1) Lifestyle modification
This is fundamental for weight loss efforts to be effective and successful. The best weight loss method is one which is safe and can be adhered to. The change in lifestyle brought about by that method can hopefully be as sustainable as possible to prevent weight regain in the long-term.
i) Identifying factors which have led to the weight gain is a vital start. Some of the often under-recognized triggers of weight gain include stress, poor sleep hygiene, change in living environment or lifestyle routines, acute medical illnesses or new medications. These must be rectified and addressed concurrently while implementing other weight loss modalities.
ii) Dietary intervention:
A change in dietary habits is necessary for weight loss to occur. In general, a reduction in 500kcal a day can lead to a 0.5kg weight loss a week. There is no “best diet” and each dietary intervention should tailor to one’s lifestyle.
Most importantly, the change in dietary habits should focus on getting oneself healthier in addition to weight loss. These dietary changes must not worsen existing medical conditions nor cause more complications. The more sustainable the change in eating habits is, the more successful one is able to lose and keep the weight off.
A dietary intake high in fibre, unsaturated plant-based fats, with adequate lean protein and low in salt, saturated fats and refined carbohydrates is generally recommended and beneficial for those with obesity-related metabolic conditions and in reducing risk for heart disease.
iii) Increase in physical activity and reduction in sedentary time: Increasing physical activity and reducing inactive time is necessary in weight loss treatment. Being physically active has many other health benefits beyond weight loss. In general, to optimize health and fitness, and to prevent disease, it is recommended for adults to participate in at least 150 minutes per week of moderate intensity aerobic exercise (e.g. 30 minutes on at least 5 days per week). This can also be achieved by accumulating intermittent bouts of at least 10-minute duration each time.
To promote weight loss and for long-term weight maintenance, higher levels of physical activity with dietary change is recommended, with 250-300 minutes a week of moderate intensity or 150 minutes a week of vigorous intensity aerobic exercise. Strength training (resistance exercise) can also be added to aerobic exercise to increase muscle strength and physical function.
For people who are physically inactive, it is strongly recommended to start at a low intensity as tolerated and progress to the recommended levels. People with joint pains, previous injuries, medical conditions such as heart disease, diabetes mellitus, or experience chest pain or breathlessness on minimal exertion, should consult your doctor first before embarking on an exercise programme.
iv) Behavioural therapy:
Psychological factors play an important role as a cause of obesity. Stress, emotional eating and mood disorders (depression / anxiety) can lead to weight gain and can sabotage weight loss efforts if left unaddressed. Cognitive behavioural therapy and intervention by a psychologist or a psychiatrist will be beneficial in these cases.
2) Weight loss medications (Anti-obesity medications)
For many people with obesity, treatment with anti-obesity medications will need to be added to lifestyle changes to achieve the weight loss needed to attain health benefits. In others, weight regain occurs after initial successful weight loss and anti-obesity medications are needed at this stage.
There are 3 types of weight loss medications approved for use in Singapore. Each medication has its own indications, weight loss effect and side effects and may not be suitable for use in everyone. It is best to discuss with your doctor on the appropriate use of these medications and the monitoring required when you are on the medication.
3) Bariatric procedures and surgery
For those with more severe stages of obesity, a very high BMI in the absence of an obesity-related condition or those with frequent weight yo-yo, bariatric procedures and surgery may be recommended in addition to the above measures mentioned.
Bariatric procedures include the intragastric balloon which can be performed by a patient swallowing a capsule under X-ray guidance and a doctor’s supervision; and the endoscopic sleeve gastroplasty performed via endoscopy.
The types of bariatric surgery commonly performed in Singapore are sleeve gastrectomy and Roux-en-Y gastric bypass which are mostly done via the key-hole method (laparoscopy).
An experienced multi-disciplinary healthcare team needs to be involved in the care of those undergoing bariatric procedures or surgery. After the procedure or surgery, regular follow-up with the team is necessary to ensure that there are no complications related to the procedure or surgery and that in the long term, the maximal effect of weight loss can be achieved.
4) Weight loss supplements
There is little scientific evidence that weight loss supplements are effective for weight loss. In fact, many over-the-counter supplements touted to be very effective contain medicines which are withdrawn from the market or may contain high doses of laxatives and diuretics. These have led to dangerous side effects after consumption.
