obesity


Is it true Singaporeans never weigh themselves?

From the recent global survey of 9,000 people across 13 countries (UK, USA, UAE, France, Czech Republic, Romania, Canada, Brazil, Saudi Arabia, Hong Kong, Singapore, Malaysia and Australia) by a global market research firm, Synovate, Singaporeans are the least weight-obsessed people in the world as compared to the American and the French :-

  • 37% of Singaporeans saying that they never weigh themselves
  • 29% said their weight never change
  • 60% eat whatever they want, whenever they wantbathroom-scale.jpg

15% of Hong Kong people weigh themselves once or more every week and 60% only weigh when they remember.

Americans and French are most weight-obsessed, 15% of French people and 12% of Americans weigh themselves every single day and 50% of them will weigh at least once a week or more.

French attributed this to the fact that “French people take care of their image as a matter of course. Being thin is part of our culture and a point of pride. We are known for it. On top of this, there is increasing awareness of the devastation that obesity can cause to one’s health.

So, is it true that Singaporeans never weigh themselves?

Most homes do not have a weighing scale even though the price is so affordable now and they comes with digital meter (more accurate), all kinds of colors and design. Are we too busy to weigh or we are like the 29% who really believed that our weight never change or there a no necessity to weigh since we believed we are healthy or weight change doesn’t matter.

Some feedbacks are that they are afraid to see their weight fluctuate, especially when it has increased. Some felt weighing scale is quite a silly gadget to buy, a waste of money. Some Chinese old folks joked that Chinese don’t weigh themselves except to animals for sale (butcher’s family!?).

Going by the sprouting of health fitness and slimming centers, etc. around the island, weighing scales are everywhere. Moreover, all medical clinics will have it too. Those who are consuming weight-loss medicine, traditional herbal weight reduction beverages, etc should be weighing prior and after the dosage period to assess its effectiveness. So, most people would have themselves weighed.

I really wonder for those 29% who said that their weight never change, are they those who frequent the fitness center or exercise regularly themselves or resort to weight control medicine or supplements? In addition, for those 37% who do not weigh, do they eat whatever they want and whenever they want?

How to add 14 more years to your life ?

While many in Singapore might be disillusioned about healthy living after seeing the sudden death last week (4th January) of Jimmy Nah, the healthy-looking 40-year-old comedian/actor who does not smoke or drink alcohol and have a clean bill of health, BBC this morning reported that a study shown “Taking exercise, drinking moderately, eating sufficient fruit and vegetables and not smoking can add as much as 14 years to your life”.

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The study between 1993 and 2006 by the UK’s Public Library of Science Medicine which involved 20,000 people aged between 45 and 79, suggested that regardless of how overweight or poor they were, they found those who failed on all criteria were four times more likely to have died than those who succeeded.

Participants were known during this period to be free from cancer or any heart problems.

The participants were awarded a point for :

1. not currently smoking
2. consuming between one and 14 units of alcohol per week (the equivalent of between half a glass and seven glasses of wine)
3. eating five servings of fruit and vegetables each day and not being inactive.

They found that the risk of

A 60-year-old person + score ZERO = a 74-year-old + FULL FOUR points

The conclusion was that many people through some simple changes can increase their lifespan as well as reduce their risk of dying from heart and circulatory disease as shown from the research participants.

You can find anything in China.

 obese-188kg-china-baby-1.jpg

The recent flashes of news across China and many countries was the discovery of a “ultra-fat little emperor” in the city of Jiangcheng in northeastern China province of Jilin.

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What made that news was that the yet-to-be-named 8-months old baby shocked the doctors in the Jilin provincial hospital. This meaty boy got a brain that is larger than many people and has grown from a normal 3.3kg at birth to an unbelievable 18.8kg, twice the weight of a normal 8-month old baby. According to the Chinese pediatrician, it will take a 5-6 years old child to reach this weight.

Both the parents of this obese boy as well as his paternal and maternal grandparents are of thin build. His size and weight started to balloon by 2kg in the second month after birth and by 2.5kg in the 7th month.

Although they are very concerned about the unexplainable growth in the early month, they had resisted visiting the doctor as they are poor and each trip to the hospital will cost them a few thousands yuan (Chinese dollar). 

