Effective Obesity Management
Lifestyle
modification is key
How
does obesity affect my health?
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
disorders* such as osteoarthritis** 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.
How can I treat
obesity?
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).
1. Improve diet
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.
2. Increase daily physical activities
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.
3. Adopt positive behaviours
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.
Notes:
* Musculoskeletal disorders are syndromes characterised by
discomfort, impairment, disability, or persistent pains in joints,
muscles, tendons or other soft tissues. ** Osteoarthritis
is characterized by a gradual loss of cartilage from the joints
and, in some people, joint inflammation.
Written by Eric Ho, Senior
Physiotherapist/Clinical Coordinator, Lifestyle Improvement Fitness
Enhancement (LIFE) Centre, Singapore General Hospital
This article was first appeared in The Graduate magazine, a
National University of Singapore Society (NUSS)
publication
