WEBVTT - How Obesity could impact mental health

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<v Speaker 1>Now health matters with Daniel Martin in recognition of the

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<v Speaker 1>upcoming World Obesity Day, which is on the fourth of March.

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<v Speaker 1>Let's talk about the link between obesity and something that

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<v Speaker 1>you might be surprised to talk about because I've done

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<v Speaker 1>many shows linking obesity to diabetes concerns to heart disease,

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<v Speaker 1>concerns mobility issues and so on.

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<v Speaker 1>But what about its impact in terms of mental health?

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<v Speaker 1>This is so important as it's been reported that, you know,

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<v Speaker 1>we've got 60% of Singapore residents living with an unhealthy

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<v Speaker 1>weight and 17.8% of them reporting poor mental health. What

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<v Speaker 1>is the link and how can both diseases be addressed

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<v Speaker 1>by medical professionals? Doctor Tan Kang Wei joins me Woodlands health,

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<v Speaker 1>senior consultant and president of the Singapore Association for the

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<v Speaker 1>study of obesity. Doctor Tan. Welcome back to the show. Hello.

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<v Speaker 1>Hello, Daniel.

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<v Speaker 2>Thank you for having me.

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<v Speaker 1>Absolute pleasure. Can you walk us through about this link?

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<v Speaker 1>Because I don't think people talk about it enough. Is

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<v Speaker 1>it known are medical researchers understanding and looking at the

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<v Speaker 1>important need to realize that if somebody is dealing with obesity,

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<v Speaker 1>that they are also potentially at the same time dealing

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<v Speaker 1>with mental health issues that are brought on by the

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<v Speaker 1>obesity probably.

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<v Speaker 2>Yeah, I I think the association is quite well known

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<v Speaker 2>among medical professionals. Um but whether it's addressed or not

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<v Speaker 2>is another story. I think it's another piece of work.

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<v Speaker 2>I would say

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<v Speaker 2>we do know that for example, people who live with

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<v Speaker 2>an unhealthy weight, particularly women, people who live with obesity

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<v Speaker 2>are three times more likely to have depression compared to

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<v Speaker 2>people from healthy weight and people with mental illnesses are

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<v Speaker 2>also 2 to 3 times higher risk of developing obesity.

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<v Speaker 2>So I think in a large way, it goes both ways,

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<v Speaker 2>work both ways. Absolutely, it's a bidirectional relationship.

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<v Speaker 2>So let's say if I have a patient with obesity

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<v Speaker 2>and particularly those of much higher BMI and I'll come

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<v Speaker 2>into the reasons why that is so later is that,

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<v Speaker 2>you know, they, they tend, they tend to have a

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<v Speaker 2>lot of these depression that's also undiagnosed that that could

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<v Speaker 2>be undercurrent, right? So it's really an onus upon a

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<v Speaker 2>lot of times as physicians

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<v Speaker 2>then also leading the discussions that because all the time

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<v Speaker 2>we're always focusing about weight, right? We talk about overweight

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<v Speaker 2>O BC was only focus about weight diet and exercise, right?

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<v Speaker 2>But we just forget that obesity is actually a very

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<v Speaker 2>chronic disease that has a lot of body haywire. So

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<v Speaker 2>this regulation of body systems is ongoing, right?

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<v Speaker 2>So, so, but we all focus about weight and then

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<v Speaker 2>we neglect, say the quality of life, the impact of obesity,

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<v Speaker 2>the person has had, has had on that person's life.

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<v Speaker 2>You know, for example, poorer function, you know, when, when

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<v Speaker 2>people are of heavier weight, their joints may ache. Um

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<v Speaker 2>you know, then they don't do

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<v Speaker 2>so well or they may have medical problems, then make

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<v Speaker 2>them not show up the work so well. And also

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<v Speaker 2>a lot of times, I think, I think one of

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<v Speaker 2>the biggest reasons is this body image, body thinness, beauty

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<v Speaker 2>that it's laid upon us by society, by media in particular.

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<v Speaker 2>And I think that a lot of times that has

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<v Speaker 2>additional stress to the person living obesity because you you

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<v Speaker 2>can't run away from obesity because it has a physical manifestation, right?

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<v Speaker 2>So a lot of times people also suffer from this

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<v Speaker 2>judgment from people that discrimination and that spills over to

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<v Speaker 2>work lower pace, job opportunities and even for Children bullying etc.

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<v Speaker 2>So when you have all these layered on a person

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<v Speaker 2>and we don't address that it just get compiled on

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<v Speaker 2>over years and that can manifest with depression particularly and anxiety.

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<v Speaker 1>And if that bidirectional relationship is known

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<v Speaker 1>and and people have been looking at it for a while. Now,

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<v Speaker 1>do you think though that it's still lacking within the

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<v Speaker 1>realm of treatment and management that if somebody is dealing

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<v Speaker 1>with obesity, we should also be offering mental health support?

