Current treatment landscape for obesity in Singapore

Abstract

The rising prevalence of obesity in Singapore is a harbinger for a corresponding increase in obesity-related complications such as type 2 diabetes mellitus (T2DM) and coronary heart disease. Obesity is a complex disease driven by multiple factors, and hence, treatment cannot follow a ’one-size-fits-all’ approach. Lifestyle modifications involving dietary interventions, physical activity and behavioural changes remain the cornerstone of obesity management. However, similar to other chronic diseases such as T2DM and hypertension, lifestyle modifications are often insufficient on their own, hence the importance of other treatment modalities including pharmacotherapy, endoscopic bariatric therapy and metabolic–bariatric surgery. Weight loss medications currently approved in Singapore include phentermine, orlistat, liraglutide and naltrexone–bupropion. In recent years, endoscopic bariatric therapies have evolved as an effective, minimally invasive and durable therapeutic option for obesity. Metabolic–bariatric surgery remains the most effective and durable treatment for patients with severe obesity, with an average weight loss of 25%–30% after one year.

Management of type 2 diabetes after metabolic bariatric surgery

“…Tirzepatide is a dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist given as a weekly subcutaneous injection, approved in the US for treatment of T2D in 2022 and for chronic obesity treatment in 2023. A 72-week RCT in participants with obesity and T2D showed a mean weight loss of 15.7% with 15 mg of tirzepatide vs. 3.3% with placebo [68] . (Another similar study in individuals with obesity but without T2D showed mean total weight loss of 16 to 22.5% after 72 weeks' of treatment with tirzepatide 5-15 mg weekly.)…”

Development and Evaluation of Phytosomes Containing Callistemon citrinus Leaf Extract: A Preclinical Approach for the Treatment of Obesity in a Rodent Model

“…The most common drugs used to control obesity are orlistat (pancreatic lipase inhibitor), phentermine (sympathomimetic amine), liraglutide (glucagon-like peptide 1 receptor agonist), and naltrexone-bupropion (opioid antagonist and a dopamine and noradrenaline reuptake inhibitor). However, all of them have undesired side effects [30] that can be reduced using natural products from plants as a strategy against obesity [31].…”

Combating obesity: a change in perspectives

“…Lee et al . [ 12 ] provided a succinct updated summary on the armamentarium of therapeutic tools to target the roots of obesity.…”