With 43.11 per cent of the Malaysian population being overweight or obese, it’s no surprise that there is an obesity clinic at Putrajaya Hospital, writes ANNIE FREEDA CRUEZ
FAZLI (not real name) was a chubby and cute toddler. Now, he’s grown - and fat.
“I was always hungry so I kept eating. I was the fattest in my class,” he bemoaned. He was always ridiculed by his friends for being obese, and for not being able to keep up with them when walking or taking part in physical activities. He was 220kg at age 22.
“My movements were restricted as I could not sit in a bus comfortably and I had difficulty getting in and out of taxis,” he said. He also suffered obesity-related health problems, so Fazli sought help. Doctors at a government hospital in one of the northern states referred him to Putrajaya Hospital’s Obesity Clinic two years ago.
He arrived in an ambulance and consultant endocrinologist Dr Masni Mohamad was entrusted with the task of helping him. “I had to assess him thoroughly on his first visit, which included evaluation of potential obesity-related diseases within history, physical examinations and laboratory tests. I had to get his weight history, and his eating and activity behaviour besides searching for trigger factors, including medications,” said Dr Masni, one of the pioneers at the clinic which opened in 2005 for just once a month.
However, when the team of six multi-disciplinary doctors realised that obesity was a real problem, they opened the clinic twice a month and the hospital started getting referrals from all over the country.
The team comprises Dr Zanariah Hussein, head of endocrine unit in Malaysia/Putrajaya Hospital, Dr Nurain Mohd Noor and Dr Masni, consultant endocrinologists, and three other specialists training to be endocrinologists. The others in the team are two bariatric surgeons, dietitians, and rehabilitation and support group experts.
Dr Masni, who was urged to join the obesity clinic by her former boss, Dr Norshinah Kamaruddin, said: “Initially, I was not keen but now I feel happy that I am championing the cause.” “I also categorise a patient’s habitual physical activities such as during leisure, travel, work and exercise,” she said. She also compiles data on the family history on obesity, diabetes, hypertension, dyslipidemia, CVS disease, obesity-related cancer, thyroid disease and does a psychological status evaluation such as a patient’s self image, mental health and screens for eating disorders before embarking on treatment.
“The patient must be ready physically and mentally to undergo the weight loss programme,” she says.
Besides surgery, Fazli was put on a diet and physical exercise regime and finally started to lose weight. He is now 120kg and is still working hard to lose more weight. The incidence of being overweight and obesity is rising globally, affecting virtually all ages and socioeconomic groups. In 2006, the National Health & Morbidity Survey revealed that 29 per cent of adult Malaysians were overweight (BMI > 25 kgm-2) and 14 per cent were obese (BMI >30 kgm-2). In fact, two in five adult Malaysians are either overweight or obese. Obesity is a major risk factor for chronic diseases including type 2 diabetes, hypertension, cardiovascular disease, stroke and certain types of cancer. All these may reduce the quality of life and increase the risk of premature death.
Putrajaya Hospital only accepts patients who are > 40 BMI and many of those in the management and treatment group also have co-morbid health conditions. The hospital has also set up an obesity support group comprising mainly patients who share their experiences, problems and achievements with others or newcomers.
“This group actually has lots of fun interacting and sharing their experiences,” said Dr Masni. The hospital holds its clinic for obesity patients in the first and third Tuesdays of the month from 2pm to 5pm.
Dr Masni is one of the speakers at the 5th Malaysian Conference On Healthy Ageing. She will highlight not only the problems related to obesity but also the ways we can overcome them.
Obese persons with BMI > 40 or those having BMI > 35 with co-morbidities are recommended to go for bariatric surgery if they fail multiple non-surgical methods to reduce weight such as self-directed dieting, nutritional counselling by a dietitian, appropriate exercise and commercial or hospital-based weight loss programmes. Bariatric surgery is currently available in Hospital Putrajaya and some private hospitals. Essentially, this surgical method reduces the size of the stomach and creates intestinal malabsorption, enabling obese persons to lose a significant amount of weight. It results in long-lasting weight loss and eliminates or improves most of the obesity-related medical complications. It helps them to either overcome or control diabetes mellitus, sleep apnea, hypercholesterolemia and gout and 80-90 per cent of hypertension and fatty liver problems. Bariatric surgery patients are managed by a multi-disciplinary team, which includes surgeons, endocrinologists, anesthesiologists, dietitians, nurses, psychiatrists, and physiotherapists.
