Weight Loss

Obesity is a serious problem.

It’s not just about looking good. Being obese puts you at risk of all sorts of nasty diseases from Heart Attacks to Strokes and even Cancer!

So how do you know if you are obese or not?

The most common way is to use the BMI. This is how you calculate it:

Take your weight in KG and divide it by your  height in Meters squared.

i.e Weight (KG) / Height (M) x Height (M)

So if you are 1.6M tall and weight 60 kg, your BMI = 60 / 1.6 x 1.6 = 23.4375

This is how you interpret it:

< 18.5 = Underweight

18.5 to 22.5 = Healthy Weight

22.5 to 25 = Overweight

< 25 = Obese

I am sure you read a lot of articles that argue the BMI isn’t a great indicator of obesity and I agree with this. However, it does give you an idea which side of the scales you are on.

So how do you lose weight?

First of all, you have to make sure your weight gain is not due to a medical problem.

If you have for example a Thyroid problem or a kidney problem, you can exercise till you are green in the face and you still will not lose weight.

In fact, in these situations, exercise may be even dangerous for you.

So head down to your friendly doctor and get him to check you out and make sure your weight gain is just due to poor lifestyle choices.

Once that is done, you can focus on actually losing the weight.

Caloric Balance

At the end of the day, weight loss all comes down to caloric balance. If you burn more calories than you take in, you will lose weight. This is an inalienable fact unless your weight gain is caused by a medical disease.

So if you burn 500 more calories (Kcal) than you take in a day, this translates to 14,000 Kcal in 4 weeks which roughly translates to 2kg of body weight.

This is safe and sustainable. The 2 key words in weight loss. You do NOT want to embark on a weight loss that is too fast. This can lead to health problems (and even death) and usually cannot be sustained. In other words, you will give up and gain back more weight than you lost.

Calories IN

This is the easiest and also hardest to control. Easy because all you have to do is to eat less and eat more healthy. Hard because as humans, we are hard wired to want to eat more (survival instinct) and we can easily give in to temptation.

What I found was helpful was to get an App. There are hundreds of Apps available to track how many calories you take in a day. They are certainly not 100% accurate but they do give you an idea. More importantly, they will highlight to you foods that you previously thought was healthy but actually was not. For example, you are at a fast food joint (which you shouldn’t be) and you decide to have the Lime juice and not the Cola because it is more healthy right? Wrong! The Lime juice contains much more sugar than Cola! If you had the App, it would have told you that.

It is also not about the total calories you take in, it is also about healthy calories. Low GI foods release sugar slowly into your system. Although they may contain the same number of calories as High GI foods, they keep you full longer and therefore you end up eating less in total. They also keep your energy levels up so you do not get that post lunch sleepiness. This also means your metabolic rate remains high and you are burning more calories.

Calories OUT

Just to keep alive, we burn calories constantly. Activities like breathing, heart beating even thinking requires calories. Depending on your activity level (usually related to the kind of job you do), this baseline caloric burn per day differs. A very rough average is 30 Kcal per KG per day. So if you are 60kg in weight, you will need about 1800 Kcal per day as a base. Which also means if you take IN 1800 Kcal per day, and do no exercise, your weight will not change.

You can take IN less than 1800 Kcal per day. Your body will then draw on your reserves to make up the difference. This will lead to weight loss.

However, this is not ideal because your body might go into starvation mode because it starts to get worried that there is no more food coming in. Your body may then reduce the metabolic rate and store more fats. You will feel hungry all the time because your body wants more calories. This will make you cranky, irritable, unable to concentrate and generally be in a very bad mood. Furthermore, you may end up skinny but very unhealthy. Because you are not getting the essential nutrients you need and you are not benefiting from exercise.

So a better way to do it is to increase your caloric output. You do that by working your muscles. Yes! Exercising!

Remember the 2 magic words? Safe and sustainable. So before you go out there and run an ultra-marathon, see your doctor to make sure you can. Start slow. In fact, start so slow that you ask yourself “this is so easy! Is this really exercising? I’m not even breathing hard!”. If you say that to yourself, you are doing it right.

A more accurate way to know how hard you should go is by monitoring your heart rate. Go invest in a heart rate monitor.

How hard do you go?

Take 220 minus your age. That is your maximum heart rate. You should be exercising at 70% to 75% of your maximum heart rate. Do this at least 5 times a week for at least 20 minutes each time.

For example you are 30 years old. Your maximum heart rate is 190 beats per minute. You should be exercising at between 133 to 142 beats per minute. When it goes above this, slow down. When it drops below this, speed up. This is your green zone. It is when your body is most efficient at using oxygen to burn away calories.

Medicines for weight loss

Honestly, if you do all the above right, you will lose weight. There is no need for fancy pills or wraps or what-have-you.

The current pills commonly used for weight loss are:

Xenical Orlistat – this is what is called a lipase inhibitor. Basically it stops your body from digesting and absorbing fats and oils. It works only in the intestines and is not absorbed into the blood stream. As such, it is very safe. However, the oil that is not absorbed has to come out from somewhere. Yup, you guessed it. It comes out from the anus. So you really need to be careful when on this medicine. A good way to control this is by taking a lot of fiber. The fiber traps the oil and you will have oily stools instead of an accident.

