Mount Elizabeth Hospital Scientific & Clinical Meeting (Incorporating The 18th Annual Seminar & 5th Annual Clinical Meeting)

06 Nov 2004

By Prof K Satkunanantham, Director of Medical Services

Venue: Sheraton Towers Singapore

Address By Prof K Satku, Director Of Medical Services, Ministry Of Health, At The Mount Elizabeth Hospital Scientific & Clinical Meeting (Incorporating The 18th Annual Seminar & 5th Annual Clinical Meeting), 6 November 2004, Sheraton Towers Singapore

Dr Lim Cheok Peng, Managing Director, Parkway Group Healthcare,

Mrs Nellie Tang, General Manager, Mount Elizabeth Hospital,

Dr Alex Fok, Chairman, Organising Committee,

Colleagues, Distinguished Guests, Ladies and Gentlemen

Good Afternoon

It gives me great pleasure to join you all this afternoon for your Annual Scientific and Clinical Meeting. I am delighted to note that Mount Elizabeth Hospital has held annual seminars for some 18 years and plays an active role in the continuing medical education of our fraternity.

As the first cycle of compulsory national CME programme for medical practitioners draws to a close, I note that more than 90% of doctors have already fulfilled their required CME activities.

Approximately 10% have not, but there is still 2 months left for them, and I also believe many have as yet not entered all their CME activities on line and than there will be those who are in their late sixties and seventies who may not wish to pursue active practice anymore. In the end I would not be surprised if it is less than 1 percent of doctors in active practice who do not fulfil their CME requirements.

What is important is that the overwhelming majority have embraced the compulsory CME requirements in their stride and this is a testimony to the progressiveness of our profession.

Despite the compulsory nature of this CME programme, our primary objective is to be inclusive and to ensure that all our colleagues remain proficient and current in patient care. For colleagues who have had difficulty meeting their requirements I would request that they write in, stating their reasons. We would consider their appeal if they have valid reasons and especially if they show evidence that they continue to actively participate in CME programmes in the months preceding the expiry of their practicing certificates.

I would now like to turn my attention to the subject of your scientific meeting, "cutting the fad- a medical approach to weight loss". The theme for this year's scientific meeting addresses an issue that is pertinent for all doctors. Obesity is reaching epidemic proportions, with an estimated 300 million obese individuals worldwide. The consequences of obesity, which include diabetes mellitus, hypertension, ischemic heart diseases, and stroke, are amongst the leading causes of morbidity and mortality in Singapore.

In 1998, 30% of Singaporean adults were overweight or obese, an increase of 16 percent from the 1992 level which was 26%. The 2004 prevalence should be available soon with the completion of the national health survey. The available indications are that the prevalence will be greater than 30%.

To aggravate matters, recent scientific reports suggest that Asians have a higher body fat distribution for all BMI categories compared to their Caucasian counterparts. Body fat distribution, as we know, is an independent predictor of cardiovascular risk. The ministry has recently adopted lower levels of BMI as trigger points for action while still retaining the international BMI categories for definition of overweight and obesity.

What can we do about this "weighty" problem? A population wide approach to prevention is fundamental in controlling this epidemic. The National Healthy Lifestyle Campaign and other health promotion activities serve to promote physical activity and a healthy diet to achieve this goal.

However, prevention of the onset of obesity is only one side of the story. Equally important will be the management of individuals who are currently overweight and obese. In a bid to make available a structured evidence based, management strategy to every doctor, my Ministry recently released clinical practice guidelines on obesity. The aim is to help you manage the overweight and obese patients more holistically and effectively.

However, when you talk about weight loss in Singapore, doctors are not the first thing that comes to one's mind. Commercial establishments dedicated to losing weight or slimming centres are more recognised. Newspapers and magazines are full of advertisements touting programmes not only on how to lose weight, but also how to do it quickly, without much trouble and inconvenience. Testimonials about the wonders of fat absorbing creams, slimming teas, herbal preparations and so-called "natural products" abound.

Judging from the success of these quick-fix establishments, there seems to be no lack of Singaporeans who want to lose weight. Scientific evidence is perhaps the last thing on the minds of those who want to see fast results. But when you talk to anyone desperate to lose weight, they will tell you how confused they feel in the midst of all these newspaper advertisements and claims. There is no way of being sure that the treatment being offered is safe and effective.

How then does the medical profession fit into this scenario? As doctors, we are constantly looked upon by our patients to provide them with effective, appropriate and safe treatment. Obesity is just like any other disorder. Medical management of obesity does not end with simple weight loss advice. It involves identification of the cause of obesity and looking for and managing obesity linked secondary conditions. It involves teaching our patients skills that they can use instead of passively following a prescribed formula. It also requires engaging them in a mutually agreeable and practical management plan so that they can take ownership of their own treatment.

If there is a need for medication, we are the ones with the expertise to judiciously prescribe, monitor for progress and side effects, and evaluate the outcome. Should there be a need for surgical intervention, we are the ones with the training to do so. In addition to the clinical management of obesity, we also have an important role in prevention of its onset, by opportunistically advising our patients and their families on weight control.

Unfortunately, our messages which urge people to increase their fitness and decrease their disease risks are often not as attractive as the claims by the commercial companies. Medical science does not have quick-fixes for this problem as yet and therefore we are unable to guarantee the fast results and magical cures. We lose out by having to tell our patients that they need to work hard to reach optimal weight, and to continue working hard to keep the scales in balance. Where is the appeal in this!

In short, we are not trained in the art of making our professional expertise more appealing to the general public; in fact we are forbidden.

I hope however that this scientific meeting will serve as a platform for the medical profession to position itself to counter the fad, and convince the public that, for the vast majority, having a balanced diet and indulging in regular physical activities, will be all that is required for obesity management.

We may not have quick fixes but it will be refreshing if we can package our message, especially if it is on prevention, to be more appealing. In case some of you feel that this is an insurmountable issue I quote Sir William Osler so that we may be inspired:

"The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head." 

"Often, the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish."

On this note, I wish you all an enjoyable learning experience and a successful meeting. Thank You.