications.' She cautions that the weekly injectables, hailed as a miracle drug by actors and influencers, do not guarantee a cure. 'Medication is not an easy fix… We need to take lifestyle into account,' she says, adding 'We have to make sure we are focussing on protein. We have to strength train.' As she says in her book 'You still need to put in the work. You still have to do the work to change your underlying habits and thought patterns related to food and weight. The drug only provides a window in which making these changes is easier and more effective long-term, because the medication normalises the underlying hormonal dysfunction. GLP-1s will almost guarantee you'll lose weight, but only by using them in partnership with lifestyle changes will you maintain the loss long-term.' Also, contrary to what social media tells you, not everyone can or should take it. 'I still advocate just diet and lifestyle changes for some people,' says Dr. Sowa, adding 'What I fear is with this widespread acceptance there has been abuse. I only prescribe it for someone who has a BMI of 27. For people who have high cholesterol, insulin resistance and significant weight gain on their waistline. This is not about getting skinny.' GLP-1 medication will also evolve. 'We have a lot of new drugs in the pipeline — they are going to become tailor-made for specific needs. Maybe one for fatty liver or one that is very effective with diabetes. We are going to become better at how we make it, and with the pill version, access will become easier,' she says. While this is certainly altering the weight loss industry, she says that it does not make it any less relevant. 'I don't think gyms are going to go away — we need to embrace how people are using these places, welcoming them with open arms and no judgement. I think there is going to be less of that multi-billion industry for 'quick weight loss in 30 days', and instead people will go back to the basics of health.' ('The Ozempic Revolution'is available on and is at a listed price of ₹499)
2 days ago
- Health
Food and fitness make or break success on weight loss meds, report finds
Drugs like Wegovy and Zepbound -- GLP-1 medications typically used to treat obesity -- can lead to impressive weight loss. But a new joint advisory from four major medical groups warns that without proper nutrition and lifestyle support, people may face muscle loss, weight regain, and high long-term costs once they take themselves off GLP-1 medications. Experts from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society contributed to the report, which noted that only about half of users continue taking their GLP-1 medication after one year and only about 15% remain on treatment after two years. Many people stop taking GLP-1 medications due to side effects, cost or disappointing results -- and when they do, they often regain weight, making long-term success depend on consistent use and a healthy diet, the report stated. The report aims to guide both clinicians and patients on nutrition and lifestyle changes to improve long-term outcomes while taking a GLP-1. "We really wanted to bring in four major societies together that focus on nutrition, lifestyle, [and] obesity and come with a consensus statement on how nutrition should be thought about when prescribing these drugs," Dr. Dariush Mozaffarian, a cardiologist, director of the Food is Medicine Institute at Tufts University, and the report's lead author, told ABC News. Mozaffarian explained that for someone to achieve success on a GLP-1, they need to commit to comprehensive lifestyle changes. "The FDA says these drugs are approved for use as an adjunct to lifestyle therapy," he said. "In fact, they are prescribed the other way around with lifestyle therapy being the adjunct if being thought about at all. Doctors are not following either society guidelines or FDA guidelines if they are prescribing [GLP-1s] without lifestyle therapy." Before starting GLP-1 medications, the report recommended that patients work with their doctors to set goals that focus on overall health, not just weight loss. It's also important to check for any stomach or bone issues that could lead to side effects like nausea, vomiting, or muscle and bone loss, the report stated. "Registered dietitians can play really key roles in comprehensive obesity care by providing medical nutrition therapy to support GLP-1 therapy," said Emily A. Callahan, registered dietitian nutritionist and director of policy strategy for the Food is Medicine Institute. "The evidence space is growing that shows when registered dietitians deliver medical nutrition therapy, it has been associated with improvements in body weight, waist circumference, blood pressure and glycemic control." People should