Recommendations for Obesity Management from Singapore
Abstract
Obesity, defined as a condition of excessive body fat with adverse effects on health, is an increasing global problem which contributes to chronic disease burden and health care costs. The Singapore Ministry of Health (MOH) released Clinical Practice Guidelines (CPG) in 2004, aimed at providing best evidence-based recommendations for diagnosis, classification, evaluation and multidisciplinary management (diet, physical activity, medication and surgery) of overweight and obesity in adults and the pediatric population. This article summarizes the guidelines, discusses their utility in Singapore and strategies for increasing their use, and briefly outlines updates in management since the CPG’s publication. A revised CPG is urgently needed in view of the increasing prevalence of overweight and obesity in Singapore and the numerous advances in the management of overweight and obesity.Downloads
References
WHO Expert Consultation. Appropriate Body-Mass Index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157-63.
National Health Survey 2004. Epidemiology and Disease Control Department, Ministry of Health, Singapore.
National Health Survey 2010. Epidemiology and Disease Control Department, Ministry of Health, Singapore.
Clinical Practice Guidelines 5/2004. Obesity. Ministry of Health, Singapore. World Health Organization.
Ministry of Health Singapore: Government Health Expenditure. http://www.moh.gov.sg/mohcorp/statistics.aspx?id=5972.
Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008;93:S9-30.
Deurenberg-Yap M, Chew SK, Lin VF et al. Relationships between indices of obesity and its comorbidities in multi-ethnic Singapore. Int J Obes Relat Metab Disord. 2001;25:1554-62.
Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their Body Mass Index/body fat percent relationship. Obes Rev. 2002;3:141-6.
Deurenberg-Yap M, Chew SK, Deurenberg P. Elevated body fat percentage and cardiovascular risks at low Body Mass Index levels among Singaporean Chinese, Malays and Indians. Obes Rev. 2002;3:209-15.
The Asia-Pacific perspective: Redefining obesity and its treatment. Melbourne: WHO Western Pacific Regional Office, IASO, IOTF, 2000. http://www.obesityasiapacific.com/pdf/obesity.pdf.
Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640-5.
Odegaard AO, Pereira MA, Koh W-P et al. BMI, all-cause and cause-specific mortality in Chinese Singaporean men and women: The Singapore Chinese Health Study. PLoS One. 2010;5(11):e14000.
Franz MJ, VanWormer JJ, Crain AL et al. Weight-loss outcomes: A systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107:1755-67.
Sacks FM, Bray GA, Carey VJ et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-73.
Heymsfield SB, van Mierlo CAJ, van der Knaap HCM, Heo M, Frier HI. Weight management using a meal replacement strategy: Meta and pooling analysis from six studies. International Journal of Obesity. 2003;27:537–49.
Catenacci VA, Wyatt HR. The role of physical activity in producing and maintaining weight loss. Nat Clin Pract Endocrinol Metab. 2007;3:518-52.
Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S–5S
Jakicic JM, Clark K, Coleman E et al. American College of Sports Medicine position stand. Appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2001;33:2145-56.
Donnelly JE, Blair SN, Jakicic JM et al. American College of Sports Medicine position stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459-71.
Levy RL, Finch EA, Crowell MD, Talley NJ, Jeffery RW. Behavioral intervention for the treatment of obesity: Strategies and effectiveness data. Am J Gastroenterol. 2007;102:2314–21.
Li Z, Maglione M, Tu W et al. Meta-analysis: Pharmacologic treatment of obesity. Ann Intern Med. 2005;142:532-46.
James WP, Caterson ID, Coutinho W et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363:905-17.
U.S. Food and Drug Administration. FDA Drug Safety Communication: Completed safety review of Xenical/Alli (orlistat) and severe liver injury. May 26, 2010.
Desilets AR, Dharkal-Karki S, Dunican KC. Role of metformin for weight management in patients without type 2 diabetes. Ann Pharmacother. 2008;42:817-26.
Ratner RE, Maggs D, Nielsen LL et al. Long-term effects of exenatide therapy over 82 weeks on glycemic control and weight in over-weight metformin-treated patients with type 2 diabetes mellitus. Diab Obes Metab. 2006;8:419-28.
Buse JB, Rosenstock J, Sesti G et al for the LEAD-6 study group. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: A 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6).Lancet. 2009;374:39–47.
Rosenstock J, Klaff LJ, Schwartz S et al. Effects of exenatide and lifestyle modification on body weight and glucose tolerance in obese subjects with and without pre-diabetes. Diabetes Care. 2010;33:1173-5.
Astrup A, Rössner S, Van Gaal L et al. Effects of liraglutide in the treatment of obesity: A randomised, double-blind, placebo-controlled study. Lancet. 2009;374:1606-16.
Buchwald H, Avidor Y, Braunwald E et al. Bariatric surgery: A systematic review and meta-analysis. JAMA. 2004;292:1724-37.
Lakdawala M, Bhasker A. Asian Consensus Meeting on Metabolic Surgery (ACMOMS). Recommendations for the use of bariatric and gastrointestinal metabolic surgery for treatment of obesity and type 2 diabetes mellitus in the Asian population. Obes Surg. 2010;20:929-36.
Han SM, Kim WW, Hyun Oh J. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469-75.
O’Brien P, Dixon JB, Laurie C et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: A randomized trial. Ann Intern Med. 2006;144:625–33.
Higa K, Ho T, Terecero F et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7:516-25.
Sjöström L, Narbro K, Sjöström CD et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741-52.
Cole TJ, Bellizzi MC, Flegal KM et al. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000;320:1240-3.
Cole TJ, Flegal KM, Nicholls DA, Jackson AA. Body Mass Index cut-offs to define thinness in children and adolescents: international survey. BMJ. 2007;335:194-201.
Annual Report. Singapore: School Health Services, Singapore. 2000.
Wee HL, Wu Y, Thumboo J, Lee J, Tai ES. Association of Body Mass Index with Short-Form 36 physical and mental component summary scores in a multiethnic Asian population. Int J Obes (Lond). 2010;34:1034-43.
Kamath CC, Vickers KS, Ehrlich A et al. Behavioral interventions to prevent childhood obesity: A systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab. 2008;93:4606-15.
August GP, Caprio C, Fennoy I et al. Prevention and treatment of pediatric obesity: An Endocrine Society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. 2008;93:4576-99.
Viner RM, Hsia Y, Tomsic T, Wong ICK. Efficacy and safety of anti-obesity drugs in children and adolescents: Systematic review and meta-analysis. Obes Rev. 2010;11:593-602.
Sinha A, Scott K. A review of adolescent obesity: Prevalence, etiology and treatment. Obes Surg. 2009;19:113-20.
Ministry of Health, Singapore: Healthcare Services (Primary Care) http://www.moh.gov.sg/mohcorp/hcservices.aspx?id=392. Accessed October 4, 2011.
Hutchinson A, McIntosh A, Cox S, Gilbert C. Towards efficient guidelines: How to monitor guideline use in primary care. Health Technol Assess. 2003;7(iii):1-97.
Hopkins KF, Decristofaro C, Elliott L. How can primary care providers manage pediatric obesity in the real world? J Am Acad Nurse Pract. 2011;23:278-88.
Svetkey LP, Stevens VJ, Brantley PJ et al. Comparison of strategies for sustaining weight loss: The weight loss maintenance randomized controlled trial. JAMA. 2008;299:1139-48.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
