Past, Present and Future of Obesity Medicine
Dr. Michele Yuen - Co-Founding President (Medical Chapter), HKOS
Welcome to the inauguration of the Hong Kong Obesity Society (HKOS)!
The Past – Misconceptions and Inopportune Time
Acceptance of obesity as a medical condition, rather than a lifestyle choice, had been slow both worldwide and locally, and the true local prevalence of obesity had been grossly underestimated. The withdrawal of anti-obesity drugs such as sibutramine and rimonabant from the market back in the 1990s severely limited the treatment options available to the medical profession, and this contributed significantly to the loss of interest in many colleagues wishing to pursue this field. Even for those forerunners (endocrinologist and bariatric surgeons) that had chosen to brave the field, many worked independently and there was a general lack of collaborative efforts.
The Present – Renewed Awareness and New Understanding
The Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) estimated that as of 2014, more than 50% of men and 30% of women in Hong Kong were either overweight or obese by body mass index (BMI), highlighting the magnitude of this health epidemic. An increasing body of evidence suggests that control of body fat mass, like other physiological processes, is under tight biological regulations 1. Deviation from this set point triggers hormonal responses that oppose efforts to create a state of negative energy balance1, making weight reduction by caloric manipulation extremely difficult. Armed with this new understanding, the recent few years have witnessed the introduction of several new classes of anti-obesity drugs with excellent safety profile (due to more stringent approval processes) and extensive clinical experience (since individual components of some combination drugs, e.g. Contrave® and Qysmia®, have been used extensively in other conditions before being explored in obesity). Further to the new drugs, the approval of endoscopic
devices (e.g. Aspire Assist™) by the Food and Drug Administration of the United States in 2016 foreshadowed a new era of endoscopic weight reduction treatment.
The Future – the Hong Kong Obesity Society
A multidisciplinary approach involving physicians, surgeons, anesthesiologists and dietitians with open collaboration appears to be most effective in treating obesity 2. With the pervasiveness of the health impact of obesity, it is anticipated that healthcare professionals will face an increasing number of patients with obesity or its related disorder(s). It is against this background that the HKOS was founded. Through HKOS, we hope to increase awareness of obesity, to engage local healthcare professionals on a common platform, and to collaborate with local and international experts to advance the field of obesity in Hong Kong. We are pleased that the aims of HKOS are met with overwhelming support from the industry and from many renowned experts both locally and internationally. It is our honour to have you with us today on this very important milestone for HKOS and we humbly wish that every one of you will join in on our efforts to advance the field of obesity medicine in Hong Kong for years to come.
References 1. Speakman JR, Levitsky DA, Allison DB, et al. Set points, settling points and some alternative models: theoretical options to
understand how genes and environments combine to regulate body adiposity. Disease models & mechanisms 2011;4:733-45.
2. The Multidisciplinary Approach to Weight Loss: Defining the Roles of the Necessary Providers. 2008. (Accessed December
18, 2016, at http://bariatrictimes.com/the-multidisciplinary-approach-toweight-loss-defining-the-roles-of-the-necessary-
providers/.)