Combating obesity: a change in perspectives

Before the COVID-19 pandemic in 2020, there already exists a pandemic related to excess body adiposity. In 2016, the World Health Organization (WHO) estimated that 1.9 billion adults and over 340 million children and adolescents aged 5–19 years were living with overweight or obesity.[1] With the prevalence of obesity rising unabated, particularly in developing economies, the World Obesity Federation has projected that one billion people globally, including one in five women and one in seven men, will be living with obesity by 2030.[2] As a chronic noncommunicable disease (NCD), obesity is acknowledged as one of the most serious global public health challenges of our times.

Obesity affects nearly every organ system and leads to a myriad of health problems and complications, including mental health disorders, cancer, and a reduced quality of life and life expectancy. The COVID-19 pandemic further reiterated the negative impact of obesity in the public consciousness, as obesity is highly correlated with COVID-19-related complications and mortality.[3] Besides contributing to considerable healthcare expenditure, obesity also has an impact on employment, productivity and workforce participation, affecting the labour market and resulting in significant economic burden.[4] Being omnipresent, obesity is commonly encountered by a wide spectrum of the healthcare community, and so it is important for all of us to be aware of its implications and management.

With obesity accounting for approximately 12% of all NCD deaths in 2019 and obesity prevalence remaining an upward trend, WHO has called upon governments and societies around the world to prioritise and accelerate obesity prevention and management through the adoption of a set of recommendations addressing the root causes of obesity through the life-course.[5] The recommendations along with an accelerated plan were further endorsed by WHO Member States at the 75^th World Health Assembly in May 2022.[6] This marks a much-awaited coordinated strategy for Member States to be on an accelerated track to avert the dire consequences of obesity.

World Obesity Day (WOD), marked annually on 4^th March, aims to increase awareness of obesity, unite stakeholders worldwide — including people living with obesity and those involved in obesity care and prevention — and advocate for positive changes and improved policies, with the ultimate goal of reversing the global obesity crisis.[7] Indeed, the theme for WOD 2023, “Changing Perspectives: Let's Talk about Obesity”, cannot be more fitting as we dedicate the March issue of Singapore Medical Journal (SMJ) to highlight the various pertinent aspects of obesity with a focus on the Singapore context.

In Singapore, obesity remains a serious public health issue, and despite much investment in our infrastructure for healthy living and modification of the food environment over the years, we ask ourselves why the obesity prevalence has not been reversed, or perhaps, if keeping a zero growth in obesity prevalence is a sufficient target for now. Regardless, a change in perspectives, starting from the approach to obesity as a chronic relapsing disease[8] with a distinct pathophysiology resulting in the disruption of body energy homeostasis, is needed for us to prevent and treat obesity effectively and wisely. With the person living with obesity as the focus, it is crucial to acknowledge that as a heterogeneous disease with multiple drivers, obesity impacts every individual differently with variable clinical manifestations; individual responses to treatment can also be heterogeneous.

In this issue of SMJ, we further explore the successes and gaps in obesity prevention and care in Singapore and how the global agenda on obesity can be implemented in the local context[9] as Singapore prepares itself for the next phase of transformative healthcare in 2023. Open and constant multi-stakeholder dialogues will allow us to appraise ourselves while discovering our blind spots for further improvement. This issue also presents a review illustrating how deep and wide the impacts of obesity are as they go beyond health impact.[10]

In addition, we focus on weight bias and stigma, which has been increasingly recognised as an aetiologic factor further fuelling weight gain and resulting in poorer outcomes in obesity care. Goff et al.[11] conducted a narrative review on the interventions to reduce weight stigma among healthcare professionals with proposals on how this may apply to Singapore.

As the complex pathophysiology and drivers of obesity continue to be elucidated, these may become intervention targets, and evolve into preventive and therapeutic strategies. These interventions include novel highly efficacious therapeutic options such as glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) agonists, as well as established options like bariatric procedures and surgery for more severe stages of disease. Lee et al.[12] provided a succinct updated summary on the armamentarium of therapeutic tools to target the roots of obesity.

The COVID-19 pandemic has taught us how effectively and swiftly a nation (and the world) can tackle an unprecedented health crisis. Perhaps, we could take a leaf out of this ’book’ as we face off the obesity crisis as a nation alongside our global partners. As Singapore gets itself ready for Healthier SG, there is no better time for changing perspectives by talking about obesity as it is.