usually start GLP-1 medications at the lowest dose and slowly increase as needed, the report said. Patients should also be aware that nausea is common when taking these drugs and this may trigger cravings for sugary, high-calorie comfort foods that work against weight loss. To stay on track, the report recommended eating small, frequent meals and focusing on minimally processed, nutrient-rich foods. The report called for exercising special caution for anyone following an intermittent fasting diet or a low-carbohydrate "keto diet" that limits foods like breads, pastas and fruit to put the body into a state called ketosis, where it burns fat for fuel instead of carbs. These individuals might be especially vulnerable to gastrointestinal side effects, the report said. The report also advised people who may not be getting enough nutrients to consider taking supplements like vitamin D, calcium and multivitamins, while increasing protein intake by 50-100% from foods such as fish, eggs, nuts and seeds. This is especially important for those eating less while on GLP-1s, since lower food intake can make it harder to get all the nutrients the body needs. The report also underscored the importance of maintaining muscle mass and bone density while losing weight. Since weight loss can also lead to muscle loss -- especially in older adults -- the report advised doing a full body strength training routine at least three times a week and getting 150 minutes of moderate cardio each week. Focusing on nutrition, physical activity and other healthy lifestyle habits should give GLP-1 users a greater chance of achieving their goals, the report concluded. "GLP-1s have the best chance of helping people achieve and sustain lasting weight reduction when they are paired with strong nutrition guidance and lifestyle support," said Callahan.
Business Times
3 days ago
- Health
- Business Times
Singapore chef of Michelin-starred restaurant sheds over 30kg: How he and others sustain their weight loss
[SINGAPORE] Han Li Guang, chef of Michelin-starred restaurant Labyrinth, is used to eating good food. A lot of it. 'In the past, my wife would always scold me when we went overseas. I'd book two fine-dining meals a day. We'd barely finish one, and go for dinner already. And I always over-ordered – rich, fatty food,' he says. 'Nowadays, I book only one fine-dining meal once every two or three days while on holiday.' And for a top chef, his meals today are downright repetitive – revolving around rice, chicken breast, eggs and prawns. His commitment to his cause – triggered just before his 2022 wedding – led to his weight falling from a peak of 94 kg to a low of 62.5 kg earlier this year. Hitting the gym six days a week, he also brought his body fat down to just 9.5 per cent, but he is now on a bulking phase to gain more muscle mass. It may sound like too much of a challenge, but for Han and others like him, traditional weight-loss methods involving diet, exercise and sheer determination beat any quick fixes. Chef Han Li Guang when his weight loss was stagnating at around 80 kg (left), and after he started working out with a personal trainer. PHOTO: MATTHEW LU/ABDUL TSAQIF/INSTAGRAM/HAN_LG Feeling healthier, happier and mentally stronger are just some of the benefits these adherents gain. They also learn about nutrition and correct common misconceptions about food and exercise. A NEWSLETTER FOR YOU Friday, 2 pm Lifestyle Our picks of the latest dining, travel and leisure options to treat yourself. Sign Up Sign Up Injectables good, lifestyle changes better The Singapore 2021/2022 National Population Health Survey found that about one in nine residents (11.6 per cent of the population) aged 18 to 74 were obese, up from about one in 10 (10.5 per cent) in 2019/2020. Obesity was more common among males, and highest among adults aged 40 to 49. Injectables using glucagon-like peptide 1 agonists (GLP-1s) – Ozempic is an example – are drugs for treating Type 2 diabetes, but have been making headlines for successfully kickstarting weight loss by suppressing appetite. GLP-1s such as Saxenda and Wegovy have been approved for weight-loss treatment in Singapore. But patients have to meet certain criteria and can get these drugs only through prescriptions from licensed medical professionals. Boxes of Ozempic and Wegovy. PHOTO: REUTERS It is important to know that these are not lifestyle products or quick fixes for those seeking to slim down. The findings of a meta analysis of 11 studies of older and newer GLP-1 weight loss drugs by the University of Oxford, presented at the European Congress on Obesity this month, noted that users regained all the weight they lost within two years of cessation. Of course, there is still an important role for these medications. There is now a better understanding of how complex weight loss is and why certain individuals are more susceptible to being overweight, making weight-loss for them an uphill battle, says Dr Joel Foo, medical director at ATA Medical. This is why drugs like GLP-1s are game-changers for patients, especially in the control of blood sugar levels in diabetics. 