From pounds to possibilities: Overcoming obesity challenges

Losing weight safely and effectively has always been a challenge. Thus, it is increasingly worrisome that we are seeing the emergence of more and more, so-called "miracle drugs" (some even claiming to be "all-natural") that promise quick and safe weight loss. 

To add to the danger, these drugs are often given by non-doctors and non-medical professionals. 

Here's your chance to get the real answers to your questions on how to lose weight right!

For this forum, Dr Deanna Lee will share more about the proper treatment available for weight loss, which include a combination of dietary changes, increased physical activity, behaviour modification, and in some cases, surgical intervention, as well as the use of medications.

Growing problem of obesity in Singapore

Obesity is a significant public health issue in Singapore, affecting approximately 10% of adults. 

It is defined by having a body mass index (BMI) of 30 or above and is characterised by an excess accumulation of body fat, which poses various health risks. 

Obesity increases the risk of several debilitating, and chronic diseases including: diabetes, cardiovascular disorders, and certain cancers, which can lead to premature death and disability. 

These conditions negatively impact one’s quality of life, causing physical discomfort, limited mobility, and social isolation.

Obesity is a complex condition, but safe, effective weight loss is possible with appropriate interventions and lifestyle modifications. 

About Dr Deanna Lee 

Dr Deanna Lee is a Consultant at the Department of General Medicine, Sengkang General Hospital (SKH), specialising in Advanced Internal Medicine with a keen focus on weight management. 

She possesses extensive experience in this field, having undergone specialised fellowship training in Weight Management and Obesity at the prestigious Boden Institute of Metabolic Medicine, affiliated with the University of Sydney and Royal Prince Alfred Hospital.

Since joining SKH in 2017, Dr Lee has played a pivotal role as the pioneering physician in weight management. Her contributions include assisting in establishing the SWITCH (Sengkang Weight Management and Complete Health) multidisciplinary team, a significant milestone in the hospital's commitment to effective weight management. 

Driven by her passion for community and healthcare engagement, she actively participates in programme development, protocol implementation, and weight management research.

Questions and answers on beating obesity

1. Question by Nurul

Dear Dr,

I am very depressed with my weight. Been body shamed lots of times. Till now I never been out to meet my friends...so I’m always with my own family.

I never been big before...people know me to be the small petite gal.. only after my accident...and my last pregnancy I started to put on weight till it’s so hard to lose. Been trying lots of method...on slimming products... slimming massage... ok intermittent fasting but still not successful.

The active gal who used to play netball... Dance...Zumba instructor before I have to stop due to my accident. I injured my back...at work also I'm on light duty and was exempted from BCLS.

Is there any way you could guide me along on what to do next?

To the extend I wanted to do liposuction...etc. But I don't have enough money to do so...is so expensive and insurance and medisave not covered. Pls help me.

Answer by Dr Deanna Lee

Dear Nurul,

I'm truly sorry to hear about what you're going through. Remember, you're not alone in this journey of losing weight – we're all here to support you. I would recommend getting a polyclinic referral to see our doctors in SingHealth hospitals such as SGH, SKH, and CGH.

We have dedicated multidisciplinary weight management clinics where physicians, surgeons, dieticians, physiotherapists, and even psychologists work together to discuss the best options for your weight management.

These options may include meal replacements, oral tablets, injectables, temporary gastric balloon insertion, and even bariatric surgery.

However, it's important to remember that successful weight management involves adopting a lifelong healthy lifestyle. Our dedicated team of allied health professionals can provide valuable advice and guidance in this aspect.

So, I encourage you to visit our clinics to discuss which options would be most suitable for you, and rest assured, we'll be there to support you every step of the way in your journey towards better health.

It is worth noting that the effects of liposuction are often temporary and may come with complications, especially if not performed by certified doctors.

2. Question by Annie

Hi Dr Deanna Lee,

Thanks for opening up this forum. I need help. I'm 57 and menopaused. I don’t think I'm obese but is certainly overweight for my height.

I have osteoarthritis on both knees that is keeping me from being more active than I would like to be. I don't eat dairy products. But easily pile on weight despite not overeating.

Your expert advice is much appreciated.

Answer by Dr Deanna Lee

Hi Annie,

Post-menopausal weight gain is common due to a decline in female hormones. As we age, our metabolism slows down, and our calorie requirements reduce. It is not uncommon for some people to continue gaining weight even when they cut down on food intake, especially if they lead a sedentary lifestyle and unable to walk due to joint conditions such as osteoarthritis like yourself.

