SUNDAY STAR, 18 OCTOBER 2020
OBESITY AWARENESS
Ray of hope for obese patients
THERE are times when obese
patients may feel hopeless during
their weight loss journey. No
matter how much they try to
control their daily food intake and
exercise level to lose some pounds,
it is just not enough sometimes.
Certain health conditions may also
be a factor that prevents an
overweight individual from
shedding some pounds.
Because excessive weight gain
and obesity can lead to a myriad of
health complications, medical
treatments may be the way to go
for such individuals. Fortunately,
Subang Jaya Medical Centre
consultant bariatric surgeon Dr
Cha Kar Huei explains that there
are quite a few treatments for
obesity nowadays which are less
invasive compared to ones a
decade ago. “Open surgery is rarely
the option anymore when these
less invasive treatments are
available,” he says.
Straightforward
procedures
Dr Cha classifies the minimally
invasive treatments into two
categories – endoscopic and
laparoscopic. Endoscopy treatment
is performed via the use of a thin,
flexible tube with a monitoring
device attached at its end, while
laparoscopy involves making
multiple small incisions at the
abdomen so that a small telescope
can be inserted through one of the
incisions to get a good view inside
the abdominal area.
The most popular endoscopic
treatment is the use of a gastric
balloon, where a balloon is
inserted through the mouth with a
scope and inflated in the stomach
to a certain size. There is no
incision needed in this case. The
balloon will then reduce the space
that is available for food. “This
balloon will help patients to cut
down their appetite and that is
how they can reduce their weight,”
explains Dr Cha. This easily
adjustable gastric balloon can be
adjusted every few months and
must be retrieved one year after
the insertion.
For laparoscopy – also known as
keyhole surgery – Dr Cha mentions
Because excessive weight gain and obesity can lead to a myriad of health
complications, medical treatments may be the way to go for such
individuals.
If patients feel like they
need to do something
with their weight
problem, they should
not hesitate to consult
a specialist.
that laparoscopic sleeve
gastrectomy is the most common
surgery chosen by patients with
obesity around the world, as more
than 50% of obese patients would
undergo this surgery. “We remove
about 70% to 80% of the stomach
and leave the patient with a
stomach about the size of a
banana.” Dr Cha explains that
patients who undergo this surgery
will not be able to eat as much as
they are used to. This will help to
change the patients’ eating habits
so that they will learn to eat better
and slower.
Laparoscopic Roux-en-Y gastric
bypass and laparoscopic mini
gastric bypass are two popular
treatments among patients.
Commonly known as a gastric
bypass, a small section from the
stomach is isolated and this smaller
portion is connected to the small
intestine which has been rerouted.
Dr Cha clarifies that while both the
sleeve and gastric bypass aid in
weight loss, “gastric bypass has an
added advantage because by doing
a bypass to the small intestine, it
eventually changes the hormonal
production of the small intestine”.
The bypass will cause the
production of hormones that are
beneficial in controlling the
patient’s blood sugar, such as
glucagon-like peptide-1. As an
example, this hormone would
benefit diabetic patients in terms
of reducing blood sugar and
insulin resistance.
Changing trends
When asked how these
treatments differ from traditional
bariatric surgery, Dr Cha explains
that performing open surgery on
an obese patient can be quite
Many patients would worry about the recovery process after receiving
treatment, and Dr Cha says the most difficult part would be the post-
surgery diet.
difficult. “To gain access to the
abdomen, you’ve got to cut through
some layers of fat and skin. So, that
is the advantage with the keyhole
surgery – you can see better.” Dr
Cha says these treatments reduce
the chances of bleeding, decrease
wound and lung infection rates,
lessen post-operation pain and
shorten the length of patients’
hospital stay. Almost every weight
loss surgery in the world right now
is done via keyhole surgery.
It is natural for anyone
considering undergoing this
surgery to worry about its risks
and complications, especially those
with underlying conditions.
However, Dr Cha assures that these
treatments are safe for obese
patients. “Patients with diabetes
and high blood pressure itself is
not a contraindication for the
surgery. In fact, it would help them
– even those with significant heart
history.” Nevertheless, if the
patient has had severe heart
failure and cannot withstand
general anaesthetic, the attending
physician would be very careful in
terms of recommending the
surgery to them.
As these treatments are
minimally invasive, the time taken
to complete the procedure can be
very quick compared to traditional
bariatric surgery. “With a gastric
balloon, the procedure will only
General surgical risks and possible side effects
Weight loss surgery, as with
any other major surgery, has
risks which patients should be
aware of.