'Weight loss at its crux is really about the treatment of metabolic syndrome, nothing more,' says Dr Foo. After some time, drug-induced weight loss typically plateaus. To make weight loss sustainable, behavioural changes involving exercise and eating habits are pivotal, especially when the patient is coming off GLP-1s. 'That's why the use of such medications really requires a lot of hand-holding,' adds the doctor, who says he used to be 'a fat kid' put through the now-defunct weight-loss Trim and Fit programme in school. What is unknown about the use of GLP-1s is how exactly they affect muscle loss and changes in body composition, says Dr Naras Lapsys, chief clinical officer and senior dietitian at Chi Longevity. He has a doctorate in molecular genetics and spent the first decade of his career studying obesity before becoming a consultant dietitian. 'Taking these medications alone without thinking about your resistance exercise, protein intake and the risks they may have on your body composition are probably some of the many issues that need to be addressed,' he says, noting that losing muscle mass is detrimental. Personal trainer Titus Toh points out that a calorie-deficit diet will cause weight loss, but an 80 kg male with 5 per cent body fat looks 'wildly different' from one with 25 per cent body fat. 'You lose fat by building muscle and there are many benefits to that, but the obvious one is that metabolism is increased, so the body can sustain itself better. People always look for the quickest or most convenient method, but whatever is built to last is often not achieved quickly.' Slow and steady – with accountability Han admits the first three months of his weight-loss journey were the hardest, especially when it came to eating: 'Fifty per cent of the battle is won in the gym, and the other 50 per cent, outside of it.' But once he got the hang of his diet – planned by Toh – and understood the science behind food, 'it was easy' building it into his lifestyle. And that includes handling dinner invitations and the 'many good meals' that come his way. No matter how late his day ends, Chef Han Li Guang exercises first thing the next morning. PHOTO: INSTAGRAM/HAN_LG 'There's a lot of discipline on my end,' he says, noting that he still tastes his restaurant's food, does research and development, and often travels for work. So he stays accountable by tracking his caloric intake with the popular MyFitnessPal app, looks for hotels with gyms and brings protein shakes along. And no matter how late his day ends, he exercises first thing the next morning. 'I'm 40, I'm married. Why am I doing all this? To feel good about myself. I want to be fit mentally and physically, I want it natural and sustainable, so my lifestyle can incorporate what I'm doing as a chef and restaurant owner. Health should be a long-term decision.' Similarly, it was a slow and arduous journey for Bernard Soh, who was overweight for most of his life. Soh weighed 99 kg and had high blood pressure and sugar levels before the Covid pandemic struck. His doctor offered him Saxenda, but he declined, wary of possible side effects and other complications. Instead, the senior manager at Dolby Laboratories chose to exercise. 'During the pandemic, there's only so much Netflix you can watch, so I tried walking a bit just to get some fresh air.' The walking became running, and Soh was soon challenging himself. 'Once you start dropping a few kilos, it really motivates you to do even more.' He read up on nutrition, learning how to eat better and exercise right, tracking his progress as he went along. Like Han, his biggest challenge was food – or lack thereof. He was hungry every night and struggled to fall asleep. 'I was really messed up because my blood sugar level was very low ,and I'd wake up extremely moody.' So he drank tea to fill his 'very big' stomach and contain his hunger. 'These are psychological things, and I needed to accept the hunger and refrain from snacking. This took a long time, six to nine months for me. It was very, very hard.' But in time, his body adjusted to the lower caloric intake. He began to feel better. This is a huge contrast to the past, when he ate whatever he could conveniently get his hands on. 