Senior Consultant Surgeon & Head of Surgery at SKH. Leads Upper GI & Bariatric Service. Fellow of RCS Edinburgh & Glasgow and World Obesity Federation. PhD in Biomedical Engineering. Expert in surgical innovation and obesity treatment.
Bariatric Surgery
Clinician's Perspective: • Mortality rates for bariatric procedures are statistically low, generally observed at less than 0.3% (approximately 3 in 1,000 patients) within the first 30 days. • Early Complications: Immediate post-surgical risks include Venous Thromboembolism (blood clots in the veins) and Anastomotic Leaks (leakage at the
Pharmacotherapy
Clinician's Perspective: • Researchers identified a specific genetic variant in the GLP1R gene (GLP-1 receptor) (the primary cellular docking site for these drugs) that directly influences how much weight a person loses. • Individuals carrying a specific version of this gene (rs10305420) experienced an additional 0.76 kg of
Understanding Obesity
Clinician's Perspective: • Insulin Resistance: 95% of patients with obesity and PCOS exhibit Insulin Resistance (a condition where cells fail to respond effectively to insulin), compared to 75% in lean patients. • Visceral Adiposity: Excessive internal belly fat is identified as the primary driver of metabolic dysfunction because it contains
Understanding Obesity
Clinician's Perspective: • Sarcopenic Obesity (SO) is when Sarcopenia (the age-related loss of skeletal muscle mass and strength) and Obesity (excessive accumulation of body fat or adiposity) occur at the same time. • Data indicates that individuals over 60 years of age in the Asia-Pacific region are at
Pharmacotherapy
Clinician's Perspective: • Modern anti-obesity medications (AOM) function by modulating central appetite signaling, delaying gastric emptying, or inhibiting lipid absorption in the gastrointestinal tract. • In Singapore, typical medical criterion for AOM treatment include a Body Mass Index (BMI) of 27.5 or higher in the presence of weight-
Bariatric Surgery
Clinician's Perspective: • Data indicates that five years after reaching their nadir (lowest weight point), 50.2% of Roux-en-Y gastric bypass patients regain a modest amount of weight, around 15% of the weight they initially lost. • The GLP-1 Deficit: While bariatric surgery successfully restores the postprandial
Bariatric Surgery
Clinician's Perspective: • Dumping Syndrome (DS) manifests in two distinct windows: Early (within 60 minutes) involving rapid fluid shifts and cardiovascular strain, and Late (1–3 hours) characterized by Reactive Postprandial Hypoglycemia (dangerously low blood sugar following a meal). • Surgical Prevalence: While bariatric surgery is highly effective for weight
Bariatric Endoscopy
Clinician's Perspective: • The procedure involves placing a medical-grade balloon typically made of silicone into the stomach via an endoscope (a flexible tube with a camera), requiring no incisions or general anesthesia. Newer generations of balloons are swallowable and do not require endoscopic insertion. • Significant Weight Reduction: On
Bariatric Surgery
Clinician's Perspective: • Between 7% and 15% of patients who undergo an initial weight-loss procedure will require a revisional surgery during their lifetime. • In patients who have had bariatric surgery before, they may qualify for revisional bariatric surgery if they experience significant weight regain, inadequate initial weight loss,
Pharmacotherapy
Clinician's Perspective: • Hormonal Mimicry: GLP-1 agonists function by mimicking the Glucagon-like peptide-1 hormone, a naturally occurring substance produced in the small intestine that regulates insulin and satiety (the feeling of fullness). • Glucose Modulation: These agents trigger insulin release and block glucagon secretion, effectively preventing blood
Bariatric Surgery
Clinician's Perspective: • Eligibility Thresholds: In Asia, bariatric surgery is indicated for individuals with Class III obesity, defined as a Body Mass Index (BMI) of 35.0 or higher, or a BMI of 30.0 when accompanied by at least one obesity-related health condition. In patients with Type
Bariatric Surgery
Clinician's Perspective: • Dual Mechanism: The procedure functions through both Gastric Restriction (limiting the stomach's intake capacity) and Intestinal Malabsorption (reducing the surface area available for nutrient uptake). • Hormonal Modulation: Post-operative weight loss is significantly driven by increases in GLP-1 (glucagon-like peptide-1) and