GLP-1 Dosing for Obese Patients in Singapore

GLP-1 receptor agonists (GLP-1 RAs) are now a key treatment option for obesity in Singapore, a condition affecting 10.5% of adults as of 2022. These medications, originally developed for Type 2 diabetes, aid weight loss by reducing appetite, slowing digestion, and stabilising blood sugar. Approved options like Wegovy, Saxenda, and Rybelsus are available under prescription, with strict medical oversight to ensure safety.

Key points you need to know:

Eligibility: BMI ≥30 kg/m²; or BMI 27–29.9 kg/m² with a weight-related condition (e.g., diabetes, hypertension).
Medications: Oral (Rybelsus) and injectable (Wegovy, Saxenda, Ozempic) options with specific dosing schedules.
Expected Results: Weight loss of 6%–22.5% depending on the drug and duration (e.g., Wegovy: 15%–20% over 68 weeks; Tirzepatide: up to 22.5% over 72 weeks).
Side Effects: Common issues include nausea, bloating, and injection-site reactions, usually manageable with proper titration.

These treatments are part of a long-term approach, combining medication with diet, exercise, and lifestyle adjustments for better outcomes. Always consult a doctor for personalised care and monitoring.

Obesity and Treatment Eligibility in Singapore

How Obesity is Defined in Singapore

In Singapore, Body Mass Index (BMI) is the standard measure for defining obesity. BMI is calculated by dividing a person’s weight in kilograms by their height in metres squared. However, Singapore applies adjusted thresholds for Asians, recognising that they tend to have higher body fat percentages and face greater risks of conditions like cardiovascular disease and type 2 diabetes at lower BMI levels. While the international benchmarks for overweight and obesity are 25 kg/m² and 30 kg/m² respectively, the World Health Organisation (WHO) guidelines for Asians lower these to 23 kg/m² for overweight and 25 kg/m² for obesity .

"The WHO definition for Asians starts at a BMI of 23 kg/m² for overweight and 25 kg/m² for obesity." - Dr. Linsey Gani, Endocrinologist

Although BMI doesn’t differentiate between muscle mass and fat or reflect body composition, it remains a practical tool for identifying health risks, including hypertension, high cholesterol, and metabolic disorders.

Who Qualifies for GLP-1 Medications

In Singapore, eligibility for GLP-1 medications is determined by specific clinical guidelines. Generally, individuals with a BMI of 30 kg/m² or higher qualify for treatment. Those with a BMI between 27 kg/m² and 29.9 kg/m² may also be eligible if they have at least one weight-related condition, such as type 2 diabetes, high blood pressure, or elevated cholesterol levels .

Before prescribing these medications, doctors conduct thorough reviews of a patient’s medical history to rule out contraindications like medullary thyroid carcinoma, multiple endocrine neoplasia type 2 (MEN 2), pancreatitis, or active gallbladder disease . For patients with established cardiovascular disease and a BMI of 27 kg/m² or higher, the use of Wegovy has been expanded in Singapore to help reduce risks of heart attack, stroke, or cardiovascular death. Additionally, liraglutide is approved for adolescents aged 12 to 17 who have obesity and weigh over 60 kg.

"The goal is patient safety: a responsible clinic confirms eligibility, checks for contraindications, explains risks and benefits, initiates therapy when appropriate, and follows up to titrate doses." - Clifford Clinic

Since GLP-1 medications are prescription-only, a formal medical consultation is essential. Public advertising of these drugs is not permitted, emphasising the need for professional medical oversight. At Trimly, Ministry of Health (MOH)-approved doctors provide detailed assessments to determine eligibility, review medical histories, and create personalised treatment plans with ongoing support. This comprehensive approach ensures safe and effective use of GLP-1 medications.

GLP-1 Dosing Protocols: Oral and Injectable Options

GLP-1 Medication Dosing Schedules and Weight Loss Outcomes Comparison

GLP-1 medications are prescribed following specific dosing protocols, starting with lower doses to help your body adjust while minimising side effects like nausea and bloating. Here's a breakdown of the protocols for both oral and injectable options.

Oral GLP-1 Medications (Rybelsus)

Rybelsus

Rybelsus (oral semaglutide) uses a step-by-step dosing approach. It begins with 3 mg once daily for the first four weeks, then increases to 7 mg. If needed, the dose can be further raised to 14 mg. The tablet should be taken on an empty stomach each morning with up to 120 ml of water. Wait 30 minutes before eating or drinking anything else.

