Masterclass 10 - Metabolic Disorder: Weight Management- a New Pandemic & Challenge to Healthcare System

Obesity has become a significant public health concern due to its growing prevalence and healthcare burden. In Hong Kong, a population health survey conducted by the Department of Health from 2020-22 estimated that 32.6% of individuals aged 15-84 were classified as obese (i.e. BMI ≥ 25kg/m²). Obesity is associated with a multitude of comorbidities, including hypertension, type 2 diabetes mellitus, coronary heart disease, stroke, obstructive sleep apnea, various cancers, reduced quality of life, increased disability and mortality. To combat the obesity pandemic, early identification of individual with obesity and timely weight management is crucial. 


Primary healthcare is the first point of contact for individuals and families in a continuous healthcare process in the living and working community, hence the forefront of weight management. The Primary Healthcare Office is steering weight management as a core service in the community-based primary healthcare system, guided by the Reference Frameworks in Primary Care setting. District Health Centres – as primary health service providers and care coordinators – provide personalised health risk assessment, Life Course Preventive Care and comprehensive lifestyle modification interventions. Exercise prescription, counselling and goal setting are offered by a multi-disciplinary team of healthcare professionals including nurses, physiotherapists and dietitians, with community support such as exercise coaches. Family doctors monitor and manage the presence of comorbidities, and seek specialist's advice when indicated. In addition, the e-Health system empowers citizens and drives weight control through technology.

Obesity is classified as non-communicable disease according to WHO and closely associated with comorbidities including diabetes, hypertension, ischemic heart disease, fatty liver, sleep apnoea etc. It is also proven to increase risk of having breast cancer, colorectal cancer, and endometrial cancer etc. Obese patients also tend to have shorter life expectancy compared to its non-obese counterpart. 
The metabolic setpoint is altered in obese individuals, solely lifestyle modification is not sufficient. Bariatric surgery plays an important role to achieve optimal weight loss and improvement on medical comorbidities. Study also supports the cost-effectiveness of using surgical therapy for severe obesity. 
UCH started our first bariatric surgery in 2008, since then over 200 patients received bariatric surgeries of different kinds including laparoscopic gastric banding, laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve duodenal jejunal bypass. While the perioperative mortality is less than 1%, patients who received bariatric surgery can achieve overall over 70% excessive body weight loss and >55% of patients can have complete diabetic remission. The weight loss and metabolic improvement effect is even more pronounced in bypass surgery. The long-term nutrition and acid reflux problem are minimal with adequate supplementation. 
With excellent perioperative and postoperative outcomes, bariatric surgery should be implemented and promoted across different specialties and to the public as a safe and cost-effective option for optimal weight loss and metabolic improvements. 

Individuals with morbid obesity have a significant impact on the healthcare system because of the chronic and relapsing nature of underlying co-morbidities. Bariatric and Metabolic Surgery has emerged as an effective treatment option, offering substantial weight loss and resolution/improvement of associated metabolic complications. However, owing to complex nature of obesity as a disease, the successful provision of bariatric service requires addressing various hurdles and actively involving community resources. This presentation highlights the challenges faced in bariatric surgery delivery, along with potential solutions and the role of community resources in driving development.


Yan Chai Hospital started providing surgical solutions to morbid obesity since 2016. Hurdles in service delivery are multifaceted and encompass several domains. First and foremost, there is a need to engage community resources into the pathway as hospital is not the most ideal place for life style intervention. Medical social collaboration is a new solution to establish a comprehensive support network for patients going through the bariatric journey. This approach addresses holistic wellness and enhances patient outcomes.


Another hurdle is public awareness regarding obesity as a disease per se. Many patients as well as clinicians are unaware of the benefits of bariatric and metabolic surgery or even hold misconceptions about the procedure. This can hinder access to bariatric service for those in need. 


Our development of bariatric service focuses on multi-disciplinary care. Regular case conferences bring together surgeon, physician, anesthesiologist, dietician, physiotherapist and clinical psychologist can ensure standardized care and continuous quality improvement.