I recommend visiting a dietician in our hospitals or polyclinics who can calculate your calorie requirement, review your food diary, and suggest diet changes. Additionally, seeing a physiotherapist can be beneficial as they can teach you muscle-strengthening exercises to support your joint muscles. Gentle yoga classes or exercises like cycling, swimming, or walking in the pool can also help strengthen your muscles, reduce knee pain, and increase calorie expenditure, aiding in weight loss.

If you find it challenging to manage, please visit our polyclinic doctors and request a referral to one of our hospital's weight management clinics.

3. Question by Sarah

Dear Dr Deanne Lee,

Besides exercising, intermittent fasting and watching your diet. Choosing healthier choice, is there other alternative to lose weight?

After being obese for > 10 years BMI 44. Height: 1.73 weight: 133. Age 41.

Would you recommend Bariatric surgery?

What other advice would you suggest?

Answer by Dr Deanna Lee

Hi Sarah,

There are plenty of options available to support your weight loss journey! From medications like oral or injectables, temporary balloons, to meal replacements, and various types of bariatric surgery, we have a range of choices to explore. I encourage you to visit one of our clinics to discuss these options further and find the best fit for your needs. Our team is here to guide you and provide the necessary support throughout your weight management process.

4. Question by Mrs Goh

Hi Dr Deanna,

What is a safe way or method to lose weight for the tummy area.

The tummy area tends to be the first area for weight gain.

Answer by Dr Deanna Lee

Hi Mrs Goh,

Generally, when you aim to lose weight, you'll experience overall fat reduction throughout the body. However, if you wish to target specific areas, incorporating area-specific exercises can be beneficial.

For targeting the tummy area, a combination of aerobic exercises like walking, jogging, or Zumba, along with core-strengthening exercises such as abs workouts, will be helpful. Additionally, remember to include muscle strengthening exercises in your routine to protect your joints from wear and tear and reduce the risk of injuries.

5. Question by Jasmine

Hi Dr Deanna Lee,

I have been trying to lose weight for quite a while now but did not have much success.

I am in my late sixties and am weighing about 70 kg and am 152cm tall.

I have tried to reduce my food intake by about a third.

I have also tried intermittent fasting without success. Lastly, I have embarked on low impact aerobic exercise for the past 2 months at frequency of 3 times a week x 45 minutes but still do not see much of a weight loss.

I believe my problem is probably with insulin resistance and I like to get advice on how I can overcome this.

PS: I do have some sleep issues as well with interrupted sleep throughout the night and I believe this probably have contributed to the very slow weight loss. Normally I get about 5 hours of sleep each night.

Thank you.

Answer by Dr Deanna Lee

Hi Jasmine,

Weight management is a complex process influenced by various factors. Diet intake, physical activities, behavioral patterns, social circumstances, sleep behaviors, age, hormones, medical conditions, and more, all interact together to impact one's weight. This complexity can make weight loss challenging.

Based on what you've shared, certain factors contributing to your weight gain are age, post-menopausal changes, and sleep patterns. Post-menopausal weight gain is common due to declining female hormones, and as we age, our metabolism naturally slows down, reducing calorie requirements. Additionally, interrupted sleep and inadequate rest can negatively affect metabolism, increase appetite, and lead to food intake.

It is crucial to ensure sufficient and uninterrupted sleep, aiming for at least 7 hours each night. If you're experiencing sleep issues, it's important to seek evaluation as there could be underlying medical conditions such as obstructive sleep apnea (OSA) contributing to weight gain.

Treating OSA and addressing weight concerns together can have positive outcomes. At our medical centers, we collaborate closely with sleep specialists to manage this condition effectively. Please feel free to request a referral to our clinics for further evaluation, particularly regarding your sleep issues.

6. Question by Elicia

Dear Dr. Deanna Lee,

I am now age 59, my weight is 62kg and height is 5ft 1.

I try many types of weight loss but not help.

I don't have time exercise because my working hours are long.

So I only do simple exercise at home, and I have eat very less but still remain same weight.

Can you please kindly advise me how to lose weight?

Answer by Dr Deanna Lee

Hi Elicia,

As we age, our metabolism naturally slows down, and it's not uncommon for some individuals to find it challenging to maintain their weight. However, the key to successful weight management lies in adopting a lifelong healthy lifestyle that is sustainable and includes a balanced and nutritious diet.

This involves not only considering the quantity of food but also its quality. Evaluating factors such as types of snacks, frequency of eating, meal timing, and the amount of sugar and fat in your diet is essential to align with your calorie requirements and expenditure. Meal replacements can also be a helpful option for reducing calorie intake.

Moreover, you can enhance the effectiveness of your exercise routine by increasing its impact or intensity. For instance, instead of just walking, try incorporating fast walks or jogs to elevate the level of activity for the same duration.

