THE STAR, TUESDAY 22 OCTOBER 2019
OBESITY AWARENESS
Aiding better diabetes management
BARIATRIC surgery (or weight
loss surgery) is a procedure to
reduce the size of the stomach
with a gastric band, through
removing a portion of the
stomach or resecting and
re-routing the small intestine to a
small stomach pouch.
It is often used to treat people
with obesity. However, Dr Pok
Eng Hong, consultant bariatric
and upper gastrointestinal
surgeon at Ara Damansara
Medical Centre, says that after
decades of research and tests, it is
also considered a weapon against
diseases that come with obesity,
such as kidney failure,
hypertension, dyslipidaemia,
stroke, heart disease and diabetes.
Type 2 diabetes is a chronic
progressive disease characterised
by the deterioration of insulin
production over time. As time
passes, the need for medication
increases, and persistent or
worsening glycaemic control may
increase the risk of complications.
However, glycaemic control is
difficult, even more so if the
person is obese. Dr Pok says, “Less
than 50% of patients have optimal
control of their diabetes in the
long term.”
He says diabetes occurs when
an obese patient has developed
insulin resistance. “Research
suggests that weight loss will
resolve insulin resistance.”
With bariatric surgery, or
more commonly known as
gastrointestinal (GI) metabolic
surgery when treating diabetic
obese patients, both obesity and
insulin resistance are dealt with
Spiralling out of control
AMONG South-East Asian
countries, Malaysia ranks as the
most obese country with the
highest percentage of obese people.
It is no surprise then that
childhood obesity rates have also
increased tremendously over the
years.
“In the National Health and
Morbidity Survey 2015, it was
reported that obesity in children
below 18 years old was 11.9%,”
says Dr Wu Loo Ling, consultant
paediatrician and paediatric
endocrinologist at Subang Jaya
Medical Centre.
Although genetic influence is a
common non-modifiable risk factor
of childhood obesity, it does not
account for the rapid increase in
the prevalence of obesity over the
years as genes take an extremely
long time to change or mutate. Dr
Wu says the major causes for the
obesity epidemic are unhealthy
lifestyles and eating habits.
We are now living in an
obesogenic environment with easy
access to calorie-dense food such as
fast food with delivery services,
unhealthy snacks and sugary
drinks, which are all attractive to
young children. In addition,
children are rather sedentary these
days and don’t exercise outdoors.
“Vending machines should be
at the same time.
Only carried out on patients
with a body mass index of above
30, GI metabolic surgery utilises a
minimally invasive keyhole
technique. Dr Pok assures this
procedure is low risk and has a
faster recovery time but notes
that patients will still need a
nutrition plan and enact certain
lifestyle changes to ensure long-
term success of the procedure.
Seek treatment early
We often link diabetic
treatment to medication, insulin
injections or dietary adjustment.
However, Dr Pok poses the
question, “If you had the chance,
will you treat your diabetes early
to prevent future complications?”
He says GI metabolic surgeries
are best done within eight years
of a diabetes diagnosis, as the
organs can still work to bring the
body back to normal. When
diabetes has been left untreated
for too long, organs such as the
pancreas may stop functioning,
hindering the patient’s chances to
reverse the diabetes. Irreversible
diabetic complications may also
arise at this time, but it will be too
late to carry out the surgery.
He says it is important to
change the mindset of the public
regarding diabetes. “If you
consider diabetes to be similar to
cancer, you would want to work
towards getting treatment early.
GI metabolic surgery does not just
resolve your diabetes, but also
many other obesity-related
conditions as well.”
Dr Wu Loo Ling.
removed from schools. School
children are often given extra
money by their parents so that
they can get food for themselves.
Unfortunately, most children
would gravitate towards unhealthy
food choices.
Overweight and obesity in
childhood are known to
significantly impact both the
physical and psychological health
of a child.
Dr Wu shares that childhood
obesity is a disease that leads to
many other diseases and serious
complications. These complications
may range from psychological
issues such as low self-esteem to
Dr Pok Eng Hong.
