Senior Consultant Surgeon & Deputy 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.
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
Bariatric Endoscopy
Clinician's Perspective: • Gastric Volume Reduction: The procedure utilizes an endoscope to reduce the stomach to a narrow tube, roughly 30% of its original capacity, without external surgical incisions. • Weight Loss Efficacy: Clinical data indicates patients achieve an average weight loss of 15% of their total body weight within
Bariatric Surgery
Clinician's Perspective: • Mechanical Restriction: The procedure involves the surgical removal of approximately 80% of the stomach, leaving a narrow, tubular "sleeve" about the size of a banana. • Hormonal Modulation: Beyond physical size, the surgery significantly reduces the production of hunger-regulating hormones, which helps suppress appetite
Understanding Obesity
Clinician's Perspective: • Limitation of BMI: Body Mass Index (a weight-to-height ratio used to categorize body mass) is a population-level tool that often fails to distinguish between lean muscle and adipose tissue (body fat) in individuals. • Clinical Staging Utility: The Edmonton Obesity Staging System (a five-