For personalised advice and a more comprehensive evaluation of your situation, I encourage you to visit our dieticians, physiotherapists, or doctors. They can provide tailored recommendations and guidance to support your weight management journey effectively.

7. Question by Angel

Hi Dr Lee,

I am a 30-year-old female with a BMI of approximately 28. I know that I desperately need to lose weight, but I just cannot stop snacking and grazing the pantry!

I would be overwhelmed with guilt and feel so sorry for doing this to myself. I have been watching some videos and have equipped myself with some knowledge on food and nutrition. Even though I have hit my calorie intake for the day. I continue to eat till I’m done 110% full.

Help me please, any advice from you is highly appreciated!

Answer by Dr Deanna Lee

Hi Angel,

To better address your snacking behavior, it's crucial to delve deeper into the reasons behind it. Are you snacking due to stress, genuine hunger, or other emotional factors?

Understanding the underlying motivations will enable us to provide more targeted and effective advice for treating your condition. For some individuals, snacking habits may be linked to binge eating patterns, often accompanied by feelings of guilt. Identifying and evaluating these factors is essential in finding the right approach to address them.

In managing your snacking behavior and supporting your weight management journey, there are medications available that can help reduce appetite and curb snacking tendencies. These medications may come in the form of tablets or injectables.

Additionally, in cases where binge eating is involved, therapy can be a valuable complement to medication, ensuring a more comprehensive and successful approach to weight management.

For personalised advice and a more comprehensive evaluation of your situation, I encourage you to obtain a referral to one of our weight management centres.

8. Question by Suz

Hi Dr,

I found that as I age and peri-menopause sets in, my tummy is significantly more swollen regardless of exercising. I’m also feeling more hungry than previously. I’m 48 this year.

What are some steps I should take? Are there specific physical activities I should be doing? E.g. Speed runs? Thanks.

Answer by Dr Deanna Lee

Hi Suz,

Peri-menopausal weight gain is a common occurrence due to a decline in female hormones. As we age, our metabolism naturally slows down, leading to reduced calorie requirements. It is not uncommon for some individuals to experience weight gain even when they have cut down on food intake, particularly if they lead a sedentary lifestyle.

The key to successful weight management lies in adopting a lifelong healthy lifestyle that sustainable. When it comes to nutrition, it's important to focus not only on the quantity of food but also on its quality. Evaluating factors such as snacking behavior, eating frequency, meal timing, and the amount of sugar and fat in your diet is crucial to align with your age-specific calorie requirements and expenditure.

For physical activity, a combination of aerobic exercises like walking, jogging, cycling, swimming, or Zumba, along with core-strengthening exercises can be beneficial. Including muscle strengthening exercises in your routine helps protect your joints from wear and tear and reduces the risk of injuries. We recommend aiming for 30 minutes of moderate impact exercise five times a week or one hour of moderate impact exercise three times a week for effective weight loss.

Furthermore, ensuring sufficient and uninterrupted sleep is essential, with a target of at least seven hours per night. Reducing stress levels and cultivating a mindful eating behavior also contribute significantly to overall well-being and weight management. By incorporating these lifestyle changes into your daily routine, you can work towards achieving your health and weight goals in a sustainable manner.

9. Question by Weng Wong

Dear Doctor Lee,

My age is 31 and my BMI is 33. I am healthy in general except my uric acid is high. I enjoy eating and don’t exercise at all.

How can I reduce my weight? Eat less and exercise are the only solutions? Should I start taking medication to reduce my weight if I don’t have the will power to exercise and eating less?

Answer by Dr Deanna Lee

Hi Weng Wong,

The key to successful weight management lies in embracing a lifelong healthy lifestyle that includes a nutritious and balanced diet along with regular exercise. Diet plays a vital role, accounting for 75-80% of successful weight loss and maintenance. Additionally, diet significantly affects the levels of uric acid in the body.

Medications and surgery can help you lose weight effectively but as soon as patients get back to their old diet and sedentary lifestyle, their weight would rebound significantly. This is quite a common pitfall of a quick solution to any problem. The available treatments are valuable tools to support individuals as they adjust to their new healthy lifestyle and aiding in their weight loss.

Therefore, it is crucial to understand that sustained weight management success can be achieved through the consistent adoption of a healthy lifestyle throughout one's life. By making mindful and lasting changes to your diet and activity levels, you can effectively work towards achieving and maintaining a healthier weight and overall well-being.

10. Question by Siti

Dear Dr,

I have finished eating Pembersy and I realise now I put on a lot of weight and dieting does not help.

What should I do as I put on so much weight now that I feel breathless and pant every time I walk?

Answer by Dr Deanna Lee

Hi Siti,

It seems that you experienced a rebound of weight when your diet became uncontrolled after completing Pembersy.

