Being more active cannot fully offset bad diet: Experts

SINGAPORE – Nearly all residents in Singapore consume double the global limit for sodium, and more than half eat too many calories, despite a whopping 87 per cent of the population hitting recommended physical activity targets. 

Staying active remains a vital pillar of health, but health experts warn that physical fitness cannot completely offset a bad diet. 

Newly released findings from the 2025 National Nutrition Survey show that more than half of Singapore’s population consumes too many calories relative to their energy needs, pushing average daily intake to 2,460 kcal, up from 2,410 kcal in 2022 and 2,360 kcal in 2019.

Total dietary fat intake has also risen over the years.

And more than nine in 10 residents (95%) also consume too much sodium, averaging roughly 4,000mg a day, double the recommended daily threshold of 2,000mg, or about one teaspoon of salt.

With more people eating out more frequently, avoiding hidden calories and sodium can be an uphill battle, especially as commonly consumed dishes like fried carrot cake with dark soya sauce, mee siam and nasi briyani have become saltier and higher in calories over time.

At the same time, people continue to consume processed foods.

Fit but unhealthy

Doctors say they often encounter patients who think burning calories through some form of physical activity, including just brisk walking or daily active commuting, grants them a free pass at the hawker centre.

“My patients are exercising more today than before, but many of them erroneously think they can compensate for that with excessive calorie and sodium intake,” said Donna Tan, a family physician, consultant and deputy director of NHG Polyclinics’ clinical services department. “You might run three times a week but still be overweight. For someone who goes to the gym regularly, if your diabetes is not optimally controlled, you would be considered unhealthy.”

Tan, who has a special interest in weight management, said she reminds her patients that exercise alone cannot offset poor diet, inadequate sleep, stress, or poorly controlled conditions such as diabetes and hypertension. 

Continue exercising, but pay attention to portion sizes and do not overeat after a workout, she said.

Hidden traps in ‘healthy’ foods

Tan cautioned that seemingly healthy options such as granola, smoothies, fruit juices, salads with creamy dressings and large sandwiches may contain excessive calories, sugar, fat or sodium.

Yong tau foo stuffed with fish paste can also be high in sodium, so Tan said it is about balancing these items with vegetables and plain tofu.

Even hydration habits can be misconstrued as healthy. Tan said that some people drink a bottle of isotonic drink or more after 30 to 45 minutes of brisk walking, line dancing or recreational cycling, but this is typically unnecessary and adds extra sodium and even calories.

The Health Promotion Board said soupy dishes are among the foods commonly consumed by residents with the highest sodium intake. Certain gravy-based dishes can also hide a lot of sodium. A bowl of mee siam contains 3,800mg of sodium today, up from 2,700mg in 2023, HPB said.

Ng Teng Fong General Hospital’s principal dietitian Lim Ruey Jiun said most people opt for clear soup-based meals as part of healthier eating. But soup can be high in sodium, especially when made with stock cubes, seasoning powders, sauces and processed ingredients.

One teaspoon of stock powder can add about 750mg of sodium, while one teaspoon of dark soya sauce can have 400mg of sodium, she said. A bowl of sliced fish noodle soup can have 1,400mg of sodium, so people should halve their sodium intake by drinking half the broth or leaving most of it behind, she said.

Also, watch out for the sodium content in these commonly consumed items: one cup noodle has about 1,900mg, one salted egg has 1,500mg and one tablespoon of ikan bilis has 450mg, Lim said.

Exercise cannot work in a vacuum

This disconnect extends beyond daily eating habits to how patients view chronic disease management.

At the National University Hospital, Tai E Shyong, a senior consultant at the Division of Endocrinology, said many patients refuse medication, telling him instead that they will just exercise.

“Patients often fall into the trap of thinking in silos, for example, believing that eating sugar is the only thing that causes diabetes, or that a high-salt diet is the only thing that causes high blood pressure,” said Tai.

But most conditions have multiple risk factors, and every choice interacts with bodies in different ways and across different time frames, he said. “People often underestimate the amount of lifestyle modification they make. They are consuming less sugar, but if their calories have gone up, they are not going to lose weight.”

Caloric excess can lead to obesity, which already affects 12.7% of residents aged 18 to 74, according to the 2024 National Population Health Survey, while rising sodium intake can cause even higher rates of hypertension.

“As blood pressure rises across the board, we will see a corresponding increase in severe, life-altering complications, specifically things like chronic kidney disease and strokes,” warned Tai.

In addition, while protein intake is largely adequate for the population, sarcopenia or age-related muscle loss remains a lingering concern among older adults.

According to the survey, half of those aged 50 to 69 still do not meet their daily protein target of 1.2g per kilogram of body weight.

Overestimating activity levels while overeating

Although total physical activity levels here – defined as participating in at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity – are high on paper, it is unclear if they align with overall health.

Tai said there is evidence showing that when people self-report their activities in surveys – the National Population Health Survey was conducted via household interviews – they tend to over-report moderate- and high-intensity activity and under-report the total.

Much also depends on the type of exercise performed – active commuting may contribute to total physical activity but may not be sufficient to burn off excessive calories. “Walking to the bus stop, some people will say that is moderate intensity,” Tai said.

Meanwhile, Mary Chong, assistant dean of education at the NUS Saw Swee Hock School of Public Health, said that relatively new culinary options such as hotpots, mala tang and xiang guo have gained popularity here. As these dishes are heavily seasoned, their intense spicy or rich herbal profiles can often mask high sodium levels, she added.

Even trendy items commonly viewed as sweet snacks or desserts, such as salted caramel items and salted egg or spicy Korean snacks, contain sodium.

But as more people become more aware that high sodium intake can cause high blood pressure and other long-term health risks, they will actively ask for less salt, gravy or sauces, which would encourage more eateries to use less sodium in their cooking, Chong said.

The good news is that dietary tweaks are helpful. Research demonstrates a clear link between a low-sodium diet and better blood pressure control, which in turn protects kidney health and reduces the long-term risks associated with hypertension, Tan said.

“If someone’s salt intake is very high and the blood pressure is borderline high, I will typically say, short of adding more medicine, just by decreasing your sodium intake. I am very confident that the blood pressure will hit optimal control,” she added.