Speaker 1: Now health matters with Daniel Martin in recognition of the
Speaker 1: upcoming World Obesity Day, which is on the fourth of March.
Speaker 1: Let's talk about the link between obesity and something that
Speaker 1: you might be surprised to talk about because I've done
Speaker 1: many shows linking obesity to diabetes concerns to heart disease,
Speaker 1: concerns mobility issues and so on.
Speaker 1: But what about its impact in terms of mental health?
Speaker 1: This is so important as it's been reported that, you know,
Speaker 1: we've got 60% of Singapore residents living with an unhealthy
Speaker 1: weight and 17.8% of them reporting poor mental health. What
Speaker 1: is the link and how can both diseases be addressed
Speaker 1: by medical professionals? Doctor Tan Kang Wei joins me Woodlands health,
Speaker 1: senior consultant and president of the Singapore Association for the
Speaker 1: study of obesity. Doctor Tan. Welcome back to the show. Hello.
Speaker 1: Hello, Daniel.
Speaker 2: Thank you for having me.
Speaker 1: Absolute pleasure. Can you walk us through about this link?
Speaker 1: Because I don't think people talk about it enough. Is
Speaker 1: it known are medical researchers understanding and looking at the
Speaker 1: important need to realize that if somebody is dealing with obesity,
Speaker 1: that they are also potentially at the same time dealing
Speaker 1: with mental health issues that are brought on by the
Speaker 1: obesity probably.
Speaker 2: Yeah, I I think the association is quite well known
Speaker 2: among medical professionals. Um but whether it's addressed or not
Speaker 2: is another story. I think it's another piece of work.
Speaker 2: I would say
Speaker 2: we do know that for example, people who live with
Speaker 2: an unhealthy weight, particularly women, people who live with obesity
Speaker 2: are three times more likely to have depression compared to
Speaker 2: people from healthy weight and people with mental illnesses are
Speaker 2: also 2 to 3 times higher risk of developing obesity.
Speaker 2: So I think in a large way, it goes both ways,
Speaker 2: work both ways. Absolutely, it's a bidirectional relationship.
Speaker 2: So let's say if I have a patient with obesity
Speaker 2: and particularly those of much higher BMI and I'll come
Speaker 2: into the reasons why that is so later is that,
Speaker 2: you know, they, they tend, they tend to have a
Speaker 2: lot of these depression that's also undiagnosed that that could
Speaker 2: be undercurrent, right? So it's really an onus upon a
Speaker 2: lot of times as physicians
Speaker 2: then also leading the discussions that because all the time
Speaker 2: we're always focusing about weight, right? We talk about overweight
Speaker 2: O BC was only focus about weight diet and exercise, right?
Speaker 2: But we just forget that obesity is actually a very
Speaker 2: chronic disease that has a lot of body haywire. So
Speaker 2: this regulation of body systems is ongoing, right?
Speaker 2: So, so, but we all focus about weight and then
Speaker 2: we neglect, say the quality of life, the impact of obesity,
Speaker 2: the person has had, has had on that person's life.
Speaker 2: You know, for example, poorer function, you know, when, when
Speaker 2: people are of heavier weight, their joints may ache. Um
Speaker 2: you know, then they don't do
Speaker 2: so well or they may have medical problems, then make
Speaker 2: them not show up the work so well. And also
Speaker 2: a lot of times, I think, I think one of
Speaker 2: the biggest reasons is this body image, body thinness, beauty
Speaker 2: that it's laid upon us by society, by media in particular.
Speaker 2: And I think that a lot of times that has
Speaker 2: additional stress to the person living obesity because you you
Speaker 2: can't run away from obesity because it has a physical manifestation, right?
Speaker 2: So a lot of times people also suffer from this
Speaker 2: judgment from people that discrimination and that spills over to
Speaker 2: work lower pace, job opportunities and even for Children bullying etc.
Speaker 2: So when you have all these layered on a person
Speaker 2: and we don't address that it just get compiled on
Speaker 2: over years and that can manifest with depression particularly and anxiety.
Speaker 1: And if that bidirectional relationship is known
Speaker 1: and and people have been looking at it for a while. Now,
Speaker 1: do you think though that it's still lacking within the
Speaker 1: realm of treatment and management that if somebody is dealing
Speaker 1: with obesity, we should also be offering mental health support?