Although surgical
complications are infrequent, it is
important for them to fully
understand any potential risks so
that they can make an informed
decision.
Potential side effects include,
but are not limited to:
last for 30 minutes.” Laparoscopic
surgery can take around one-and-
a-half hours to three hours,
depending on the type of surgery.
Minimal risks
Dr Cha notes that patients who
undergo these treatments usually
do experience some side effects.
“Feeling bloated, nausea or
vomiting during the first four days
after the insertion of the balloon
are normal. Patients can also easily
get dehydrated.” He mentions that
there are patients who require
some intravenous fluid
replacement after the gastric
balloon placement because of
dehydration. In terms of
complications of the gastric
balloon, Dr Cha says gastric ulcers,
bleeding because of gastric ulcers
or any perforations of the stomach
are rare.
For laparoscopic weight loss
surgery, leakage from the staple
line or anastomosis (connection)
leaks are a major complication. A
leak may result in the need for
more surgeries, revisions and
prolonged hospitalisation with
rehabilitation. However, the risk of
developing a leak is approximately
between 0.5% and 1%.
Quite a lot of patients would
worry about the recovery process
after receiving treatment, and Dr
l Nausea, vomiting
l Gas, bloating
l Lactose intolerance
l Changes in bowel habits
Potential complications
include, but are not limited to:
l Infection, bleeding or leaking
l Dehydration
l Blockage of the intestines or
stomach pouch
l Protein malnutrition
Dr Cha Kar Huei.
Cha says the most difficult part
would be the post-surgery diet.
“Right after surgery, you have to
be on a liquid diet for one week.
The second week is like a puree
diet and blended diet. The third
and fourth weeks are soft food
like porridge,” he says. In terms
of other diets, a nutritionist will
be standing by to recommend the
appropriate food intakes. Post-
operative pain is normally not an
issue for patients, and patient are
encouraged to ambulate early
after surgery.
As for exercising, patients should
be able to get back on track after a
month – though they may still
suffer from mild abdomen
discomfort then. Dr Cha also
stresses that a support group is
vital for patients because it would
provide them mutual support in
dealing with the sudden changes to
their diet.
The other common question
asked by patients is whether they
would gain their previous weight
back. Dr Cha explains that weight
loss with the gastric balloon is not
as sustainable as the surgery and
only acts as a temporary fix. “The
patient would gain some weight
back after the removal of the
balloon. That is why lifestyle
changes is important.”
Dr Cha adds that he only offers
the balloon treatment for those
who do not need to lose a lot of
weight. Surgery, on the other hand,
is different since it is more
permanent. Weight loss surgery
would usually be offered to those
with a body mass index of more
than 30.
Finally, Dr Cha says the
treatments for obesity nowadays
are very straightforward and much
safer compared to open surgery in
the past, and that they are even
safer than emergency gall bladder
surgery. “If patients feel like they
need to do something with their
weight problem, they should not
hesitate to consult a specialist.
While doctors may offer various
types of weight loss procedures,
and whatever the procedure that
patients end up choosing, the
single most important thing is that
the patients will have to change
their lifestyles.”
n For more information, call
03-5639 1212.
8 Obesity Awareness
Introducing online solutions
THE issue of obesity is nothing new in
Malaysia, with the nation holding the
lamentable position of having the highest
rate of obesity among Asian countries.
Globally, obesity has been a public health
concern of the World Health Organization
(WHO) since 1975.
In Malaysia itself, obesity is recognised as
one of the leading risk factors contributing to
the rise of non-communicable diseases
which, according to the WHO, causes up to
71% of deaths globally.
This concern is further intensified with
evidence from multiple studies – among
which are two research articles published
this year titled Individuals with obesity and
Covid-19: A global perspective on the
epidemiology and biological relationships
and Prevalence of obesity among adult
inpatients with Covid-19 in France –
indicating that obesity increases the risk
and severity of Covid-19.
Joining ongoing obesity and mental
health awareness campaigns, BookDoc is
highlighting two of its features – namely,
Digital Health coaching by in-house health
coaches who provide personalised advice
on nutrition and exercises to ensure that
people stay fit and physically healthy; and
Mental Health consultations by mental
health professionals via the BookDoc Tele-
Consult to address any significant and
sustained rise in mental health issues.
