1. Overview of obesity – definition, what are the signs? What are the causes?
Obesity is a disease of abnormal or excessive fat accumulation. It can occur both in children and adults. Obesity is a global pandemic with serious consequences to both the life expectancy and quality of life of those involved. It has been projected by the World Obesity Federation that nearly 1 in 5 adults will be living with obesity by the year 2030. A similar prevalence of obesity was already shown in our National Health and Morbidity Survey (NHMS) in Malaysia in 2019. The more recent NHMS in 2022 showed 1 in 3 Malaysian teens aged 13-17 to be overweight or obese.
This condition is complex and multifactorial involving both genetic and environmental factors. There are also certain secondary causes such as endocrine diseases, central nervous system disorders, genetic syndromes and medications leading to excessive weight gain in a small proportion of individuals. However, unhealthy eating habits and a sedentary lifestyle are undeniably the key factors contributing to this condition in the general population.
2. How is obesity diagnosed?
Obesity is most commonly diagnosed using body mass index (BMI), which is calculated from the weight and height of a person. In the Asian population, the cut-off point of ≥ 27.5 kg/m2 is used to diagnose overweight and obesity. An individual with a BMI ≥ 23.0kg/m2 is defined to be overweight. Waist circumference is a good measure of abdominal fat which is an independent cardiovascular risk factor in particular in those who are of normal or overweight BMI class. There are also other methods of body fat analysis that can be used to diagnose this condition but these methods are not as readily available.
3. What are the complications and Why is weight management important?
Obesity results in various complications which reduces both quality and life expectancy. Obesity-related metabolic complications include Metabolic syndrome, Type 2 Diabetes Mellitus, Hypertension, Dyslipidaemia and Metabolic Associated Fatty Liver Disease (MAFLD). In addition, excess weight leads to mechanical complications such as Obstructive Sleep Apnea (OSA), Gastroesophageal Reflux Disease (GERD), Degenerative Joint Disease and Osteoarthritis. Obesity also increases risk of certain cancers such as breast, colorectal, endometrial, liver, etc. A person who is obese also often struggles with numerous mental health problems such as major depression disorder, generalised anxiety disorder, eating disorders and so on.
4. What can a patient do to manage obesity?
A person with obesity needs to firstly understand and accept his or her excessive weight as a problem with potential harmful complications. This will in turn bring about motivation and commitment to manage their weight. Empowering people with knowledge with regards to obesity and basic concepts of weight management is key to its success. It is often useful to seek professional help to assess, educate and guide their weight reduction journey.
5. What is medical weight management?
Medical weight management is supervised weight loss support from a healthcare professional. It involves comprehensive lifestyle interventions, as well as medical and surgical treatment options. A detailed medical assessment and review of lifestyle is essential prior to medical weight management to enable safe and effective weight reduction. Programmes need to be well structured, personalised and holistic aiming for weight reduction and maintenance, management or prevention of complications and appropriate physical and psychological support. It usually comprises a multidisciplinary team involving an endocrinologist/physician, bariatric surgeon, physiotherapist or physical therapist, dietitian or nutritionist and mental health support professionals.
6. Who should seek medical weight management?
Medical weight management is warranted in anyone who is overweight or obese who is motivated to reduce their weight and is willing to commit to a structured programme. Medical weight management is particularly encouraged in people with obesity related complications who require closer supervision and guidance in their weight management.
7. The importance of follow-up appointments for medical weight management
Follow up is key in medical weight management and is important during weight reduction and the maintenance phase. During the weight reduction phase, modalities used including diet plans, exercise programmes, medical therapy and surgical interventions will require monitoring for efficacy and adverse effects. The weight management team will focus on safe and effective weight reduction until target weight is achieved. During the maintenance phase, a structured follow-up is equally important to prevent regaining weight.
Dr Shamharini A/P Nagaratnam
Consultant Internal Medicine Physician & Endocrinologist
Columbia Asia Hospital – Petaling Jaya
