Singapore

Obesity prevalence

% Adults living with obesity in Singapore 1998-2017

% Adults living with overweight or obesity in Singapore 1998-2017

Insufficient physical activity

Estimated per-capita fruit intake

Estimated per-capita processed meat intake

Estimated per-capita whole grains intake

Mental health - depression disorders

Mental health - anxiety disorders

Oesophageal cancer

Breast cancer

Colorectal cancer

Pancreatic cancer

Gallbladder cancer

Kidney cancer

Cancer of the uterus

Raised blood pressure

Raised cholesterol

Raised fasting blood glucose

Diabetes prevalence

Health systems

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 subsidies 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 of private health insurance plans that can supplement the above.

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 are 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 are evidence-based and generally followed by health care practitioners.

Based on interviews/survey returns from 4 stakeholders

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