I will preface this article by agreeing with all of you; weight loss is indeed a challenging task! It requires a great deal of willpower to fight the endless temptations. I'm not going to pretend that it's easy.
Many patients come to me feeling very despondent. They've already tried countless of weight loss methods (from the Atkins diet, to the South Beach diet, to the Ketogenic diet), but to no avail. From my interactions with them, I know that they are at their wits' end.
Therefore, I have decided to write this article to help those of you who are struggling to lose weight. Weight loss is not an urban myth! With the right methods, you can achieve your desired weight.
Related: This Singapore-Based Clinical Dietician Discusses Fad Diets
I eat healthy and exercise. Why am I still not losing weight?
More often than not, this is the first question my patients ask me. Before we delve deeper, let me break it down for you.
The main reason why you are not losing weight is because your body is in “caloric excess”.
To lose weight, you need to be in “caloric deficit”
For you to maintain a constant weight, your energy intake (the food you eat) needs to be equivalent to the energy you expend. This is referred to as “caloric balance”.
So, if you want to lose weight, you need to use more energy than you consume. You need to put your body in a caloric deficit state.
However, if you eat more calories than you use, you're putting your body into caloric excess. This is means that you will gain weight.
“Caloric deficit” is a numbers game
Let me put this in perspective using numbers.
An average adult male needs around 2,100 kcal a day to maintain a healthy body weight. An average adult female needs about 1,800 kcal a day. This daily requirement varies according to factors such as:
- Age
- Gender
- Height
- Weight
- Activity level
If you have a deskbound job, you'll need fewer calories than a salesman or waiter who is often on the move. Hence, if you're a male and you eat more than 2,100 kcal a day, you'll need to burn off the extra calories or you will gain weight.
You might not be eating healthy at all
Many people like to think that they are eating healthily. However, the food we perceive as “healthy”, may be far from it.
Let's take a look at Subway, the fast food chain that is positioned as a healthier choice. Their set meal that comes with a sandwich, a drink, and two cookies is a hit with many office workers.
However, when you take a closer look at the calories these items provide, it actually adds up to more than 1,000 calories! This makes up half of your required calorie intake, and bear in mind that this is one meal.
Food item
Energy (kcal)
Oven roasted chicken on multigrain bread with cheese & mayonnaise
437
Coke (300 ml)
139
Chocolate chip cookie
209
Peanut butter cookie
216
Total
1,001
Also read: 11 Common Food Myths Busted By An Experienced Clinical Dietician
How should I cut down my calorie intake?
I often advise my patients to change up their food choices.
Food item
Energy (kcal)
Oven roasted chicken on multigrain bread with honey mustard
323
Coke Zero
0
Chocolate chip cookie
209
Total
532
This way, you have successfully cut down your calorie intake almost by half! By making simple changes to your food choices, you can save a lot of unwanted calories.
In this example, you are cutting out 469 kcal daily, which is equivalent to losing about 46g of fat.
At one glance, it might not seem very significant. However, if you multiply that by a month, you can potentially lose 1.3 kg. In a year, you can lose more than 15 kg!
Most doctors and dieticians like to build meal plans from scratch. However, I prefer to eliminate certain high calorie foods from a patient’s normal intake to make it easier to follow.
It is like pouring water out of a full glass rather than filling up an empty glass to get a glass half full! Same result, different method.
Is there an easier way to lose weight?
The truth is, diets are an integral part of weight loss. However, what you can do to ease this seemingly ardous task is to make small changes in your daily diet. This will help you stay within your daily caloric requirement.
More importantly, it will help you achieve sustainable weight loss.
Here is a chart to elaborate on the example I have given above, to show how many calories you can remove just by making simple changes to your food choices.
Instead of:
Replace with:
You cut:
Subway Club sandwich with cheese 317 kcal
Subway Club sandwich without cheese 278 kcal
39 kcal or 4 g of fat
1 tbsp mayonnaise 107 kcal
2 tsp mustard 7 kcal
100 kcal or 10 g of fat
16.9oz Coke 201 kcal
16.9oz Coke Zero 0 kcal
201 kcal or 20 g of fat
Starbucks venti latte 300 kcal (of which 140 kcal comes from milk)
Americano:
with no sugar 0 kcal
with 1 tsp sugar 16 kcal
300 kcal or 30 g of fat
284 kcal or 28 g of fat
While milk is healthy, it also contains a lot of fat. By removing milk and sugar from your coffee every day, you can potentially lose close to 1 kg a month or 12 kg in a year!
These small changes amount to significant fat loss over time.
I also understand that giving up your favourite foods like fried chicken, creamy pastas, and ice cream completely is a big sacrifice. For those of you who love to eat, it might seem quite impossible.