'It's like 'I'm going to settle a hunger problem now'. So, anything goes. I don't know how many dinners and suppers I used to have (every night).' Today, the 46-year-old tracks his diet and exercise six days a week, even though his regional role requires him to travel two to three weeks in every month. At his thinnest, he weighed 66.7 kg, but he is now 75 kg, bulking up for muscle growth. He enjoys running, something he could never imagine himself saying before. 'I used to take taxis everywhere. But now, I'd gladly walk 2 km home from my gym.' It helps that staying accountable and tracking calorie-consumption has become easier and more convenient. Financial-services consultant Desmond Fu worked out at least five days a week and shed some 20 kg from his 78 kg frame in 2009. Realising he could lose weight, the 49-year-old began focusing on building muscle, which he needed to do to reduce his level of body fat. That was when he turned to Welling AI, an app by a Singapore-based startup which works like a virtual nutrition coach powered by artificial intelligence. Financial-services consultant Desmond Fu at his heaviest. PHOTO: DESMOND FU The 49-year-old is now at a healthier weight. PHOTO: DESMOND FU Having used it since Chinese New Year, Fu, who says he puts on weight easily, discovered how 'very innocent-looking snacks' can be extremely calorie-dense. By actively adjusting his food choices to stay within his calorie count, the father-of-four now weighs 61.5 kg. Welling AI's co-founder, technopreneur Philip Man, says the app – launched in August 2024 – was trained on Asian food data. Users log meals via photos, voice or text and get calorie and macronutrient estimates. Personalised feedback, aligned with the user's goals, takes the form of 'positive reinforcement' and meal suggestions. Welling AI's app is trained on Asian food data. PHOTO: WELLING Users of Welling AI get personalised feedback in the form of 'positive reinforcement' and meal suggestions. PHOTO: WELLING The app now has a few thousand paid subscribers and is averaging 50 to 60 per cent month-on-month growth. 'Becoming mindful about what you're eating is a much better long-term habit that will get you into general health than a quick fix,' says Man. A cause greater than weight-loss It is often the struggle with sticking to a diet and exercise plan that leads many to give up. 'First of all, acknowledge that making changes is often difficult,' suggests Dr Lapsys. 'Weight loss is a long and slow process. So it's better to make one or two changes and bed them down as successful habits before taking on more. Frame the small changes you make not as sacrifices, but as alternatives that are compelling, or find upsides to the changes you've made. That's a very good starting point.' For Toh, it is most important to keep purpose in mind. 'Understand why you're doing what you're doing,' he emphasises. 'If you put the aesthetic part aside, it's more about leading a healthy lifestyle. Shouldn't it be a norm to know what and exactly how much you're putting into your body, instead of being judged for bringing your own home-prepped meal when eating out? It's funny how when you choose to take control of your health and diet, you get criticised, when it should be the other way round.' Besides, when one knows how to track food consumption and incorporate different food sources, there is still flexibility within meal plans, he says. Indeed, a common refrain is that one should not be too harsh on oneself. 'If you're consistent 80 per cent of the time, I think it's fine,' says Fu. 'It retains your sanity. I mean, I still eat ice cream. I just make up for it and work within my calorie budget.' Adds Soh: 'I used to be very precise about the metrics. And sometimes, it's very hard to track when you're travelling. But after a while, you roughly know the correct portions. I try to meet the goal and sometimes, I fluctuate a bit, but it's fine.' The good thing is, the health benefits of weight loss also come with less-obvious perks. For instance, his blood work results are now good; he feels more confident and enjoys buying clothes. 'Previously, I had to look for XL- or XXL-sized clothes, and felt very discouraged. But now, size M is big enough. These are the small victories people don't know about.' The physical change has also given him greater mental strength. 'I have become more focused and determined. I used to look for the easiest way out of every situation and avoided making difficult decisions, especially when I was tired. But today, I think 'Whether it's good or bad, I'll see this through'. So it has really helped me in terms of changing my mentality.' At the end of the day, Han says weight loss 'doesn't have to be painful'. 'You just have to be very disciplined and mindful about what you're eating. I'm a chef. I'm exposed to all this good food. So the good news is: if I can do it, others can too.'
