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Obesity and Metabolic Disease

 

Obesity is more than a cosmetic problem and may be complicated by a diverse spectrum of conditions including obstructive sleep apnoea, joint pains or metabolic diseases (e.g. diabetes, hypertension, subfertility, fatty liver disease, polycystic ovarian syndrome) and may result in an overall decrease in life expectancy. Patients suffering from significant obesity also struggle with self-esteem and psychological issues. While losing weight is beneficial, many patients are unable to achieve a sufficient quantum to see significantly improvement in associated medical conditions and quality of life.
Fortunately, obesity can be successfully treated by a multidisciplinary approach involving our team of dedicated weight management experts at the NUH's Centre for Obesity Management and Surgery (COMS). Both adult and adolescent patients undergo holistic assessment by dietitians, physiotherapists, psychologists, endocrinologists, hepatologists and surgeons. Patients receive important counselling and interventions including dietary and lifestyle modifications in addition to an in-depth exercise plan with trained physiotherapists. Bariatric surgery is an effective tool for weight loss and is discussed alongside important lifestyle changes that are crucial for successful and sustained weight loss.
In suitable patients who are keen to pursue bariatric surgery, COMS offers a full range of weight loss procedures including endoscopic (intra-gastric balloon) and surgical options such as Vertical Sleeve Gastrectomy (VSG) and Roux-en-Y Gastric Bypass (RYGB). In addition, COMS is an early adopter of the One-Anastomosis Gastric Bypass (OAGB) procedure; a shorter and simpler procedure which confers similar benefits relative to the RYGB procedure. A proportion of patients who undergo these procedures see improvement or even resolution of conditions like diabetes and hypertension. COMS also has expertise in managing patients with complications of prior bariatric surgery, such as gastro-esophageal reflux disease (GERD) after VSG and excessive weight-loss/malnutrition from previous RYGB. The management of GERD post-VSG is particularly challenging, as the fundus of the stomach is removed and traditional fundoplication (wrapping of fundus around the gastro-esophageal junction) is not feasible. In this setting, COMS offers the option of implanting a magnetic sphincter augmentation device known as LINX® device as well as more extensive salvage procedures such as conversion to RYGB.
Bariatric surgery has been shown to improve life expectancy and quality of life in patients with significant obesity and associated complications. The team at COMS is committed to helping patients attain better health with a multidisciplinary and holistic approach. The COMS is also committed to advancing the current understanding of metabolic disease and is actively participating in a number of clinical trials and research projects (see below) to improve the care we provide.

Ongoing Research

  • A randomized controlled trial comparing Goal Directed versus Conventional Weight Loss Program post laparoscopic sleeve gastrectomy (Go-Pro). NCT02885220
  • Sexual Health in Bariatric Patients (SeB)
  • Accessing Deficiencies and Diseases in Asians Seeking Bariatric Surgery
  • Long-term outcomes of metabolic diseases for patients undergoing bariatric surgery in Singapore *upcoming*
  • The impact of Bariatric surgery induced weight loss on the dynamics of small non-coding RNA (BEACON)
  • Vitamin D Intramuscularly for Bariatric Surgery (Vitamin-DIBS): Randomised controlled Trial comparing use of Intramuscular Cholecalciferol Injection versus Oral Cholecalciferol in Patients with Hypovitaminosis D Undergoing Bariatric Surgery *upcoming*

Recent Publications

  • Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants.

Syn NL,.., Kim G, So JB, Kaplan LM, Dixon JB, Shabbir A.
Lancet. 2021 May 15;397(10287):1830-1841. doi: 10.1016/S0140-6736(21)00591-2.
PMID: 33965067 https://pubmed.ncbi.nlm.nih.gov/33965067/

  • Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus.

Kermansaravi M, .., Shabbir A, .., Nimeri A.
Obes Surg. 2021 Dec;31(12):5303-5311. doi: 10.1007/s11695-021-05724-z. Epub 2021 Oct 6. PMID: 34617207   

  • The first modified Delphi consensus statement on sleeve gastrectomy

Kamal K Mahawar,…, Asim Shabbir,..,Ali Aminian.
Surg Endosc. 2021 Jan 12. doi: 10.1007/s00464-020-08216-w
PMID: 33433676 https://pubmed.ncbi.nlm.nih.gov/33433676/

  • Plasma Clearance of B-Type Natriuretic Peptide (BNP) before and after Bariatric Surgery for Morbid Obesity.

Kian Keong Poh, Asim Shabbir, Jinghao Nicholas Ngiam, Poay Sian Sabrina Lee, Jimmy So, Christopher M Frampton, Christopher J Pemberton, Arthur M Richards.
Clinical Chemistry, 2020 Dec 31, hvaa308, doi: https://doi.org/10.1093/clinchem/hvaa308

  • Correlation of Telomere Length in Adipose Tissue and Leukocytes and its Association with Postsurgical Weight Loss.

Gurung RL, M Y, Moh AMC, Dorajoo R, Liu S, Liu JJ, Shabbir A, So JBY, Tan CH, Cheng AKS, Lim SC.
Obesity (Silver Spring). 2020 Dec ; 28(12):2424-2430. doi: 10.1002/oby.23017.
PMID: 33230966.