Orforglipron
Hot on the heels of Ozempic and Mounjaro is Lilly's ORFORGLIPRON, another Glucagon Like Peptide 1 molecule, which is another weight loss medication, seeking approval from the Food and Drug Administration. The New York TImes reported on Orfloglipron August 7, 2025.
What is the prevalence of obesity in Singapore? We are following the trajectory of developed nations.
Within a short span of a few decades, Singapore has undergone rapid economic and urban development with a commensurate rise in NCD prevalence and mortality. From 2004 to 2010, obesity prevalence rose by nearly 60%, from 6.9% to 10.8%, with a corresponding 38% rise in prevalence of diabetes mellitus to an all-time high of 11.3% in 2010.] In the ensuing years to 2017, the obesity prevalence remained at 8.6%, but rose again to 10.5% in 2020. Obesity results in a plethora of complications, which occur at a lower body mass index (BMI) in Asians. Using the BMI cut-off reflecting the health risk of excess adiposity in Asians, it was found that in 2020, 58% of adults in Singapore were living with an unhealthy weight (BMI ≥23 kg/m2), with 20.7% having obesity (BMI ≥27.5 kg/m2) and 40.6% having abdominal obesity. While the prevalence of obesity among adults in Singapore remained steady from 2010 to 2020, among school-going youths aged 6–18 years, obesity has risen from 11% in 2013 to 13% in 2017 and further to 16% in 2021. The COVID-19 pandemic has undoubtedly affected health-related behaviours and weight. The increase of obesity in youths from 2017 to 2021 was mainly observed in 2020–2021 due to the effect of the COVID-19 pandemic. Given that 70% of children with overweight remain overweight as adults, the adult prevalence of obesity will likely increase in the coming decades if effective measures are not implemented in childhood and adolescence. (Tham et al, Singapore Medical Journal 2023; 64(3): 182- 187)
Selenium and the Thyroid Gland
Selenium is a mineral found in naturally in food, added to food or used as a supplement. Its role in thyroid disease has been the subject of considerable investigation. There is now evidence that selenium may benefit some patients with thyroid eye disease (Graves' ophthalmopathy) such as the patient on the right, and help in reducing the inflammation of autoimmune lymphocytic thyroiditis (Hashimoto's disease).
A recent review of the role of selenium in thyroid disease may be found in Medscape (www.medscape.com/viewarticle/777483_5) or by clicking on this link.
MOH of Health Disallows Bio-Identical Hormone Replacement Therapy
On 15 April 2014, Ministry of Health Singapore issued a circular stating that bio-identical hormone replacement therapy is "non-evidence based" and may only be prescribed in the context of a clinical trial. The full text of the circular is available by following this link.
Problems with A Large Thyroid Gland
Some patients present with really large thyroids. One such patient is shown on the right, who presented with a 2 kg thyroid gland. (Normal thyroids are about 20 grams in weight). This was a huge cosmetic embarassment as he was unable to wear clothes properly. The thyroid also had a detrimental effect on his growth and mentation. He looks 6 years of age but was actually 12 years and some months old.
Following surgery and supplemenation with thyroid hormone, he rapidly gained height and weight and is well today. Unfortunately Ministry of Health has determined that the post-treatment picture cannot be displayed as it contravenes the Ministry's Publicity Regulations
Researchers Claim Reversal of Diabetes by Calorie Restriction
The 9th June 2011 issue of Diabetologia (Journal of the European Association for the Study of Diabetes) carried a paper by Lim and his colleagues claiming that diabetes is not an inevitably progressive condition. The researchers subjected a small group of individuals to a severely restricted diet of 600 KCal daily, which they claim resulted in reversal of the abnormalities of diabetes mellitus. The scientific paper (175KB PDF) is freely available online. For your convenience, it is downloadable by clicking on the link provided.
The universally recognized Big Mac which contains 570 KCal gives you an idea what amount of food a 600 Kcal /day meal may comprise.
The Dangers of Porcupine Kidney Powder
In March 2007, this young man consulted me regarding weight gain of 9 kg (about 20 lbs) over a 2 week period. His mother had given him some pills obtained from a Chinese physician. He was told that the pills contained "porcupine kidney powder" and if taken, would significantly boost his immunity. He disliked the sudden increase in his girth, but was particularly distressed by the appearance of red striae (picture on right) on his abdomen and arms. It turns out that he was unknowingly given steroids, resulting in his frightful appearance typical of Cushing's syndrome. The lesson for all of us is not to unquestioningly accept treatments from anyone, no matter how well intentioned.
Tour de France Doping Controversy - July 29, 2006
The winner of this year's Tour de France was accused of having used anabolic agents to boost his performance. The basis of this accusation was an abnormal testosterone / epi-testosterone ratio. In 1982 the IOC ruled that a T/E ratio > 6 was evidence of illicit T use. The expected T / E ratio in healthy males is ~ 1.
In practice, there are many confounding factors. In the general male population, less than 0.8% of individuals not on T or anabolic steroids will show a T/E ratio of > 6. Therefore there is a false positive rate. The lowering of the T / E ratio to 4 by the Cycling Federation will result in significantly more false positive tests. It's also been shown that chronic use of androstenedione (an anabolic steroid) can be compatible with a T / E ratio of < 6. Without prior knowledge of an athlete's T / E ratio out of competition (where AS or T use is less likely), one would be foolish to level accusations regarding use of performance enhancing drugs.
The question now is how much over the mark Landis's T / E ratio is. If it's between 4 and 6, reasonable doubt can be cast about steroid use. If it is just over 6, doubt can still be cast about testosterone use. If it's exceedingly over 6, testosterone-assisted performance is highly likely. If you are interested in the science of dope testing, kindly view or download the 2 files T-E Ratio in Sport (143KB PDF) and Urinary Steroids after Chronic Androstenedione Ingestion (99KB PDF).