Speaker 2: Absolutely, totally agree. So actually, that's why we also need
Speaker 2: to raise awareness, not on this day, in particular O
Speaker 2: BC day, but also, you know, ongoing because there's a
Speaker 2: lot of talk about mental wellness, right? So I think
Speaker 2: before someone even gets to putting on weight, I think
Speaker 2: when Trump starts to struggle with mental health issues, right?
Speaker 2: I think as employers, as colleagues, family and friends, we
Speaker 2: should start helping to take care of them in that
Speaker 2: aspect
Speaker 2: that disruption the sleep, that stress can disrupt someone's appetite
Speaker 2: and make someone tired and not feel like exercising. So
Speaker 2: I think the support system is very important in that part.
Speaker 2: So that can also negate or reduce the weight gain,
Speaker 2: right? So when person actually comes to our clinics, for example,
Speaker 2: we tend to have what we call complicated obesity or
Speaker 2: more severe forms of obesity. We do screen them for depression, anxiety,
Speaker 2: disordered eating and even try to elicit potential abuse of
Speaker 2: it, mental physical or even sexual abuse because people whose
Speaker 2: abuse especially in childhood tend to have more severe forms
Speaker 2: of obesity. We do have trained psychologists to address this issue.
Speaker 2: So the multidiscipline team will always have a psychologist trained
Speaker 2: to address these issues as well.
Speaker 1: Depression said to be three times higher amongst women who
Speaker 1: are dealing with obesity. You brought this up earlier on
Speaker 1: why do we know why?
Speaker 2: Yeah, I think the the postulation obviously is, I mean,
Speaker 2: obviously sorry is body image, women are more I speak
Speaker 2: for myself. We are more subjected to this image of thinness.
Speaker 1: The male gaze is real, sorry, the male gaze is real.
Speaker 1: I mean, this idea of representing imagery in public that
Speaker 1: whether it's mass media or social media.
Speaker 2: Absolutely. I mean, it's not just I think it's particularly
Speaker 2: affecting a women and men, men are also affected, it's
Speaker 2: just more so women and I think also women struggle
Speaker 2: with hormonal changes throughout the life, you know, be it
Speaker 2: after having Children or eventually when they are actually go
Speaker 2: into menopause, etc,
Speaker 2: they also have to deal with many responsibilities. Not that
Speaker 2: men do not, for example, home Children, et cetera. So
Speaker 2: that can also, you know, press them even further. In
Speaker 2: addition to this image, image pressure of image.
Speaker 1: Yeah, I'm interested in it going the other direction as well.
Speaker 1: You said if somebody is doing the depression, there's also
Speaker 1: that slippery slope and path towards obesity. Can you talk
Speaker 1: us through this direction?
Speaker 2: Sure. So in depression or anxiety or actually some of
Speaker 2: the psychiatry illnesses or sleep may get disrupted and that
Speaker 2: in itself can also predispose one to weight gain. The
Speaker 2: other is also the stress, the stress state in itself
Speaker 2: also tends to some people, they get down regulation of
Speaker 2: the appetite but more often than not increase in appetite
Speaker 2: and also cravings. And this is not because someone likes
Speaker 2: to do this, but there's a lot of neurotransmitters, a
Speaker 2: lot of hormones affecting our appetite center this appetite regulation
Speaker 2: gets a bit disrupted. And so and also medications for
Speaker 2: depression and some psychiatric disorders like schizophrenia, so particularly known
Speaker 2: to cause one to gain weight.
Speaker 1: Isn't that ironic that the medication is there to help?
Speaker 1: But potentially the side effects can also bring on something
Speaker 1: else to deal with, which could also worsen the anxiety
Speaker 1: or depression to begin with.
Speaker 2: Yes, it did. And I think the psychiatrists have been
Speaker 2: working very hard in fairness. They are well aware,
Speaker 2: they're working very hard to have that public health messaging
Speaker 2: to take care of yourself. So it's not just about
Speaker 2: eating and exercise, right? It's really taking care of yourself.
Speaker 2: The sleep stress in the environment, the family is so
Speaker 2: important that we should never be the saboteur. We should
Speaker 2: help our family along, especially when they are going through
Speaker 2: very acute mental illnesses. And I think, but firstly, if
Speaker 2: someone is really going through an acute mental illness, we
Speaker 2: have to stabilize that first, right?