Medscape
3 days ago
- Health
- Medscape
GLP-1s Treat and Even Reverse Some Forms of Liver Disease
In the past two decades, the global prevalence of metabolic dysfunction–associated steatohepatitis (MASH) has increased dramatically as a result of the obesity epidemic. Researchers project that by 2040, rates of MASH will increase by 55%. Prior to that most liver diseases were caused by alcohol use and hepatitis C, a viral infection that primarily affects the liver. MASH, a preventable form of liver disease previously called nonalcoholic fatty liver disease, is caused by a buildup of visceral fat cells that accumulate on top of the internal organs, in this case the liver, and keep it from functioning properly. The liver's primary role is to filter blood, nutrients, and bile used for digestion, as well as to remove toxins from the body. Excess fat cells blanket the liver and keep it from working at full capacity. Fat cells are also metabolically active and can cause a chronic state of inflammation in the part of the body where they reside. Over time, these fat cells can cause cirrhosis of the liver, or permanent scarring. Once patients reach this stage, the only option is a liver transplant. New Research on Glucagon-Like Peptide 1 (GLP-1) Agonists and MASH Until recently, the lone treatment for early-stage MASH was weight loss to reduce the number of fat cells that surround the internal organs. But new research has shown that GLP-1 agonists can reduce and even reverse the condition. In a study published last month in The New England Journal of Medicine , researchers were able to show that semaglutide resolved fatty liver and inflammation in over 60% of cases and decreased scar tissue in just over a third of patients. 'These findings suggest that semaglutide may prevent fatty liver disease from progressing to cirrhosis and can indeed reverse the course of the disease,' said Arun J. Sanyal, MD, study author and director of the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University in Richmond, Virginia. Another study published last year in JAMA Internal Medicine had a similar finding, showing that GLP-1 agonists were associated with less progression of the disease and reduced mortality in patients with MASH and diabetes. Another large-scale observational study published in Nature Medicine found that GLP-1s reduced the risk for hepatic failure, which occurs when the liver is unable to perform basic functions, as well as liver cancer, both of which are downstream consequences of MASH. How GLP-1s Improve Liver Function 'These medications reduce fat burden, which results in fat loss everywhere, including around the liver,' said Ziyad Al-Aly, MD, an assistant professor in the Division of General Medicine & Geriatrics at Washington University School of Medicine in St. Louis and author of the recent study in Nature Medicine . 'When fat cells are reduced in size and volume, the normal liver cells have more room to grow and function.' Ziyad Al-Aly, MD These medications also seem to work on reducing the inflammation and oxidative stress caused by metabolic disease, which allows for a better environment for the liver to function. 'Fat is not an inert tissue, it's metabolically active, causing a slow burn to all the cells surrounding it,' said Al-Aly. These medications keep the disease from progressing and reduce scarring, which improves the damage that's already been done, he said. Changing How Primary Care Physicians Diagnose Liver Disease Primary care physicians are most often the first line of defense against liver disease, and as a result, they need to be vigilant in the way that they screen for the condition, said Charu Sawhney, DO, MPH, an internal medicine physician with Harbor Health in Round Rock, Texas. Physicians need to be aware that even if liver enzymes appear even slightly elevated, there still could be a reason to utilize these medications to prevent later-stage MASH. Charu Sawhney, DO, MPH 'Normal levels for liver enzymes in some patients can be lower than what labs show,' said Sawhney. This is especially true if a patient has other metabolic risk factors such as diabetes, obesity, or high cholesterol. If liver enzymes continue to go up even after diet and lifestyle changes, patients might require liver imaging, specifically a wave-based ultrasound called elastography, which measures the elasticity or stiffness of tissues on the liver and can judge if certain portions of it have scarred or hardened. When liver cells change texture and become harder, the scan can estimate levels of fibrosis and, therefore, the stage of MASH that a patient is in. Additionally, the severity of fatty liver disease depends on other factors besides weight and can sometimes be surprising. 