Obesity is a chronic disease which is often relapsing and progressive due in part to the physiology of energy homeostasis in people with obesity, rendering them with the challenge of attaining adequate weight loss and weight maintenance after successful weight loss. Depending on the presence, types and severity of the obesity-related comorbidities (ORCs), some patients will require an amount of weight loss beyond what lifestyle and behavioural modification can achieve. Even after bariatric surgery, patients may not lose the expected amount of weight or experience weight regain. Anti-obesity medications may be required to support them further. Hence, the use of pharmacotherapy in obesity management remains an important adjunct to lifestyle and behavioural modifications and even to bariatric surgery, particularly in those with more severe ORCs and with a high body mass index. This article discusses the general approach to the use of pharmacotherapy in obesity management and the various anti-obesity medications currently approved.

Obesity is now recognised as a chronic disease which needs chronic treatment to treat or prevent obesity related complications. This article discusses the biology of weight regulation as a basis to understanding obesity as a disease, and to appreciate the complex and multifactorial nature of the obesity problem. Finally, the article highlights the dietary approaches as part of the multi-pronged approach to treating obesity and gives a brief update on intermittent fasting.

The prevalence of obesity is increasing. It is associated with conditions such as type 2 diabetes mellitus, hypertension, dyslipidaemia and non-alcoholic fatty liver disease and together with its co-morbidities, obesity has become a fast-growing public health concern and health burden. However, weight loss has been shown to reduce the development and improve these conditions. This paper looks at the epidemiology, obesity-related comorbidities, in particular pre-diabetes, and the various strategies that can be implemented to prevent and treat this looming problem.

INTRODUCTIONComprehensive sleep architecture and respiratory event data in local patients with suspected obstructive sleep apnoea (OSA) from overnight polysomnography (PSG), the gold standard for the evaluation of sleep-related breathing disorders, are not widely available. We present 1 year retrospective PSG data with the objective of describing PSG characteristics of patients evaluated for OSA in Singapore.

MATERIALS AND METHODSPSG data of patients evaluated for OSA in 1 year (January through December 2005) in the Sleep Laboratory of a public tertiary hospital were retrospectively reviewed.

RESULTSFive hundred and eighty-four diagnostic PSG studies were performed in patients with symptoms suggestive of sleep-disordered breathing, including snoring, excessive daytime sleepiness, unrefreshing sleep, or recurrent unexplained awakenings. There were 449 male patients (76.9%) and 135 female patients (23.1%), with a mean age of 47.5 years (SD 12.7). Men were on average younger than women, 46.1 years versus 52.0 years (P <0.0005). The mean body mass index (BMI) was 27.9 (SD 6.7), with no significant difference between genders. An association was shown between apnoea-hypopnoea index (AHI) and BMI (Pearson correlation index r = 0.362). Men had overall significantly higher AHI (16.5 vs 9), shorter mean sleep onset latency (11 vs 16.5 minutes), more light sleep (65.5% vs 58.9%), less deep sleep (17.7% vs 23%), and more respiratory event related arousals per hour of sleep (11.6 vs 5.1) (P <0.0005). Severity was classified: AHI <5 ("Normal Overall AHI") (28.3%), AHI 5-15 ("Mild") (22.3%), AHI >15-30 ("Moderate") (18.3%), AHI >30 ("Severe") (31.2%). There was no significant age difference among the 4 groups. More severe OSA patients were significantly heavier, and had more light sleep, less deep sleep, less REM sleep, more respiratory event related arousals and lower levels of oxygen desaturation.

CONCLUSIONOSA is predominant in middle-aged, overweight Singapore males and much less common in females who tend to be older. A majority of patients have moderate to severe OSA, which significantly disturbs normal sleep architecture. The relatively lower BMI compared to Caucasian OSA populations may be related to local craniofacial characteristics and/or higher percentage of body fat for BMI which has been described in Singaporeans.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Obesity ; epidemiology ; Polysomnography ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Sleep Apnea, Obstructive ; diagnosis ; epidemiology ; physiopathology

INTRODUCTIONObesity is a risk factor for type 2 diabetes mellitus (T2DM). Metabolic-bariatric surgery (MBS) results in significant weight loss with dramatic improvement in T2DM. This study analysed the effects of MBS on patients with T2DM in a tertiary centre in Singapore.

