I have never understood the REAL problem of being over weight in Singapore until recently. Is there a big problem in Singapore? Surely we have fewer obese individuals in Singapore as compared to the west. Yet in spite of that, weight is an ever-growing concern here. Why is that so?
This is what I think. In almost every facet of our lives, things have improved over the years. No just improved, but in the case of Singapore, leapt forward at an incredible pace. From effectively a monolingual, basic needs society one generation ago, we now have a first world society. Having met our basic needs, society is hungry for more in life.
Weight management, however, is something that has not improved in tandem with Singapore’s rapid advancements. Most of us are heavier than our parents and I am not referring to just being taller. I am quite sure I do not need to pull up fancy statistics to substantiate that or to convince most people that this is so.
I remember when I was in school. It was always much harder to do well in local exams than foreign ones. Whether it was for GCE ‘O’ levels or my exams for Membership into the Royal College of Surgeons of Edinburgh, scoring well has always been easier overseas. We Singaporeans have always been more demanding of ourselves than others demand of us or more demanding of ourselves than we need to be.
So after this long dissertation, I have come to the point that I am trying to make. The body weight that society considers to be acceptable in Singapore has become more stringent with time while most people have gone the other way by becoming heavier. Singapore’s society as a whole has gone beyond needing to be slimmer to decrease the risk of disease or because some important doctor or researcher says we need to. It needs to go lower because society demands of it. How have we done so far? Not very well, I am afraid.
So we have not been very good at maintaining our weight. So, where can we go for help and how effective are these sources of assistance?
Firstly, there are beauty salons specialised to provide a range of services from wraps to machine treatments, herbs, meal replacements, and counseling. Then there are clinics, which prescribe medications that curb appetite or block fat. Then there are aesthetic and plastic surgery clinics, which do invasive or non-invasive fat reduction treatments.
What are my thoughts on the current weight management services? I think that there are many good clinics and salons, which do a great job at what they do. However, not many offer comprehensive services to address all aspects of slimming. Frankly, slimming is difficult and we need to attack it in more ways than one.
Let me illustrate. When I talk to patients, there are a couple of concerns that I hear all the time. Firstly, most patients want it fast, then they want it easy and they want it to be safe. Those who want it fast would go to beauty salons. Those who want it safe would go to GP clinics for medications and those who want it easy would go to aesthetic doctors or plastic surgeons. What about those who want all three? There are not many places that they can go.
This is my approach to weight management and its pretty different from what other people think. So if you think otherwise, I fully understand.
Firstly, go big and fast or go home. We are all emotional beings. Motivation is very important. We need to see rapid weight loss to motivate us to continue to go harder at it. Therefore, I feel short-term medications are important. Singapore guidelines state that it is better to give medications to people whose BMI are above 30. What are these guidelines based on? Disease risk as studied in big medical trials. How about societal concerns? Nobody measures that stuff.
Secondly, treatments need to be scientific and safe. Even with well studied, FDA-approved medications, side effects can and infrequently do occur. Every now and then, we hear of complications resulting in people consuming off-the-counter slimming medications landing up in hospital. Treatments need to be supervised by trained personnel. Period.
Thirdly, treatments need to be sustainable… but most people are scared to commit to hard work when advised to do so. Buy-in to a healthy lifestyle must come slowly. After seeing great initial results, people get hungry for more and that is when people commit to work hard. Commitment to change and results must go hand in hand. Once commitment to change is there, the doctor’s help is rarely needed.
Lastly, do not forget about body contouring. I see many people fanatical about slimming but forget entirely about looking good. You can be skinny and have bad body shape or be slim with great body shape. Which would you choose? Technology has advanced to a point where there are great machines and methods to non-invasively reduce fat over troublesome places. Looking good is not just about being skinny.
So that is my approach to slimming. Would it not be great if services provided by the beauty salon can be backed up by safe and effective slimming provided by GP clinics, complemented by body contouring at aesthetic clinics, all rolled into one place?
Dr Terence Tan
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