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