Lessons from Singapore’s national weight management program, Lose To Win

Abstract

The prevalence of overweight and obesity in Singapore is lower than in most countries, but it is increasing. There is evidence health complications may appear at lower weights among Asians. We describe the evolution of a national weight management program [Lose To Win (LTW)] organized by the Singapore Health Promotion Board from 2009 to 2013. LTW is a 12-week program comprising nutrition education, physical activity and mental wellbeing sessions and interim assessments. Individuals aged 18-69 years with a body mass index (BMI) between 23 and 37.4 kg/m2 were included. Primary outcomes were change in weight and BMI from baseline to end of 12-weeks. Effectiveness of the weight loss program was assessed using non-randomized control group (delayed intervention) during LTW 2010 and 2012. LTW 2009 enrolled 285 participants from 72 worksites. LTW 2010, expanded to the community, enrolling 952 participants (641 community-based and 311 workplace-based). In LTW 2012 and 2013, 959 and 1412 participants, respectively, were recruited from the community only. Completion rates of the 12-week program varied from 49 to 88%. Average weight loss ranged from 1.3 to 3.6 kg. For rounds including a control group, weight loss was higher in the intervention than in the control group. Competition and incentives were important motivators for participation. The LTW program was well-received and effective in producing short-term weight loss. Enhancements will be done to reinforce success factors in subsequent rounds to boost participation and follow-up rates and to ensure long-term sustainability.

The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: A Systematic Review and Narrative Synthesis

“…Twenty-four studies were conducted in the Caribbean: nine in Haiti [25][26][27][28][29][30][31][32][33], three in Cuba [34][35][36], three in Dominican Republic [37][38][39], three in Jamaica [24,40,41], three in Trinidad and Tobago [42][43][44], two in Puerto Rico [45,46] and one in Barbados [47]. Eighteen studies were conducted in the Atlantic, Indian Ocean, Mediterranean and South China Sea (AIMS region): fifteen in Singapore [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62], two in Mauritius [63,64] and one in Seychelles [65]. Eight studies were conducted in the Pacific region: two in Fiji [66,67], one in American Samoa [68], one in Tonga [69], one in French Polynesia …”

“…Of the fifty studies, twenty-eight used randomised designs: fifteen individuallyrandomised parallel group trials [40,41,[43][44][45][46][48][49][50][51]53,55,57,64,65], eight cluster-randomised parallel group trials [25,[29][30][31]33,61,68,72], and five individually-randomised cross over or other matched trials [24,46,52,58,64]. Twenty-two were of non-randomised study design: fifteen uncontrolled before and after studies [32,34,36,37,39,47,52,54,56,57,59,62,63,67,71], six controlled before and after studies [26,38,60,66,69,…”

“…Two interventions were implemented at the household level, one targeted adults within a clinical setting [68] and one targeted children within a community setting [33]. Five were implemented at the institutional level, three targeted children within a school setting [44,45,70], and two targeted adults within the workplace [59,60]. Four were implemented at the community level, targeting children at school [69] and within the community [66], and adults within the community [61] or general population [39]; two were implemented at the national or policy level, targeting adults within the general population [67,73].…”

“…Effective metabolic-based outcomes (Table 3) included those with significant improvements in markers of glycemia [39,40,47,52,56,58,62,68], BMI [43,45,49,59,60], BP [24,42,61,67], weight change [54,57] and endothelial function [51]. Ten interventions were multifaceted, in other words, they included several modalities [39,45,52,57,[59][60][61][62]67,68], five had an aspect of dietary change including direct changes to diet such as cooking method, calorie reduction, salt modification and change in dietary pattern (i.e., fasting) [24,40,43,47,56], two were based on nutrition education [49,54], two were based on specific foods [42,58], and one was based on a nutrition supplement [51]. Effective nutrition-based outcomes included those with significant improvements in markers of anaemia [25,31], weight for age and BMI for age z scores [3...…”

“…Effective multifaceted interventions with metabolic outcomes incorporated an aspect of nutrition education [45,52,[59][60][61][62]67,68], including study nutritionists to advise participants [39,57]. Most incorporated an aspect of physical activity such as educational sessions [45,[59][60][61]68], promotion (i.e., by giving participants resistance bands) [52] or access to a physiotherapist [39,57], while some incorporated sessions on behaviour therapy or change [57,60,61,68], as well as stress reduction [45], medical support such as diabetic self-medication management sessions [39,62,68], and promotion of glucose monitoring through distribution of glucometer kits [52]. Two studies included practical aspects such as healthy cooking sessions [59] or a dietician-accompanied tour of a supermarket [60], while one included national campaigns to increase consumer awareness [59].…”