Current treatment landscape for obesity in Singapore

The rising prevalence of obesity in Singapore is a harbinger for a corresponding increase in obesity-related complications such as type 2 diabetes mellitus (T2DM) and coronary heart disease. Obesity is a complex disease driven by multiple factors, and hence, treatment cannot follow a 'one-size-fits-all' approach. Lifestyle modifications involving dietary interventions, physical activity and behavioural changes remain the cornerstone of obesity management. However, similar to other chronic diseases such as T2DM and hypertension, lifestyle modifications are often insufficient on their own, hence the importance of other treatment modalities including pharmacotherapy, endoscopic bariatric therapy and metabolic-bariatric surgery. Weight loss medications currently approved in Singapore include phentermine, orlistat, liraglutide and naltrexone-bupropion. In recent years, endoscopic bariatric therapies have evolved as an effective, minimally invasive and durable therapeutic option for obesity. Metabolic-bariatric surgery remains the most effective and durable treatment for patients with severe obesity, with an average weight loss of 25%-30% after one year.

The Factors Associated with Change in Percent Obesity after Obesity Treatment among Obese Children and Adolescents

BACKGROUND: The purpose of this study was to find changes in percentage obesity and the factors associated with the changes after its treatment in obese children and adolescents. METHODS: A total of 42 obese children from 3- to 17- year-olds (males 60%) were enrolled in an obesity treatment program at least 3 times. They were provided with an individual weight control program that included dietary, activity, and behavioral change information. The paired t-test, Kruskal-Wallis test, Mann-Whitney test, and linear regression were used for analyses. RESULTS: The means of BMI, percent body fat, and percent obesity were 27.4 kg/m2, 39.4%, and 52.3%, respectively. Among them, 85.3% of obese children had one or more abnormalities on biochemical tests and 32.4% of them had 3 or more abnormalities. There was a significant reduction in weight (1.4 kg), BMI (1.1 kg/m2), percent body fat (1.8%) and percent obesity (7.1%), whereas height increased significantly by 1.3 cm after the treatment. The decrease in percent obesity was associated significantly with the number of follow-up, the number of accompanied biochemical abnormality, and the duration of treatment. The decrease in percent obesity was 12.9% among obese children who were followed-up 6 times or more, by 12.2% among those who did not accompany biochemical abnormality and by 13.3% among those who were retained in the program for 76 days or over. However, the change in % obesity was not associated with sex, age groups (or=12-year-old), severity of obesity and parental obesity. The percent obesity decreased by 5.2% as the number of follow-up (n=3/4, 5/6~17) increased after adjusting for sex, age groups and the number of biochemical abnormalities. The number of follow-up also explained 38% for the variance of change in percent obesity in that model. CONCLUSIONS: Continuous program retention was an effective factor to reduce percent obesity. Therefore, further investigation is needed to develop methods to enforce program retention.