Obesity has been recognised by the World Health Organization as a chronic disease – and the reasons go well beyond what we put on our plates or how often we hit the gym.
In Singapore, overweight rates have climbed from 10.5 per cent in 2019-2020 to 12.7 per cent today, driven by calorie-dense diets, sedentary lifestyles and broader environmental factors.
Those living with obesity often have further related medical complications that include not just joint pain, but also fatty liver and Type 2 diabetes, says Dr Ester Yeoh, medical director and senior consultant endocrinologist at Aspen Diabetes & Endocrine Clinic at Novena Medical Center.
She explains why obesity is harder to treat than many assume and what the latest therapies offer.
Obesity is characterised by excessive body fat accumulation. In the Asian context, the body mass index (BMI) threshold is set at 27.5 kg/m² – lower than Western benchmarks – because Asians carry higher body fat and metabolic risk at lower body weights.
Waist circumference is equally important: Above 90cm for men and 80cm for women signal dangerous levels of visceral fat, a key driver of Type 2 diabetes and cardiovascular disease.
The World Health Organization classifies obesity as a chronic complex disease because it arises from the interaction of genetics, neurobiology, behaviour, access to healthy food, market forces and the broader environment.
With over 50 obesity-related conditions identified – from Type 2 diabetes to chronic kidney disease – recognising and treating obesity as a chronic condition is essential to preventing the slew of complications that may follow.
The most common obesity-related complications seen in Singapore are musculoskeletal complaints, obstructive sleep apnoea and fatty liver.
Diabetes is particularly closely linked – 80 per cent to 90 per cent of people with Type 2 diabetes are overweight or living with obesity, with the risk rising sharply as BMI increases.
For patients at very high BMI levels, joint problems affecting the knees, hips, ankles and feet become chronic and function-limiting, often leading to a more sedentary lifestyle – which in turn drives further weight gain.
Research over the past two decades has demonstrated that body weight is tightly regulated by complex hormonal and neurological systems that control hunger, satiety and energy balance.
The body’s natural response to weight loss is to slow metabolism, increase hunger hormones and reduce satiety – making weight maintenance difficult.
In Singapore, treatment typically starts with diet, exercise and behavioural support, with prescription medication introduced if these measures are not enough.
Current medications work by targeting the brain-gut connection. For example, a dual GIP and GLP-1 receptor agonist activates two hormone pathways at once, helping to better control appetite and support metabolism.
Clinical trials have shown average weight reductions exceeding 20 per cent in some patients.
These medications activate receptors for two naturally occurring hormones that regulate satiety, insulin sensitivity and fat utilisation. By engaging multiple pathways simultaneously, they enhance the body’s appetite-control signals and improve metabolic function.
Clinical studies show substantial and sustained weight reduction, alongside meaningful improvements in blood glucose and other cardiometabolic markers.
However, these medications must be used under medical supervision. Common side effects are gastrointestinal issues – nausea, bloating, abdominal pain, constipation or diarrhoea.
Rapid weight loss also carries risks such as muscle and bone density loss, and nutritional deficiencies. Hence, regular monitoring throughout the treatment is essential.
That said, medication is only part of the picture. The most important foundation remains sustainable, long-term habits rather than short-term dieting.
Small, consistent changes such as improving dietary quality, portion control and incorporating regular movement into daily routines can have meaningful effects on weight and metabolic health over time.
One of the barriers to seeking help is the stigma that still surrounds obesity – the perception that failure to lose weight is a personal failing. Framing obesity as purely a matter of personal responsibility overlooks the important roles of genetic and environmental factors.
Weight loss medications should not be misunderstood as a standalone solution. They are most effective when used within a structured, professional-led care plan that includes nutrition, physical activity and long-term monitoring.
The goal is not simply weight loss, but also improving long-term health and metabolic well-being.
This message is provided for general information and educational purposes only. It does not constitute medical advice, diagnosis or treatment. Individuals should consult a qualified healthcare professional for medical concerns or before making any healthcare decisions. For more information, visit letstalkweight.sg