Here’s the good news: you don’t have to stop eating them completely. I always advise my patients to cut down their total caloric intake by making small sacrifices on a regular basis. That way, you can still enjoy these high caloric foods occasionally.
However, that doesn’t mean binge eating! You still have to eat in moderation and maintain caloric deficit to achieve weight loss.
That is why my weight loss principle is to find pain-free ways to take out the calories from your diet. This makes it easier for you to keep this up for a longer period of time.
“It's so troublesome to keep watching what I eat!”
Many times, following a strict diet is what makes losing weight impossible for some people. It seems like more you try to starve, the more you seem to put on. So how do some people do it successfully?
Here is where my concept differs from some other doctors. It is difficult to lose weight, and I believe it can be made easier if we:
- Adopt pain-free ways to cut calories from your daily diet
- Start the process with weight loss medications
Related: How can I get rid of a tummy bulge that won't go away despite exercise and dieting?
Why take medications for weight loss?
From my experience, I believe that short-term weight loss medications can help many people, even if the experts tell us that based on their studies, medications are only for people with a body mass index (BMI) of above 30.
Firstly, doctors in Singapore hardly see many patients with a BMI of above 30.
Secondly, results are based on big medical trials done by experts to prove preconceived theories. In this case, the studies are designed to compare the risk of taking medications to the complications associated with being overweight.
How about societal concerns of being overweight? Do they measure the risk of taking weight loss medications to achieve societal acceptance, to find a job, a girlfriend or a boyfriend if one is not overweight? No medical trial measures that stuff.
These studies have no means of measuring intangible things like that. If that is the case, are we still so sure that we should not be helping more people lose weight with medications?
When is the best time to introduce weight loss medications?
Phase 1: Ease initial Weight Loss pains with medications
The journey to achieving sustained weight loss is generally divided into two phases. Phase 1 is the active weight loss phase.
Many of my patients consider this as the most difficult and painful phase. This when your diet is heavily restricted and you have to exercise far more then you used to. During this phase, I believe that it is crucial to use weight loss medications.
They can help you to cope better with your hunger pangs. Furthermore, weight loss medications allow you to see rapid weight loss. Rapid weight loss is a great motivator. Motivation is the single most vital driving force in any weight loss journey!
Phase 2: Weight Loss maintenance
By this stage, you would have achieved your ideal weight. The goal now is for you to maintain a caloric balance. If you've achieved your desired weight, you should stop or cut down on your medications.
Reason being, there's no need to maintain an ultra-low calorie diet any more. This means you're now able to eat more than what you could in phase one. It might sound like a relieve, but many people who have successfully lost the extra weight feels that they are losing ground.
You should be motivated by the fact that you have already lost all the weight you need to. You just need to maintain it.
Where should I seek help for weight loss treatments in Singapore?
Firstly, there are beauty salons who sell weight loss programmes. They provide range of services such as, machine treatments, meal replacements, and even counselling.
Secondly, there are some clinics that prescribe medications that curb appetite or 'block' fat.
Last but not least, there are aesthetic and plastic surgery clinics. They help you with weight loss through performing invasive or non-invasive fat reduction treatments.
While there are many reputable clinics and salons who have successfully help some patients slim down, I feel that not many offer a full suite of services that address all aspects of slimming.
Also read: Face Slimming: An Aesthetic Doctor Shares How You Can Achieve It Without Surgery
What are common weight loss concerns?
When I talk to my patients, there are a couple of concerns that I hear all the time. They want the process to be:
- Fast
- Easy
- Safe
Those who want it fast would go to beauty salons. Those who want it safe would go to GP clinics for medications, and those who want it easy would go to aesthetic doctors or plastic surgeons.
What about those who want all three? There are not many places that they can go.
What are the key principles of successful weight loss programme?
To me, a successful programme is one where you've lost enough weight to be self-motivated to maintain a healthy weight for the rest of your life independently.
Weight loss treatment principle 1: Go big or go home
During the first meeting with your weight loss doctor, you should undergo a full body checkup.
It should include a full-body examination, body fat analysis, BMI analysis, waist circumference measurement, and blood pressure measurement.
From there, your doctor will work with a nutritionist to customise a weight loss plan. They will be able to determine your optimal weight, optimal daily calorie intake, and craft a nutrition strategy.
You'll also get insights on dieting, healthy eating, exercising, and lifestyle, as well as discuss common misconceptions on dieting and nutrition. This plan must be safe and promises realistic results.
From my experience, I know that many of you need to see rapid weight loss at phase one to be motivated to continue the fight for weight loss.
This is why I often include weight loss medications at the start of my programmes. They can help suppress appetite and prevent fat from being digested by the body.
Weight loss treatment principle 2: Safety
Treatments all need to be scientific and safe. Even with well-studied, medications approved by the Food and Drug Administration (FDA), side effects can and infrequently do occur.