Finally, they had decided to see the pediatrician probably because his obesity is becoming unbearable to the people around him.  His mother has to breastfeed him 20 times a day because he gets hungry very fast and cries. He refused to drink powdered milk or porridge. Dressing or bathing him up requires 2 persons which stresses both the parents as well as grandparents. His mother can only carry him for about 5 minutes which she said is like a weight-lifting exercise.

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It is good that they finally seek medical attention as the weight is affecting his development.  At 78 centimeters tall, he cannot walk or even crawl and can only sit occasionally to play. Experts said that he is suffering from an obesity disorder syndrome and further test will be conducted.

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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.”

5 + 4 about Good Cholesterol.

Cholesterol, the fat-like substance is the word that most people especially the middle-age group and above hate to hear.

It is a constant advice that we should all cut down or avoid red meats, seafood and products from animal fats because they are high in cholesterol or are high saturated fatty acids which will raise the triglycerides (a form of fat made in the body) and cholesterol levels in the body. However, for most people, without the wonderful delicious pork, beef, mutton, liver, skin of poultry, ham, bacon; drunken prawns, chilly/pepper “Sri Lanka” crabs, “hum/tua tao/lala” (clam), “sotong” (squid, cuttlefish), lobsters; butter, lard, egg yolk, etc., life will be meaningless.

That is just negative which we remembers. The flipped side is that our body needs cholesterol for functions such as making hormones. Besides being found in those products above, it is also produced in our body.

There are good and bad cholesterols. They can’t dissolve in the blood and have to be transported through the bloodstream in different carriers called lipoproteins. Low-density lipoproteins (LDL or “bad” cholesterol) deliver cholesterol to the body, while high-density lipoproteins (HDL or “good” cholesterol) take cholesterol out of the bloodstream to the liver which will then passes them out of the body.

We are told the higher your HDL cholesterol, the better it is. Now, I learned that biological reality is more complex as genes direct the body’s production of HDL and that many of us might not be lucky enough to inherit genes that result in a lot of HDL. Luckily, genes are only part of the story because lifestyle factors and, to a smaller extent, medications can strongly influence HDL levels.

The National Cholesterol Education Program (NCEP) and the American Diabetes Association advise people to aim for HDL levels of at least 40 mg/dL. An even more protective goal, according to the NCEP, is 60 mg/dL or higher.

Why is having high HDL cholesterol is important?

At first, scientists believed that HDL was simply a garbage collector that picked up cholesterol from an artery’s walls and delivered it to the liver for disposal. That’s still considered the main role of HDL, but research is starting to suggest that HDL can help protect the heart in many ways:

  • Reverse cholesterol transport. HDL latches onto LDL embedded in an artery wall, lugs it back into the bloodstream, and carries it to the liver. The liver collects cholesterol from the HDL particles, packages it into bile salts and bile acids, and dumps it into the intestines for excretion.
  • Antioxidant activity. LDL cholesterol in the artery wall is bombarded by oxygen free radicals, which turns it into oxidized LDL cholesterol. Oxidized cholesterol is the stuff that’s actually responsible for arterial damage — and research shows that HDL can help protect LDL cholesterol from free radicals.
  • Anti-inflammatory action. HDL helps to quiet the inflammation of an atherosclerotic plaque. Elevated levels of C-reactive protein (CRP) reflect the inflammation of such a plaque and HDL may neutralize CRP’s tendency to perpetuate the inflammatory cycle.
  • Antithrombotic activity. Plaque rupture triggers the formation of an artery-blocking blood clot. By halting the flow of oxygen-rich blood, the clot kills heart muscle cells (heart attack) or brain cells (stroke). HDL reduces clot formation and accelerates the healing process that dissolves clots.
  • Endothelial function. Blood vessels plagued with atherosclerosis sustain other damage. In particular, the endothelial cells lining the arteries fail to produce normal amounts of nitric oxide, the chemical that allows arteries to dilate (widen) when tissues need more oxygen. HDL helps preserve nitric oxide production and protect endothelial function.

How much does HDL help?

The Framingham Heart Study was responsible for many landmark discoveries about HDL cholesterol, and the Physicians’ Health Study helped confirm that HDL was protective, reporting that various HDL subtypes are all helpful. Data continue to show that the good cholesterol is very good indeed.

