Understanding Obesity and the Role of Medical Treatment

Introduction

Obesity is becomingly known as a long term medical condition whereby one fails to sustain an ideal weight. Despite regular exercise and careful diet, losing weight tends to fail with frequent relapse and worsens over time.

Understanding the basics and chronicity of obesity, allows us to understand a more holistic and multifaceted approach involving medical treatment in tackling our weight concerns.

Obesity

Over the past years, global obesity is rising exponentially. In Singapore, the National Population Health Survey in 2022 reveals that nearly 12% of locals are obese, while at least 40% of the population is overweight.

Obesity is associated with various health complications such as hypertension, diabetes, high cholesterol, stroke, heart attack, fatty liver disease, osteoarthritis, obstructive sleep apnoea, fertility disorders, cancers and mood disorders. Obesity reduces a person’s quality of life, increases morbidity and mortality and is associated with higher healthcare expenditure. It is clear that obesity is becoming a global health issue. 

What regulates our weight? Understanding that obesity is a chronic disease

Obesity is often associated with overeating, lack of exercise or even pure laziness. But this is an oversimplified perception and many of those with obesity did attempt to lose weight with inevitable regain of weight.

The cause of obesity is complex and multifactorial involving linkage between genetic predisposition, concurrent medical conditions, environmental factors such as socio-economic status, behavioral and cultural factors.

The body has a physiological homeostatic regulatory system allowing a person to maintain a stable blood pressure, glucose level. Similarly, for body fats (also known as adipose tissues), the nerve-hormonal system in our brain monitors and controls our metabolic responses. This allows the brain sending signals to adipose tissues to burn either ‘more’ or ‘less’ fats. 

Unfortunately, when a person actively loses weight through lifestyle exercise or dietary changes, the body will reset the weight back to its original point as a physiological response leading to failure of losing weight or regaining weight after active weight loss. 

Furthermore, the brain also has an interconnected network of structures that regulates ‘rewarding’ mechanism. This rewarding system can override the homeostasis ‘set-point’ and encourages one to repeat a person’s eating behavior due to previous ‘pleasurable experience’. In obesity, the sight of palatable food encourages one to ‘like’ or ‘want’ to consume the food repeatedly, leading to over-eating and weight gain.

Why should we seek medical assistance in persistent obesity?

• Medical studies have proven that a loss of 5-10% of body weight reduces cardiovascular risk factors and improves comorbidities associated with obesity such as obstructive sleep apnoea, fatty liver and even delays the onset of diabetes.
• Functional symptoms associated with osteoarthritis and resumption of ovulation or fertility (in female) improves following achievement of weight loss of more than 10%
• Psychologically, one may feel better in overall self-esteem, body image and lesser mood disorders such as anxiety and depression following controlling a person’s weight.

Role and Challenges of Medical Management for Obesity

The challenge of maintaining an ideal weight suggests that solely lifestyle and dietary modification alone may be insufficient and medical management of weight may be required. 

While some may consider bariatric surgery, some of the patients following operation can still regain weight over time.  Pharmacological management of weight as a complement treatment on top of lifestyle modification is an effective option and safe under the close monitoring of your healthcare providers. They are used to counteract the body’s physiological and adaptive response towards weight homeostasis.

The pharmacological uptake of obesity medications are generally poor.

This is due major concerns and poor confidence of patients over obesity drugs resulting in adverse health side effects such as organ failure or even death. 

Over the years, thankfully, in view of severe health complications, dangerous obesity drugs such as fenfluramine, sibutramine, rimonabant, lorcaserin are already withdrawn from the market. These are revised and replaced with newer obesity medicine with safer drug profile and better efficacy in long term use to manage weight loss and prevent obesity related comorbidities and complications.

Who is suitable for obesity medication?

In Singapore, those with 

• body-mass index (BMI) of 30 kg/m² or more  OR 
• body-mass index (BMI) of 27 kg/m² or more + presence if obesity related comorbidities 

can consider medical management for obesity.

Obesity medication is not a substitute against lifestyle modification, rather it is an adjunct treatment for obesity, to synergize the positive outcome of lifestyle modification and weight losing.

Your healthcare providers will need to evaluate your health condition and past medical history prior starting you on obesity medication.

GLP-1RAs: Glucagon-like peptide-1 receptor agonists and weight loss

Glucagon-like peptide-1 (GLP-1) is a type of hormone that is released by the gastrointestinal tract when food is present in the gut. It regulates our blood glucose and digestive process

GLP-1RAs medications mimic the effect of this natural hormone by:

• Lowering blood sugar (More insulin is released from the pancreas, and less glucagon is secreted from the gut),
• Slowing down the process of digestion (Food stomach emptying is slower)
• Reducing appetite and eating (Creating satiety by signaling to the brain that one is full)
• Resulting in desirable end point of weight loss

GLP-1RAs can be administered orally or via injection. Common side effects of GLP-1RAs include gastrointestinal upsets such as diarrhea, nausea, vomiting, bloatedness. Less common yet severe side effects include pancreatitis.

GLP-1RAs that are currently licensed for obesity management include LIraglutide, Semaglutide.

Take home messages…

• Obesity is now considered as a chronic medical condition.
• Obesity increases risk of cardiovascular diseases and associated with various health comorbidities.
• Understanding the chronicity of obesity and the inevitability of regaining weight after losing weight allows one to consider medical management of obesity.
• The use of obesity medication can complement lifestyle modification and boost the effect of weight loss, achieving and maintaining ideal weight, reducing obesity related comorbidities.
• Long term care is needed in weight management with periodical assessment of treatment, weight regain, patient’s lifestyle motivation, and obesity related illnesses.

If you’re ready to take the first step toward managing obesity with professional guidance, DB Clinic is here to help. Our medical team will work with you to understand your needs and recommend suitable treatment options. Learn more or book your consultation today through our contact page.

References:

1. Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, Leibel RL. Obesity Pathogenesis: An Endocrine Society Scientific Statement. Endocr Rev. 2017 Aug 1;38(4):267-296.
2. Segal Y, Gunturu S. Psychological Issues Associated With Obesity. [Updated 2024 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-
3. Ministry of Health Singapore. Executive Summary on National Population Health Survey 2022. https://www.moh.gov.sg/others/resources-and-statistics/nphs-2022
4. Sumithran P, Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci (Lond). 2013 Feb;124(4):231-41.
5. Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology and Management of Obesity. N Eng J Med. 2017 Jan;376(3):254-266.
6. Lee YS, Biddle S, Chan MF et al. Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Obesity. Singapore Med J. 2016 June;57(6):292-300.
7. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systemic and clinical review. JAMA. 2014 Jan; 311(1):74-86.