Panebsy/Duromine – these are called phentermines and are also known as appetite suppressants. They basically trick your brain into believing that you are full. These pills can have side effects like palpitations and insomnia. They also stop working after about 3 months. It is best to think of these pills as a very short term kick start to a more sustainable weight loss program based on lifestyle changes.

Glucobay – this is a medicine used to treat diabetes but has been used by  doctors for weight loss. What it does is it blocks the body from absorbing carbohydrates. Because it is not absorbed into the blood stream, it is also relatively safe. However, the undigested carbohydrates in the gut will be broken down by bacteria and this can cause a lot of gas. A socially embarrassing but not dangerous side effect.


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In hot and sunny Singapore, it is normal to sweat, right?

Check out our New Article on Tablets to stop Sweating HERE. 

Yes, it is usually normal. Indeed, sweating is one of the most important ways that your body dissipates heat and regulate the body’s temperature. However, for a small minority of people, their body produces sweat in amounts far greater than what is needed for normal thermoregulation.

In most cases, this excessive sweating is often produced on relatively minor triggers like certain types of food or in social situations involving minor anxiety or strong emotions; In some people, the sweating reflex is even triggered inappropriately e.g. When feeling cold.

Medically this excessive sweating is termed as hyperhidrosis. Studies show that as many as 2-3% of the population suffer from this problem. Hyperhidrosis leaves patients constantly feeling wet or damp in certain parts of the body. Nowhere is this more embarrassing than having the telltale sweat marks on the clothing in the armpit area; Not to mention the possible odour that it causes.

To be sure, the sweat itself doesn’t produce the odour, but if the sweat remains in the armpits for a sufficient amount of time, bacteria eventually starts to work on the sweat and this produces the smell that we are all too familiar.

Most combat this problem using anti-perspirants, which have a long history, being invented more than a century ago. The active ingredient in such products are actually aluminum salts and now comes in many forms like aerosol sprays, creams, roll-ons and even crystals.

These work by interacting with the electrolytes in sweat to form a gel-like plug in the ducts of the sweat gland to prevent the sweat from reaching the surface of the skin. This is actually quite an elegant solution to the problem but this plug may not last long and gets sloughed off easily. In addition, its efficacy varies from person to person, working well for some people while being close to ineffective in others.

In particular, for people with hyperhindrosis or excessive sweating, anti-perspirants are only effective if used in high concentrations and in these concentrations, local skin irritation is common.

Nevertheless, anti-perspirants are easily available over-the-counter and is currently the most popular treatment for hyperhindrosis.

For patients whose sweating problems are more severe than what anti-perspirants can treat, or desire a more complete and lasting treatment, they can undergo a surgical procedure called endoscopic thoracic sympathectomy (ETS). This involves clamping or destroying the part of the nerve that controls sweating in the affected areas.

Being a surgical procedure, this involves some downtime for patients and some side effects are often reported. These side effects can range from trivial to some relatively debilitating. Oftentimes, there is compensatory sweating in areas that have not been treated, causing more sweating that what is usually experienced in other parts of the body.

Additionally, due to nerve regeneration, the procedure may not ensure a complete and permanent relief, with some patients reporting a recurrence of the sweating problem as early as 6 months post procedure.

For patients who are not keen for surgery, this is where BOTOX comes in.

As most are aware, BOTOX is the protein derived from toxin produced by certain bacteria which paralyses muscles, including those of the face to remove wrinkles.

What is less known however, is that this same protein is also useful in disabling sweat glands. This new indication for the use of BOTOX has been approved by the United States Food and Drug Administration just over 5 years ago.

This procedure involves first using a dye to highlight the areas that are producing excessive sweat in the armpits. Then, using a very fine needle, a series of injections are made in the offending areas. As the needle is very fine and only a small amount of fluid injected each time, pain is usually not an issue. There is also no downtime and normal activities can be resumed almost immediately post procedure.

The BOTOX works by interrupting the actions of the nerves that supply the sweat glands and hence, preventing the glands from producing sweat.

The sweating stops in more than 90% of patients less than a week after treatment with many reporting good results as early as a few days post injection. In rare cases, a top up may be needed to augment the effects if results are not satisfactory after the first procedure. Side effects from the procedure are usually minor, e.g. Mild swelling and erythema at the injection site. As the injections are very superficial, it does not affect the underly tissues like nerves and blood vessels. Moreover, the treatment is local, so there are no widespread side effects on the body.

For long suffering patients, this therapy is a delightful change, liberating them from the daily worries of sweating in the wrong place at the wrong time. Along with it, odour problems become a thing of the past.

Nevertheless, BOTOX is not a permanent cure for hyperhindrosis and the effects last anywhere from half a year to almost year (depending on individual patients) before starting to wear off slowly. When this happens, don’t worry, the treatment can be repeated… No sweat!

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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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