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<v Speaker 2>Absolutely, totally agree. So actually, that's why we also need

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<v Speaker 2>to raise awareness, not on this day, in particular O

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<v Speaker 2>BC day, but also, you know, ongoing because there's a

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<v Speaker 2>lot of talk about mental wellness, right? So I think

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<v Speaker 2>before someone even gets to putting on weight, I think

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<v Speaker 2>when Trump starts to struggle with mental health issues, right?

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<v Speaker 2>I think as employers, as colleagues, family and friends, we

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<v Speaker 2>should start helping to take care of them in that

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<v Speaker 2>aspect

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<v Speaker 2>that disruption the sleep, that stress can disrupt someone's appetite

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<v Speaker 2>and make someone tired and not feel like exercising. So

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<v Speaker 2>I think the support system is very important in that part.

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<v Speaker 2>So that can also negate or reduce the weight gain,

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<v Speaker 2>right? So when person actually comes to our clinics, for example,

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<v Speaker 2>we tend to have what we call complicated obesity or

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<v Speaker 2>more severe forms of obesity. We do screen them for depression, anxiety,

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<v Speaker 2>disordered eating and even try to elicit potential abuse of

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<v Speaker 2>it, mental physical or even sexual abuse because people whose

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<v Speaker 2>abuse especially in childhood tend to have more severe forms

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<v Speaker 2>of obesity. We do have trained psychologists to address this issue.

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<v Speaker 2>So the multidiscipline team will always have a psychologist trained

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<v Speaker 2>to address these issues as well.

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<v Speaker 1>Depression said to be three times higher amongst women who

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<v Speaker 1>are dealing with obesity. You brought this up earlier on

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<v Speaker 1>why do we know why?

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<v Speaker 2>Yeah, I think the the postulation obviously is, I mean,

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<v Speaker 2>obviously sorry is body image, women are more I speak

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<v Speaker 2>for myself. We are more subjected to this image of thinness.

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<v Speaker 1>The male gaze is real, sorry, the male gaze is real.

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<v Speaker 1>I mean, this idea of representing imagery in public that

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<v Speaker 1>whether it's mass media or social media.

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<v Speaker 2>Absolutely. I mean, it's not just I think it's particularly

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<v Speaker 2>affecting a women and men, men are also affected, it's

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<v Speaker 2>just more so women and I think also women struggle

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<v Speaker 2>with hormonal changes throughout the life, you know, be it

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<v Speaker 2>after having Children or eventually when they are actually go

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<v Speaker 2>into menopause, etc,

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<v Speaker 2>they also have to deal with many responsibilities. Not that

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<v Speaker 2>men do not, for example, home Children, et cetera. So

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<v Speaker 2>that can also, you know, press them even further. In

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<v Speaker 2>addition to this image, image pressure of image.

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<v Speaker 1>Yeah, I'm interested in it going the other direction as well.

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<v Speaker 1>You said if somebody is doing the depression, there's also

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<v Speaker 1>that slippery slope and path towards obesity. Can you talk

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<v Speaker 1>us through this direction?

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<v Speaker 2>Sure. So in depression or anxiety or actually some of

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<v Speaker 2>the psychiatry illnesses or sleep may get disrupted and that

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<v Speaker 2>in itself can also predispose one to weight gain. The

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<v Speaker 2>other is also the stress, the stress state in itself

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<v Speaker 2>also tends to some people, they get down regulation of

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<v Speaker 2>the appetite but more often than not increase in appetite

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<v Speaker 2>and also cravings. And this is not because someone likes

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<v Speaker 2>to do this, but there's a lot of neurotransmitters, a

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<v Speaker 2>lot of hormones affecting our appetite center this appetite regulation

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<v Speaker 2>gets a bit disrupted. And so and also medications for

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<v Speaker 2>depression and some psychiatric disorders like schizophrenia, so particularly known

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<v Speaker 2>to cause one to gain weight.

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<v Speaker 1>Isn't that ironic that the medication is there to help?

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<v Speaker 1>But potentially the side effects can also bring on something

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<v Speaker 1>else to deal with, which could also worsen the anxiety

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<v Speaker 1>or depression to begin with.

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<v Speaker 2>Yes, it did. And I think the psychiatrists have been

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<v Speaker 2>working very hard in fairness. They are well aware,

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<v Speaker 2>they're working very hard to have that public health messaging

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<v Speaker 2>to take care of yourself. So it's not just about

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<v Speaker 2>eating and exercise, right? It's really taking care of yourself.

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<v Speaker 2>The sleep stress in the environment, the family is so

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<v Speaker 2>important that we should never be the saboteur. We should

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<v Speaker 2>help our family along, especially when they are going through

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<v Speaker 2>very acute mental illnesses. And I think, but firstly, if

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<v Speaker 2>someone is really going through an acute mental illness, we

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<v Speaker 2>have to stabilize that first, right?

