The prevalence of child and adolescent obesity is increasing globally and in Singapore, and primary care providers play an important role in stemming this rise.Accurate measurement of Body Mass Index (BMI) and monitoring of growth across time can enable early diagnosis and intervention.Addressing childhood and adolescent obesity and its consequences should be done in a sensitive and non-judgemental manner.Childhood and adolescent obesity have adverse medical and psychosocial consequences and early screening for these complications is important in assessment.Adopting a family-based approach for healthier lifestyle changes is important in the prevention of childhood and adolescent obesity.Pharmacotherapy may be considered as an adjunct to lifestyle changes in selected cases.SFP2023; 49(9): 45-50
The rate of overweight and obesity is increasing worldwide, with significant impact on health.Obesity is a risk factor for morbidity and mortality, and weight loss should take a multi-pronged approach, including dietary control and physical activity.The lack of physical activity, sedentary behaviour, and poor cardiorespiratory fitness are all independent risk factors for morbidity and mortality, thus it is important to advise lifestyle changes to address these issues.Most individuals who have no contraindications can embark on light-to moderate-intensity physical activity without the need for medical clearance.Specific advice on physical activity should be given, targeting the individual, and this can be done using the FITT (frequency, intensity, time, type) principle.Physical activity should also be reviewed regularly and progressed gradually to target physical activity guidelines.Individuals should also be encouraged to replace sedentary behaviour with at least lightintensity physical activity whenever possible.
Genetic variation may account for variations in drug responsesthat are unaccounted for by conventional efforts to optimise drug response.The use of pharmacogenomics (PGx) may optimise pharmacotherapy in terms of safety and efficacy and provide individualised therapeutic choices.There is established evidence and guidelines for multiple drug-gene pairs to support the clinical implementation of PGx and some examples that are pertinent to primary care are briefly described.This article also outlines the landscape of the use of PGx in Singapore and addresses the potential concerns about insurability and genetic counselling for PGx tests.
Familial hypercholesterolaemia (FH) is a common genetic disorder associated with premature cardiovascular disease caused by excessive accumulation of cholesterol since childhood and adolescence.While homozygous FH presents in childhood with physical signs of cholesterol deposition, heterozygous FH is often "silent", undiagnosed, and often diagnosed in adulthood when a third of patients would already have developed cardiovascular disease (CVD).Genetic testing and subsequent cascade screening of families of affected individuals is critical in detecting FH early, allowing for early initiation of effective lipid-lowering treatment.SFP2024; 50(1): 17-22
