Obesity Causes and Management

Obesity is defined as having a Body Mass Index of more than 27.5kg/m2 for Asians. It is derived by taking your weight in kilograms, divided by the square of your height in meters.

Some may remember the cut-off of 30kg/m2 used a decade ago. Since then, studies conducted in Hong Kong, Thailand, Taiwan, Korea, and Singapore (no less!) have shown that Asian populations have higher percentages of body fat at lower BMIs. This also reflects the increased risk of chronic disease (for eg, diabetes and heart disease) and death at lower BMIs in Asian populations.

According to Singapore’s Ministry of Health, 10.8% of the national population between 18 to 69 years were suffering from obesity in 2010. 11.3% of the same national population has diabetes. Both numbers are highly correlated and have been on an increasing trend showing no signs of slowing.

The recent annual medical examination showed 28.6% of staff in PCS being categorised as “Obese and above”.

We have been warned about the “ silver tsunami “ of the elderly by many sectors but most choose to remain silent on obesity. It remains the “elephant in the room” due to political and economic considerations despite numerous calls for action by various international health organisations. Obesity remains the largest contributor to preventable deaths in the world. The second largest is smoking.

Contributing factors

Risk factors for associated diseases

Management/Prevention

Weight management and a healthy lifestyle are intertwined. Breaking each task into simple practicable steps is the best way to nudge yourself into behaviour change. I have listed out my usual points to some of these advice and one can pick what is best and most suited for you.

Lifestyle Advice	Small Steps ( Choose either, or all)	Keeping in Mind
Increasing exercise	Start with what you enjoy, or what you are familiar with. Straight leg raises when sitting at your desk (minimum 30 sec). Core exercises (bridge, superman, flutterkicks) while getting up from bed or going to sleep. For regular swimmers, cyclists and runners, instead of clocking only mileage, concentrate on interval sets and efficient use of exercise time.	Your muscles will protest with each increment over 2 days, but after 2 weeks, they will get used to it, and it will be time to consider the next increase!
Eating Healthily	Recognise our usual carbohydrate intake is 2-3x the recommended amount for a sedentary individual. Do not totally cut out a particular food group – eat small amounts of each, especially carbohydrates, to avoid overeating the next meal. Never pay lip service to yourself – choose an easy-to-do item (50% reduction) instead of merely saying you “will eat less.“ Involve your family – you never know, they may have been waiting to say the same thing. Enjoy small frequent meals. Never snack more than what you eat for breakfast. Understand it is OK that food stall vendors may be surprised at your request – they will get used to it. Don’t feel shy to ask for smaller portions of rice when you eat out.	Most dietary habits can be changed with willpower for only 2 weeks. It takes constant effort from 2-6 weeks for it to form a habit. Don’t give up if you find you have lapsed. If you can persist to 3 months, a new habit is usually formed.
Losing Weight	Buy a weighing scale if not done. Always know your weight within the last week. Weight measurement every 2-3 days. Drink a glass of plain water before a meal. When eating out, instead of ordering more when still hungry, walk off to another stall at another location to buy a small dessert – you will still end up eating less than if you had stayed around to finish another dish.	There will be days where you may compensate for your “ healthy” behaviour ( eg. rewarding yourself with a Big Mac after a heavy workout). Instead of giving up, work out how many times in a week that happens and try to decrease it.