Sunday, September 13, 2009

Start small

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MANAGING OBESITY

A modest weight loss is enough to reverse certain health problems

Eveline Gan, eveline@mediacorp.com.sg


35, Tina Rudaie is supposed to be at the prime of her life. But since the time she was young, she has been so debilitated by her weight that even a 5-minute walk leaves her in pain and gasping.

Last year, the mother-of-one weighed 173kg, more than twice the healthy weight for someone who is 1.57m tall. This brought on problems such as back pain, osteoarthritis in the knees, Type 2 diabetes, hypertension and high cholesterol.

Tina decided to turn her life around when her mother, who was also severely obese - she weighed about 200kg - died from diabetes-related complications. She sought help at the Singapore General Hospital (SGH) Life Centre, a one-stop centre for people with lifestyle-related health conditions.

"I told myself I need to survive for my daughter's sake. She's only 13," said Tina.

Tina went on to lose 39kg after a gastric bypass early this year. But it didn't take such a drastic weight loss before her health improved. Just three days after the surgery, she no longer required medication for diabetes. Three months later, she was able to stop medication for hypertension and high cholesterol. By then, she had lost about 15 per cent, or 27kg, of her initial weight.

Turning the tide

According to Dr Kwek Hwei Min, a sports medicine registrar at Changi Sports Medicine Centre at Changi General Hospital, weight reduction can indeed help reverse or improve obesity-related conditions such as Type 2 diabetes and hypertension.

In fact, said Dr Tham Kwang Wei, a consultant endocrinologist and director of SGH's Obesity and Metabolic Unit, a weight loss of about 5 to 10 per cent of one's body weight is enough to achieve this.

"People can be quite unrealistic when setting weight-loss targets. They think they need to lose a lot of weight in one go to see the effect. In fact, a modest weight loss of 5 per cent of one's body weight can yield significant benefits such as decreasing blood pressure and reducing the risk of diabetes by up to 60 per cent," said Dr Tham.

And although medication and surgical interventions can help, both doctors stressed that making lifestyle changes is key to managing obesity.

A belly full of health risks

Dr Tham said the larger-than-usual waistline of the obese puts them at extra risk. Excess abdominal fat produces chemicals called adipokines, which increase the risk of heart disease and diabetes.

"How you lose weight is important, as it is more favourable to lose fat than muscle during weight loss. For example, when you incorporate exercise in your weight-loss regime, it helps you lose metabolically active fats around your waist.

This decreases the amount of harmful adipokines produced. Exercise also helps lower blood sugar levels, important in preventing and treating Type 2 diabetes," explained Dr Tham.

For the overweight, weighing less also has other health benefits. "Besides reduced pain for those suffering from knee osteoarthritis, you'll see an improvement in mobility and breathing," said Dr Kwek.

But the doctors cautioned against creating a drastic diet or extreme exercise regimen on your own if you're obese.

"Obese patients with medical conditions like diabetes should first undergo a medical examination. This is to ensure their blood sugar levels are well controlled and that there is no underlying heart disease," said Dr Kwek. She added that a safe weight-loss guide is a lost of about 0.5kg to 1kg per week, until the target weight is achieved.

Dr Tham added: "Without medical supervision, you could end up losing more muscle than fat, or end up with malnutrition, or vitamin and mineral deficiencies. Extreme exercise regimes also put one at risk for injuries."

Tina, who hopes to eventually meet her target weight of 100kg, now enjoys activities she has never been able to do before, such as taking long, uninterrupted walks in the park with her daughter. She said: "Now, I can walk very far and I don't feel tired at all. I've never felt healthier and happier."

From TODAY, Health – Tuesday, 18-Aug-2009