'How bad fatty liver disease is in a patient isn't always related to how much weight someone has gained,' said Carolynn Francavilla, MD, a nationally recognized obesity physician who owns and operates Green Mountain Partners for Health and Colorado Weight Care, both in Denver. It's important for physicians to realize that some patients with fatty liver disease might not have obesity as would be expected. For these patients, adipose tissue seems to accumulate on the liver before it does on other parts of the body. This could be related to the quality of our food system, including the use of sugar substitutes like high fructose corn syrup, which research has shown is even harder on the liver. There might also be a genetic propensity toward fat storage around the organs. A New Way to Treat MASH If indeed GLP-1s are a potential treatment in those with MASH, this might also change the way that primary care physicians treat these patients and how the medication is prescribed in those with earlier stages of the disease, said Francavilla. Right now, there's not an official approval from the US Food and Drug Administration (FDA) for prescribing GLP-1s in patients with MASH, but Francavilla hopes that it's forthcoming. 'It will be really exciting to have these medications as a treatment option because right now there's only one medication, and it's for people who have pretty advanced fatty liver disease,' said Francavilla. This medication, called resmetirom , is approved by the FDA to target a protein in the liver to reduce fat and inflammation and scarring. But GLP-1s can be used much earlier to prevent the condition. 'With so many cases of MASH happening so much younger, it's a disease that physicians really need to take seriously,' said Sawhney. 'If we want to catch this disease at the early stages when we can still do something about it, it's most likely going to be primary care physicians who see it.'
Business Times
3 days ago
- Health
- Business Times
Singapore chef of Michelin-starred restaurant sheds over 30kgs: How he and others sustain their weight-loss
[SINGAPORE] Han Li Guang, chef of Michelin-starred restaurant Labyrinth, is used to eating good food. A lot of it. 'In the past, my wife would always scold me when we went overseas. I'd book two fine-dining meals a day. We'd barely finish one, and go for dinner already. And I always over-ordered – rich, fatty food,' he says. 'Nowadays, I book only one fine-dining meal once every two or three days while on holiday.' And for a top chef, his meals today are downright repetitive – revolving around rice, chicken breast, eggs and prawns. His commitment to his cause – triggered just before his 2022 wedding – led to his weight falling from a peak of 94 kg to a low of 62.5 kg earlier this year. Hitting the gym six days a week, he also brought his body fat down to just 9.5 per cent, but he is now on a bulking phase to gain more muscle mass. It may sound like too much of a challenge, but for Han and others like him, traditional weight-loss methods involving diet, exercise and sheer determination beat any quick fixes. Chef Han Li Guang when his weight loss was stagnating at around 80 kg (left), and after he started working out with a personal trainer. PHOTO: MATTHEW LU/ABDUL TSAQIF/INSTAGRAM/HAN_LG Feeling healthier, happier and mentally stronger are just some of the benefits these adherents gain. They also learn about nutrition and correct common misconceptions about food and exercise. A NEWSLETTER FOR YOU Friday, 2 pm Lifestyle Our picks of the latest dining, travel and leisure options to treat yourself. Sign Up Sign Up Injectables good, lifestyle changes better The Singapore 2021/2022 National Population Health Survey found that about one in nine residents (11.6 per cent of the population) aged 18 to 74 were obese, up from about one in 10 (10.5 per cent) in 2019/2020. Obesity was more common among males, and highest among adults aged 40 to 49. Injectables using glucagon-like peptide 1 agonists (GLP-1s) – Ozempic is an example – are drugs for treating Type 2 diabetes, but have been making headlines for successfully kickstarting weight loss by suppressing appetite. GLP-1s such as Saxenda and Wegovy have been approved for weight-loss treatment in Singapore. But patients have to meet certain criteria and can get these drugs only through prescriptions from licensed medical professionals. Boxes of Ozempic and Wegovy. PHOTO: REUTERS It is important to know that these are not lifestyle products or quick fixes for those seeking to slim down. The findings of a meta analysis of 11 studies of older and newer GLP-1 weight loss drugs by the University of Oxford, presented at the European Congress on Obesity this month, noted that users regained all the weight they lost within two years of cessation. Of course, there is still an important role for these medications. There is now a better understanding of how complex weight loss is and why certain individuals are more susceptible to being overweight, making weight-loss for them an uphill battle, says Dr Joel Foo, medical director at ATA Medical. This is why drugs like GLP-1s are game-changers for patients, especially in the control of blood sugar levels in diabetics. 