Medical weight management

Weight is influenced by much more than willpower. Hunger, fullness, cravings, genetics, sleep, stress, medications, lifestyle and the way the body regulates weight can all play a part.

When weight comes down, the body may respond by increasing hunger and using less energy. This protective response can make further weight loss more difficult and weight regain more likely.

This is why successful weight management is not only about losing weight. Keeping it off often needs its own sustainable long-term plan.

Eating less does not always mean that weight will keep coming down.

Overall eating patterns, food choices, activity, sleep, medical conditions, medications and the body's adaptation to previous weight loss can all matter.

If you are already eating quite little, simply reducing food further may not be useful. It is better to understand the overall picture first.

Exercise is very important for health, but it does not always produce large changes on the weighing scale.

It improves fitness, strength and metabolic health, and helps preserve muscle. If further weight loss is needed, exercise may need to be combined with changes in other areas rather than simply doing more exercise.

Yes. All of these can play a part.

They may affect hunger, food choices, body composition, energy levels or how easily weight is gained or lost. Their importance varies from person to person.

Possibly.

Some medications can contribute to weight gain, and certain medical conditions can make weight management more difficult.

Your medical history usually helps us decide whether further investigation is needed. Not everyone needs an extensive hormonal work-up.

Yes. The World Health Organization recognises obesity as a chronic, relapsing disease, much like other long-term conditions such as high blood pressure or diabetes.

It involves the way the body regulates weight and is associated with a higher risk of conditions such as diabetes, heart disease, fatty liver and sleep apnoea.

This does not mean everyone with a higher weight needs medication. It means obesity is more complex than simply eating too much or not trying hard enough.

Medical weight management may be useful if your weight is affecting your health, you repeatedly lose and regain weight, or the things you have tried are no longer enough.

BMI is one guide, but we also consider conditions such as prediabetes, high blood pressure, high cholesterol, fatty liver and sleep apnoea.

For Asian patients, weight-related health problems can occur at a lower BMI, so the overall health picture matters more than BMI alone.

For prescription weight loss medication, the usual threshold is BMI 30 or above, or BMI 27 or above with a weight-related medical condition.

If your BMI is below 27 and you are otherwise healthy, medication would generally not be our preferred approach.

If there are other health concerns, we can still assess the overall situation and advise on an appropriate approach.

When you book a weight management appointment, we will usually send you a short pre-visit questionnaire about your medical history, weight history and previous weight management attempts.

This helps us understand your background before you come in, so more of the consultation can be spent discussing the areas most relevant to you.

We will look at your health, lifestyle, eating patterns, physical activity, previous experiences, concerns and preferences. We may also discuss diet, exercise and medication options, and address your questions about weight and treatment.

The aim is to understand the overall picture and work towards a plan that is individualised and practical for you.

The first consultation usually takes about 30 to 45 minutes.

Not necessarily.

If you already have recent blood tests or health screening results, they may provide much of the information needed.

Additional tests are usually only recommended when they are likely to help with the assessment or treatment decision.

Yes. You do not need to decide about medication before the consultation.

Medication is only one possible part of weight management. We can first understand your situation and discuss the options before deciding what, if anything, is appropriate.

Medical weight management can involve nutrition, physical activity, strength training, sleep, treating contributing medical problems and prescription weight loss medication.

For selected patients, weight management procedures or bariatric surgery may also be considered.

The combination will depend on your health and individual needs.

Medication may be considered when lifestyle changes alone are not giving enough benefit, or when hunger, repeated weight regain or other biological factors are making weight management difficult.

We consider your BMI, health conditions, previous attempts, other medications, possible side effects, cost and your preferences.

Medication is recommended when it is likely to provide enough benefit to make it worthwhile.

GLP-1 and GIP are naturally occurring hormones involved in appetite, fullness, digestion and blood glucose regulation.

Some weight loss medications act mainly on the GLP-1 pathway, while others act on both GIP and GLP-1 pathways.

They can help you feel full with smaller amounts of food, reduce hunger between meals and reduce cravings or persistent thoughts about food. They can also slow how quickly food leaves the stomach and improve blood glucose regulation.

1

Released in the gut

GLP-1 is released from the intestine after eating.

2

Reduced appetite

GLP-1 acts on areas of the brain involved in appetite and fullness, helping you feel satisfied sooner and for longer.

3

Slower stomach emptying

Food stays in the stomach for longer, which can increase feelings of fullness.

4

Supports blood sugar control

Helps the body release insulin when needed.

They are not simply appetite suppressants. Different medications vary in effectiveness, side effects, dosing and cost, so the choice depends on your health, treatment goals, preferences and individual response.

Possibly. Eating relatively little does not necessarily mean that an appetite-regulating medication will not work.

In clinical studies, people receiving GLP-1 based treatment have lost substantially more weight than people following the same prescribed calorie-restricted diet and lifestyle programme without medication. In one study, the difference was about 10 percentage points of body weight.

This suggests that the effect is not simply about eating less. These medications can also reduce hunger, cravings and thoughts about food, and may make a lower-calorie eating pattern easier to sustain.

If you already eat relatively little, we would look more closely at your nutrition, eating pattern and other factors affecting your weight rather than simply trying to reduce your food intake further.

Treatment can be reviewed.

Some people need more time at a particular dose. Others may experience troublesome side effects or may not get enough benefit.

We look at your response, dose, side effects and overall progress before deciding whether to adjust the dose, give it more time, change medication or take a different approach.

There is a wide range, and it is difficult to predict exactly how much any one person will lose.

With newer GLP-1 and GIP/GLP-1 weight loss medications, clinical studies have generally reported average weight loss of around 10% to 20% of starting body weight over about a year or longer, depending on the medication and dose.

