healthcare


On 16th November 2007, the Prime Section’s headline of the Straits Times, “Want to slim down? Don’t count on weigh-loss drugs” would have a lot of Singaporeans and those reading in the air (e.g. Singapore Airlines) fitting their eyes on this piece of news.

What a great catchy headline as many Singaporean particularly the female population considered themselves overweight, judging by the continuous flood of slimming advertisements in all appropriate local media. Is this to wake Singaporean up as their online version was not punchy – Weight loss drugs may slim users down – but at high costs” ?

It has been reported obesity and overweight affect over 1.1 billion individuals worldwide and are highly and increasingly prevalent chronic conditions associated with premature mortality, chronic morbidity, and increased healthcare use.

Apart from traditional non-medicinal herbal options, the commonly used treatments are through the use of anti-obesity drugs such as orlistat, sibutramine and rimonabant. They are approved for long term treatment of obesity and choked up an estimated US$1.2 billion in global sales in 2005. The 3 drugs are prescribed for severe cases of obesity as obese people can reduce their risk of getting diabetes by 30 to 40 percent if they were to lose 4 kg.

Orlistat also known as tetrahydrolipstatin is marketed under the trade name Xenical. Its primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake.

Sibutramine is marketed under the trade name Meridia in the USA and Reductil in Europe and other countries. It acts by increasing serotonin and norepinephrine levels in the brain. The S$4 pill makes the patients feel full with less food and is needed to be taken for between 6-12months.

Rimonabant which is also known as Accomplia, Riobant, Slimona, Rimoslim, Zimulti and SR141716, is an anorectic anti-obesity drug. Its main avenue of effect is the reduction in appetite. On 15 June 2007 the BBC News reported that a committee advising the US FDA has voted not to recommend the drug’s approval because of concerns over suicidality, depression and other related side effects associated with use of the drug.

The Straits Times report was following up on the British Medical Journal’s article published a day ago on their meta-analysis that :-

  • 30 per cent of patients on Xenical lost an average of 3 kgs and had unpleasant digestive and intestinal side effects, such as incontinence.
  • Patients on Reductil lost 4 kgs and had improved cholesterol levels. But up to 20 percent suffered from raised blood pressure and pulse rates, insomnia and nausea.
  • Patients on Accomplia lost the most weight – 5 kgs on average. Their blood pressure and cholesterol levels also improved but their risk of mood disorders rose 6 percent.

Straits Times reported that another study released on Friday by a different medical journal, The Lancet, found that patients on Accomplia were far more likely to suffer from depression, anxiety and, in severe cases, suicidal tendencies.

Thus the conclusion from the BMJ article is that “Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.”

Obesity Epidemic – Can America learn from Singapore TAF programme?

It is sad to read headline news recently like this one in the Philadelphia Inquirer Americans getting ever fatter. In most states, a new report says, 1 in 5 is obese. But little is being done about it“.

This came right after Trust for America’s Health (TFAH) released the report “F as in Fat: How Obesity Policies are Failing in America, 2007”.

Notwithstanding some experts think the estimates in the report are conservative because people are underreporting their weight in surveys, 85% of the Americans surveyed believed obesity has become a public health epidemic. Yet it seems that most Americans aren’t doing much about it and they are not only getting fatter, but they are actually getting fatter faster.

The unfortunate young generation

Washington Post reported that “A new report gives District (Washington DC) children a dubious distinction: Nearly one in four of those ages 10 to 17 is overweight, making them the heaviest kids in the country.

In the Los Angeles Times, Jim Marks, a senior vice president of a healthcare philanthropy group was reported that he was so discouraged that “These children could be the first generation to live sicker and die younger than their parents“.

Obesity costs America US$117 billion a year in preventable healthcare expenditures and Mark said that it “is pushing the healthcare system to the breaking point“.

How can it so high and still growing when corrective measures at the local and state levels have been implemented? Example, nine of the states with the highest percentages of overweight kids track the MBI (body mass index) of students, improve the nutrition of school lunches or limit the sale of high-calorie foods in school vending machines or snack bars.

However, it seems that the desired effect is doubtful. Weeks ago, I watched a documentary on Singapore TV station, Channelnews Asia in which one of the experts commented that although American schools provide healthy meals, kids are flocking to the vendor machines filled with irresistible unhealthy snacks and beverages. It also showed that young teenagers are getting diabetes and are experiencing heart diseases.

Should America learn from Singapore ?

Although being criticized from time to time even by foreign media, Singapore’s TAF (Trim and Fit) programme which was launched in 1992 by the Ministry of Education (MoE) and refined through the years have reduced the percentage of overweight students (primary schools to pre-university levels) from 14% to 9.8% in 2002.

No system is perfect but the result has been impressive. Many children have emerged from the TAF Programme fitter and more aware of the importance of keeping a healthy lifestyle; and the number of students passing the Singapore government’s National Award for Physical Fitness (NAPFA) test went up from 58% in 1992 to 82% in 2002.

MoE works with the Health Promotion Board (School Tuckshop Programme), school canteen operators and parents closely to make the “TAF programme a more meaningful part of school life, with due emphasis on the physical, nutritional and psychological aspects. It will work with schools to introduce activities and programmes that are inclusive, fun-filled and interesting for all students, so that they take pride and ownership in their own health and physical well-being.”