You would think Doctors, with all our knowledge, are really good at taking care of our own health. I cannot speak for my colleagues but for myself, learning how to manage my weight and get back to good health was a journey of learning and discovery. I would like to share this journey with you and perhaps you can pick out some pointers that may be relevant to your own health journey.
Sporty and Healthy in my youth
I must say with some pride that I was very sporty in my youth. I was part of my school’s swimming team and even managed to reach the national finals in my event. Although I did not win any medals on the national stage. I was a svelte 45 kg and even boasted visible abdominal muscles. Yes, the legendary 6-pack.
Going downhill after graduating
I graduated from NUS School of Medicine. And like every other junior Doctor, was assigned to work in a government hospital. As you would expect, work was tough. We were regularly pulling 100 working hours a week. With that kind of schedule, even sleep became a luxury. Much less can be said of exercise. Meals also became extremely hurried affairs often with the easiest, fastest usually carbohydrate laden food that we can grab.
Leaving the hospital and going into private practice was not much better. Aside from the stress of clinical practice, there was the additional stress of running the administrative side of the business as well. Again, attention to a healthy lifestyle took a backseat.
Before I knew it, my BMI had ballooned to 28.2 kg/m2. To put this into context, the definition of obesity for Asians is a BMI of 27.5 kg/m2 and above. So yes, I was officially obese. And also extremely out of shape. I could barely jog for 15 minutes without huffing and puffing and slowing down to a walk. I could barely climb 3 flights of steps without feeling out of breath.
Getting back into shape
Finally I had to face the reality that if I continued on this path, my risk of chronic diseases like Diabetes and high blood pressure and even my risk of heart disease and heart attacks would be unacceptably high.
So I fell back on what was considered “common medical wisdom” at the time. And that is if you want to lose weight, you just have to eat less and exercise more.
Determined, I went out and bought a pair of running shoes. It was a pair of red Adidas Adizero. I even splashed on a tiny device that went into the shoe to measure my gait and speed. I downloaded a running app and was all ready to start my new healthy lifestyle.
But I knew exercising was not enough. I changed my diet by skipping breakfast, eating only a tuna sandwich for lunch and a tiny bowl of rice for dinner.
And guess what? It worked! My weight started dropping. My BMI reached as low as 26.7 kg/m2. I was elated!
Then it stopped working
There came a time when I was running between 40 km to 50 km a week. And almost every meal I was eating like a rabbit. I was miserable and hungry all the time.
What made it worse was the weight was just not dropping. And what made it even worse than that was all I needed to do was to eat just a teensy weensy bit more over the weekend and entire kilograms started piling pack on.
Figuring out the mystery
This was when I started researching weight loss, or more accurately fat loss, as a medical topic. It so happened that this was the time there was a paradigm shift in the medical profession’s view of obesity. In that obesity was a disease and not just a lifestyle choice. Carrying too much body fat was not purely a function of lifestyle.
This was what I learned
The body is great at keeping things stable. A fancy term Doctors use for this is homeostasis. Without any input from us our bodies keep our blood sugar, blood pressure, body temperature and many other parameters stable. In fact, we have very little control over it. So it seems strange that we think we have control over our body weights.
Our body will do all it can to keep our weight stable. And if it cannot, it is because there is something wrong with the body NOT just our lifestyle. Just like if our body cannot keep our blood sugar stable it is a disease called Diabetes. Which, yes, lifestyle can be a contributing cause and lifestyle change can help control it but it is NOT the only factor. And obesity, just like Diabetes, has to be treated.
Not just calories in and calories out
I also learned that the body is alive (surprise!). In other words, it is not a passive vessel that takes in calories and puts out calories. The body controls how much calories we consume via hormones that control hunger and satiety. The body controls how much calories we consume by changing our resting energy expenditure. Even when we exercise, our body changes our biomechanics to conserve energy. This explains why the number of calories that your phone app tells you you have burned, is not the actual number of calories you burned. When we take in calories our body decides whether to store it, use it and how and where to store it.
So this finally solved the mystery of why, with my exercise and diet and my carefully calculated net negative calorie intake daily, I was not losing weight and in some weeks actually gaining weight.
The solution
So if Obesity is a disease like Diabetes, it means it has to be treated with a medicine like Diabetes. At the time, there was a new medicine called Liraglutide that was newly approved for the treatment of obesity. It was part of a family of medicines called incretins. What it does is to mimic an overeaten state in the body without actually eating. Let me explain. After having had a full meal, your body produces insulin. Your blood sugar goes back to normal. Your body is burning energy and fat. You feel full (satiated). You do not have any appetite to eat more. If you have eaten way too much (maybe at a buffet?) you may even feel slightly nauseous. Liraglutide reproduces all these effects without you having to eat.
So I started myself on this medicine. The results were simply astounding. I was losing weight without even trying. In fact, I probably could not put on weight even if I tried.
A better solution
The only drawback to Liraglutide was that it required daily self injection. To be honest, the injections were not painful in the slightest. I literally did not feel the needle. But having to give myself a needle every single day got a bit tiresome.
Fortunately, a new medicine came along called Semaglutide. It did everything Liraglutide did except that I only had to give myself the injection once a week. This made it all the more easier.
The caveat
Of course being on this medicine does not mean I can stop exercising and eat whatever I want. Our bodies need energy but more importantly it needs nutrients. Which means I concentrate on eating foods which are high in vitamins, minerals, natural fiber, lean protein and antioxidants. I also keep to an exercise regime of 200 to 300 minutes a week of moderate to high intensity exercise. As I often say to my patients “skinny does not mean healthy.”
The results
My BMI fell to 23.6 kg/m2. My waist circumference shrank so much I had to get new pants and punch new holes in my belt. I wake up feeling energetic. There are even days I wake up before the alarm has gone off. I feel good and strong when I go for my runs or go to the gym. I feel sharper at work. Most importantly, my calculated cardiovascular risk (risk for heart disease and heart attacks) have gone way down.
The future
I do not know when or if I will ever stop using Semaglutide. Simply because it makes it so easy to maintain my weight. Also, from the research I had read so far, it does not have any long term side effects. In fact, the available data shows it lowers risk of Diabetes, lowers blood pressure, reduces risk of heart disease and may even be beneficial for the liver.
Perhaps in the future there will be another paradigm shift to how we approach obesity. But for now, I am extremely happy with the new lease of good health Semaglutide coupled with a healthy lifestyle has given me.
Dr Tan Kok Kuan