2013: Issue 27

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2013 > Stay Active & Pain - Free > Weight management

Weight Management

Weight management approach tackles obesity’s heavy toll

As obesity rates continue rising, so does the number of people afflicted with obesity-related health problems – from painful bone and joint conditions to life-threatening diseases like diabetes, stroke and heart disease.

Asia’s obesity problem is getting worse, and anincreasing number of overweight people in Thailand and across Asia are suffering the damaging consequences in declining health and quality of life.

Obesity is no longer a problem confined to the West. The number of Thais who are overweight or obese is growing at an alarming rate. According to the latest available statistics from Thailand’s Ministry of Public Health, in 2011, the obesity rate increased at the fastest annual pace in a decade. 

Thailand’s obesity rate (among those aged 15 and older) is now the fifth highest in the Asia Pacific region. At the current pace, the number of overweight and obese Thais, currently 17 million, will increase by an additional four million every year. 

The challenge of losing excess weight and maintaining a healthy weight involves complex, interconnected health issues. Public confusion over conflicting information, aggressive marketing tactics, and the natural preference for solutions that are quick and painless simply add to the challenge.


Dr. Nopawan Kittivat Bumrungrad Bangkok Hospital Thailand


The integrated approach

For an in-depth under-standing of healthy weight loss and weight control, Better Healtinvited a team of doctors from Bumrungrad’s Weight Management Center to share their insights and expertise.

Dr. Nopawan Kittivat, a specialist in endocrinology, notes that both overweight and obesity are chronic medical conditions best treated through an integrated approach that emphasizes changes to diet and exercise habits. “Successful lifestyle modification requires motivation and a strong will, but the payoff in long term, lasting effectiveness is significant,” she says.

“In theory, fasting for a few days results in significant weight loss,” Dr. Nopawan explains. “But the results will be fleeting, and the lost weight almost always comes back.” That’s because the initial weight loss comes mainly from water and muscle mass. “In the long run,” says Dr. Nopawan, “losing weight is made even more difficult because the patient will have less muscle mass than before.”

According to Dr. Chulaporn Roongpisuthipong, a US-board certified specialist in clinical nutrition, patients need to maintain control over not only the kinds of foodsthey eat, but also the size of portions consumed. The most successful weight management programs are those that can be individually tailored for each patient’s unique situation.

“We use body composition analysis to understand dietary habits and to identify whether the right foods are being consumed, and in the proper amounts,” says Dr. Chulaporn, “At Bumrungrad, we incorporate the concept of food exchange into the patient’s weight management plan. The variety offered through food exchange gives patients a better chance at long term success.”

A patient’s daily plan contains guidelines on portion size and classifies foods into six categories. “The food items in each category have roughly the same nutritional and caloric values,” Dr. Chulaporn notes. “Patients have plenty of interchangeable choices – which research shows is an important factor for making sustainable changes to dietary habits.”



Chulaporn Roongpisuthipong Bumrungrad Bangkok Hospital

Measuring fat


Obesity is the medical term for the excessive accum-ulation of fat sufficient to cause health problems. Body Mass Index (BMI) and waist circumference measurements are the most commonly-used methods to measure body fat.

BMI is a useful tool, but it has limitations, too. BMI would classify bodybuilders, highly-fit athletes and well-muscled people as being obese, even though body composition testing would likely show they are not obese. Two people can weigh the same despite having very different body compositions – one may have high levels of body fat while the other has significantly more muscle mass.


The role of medication

Many obese patients also suffer from one or more co-existing metabolic conditions such as diabetes and hypertension. “When a patient’s obesity leads to health complications, doctors often prescribe medication that promotes quick weight loss without harming overall health,” explains Dr. Nopawan. “Lifestyle modification alone isn’t always effective for these patients, and exercise tends to be more difficult as obesity is a major cause of joint problems.”

Patients taking medication must be closely monitored for potential complications or side effects.“When the weight loss goal is reached,” notes Dr. Nopawan, “patients with high blood pressure, diabetes, joint problems or kidney ailments will usually see noticeable improvement.”


Surgical treatments

For morbidly obese patients (defined as having a Body Mass Index over 40) – and for some patients classified as obese who have serious co-existing health problems – effective weight loss is often a necessity. When patients in these two BMI groups aren’t able to reach the desired weight loss through the combination of lifestyle modifications and medication, doctors may then recommend bariatric surgery or another type of surgical treatment to achieve the necessary weight loss.

Bariatric surgery is a highly effective treatment that alleviates a number of potential health risks tied to morbid obesity. “In evaluating a patient’s suitability for bariatric surgery, the doctor looks both at the patient’s BMI and their overall health condition,” notes Dr. Theerapol Angkoolpakdeekul, a specialist in laparoscopic surgery.

“Western patients classified as morbidly obese (i.e. BMI above 40) are likely to benefit the most from bariatric surgery.” he says. “Surgery may be also be the best option for a patient with a BMI of around 35, especially if they have a co-existing chronic condition such as GERD, obstructive sleep apnea, diabetes or heart disease, or there’s a family history of coronary artery disease.”


Dr. Theerapol Angkoolpakdeekul Bumrungrad Hospital Bangkok Thailand


Two surgery types

There are two main types of bariatric surgery. The first involves a surgical reduction in stomach size to restrict the amount of food the patient can consume. Stomach size reduction can be done through gastric banding or by the surgical removal of a portion of the stomach.

The second type of procedure involves surgically partitioning the upper part of the stomach together with a bypass technique that reduces the volume of food that can be digested.

“Years ago, bariatric surgery was a highly-invasive operation that resulted in significant changes to a patient’s digestive system structure, and there were a number of potential complications,” Dr. Theerapol explains. “The current generation incorporates less-invasive laparoscopic technology that causes much less physical trauma, and speeds recovery.”


Lasting success

The rate of post-surgery complications is much lower now compared to the previous generation of surgeries. “Most patients need just a few days’ stay in the hospital,” notes Dr. Theerapol. “Studies have shown that obese patients who undergo the weight-loss surgery are more likely to have long term success controlling their weight.”

Obesity has nothing to do with aesthetics or physical appearance. It’s a serious medical condition that’s been described as a ticking time bomb, lurking quietly while the damage to health continues to worsen. Getting one’s weight under control takes motivation and a longterm commitment. It also requires close professional super-vision to make sure weight loss is accomplished in a healthy way, so patients get the best possible chance to achieve life-long success.



Obesity, joint pain and osteoarthritis

Packing on those extra kilos puts an even greater strain on weight-bearing joints, especially knees and hips. Years of obesity raise the risk of a variety of painful joint conditions – inflammation, balance and mobility problems, and an eventual diagnosis of osteoarthritis. A body in motion produces a multiplying effect on the weight being placed on joints. Walking causes a three-fold increase in pressure on weight-bearing joints, and a multiple of seven to ten times one’s body weight during running or stair climbing. For example, if you weigh 50 kg., your knees must bear the equivalent of 150 kg. When you’re walking, and as much as 500 kg. during running or stair climbing. Premature joint degeneration is one of most common obesity-related health problems. Keeping your body weight under control is fundamental to the continued good health of your bones and joints, and to protecting your good quality of life for the long term.  

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