Obesity Causes and Management

Design Sg
Sep 13, 2023
2 min read

Updated: Dec 4, 2023

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

An Asian post-WW2 culture being taught not to waste food, a rising abundance of cultivated crops translating to low-dollar cost of “ junk food”, increasingly sedentary lifestyles over the years, a practical de-emphasis on sports, persisting cultural/ family-based practices – they have all been offered as reasons for the increasing trend in weight gain/ obesity and its associated diseases of hypertension, diabetes and high cholesterol – which ultimately lead to heart attacks and strokes. Instead of waiting for Ministry-level policy to “ nudge” us, simply being aware of the above factors may sometimes be just enough to slow down this silent epidemic.

Risk factors for associated diseases

Obesity highly increases the likelihood of various diseases, particularly diabetes, heart disease, some types of cancer (for e.g colon), and knee osteoarthritis. Obesity contributes to preventable deaths, largely due to the high risk of diabetes and its complications, which accounts for more than half of worldwide disability-adjusted life years (DALYS), a measure of overall disease burden from life lost from premature death and disability. A diabetic, at diagnosis, has a 90% lifetime risk of succumbing to cardiovascular causes of death (heart attacks and strokes) as compared to the general population. It remains the biggest cause of kidney failure in the working population (60%). There is a 25% lifetime risk for lower limb amputation for a diabetic, and amongst these, 95% of all diabetic amputations were smokers. Being overweight and having diabetes are inextricably linked, and obese patients are most at risk. Fortunately, serial annual measurements of glucose allow anyone to be able to check if they have developed impaired fasting glucose or “prediabetes” to be able to act before they develop diabetes.

Management/Prevention

While the primary method of fighting obesity includes adopting a healthy diet and engaging in physical exercise, anti-obesity medication may also be introduced when tangible lifestyle changes fail to address the problem (metformin). A multi-prong approach is the ONLY effective way, rather than targeting exercise or diet alone.

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.