METHODSIndividuals with T2DM who underwent MBS in a single centre from September 2008 to May 2012, with at least 12 months of regular follow-up, were included in our study. The primary outcome measure was good glycaemic control (glycated haemoglobin [HbA1c] < 6.5%, with or without medications) 12 months after surgery. Secondary outcome measures were partial DM remission (fasting blood glucose [FBG] < 7.0 mmol/L and HbA1c < 6.5% without DM medications), complete DM remission (FBG < 5.6 mmol/L and HbA1c < 6.0% without DM medications), weight, body mass index, blood pressure, and fasting serum lipid, serum glucose and serum insulin levels.

RESULTSOf the 19 patients who met the inclusion criteria, 14 underwent gastric bypass and 5 underwent sleeve gastrectomy. At 12 months postoperatively, 17 (89.5%) patients achieved good glycaemic control. DM remission was achieved in 14 (73.7%) patients, with 10 (52.6%) attaining complete remission.

CONCLUSIONIn Singapore, MBS is an effective treatment modality for obese patients with T2DM. Despite the small sample size and lack of matched controls, the present study suggests that MBS is effective in achieving significant weight loss and eliciting a significant and sustainable improvement in the glycaemic control of patients with T2DM, for up to 12 months.

Adult ; Bariatric Surgery ; Blood Glucose ; analysis ; Body Mass Index ; Diabetes Mellitus, Type 2 ; prevention & control ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Insulin ; blood ; Lipids ; blood ; Male ; Middle Aged ; Obesity, Morbid ; surgery ; Prospective Studies ; Risk Factors ; Singapore ; Treatment Outcome

Prader Willi Syndrome (PWS) includes complex endocrinological issues because of the hypothalamic and pituitary dysfunction which include obesity and diabetes, as well as behavioural issues. Other important aspects of PWS, such as hepatosplenomegaly are sometimes neglected. We present a case of diabetic ketoacidosis precipitated by torsion of a wandering spleen in a 22-year-old woman with PWS and type 2 diabetes mellitus. The pancreatic tail was involved in the torsion leading to hyperamylasaemia and pancreatitis. The splenic torsion and pancreatitis were initially treated conservatively with resolution of symptoms. A year later, she had another 2 episodes of severe abdominal pain due to worsening splenic torsion which subsided with conservative management. She subsequently underwent an elective splenectomy which revealed an enlarged and wandering spleen, with 720 degrees torsion of the long splenic pedicle.
Prader-Willi Syndrome

Addressing weight stigma is essential to obesity management as it causes inequalities in healthcare and impacts the outcomes of health. This narrative review summarises systematic review findings about the presence of weight bias in healthcare professionals, and interventions to reduce weight bias or stigma in these professionals. Two databases (PubMed and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) were searched. Seven eligible reviews were identified from 872 search results. Four reviews identified the presence of weight bias, and three investigated trials to reduce weight bias or stigma in healthcare professionals. The findings may help further research and the treatment, health and well-being of individuals with overweight or obesity in Singapore. Weight bias was prevalent among qualified and student healthcare professionals globally, and there is a lack of clear guidance for effective interventions to reduce it, particularly in Asia. Future research is essential to identify the issues and inform initiatives to reduce weight bias and stigma among healthcare professionals in Singapore.
Humans ; Weight Prejudice ; Singapore ; Asia ; Databases, Factual ; Health Facilities

Humans ; Singapore ; Obesity

INTRODUCTIONObesity is a key risk factor in the development of Type 2 diabetes mellitus (T2DM). Bariatric surgery causes a large amount of durable weight loss in those with clinically severe obesity. We reported the effect of weight loss via bariatric surgery on DM prevention in those at high risk of developing DM.

METHODSThis was a retrospective cohort study of 44 patients with obesity (mean body mass index 43.8 kg/m) and pre-DM who underwent bariatric surgery and were followed up for up to three years. We also reviewed a non-surgical cohort of patients with obesity and pre-DM seen at the weight management clinic.

RESULTS91% of patients attained normal glycaemic status at one year after bariatric surgery. At the three-year follow-up, 87.5% of the patients maintained normoglycaemia. None of the patients developed T2DM after surgery. 26.9% of patients achieved absolute weight loss at one year after bariatric surgery and maintained this at two and three years post surgery (p < 0.001 vs. baseline). The homeostatic model assessment-insulin resistance index in patients also decreased from 5.50 at baseline to 1.20, 1.14 and 1.44 at one, two and three years, respectively (p < 0.001).

CONCLUSIONBariatric surgery produces significant weight loss, and leads to reversion from the pre-diabetic state to normal glycaemic status and reduction of the incident DM rate in those with pre-DM and morbid obesity.