#HEALTH: Going beyond the scale

Obesity is more than just a number on the scale. While weight may be the first thing people notice about obesity, health experts are increasingly highlighting that where fat is stored in the body can be just as important. In Malaysia, abdominal obesity—fat around the abdomen—is a significant health concern. According to the 2023 National Health and Morbidity Survey, 54.5% of Malaysian adults had abdominal obesity, up from 45.4% in 2011.

Health professionals emphasize that relying solely on weight or appearance can be misleading. There are different types of fat in the body. Subcutaneous fat is stored just beneath the skin and is often visible around areas like the abdomen, hips, and thighs. Visceral fat, however, is found deeper within the abdominal cavity, surrounding internal organs. Excess visceral fat is linked to various health issues, including insulin resistance, type 2 diabetes, high blood pressure, heart disease, and chronic inflammation.

It's important to remember that someone may not need to be severely overweight to have high levels of visceral fat. This means that simply looking at someone's weight or shape may not give a full picture of their metabolic health. Dr Foo Wing Jian, a senior aesthetic doctor at Premier Clinic, explains that a more holistic approach is needed to assess obesity. Factors like waist circumference, body composition, medical history, and overall metabolic health should be considered.

Many people believe that if their weight isn't extremely high, they don't need to worry about their health. But weight alone doesn't tell the whole story. Dr Foo stresses that abdominal obesity can be a warning sign of underlying metabolic problems. Relying only on weight loss for health improvement is not enough; one should also consider improvements in body composition and metabolic health.

People often think that losing weight comes down to willpower. However, the body has complex biological mechanisms that control hunger, fullness, energy intake, and weight. During weight loss, changes in appetite and other bodily processes can make it hard for some people to keep the weight off long-term. This is why some individuals may struggle with maintaining weight loss over time.

While lifestyle changes like nutrition, exercise, sleep, and behaviour still matter, some people may need additional medical help for weight management. This has led to an increased interest in medical weight management, where healthcare professionals evaluate an individual's health and weight-related risks before deciding if treatment is needed.

Medical weight management can help people with obesity by reducing appetite and making them feel fuller, which can lead to a decrease in food intake. When combined with proper lifestyle measures, this can result in meaningful weight loss. This represents a shift from the old idea that weight loss is simply about eating less and exercising more.

Medications can also play a role in treating obesity. Certain prescription drugs help address the biological pathways involved in appetite and metabolism, providing an extra tool for some patients who might benefit from additional support.

However, it's crucial to get a proper medical assessment and be under the supervision of a trained healthcare professional when considering prescription weight-management medication. Not everyone who wants to lose weight needs this kind of treatment. Decisions about medical intervention should take into account factors like BMI, waist circumference, existing health conditions, current medications, metabolic health, lifestyle, and personal goals.

The goal of medical weight management is not to replace healthy lifestyle habits or promise quick cosmetic weight loss. Instead, it's about providing evidence-based medical support for those who may need more than lifestyle changes alone.