Obesity is a growing epidemic that is affecting billions of people around the world. According to the National Health Survey (2004), 25.6% of Singaporeans are overweight (BMI: 25.0kg/m2 – 29.9kg/m2) and 6.8% are obese (BMI > 30.0kg/m2).
It is well established that obesity increases the risk of developing chronic diseases, including Type II Diabetes Mellitus, cardiovascular diseases and several types of cancer. Individuals who are obese are also at higher risk of developing musculoskeletal disorders1 such as osteoarthritis2 of weight-bearing joints, chronic kidney disease and obstructive sleep apnoea. These obesity-related co-morbidities increases the individual’s mortality, decreases the functional capacity and quality of life.
A modest weight loss of about 5 - 10 per cent of the individual’s current body weight has been shown to be capable of reducing cardiovascular risk factors. The weight loss helps to decrease blood pressure in hypertensive and pre-hypertensive patients; improve insulin sensitivity and glucose tolerance in patients with impaired fasting glucose or Type II Diabetes Mellitus; increase high-density lipoprotein (“good” cholesterol”); and decrease total cholesterol and triglycerides in hyper-lipidemic patients.
Despite the increased availability of medications and surgical interventions that promises to treat obesity, lifestyle modification is key to obesity management. Lifestyle modification has been shown to be capable of preventing the development of chronic diseases such as Type II Diabetes in obese and high-risk patients.
A comprehensive and effective obesity management focuses on health gains but not weight loss via lifestyle modification. It emphasises on healthy changes to the individual’s dietary habits, increase in daily physical activities, structured exercise programme and behavioural modification (such as motivation techniques, stress management).
Dietary changes have also been shown to be effective in lowering cardiovascular risk factors, such as blood lipid levels. Epidemiology studies have also shown a relationship between dietary habits and chronic diseases, suggesting strongly that dietary changes will have favourable effects on disease prevention. Studies have shown that people who are most successful in losing weight and maintaining the weight loss eat a light but healthy breakfast, have a calorie-reduced diet that is low in fat instead of following fad diets and have a high fibre intake.
Individuals who are obese but physically fit have lower mortality and morbidity compared to those who are skinny but physically unfit. Physical fitness is now established as an indicator of mortality, independent of the individual’s weight status. Adults should aim to achieve at least 10,000 steps daily to maintain healthy weight. Sedentary individuals aiming to reduce weight should start by achieving 2000 steps above the current number of steps taken. Individuals are advised to have at least 30 minutes of moderate intensity aerobic exercises (eg: brisk walking, cycling, swimming, jogging) for most, if not all days of the week to maintain healthy weight.
Behavioural modification is one of the most crucial components of all lifestyle modification interventions. Many studies have shown the effectiveness of behavioural modifications via counselling to adopt healthy changes in dietary habits and increase amount of physical activities. Such counselling can done via the telephone, internet or in-person, all of which have been shown to be effective. Begin by setting realistic and achievable goals – this can be done with a physician or dietitian specialising in obesity. Identify causes of weight gain or reasons for unsuccessful weight loss by conducting a thorough examination of current lifestyle and medical history. Develop specific strategies to overcome these barriers and set achievable goals. Do not be overly ambitious - establish small objectives (eg: “I will reduce time spent watching television by 30 minutes, 3 times a week and go for a brisk walk in the park instead”). Provide non-food incentives as rewards when goals are achieved.
All these lifestyle modifications are best done with your specialist physician, dietitian or trained counsellor. Follow-ups are important to maintain weight loss, set new goals, improve current diet and exercise habits further and new lifestyle habits.