'Weight loss at its crux is really about the treatment of metabolic syndrome, nothing more,' says Dr Foo. After some time, drug-induced weight loss typically plateaus. To make weight loss sustainable, behavioural changes involving exercise and eating habits are pivotal, especially when the patient is coming off GLP-1s. 'That's why the use of such medications really requires a lot of hand-holding,' adds the doctor, who says used to be 'a fat kid' who was put through the now-defunct weight-loss Trim and Fit programme in school. What is unknown about the use of GLP-1s is how exactly they affect muscle loss and changes in body composition, says Dr Naras Lapsys, chief clinical officer and senior dietitian at Chi Longevity. He has a doctorate in molecular genetics and spent the first decade of his career studying obesity before becoming a consultant dietitian. 'Taking these medications alone without thinking about your resistance exercise, protein intake and the risks they may have on your body composition are probably some of the many issues that need to be addressed,' he says, noting that losing muscle mass is detrimental. Personal trainer Titus Toh points out that a calorie-deficit diet will cause weight loss, but an 80 kg male with 5 per cent body fat looks 'wildly different' from one with 25 per cent body fat. 'You lose fat by building muscle and there are many benefits to that, but the obvious one is that metabolism is increased, so the body can sustain itself better. People always look for the quickest or most convenient method, but whatever is built to last is often not achieved quickly.' Slow and steady – with accountability Han admits the first three months of his weight-loss journey were the hardest, especially when it came to eating: 'Fifty per cent of the battle is won in the gym, and the other 50 per cent, outside of it.' But once he got the hang of his diet – planned by Toh – and understood the science behind food, 'it was easy' building it into his lifestyle. And that includes handling dinner invitations and the 'many good meals' that come his way. No matter how late his day ends, Chef Han Li Guang exercises first thing the next morning. PHOTO: INSTAGRAM/HAN_LG 'There's a lot of discipline on my end,' he says, noting that he still tastes his restaurant's food, does research and development, and often travels for work. So he stays accountable by tracking his caloric intake with the popular MyFitnessPal app, looks for hotels with gyms and brings protein shakes along. And no matter how late his day ends, he exercises first thing the next morning. 'I'm 40, I'm married. Why am I doing all this? To feel good about myself. I want to be fit mentally and physically, I want it natural and sustainable, so my lifestyle can incorporate what I'm doing as a chef and restaurant owner. Health should be a long-term decision.' Similarly, it was a slow and arduous journey for Bernard Soh, who was overweight for most of his life. Soh weighed 99 kg and had high blood pressure and sugar levels before the Covid pandemic struck. His doctor offered him Saxenda, but he declined, wary of possible side effects and other complications. Instead, the senior manager at Dolby Laboratories chose to exercise. 'During the pandemic, there's only so much Netflix you can watch, so I tried walking a bit just to get some fresh air.' The walking became running, and Soh was soon challenging himself. 'Once you start dropping a few kilos, it really motivates you to do even more.' He read up on nutrition, learning how to eat better and exercise right, tracking his progress as he went along. Like Han, his biggest challenge was food – or lack thereof. He was hungry every night and struggled to fall asleep. 'I was really messed up because my blood sugar level was very low ,and I'd wake up extremely moody.' So he drank tea to fill his 'very big' stomach and contain his hunger. 'These are psychological things, and I needed to accept the hunger and refrain from snacking. This took a long time, six to nine months for me. It was very, very hard.' But in time, his body adjusted to the lower caloric intake. He began to feel better. This is a huge contrast to the past, when he ate whatever he could conveniently get his hands on. 