For users who are hesitant to reach out or
value their privacy highly, a Mental Health
consultation can be obtained anonymously
from the app. In addition, users can seek
quick consultations, should they suspect
themselves of possessing any Covid-19
symptoms. Doctors can screen the affected
patients swiftly and appropriate measures
can be implemented to limit any further
contamination. The BookDoc app also
enables physical distancing for those looking
to have any type of health consultations.
Health director-general Tan Sri Dr Noor Hisham Abdullah (third from left) and BookDoc
founder Datuk Chevy Beh (fourth from left) commemorating BookDoc’s collaboration with
the Ministry of Health Malaysia in April this year.
BookDoc is a multi-award-winning
company that has won recognition from
CNBC, the ASEAN Summit and Frost &
Sullivan (2015-2019) as one of the most
innovative healthcare technology start-ups
in the region and globally. With a presence
in five countries (Malaysia, Singapore,
Indonesia, Hong Kong and Thailand) and 20
cities, BookDoc is an online platform that
operates across the healthcare continuum,
connecting patients to healthcare
professionals anytime and anywhere.
BookDoc’s end-to-end healthcare
ecosystem comprises seven comprehensive
platforms benefiting all users:
1) Search & Book: A fast and hassle-free
online appointment system with healthcare
professionals to help facilitate physical
distancing
2) Activ: The higher the step count, the
greater the rewards. By exercising, users
can earn rewards and discounts from over
100 major retail partners in 12 countries
(redeemable across over 4,400 offline and
online locations).
3) Marketplace: A premium e-commerce
platform with a variety of health services
available which users can enjoy at
discounted rates and redeem at hospitals,
clinics and other health/wellness facilities
SUNDAY STAR, 18 OCTOBER 2020
Users can seek quick
consultations, should they
suspect themselves of
possessing any Covid-19
symptoms. Doctors
can screen the affected
patients swiftly and
appropriate measures can
be implemented to limit any
further contamination.
with over 5,000 stock keeping units
4) Tele-Consult: Professional consultations
from the comfort of home. Tele-Consult
brings healthcare to users’ fingertips through
a live chat session with healthcare
practitioners and specialists covering topics
including children, skin, mental, women’s
and sexual health.
5) Events & News: The latest medical and
health information are made available here,
along with events such as health
conferences, marathons, blood donation
drives and so on
6) Health Coaching: With this feature,
users will be able to reach out to its team of
in-house nutritionists and dietitians about
dietary advice to achieve their desired goals
7) Covid-19 Feature: Users can make use
of its lab uberisation of real-time Covid-19
PCR tests and webinar sessions on Covid-19-
related matters, among others
n For more information, download the
BookDoc app at the Google Play Store or
Apple App Store, or visit www.bookdoc.com
SUNDAY STAR, 18 OCTOBER 2020 9
10 Obesity Awareness
Obesity
stigma – the
hidden scars
OBESITY is no small issue in
Malaysia. According to the World
Health Organization (WHO), in
2019, Malaysia had the highest rate
of obesity among Asian countries
with 64% of males and 65% of the
female population living with the
condition. The physical
complications of obesity are
numerous, with cardiovascular
disease, diabetes and various types
of cancers only comprising a small
part of it.
However, the issues of obesity
bring more than just physical
problems. The stigma surrounding
obesity has begun to rise among
citizens as well. According to a
study published this year titled
Obesity, Stigma and Discrimination,
the obesity stigma affects the
media, schools, workplaces and
even in the healthcare sector.
Obese individuals are often the
butt of jokes in mainstream media,
and overweight children are
constantly being teased in school.
Obese or overweight people are
often depicted as lazy or stupid, and
their weight is often implied to be
their own fault – a sentiment that
has repeatedly been proven wrong.
Moreover, healthcare
professionals have been found to
display biased attitudes towards
obese patients. In the same study,
it’s shown that doctors with weight
bias spend less time with, and offer
less support and empathy towards
their overweight patients.
As the stigma of obesity is
everywhere, it’s nearly impossible
to miss, especially to those living
with the condition. Obese
individuals see reminders of their
condition everywhere – and more
jarringly, what their friends, family
and community think of it.
> TURN TO PAGE 12
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SUNDAY STAR, 18 OCTOBER 2020
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This is a traditional formula. This
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SUNDAY STAR, 18 OCTOBER 2020
Natural way to maintain
a healthy cholesterol level
IN recent years, the incidences of non-
communicable diseases (NCDs) such as
heart disease have been on the rise in
Malaysia, according to the 2019 National
Health and Morbidity Survey by the
Ministry of Health Malaysia. NCDs are diet-
related chronic diseases and the dominant
risk factors are a high blood cholesterol
level, diabetes, hypertension and obesity.