To support your weight loss journey, there are alternative options available, such as continuing with Pambersy at a lower dose and gradually decreasing it instead of abruptly stopping.

Additionally, there are other oral medications, injectables, temporary balloons, meal replacements, and various types of bariatric surgery that can be considered. I encourage you to visit one of our clinics to discuss these options further and find the best fit for your specific needs.

It's important to emphasise that the key to successful weight management lies in adopting a lifelong healthy lifestyle, which includes maintaining a nutritious and balanced diet while incorporating regular exercise. This approach will help prevent rebound weight gain and promote long-term success in managing your weight and overall health.

11. Question by Chua

Dear Doctor,

I have been overweight since childbirth 3 years ago and my BMI has been BMI = 29.7 kg/m². I have attempted small steps such as taking the stairs and standing at work instead of seating down, as well as changing my breakfast to healthier options like boiled egg.

I do not see a difference on the scale at all despite months, perhaps due to the minimal effort I am making.

Could you recommend a more realistic approach that is sustainable?

Are there any safe medical method that I can undertake?

Are there medical practitioners I can consult with on this journey?

Answer by Dr Deanna Lee

Hi Chua,

I'm thrilled to see you taking small steps towards a healthier lifestyle, as it's a fantastic long-term investment in your well-being. Successful long-term weight management is all about adopting a lifelong healthy lifestyle, which includes a nutritious and balanced diet combined with regular exercise.

In your journey to shed some weight first, there are various options available to explore. From medications like oral or injectables, temporary balloons and meal replacements, we offer a range of choices tailored to your needs. I encourage you to visit one of our weight management clinics to discuss these options further and find the best fit for you. Additionally, our experienced dieticians and physiotherapists can provide personalized advice based on your individual calorie requirements, diet, and suitable exercises. You can obtain a referral from the polyclinics nearest to you to get started on this transformative journey towards a healthier and happier you!

12. Question by Jolyn

Dear Dr Deanna Lee, these are my questions:

Q1: I have been doing the 16-8 Intermittent Fasting (IF) for about a year now, weight loss seems to have reached a plateau. Is it better to stop or alternate different IF for better and continued results?

Q2: Is it worse to have fats above your waist or below your waist? Which is easier to lose?

Q3: How can one lose weight in the lower half of the body?

Answer by Dr Deanna Lee

Hi Jolyn,

Q1:
Intermittent fasting can sometimes reach a plateau due to various reasons. Some of them may include.

Adaptation: Your body may adapt to the fasting routine, and the initial weight loss might slow down as your metabolism and hormones adjusts to the new eating pattern.

Calorie Intake: Even with intermittent fasting, it's possible to consume too many calories during your eating window, which can hinder weight loss progress.

Lack of Exercise: If you're not incorporating regular physical activity into your routine, it can slow down your weight loss efforts.

Improving weight management through intermittent fasting (IF) or any diet involves considering individual preferences, lifestyle, and health goals, including desired weight and BMI. While various IF protocols offer calorie restriction as a common factor for weight loss, the key is to find an approach that is sustainable in the long run to prevent weight rebound.

Based on your specific goals and current BMI, there are other options available to explore. I recommend obtaining a referral to our specialized clinics or consulting with dietitians at polyclinics for personalized guidance. Ultimately, successful long-term weight management requires adopting a lifelong healthy lifestyle, which includes a nutritious, balanced diet, regular exercise, sufficient sleep, and stress reduction. By incorporating these habits, you can achieve sustainable results and improve overall well-being.

Q2 & 3:
Both types of fat, whether above or below the waist, can have different implications for health and can be challenging to lose.

Fat above the waist (Visceral Fat): This type of fat is located around the abdominal organs and is often referred to as visceral fat. Excess visceral fat is associated with an increased risk of various health issues, such as heart disease, type 2 diabetes, and metabolic syndrome. Losing visceral fat can be beneficial for overall health.

Fat below the waist (Subcutaneous Fat): This type of fat is located under the skin and is often referred to as subcutaneous fat. It is commonly found in areas like the thighs, hips, and buttocks. While subcutaneous fat may not have the same health risks as visceral fat, it can still impact body shape and self-esteem.

The ease of losing fat in specific areas can vary from person to person and is influenced by factors such as genetics, hormone levels, and lifestyle habits. Generally, losing fat overall through a combination of calorie-controlled diet and regular exercise is necessary to reduce fat in both areas.

Spot reduction (targeting fat loss from specific areas) is not scientifically proven and can be challenging. Focusing on overall fat loss by maintaining a healthy lifestyle, including a balanced diet and regular exercise, is the most effective approach to promote both physical and overall well-being.

