Some thoughts on the diabetes issue in Singapore

We were discussing about food choices in the office and my colleague said to me “You’re lucky to have high metabolism.”

I said, “What? I don’t have a high metabolic rate. In fact, I gain weight easily.”

He looked surprised and I showed him a photo of what I used to look like five years ago.

It has been four and a half years since I cleaned up my diet, lost 10kg, and even wrote a simple e-book about how “Anyone Can Lose Weight“. I decided to lose weight largely out of vanity and frustration, but it was only later that I realized how beneficial it was to my health and preventing diabetes.

This month, our Singapore prime minister Lee Hsien Loong spoke about the diabetes epidemic in Singapore during the National Day Rally. Singapore has the second highest rate of diabetes in the developed world, and it is a big problem. And from Channelnewsasia:

Today, diabetes affects one in nine Singaporeans and among those over 60, three in 10 have diabetes. The onset of diabetes is also getting younger with each generation – overweight teenagers can now succumb to what was previously termed “adult-onset” or Type 2 diabetes, the most common form.

Last year when the spotlight began to focus on the diabetes problem, I dropped an email to the minister in charge and offered to provide feedback and suggestions. He routed me to another team in the health ministry and they sent me a thank you email to close the conversation without any further action.

Oh well, I’m not a “professional” expert on the topic, nor am I a doctor, so to our civil servants, what good would I be to the fight against this disease in Singapore?

Nevertheless, I’d like to share some thoughts on how the country is currently dealing with diabetes and offer some pragmatic suggestions.

Perhaps if I show the following image of my weight tracker over the past few years where I have not really gained weight without trying to starve myself, I might convince someone I know what I am talking about.

I use a Fitbit Aria weighing scale that records my weight to the cloud. This is from Jan 2014 to Aug 2017 where I have maintained my benchmark weight around 63kg for my 171cm height (BMI <22).

My secret to losing 10kg and then maintaining a healthy weight? Simply being aware of how much I am eating each day, and doing some mild exercise (I jog at moderate speeds) maybe 2 or 3 times a week. But it took a lot of self-learning of food nutrition, as well as trial and error of exercise regimes to get it right.

The following will be a compilation of my Facebook posts in recent weeks plus a bit more details, so it will be familiar to my friends and followers.

A lack of knowledge

I believe the root cause of our diabetes epidemic lies in the utter ignorance of food nutrition on the public’s part. But this root cause is ignored as everyone scuttles around to tell you a million other messages dealing with the symptoms.

You might ask:

“Should I exercise more? Should I stop eating white rice? Should I cut out all carbohydrates? How many cans of Coke can I drink a day? How much can I be overweight?”

I don’t know about you, but I’ve been reading all the news stories and government updates on diabetes, and I’d be confused to death if I were a newbie to the subject.

There does not seem to be a single source of truth for everyone to refer to.

I read this site from HealthExchangeSg, a government site  and it was pretty vague on how to prevent diabetes :

Follow a proper diet. Besides insulin and medicine, eating healthily helps to control blood glucose levels and weight.

Maintain a healthy weight. If overweight, losing a few kilos can reduce the risk of diabetes.

Get regular exercise. Exercise helps to control weight and also keeps the heart healthy.

The advice is so subjective, no?

Don’t kill our food culture

There have been government directives for hawker stalls and food eateries to use less salt and sugar when cooking dishes. But this is barking up the wrong tree.

It is completely unnecessary to change the way these Asian (especially Malay and Indian dishes) are cooked. People just need to exercise moderation – eat less of such rich dishes, and have more healthy dishes in between.

Asking a famous char kuay teow stall to neuter the taste of their dish is to threaten their livelihood! Give me all the pork lard I paid for, mister!

And to ask to have normal white rice in Hainanese chicken rice, instead of the delicious oily rice cooked with pandan leaf and chicken stock, is to kill a national dish. It’s all or nothing if I choose to eat chicken rice (which is perhaps once a month for me).

The authorities ought to incentivize food stalls and eateries by reducing stall rental, rebates, etc if they offer more balanced dishes. But leave our rich (literally) food heritage alone.

The reason why people do not exercise moderation, is again due to their poor habits borne out of ignorance and peer pressure.

Eating healthily actually saves money

You don’t have to go out and buy organic food and all that, you simply need to spend less money on expensive sugary drinks, snacks, pastries, alcohol (yes, beer is really fattening), and so on.