The aforementioned survey noted that eight
million Malaysians have a high cholesterol
level, 3.9 million Malaysians have diabetes,
6.4 million Malaysians are afflicted with
hypertension and 3.7 million Malaysians
are obese.
It is estimated that the prevalence of
these NCD risk factors will continue to
increase and is indeed a worrying trend for
the country because many people seem to
be oblivious to the truth and continue to
indulge in unhealthy lifestyles.
A slight modification in an individual’s
daily diet with the inclusion of high fibre
foods such as oat bran – which contains
the cholesterol-lowering substance called
“oat beta-glucan” – is one of the most
natural ways of managing a high blood
cholesterol level.
Oat beta-glucan is a soluble form of
dietary fibre that produces a cholesterol-
lowering effect due to its high viscosity. It
dissolves inside the digestive tract where it
forms a thick gel in the small intestine. This
viscous ‘net’ traps cholesterol and
cholesterol-related particles (bile acids) and
prevents them from being absorbed into the
bloodstream. They are then passed,
harmlessly, out of the body. When the liver
subsequently has to produce more bile acids
– which are needed by the body for fat
absorption – it uses cholesterol in the
bloodstream to do so. This results in a
reduction of one’s low-density lipoprotein
cholesterol (bad cholesterol) level.
Two-in-one health benefits
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Approved health claims:
The health claims for oat beta-glucan
that are approved by the European Food
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l 3g of oat beta-glucan daily aids in
lowering cholesterol
l Oat soluble fibre (beta-glucan) helps
to decrease the rise of blood glucose,
provided that it is not consumed together
with other food
l Consumption of beta-glucan from
oats contributes to a reduction of the
glucose rise after a meal
Obesity Awareness 11
A slight modification in an
individual’s daily diet with
the inclusion of high fibre
foods such as oat bran is
one of the most natural ways
of managing a high blood
cholesterol level.
oats and barley and maintenance of normal
blood LDL-cholesterol concentrations,
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energy intake, reduction of post-prandial
glycaemic responses and “digestive function”
pursuant to Article 13(1) of Regulation (EC)
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12 Obesity Awareness
Health risks of being overweight
OBESITY is currently a prevalent condition
among Malaysians. It is a multifactorial and
complex condition which is characterised by
excessive fat and leads to excess weight gain.
Generally, obesity is classified according to
the body mass index (BMI) and is calculated
as: BMI = Weight (kg) / Height (sq m).
There are also other ways to measure an
individual’s degree of overweight or obesity
such as the body fat percentage or waist
circumference (to measure abdominal fat
levels). Usually, a body fat percentage of
25% or more in males and 35% or more in
females is considered as obese and requires
intervention to prevent other complications.
A study carried out among the Malaysian
population by the National Institutes of Health
Malaysia showed 52.6% of adults suffered
abdominal obesity last year, higher than the
48.6% in 2015, while obesity prevalence in
adults rose from 17.7% (or 3.3 million people)
in 2015 to 19.7% last year. The percentage of
overweight individuals also increased slightly
from 30% in 2015 to 30.4% last year. This
means that half of the adults in Malaysia are
either overweight or obese as of last year.
Obesity by itself is a condition that needs
to be addressed as it leads to various other
medical conditions and lifestyle implications.
Some of the medical conditions indirectly
caused by obesity are:
l Hypertension
l Type 2 diabetes mellitus
l High cholesterol
l Coronary heart disease, which leads to a
heart attack
l Obstructive sleep apnoea
l Cardiac failure
l Fatty liver disease
l Gallstones
l Stroke
l Osteoarthritis of the knees due to
excessive weight
l Certain cancer conditions
Besides developing into chronic illnesses
Dr Imran Khan Jallaldeen.
due to obesity, the quality of life of an obese
patient is hampered by his difficulty in
performing daily activities and the uptick
in sedentary habits that will lead to more
weight gain and increased morbidity.
One simple modification to lower a
patient’s overall weight is by cutting down
his portion of daily intake which will
indirectly reduce daily calorie intake and,
hence, create an overall calorie deficit. In
addition, freshly prepared food with high
fibre should be included in his diet. A calorie
deficit of 500 kilocalories (kcal) to 1,000kcal
from the patient’s total daily maintenance
calories is needed for weight loss.
