Medical Weight Management in Kota Kinabalu

Oct 5

11 min read

中文摘要在文末

Let me tell you something about myself first.

I am not one of those people who can eat whatever they like and stay the same weight. You know the type. They have a second helping, they skip the gym for a month, and nothing happens to them. Their body just quietly absorbs it all and carries on.

That's not me. If I stop paying attention for a few weeks, I gain a few kilos. Reliably. It doesn't require a holiday or a crisis — just a period of not watching, and it's back.

So I've spent most of my adult life in a cycle. Gain a bit, notice, tighten up, lose it, relax, gain it again. Round and round.

I'm telling you this because I want you to know where I'm writing from. I'm not a naturally lean doctor explaining to you that it's simple. I know what it's like to see a number move in the wrong direction and feel that particular sink in your stomach. I know what it's like to do well for two months and then watch it come back.

And that experience is a large part of why I built this programme the way I did — because the cycle is the actual problem. Losing weight isn't the hard part. Plenty of things will make you lose weight. Not gaining it back is the hard part, and almost nothing on the market is designed for that.

The other thing I want to say before we go further:

I don't think you lack discipline.

I know that's the story you've probably been told — possibly by family, possibly by a previous doctor, almost certainly by yourself at two in the morning. Here's how I actually see it, and I mean it literally rather than as something comforting to say. If I had been born as you, into your body, your family, your circumstances, and grown up the way you did — ninety-nine times out of a hundred I would have ended up in exactly the same place.

So the interesting question isn't why you lack willpower. It's what forces shaped your habits, your appetite, and your metabolism — because something did. Those forces are usually findable. And once you can see them, you can work with them.

That's what I'm here to do. Not to hand you a lecture you've already heard.

What this programme actually is

There's a lot of weight loss medication being handed out in Malaysia right now. Someone gets a prescription, injects it themselves at home, and that's the entire service. No monitoring, no titration, no idea what's happening to their muscle, no plan for what comes after.

That's not what we do here, and I want to explain the difference with an analogy I use in the room.

Think of it as flying a plane.

The medication is the engine. It's genuinely powerful, and I'm not going to pretend otherwise — it's what makes the whole thing possible. But an engine bolted to nothing doesn't fly.

I'm the pilot. Someone has to decide the altitude, adjust for conditions, respond when something goes wrong, and know when to start the descent.

And then there's everything else — nutrition, exercise, supplements, sleep. Those are the wings, the landing gear, the instruments. You need the wings to fly at all. And you need the landing gear to come back down safely, which is the part almost everyone forgets about until they need it.

Medication alone is an engine with no wings. It'll generate a lot of force and you'll go somewhere, but you don't control where, and you have no way to land.

Who this is for — and who it isn't

I need to be direct about this, because it's where I disappoint some people who come in.

This is a metabolic reset programme. Weight is one measure of whether it's working — it is not the point of it.

I follow current guideline criteria. Broadly, that means an Asian BMI in at least the overweight range with at least one metabolic comorbidity, or diabetes. Meet that, and we can have the conversation.

What I turn away: people at a normal BMI who want to shave off a few kilos for how they'd look, and people in the overweight range with no metabolic problems at all.

I know that's frustrating to hear, and I don't say it to be difficult. Here's the reasoning.

Every medication carries risk. Not high risk here, but real risk. As doctors, our job is to weigh that risk against the benefit for the person in front of us. When someone has excess weight plus metabolic disease, the risk of leaving that untreated clearly outweighs the risk of the programme — so I offer it. When someone has a normal BMI and wants this for appearance, the balance tips the other way. The risk exceeds the benefit.

At that point prescribing isn't just poor judgement. It's unethical, and it's unlawful.

There are also absolute exclusions regardless of BMI — certain thyroid conditions, a family history of pancreatic cancer, and certain eye conditions, because of side effects that are uncommon but serious. Those get screened before anything starts.

If I turn you away, I'll explain exactly why, and where it's appropriate I'll help you with what you do need.

Why I see you every single week

This is the part that makes our programme different from a prescription, and it's the part I'd want to ask about if I were assessing any weight programme.

We store your medication here and our trained staff administer it weekly. You come in, every week, for the whole programme.