Dr Masni says a low calorie diet (LCD) of 1,200-1,600 Kcal/day, is recommended for weight loss in overweight and obese persons. “Reducing fat (25-30 per cent of energy) is part of the LCD to reduce calories. We normally have a meal replacement therapy to achieve the LCD by recommending patients to take nutrient-rich formula, vitamin and mineral fortification,” she added. When patients are put on very low calorie diet, then it is done under close supervision, although it’s not usually recommended.
Eat to live, not live to eat WHEN it comes to obesity, women are worse off than men and many of them suffer from diabetes and hypertension.
Most of the women are aged between 40 and 59 years and factors that contribute to their being overweight and obese include genetic reasons, a sedentary lifestyle, medication and, in most cases, food.
“While it used to be eat to live in the past, it’s now live to eat,” says consultant endocrinologist Dr Masni Mohamad.
What Malaysians do not realise is that when you are overweight and obese, you face many health problems.
Her advice is to go running, swimming, cycling and taking part in aerobic activities. These can last from 30 to 60 minutes.
She said poor lifestyle activities are also a contributing factor. Lots of people prefer to take the lift and escalator instead of walking up the stairs and they park their cars near their destinations so that they don’t have to walk.
“Instead of driving, walk or run to do your errands, stand instead of sit and get up to turn off TV instead of using the remote control. Little exercises can go a long way to help maintain an ideal body weight,” she adds.
She also says we should not skip the three daily meals but we should avoid snacking in between meals and drinking sweet or carbonated drinks. We should also eat plenty of vegetables and fruit with some fish or meat and a little rice.
Dr Masni said soups, congee and high fibre food such as oats are good for those who want to lose weight.
FAZLI (not real name) was a chubby and cute toddler. Now, he’s grown - and fat.
“I was always hungry so I kept eating. I was the fattest in my class,” he bemoaned. He was always ridiculed by his friends for being obese, and for not being able to keep up with them when walking or taking part in physical activities. He was 220kg at age 22.
“My movements were restricted as I could not sit in a bus comfortably and I had difficulty getting in and out of taxis,” he said. He also suffered obesity-related health problems, so Fazli sought help. Doctors at a government hospital in one of the northern states referred him to Putrajaya Hospital’s Obesity Clinic two years ago.
He arrived in an ambulance and consultant endocrinologist Dr Masni Mohamad was entrusted with the task of helping him. “I had to assess him thoroughly on his first visit, which included evaluation of potential obesity-related diseases within history, physical examinations and laboratory tests. I had to get his weight history, and his eating and activity behaviour besides searching for trigger factors, including medications,” said Dr Masni, one of the pioneers at the clinic which opened in 2005 for just once a month.
However, when the team of six multi-disciplinary doctors realised that obesity was a real problem, they opened the clinic twice a month and the hospital started getting referrals from all over the country.
The team comprises Dr Zanariah Hussein, head of endocrine unit in Malaysia/Putrajaya Hospital, Dr Nurain Mohd Noor and Dr Masni, consultant endocrinologists, and three other specialists training to be endocrinologists. The others in the team are two bariatric surgeons, dietitians, and rehabilitation and support group experts.
Dr Masni, who was urged to join the obesity clinic by her former boss, Dr Norshinah Kamaruddin, said: “Initially, I was not keen but now I feel happy that I am championing the cause.” “I also categorise a patient’s habitual physical activities such as during leisure, travel, work and exercise,” she said. She also compiles data on the family history on obesity, diabetes, hypertension, dyslipidemia, CVS disease, obesity-related cancer, thyroid disease and does a psychological status evaluation such as a patient’s self image, mental health and screens for eating disorders before embarking on treatment.