Moreover, it is recommended to drink six
to eight glasses of water a day and make a
habit of exercising in order to prevent
obesity. Obese people can start exercising
with a lower intensity during a shorter time
period, then steadily and progressively
increase the duration and intensity.
Weight loss clinics provide counselling to
Classifications of BMI
Classification
Underweight
Normal Weight
Overweight
Pre-Obese
Obese-1
Obese-2
Obese-3
The ideal weight loss should be about 0.5kg to 1kg a week over a six-month duration, says
Dr Imran.
evaluate patients’ eating habits and lifestyles
that can be modified to reduce their weight.
With the available health screenings and
evaluations, any underlying illnesses
causing excessive weight gain such as
hypothyroidism or metabolic syndromes
can be identified and quickly addressed.
Such changes would undoubtedly cause
most patients to experience a significant
amount of stress and demotivate them –
therefore, it is suggested that they utilise
some of the more common ways to manage
or cope with stress such as meditation,
relaxation techniques and even physical
activity. Weight loss support groups will
also help those with low self-confidence to
overcome this mindset, besides offering
more advice about sustainable methods for
weight loss.
According to Dr Imran Khan Jallaldeen,
MyHomeMedic Unit head at MSU Medical
Centre, “A reasonable weight loss goal
must be set up and the ideal weight loss
should be about 0.5kg to 1kg a week over a
Grappling with body-shaming
> FROM PAGE 10
The weight of the stigma on people with
obesity becomes apparent in their mental
health. All stigmas are hurtful regardless of
their type, and people who are constantly
reminded that their obesity is something to
be ashamed of and reviled begin to
internalise it, believing that their condition
is indeed rightly attacked and hated.
Obese individuals constantly exposed to
the stigma commonly suffer from mental
health issues such as depression, feelings of
worthlessness, low self-esteem, poor body
image and suicidal thoughts. A report by
WHO indicates that such individuals often
redirect the body-shaming and stereotypes
onto themselves, joining others in the hatred
and dissatisfaction of their own bodies.
In an ironic twist, the weight stigma has
always had the opposite effect on people
with obesity when it comes to their
physical health and improving it. According
to a 2018 article published in Today’s
Dietitian titled The Health Impact of Weight
Stigma, the stigma has been intentionally
used in healthcare centres and in society
as a “motivator” for obese people to lose
weight. However, those who have been
shamed by their healthcare providers or
have sensed the weight bias from their
doctors are much more reluctant to return
for their appointments, as they’ve lost trust
in their doctors or have been hurt by them.
Additionally, those with obesity often face
assumptions of bias from their healthcare
providers, such as the belief that their health
issues can purely be solved by losing weight.
This leads to inaccurate consultations and
diagnoses, and obese patients are often left
believing that their doctors won’t take them
seriously due to their weight.
These factors combined create an
unpleasant cocktail of hurt, mistrust and low
self-worth for obese patients. They would
then cancel further appointments and often
avoid medical care altogether. Furthermore,
many people with obesity cope with their
SUNDAY STAR, 18 OCTOBER 2020
BMI
<18.5
18.5 - 22.9
>23
23 - 27.4
27.5 - 34.9
35 - 39.9
>40
six-month duration. Losing a large amount
of weight over a shorter period is
considered dangerous to the patient’s
overall health and may cause rebound
weight gain once the individual deviates
from his weight loss routine (eating a very
low number of calories during the weight
loss phase, for example).
“It is vital to increase patients’ knowledge
regarding obesity and its complications, and
provide awareness to others.”
He adds, “Obesity is a chronic condition
that will lead to various other medical
conditions that could be detrimental to
patients’ health and may reduce their
overall quality of life. Hence, modifications
and interventions will be required to
improve the quality of life and to prevent
the development of conditions like
hypertension, type 2 diabetes and so on.
“In Malaysia, the adult obesity rate is
increasing alarmingly and needs to be
addressed by all parties to build a healthier
and fitter nation overall.”
Continuous stigma surrounding obesity can
negatively affect the mental health of
individuals.
negative feelings by delving into self-
destructive behaviour such as binge eating
and not exercising, which results in them
gaining even more weight than before.
Stigmas are never seen as good or helpful,
regardless what form they may appear in.
However, the stigma around weight has
been widely accepted by society – even by
obese individuals themselves.
Instead of encouragement and support,
they’re faced with judgement and
mockery, some done in the guise of
“motivating” them to live a healthier
lifestyle. Would people want to live in a
society where obese individuals have
stopped believing in themselves because
no one said they could? Would you? Think
carefully about the answer.