It doesn’t mean depriving yourself either – just share portions of these sweet stuff with friends and families.

And if you are one of those who drink expensive and sweet Starbucks beverages every day – why?!?

Then I read about how we should avoid trying to stigmatize diabetes patients. I think this needs a different approach – many who get afflicted with Type 2 diabetes could probably have controlled the multiple factors that increase the risk of getting diabetes, they were simply not aware of how to prevent it.

We spend a lot of time telling people not to smoke or take drugs, why not treat diabetes with a more grim approach? Please do not misunderstand that I am saying we should make people who inherit diabetes (eg. Type 1 diabetes or juvenile diabetes) feel guilty.

We should approach this from the point of general education about how to eat and live well.

Wrong mindset on weight

There is a wrong mindset among too many people that it’s too much to try to be trim and fit especially when you get older.

No one is saying you should be underweight or anorexic, but simply not exceeding your BMI limit (that’s 23 for Asians) will greatly reduce your chance of diabetes and heart disease. I’ve met too many people who insist it’s normal to become overweight as you age – it’s a terrible excuse for not eating and living right.

Recently, there has been a trend to promote “fat but fit” but it’s already been debunked as a myth.

What does it mean to eat and live right?

Why is it that most of us know the value of pi (3.14) but cannot figure out how many calories is in that dish and how to ensure it is a balanced meal?

Because our education system – as I tire of repeating – doesn’t teach things people really need to know.

If people truly understood food nutrition (which isn’t rocket science limited to nutritionists and doctors), their lives would transform overnight. And where should we start with teaching food nutrition?

Again, back to the single source of truth that doesn’t exist today for the masses. We also need to start educating folks from a young age – a lot of damage to the body is done by poor eating habits in one’s youth, 30s and 40s.

And if you’re dying to know what basic food nutrition means, a simple summary is – eat everything in moderation, eat within your daily calorie limit, eat all major food groups in the right proportion, favor vegetables and fruits over meats, treat sweet delicacies as snacks to be had sparingly, avoid sweet drinks and exercise regularly. 

The advice is so commonplace and simple that most people actually reject it because they believe it cannot be that straightforward.

But these are the same people who say drinking fruit juice daily is good for you, when it often has more sugar than a can of Coke. They really do not know what they do not know.

And I am always amused when I tell people the daily milk coffee or milk tea they are having is one of the prime causes of their unstoppable weight gain.

Of course, food nutrition is a much more detailed subject that cannot be covered in this piece. It’s a full-blown subject that is going to pay more dividends than learning how to do today’s silly and impractical PSLE problem sums.

As I wrote in my book, most people reject healthy diets because they have often failed at maintaining theirs due to a lack of discipline and understanding of how their body works.

What about different body shapes? Those of us who have done National Service or OCS will know that with every body shape, there’s a “fit” version and “unfit” version. It’s your choice how you want to maintain your body, and you should not let your body shape dictate how you eat.

I am not convinced of the general recommendation in Singapore that you can eat 2000 kcal a day. Given your sedentary lifestyle, it’s more likely to be 1800kcal. But then again, the only way to find out is to keep measuring your food intake daily in terms of calories + exercise expenditure, and measuring at which point does your body “break even” (not gain or lose weight).

What does 1800kcal mean in terms of food dishes? Go download the app MyFitnessPal and find out how much you’re actually eating. And don’t cheat ok?

Of course, I’ll have to eat my words here if I actually do contract diabetes one day. My cousin on my father’s side, whom I hardly get to meet, once whispered to me : “Our family has a history of diabetes you know”. Well, at least I think I know what to do about it…

Closing suggestions

Anyway, some concrete suggestions to make to the people who are making the big decisions to help Singapore solve its diabetes problem

Educate our kids from young by teaching about food nutrition in our schools. And I don’t mean just showing a food pyramid, but teaching how calories are consumed and expended in a mathematical manner.

Provide a single source of truth – a simple national brochure or website on fighting diabetes – that isn’t filled with complex words or techniques – but gets straight to the heart of how to eat and live well. We think people know, but they don’t.

Do not stymie our food culture of rich delicacies but encourage a new one to grow beside it with the right incentives and approach.

A bit drastic, but the IPPT program for all national servicemen has been useful in getting sedentary guys to get out and exercise at least a few weeks a year. Would a national fitness test work for all genders and ages? The incentive could be either rebates on utilities, tax breaks or something practical that Singaporeans and business owners will respond to positively.

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