“The patient must be ready physically and mentally to undergo the weight loss programme,” she says.
Besides surgery, Fazli was put on a diet and physical exercise regime and finally started to lose weight. He is now 120kg and is still working hard to lose more weight. The incidence of being overweight and obesity is rising globally, affecting virtually all ages and socioeconomic groups. In 2006, the National Health & Morbidity Survey revealed that 29 per cent of adult Malaysians were overweight (BMI > 25 kgm-2) and 14 per cent were obese (BMI >30 kgm-2). In fact, two in five adult Malaysians are either overweight or obese. Obesity is a major risk factor for chronic diseases including type 2 diabetes, hypertension, cardiovascular disease, stroke and certain types of cancer. All these may reduce the quality of life and increase the risk of premature death.
Putrajaya Hospital only accepts patients who are > 40 BMI and many of those in the management and treatment group also have co-morbid health conditions. The hospital has also set up an obesity support group comprising mainly patients who share their experiences, problems and achievements with others or newcomers.
“This group actually has lots of fun interacting and sharing their experiences,” said Dr Masni. The hospital holds its clinic for obesity patients in the first and third Tuesdays of the month from 2pm to 5pm.
Dr Masni is one of the speakers at the 5th Malaysian Conference On Healthy Ageing. She will highlight not only the problems related to obesity but also the ways we can overcome them.
Obese persons with BMI > 40 or those having BMI > 35 with co-morbidities are recommended to go for bariatric surgery if they fail multiple non-surgical methods to reduce weight such as self-directed dieting, nutritional counselling by a dietitian, appropriate exercise and commercial or hospital-based weight loss programmes. Bariatric surgery is currently available in Hospital Putrajaya and some private hospitals. Essentially, this surgical method reduces the size of the stomach and creates intestinal malabsorption, enabling obese persons to lose a significant amount of weight. It results in long-lasting weight loss and eliminates or improves most of the obesity-related medical complications. It helps them to either overcome or control diabetes mellitus, sleep apnea, hypercholesterolemia and gout and 80-90 per cent of hypertension and fatty liver problems. Bariatric surgery patients are managed by a multi-disciplinary team, which includes surgeons, endocrinologists, anesthesiologists, dietitians, nurses, psychiatrists, and physiotherapists.
Dr Masni says a low calorie diet (LCD) of 1,200-1,600 Kcal/day, is recommended for weight loss in overweight and obese persons. “Reducing fat (25-30 per cent of energy) is part of the LCD to reduce calories. We normally have a meal replacement therapy to achieve the LCD by recommending patients to take nutrient-rich formula, vitamin and mineral fortification,” she added. When patients are put on very low calorie diet, then it is done under close supervision, although it’s not usually recommended.
Eat to live, not live to eat WHEN it comes to obesity, women are worse off than men and many of them suffer from diabetes and hypertension.
Most of the women are aged between 40 and 59 years and factors that contribute to their being overweight and obese include genetic reasons, a sedentary lifestyle, medication and, in most cases, food.
“While it used to be eat to live in the past, it’s now live to eat,” says consultant endocrinologist Dr Masni Mohamad.
What Malaysians do not realise is that when you are overweight and obese, you face many health problems.
Her advice is to go running, swimming, cycling and taking part in aerobic activities. These can last from 30 to 60 minutes.
She said poor lifestyle activities are also a contributing factor. Lots of people prefer to take the lift and escalator instead of walking up the stairs and they park their cars near their destinations so that they don’t have to walk.
“Instead of driving, walk or run to do your errands, stand instead of sit and get up to turn off TV instead of using the remote control. Little exercises can go a long way to help maintain an ideal body weight,” she adds.
She also says we should not skip the three daily meals but we should avoid snacking in between meals and drinking sweet or carbonated drinks. We should also eat plenty of vegetables and fruit with some fish or meat and a little rice.
Dr Masni said soups, congee and high fibre food such as oats are good for those who want to lose weight.