  • Heart disease. Low HDL levels are associated with an increased risk of heart attacks, while high levels are protective. According to the Framingham Heart Study, cardiac risk rises sharply as HDL cholesterol levels fall below 40 milligrams per deciliter (mg/dL). In general, each 1 mg/dL rise in an HDL cholesterol level can be expected to cut cardiac risk by 2% to 3%.
  • Stroke. Strokes come in many forms, but the most common type, ischemic stroke, shares many risk factors with heart attack. High HDL cholesterol levels reduce the risk of stroke; in several studies, HDL cholesterol is a much better predictor of risk than LDL cholesterol, particularly in people older than 75.
  • Erectile dysfunction. Normal erections depend on many things, including healthy arteries that produce good amounts of nitric oxide. It’s no surprise, then, that the Massachusetts Male Aging Study found that 16% of men with low levels of HDL cholesterol had erectile dysfunction, but none of the men with the highest levels did.
  • Longevity. Several investigations suggest that high HDL levels are linked to longevity, particularly exceptional longevity. Other research links high levels of HDL cholesterol to preserved cognitive function in old age. More research is needed to learn if HDL deserves the credit or if other genetic factors are responsible.

Ways to raise your HDL

  • Exercise. Exercise is an important way to boost HDL levels. On average, sedentary people who start to exercise regularly can expect their HDL levels to rise by 3% to 20%. The benefit can occur with as little as one mile of walking or jogging a day, but the more you do, the better your result. Brisk walking for 40 minutes a day is a good target, but if you need more help, aim higher.
  • Watch your dietary fats. Saturated fat won’t affect your HDL cholesterol, but it will raise your LDL cholesterol. The latest American Heart Association (AHA) guidelines call for limiting saturated fat to less than 7% of your total daily calories. Reduce your intake of trans fats to less than 1% of your total daily calories. Trans fat lowers HDL cholesterol and raises LDL cholesterol, a double whammy to health. But unsaturated fats like virgin olive oil may boost HDL levels, and the omega 3 fats in fish, nuts, and canola oil may promote cardiac health even if they don’t affect your HDL reading.
  • Watch your carbs! Or at least the types of carbs you’re eating. Diets that provide large amounts of rapidly absorbed carbohydrates are clearly linked to low levels of HDL cholesterol. Avoid highly refined carbohydrates in favor of coarsely ground, whole grain, unrefined carbs like whole grain bread, oatmeal, and beans.
  • Alcohol. Moderate drinking will raise HDL levels by about 4 mg/dL, which should cut cardiac risk by about 10%. This translates to one to two drinks a day for men, and one drink a day for women. For this “prescription,” count 5 ounces of wine, 1½ ounces of liquor, or 12 ounces of beer as one drink.
  • Weight control. Obesity is linked to low HDL levels, but weight loss can help. Exercise and diet are the dynamic duo for weight loss, but shedding excess pounds will boost HDL levels over and above the independent effects of regular exercise and a healthful diet.

WANT TO REDUCE WEIGHT? PLAY SOCCER Sports scientist Peter Krustrup and his colleagues from the University of Copenhagen, the Copenhagen University Hospital and Bispebjerg Hospital did a research which showed that playing soccer is healthier, burn more fat and more fun than jogging.

For a period of 12 weeks, a group of soccer players and joggers have been active for one hour 2-3 times a week. The participants have been continuingly subjected to tests: fitness rating, percentage of body fat, total mass of muscles, cholesterol, blood pressure, insulin sensitivity and balance.

After the period, the result :

* Soccer players – lost 3.5 kilos of fat, gained more than 2 kilos of extra muscle mass
* Joggers – lost 2 kilos of fat, no change in total muscle mass.
* Both groups – showed significant improvements in blood pressure, insulin sensitivity and balance

Peter Krustrup said that “Soccer is an all-round form of practise because it both keeps the pulse up and has many high-intensity actions. When you sprint, jump and tackle your opponents, you use all the fibres in your muscles. When you jog at a moderate pace, you only use the slow fibres.”

Although both groups moved at the same average speed, soccer is more fun than jogging because jogging focuses on oneself, which led to the joggers noticing their efforts and the breathlessness and can lead to them feeling sorry for themselves. Soccer players forget it is hard because all contributed to the effort as they focus on the game and don’t notice that their hearts are pounding.

Therefore, to fight obesity and inactivity, soccer seems to be an obvious alternative to jogging and fitness.

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