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Obesity is associated with an increased
risk of premature death and chronic illness such as diabetes mellitus,
high blood pressure, high cholesterol, stroke and heart disease. Weight
reduction not only leads to decline in these health risks but also
improves appearance, mental health, quality of life and offers better
social and workplace acceptance. It is imperative that overweight and
obese individuals seek professional medical advice on how to lose
weight. They should not take Over-The-Counter (OTC) slimming
products. Weight Management
A multidisciplinary, structured team
approach is required for successful management of obesity. The weight
management team usually comprises of a physician, endocrinologist,
bariatric surgeon, dietician, behavioral therapist or psychiatrist and
exercise therapist. 95% of obese patients have no known cause but it is
essential to exclude any underlying cause (ex, thyroid disorders,
Cushings syndrome, etc) before treatment. Obesity-related disorders
require careful evaluation. Diet, exercise and behavioral changes remain
the cornerstones of treatment of overweight and obese adults.
Diet
Dietary strategy involves calorie
restriction through dietary modification. A dietician will educate
patients and family on the most appropriate diet to lose weight.
Problematic areas in patients current diet are highlighted and
suggestions are offered to make the diet healthier. Patients are taught
the reading of labels an glycaemic index of foods. Meals of adequate
size are advised so that snacks are not needed between meals. Any one of
the 3 main meals should not be 'skipped' as a weight control method.
Behavioral Therapy
The key to long-term weight loss is
behavioral modification. Behavioral therapy aims to :
- change key attitudes
- motivate self-change while
maintaining self-esteem
- maintain changes with peer support
- control responses to external
stimuli
- learn problem solving
- and prevent relapses through
rewards
Medication
Slimming medications can be a useful
adjunct to exercise and behavioral therapy. They must never used alone
for weight reduction. The judicious of slimming medications under
medical supervision achieve excellent results in weight reduction and
weight maintenance. These are commonly used for patients with BMI
30kg/m2 or above, and those with BMI 27kg/m2 or above with concomitant
medical problems which include diabetes mellitus, hypertension, stroke
and heart disease. They should not be prescribed for patients below 18
years of age and women who are pregnant or breastfeeding.
Surgery
Surgical treatment is indicated for the
morbidly obese (ie; BMI 40kg/m2 or above) or those with BMI 35-39.9kg/m2
with severe mediScal problems. Surgery is the last resort when all the
above mentioned options have been used for a period of 6 months and
failed to achieve any significant weight loss. Gastric bypass, gastric
plication or gastric banding are the usual surgical procedures. Other
procedures include jaw wiring and replacement of gastric balloons.
Laparoscopic banding is another procedure in which an adjustable silicon
band is placed around the upper portion of the stomach, thus creating a
small pouch. When food is consumed, the pouch distends rapidly, thus
creating a feeling of fullness.
Weight loss of more than 20kg over 6
months have been achieved in some patients treated with Lap-Band. Like
all surgical procedures, there is a small but definite risk of
complications. Subsequent plastic surgery to correct folds of loose skin
is usually required after weight loss has been achieved. Liposuction is
useful for removing unsightly local collections of fat.
Prevention
Last but not least, "prevention is
better than cure". A healthy lifestyle needs to be developed throughout
life. Incorporation of healthy eating and daily physical activity into
person's lifestyle make him more likely to achieve and maintain a
healthy weight.
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