13. Question by Jimmy

Dear Doctor,

Why is it so difficult to lose weight when I am eating only two meals a day instead of three?

Answer by Dr Deanna Lee

Hi Jimmy,

Losing weight is a complex process that involves a combination of factors, and the number of meals you consume each day is just one of them. While some individuals may find success in weight loss by eating two meals a day instead of three, others may experience challenges.

Here are some possible reasons why it might be difficult to lose weight with this eating pattern:

Caloric intake: The total number of calories consumed in a day plays a crucial role in weight management. Even if you eat only two meals, if those meals are high in calories, it can still lead to weight gain or hinder weight loss. The key is to ensure that your total caloric intake aligns with your weight loss goals.

Portion sizes: Eating two meals a day may lead to larger portion sizes during those meals, which can contribute to consuming more calories overall. It's essential to be mindful of portion control, even when eating less frequently.

Hunger and satiety: Some people may find it challenging to manage hunger and maintain satiety with only two meals a day, leading to increased snacking or overeating during the two meals.

Nutrient balance: Eating two meals a day might make it more challenging to ensure a balanced intake of essential nutrients, including vitamins and minerals, which are essential for overall health and weight management.

Metabolism: Each person's metabolism is unique, and some individuals may not respond favorably to eating two meals a day. The frequency and timing of meals can impact metabolism differently for different individuals.

Activity level: Your level of physical activity and exercise plays a significant role in weight loss. If your activity level is low, it may be more challenging to create the caloric deficit needed for weight loss, regardless of meal frequency.

Hormonal factors: Hormones, such as ghrelin (hunger hormone) and leptin (satiety hormone), play a role in appetite regulation and can be affected by meal patterns.

It's essential to remember that there is no one-size-fits-all approach to weight loss. Different strategies work for different people, and finding the most suitable approach may require experimentation and monitoring your body's response. Consulting with a healthcare professional eg dietitian can be beneficial in developing a personalized and sustainable weight loss plan that meets your individual needs and goals.

14. Question by Ming Ying

Dear Dr Lee,

I have been trying to lose weight for the past few years but I have been putting on 5kg for about half a year. I am around 69-70kg and I am 155cm which means my BMI is obese.

I am a wheelchair user which means I am seated all the time. I play para badminton 2x a week for 2 hours. However, I am still unable to lose weight.

I suffer from epilepsy for about 30 years and I am currently taking Keppra, Lamotrigine and Clobazam. On top of that I suffer from CRPS and am also taking Gabapentin and opioids for pain relieve as the pain from CRPS can be quite debilitating. I suffer from CRPS for close to 20 years.

My neurologist and pain doctor told me the medication does not make me put on weight so I reckon that should be my diet? I don’t take lots of carbs, so I am not sure where should I be cutting down. I love to eat sweet stuff that could be one of the reasons?

Looking forward for your advice. Thanks.

Answer by Dr Deanna Lee

Hi Ming Ying,

I understand that you have been facing challenges with weight loss despite your efforts. It's important to recognize that various factors, such as your medical conditions, medications, and reduced physical mobility due to being a wheelchair user, can influence weight management. Here are some considerations and suggestions to help you on your weight loss journey:

Physical activity: It's great that you are playing para badminton twice a week for two hours. Regular physical activity is essential for overall health and can aid in weight management. If possible, try to incorporate more low-impact exercises or movements tailored to your abilities, even while seated, to increase your daily activity level.

Diet modifications: While you mentioned not consuming lots of carbs, it might still be helpful to assess your overall dietary intake and identify areas for improvement. Sweet treats and high-calorie snacks can contribute to weight gain. Consider reducing the consumption of sugary and high-calorie foods while including more nutrient-dense options like fruits, vegetables, lean proteins, and whole grains. (Sugary food are considered carbs and they contribute a lot to weight gain)

Portion control: Pay attention to portion sizes, as overeating, even healthy foods, can hinder weight loss. Consider smaller, more frequent meals to help manage hunger and improve metabolism.

Mindful eating: Be mindful of emotional eating or eating in response to stress or boredom. Identifying triggers and finding alternative coping mechanisms can be helpful.

Water intake: Ensure you are adequately hydrated throughout the day. Sometimes, thirst can be mistaken for hunger.

Patience and consistency: Weight loss can be a gradual process, especially considering the complexities of your health conditions. Be patient with yourself and stay consistent with your efforts. Each person's weight loss journey is unique, and it's important to approach it holistically, considering your individual circumstances.

15. Question by Suhaimi

Hi Deanna,

At my age now 63 years old, height 163m weight 83kg. I am finding it difficult to reduce my weight.

