SINGAPORE - Most people walking pass Belmond Lee would not recognise him even if they knew him.
Two years ago, Belmond used to weigh a whopping 146kg. At a hight of 1.82m, this made his body mass index an alarming 44, indicating that he was severely obese.
He told The Straits Times (ST) that he had always been big, just like his parents. Of his whole family, only his sister is of normal weight.
At age 19, he was already suffering from intense back and knee pain - caused by the huge amount of excess weight he was carrying.
Desperate to lose weight, he followed his doctor's instructions to follow a weight loss programme which required him to eat less and exercise more, all the while taking weight loss medication.
He remained active in school, taking part in sports events such as discus and shot put, and did not pig out in his opinion.
However, he lost only about 5kg, and nothing more.
That was when he made a life changing decision. Belmond decided to take up his doctor's suggestion to go for weight loss surgery.
He admitted that the thought was 'scary', but decided to take the leap for a healthier life, even if it meant sacrificing something.
He opted for sleeve gastrectomy, which is a minimally invasive surgery where a large portion of his stomach is cut out, leaving the stomach the size and shape of a large banana.
This meant that Belmond could no longer eat large quantities of food, and in just nine months, his excess weight melted off, leaving him 71kg lighter.
And more than a year later, he has maintain his new slim silhouette. His BMI is a healthy 22.6, and although he still suffers from backache, his knees are no longer a problem.
Belmond said that he also does not fit into his old clothes, and one of the perks of his new size means he can fit into a wider range of clothes, making shopping a breeze.
It made up for the difficulties he faced in the beginning, where he had to stick to a soft diet, and could not eat quickly.
More than an hour to eat a burger
More than an hour to eat a burger
Even now, he has to chew and swallow his food so slowly, that it takes an hour and a half to finish just a hamburger.
It has changed his eating habits drastically. Where in the past he would have gone for buffets, he now goes for appetisers and snack-sized portions. When he goes out to eat with others, he shares a main course with another person.
If he eats too quickly or too fast, he will feel nauseous, which makes him stop eating. He admits that there are times when he has the urge to eat more, but is quick to add that he finds it a "worthy sacrifice" for a better body.
He told ST that he doesn't lose out as he gets to eat and taste everything, just in small portions.
According to ST, the number of people taking drastic weight-loss surgery has more than doubled in recent years.
These procedures involve surgeons cutting away or shrinking a large portion of their stomachs to prevent them from eating too much.
In Singapore, there are at least 16,000 people who are morbidly obese. About 150 operations were done last year, up from 131 in 2010 and 66 in 2009.
Most patients were females aged 25 to 45 years of age.
Public hospitals here offer three forms of weight loss surgery, mainly lap band surgery, gastric bypass and sleeve surgery.
Lap band surgery is when a band is placed around the upper part of the stomach to create a smaller stomach pouch. This restricts the amount of food that can be consumed and also the amount of time the stomach takes to empty out.
Gastric bypass is when the stomach is staped to leave only a small pouch on top, which is then connected directly to the small intestine.
Sleeve surgery is when the stomach is cut so that pnly a long, narrow tube remains.
Which is the safest option?
Fighting against early death
Of the three, sleeve surgery is the most popular as it is believed to be the safest option, as complications arise once in about every 50 cases.
However, prospective patients should be made aware that sleeve surgery is irreversible, unlike the other two.
The price range of the different methods vary from up to $17,000 as a private patient to $7,000 if subsidised. Patients are warded about five days after surgery in hospital. Although the procedure is minimally invasive, scarring will occur from the small holes made in the abdomen.
Surgery is only considered for those morbidly obese, which means that the prospective patient must have a BMI of 27.5 and above. However, if the patient has a chronic ailment like diabetes, the BMI requirement can be lowered to 32.5.
In addition, the operations are only allowed if the patient has tried for several months other methods of losing weight, such as exercise, eating less and medication.
The popularity of weight loss surgery is simply due to the fact that it works. Most find that their weight melt away within 18 months, and for at least 50 per cent of those who choose the more invasive methods, like gastric bypass, the weight stays off.
The amazing numbers, reported in the New Scientist magazine, is a far cry in success rates from methods such as dieting and pills.
And weight loss is not just about looking good. An Asian with a BMI of 27.5 is already risking early death from health problems.
According to The World Health Organisation (WHO), obesity is the third leading risk factor to death in middle to high-income countries, such as Singapore.
Nearly half of diabetics, 23 per cent of those with heart problems and more than 40 per cent of those with cancer are obese.
The dark pigmentation that the obese often have around their necks and armpits indicates that their pancreas are working extra hard, said Dr Loh Keh Chuan, an endocrinologist in private practice.
They often have several chronic problems, from breathing problems, walking difficulties to heart problems, and live on average 20 to 30 per cent shorter lives.
Worth the risk?
However, for those considering drastic weight loss surgery, be warned: There may be undesirable side effects.
According to the writer of The Subtle Knife, an article published in New Scientist, weight loss surgery for him lead to a hypersensitivity to sweetness - meaning that a peach tea drink sometimes tasted like fish.
There have been accounts as well of memory loss, anxiety to auditory hallucinations. But they are not all bad - a significant number reported an unexplained "mental boost" months after surgery.
According to Samantha Murphy, the author, weight loss surgery doesn't only work because you are forced to eat less, but because of food cravings being massively dampened due to the brain being re-wired.
Weight-loss surgery patients often report reduced levels of hunger and fewer food cravings. Some find that they can't even stand the taste of sugar or fat.
Doctors interviewed by ST warn as well that there are risks associated with bariatric surgery, with as many as one in four patients suffering from complications such as infections and bleeding.
The risk of death is very low, but it's still there. There've been two known deaths in Singapore following bariatric surgery, with the latest case in 2006, when a 31-year-old man suffered excessive bleeding, fell into a coma and died.
However, as Murphy noted, taken into context with health risks of long term obesity, such risks for many is one worth taking.