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Obesity and Metabolic Syndrome: Not just about weight

Obesity is a medical condition, defined by excessive or abnormal accumulation of body fat to an extent that adversely affects health. Being overweight increases a person's risk for developing cluster of medical conditions - IHD (Ischaemic Heart disease), Stroke and Type-II Diabetes Mellitus known as Metabolic syndrome.

According to new IDF (International Diabetes Federation) definition, metabolic syndrome is defined as central obesity plus any two of the following risk factors – Hypertension, Raised Fasting Plasma Glucose, Raised triglycerides and Reduced HDL cholesterol. It is estimated that around 20-25 per cent of the world's adult population have the metabolic syndrome and they are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome. In addition, people with metabolic syndrome have a fivefold greater risk of developing type 2 diabetes. Other chronic diseases such as cancer, gallbladder disease, and osteoarthritis and sleep apnoea also occur more commonly in people who are overweight.

About one-third of Singaporeans are considered overweight, and slightly less than 10% are obese.  Indeed, obesity rate has increased by 50% in the last 20 years.

How to tell if you are overweight

Calculating your body mass index (BMI):

Measuring your abdominal circumference:

Measure around your abdomen midpoint between the lowest rib you can feel and the top of your hip bone.

Definitions of excess fat in Singaporeans

 
Body mass index (kg/m2)Waist circumference (cm)

OverweightObese
Male≥23
≥27.5
>90
Female≥23 ​
≥27.5​>80

 

What can you do if you are overweight?

Many people are able to lose weight on their own, by changing their lifestyle through healthy eating and exercise, while others need help to achieve their weight loss goals.  Research studies have shown that weight management programmes that comprise of comprehensive lifestyle interventions that address diet, physical activity and behavior therapy (all 3 components) delivered intensively can result in sufficient weight loss to improve health.

In addition, weight loss and metabolic surgery may be indicated for some individuals, namely those with BMI higher than 37.5 kg/m2 without any other illness or above 32.5 kg/m2 with other conditions such as diabetes, hypertension, hyperlipidaemia or obstructive sleep apnoea (OSA).  The Ministry of Health Obesity Clinical Practice Guidelines published in 2004 and 2016 endorses the role of bariatric and metabolic surgery. Results from recent randomised trials suggested that bariatric and metabolic surgery combined with intensive medical therapy is more effective than optimal medical treatment alone for glycaemic control in obese individuals with Type 2 diabetes. Additional benefits were noted in the control of blood pressure and lipid levels in the surgery group. The benefits of bariatric and metabolic surgery among anti-diabetes interventions for "diabesity" is also recognised by recent joint statement from International Diabetes Organizations in Diabetes Surgery Summit (DSS-II).

The SWITCH (Sengkang Weight Improvement Therapy and Complete Health) programme is run by a multidisciplinary team consisting of doctors (surgeons and physicians), dietitians, physiotherapists, psychologists and nurses, who work together to deliver a comprehensive programme, based on the latest scientific evidence, to assist and guide you in your weight loss journey.

Do I qualify for the SWITCH programme?

The SWITCH programme is for people who fulfil the following criteria:

  • Motivated to make lifestyle changes and willing to participate in moderately intensive physical activity AND
  • BMI ≥ 32 kg/m2 OR
  • BMI ≥ 27 kg/m2 with any of the following co-morbid conditions
    • Diabetes
    • Coronary heart disease
    • Hypertension
    • Dyslipidaemia (low HDL/high LDL/high TG)
    • Diagnosed obstructive sleep apnoea
    • Non-alcoholic steatohepatitis
    • Polycystic ovarian syndrome