That's not an inconvenience I've invented. It's the entire mechanism. Every week we:

Reassess your weight and your body composition — because those are different things and the second one matters more
Check how you're tolerating the medication and titrate accordingly
Talk about what you've been eating, and why
Review your activity — steps, walking, and later resistance training
Catch side effects while they're small and manageable

And critically, that weekly conversation is where I learn things you didn't come in planning to tell me. Eating patterns. What you reach for when you're upset. Whether the weekend looks nothing like the week. That's not surveillance — it's the actual substance of the treatment, and it's why my consultations here run heavily towards talking.

Between visits, you can contact the clinic. You don't wait a week if something's wrong.

The three phases

We recommend at least six months. Here's the shape of it.

Phase one: Adaptation (about 2–3 months). The most demanding phase and the one requiring closest supervision.

Three things are adapting at once. Your body is adapting to the medication and its side effects, which is why titration has to be done properly rather than escalated on a fixed schedule. Your body and mind are separating from each other in a way that surprises almost everyone — the medication mimics a fullness signal, so you're not hungry, but it's lunchtime and you feel slightly weak, and something in you starts craving. That craving is real, and it's not always about food.

Because here's the thing: in modern life we don't eat mainly for survival or calories. We eat for enjoyment. So when the appetite goes quiet, the mind notices something missing — and if you don't understand what's happening, it's disorienting. Part of what we do in this phase is help you identify these signals, name them, and adapt to them deliberately.

And your activity is adapting. You're in a calorie deficit, so exercise has to build progressively, chosen to burn fat while preserving muscle rather than just burning anything.

Phase two: Burning (2–10 months). Once everything is optimised, this phase needs time. It's like a stew — you can't rush it. The fat comes off gradually while we monitor closely to make sure muscle is preserved and your electrolytes and nutrients don't drop.

This is where resistance training starts properly.

Phase three: De-escalation (1–2 months). We reduce the medication dose deliberately, to let your body acclimatise to coming off it.

I want to be clear about why this phase exists: I don't believe in staying on these medications indefinitely. This isn't a subscription. During de-escalation we reinforce every habit built along the way, so what's holding your weight afterwards is your lifestyle rather than a drug.

That's the landing gear.

Muscle, protein, and the criticism I think is fair

The most legitimate criticism of GLP-1 weight loss is that people lose muscle along with fat. It's a real problem and I take it seriously.

Two things address it.

Protein. Whey protein is part of the supplement stack, adjusted monthly according to your needs — not a fixed scoop for everyone. Alongside that, we teach you how to find protein in ordinary food, which matters more long-term than any powder.

Resistance training — but introduced in the burning phase, not on day one, and deliberately not by sending you to a gym with a personal trainer.

That's not snobbery about gyms. It's that a gym membership taken by someone who wasn't already committed doesn't survive month three, and then the training stops entirely. So we start with movements you can do at home, adjustable to your capability, roughly three times a week. Squats and lunges first — because the muscles in your lower limbs are the largest muscle mass in your body, so that's where the return is. Push-ups added if and when you're able.

The weight on the scale isn't the target. Fat is the target, and muscle is what we're protecting. You'll see weeks where the scale doesn't move while your body fat percentage drops and your muscle mass rises. That's a good week, even though it doesn't feel like one.

What we measure

Baseline bloods before starting: full blood count, renal profile, liver function, lipid profile, fasting glucose, HbA1c where relevant, electrolytes, urine, and thyroid function. Others where the picture calls for it — hormonal studies in PCOS, for example, or testosterone where obesity has suppressed it.

Then we repeat at the end of the programme, and again three months after it ends.

That second repeat is deliberate, and it's the one that tells you what our philosophy actually is.

Anyone can show you improved numbers while you're on treatment. The question that matters is whether the improvement holds without the medication supporting it. That's the whole point of the exercise.

What happens when you stop

The question everybody has, so let me answer it plainly.

You'll typically regain one to two kilograms. That's water weight, it's expected, and it's fine.

After that, you find out whether the lifestyle you've built is genuinely sustainable. That's not a threat — it's the honest situation, and it's precisely why the programme is built the way it is. Every phase is designed to leave you with something that works without the engine running.

We follow up at three months to see how you're coping and help where needed. If someone genuinely struggles, we can consider a lower dose to let the body adjust more gradually. That's rarely needed.

One case worth telling you about

A woman in her thirties came to see me. She'd been getting weight loss medication from a doctor for five months — just the medication, no monitoring, no titration. Her weight dropped initially and then stopped completely. She'd become sluggish and low on energy, always cold, always sleepy, and it was affecting her daily life.

