• Overview
  • Obesity prevalence
  • Trends over time
  • Drivers
  • Comorbidities
  • Health systems
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Obesity prevalence

Adults, 2017

Survey type:Measured
Age:18-74
Sample size:1100
Area covered:National
References:Ministry of Health. National Population Health Survey. 2016/17. Available from: https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/executive-summary-nphs-2016_17.pdf (Accessed 2 April 2019).
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2010

Survey type:Measured
Age:18-69
Area covered:National
References:Singapore Health Board - Personal Communication
Notes:Full details will be entered when full report published
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2004

Survey type:Measured
Age:18-69
Sample size:4168
Area covered:National
References:Ministry of Health. National Health Survey 2004: Singapore. WHO Report 2005.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1998

Survey type:Measured
Age:18-69
Area covered:National
References:National Health Survey 1998
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 1993

Survey type:Measured
Age:10
Sample size:5350
References:Bellizzi MC, Horgan GW, Guillaume M, Dietz WH. Prevalence of childhood and adolescent overweight and obesity in Asian and European countries. In: Obesity in Childhood and Adolescence. Editors: Chunming Chen, William H. Dietz. Nestle Nutrition Workshop Series Pediatric Program. Philadelphia: Lippincott Williams and Wilkins, 2002.
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3.
Cutoffs:IOTF

Insufficient physical activity

Adults, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Men, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Women, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Children, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Boys, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Girls, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Estimated per-capita fruit intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita fruit intake (g/day)

Estimated per-capita processed meat intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita processed meat intake (g per day)

Estimated per-capita whole grains intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita whole grains intake (g/day)

Mental health - depression disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with depression disorders

Mental health - anxiety disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with anxiety disorders

Oesophageal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Breast cancer

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000

Colorectal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Pancreatic cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Gallbladder cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Kidney cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Cancer of the uterus

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000

Raised blood pressure

Adults, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Men, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Women, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Raised cholesterol

Adults, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Men, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Women, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Raised fasting blood glucose

Men, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Women, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Diabetes prevalence

Adults, 2017

References:Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org
Definitions:Diabetes age-adjusted comparative prevalence (%).

Health systems

Economic classification: High Income

Health systems summary

Singapore have a multi-layered health system that is considered one of the most efficient in the world. Universal health coverage is funded through a combination of government subsidies paid for by general tax revenue, private individual savings and other healthcare financing schemes. Government subsides cover up to 80% of the cost of care provided in public hospitals and primary care clinics, with remaining costs tending to be covered by Medisave, Medishield or Medifund. Not all financing schemes cover all services though - for example, Medishield generally does not cover preventive services. As a result of these differences in coverage, out-of-pocket spending is not uncommon. There are also a range private health insurance plans that can supplement the above.

Indicators

Where is the country’s government in the journey towards defining ‘Obesity as a disease’?Some progress
Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a disease’?Some progress
In practice, how is obesity treatment largely funded?Not known
Is there specialist training available dedicated to the training of health professionals to prevent, diagnose, treat and manage obesity?Partial
Have any taxes or subsidies been put in place to protect/assist/inform the population around obesity?No
Are there adequate numbers of trained health professionals in specialties relevant to obesity in urban areas?Yes
Are there any obesity-specific recommendations or guidelines published for adults?Yes
Are there any obesity-specific recommendations or guidelines published for children?Yes

Perceived barriers to treatment

  • High cost of out of pocket payments
  • Obesity no recognised as a disease
  • Lack of training for healthcare professionals
  • Failure in primary care
  • Failure to recognise or accept all treatment options
  • Poor availability of pharmaceutical treatments

Summary of stakeholder feedback

Stakeholders felt that the government was on its way to recognising obesity as a disease, with there being several policies and resources dedicated to the cause. In particular, there is investment into health promotion to increase physical activity and the consumption of healthy foods.

Despite increased recognition of obesity as a disease, government subsidies for obesity treatment is not as comprehensive as they are for other chronic diseases such as diabetes. For eligible patients, there are government subsidies of approximately 50% for consultations, investigations and bariatric surgery. For those that are fully dependent on public funding, a full subsidy is available providing certain criteria is met. Pharmacotherapy, however, is generally paid for out of pocket in the public system and coverage from private insurance tends to be poorer than that in the public system. It was said that that those living with overweight and obesity tended to become eligible for pharmacotherapy when their BMI was >30 kg/m² without comorbidities, and then bariatric surgery when their BMI was >37.5 kg/m².

It was reported that people living with obesity tended to enter the system via primary care. Some self-refer and others are referred to obesity clinics by general practitioners or specialists. Unfortunately, stakeholders claimed that most healthcare providers treat obesity as a “cosmetic” issue that is a result of poor lifestyle choices rather than a disease and so this impedes the care pathway. Usually, support is only offered to those with medical complications associated with obesity, not for the obesity itself per se. Stakeholders noted that individuals tended to leave the system by not turning up or cancelling appointments when they realised it was to discuss their obesity or because they were not appropriately referred on to specialist care.

Overall, there is a reasonable number of suitably qualified obesity treatment professionals in Singapore. This is despite there being limited specialist training available. The best training was limited to certain institutions and mostly for endocrinologists and other physicians.

Singapore has a national non-communicable disease strategy that has sections relevant to the obesity agenda. Since the implementation of the measures in the strategy, it was reported that obesity prevalence has fallen. There is also the Ministry of Health Clinical Practice Guidelines for obesity that is evidence-based and is generally followed by health care practitioners.

Based on interviews/survey returns from 4 stakeholders

Last updated: June 2020

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