Beyond the Scales: Understanding Obesity Medications
by Dr. Tash Mirando
Osler Health International
What is obesity?
Obesity is a chronic condition and occurs when there is an unhealthy and high percentage of fat in your body. It is measured using a formula called Body Mass Index (BMI), based on your height and weight and a BMI above 30kg/m2 defines obesity. BMI is not an accurate measure of obesity for everyone, especially those with a high bone and muscle mass and low-fat percentage, like certain athletes. The BMI range can also change in certain ethnic groups – for example, a healthy BMI for South Asians would be less than 23 (compared to less than 25, as a general benchmark).
How common is obesity?
Data from the World Health Organisation (WHO) shows rates of obesity continuing to grow in adults and children. More than 1 billion people worldwide, and 18% of kids aged 5-19 years are obese.
What causes obesity?
Obesity is complex and has many causes ranging from eating too much and exercising too little, to genetic/medical conditions and a symptom of certain medications. Smoking and alcohol plays a key role as well.
What can I do about it?
The first step should be talking to a healthcare professional! There are various ways to lose weight safely starting with lifestyle measures including getting enough sleep, maintaining good nutrition, and engaging in the right exercise.
There is also a growing trend toward taking medication to support weight loss, of which GLP-1 (Glucagon-like peptide-1) agonists have become popular.
What is a GLP-1 agonist and is it right for me?
GLP-1 is a hormone naturally produced in our small intestines and works to help the body lower blood glucose. As such, GLP-1 agonist medications were created as diabetic treatments and proved to be highly effective, with weight loss found to be a ‘side effect’ from it. This led to them being studied specifically for weight loss in patients without diabetes.
If you have struggled to lose weight with nutrition and exercise, you would benefit from further investigations. Conditions like thyroid disease, diabetes, insulin resistance, and hormonal changes like going through the menopause, can affect your ability to lose weight.
If your BMI is 27 with other chronic medical problems (high blood pressure, diabetes, raised cholesterol for example), or 30 without any problems, you can be considered for weight loss medication. You still need to eat healthily and exercise to lose weight – this is not a quick fix. The aim is to lose 2-5% of your bodyweight in the first 3 months and overall, about 10-15%. These medications can be used long-term if it continues to cause weight loss or is used for maintenance - this needs to be individualised as results and side-effects can vary from person to person.
You will not be able to use these medications if you or your family have had a rare condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN2), history of a severe allergic reaction to these medications or its ingredients, or if you are pregnant or planning pregnancy.
I would highly recommend speaking to a healthcare professional early, so they can help guide your understanding and decision-making in a holistic way, and one that is tailored to you.
Are there any side effects with GLP-1 agonists?
The most common side effects may include nausea, vomiting, diarrhoea, stomach/abdominal pains, constipation, tiredness, and headaches.
More serious but less common side effects can include inflammation of the pancreas, thyroid problems, change in vision, low blood sugar, kidney problems, serious allergic reactions, and gallbladder problems.
What else can I try?
Healthy lifestyle is key and should be done regardless of medication or, which stage in life you are currently at. Seeing a nutritionist and psychologist would help with nutritional and mental health support to manage any associated stress and mood changes. Aesthetic and herbal remedies are considered by many, but are not necessarily safer, so please consult a healthcare professional first. Finally, weight-loss surgery, also called bariatric surgery, could be considered for anyone with severe obesity.
Okay, so what next?
Start lifestyle measures including good nutrition, sleep, and exercise early.
If you would like to consider starting a GLP-1 agonist, please speak to a healthcare professional who is knowledgeable in the safe use and administration of these medications in Singapore.
If you do start a GLP-1 agonist and have any serious side effects, please seek medical advice immediately.
Finally, have an open conversation with family, friends, and colleagues – you are not alone!
Dr Tash Mirando
MBChB (Sheffield, UK) MRCGP (UK) DRCOG (UK)
Osler Health International
Dr Tash is a British-trained GP based at Osler Health’s Raffles Hotel Arcade clinic. Dr Tash worked in a busy London GP clinic before moving to Singapore. She is known for her down-to-earth and non-judgemental approach to care, and has a reputation for her menopause support. She is passionate about Lifestyle Medicine and is one of the few doctors in Singapore who is certified by the International Board of Lifestyle Medicine.
If you are unhappy with your weight and want to get healthier for the long term, you may want to discuss Osler’s Weight and Exercise Management Programme with Dr Tash. This is a curated 12-week programme in association with Osler Health, their in-house dietician and UFIT. The programme may include weight loss medication, dependent upon your discussion with your doctor. Osler Health International is a GP medical clinic offering personalised healthcare for the whole family with two practices in Singapore (Raffles Hotel Arcade in the CBD and Star Vista off Holland Road). www.osler-health.com