'It's like 'I'm going to settle a hunger problem now'. So, anything goes. I don't know how many dinners and suppers I used to have (every night).' Today, the 46-year-old tracks his diet and exercise six days a week, even though his regional role requires him to travel two to three weeks in every month. At his thinnest, he weighed 66.7 kg, but he is now 75 kg, bulking up for muscle growth. He enjoys running, something he could never imagine himself saying before. 'I used to take taxis everywhere. But now, I'd gladly walk 2 km home from my gym.' It helps that staying accountable and tracking calorie-consumption has become easier and more convenient. Financial-services consultant Desmond Fu worked out at least five days a week and shed some 20 kg from his 78 kg frame in 2009. Realising he could lose weight, the 49-year-old began focusing on building muscle, which he needed to do to reduce his level of body fat. That was when he turned to Welling AI, an app by a Singapore-based startup which works like a virtual nutrition coach powered by artificial intelligence. Financial-services consultant Desmond Fu at his heaviest. PHOTO: DESMOND FU The 49-year-old is now at a healthier weight. PHOTO: DESMOND FU Having used it since Chinese New Year, Fu, who says he puts on weight easily, discovered how 'very innocent-looking snacks' can be extremely calorie-dense. By actively adjusting his food choices to stay within his calorie count, the father-of-four now weighs 61.5 kg. Welling AI's co-founder, technopreneur Philip Man, says the app – launched in August 2024 – was trained on Asian food data. Users log meals via photos, voice or text and get calorie and macronutrient estimates. Personalised feedback, aligned with the user's goals, takes the form of 'positive reinforcement' and meal suggestions. Welling AI's app is trained on Asian food data. PHOTO: WELLING Users of Welling AI get personalised feedback in the form of 'positive reinforcement' and meal suggestions. PHOTO: WELLING The app now has a few thousand paid subscribers and is averaging 50 to 60 per cent month-on-month growth. 'Becoming mindful about what you're eating is a much better long-term habit that will get you into general health than a quick fix,' says Man. A cause greater than weight-loss It is often the struggle with sticking to a diet and exercise plan that leads many to give up. 'First of all, acknowledge that making changes is often difficult,' suggests Dr Lapsys. 'Weight loss is a long and slow process. So it's better to make one or two changes and bed them down as successful habits before taking on more. Frame the small changes you make not as sacrifices, but as alternatives that are compelling, or find upsides to the changes you've made. That's a very good starting point.' For Toh, it is most important to keep purpose in mind. 'Understand why you're doing what you're doing,' he emphasises. 'If you put the aesthetic part aside, it's more about leading a healthy lifestyle. Shouldn't it be a norm to know what and exactly how much you're putting into your body, instead of being judged for bringing your own home-prepped meal when eating out? It's funny how when you choose to take control of your health and diet, you get criticised, when it should be the other way round.' Besides, when one knows how to track food consumption and incorporate different food sources, there is still flexibility within meal plans, he says. Indeed, a common refrain is that one should not be too harsh on oneself. 'If you're consistent 80 per cent of the time, I think it's fine,' says Fu. 'It retains your sanity. I mean, I still eat ice cream. I just make up for it and work within my calorie budget.' Adds Soh: 'I used to be very precise about the metrics. And sometimes, it's very hard to track when you're travelling. But after a while, you roughly know the correct portions. I try to meet the goal and sometimes, I fluctuate a bit, but it's fine.' The good thing is, the health benefits of weight loss also come with less-obvious perks. For instance, his blood work results are now good; he feels more confident and enjoys buying clothes. 'Previously, I had to look for XL- or XXL-sized clothes, and felt very discouraged. But now, size M is big enough. These are the small victories people don't know about.' The physical change has also given him greater mental strength. 'I have become more focused and determined. I used to look for the easiest way out of every situation and avoided making difficult decisions, especially when I was tired. But today, I think 'Whether it's good or bad, I'll see this through'. So it has really helped me in terms of changing my mentality.' At the end of the day, Han says weight loss 'doesn't have to be painful'. 'You just have to be very disciplined and mindful about what you're eating. I'm a chef. I'm exposed to all this good food. So the good news is: if I can do it, others can too.'