Your result will also depend on your starting weight, health, diet, physical activity, lifestyle and individual response.

These figures are clinical trial averages, not a target or guarantee. Some people lose less and others more.

The aim is not to lose weight as quickly as possible. We generally prefer gradual, healthy and sustainable weight loss.

A commonly used guide is around 0.5 to 1 kg per week, although the appropriate pace varies between individuals and at different stages of treatment.

Losing weight too rapidly can make it harder to maintain adequate nutrition and muscle, and may increase the risk of problems such as gallstones.

We therefore focus on a healthy trend over time rather than the fastest possible weight loss.

Plateaus are common.

As weight decreases, the body's energy needs change and it adapts to the lower weight.

We first consider whether further weight loss is actually needed. If it is, we can review the treatment plan. Sometimes maintaining the weight already lost is itself a good outcome.

Digestive symptoms are the most common side effects. These include nausea, vomiting, diarrhoea, constipation, abdominal discomfort, bloating and indigestion.

For most people, symptoms are mild to moderate and often improve as the body adjusts. Gradual dose increases and simple changes such as smaller portions, eating more slowly and avoiding very heavy or high-fat meals can improve tolerability.

With gradual dose adjustment and appropriate dietary changes, most people are able to manage these side effects reasonably well.

Uncommon but important complications include pancreatitis and gallbladder problems. Severe allergic reactions are rare. A very rare eye-related complication has also been reported with some GLP-1 based treatments.

If side effects are troublesome, the treatment plan can be reviewed rather than simply pushing through them.

Suitability depends on the medication and your medical history.

Pregnancy is an important consideration. Certain medical conditions, gastrointestinal problems, allergies and other medications may also affect which treatments are suitable.

If you are planning a pregnancy, pregnant or breastfeeding, discuss this before starting treatment.

When you lose weight, some of the weight lost will usually come from muscle as well as fat. This can happen with weight loss from diet, medication or surgery. It is not specific to GLP-1 treatment.

Preserving muscle is important because it helps:

1. Maintain strength and physical function
2. Maintain energy expenditure and metabolic health
3. Support continued weight loss and make long-term weight maintenance easier

The aim is therefore not simply to lose as much weight as possible, but to lose more fat while preserving as much muscle as possible.

Adequate protein intake and strength or resistance exercise can help reduce muscle loss during weight loss.

Not necessarily. There is no single diet that is right for everyone, and calorie counting is not essential for everyone.

Good nutrition still matters for health, muscle preservation and long-term weight maintenance. Some people find calorie tracking useful, while others find it difficult to sustain.

Most importantly, your eating pattern should be practical and sustainable. It should fit your health, preferences, lifestyle and usual way of eating, including meals with family, eating out and foods you enjoy.

A diet that works only for a few months is unlikely to be useful for long-term weight maintenance.

Exercise is only one part of being physically active.

Everyday movement matters too. This can include walking more, taking the stairs, walking short distances instead of driving, moving more during the day and spending less time sitting.

Structured cardiovascular and strength exercise can then be added according to your health, fitness and available time.

There is no single programme everyone needs to follow. The aim is to gradually reach a level of activity that is beneficial and sustainable.

Starting weight loss medication does not mean that you have to take it for life.

It is entirely possible to stop treatment. However, appetite may increase again and some weight regain is common. How much weight comes back varies greatly from person to person.

Some people can maintain their weight without medication. Others may benefit from longer treatment or an ongoing treatment plan at an appropriate dose.

The long-term plan does not need to be decided when treatment first starts. It can be adjusted over time.

Once you reach a weight that is healthy and appropriate for you, the focus changes from losing weight to maintaining it.

We look at your appetite, eating pattern, physical activity, muscle preservation and weight trend. If medication has been stopped, some weight fluctuation is normal and does not automatically mean treatment needs to restart.

If there is significant or continuing weight regain, we review what may be contributing and adjust the plan. This may involve lifestyle changes, restarting medication or considering longer-term treatment.

The aim is to find a practical, sustainable and cost-effective way of maintaining the health benefits you have achieved.

Obesity medicine is developing rapidly. Recent advances include higher doses of existing GLP-1 treatments, oral GLP-1 medications and newer medicines acting on several hormone pathways.

We follow new research as it emerges, looking at effectiveness, safety, longer-term outcomes and where new treatments may fit into clinical practice.

Many promising treatments are first studied or introduced overseas, and it can take time before they are reviewed, approved and available in Singapore.

The direction is promising. As evidence grows, weight management is likely to become increasingly effective, flexible and individualised.

The initial consultation is $109. It usually takes more time to understand your health, weight history, previous attempts and goals before recommending an appropriate approach.

Subsequent consultation fees range from $32.70 to $87.20, depending on consultation duration.

As a general guide:

• Oral weight loss medication: $70–$400 per month
• Injectable weight loss medication: $400–$800 per month

Actual costs depend on the medication, dose and treatment plan. Where there is more than one medically appropriate option, we also consider long-term affordability and cost-effectiveness.

All prices are inclusive of GST.

Currently, there is no CHAS subsidy and MediSave cannot be used for weight management treatment or weight loss medication.

Private insurance and company medical benefits vary between policies. Please check directly with your insurer or benefits provider.

Follow-up is usually about once a month initially, particularly while medication is being adjusted.

During this period, we review your progress, side effects, correct medication use, diet, physical activity and other lifestyle changes while gradually working towards an appropriate maintenance dose.

Once treatment is stable, follow-up can usually be spaced to around every 3 to 6 months.

The exact interval depends on your progress, side effects, weight trend, medical conditions and whether changes to the treatment plan are needed.