Thus, he stresses that patients
who struggle with obesity and
diabetes can get another chance at
a normal and healthy life with
such a surgery.
n For more information, call
03-5639 1212.
Growing knowledge field
Dr Pok Eng Hong,
consultant bariatric and upper
gastrointestinal (GI) surgeon at
Ara Damansara Medical Centre,
says doctors still do not fully
understand why patients who
have diabetes can bounce back
after GI metabolic surgery. The
original intent of the surgery is
to help people lose weight, but
doctors soon realised that
insulin resistance in patients
who have undergone this
surgery has disappeared.
physical issues like respiratory
illnesses (including asthma and
obstructive sleep apnoea), high
blood pressure, abnormal lipid
profile, type 2 diabetes mellitus,
fatty liver disease and respiratory
and heart failure. We are
encountering these complications
in many obese teenagers before
they reach adulthood.
Misconceptions about
obesity
When it comes to overweight
and obese children, there are a few
misconceptions that are prevalent
in our society. One of these is the
belief that obesity is solely about
appearance. Dr Wu emphasises
that obesity is a disease, saying,
“Most people don’t think so and
perceive it as a family trait, so
there is no motivation to lose
weight,” she says.
Another misconception Dr Wu
address is that parents think their
child has time to lose the weight.
Although some children may lose
weight as they grow, this isn’t so
for many children. Losing weight
isn’t easy. Childhood obesity tends
to track into adulthood. An obese
child has a 50% chance of being an
obese adult. An obese adolescent
Gastrointestinal metabolic surgery can be the answer for people who
struggle with obesity and the diseases associated with it.
New studies suggest that the
surgery can change a patient’s
GI anatomy to directly influence
blood sugar regulation.
Dr Pok adds that over the past
decade, efforts have been made
to explain the link between GI
metabolic surgery and diabetes.
Currently, some potential
theories have been identified:
l The alteration of the
amount and timing of the
secretion of gut hormones,
which in turn influences
It is crucial for
parents to control
their children’s diet as
they tend to gravitate
towards unhealthy
food options.
has 80% chance of remaining
obese in adulthood.
Many people don’t see
themselves as being overweight.
The National Health and Morbidity
2017 study has shown that in their
cohort of overweight adolescents,
only 44% perceive themselves as
overweight. In this instance, there
is much to be concerned about as
ignorance isn’t bliss and being
overweight is a stepping stone to
other health issues.
Too late?
“Don’t wait until your child is
obese to take action,” says Dr Wu.
Ensure that your child leads a
healthy lifestyle from the start. This
insulin production.
l The increase in production
of certain bile acids that make
cells more sensitive to insulin,
or increase the uptake of glucose
by the gut cells themselves,
thereby lowering blood glucose
levels.
l Changes in the composition
of gut microbiota.
l Increased efficiency of
intestinal nutrient sensing to
regulate glucose metabolism in
the body.
requires specific disciplines first on
the parents and family members
to lead by example. A child’s
upbringing is important as it instils
habits she will carry with her
throughout her life.
Children learn from observing
the behaviours of the adults; hence,
the family must practise a healthy
lifestyle themselves. “You may say
urbanisation has killed our parks,
but that is only an excuse,” says Dr
Wu, who suggests taking your child
out to do activities that enable him
to run around, play and exercise
instead. Do this together as a
family.
n For more information, call
03-5639 1212.
2 Obesity Awareness
Obesity can be Weight loss,
the natural way
unrelated to bingeing
MOST of the time, we hear that the
cause of obesity is overeating. While
it is true, overeating is not the sole
reason. There are times where the
cause of obesity is the result of
various medical conditions.
There are diseases that are
medically proven to cause obesity.
In addition, it is possible for weight
gain to be a side effect from
medication. Below are several
conditions that can cause obesity.
Hypothyroidism
Also known as the underactive
thyroid disease, hypothyroidism is a
disease where the thyroid gland
does not make enough thyroid
hormones. These hormones
generally help the body break down
fat, allowing the liver and pancreas
to metabolise stored calories for
energy.
These hormones also help the
muscles throughout the body as
they use energy. The hypothalamus
reduces the level of thyrotropin
regulating hormone secretion when
a sufficient amount of thyroid
hormones is circulating in the body.