Still working as supervisor in an aviation company, am unable to climb stairs without holding on the rail if any othwrwise use my hand and palm of hand for support.

Although doctors advise to reduce weight till 62kg. Every methods I’ve tried. But to no avail. Hais!

Maybe you can help me without operation or spending a lot on machines to exercise. Thank you.

Answer by Dr Deanna Lee

Hi Suhaimi,

Successful long-term weight management is all about adopting a lifelong healthy lifestyle, which includes a nutritious and balanced diet combined with regular exercise.

I recommend visiting a dietician in our hospitals or polyclinics who can calculate your calorie requirement, review your food diary, and suggest diet changes. Additionally, seeing a physiotherapist can be beneficial as they can teach you muscle-strengthening exercises to support your joint muscles.

Gentle yoga classes or exercises like cycling, swimming, or walking in the pool can also help strengthen your muscles, reduce knee pain, and increase calorie expenditure, aiding in weight loss.

In your journey to shed some weight first, there are various options available to explore. From medications like oral or injectables, temporary balloons and meal replacements, we offer a range of choices tailored to your needs. I encourage you to visit one of our weight management clinics to discuss these options further and find the best fit for you.

Additionally, our experienced dieticians and physiotherapists can provide personalised advice based on your individual calorie requirements, diet, and suitable exercises. You can obtain a referral from the polyclinics nearest to you to get started on this transformative journey towards a healthier and happier you!

16. Question by Suhaimi

Hi Doctor,

I am in my mid 50s. Have tried many ways to lose weight. Succeeded but finally still gain back. Today I am at my heaviest, 70kg. I am 1.58cm. Getting an extra layer of bulge below belly button and double chin.

I was told by a beautician that I have lymphatic issues and not just fats. What should I do? Thank you.

Answer by Dr Deanna Lee

Hi Mei Yin,

The key to successful weight management lies in embracing a lifelong healthy lifestyle that includes a nutritious and balanced diet along with regular exercise. Diet plays a vital role, accounting for 75-80% of successful weight loss and maintenance.

Medications and surgery can help you lose weight effectively but as soon as patients get back to their old diet and sedentary lifestyle, their weight would rebound significantly. This is quite a common pitfall of a quick solution to any problem. The available treatments are valuable tools to support individuals as they adjust to their new healthy lifestyle and aiding in their weight loss.

Therefore, it is crucial to understand that sustained weight management success can be achieved through the consistent adoption of a healthy lifestyle throughout one's life.

In your journey to shed some weight first, there are various options available to explore. From medications like oral or injectables, temporary balloons and meal replacements, we offer a range of choices tailored to your needs. I encourage you to visit one of our weight management clinics to discuss these options further and find the best fit for you.

f a beautician has suggested that you have lymphatic issues, it is essential to seek advice from a qualified healthcare professional, to properly assess, diagnose and address your condition.

17. Question by Simone

Hi Dr,

I am a 61-year-old female and my body weight is 71kg. May I request a 2-week meal plan so that I can reduce my weight. My goal weight is 63kg. Thanks for your help.

Answer by Dr Deanna Lee

Hi Simone,

The key to successful weight management lies in adopting a lifelong healthy lifestyle that is sustainable and includes a balanced and nutritious diet. This involves not only considering the quantity of food but also its quality.

Evaluating factors such as types of snacks, frequency of eating, food portion, meal timing, and the amount of sugar and fat in your diet is essential to align with your calorie requirements and expenditure. Focus on a Balanced Diet or healthy plate.

Consider incorporating a variety of nutrient-dense foods into your diet, such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Eating a balanced diet can help manage hunger and improve overall well-being. Meal replacements can also be a helpful option for reducing calorie intake.

I recommend visiting a dietician in our hospitals or polyclinics who can calculate your calorie requirement, review your food diary, and suggest diet changes tailored to your health conditions, age, BMI and lifestyle instead of just a random 2-week generic meal plan. We believe in individualised recommendations to ensure sustainable long-term success.

Meanwhile you can get some generic ideas from HPB’s healthy plate website.
https://www.healthhub.sg/programmes/191/nutrition-hub/eat-more

18. Question by Kathleen

Dear Dr,

I am a mother of 4 children with current ages 17-25.

At age 52 now, I am finding it a bit of a challenge to lose tummy fats despite eating little or no rice at dinner. I do not snack on chips or sweets. I also do not take any sweet or carbonated drinks. I rarely eat fried food also.

I have started to do simple exercises at home to be active & to burn some calories.

I would like to know what else can I do to reduce belly fats. I am about 1.5m and my weight is 45kg. Thank you.

Answer by Dr Deanna Lee

Hi Kathleen,

I commend you on your efforts to lead a healthy lifestyle. It's wonderful to hear that you are already making conscious choices regarding your diet and engaging in simple exercises at home.

