Obesity in South and Southeast Asia—A new consensus on care and management

Abstract

Summary Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.

Weight bias and stigma in healthcare professionals: a narrative review with a Singapore lens

“…Such research may be especially important to inform future initiatives to reduce barriers to access and provision of care. Finally, given the diversity of ethnic backgrounds, the unique food culture in Asia and Singapore and the influence of culture on one's view on bodyweight,[ 3 ] further research is needed on the impact of cultural beliefs on weight bias, especially implicit bias, and weight stigma.…”

“…[ 2 ] This number is expected to rise to more than 1 billion adults, affecting one in five women and one in seven men worldwide by 2030. [ 2 ] In Southeast Asia, predictions forecast that the prevalence of obesity will double between 2010 and 2030[ 3 ] and will affect 50% of children by 2030. [ 2 ] In Singapore, about one-third of adults are living with overweight and 11% are living with obesity.…”

“…[ 5 ] Estimated figures for Singapore are, at best, conservative and likely to underestimate the scale of the problem, given that people of Asian descent have a higher proportion of body fat detrimental to health and experience obesity-related complications at lower body mass index (BMI) values, relative to other populations. [ 3 ]…”

Culturally Tailored Dietary Interventions for Improving Glycaemic Control and Preventing Complications in South Asians with Type 2 Diabetes: Success and Future Implications

“…Additionally, switching to low glycaemic index foods has been effective in reducing HbA1c levels [ 39 ] and could be better accepted when the substitutions included culturally acceptable (or familiar) foods that do not cause drastic changes to the traditional diet [ 23 ]. It is worth noting that it is unlikely that the weight loss achieved in the included studies equated to 5%, which is recommended as a clinically significant decrease in weight [ 52 ]. It has been previously suggested that improvements in glycaemic control can be effective in reducing fatty liver independent of weight loss, suggesting the importance of optimising blood glucose levels for managing diabetes regardless of weight change [ 53 ].…”

The global agenda on obesity: what does this mean for Singapore?

“…In addition, some would require more intensive interventions such as dietary prescriptions, cognitive behaviour therapy, antiobesity pharmacotherapy and bariatric surgery. [ 38 39 ] Referral to tertiary care may be warranted to manage more severe obesity complications. Viewed merely as a lifestyle factor which increases the risk of other diseases rather than a disease itself, obesity treatment in Singapore is mostly an out-of-pocket cost.…”