"Oral Semaglutide 14mg is approximately equivalent to injection semaglutide 0.5mg once weekly."
– Dr. Hoe Ying Min, Medical Director, Bay Aesthetics Clinic

Clinical trials back up its effectiveness. In the PIONEER 4 trial, patients taking 14 mg daily experienced an average weight loss of 4.3 kg over 52 weeks. The PIONEER 6 trial found that 35% of participants lost more than 5% of their body weight, while 15% lost over 10% during a 16-month period. Side effects, such as gastrointestinal discomfort, usually subside within three to four weeks as your body acclimates.

In Singapore, oral semaglutide is priced between S$400–S$600 per box, while injectable options range from S$500–S$800 per box.

Injectable GLP-1 Medications (Ozempic, Wegovy, Saxenda)

Ozempic

Injectable GLP-1 medications come with their own dosing schedules:

Ozempic: Typically used for managing Type 2 Diabetes, it starts at 0.25 mg weekly for four weeks, then increases to 0.5 mg. Depending on individual needs, the dose can go up to 1 mg or 2 mg.
Wegovy: Designed for weight management, it follows a gradual titration plan. Starting at 0.25 mg weekly, it reaches a maintenance dose of 2.4 mg by week 17.
Saxenda: Administered daily, this begins at 0.6 mg and increases by 0.6 mg each week until reaching the maintenance dose of 3.0 mg at week five.

Here’s a quick overview of the dosing schedules:

Medication	Frequency	Starting Dose	Titration Interval	Maintenance Dose
Ozempic	Weekly	0.25 mg	4 weeks	0.5 mg, 1.0 mg, or 2.0 mg
Wegovy	Weekly	0.25 mg	4 weeks	2.4 mg
Saxenda	Daily	0.6 mg	1 week	3.0 mg

For injectables, it's important to rotate injection sites weekly between the abdomen (at least 5 cm away from the navel), front thigh, or back upper arm to avoid complications like lipodystrophy. Unopened pens should be refrigerated at 2°C–8°C. Once opened, they can be stored at room temperature (below 30°C) for six to eight weeks.

At Trimly, MOH-approved doctors oversee the entire titration process, tailoring doses to your response and tolerance. This ensures that your treatment is both safe and closely monitored.

Dose Titration and Adjustment Factors

Titration Schedules for GLP-1 Medications

GLP-1 medications are typically introduced using a "start low and go slow" method. This means starting with a low dose and gradually increasing it every four weeks. This approach helps minimise common gastrointestinal side effects like nausea and bloating, making the adjustment process more manageable.

Doctors usually increase the dose monthly, provided it’s well tolerated. For instance, when using Wegovy, the dosage is gradually increased over a 16-week period until it reaches the maintenance dose of 2.4 mg. This dose is then maintained for long-term weight management.

"Doctors adjust the titration schedule to balance momentum with comfort."
– Clifford Clinic

If you miss several doses, your doctor might suggest restarting at a lower dose instead of continuing where you left off. This precaution helps avoid severe side effects. While the standard dose escalation is followed, other factors can influence how adjustments are made.

What Affects Dose Adjustments

When it comes to adjusting doses, individual responses play a key role. Tolerance and side effects are major considerations. If you experience persistent nausea or vomiting, your doctor may slow down the titration pace or temporarily reduce the dose.

Pre-existing health conditions also impact dose adjustments. For example, patients with Type 2 Diabetes who are on insulin or sulfonylureas may require adjustments to those medications to avoid hypoglycaemia when starting GLP-1 therapy. Similarly, individuals with liver or kidney issues, cardiovascular disease, or a history of gallbladder problems or pancreatitis need close monitoring during treatment. Additionally, patients with a history of depression or suicidal thoughts require careful observation, as there have been rare reports of increased suicidal ideation linked to these medications.

Your progress is another critical factor. Doctors tailor dose escalation based on your weight loss journey and improvements in metabolic markers, such as blood pressure, glucose levels, and lipid profiles. At Trimly, MOH-approved doctors closely monitor your progress and adjust doses to ensure safe and effective treatment. This ongoing monitoring helps personalise your care for better outcomes.

Side Effects, Monitoring, and Safety Tips

Common Side Effects and How to Manage Them

When starting GLP-1 medications, gastrointestinal symptoms are the most common side effects, especially during the initial dose adjustment phase. Over 10% of users report experiencing nausea and diarrhoea. Thankfully, these symptoms usually subside as your body gets used to the medication.