Losing tummy fat can be challenging, especially as we age and experience changes in our metabolism and hormonal balance. Rest assured that your BMI is within the normal range. Here are some tips for you to lead a sustainable lifestyle:

Focus on a Balanced Diet: While you have already made some healthy choices, consider incorporating a variety of nutrient-dense foods into your diet, such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Eating a balanced diet can help manage hunger and improve overall well-being.

Monitor Portion Sizes: Be mindful of portion sizes during meals. Even when eating nutritious foods, consuming large portions can contribute to excess calorie intake.

Stay Hydrated: Drink plenty of water throughout the day. Adequate hydration supports digestion and can help you feel fuller, reducing the likelihood of overeating.

Strength Training: Incorporate strength training exercises into your routine. Building muscle can help boost your metabolism and burn more calories, including those from tummy fat.

Cardiovascular Exercise: Consider adding more cardio exercises, such as brisk walking, cycling, or swimming, to your routine. Cardiovascular workouts can help burn calories and reduce overall body fat, including tummy fat.

Be Patient and Consistent: Weight loss takes time, and it's essential to stay patient and consistent with your healthy habits. Celebrate small successes along the way and remember that slow progress is still progress. The key to successful weight management lies in adopting a lifelong sustainable healthy lifestyle.

19. Question by Siew Lian

Dear Doctor Lee,

Apart from healthy eating habits, how should middle age group adopt to stay slim n healthy. Pls recommend some healthy recipes that can be delicious n easily prepared. Thanks.

Answer by Dr Deanna Lee

Hi Siew Lian,

In addition to healthy eating habits, middle-aged individuals can adopt various lifestyle strategies to stay slim and maintain overall health. Here are some important tips:

Regular Physical Activity: Engage in regular exercise to promote weight management and overall well-being. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity per week, along with muscle-strengthening activities on two or more days per week.

Strength Training: Include strength training exercises to build and maintain muscle mass, which can help boost metabolism and support weight management.

Stay Hydrated: Drink plenty of water throughout the day to maintain hydration and prevent mistaking thirst for hunger.

Limit Sugary Beverages: Minimize the consumption of sugary drinks, including sodas and sweetened beverages, as they can contribute to excess calorie intake.

Reduce Sedentary Time: Aim to reduce prolonged periods of sitting or sedentary activities. Take short breaks to move and stretch throughout the day.

Prioritize Sleep: Ensure adequate and restful sleep, as poor sleep can affect hunger hormones and lead to weight gain.

Manage Stress: Practice stress-reduction techniques such as mindfulness, meditation, or yoga, as chronic stress can contribute to emotional eating and weight gain.

Monitor Alcohol Intake: Limit alcohol consumption, as alcoholic beverages contain calories and can hinder weight management efforts.

Mindful Eating: Be mindful of eating habits and practice mindful eating techniques. Pay attention to hunger and fullness cues, and avoid distractions while eating.

Social Support: Engage in social activities and surround yourself with a supportive network of friends and family, as social connections can positively impact overall well-being.

Regular Health Check-ups: Schedule regular check-ups with healthcare professionals to monitor weight, blood pressure, cholesterol, and other health indicators.

Set Realistic Goals: Set achievable and realistic health goals. Focus on making sustainable lifestyle changes rather than quick fixes.

Be Consistent: Stay consistent with healthy habits, as long-term success comes from forming positive and lasting lifestyle changes.

Remember that individual needs may vary, and it's important to tailor these strategies to personal preferences and health conditions. Consulting with a healthcare professional or a registered dietitian can provide personalized guidance and support in achieving and maintaining a healthy weight and lifestyle.

For healthy and tasty recipes, there is a wide selection on the HealthXchange website. You see the recipes by clicking here. From wholesome meals to delightful snacks, there is a wide selection of options for you to try and enjoy!

20. Question by Cindy

Dear Doctor,

I have gained more than 10kg in 2 years, would like to know more on Pembersy. Price and where to buy?

Have been thinking of liposuction but do not know where to do it.

Age: 61
Height: 1.59mtr
Weight 68 kg
Waist: 95cm

Answer by Dr Deanna Lee

Dear Cindy,

Based on the BMI calculation your BMI is 27 which falls in the overweight category. For those who are overweight without co-morbidities (medical problems) we would recommend lifestyle intervention which includes exercise and healthy eating habits. The key to successful weight management in the long-term lies in adopting a lifelong healthy lifestyle that is sustainable and includes a balanced and nutritious diet and exercise.

Some tips for healthy eating and exercise would include:

• Prioritizing a balanced diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats to ensure you get essential nutrients.

