Q I am a 42-year-old man. I am married with two children and I feel generally healthy.
But lately, I have been putting on some weight around my belly and my energy levels are lower than usual.
I have a family history of high blood pressure and diabetes. My father has been suffering from hypertension since he was in his 40s and my mother was diagnosed with high blood pressure and diabetes in her 50s.
What type of screening should I go for and what kind of diet or exercise can I do to avoid getting high blood pressure and diabetes?
A It is good to go for regular health screenings after turning 40 as the incidence of chronic diseases and cancers do increase with age.
You can choose to do this earlier if you have a family history of certain diseases or if you lead an unhealthy lifestyle.
Screenings should ideally be done when you are relatively well and asymptomatic. If a medical condition is diagnosed, it is usually in its early stage when the prognosis is often good.
The factors to be taken into consideration when choosing the type of health screening include age, sex, lifestyle, family history and concurrent medical conditions.
In your case, the main complaints are your weight gain and low energy level. A thorough review of the lifestyle factors causing your weight gain will first be evaluated, before further tests are recommended.
Very often, weight gain is due to overeating or under-exercising. Useful laboratory tests relevant to middle-age weight gain and energy loss would include checks on your thyroid hormones and sex hormones.
For general screening, I would suggest checking your cholesterol and sugar levels, together with your blood pressure.
A baseline check of your liver and renal function would be useful too.
Statistically, about one in four Singaporeans will eventually succumb to heart diseases, strokes and kidney failure. These often fatal morbidities are usually secondary to poorly-controlled chronic diseases, including dyslipidemia, diabetes and hypertension.
Early detection and subsequent management of these three chronic diseases will reduce the incidence of their associated morbidities.
You can also do a cancer screening, though not all cancers can be screened. Cancers account for 30 per cent of mortalities in Singapore. The prognosis of cancer depends largely on the stage at which it was diagnosed.
However, there are blood markers, stool tests and certain ultrasound scans and X-rays that may provide information leading to an earlier diagnosis of certain cancers before the symptoms manifest.
Other more invasive tools to screen for cancers would include a colonoscopy and this could be discussed during your screening.
As it is your intention to start exercising regularly, I would suggest a pre-exercise cardiac assessment involving a Stress ECG Test. This is especially important if you were to discover during your screening that you already have a chronic disease.
I would suggest up to 300 minutes of exercise per week for weight loss. This may translate to 60 minutes of physical activity on most days of the week. You do not have to do the full 60 minutes at one go. It can be split into a few shorter sessions.
If you have not done any exercise for a long time, you should start with short workouts and plan for longer rest periods in between the exercise sessions. To prevent injuries, it is best not to stress the same muscle group or joints daily.
To do a proper exercise prescription, I will have to take into consideration your general fitness, sports abilities as well as concurrent medical conditions, physical hindrances and personal inclination.
For healthy eating, I often recommend the Mediterranean diet. With its emphasis on fish, lots of vegetable, nuts and olive oil, the diet has been linked to a healthier heart and greater longevity. Fish can be substituted with lean red meat or chicken.
Indulgences like desserts and alcohol should be enjoyed only occasionally.
Health screening is just the first part of the equation. What we do upon receiving our results is even more important.
Regular exercise, together with healthy eating habits, goes a long way in promoting good health and maintaining our energy level. It is useful if you want to delay or manage hypertension and diabetes. And it is paramount if you are trying to lose weight.
Dr Derek Koh
Resident physician, Thomson Lifestyle Centre
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