Every now and then, we hear of complications resulting in people consuming off-the-counter slimming supplements and landing up in hospital. While some of these supplements might end up being effective, but don’t be the first one to test them out!
In my practice, the medications I prescribed are all FDA-approved. These medications are clinically-tested and safe. The dosage and duration will be prescribed personally by me, and your progress will be closely monitored.
Related: Your Complete Guide to Food Supplements in Singapore (2021)
How long after starting on a programme can I expect to see results?
In all my patients, there has been no lag time in weight loss. As long as there is a negative calorie balance on your daily routine, there will be weight loss.
How safe are weight loss programmes in Singapore?
Meal replacements such as Optifast and body contouring treatments like CoolSculpting have been approved by the FDA. This is a stamp of approval that indicates that they are safe and effective.
1. Opifast
This is prescribed for patients who may not need weight loss medications, but require a low calorie diet. It’s also for patients who prefer not to consume weight loss medications.
Nestlé’s Optifast®, for instance, is a meal replacement product dedicated to clinic use. It needs to be consumed under the guidance of a qualified nutritionist or doctor.
Although individual results vary, based on studies, the typical patient on a full Optifast diet loses an average of 22 kg in 26 weeks. It is a clinically-proven meal replacement product to help overweight patients lose excess weight, improve health, and lower weight-related health risks.
2. CoolSculpting
CoolSculpting is for body contouring, not weight loss. This no downtime, non-invasive fat reduction treatment is good for removing stubborn fat that still lingers on despite a lot exercise.
It uses a cooling temperature to remove fat in the double-chin, arms, armpit area, abdomen, love handles, thighs, back or bra fat, knee, and other areas.
While not all weight loss patients require a CoolSculpting treatment, it will certainly help those who desire a more sculpted body shape. The results from CoolSculpting can be considered as more long lasting. This treatment is cleared by the US FDA, and is safe.
Also read: How effective is Coolsculpt for losing tummy fats after childbirth?
Weight loss treatment principle 3: Sustainability
Weight loss treatments need to be sustainable. You need to be committed and keep going at it until you see results. Once you see great initial results, you'll be hungry for more. Trust me, after this hurdle, your weight loss process will only get easier!
By the time you're able to self-motivate, you wouldn't need the help from a doctor anymore.
Weight loss treatment principle 4: Body contouring
Some you can be too focused on just getting the numbers on the weighing scale down. In the midst of that pursuit, they forget about their body shape.
There are great machines to help you reduce fat over stubborn places in a non-invasive manner. Looking good is not just about being skinny.
For example, CoolSculpting is for meant for body contouring, not weight loss. This no-downtime, non-invasive fat reduction treatment is used to remove stubborn fat that will not go away with exercise.
It uses a cooling temperature to remove fat in the double-chin, arms, armpit area, abdomen, love handles, thighs, back or bra fat, knee, and other areas.
Related: The Essential Guide to Body Shaping in Singapore (2020)
How much does a weight management programme in Singapore cost?
To help you with your research and for you to better plan your budget, I have listed a rough guideline of the cost of the treatments that I've mentioned.
Weight loss programmes with a doctor and/or nutritionist and medications: $660 - $990
Nutritionist counselling: $100
As for CoolSculpting, the total cost will depend on how many applicators your doctor prescribes for you based on your needs and expectations.
How do you decide which weight loss programme is best for you?
From my experience, it's best to let your doctor assess your suitability for any weight loss treatments.
Weight loss is difficult, so you want to make sure you have a strategy that will motivate you and help you stay on track.
Also read: Do $300 Spa Slimming Sessions Really Work? This Singaporean Doctor Explains
The 4 weight loss key points you need to remember:
- To lose weight, you have to eat fewer calories than what your body burns each day.
- Your food choices may not be as healthy as you think. So always check before you eat!
- Eat within your daily caloric requirements and exercise to burn off those calories. You don’t have to avoid all your favourite foods!
- Make your weight loss sustainable by incorporating small changes to reduce your daily caloric intake.
Now that you understand why you should achieve caloric deficit to lose weight (i.e. use more energy than you consume), you have to watch what you eat.
Interested to find out how you can improve the appearance of your abdomen? Read our guide to Tummy Tuck.
Conclusion
I hope the strategies and principles highlighted in this article can help guide people on that path because weight loss is difficult, you really shouldn’t be doing it alone.
You can now look forward to a healthier life!
Dr. Terence Tan obtained his Bachelor of Medicine and Bachelor of Surgery and Master of Medicine (Surgery) from the National University of Singapore (NUS). He was accepted as a Member of the Royal College of Surgeons (Edinburgh) in 2003. He then furthered his training with medical aesthetic specialists. He is happily married, and a father to two boys. When not in his scrubs, he loves cooking for the family and planning their next holiday.
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