Obesity rates in Singapore have been steadily rising over the past decade, increasing from 8.6% in 2013 to 11.6% in 2022. According to a recent infographic by Seasia Stats, Singapore has the third highest proportion of overweight individuals among Southeast Asian countries, following Brunei and Malaysia. It is no longer seen as just excess weight or a lifestyle issue.
Medical experts now define it as Adiposity-Based Chronic Disease (ABCD) — a term that reframes obesity as a long-term, biologically driven medical condition, not a matter of personal failure.
In this article, Dr Kevin Tan, an endocrinologist at Farrer Park Hospital, discussed Adiposity-Based Chronic Disease (ABCD) and why weight loss can be hard for some individuals.
The term “Adiposity-Based” focuses on fat tissue, or adipose tissue, which play an active role in regulating metabolism, inflammation, and hormones. It emphasises that health problems arise not just from having too much fat, but from where fat is stored (such as around internal organs), how fat cells function, and how they communicate with the rest of the body. Dysfunctional or inflamed fat tissue can disrupt hormonal balance, increase insulin resistance, and contribute to chronic inflammation throughout the body.
“Chronic Disease” signifies that obesity is not a temporary condition or a matter of poor choices, but a lifelong medical issue that often requires continuous management. Like diabetes or high blood pressure, ABCD increases the risk of serious health complications ranging from cardiovascular disease and stroke to cancer and premature death.
This redefinition marks a critical shift. Obesity is no longer seen as a lack of willpower. It is a biologically driven condition, deserving of the same level of medical attention and empathy as any other chronic illness.
According to Dr. Kevin, obesity does not happen in isolation. Instead, it arises from the interaction of four major systems in our body:
• Genetics influence how our bodies store fat, how hungry we feel, and how efficiently we burn calories.
• Environment shapes access to healthy food, safe spaces for exercise, and quality healthcare. Urban design, food marketing, and socioeconomic factors all matter.
• Biology includes hormones like insulin, leptin, and ghrelin, as well as factors like age, gender, and birth weight.
• Behaviour incorporates diet, sleep, stress levels, mental health, and cultural habits.
These systems interact through what scientists call the “Human Interface”: a control centre that determines the body’s weight “set point”. If this set point is elevated due to biological or environmental factors, losing weight and keeping it off becomes more difficult without medical intervention.
Understanding ABCD also means recognising that obesity manifests in different forms
• Hedonic Obesity is primarily driven by the brain’s reward system. In this type, people eat not out of hunger, but in response to pleasure or emotions. Diets high in ultra-processed, sugar-rich foods can override satiety signals, causing individuals to eat beyond their energy needs.
• Metabolic Obesity, on the other hand, is driven by internal systems that regulate body weight. The body may respond to calorie restriction by slowing metabolism, increasing hunger hormones, and resetting the weight set point to a higher level. Even when individuals lose weight, these physiological mechanisms often push the body to regain it.
One of the most misunderstood aspects of obesity is why maintaining weight loss feels like an uphill battle. When people lose weight, several biological changes occur:
• Hunger hormones like ghrelin surge, making you feel hungrier and food more appealing.
• Satiety hormones that play a role in making you feel full and satisfied after eating decrease.
• Metabolic rate slows down, meaning the body burns fewer calories than before.
• Stress and cravings increase, especially for high-calorie comfort foods.
These changes are part of the body’s survival mechanisms, evolved to protect against starvation.
Unfortunately, in today’s environment of abundant food, they contribute to a vicious cycle of weight regain.
Body fat functions to store and release energy as well as provide insulation to your body. Adipose tissues contain nerve cells and blood vessels, and communicate with the other organs in your body through hormone signals.
However, not all fat tissues are created equal. The body contains three main types of fat:
• White adipose tissue (WAT) is the most abundant in the body and serves to store energy, cushion soft organs and provide insulation. In excess, it can accumulate around internal abdominal organs and can contribute to disease by secreting inflammatory molecules.
• Brown adipose tissue (BAT) is most abundant during infancy and diminishes as we age. It burns energy and generates heat.
• Beige adipose tissue has all the good properties of Brown Adipose Tissue. In certain scenarios like exercise, White Adipose Tissue can convert to Beige Adipose Tissue ( a process known as ‘WAT browning’)
In obesity, white fat cells enlarge and become dysfunctional. They begin to send out harmful signals that impair insulin sensitivity, alter hormonal balance, and negatively affect heart, liver, and muscle function. This low-grade, chronic inflammation doesn't just add weight; it spreads throughout the body, increasing the risk of over 200 medical conditions.
The consequences of untreated ABCD are systemic, affecting nearly every organ. These include:
• Mental and brain health: Depression, anxiety, stroke, and even dementia
• Respiratory system: Sleep apnoea, asthma, blood clots
• Cardiovascular health: Heart disease, hypertension, heart failure
• Cancer: Increased risk for breast, colon, liver, kidney, and several other cancers
• Digestive system: Acid reflux, gallstones, fatty liver disease
• Renal and urinary health: Chronic kidney disease, urinary incontinence
• Reproductive health: Hormonal imbalances, polycystic ovarian syndrome (PCOS), infertility
• Musculoskeletal health: Osteoarthritis, joint pain, reduced mobility
• Psychosocial wellbeing: Weight stigma, low self-esteem, and social withdrawal
Obesity is not merely excess weight — it is a disease state that can cause or exacerbate many others.
Managing ABCD effectively requires a shift in focus from reducing fat quantity to improving fat quality and function. While lifestyle changes remain foundational, they are often not enough on their own.
Medical treatments now include anti-obesity medications. These drugs work by regulating appetite, improving fat cell behaviour, reducing inflammation, and protecting against diseases like diabetes and heart failure. For many people, they offer a sustainable way to reset the body’s metabolic systems and defend against weight regain.
Crucially, treatment is not about chasing a number on the scale. It’s about restoring health, supporting long-term well-being, and addressing obesity as the multifaceted medical condition it is.
Recognising obesity as a disease, not a personal failing, helps reduce stigma, encourages compassionate care, and supports long-term, effective treatment.