Nausea tends to be the most troublesome. To ease it, try eating smaller, more frequent meals instead of large ones. Avoid foods with strong odours, and steer clear of oily, spicy, or overly sweet dishes. Some people find that crackers, mints, or ginger-based drinks can help, especially if consumed about 30 minutes after injecting. For diarrhoea, staying hydrated is key - drink plenty of water and temporarily avoid dairy and high-fibre foods. On the flip side, if you experience constipation, increase your fibre intake and keep your water consumption high.

Injection site reactions can also occur. To minimise these, rotate your injection sites weekly. Alternate between your abdomen, thigh, and upper arm to avoid skin issues like lipodystrophy (lumps or dents). Always use a fresh needle and dispose of it safely.

In clinical trials for Wegovy, about 3% of patients reported hair loss, compared to 1% in the placebo group. While rare, more severe side effects demand immediate medical attention. Be on the lookout for persistent stomach pain (a possible sign of pancreatitis), upper right abdominal pain with yellowing of the skin or eyes (potential gallbladder issues), or sudden changes in vision. Alarmingly, the UK's Medicines and Healthcare products Regulatory Agency has linked GLP-1 medications to 574 cases of acute pancreatitis and 10 deaths. Recognising these warning signs early can make a critical difference.

Given these risks, consistent monitoring is crucial.

Monitoring and Safety Practices

Managing side effects effectively goes hand in hand with regular monitoring. In Singapore, GLP-1 medications are prescription-only, meaning your doctor will oversee your treatment closely. Routine follow-ups will focus on tracking your weight, waist circumference, blood pressure, and key metabolic markers like fasting glucose, HbA1c, and lipid profiles.

Monitoring organ function is equally important. Your healthcare provider will regularly check liver and kidney function, as severe gastrointestinal side effects can lead to dehydration and, in some cases, acute kidney injury. If you're also on insulin or sulfonylureas, your doctor will monitor for hypoglycaemia. If you notice cold sweats or dizziness, follow the 15-gram rule: consume 15g of fast-acting sugar (like three glucose tablets or 200ml of fruit juice), wait 15 minutes, and recheck your levels.

Patients with a history of mood disorders need to stay vigilant. Report any mood changes, feelings of depression, or suicidal thoughts to your doctor immediately. At Trimly, MOH-approved doctors provide ongoing support and monitoring to ensure your treatment is both safe and effective throughout your weight loss journey.

For those taking oral semaglutide (Rybelsus), proper timing is essential. Take the tablet on an empty stomach first thing in the morning with no more than 120ml of plain water. Wait at least 30 minutes before eating or taking other medications. These safety measures, combined with the earlier titration protocols, are designed to maximise the benefits of your treatment.

Expected Weight Loss and Long-Term Benefits

Weight Loss Outcomes with GLP-1 Medications

When it comes to GLP-1 medications, the weight loss results can vary depending on the specific drug prescribed. Clinical studies reveal that semaglutide (Wegovy), when paired with diet and lifestyle adjustments, can lead to an average weight reduction of 14.9%–15.8% over 68 weeks. For someone weighing 90kg, this translates to roughly 13–14kg lost over 16 months.

Tirzepatide (Mounjaro/Zepbound), a newer dual-agonist therapy targeting GLP-1 and GIP pathways, has delivered even more promising outcomes - up to 22.5% weight loss over 72 weeks. In contrast, liraglutide (Saxenda), which involves daily injections, typically results in 6%–8% weight loss over 56 weeks. For those opting for oral semaglutide (Rybelsus), the expected weight reduction falls between 8%–10%.

It’s worth noting that individuals with Type 2 Diabetes often see slightly lower weight loss outcomes. Generally, patients may start noticing reduced hunger within 2–4 weeks, achieve around 5% weight loss by 4–6 months, and reach a 10%–15% reduction within 7–12 months. These figures highlight the importance of combining medication with consistent lifestyle changes for lasting results.

Long-Term Use and Maintaining Results

GLP-1 medications are not a short-term solution; they are part of a comprehensive, long-term plan. Obesity is recognised as a chronic neurometabolic condition, meaning these therapies work best when integrated with a broader approach that includes medication, balanced nutrition, regular exercise, quality sleep, and stress management.

The STEP 4 trial reinforces this point. Participants who continued taking semaglutide for 104 weeks (2 years) maintained significantly more weight loss compared to those who discontinued the medication, who regained 6.9% of their body weight. Stopping the medication without making sustainable lifestyle changes often leads to weight regain, underlining the need for a well-rounded strategy.

