Staying in good shape reduces the risks of chronic diseases and increases life expectancy
AT HiS heaviest, Mr Edwin Goh (right) weighed 126kg, with a waist measuring 124cm. Besides hypertension or high blood pressure, he suffered from Obstructive Sleep Apnoea (OSA) and always woke up tired. He also needed to take several long naps every day. He ate a lot and a typical meal included two bowls of rice, two sugary drinks and an additional plate of char kway teow he shared with friends. Now at a trim 78kg, Mr Goh, 32, is a picture of health. He says he has “never been small” and this was his weight when he was 11 years old. He has gone on many diets to bring down his weight. in 2009, he read an article about surgical options for obese individuals and sought help at the Life (Lifestyle improvement & Fitness Enhancement) Centre at Singapore General Hospital (SGH). Before a patient is allowed to undergo surgical intervention for obesity, he must be proven to have failed all other medical treatment, says Dr Tham Kwang Wei, director at Obesity & Metabolic Unit and consultant at Department of Endocrinology, SGH.
With medical advice and lifestyle modifications, Mr Goh dropped about 20kg. He learnt to make better food choices and increase his physical activities. But his weight started to go up again. Dr Tham says this is common in obese patients. In August last year, Mr Goh went for a Laporoscopic Sleeve Gastrectomy (LSG). in this procedure, the stomach is tubularised and the excess part is removed. This means that he can now eat less and yet feel satiated. Apart from surgery, maintaining a healthy weight is a lifelong affair and Mr Goh has to be regularly monitored for life. The key is to continue to eat right and lead an active life. Now Mr Goh goes to the gym two to three times a week and spends about an hour doing a combination of cardiovascular workouts and strength training. This regime has benefited him well. “Every aspect of my life has improved,” he says.
Obesity is a risk factor for high blood pressure (hypertension), which also increases your chance of having a stroke, heart attack, heart failure, kidney disease and early death. Says Dr Tan Hong Chang, associate consultant, Department of Endocrinology at SGH: “Patients who are overweight or obese have a reduced life expectancy, lower quality of life and there is also a whole range of psychological and social stigmatisation.” During the initial check-up, Mr Goh was found to have hypertension or high blood pressure as well as low high-density lipoprotein cholesterol (HDL) levels. An HDL of 40 mg/ dL and below is a major risk factor for heart disease. In 2009, it was a low 23mg/dL. After losing 18kg, it went up to 30mg/dL and then subsequently to 50mg/dL after he lost another 26.5kg. This is particularly significant, as Dr Tan says that good cholesterol levels are very difficult to raise, and with current medication, an improvement of only about 20 to 30 per cent is expected. Weight loss and medication has brought his blood pressure down significantly, from 202/128mmHg when he was 126kg to the current 137/86mmHg. The top number is the systolic blood pressure, and the bottom number is the diastolic blood pressure.
A person whose systolic blood pressure is 140mmHg or more, or diastolic blood pressure is 90mmHg or more, or both, has hypertension. Mr Goh’s weight loss has led to a reduction in the risks of heart disease for him as well as incidence of cancer, says Dr Tan, thereby improving his quality of life and life expectancy. His OSA has also improved as he experiences less disrupted sleep. Dr Tey Beng Hea, senior consultant at the Department of Medicine and director, weight management programme, Alexandra Hospital ( JurongHealth) says: “A modest weight loss of 5 to 10 per cent of the initial body weight, and longterm maintenance of that weight loss can bring significant health gains, including lowered blood pressure, reduced blood levels of cholesterol, reduced risk of Type 2 (adult-onset) diabetes; decreased chance of stroke; decreased complications of heart disease; and decreased overall mortality.”
He adds that studies have also shown that women who lose 5kg of weight reduce their risk of diabetes by 50 per cent or more. If you are obese and would like to lose weight, you should seek medical advice first. Dr Tey says: “Obese individuals should be examined by a doctor for possible secondary causes of obesity such as hormonal disorders (hypothyroidism, Cushing’s syndrome), medications (such as the ingestion of steroids, psychotropics, antidepressants, betablockers, hormone replacement therapy etc), hypothalamic damage, and brain tumours. These secondary causes constitute about 5 per cent and should be treated first before commencing on any weight management programme.” He adds that it is particularly important to exclude any underlying heart disease before commencing exercise, as it may precipitate a heart attack in individuals with undetected underlying heart disease. Also, exercise may have to be customised for those with joint problems such as gout or osteoarthritis.
Dr Darren Leong, resident physician at Changi Sports Medicine Centre (CSMC), Changi General Hospital says: “For those new to exercise, I would advise starting with exercise at a low intensity and choosing a mixture of weight-bearing and non-weight bearing, impact and non-impact type of exercises — cycling machine, treadmill walking. These are useful for beginners as they are easy to maintain at a constant intensity and do not require a special skill set.” Weight management programmes at the hospitals employ a multidisciplinary approach and evidence-based programmes to address weight loss. Patients work with a team of doctors, physiotherapists, psychologists and dieticians.
Targeting on diabetics to keep their weight and sugar levels down, Life Centre offers a programme, Diabex, that consists of supervised gym exercises where patients are assessed on their fitness levels and prescribed an intensity of exercises appropriate to them, says Dr Tham. She adds: “We have seen tremendous improvements in blood sugars, blood pressure and even cholesterol levels as well as fitness and confidence levels of our patients through such a programme.” At Alexandra Hospital ( Jurong- Health), Dr Tey shares that over twothirds of the participants have lost at least 5 to 10 per cent of their initial body weight — a medically significant weight loss — by the end of the weight management programme. For CSMC, Dr Leong says that on average, our patients lose 7.3kg and shed 8.3cm off their waistline at the end of the six-month programme. Overall, the emphasis of treatment should be to commit to the process of lifelong healthy living, including eating more wisely and increasing physical activity, says Dr Tey.