Being overweight is really common (36% of Singaporeans!) and it can have a significant impact on your health. As your weight increases so does your risk of high blood pressure, diabetes, heart disease, stroke and cancer. In Asian populations having a BMI over 23 is considered overweight. Weight loss not only makes you feel better but can reverse diseases like diabetes and hypertension. But we all know that weight loss is not simple! It generally takes significant modification of lifestyle, will power and time. Even then, once you lose the weight, most people put it back on within a year or two.
This is where medical weight loss comes to your aid. As an obesity physician and cardiologist my job is to help people reduce their weight, treat their underlying disease, prevent heart attacks and strokes, and help keep their weight off in the long-term. To do this we have multiple treatment options that we tailor to the individual:
- Low calorie diets
- Ultra low calorie diets
- Meal replacement
- Carbohydrate restriction
- Prescription weight loss medications
- Bariatric surgery
In this short article I will go over some of the most commonly asked question about medical weight management.
What pills can a doctor prescribe for weight loss?
There are multiple drugs approved for weight loss in Singapore. Each as their own side effect profile and some are more effective than others. Main medications are: Orlistat, phentermine and Saxenda.
- Orlistat – prevents the absorption of fat in the gut. Because of this it can have intolerable GI side effects such as flatulence, loose stools and faecal incontinence. To prevent these side effects, you really need to follow a low fat diet.
- Phentermine – This drug has been around for a long time. It is similar to amphetamine and is an appetite suppressant. It stimulates certain neurotransmitters in the brain. It has side effects of nervousness, palpitations, dry mouth and sleeplessness. However, it cannot be used in patients with high blood pressure and heart problems.
- Saxenda (liraglutide) – This is an injectable drug that suppresses appetite and makes you feel full. It mimics a hormone called Glucagon Like Peptide -1 (GLP-1). Unlike phentermine it is safe in patients with high blood pressure and heart conditions. It is currently one of the most effective drugs on the market for weight loss.
What is the best prescription weight loss pill?
The most effective weight loss drug is not yet available in Singapore (June 2021) it has just been approved for use by the FDA. It is called Wegovy (Semaglutide 2.4mg) it is very similar to Saxenda (Liraglutide), it is a GLP-1 agonist, except that it is longer acting and only needs to be injected once per week! In long-term trials, patients lost on average 15% of their body weight when given in conjunction with diet and exercise! Until it is approved, the most effective and safest drug is Saxenda. Safety for my patients in particular is very important, many patients with obesity also have heart conditions or high blood pressure.
If I use a weight loss medication, do I still need to diet and exercise?
Weight loss medications are not magic bullets. They need to be used alongside calorie restriction, behavioural modification and exercise programs. The patients that do best with these medications also put effort into the other parts of their weight loss program.
How much does Saxenda (Liraglutide) cost in Singapore?
The price of a Saxenda pen is very standard, and varies from $130-160 SGD. Once you are on the full dose, each pen lasts for 6 days. So in one month you will use 5 Saxenda pens and it will cost around 700SGD.
How can I lose weight in Singapore?
The most successful way to lose weight is to use a multi-pronged strategy that includes dietary modification, behavioural modification, exercise and sometimes medical treatment. Focusing on one area is not usually enough. Take a look at this chart of how complex obesity really is.
The map can be seen here.
Obesity is not just about one single factor like eating too much or not exercising. It is a chronic, and complex disease caused by multiple interacting pathways. This is why most successful approaches to weight management deal with multiple areas at once.
- Medical treatment
If you want to lose weight a comprehensive program is often the most successful.
Which diet is the best for weight loss?
It is best not to focus on “dieting” as a way to lose weight. Ideally you need to make changes to your lifestyle that are sustainable long-term. However, a short period of intensive weight loss can be effective to shift the initial weight whilst you start making longer term changes. There is no one perfect diet. What works for one person may not work for others, so although your friend swears by a keto diet, it may not work for you because it causes you constipation for example.
Many companies will try and tell you that their diet works best, but that is because they are trying to sell you something. Clinical trials have shown that there is no diet that is truly superior to others. Ideally you need to find a style of eating that works for you and your lifestyle. If you have a look at the chart above you can see how complex obesity is, and the areas that affect your weight will be different to other people. A bespoke and tailored approach to all the 4 components above is usually the most successful for long term weight control.
How can I lose tummy fat fast?
Despite what some clinics will tell you, you really cannot spot reduce areas of fat with exercise or nutritional changes. There are 2 types of fat in the body – 1) subcutaneous fat – this is the fat under the skin all over the body, ie on the bum and hips and legs. 2) Visceral fat – this is the fat around the internal organs. Visceral fat is the most metabolically active and is the one associated with diabetes, heart disease and high blood pressure.
As you lose weight you will lose roughly equal amounts of visceral and subcutaneous fat. So if you want to lose your tummy you need to focus on weight loss and eventually the tummy will come off too. Sit ups do not spot reduce fat, but they will help to tone the underlying muscles.
How can I lose weight fast without exercise?
First of all, we need to be clear that it is actually fat you want to lose not muscle.Changing your eating habits is by far the most important part of weight management. It is very difficult to exercise off excess calories. One doughnut can be 450 calories and this is equal to the amount of calories an average man would expend with 1 hour walking! It is a lot easier not to eat 1 doughnut than walk for an hour. The most effective way to lose weight is when you combine caloric restriction with exercise. The exercise allows you to preserve muscle mass during the weight loss process, and in addition adds some extra caloric loss.
How can I lose 20lbs (9Kg) in 2 months?
Believe it or not, it is perfectly possible to lose 20lbs or 9Kg in 2 months! In fact, that is the rate of loss you need to go for. 1Kg is equal to 7000Kcal so you need to have a roughly 1000Kcal deficit per day to achieve this.
Work out your target calorie intake per day to do this, click here
Dr Michael MacDonald is a heart doctor and cardiologist working in Singapore.