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<v Speaker 2>So I think whatever medications that takes to stabilize them,

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<v Speaker 2>of course, medication is never the first line. We try

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<v Speaker 2>different methods. But when medications are needed that whatever that

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<v Speaker 2>works with the person is the first line that's been

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<v Speaker 2>shown to be proven to be good and safe. And

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<v Speaker 2>sometimes when people are more stabilized and they do respond

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<v Speaker 2>with really severe weight gain, the psychiatrist can work with

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<v Speaker 2>them to choose medications that may be what we call

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<v Speaker 2>more weight neutral or not cause so much weight gain

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<v Speaker 1>mentioning or talking of medication, I can't help but ask

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<v Speaker 1>about the Hollywood drug that everybody is talking about and

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<v Speaker 1>whether or not OIC could have a potential benefit. I mean,

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<v Speaker 1>obviously it was a diabetes drug and medication. Could it

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<v Speaker 1>potentially have benefits for people doing obesity and lessening the

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<v Speaker 1>risk of depression, anxiety forming?

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<v Speaker 2>Yeah. So um Ozempic is the name that we use

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<v Speaker 2>for the very same drug for diabetes that we also have.

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<v Speaker 2>We also use for obesity. Just it's a higher dose,

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<v Speaker 2>it's called we OV.

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<v Speaker 2>So actually, you might have heard there were some reports

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<v Speaker 2>of increased suicide that is being investigated right now. As

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<v Speaker 2>of now, there have been some findings from FDA that

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<v Speaker 2>actually is not caused increased suicide or depression.

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<v Speaker 2>So what we do is to err on the side

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<v Speaker 2>of caution when someone is have acute illnesses, a psychiatric

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<v Speaker 2>illness or may be prone to suicide. We do generally

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<v Speaker 2>still avoid some of the medications but when they're stabilized, yes,

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<v Speaker 2>these drugs, these classes medications are good. They can help

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<v Speaker 2>to modulate the appetite and sometimes even certain cravings and

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<v Speaker 2>beyond the weight loss. So someone just needs to lose

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<v Speaker 2>a little bit of weight to improve the metabolic health

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<v Speaker 2>because you know, I might not have mentioned these people

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<v Speaker 2>with a very serious mental illness, right?

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<v Speaker 2>Die 15 to 20 years younger than the counterparts, right?

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<v Speaker 2>Due to metabolic illnesses has brought on mostly by the obesity.

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<v Speaker 2>So these medications do more than just making one lose weight,

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<v Speaker 2>but they also help in terms of reducing the cardiovascular

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<v Speaker 2>or the heart attacks, etc the risks that come from

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<v Speaker 2>obesity

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<v Speaker 1>as well. I was actually just speaking to a researcher

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<v Speaker 1>from Singapore who's looking at relaxing three, a neuropeptide, which

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<v Speaker 1>they hope there could be a better delivery mechanism or

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<v Speaker 1>medication approach for persons dealing with anxiety and depression and

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<v Speaker 1>reducing the side effects. But of course, we're still years

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<v Speaker 1>and years and years away from a more fine tuned

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<v Speaker 1>approach like that. So outside of that, I think what

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<v Speaker 1>is the key message was the key take away that

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<v Speaker 1>you want people to remember if they are dealing with

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<v Speaker 1>either of these right now? Sure.

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<v Speaker 2>I think just a step, take a step. But I

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<v Speaker 2>think all of us need to be kind to ourselves

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<v Speaker 2>and we really need to be kind to our family

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<v Speaker 2>and friends around us. I think people with obese with waves, overweight,

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<v Speaker 2>obesity suffer from a lot of judgment from saying, you know,

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<v Speaker 2>it's because you're lazy, you're not trying hard enough. That's

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<v Speaker 2>why you're who you are. I think we should stop

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<v Speaker 2>that and understand obesity as a disease for people with

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<v Speaker 2>mental ill illness as well. Don't be afraid because I

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<v Speaker 2>think we don't talk enough about it in Singapore. So

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<v Speaker 2>the stats are always higher in the west. So for us,

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<v Speaker 2>start talking about opening up, seek help early

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<v Speaker 2>and and really be kind as really health of every

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<v Speaker 2>size at every size and we need to accept ourselves

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<v Speaker 2>first and accept each other.

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<v Speaker 1>Doctor. Th Always a pleasure. Thank you so much for

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<v Speaker 1>coming on the show. Doctor Tom Kang Wei, the Woodlands Health,

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<v Speaker 1>senior consultant and president of the Singapore Association for the

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<v Speaker 1>study of obesity. I'm Daniel Martin. Let's take a message

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<v Speaker 1>to heart here on health matters.

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<v Speaker 1>Before making any decisions. Based on the information in our program,

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<v Speaker 1>please consult a medical professional.