To maintain your progress, focus on a diet rich in protein and fibre, engage in regular physical activity, and prioritise good sleep habits. The appetite suppression provided by the medication offers an ideal window to establish long-term dietary habits. At Trimly, MOH-approved doctors offer continuous support and unlimited follow-ups to help you sustain your progress well beyond the initial weight loss phase.

Conclusion

GLP-1 medications have shown to be an effective option for weight loss in obese patients in Singapore, provided they are used under strict medical supervision. Proper titration is critical - starting semaglutide at 0.25 mg weekly and gradually increasing the dose over 16 weeks helps to minimise side effects. Medical oversight ensures patients are screened for contraindications, such as a history of medullary thyroid cancer or pancreatitis, and monitored for rare but serious risks.

The results speak for themselves: semaglutide can lead to 15%–20% weight loss over 68 weeks, while tirzepatide offers up to 22.5% weight reduction. When paired with balanced nutrition, regular exercise, and healthy lifestyle habits, GLP-1 therapy delivers results that are more sustainable.

"The best plan is the one you can follow consistently and safely, with the right amount of medical oversight." – Clifford Clinic

These findings underline the importance of customised treatment plans, particularly given Singapore's specific BMI threshold for obesity, which starts at 25 kg/m² for Asian populations. Beyond aiding weight loss, these therapies also improve metabolic health and reduce cardiovascular risks. Professional guidance and ongoing support are crucial throughout this process, ensuring a safe and effective treatment journey.

At Trimly, MOH-approved doctors provide personalised treatment plans, unlimited follow-ups, and convenient doorstep delivery of medications. Whether you opt for oral or injectable solutions, professional medical care is essential in turning temporary weight loss into long-term success.

FAQs

How do GLP-1 medications support weight loss?

GLP-1 (glucagon-like peptide-1) receptor agonists are medications designed to mimic the effects of the natural GLP-1 hormone in your body. These drugs work by activating the brain's satiety centres, helping you feel satisfied after meals. They also slow down how quickly your stomach empties and boost insulin secretion, which helps stabilise blood sugar levels and may reduce overall calorie intake.

In Singapore, semaglutide and liraglutide are approved for managing obesity and diabetes. Clinical research indicates that using semaglutide injections alongside a healthy diet and regular exercise can result in an average weight loss of 10–15 kg within a year. For those looking for a convenient option, Trimly, an MOH-approved telehealth clinic, provides tailored GLP-1 treatment plans. These plans include medication delivered straight to your home, offering a safe and effective way to achieve weight loss goals.

Who is eligible for GLP-1 treatment in Singapore?

In Singapore, medications like semaglutide or tirzepatide, which fall under the GLP-1 category, are prescribed only after a thorough medical evaluation. This process ensures that the prescription aligns with clinical guidelines established by the Health Sciences Authority and the Ministry of Health.

Here’s what’s required to qualify:

Body Mass Index (BMI): Patients must have a BMI of 27.5 kg/m² or higher, meeting the threshold for obesity-related treatments in Singapore.
Health Conditions: A doctor must diagnose either type 2 diabetes or an obesity-related health issue, such as high blood pressure or cholesterol.
Prescription-Only: These medications require a prescription from a qualified doctor.

In Singapore, lifestyle counselling may begin at a lower BMI (≥23 kg/m²) for Asian populations. However, GLP-1 treatments are typically reserved for individuals with a BMI of 27.5 kg/m² or above. Additionally, patients must be prepared to follow a doctor-recommended lifestyle and behavioural programme alongside the medication for optimal results.

What should I do if I experience side effects from GLP-1 medications?

If you notice side effects like nausea, vomiting, diarrhoea, constipation, abdominal bloating, reduced appetite, or injection-site reactions while using GLP-1 medications, it's important to contact your prescribing doctor or telehealth provider promptly. They can evaluate whether the symptoms are mild and suggest steps to manage them, such as taking the medication with food, staying well-hydrated, or changing the injection site. In some situations, they might recommend adjusting the dosage or temporarily stopping the medication.

However, for severe symptoms - such as ongoing vomiting, sudden sharp abdominal pain, signs of pancreatitis, or symptoms of low blood sugar - seek immediate medical attention at the nearest A&E or call 995 for emergency help. Keeping a detailed record of your symptoms and any other medications you're on can assist your doctor in fine-tuning your treatment plan.

In Singapore, you can turn to MOH-approved telehealth clinics like Trimly for personalised care and unlimited follow-ups. Their doctors can assess your side effects, modify your treatment plan, and provide ongoing support - all without needing to step into a physical clinic.