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.
Pharmacotherapy
Clinician's Perspective: • Synergistic Weight Loss: Combining phentermine and topiramate-ER (extended-release) provides a more robust weight reduction than either drug used alone by targeting different metabolic pathways. • Significant Results: In the EQUIP trial involving 1,267 participants, the high-dose group achieved an average weight loss of
Bariatric Surgery
Clinician's Perspective: • Superior Weight Maintenance: Roux-en-Y Gastric Bypass (RYGB) achieved a 65.9% excess body mass index loss compared to 56.1% for Sleeve Gastrectomy (SG) after 10 years. • Nearly 30% of patients who initially underwent a Sleeve Gastrectomy (32 out of 107 participants) required a
Lifestyle & Wellness
Clinician's Perspective: • The Genetic Minority: Research from the Danish Twin Study, which followed 2,872 pairs of twins, reveals that only 20% of the average person’s lifespan is determined by genes, while 80% is dictated by lifestyle and environment. • The Power 9 Framework: Researchers identified nine specific
Lifestyle & Wellness
Clinician's Perspective: • The 10-Calorie Rule: For every permanent reduction of 10 kcal (calories) in daily intake, an average person will eventually lose about 1 lb (0.45 kg) of weight, but reaching this steady state takes approximately three years. • The 3,500-Calorie Fallacy: The traditional rule
Understanding Obesity
Clinician's Perspective: • Redefining Obesity: A commission of 58 global experts has officially redefined obesity not just as a risk factor, but as a chronic, systemic illness called "Clinical Obesity" when it impairs organ function. • BMI Limitations: The commission recommends that Body Mass Index (BMI) be used
Lifestyle & Wellness
Clinician's Perspective: • Bidirectional Nature: The data suggests a "chicken or egg" relationship where it is difficult to determine if poor mental health leads to obesity or if obesity triggers psychological distress. • Environmental Exclusion: Participants described a "literal not fitting in," referencing the daily mental
Lifestyle & Wellness
Clinician's Perspective: • Similar level of Calories: Researchers identified no significant difference (p = 0.150) in total energy (the total number of calories) between 25 popular local Asian dishes and 29 Western fast food items. • High Saturated Fat: Local Asian dishes were found to contain significantly higher levels of
Understanding Obesity
Clinician's Perspective: • While the global BMI (Body Mass Index) cutoff for obesity is 30 kg/m², many Asian populations face metabolic risks at much lower levels, leading the WHO to suggest a lower obesity threshold of 27.5 kg/m². • Asian subgroups are not a monolith; for instance,
Understanding Obesity
Clinician's Perspective: • Weight Correlation: Individuals classified as "Evening Types" (late chronotypes) are significantly more likely to be overweight or obese compared to "Morning Types." • Caloric Consistency: Data across the reviewed studies show that both morning and evening types consume a similar total amount of
Lifestyle & Wellness
Clinician's Perspective: • Unlike glucose, fructose is processed almost entirely in the liver, where it bypasses regulatory "off-switches" to trigger De Novo Lipogenesis (the metabolic process of converting excess sugar into new fat). • High Fructose Corn Syrup (a chemically produced sweetener) is identified as a primary
Bariatric Endoscopy
Clinician's Perspective: • The controlled study randomized 40 participants to either Endoscopic Sleeve Gastroplasty (ESG) or a sham (simulated) procedure to isolate the specific impact of the intervention. • Weight Loss Efficacy: Participants in the ESG group achieved a mean total body weight loss (TBWL) of 9.47%, more than
Bariatric Surgery
Clinician's Perspective: • Reduced Mortality: Metabolic-bariatric surgery was associated with a 49% reduction in all-cause mortality (the risk of death from any cause) compared to traditional non-surgical weight management. • Diabetes Advantage: Participants with Type 2 Diabetes saw the most significant gains, with a 59% reduction in