All these actions may be disturbed
if the amount of thyroid hormones
declines or the thyroid gland’s
function diminishes. In addition to
fatigue, the body stores the extra
calories as fat, which can be
particularly challenging to
metabolise.
Symptoms of hypothyroidism
include greater sensitivity to cold,
swelling of the thyroid gland (goitre)
and unexplained weight gain or
difficulty losing weight. Weight gain
may signal low levels of thyroid
hormones.
Cushing’s disease
Symptoms for this disease can
vary depending on the person, but
when it is at its peak, common
symptoms are thinning skin that
easily bruises, weight gain
(especially in the upper body) and
weak muscles. Children with
Cushing’s disease are usually obese
and tend to grow slowly.
> TURN TO PAGE 4
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THE STAR, TUESDAY 22 OCTOBER 2019
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This is a traditional product
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KKLIU No.0384/2019
THE STAR, TUESDAY 22 OCTOBER 2019 3
4 Obesity Awareness
Where work
meets workout
THE “sitting disease” is becoming a
global concern as our lifestyles
become increasingly sedentary
with the latest tools and gadgets
that bring convenience in our daily
tasks to suit our hectic lifestyle.
The increasing sedentary
lifestyle or “sitting disease” is a
term used to describe an individual
whom does not engage in enough
physical activity to be healthy.
Research has linked sitting for long
periods of time with several health
risks, including obesity, diabetes,
high blood pressure, cancer and
cardiovascular diseases such as
coronary heart disease, stroke and
heart attack.
A study involving one million
people has found that physical
inactivity costs the global economy
US$67.5bil (RM283bil) a year in
healthcare costs and productivity
losses, but an hour a day of
exercise could eliminate most of
that. Such inactivity is estimated to
cause more than five million
deaths a year – almost as many as
smoking, which the World Health
Organization says kills six million
people a year.
Making physical inactivity the
fourth leading risk factor for global
mortality. To reduce sitting too
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com.my or shop online
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While obesity has often been linked to gluttony and binge-eating, the truth
is that some medical conditions can make it harder to prevent obesity.
More than
just about food
> FROM PAGE 2
It is all about the stress
hormone: cortisol. When your
body has too much of it, the excess
hormone can affect bodily systems.
The condition, also known as
hypercortisolism, is more common
in women than men. It is most
often seen in people aged 25 to 40.
Symptoms of Cushing’s disease
and how long they last depends on
each patient’s overall health. Most
of the time, Cushing’s disease can
be treated and cured. If it is not
curable, patients may want to look
for ways to manage their weight
gain, muscle weakness and
tiredness.
Consumption of
medication
Drug-related weight gain is not
uncommon, especially with certain
types of drugs. For instance,
steroids and antidepressants are
among the many medications that
can cause weight gain.
Drug-related weight gain can
have many causes. Some may
stimulate your appetite, causing
you to eat more and gain weight.
Certain drugs may affect your
metabolism and cause your body
to burn calories at a slower rate.
Other medicines might affect how
your body stores and absorbs
THE STAR, TUESDAY 22 OCTOBER 2019
sugars and other nutrients.
Drugs that may cause weight
gain include:
l Medications for diabetes such
as insulin. It is normal for insulin
to cause weight gain as insulin
helps you manage your blood
sugar level.
l Antidepressants such as
sertraline. Weight gain caused by
sertraline may be because of fluid
retention, lack of exercise and
increased appetite. Experts
recommend physical activity and
eating fewer high-calorie foods to
manage weight gain while taking
the drug.
l Steroidal hormone drugs such
as prednisone. Weight gain caused
by prednisone is usually because
of fluid retention and increase
appetite. Some people also
experience body fat redistribution,
a symptom that is characterised by
fat deposits collecting in unusual
areas like the base of the neck or
back.
It is normal for everyone to
misunderstand the cause of
obesity as we have always heard
that it happens because of
overeating. Drug complications
and medical conditions that can
cause diabetes should be among
the information doctors give
patients that should be concerned
with possible weight gain from
medical causes.