• Portion control is key; be mindful of serving sizes to avoid overeating and maintain a healthy weight.

• Limit sugary beverages and opt for water or herbal teas to stay hydrated without added calories.

• Reduce processed and high-sodium foods, and opt for fresh, whole foods whenever possible.

• Plan and prepare meals in advance to avoid impulse eating and make healthier choices throughout the day.

• Regular Physical Activity: Engage in regular exercise to promote weight management and overall well-being. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity per week, along with muscle-strengthening activities on two or more days per week.

• Strength Training: Include strength training exercises to build and maintain muscle mass, which can help boost metabolism and support weight management.

• Prioritize Sleep: Ensure adequate and restful sleep, as poor sleep can affect hunger hormones and lead to weight gain.

• Manage Stress: Practice stress-reduction techniques such as mindfulness, meditation, or yoga, as chronic stress can contribute to emotional eating and weight gain.

Pembersy’s chemical name is Phentermine. Phentermine is a prescription only medication that is used as an appetite suppressant to aid in weight loss. Hence, you can only obtain it through registered doctors who would be required to monitor you as you take the medication.

Phentermine belongs to a class of drugs known as sympathomimetic amines, which work by stimulating the release of certain neurotransmitters in the brain, such as norepinephrine and dopamine. These neurotransmitters help to reduce appetite and increase feelings of fullness, which can lead to decreased food intake. Common side effects may include increased heart rate, elevated blood pressure, dry mouth, insomnia, and nervousness. 

Phentermine is typically prescribed for as part of a comprehensive weight loss program that includes a reduced-calorie diet and increased physical activity. Without lifestyle modification, patients would experience weight rebound after cessation of phentermine. The price of phentermine for a month is typically about 30-60 SGD/ month.

Liposuction is a surgical procedure that aims to remove excess fat deposits from specific areas of the body to improve body contour and proportion. It is not a weight loss method but rather a body contouring procedure. During the liposuction procedure, a thin, hollow tube called a cannula is inserted through small incisions in the skin. The cannula is used to break up and suction out the unwanted fat.

Liposuction is commonly performed on areas such as the abdomen, thighs, hips, buttocks, arms, and neck. It is important to note that liposuction is not a substitute for a healthy lifestyle, and it is not recommended for overall weight loss. It is worth noting that the effects of liposuction are often temporary and may come with complications, especially if not performed by certified doctors who are typically surgeons. Some complications can include infection, bleeding, fluid accumulation, injury to internal organs, fat embolism and changes in skin sensation.

21. Question by Gerlynn

Hi Dr Deanna Lee,

My son is obese since he was 10 and now 17.  He is about 105kg and 165cm.

He does not eat excessively. He loves food but I will not say he is indulging mindlessly. He does observe certain restrictions in his diet like low sugar drink, low GI carbo. The difficult part is when he eats out which is usually lunch.

He does HIIT exercise about 3x a week. Are there other recommendations for him to improve on? Thank you.

Answer by Dr Deanna Lee

Hi Gerlynn,

Based on the BMI calculation, your son’s BMI is approximately 38.58. According to the World Health Organization (WHO) classification, this falls within the "Obese Class II" category.

It's commendable that your son is making efforts to maintain a healthier lifestyle through diet modifications and regular exercise. However, it's important to acknowledge that obesity is a complex issue involving various factors like hormones, metabolism, diet, and behavior. Weight loss can be challenging as the body tends to resist changes to its BMI.

In addition to his current efforts, there are further strategies to support his weight management journey, including portion control, reducing snacking, considering the timing and quality of his food choices (e.g., fresh foods over processed or fast foods), improving sleep habits, and managing stress.

As your son falls under the obesity category, I strongly recommend seeking support from a weight loss center in one of our SingHealth hospitals. 

Early intervention can be beneficial, and our team can help create personalized meal plans, exercise routines, and behavioral strategies. There are also approved medications for adolescent weight loss, such as GLP-1s injectables like Liraglutide (brand name Saxenda). Liraglutide works by mimicking the effects of a naturally occurring hormone called GLP-1, which is released by the intestines in response to food intake. 

By activating GLP-1 receptors in the brain, liraglutide helps to regulate appetite, increase feelings of fullness, and reduce overall food intake. Many adolescents respond well to these interventions, especially when combined with a balanced diet and exercise. I have several adolescent patients achieve successful weight loss and improved well-being through this approach.

Early intervention is crucial for adolescents to shed weight more effectively and establish healthier habits, reducing the risk of future medical complications like diabetes, hypertension, and sleep apnoea. It also enhances their overall quality of life, including confidence, concentration levels and academic performance. 

Ref: I23