In Singapore, obesity and overweight rates for both adults and children are on the rise. In MOH’s annual National Population Health Survey for 2019/2020, it was found that the obesity rate of adult Singaporeans has increased to 10.5%. This was the same obesity rate last seen in 2010, after a slight decrease in 2013 and 2017 (both at 8.6%). From 2017 to 2021, the proportion of students who were overweight (ranging from primary to pre-university levels) had increased from 13% to 16%. Obesity among adults aged 30 to 59 years is around 12.5%, almost double of those aged 18 to 29 years old (6.6%). Globally, it is expected that by 2035, 1 in 4 will be living with obesity, and the expected obese population will be 1.9 billion.
Based on body fat equivalence and comorbid disease risk for Asians, BMIs of 23 kg/m2 and 27.5 kg/m2 defines overweight and obesity respectively. Waist circumference cut-offs of 80 cm for Asian women and 90 cm for Asian men implies abdominal obesity,
Obesity is a disease and has many complex ‘roots’, including mental health, genetic risk, biological factors, physical and social environment, lifestyle, negative stigma, healthcare access, and access to unhealthy foods. Weight is one indicator of obesity, but treating obesity is about improving overall health too.
Read on to find out more on how you can manage obesity with a 3-in-1 approach, from the perspectives of a clinical psychologist, clinical dietitian, and TCM physician.
1. Importance of Stress and Sleep
There is a strong connection between stress and food. Research studies have shown that people tend to respond to stress by either eating more or less. Also, stress can lead to preference of unhealthy food options. Women under psychological stress have shown a strong relationship between stress and unhealthy diet (high in fat, sugars, sat fats; and low in fruits and vegetables). It was also found that impulsivity and emotion suppression influence the relationship between the affected individual and food intake. Also, the body tends to store more fats when stressed, than when relaxed.
Stress eating is also known as emotional eating. When we feel down, we inherently want to do pleasant things that make us feel good and satisfied. Stress eating happens primarily because we are trying to use food to resolve an emotional problem (self-soothe). As such, people are unlikely to notice any sensation of fullness and thus, they will continue to want to eat more. In contrast, physical hunger develops slowly over time and is dependent on the time you last ate. You are likely to experience a sensation of fullness which is the cue to make you stop eating.
Contrary to popular belief, stress eating is not due to a lack of self-control. In fact, people who stress eat are often able to identify other aspects of their life that they feel in control over. Therefore, it is possible to control stress eating.
Sleep is one of our basic needs and it is important for both our physical and mental wellness. However, not everyone is able to sleep well at night. Insomnia is a common sleep disorder that prevalently affects about 10-30% of the population worldwide, some as high as 50-60%. It is more common in older adults, females, and individuals with medical and mental health problems. Insomnia can lead to impairment in daily functioning in terms of poorer work performance and quality of life as well as increase risk of road-traffic accidents.
It is often overlooked that there is a bidirectional relationship between sleep and food. Sleep deprivation can affect appetite and food choices, influencing the likelihood of overeating and choosing unhealthy foods. Research studies have linked insufficient sleep to weight gain, and a higher risk of obesity. Sleep deprivation affects disruptions to normal hormone production, and may affect parts of brain activity in influencing how we think about food.
A lack of sleep has been found to trigger increased levels of certain hormones that influence appetite and hunger, trigger decreased levels of hormones that influence satiety, and enhance brain activity in viewing food as a positive reward. This may make us more vulnerable to eating more than usual to cope with the lack of sleep and increase in fatigue. Overeating heavy or spicy food can also worsen sleep quality by interfering with digestion and increasing risk of heartburn.
THINK: How can you better cope with managing your stress and sleep, such that it does not affect your eating habits?
2. Assess and treat (any) underlying conditions of the body (TCM)
From a TCM’s perspective, excess fats are mostly due to ‘dampness’ and ‘phlegm’ in the body. Our spleen is in charge of the transportation, and transformation of food and our bodily fluids. Over time, due to inactivity and excessive intake of sweet, fried and greasy food, the spleen becomes less efficient in the movement and transport of fluids and food. Hence, ‘dampness’ and ‘phlegm’ accumulate and turn into fatty tissues.
There are 3 main body types associated with obesity. Most of the time, the way our body metabolises the food we eat and the response of the system is influenced by one dominant gland. As every individual is unique, it is possible to have up to 2 dominant imbalances. Consulting with a TCM physician can help to assess your body type accurately and give you the right type of treatments to nourish the body and avoid overstimulation of the metabolic system.
A TCM treatment does not deal only with the excess fats. It also treats the underlying condition of the body that might have led to weight gain. TCM treatments bring harmony and restores balance; and once one’s overall wellness is taken care of, the spleen and metabolism will then be able to process fluids and food efficiently. Losing weight will then no longer be an issue as long as the correct food is consumed in suitable portions.
THINK: Your body type may be more prone to weight gain, sluggishness or fatigue. Do you know what your body type is?
3. Sustainably keep weight off, especially on the rebound.
Losing weight is not the hardest, maintaining the weight loss is. Many weight loss diet plans promote quick and easy ways to shed the kilos, but the weight eventually creeps up and you may not only regain back the numbers but also put on a few more extra!
Obesity is a complex disease, but so are our bodies! Our muscles, hormones, metabolism and other body systems are in flux as our age increases; and losing weight is not just simply any diet and exercise. The type of diet, how much calories to reduce, and type of exercise matters.
Calorie deprivation results in physiological, neural, and attentional changes, and those changes make it difficult to engage in the behaviours necessary to keep weight off. But since those changes do not directly cause weight to return, it is still possible to keep weight off. This possibility allows people to discount the powerful role of these changes, and instead to argue that if people regain the weight, it must be due to their poor self-control. The key misunderstanding here is the different physical and cognitive context in which dieters hold the fork compared to non-dieters: they feel hungrier, their attention is focused on food, they find food tastier, and they get more reinforcement from it.
Severe calorie restriction can also be risky as it can result in an overall decrease in basal metabolic rate (BMR) due to intentional under-feeding and nutritional inadequacy of macro- and micronutrients. This then results in an increase in muscle loss first (fat loss occurs after an extended period), chronic fatigue, and a higher risk of osteoporosis. It is important to support metabolic health and retain lean muscle while losing weight, such that metabolism is not drastically compromised with weight loss.
THINK: How can you lose weight without affecting your metabolism and lean muscle mass?
What Can You Do?
Obesity is a complex disease and it is linked to over 200 other diseases; including diabetes, cardiovascular disease, stroke, osteoarthritis, infertility in women, sleep apnoea and an increased risk of 13 different types of cancers such as liver, kidney and breast. It is not just one individual’s responsibility to bear, and most often, watching one’s diet and exercise alone are not always enough for weight loss and to maintain that weight loss.
With the recent increase in obesity rates post-pandemic, obesity has been recognised to be a chronic disease that requires long-term medical follow-up / management, and should be managed by a team of healthcare professionals. To treat it successfully, you need a custom-designed treatment plan that fits your specific needs. The plan will vary depending on your circumstances, health issues, previous measures taken, and reasons for your weight gain (biology, psychology and behaviour).
Certain behaviours (e.g. stress eating or insomnia) could be stemming from emotional problems. Therefore, seeking professional support to work through, process and regulate difficult emotions can greatly help to reduce such behaviours from affecting you and your weight. Consulting with professional dietitians and TCM physicians to help you take into account your unique body type and metabolism could also help you to achieve weight loss that is sustainable, in a way that’s right for you and for your body..