In conclusion, the provision of bariatric service faces several hurdles but with implementation of solutions like community engagement, public education and multi-disciplinary care, we can overcome these challenges and improve the health and well- being of individuals with morbid obesity.

The Multidisciplinary Metabolic Surgery Service (MMSS) team, established since 2016, is a multi-disciplinary team involving upper gastrointestinal surgeons, anaesthetists, medical endocrinologists, dietitians, physiotherapists, clinical psychologists, providing efficient and effective care to obese patients through surgery. 


Our aim is to help obese patients through surgery to have long-term weight loss and to improve obesity-related comorbidities including diabetes, hypertension, hyperlipidaemia, osteoarthritis of knee and obstructive sleep apnoea. Obesity related comorbidities contribute a huge burden towards our healthcare. Our aim is to decrease this economic and social burden so that our healthcare system can continue to run efficiently without exhausting limited resources. 


Standardized protocol is formulated to include outpatient based preoperative assessment and preparation, and to ensure adequate time for prehabilitation. The MMSS team holds regular preoperative briefing and postoperative review to facilitate communication and formulate improvement plans. 


More than 100 bariatric surgeries have been performed in QEH since 2016 for obesity. Either sleeve gastrectomy or gastric bypass were performed. 65% of patients who received surgery had hypertension. Of these hypertensive patients, 32% had partial resolution and while 32% had complete resolution after surgery. 54% of patients who received surgery had diabetes. Of these diabetic patients, 22% had partial resolution and while 56% had complete resolution. 43% of patients who received surgery had hyperlipidaemia. Of these patients with hyperlipidaemia, 8% had partial resolution and while 25% had complete resolution. 


Patients with complete resolution no longer requires treatment. Patients with partial resolution have reduced dosage or discontinuation of medications. This ultimately translate to less drug prescriptions, less clinic time and decreased waiting time for other patients. Surgery also improves comorbidities such as osteoarthritis of the knee, obstructive sleep apnoea. This ultimately leads to better resource allocation and lessen burden of the health care system. 

Morbid obesity poses a significant public health challenge worldwide, necessitating innovative and region-specific approaches to combat its escalating prevalence. This presentation delves into the distinctive experience of the Greater Bay Area (GBA) in addressing morbid obesity, offering valuable insights for the global medical community. As a metabolic and bariatric surgery surgeon and researcher, I bring forth a comprehensive overview of our multifaceted strategies, encompassing surgical interventions, comprehensive patient care, and community engagement.


The GBA, with its unique socio-cultural dynamics and diverse population, demands a nuanced approach to tackling morbid obesity. Surgical interventions, such as laparoscopic sleeve gastrectomy and gastric bypass, have emerged as effective tools in achieving sustainable weight loss and resolving comorbidities. The presentation will showcase key outcomes, highlighting the safety, efficacy, and long-term benefits of these procedures in our local context.


However, the battle against morbid obesity extends beyond the operating room. Our holistic approach emphasizes pre-operative education, post-operative support, and long-term lifestyle modifications. Collaborative efforts between healthcare professionals, nutritionists, and psychologists have been pivotal in ensuring the overall well-being of our patients.


Furthermore, community engagement initiatives have played a vital role in creating awareness and destigmatizing obesity. The presentation will delve into successful public health campaigns, emphasizing the importance of early intervention, healthy lifestyle promotion, and the role of community-based support networks.


The GBA experience serves as a paradigm for the integration of evidence-based medicine and community-focused strategies. This presentation aims to inspire dialogue among healthcare professionals at the Hospital Authority Convention (HAC) in Hong Kong, fostering an exchange of ideas that transcend geographical boundaries. By sharing our successes, challenges, and innovative approaches, we aspire to contribute to a global effort in the fight against morbid obesity, ultimately improving the health and well-being of individuals in our communities and beyond.