Speaker 2: So I think whatever medications that takes to stabilize them,
Speaker 2: of course, medication is never the first line. We try
Speaker 2: different methods. But when medications are needed that whatever that
Speaker 2: works with the person is the first line that's been
Speaker 2: shown to be proven to be good and safe. And
Speaker 2: sometimes when people are more stabilized and they do respond
Speaker 2: with really severe weight gain, the psychiatrist can work with
Speaker 2: them to choose medications that may be what we call
Speaker 2: more weight neutral or not cause so much weight gain
Speaker 1: mentioning or talking of medication, I can't help but ask
Speaker 1: about the Hollywood drug that everybody is talking about and
Speaker 1: whether or not OIC could have a potential benefit. I mean,
Speaker 1: obviously it was a diabetes drug and medication. Could it
Speaker 1: potentially have benefits for people doing obesity and lessening the
Speaker 1: risk of depression, anxiety forming?
Speaker 2: Yeah. So um Ozempic is the name that we use
Speaker 2: for the very same drug for diabetes that we also have.
Speaker 2: We also use for obesity. Just it's a higher dose,
Speaker 2: it's called we OV.
Speaker 2: So actually, you might have heard there were some reports
Speaker 2: of increased suicide that is being investigated right now. As
Speaker 2: of now, there have been some findings from FDA that
Speaker 2: actually is not caused increased suicide or depression.
Speaker 2: So what we do is to err on the side
Speaker 2: of caution when someone is have acute illnesses, a psychiatric
Speaker 2: illness or may be prone to suicide. We do generally
Speaker 2: still avoid some of the medications but when they're stabilized, yes,
Speaker 2: these drugs, these classes medications are good. They can help
Speaker 2: to modulate the appetite and sometimes even certain cravings and
Speaker 2: beyond the weight loss. So someone just needs to lose
Speaker 2: a little bit of weight to improve the metabolic health
Speaker 2: because you know, I might not have mentioned these people
Speaker 2: with a very serious mental illness, right?
Speaker 2: Die 15 to 20 years younger than the counterparts, right?
Speaker 2: Due to metabolic illnesses has brought on mostly by the obesity.
Speaker 2: So these medications do more than just making one lose weight,
Speaker 2: but they also help in terms of reducing the cardiovascular
Speaker 2: or the heart attacks, etc the risks that come from
Speaker 2: obesity
Speaker 1: as well. I was actually just speaking to a researcher
Speaker 1: from Singapore who's looking at relaxing three, a neuropeptide, which
Speaker 1: they hope there could be a better delivery mechanism or
Speaker 1: medication approach for persons dealing with anxiety and depression and
Speaker 1: reducing the side effects. But of course, we're still years
Speaker 1: and years and years away from a more fine tuned
Speaker 1: approach like that. So outside of that, I think what
Speaker 1: is the key message was the key take away that
Speaker 1: you want people to remember if they are dealing with
Speaker 1: either of these right now? Sure.
Speaker 2: I think just a step, take a step. But I
Speaker 2: think all of us need to be kind to ourselves
Speaker 2: and we really need to be kind to our family
Speaker 2: and friends around us. I think people with obese with waves, overweight,
Speaker 2: obesity suffer from a lot of judgment from saying, you know,
Speaker 2: it's because you're lazy, you're not trying hard enough. That's
Speaker 2: why you're who you are. I think we should stop
Speaker 2: that and understand obesity as a disease for people with
Speaker 2: mental ill illness as well. Don't be afraid because I
Speaker 2: think we don't talk enough about it in Singapore. So
Speaker 2: the stats are always higher in the west. So for us,
Speaker 2: start talking about opening up, seek help early
Speaker 2: and and really be kind as really health of every
Speaker 2: size at every size and we need to accept ourselves
Speaker 2: first and accept each other.
Speaker 1: Doctor. Th Always a pleasure. Thank you so much for
Speaker 1: coming on the show. Doctor Tom Kang Wei, the Woodlands Health,
Speaker 1: senior consultant and president of the Singapore Association for the
Speaker 1: study of obesity. I'm Daniel Martin. Let's take a message
Speaker 1: to heart here on health matters.
Speaker 1: Before making any decisions. Based on the information in our program,
Speaker 1: please consult a medical professional.