She came to me wanting proper supervision rather than doing it herself.

But during screening, taking a long history, something didn't sit right. She'd always been larger and inactive — but she'd also always felt cold, and her mood had always been low. Not just recently. Always.

Her bloods showed clinical hypothyroidism.

Now — hypothyroidism isn't automatically a barrier to weight treatment. But an underactive thyroid causes fluid retention and lowers your metabolic rate, which makes weight gain easier and loss harder. She'd been trying to force weight off a body that was working against her for a reason nobody had looked for.

So I told her the priority wasn't losing weight. It was getting an endocrine review and her thyroid under control.

She's been on thyroid treatment from her endocrinologist since. Her weight became far easier to manage, and she has never needed to go back to weight loss medication at all.

I tell this story because five months of medication without anyone taking a proper history nearly cost her the actual diagnosis. The screening isn't paperwork. Sometimes the screening is the treatment.

Coming in

If you want to know whether this is appropriate for you, come and have the conversation. We'll go through your history, your eating patterns, your circumstances, and your bloods — and I'll tell you honestly whether this programme is right, whether something else is, or whether you don't need it.

Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu.

WhatsApp 017-234 7328. Appointments preferred — this consultation needs proper time.

And come without the apology you've probably rehearsed. I'm not going to tell you what everyone else has already told you. My job is to find the external forces that shaped this, and help you work with them.

Book a consultation with Dr. Tan — Book Online or WhatsApp 017-234 7328.

简要说明

我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan。

先说说我自己。 我不是那种怎么吃都不胖的人。如果我几个星期不留意，体重就会上升几公斤——很准时。所以我这辈子多数时间都在同一个循环里：胖一点、发现、收紧、瘦下来、放松、又胖回去。

我说这些是想让你知道我是从什么位置写这篇文章的。减重不难，难的是不复胖——而市面上几乎没有产品是为「不复胖」而设计的。这也是我把这个计划设计成现在这样的原因。

另外一句：我不认为你缺乏自制力。

如果我出生在你的身体、你的家庭、你的成长环境里，一百次里有九十九次，我会走到跟你一样的位置。所以真正值得问的不是「为什么你没有毅力」，而是有什么外在因素塑造了你的饮食习惯、食欲和代谢——因为一定有。找出来，就能着手处理。

这不是「只开药」的减重方式。 我用飞机来比喻：

药物是引擎——确实强大，但引擎接不上机身是飞不起来的。
医生是机师——决定高度、应对状况、知道何时开始下降。
营养、运动、补充剂、睡眠是机翼、起落架和仪表——没有机翼飞不起来，没有起落架就无法安全降落，而降落这部分几乎所有人都忽略了。

适合谁：这是代谢重置计划，体重只是其中一个指标，不是目的本身。依照现行指引，亚洲人 BMI 至少在过重范围并且有至少一项代谢共病，或糖尿病。

不适合谁：BMI 正常、纯粹为了外观想瘦几公斤的人，以及过重但完全没有代谢问题的人。任何药物都有风险。当过重加上代谢疾病时，不治疗的风险明显高于计划的风险；当 BMI 正常只为美观时，风险高于好处——这时候开药不只是判断不当，而是不合伦理也不合法。

绝对排除：某些甲状腺疾病、胰脏癌家族史、某些眼疾——因为有罕见但严重的副作用。

每周复诊：药物存放在诊所，由受训人员每周施打。每周评估体重和身体组成、调整剂量、检讨饮食与活动、及早处理副作用。两次复诊之间随时可联络诊所。

三个阶段（建议至少六个月）：

适应期（约2–3个月）——身体适应药物和副作用；身心分离：药物模拟饱足讯号，你不饿，但到了午餐时间会觉得虚弱、开始渴望某些东西。现代人吃东西不只为了热量，也为了享受——所以食欲安静下来时，心理会察觉少了什么。我们帮你辨认这些讯号并适应它。
燃烧期（2–10个月）——像炖汤，需要时间。密切监测以保住肌肉、维持电解质和营养。阻力训练在这个阶段正式开始。
减量期（1–2个月）——刻意降低剂量让身体适应停药。我不认为应该长期依赖这类药物。 这是起落架。

肌肉与蛋白质：这是对 GLP-1 减重最合理的批评，我认真看待。补充剂含乳清蛋白，每月由医生调整，同时教你从一般食物中辨认蛋白质。阻力训练从在家可做的动作开始（深蹲、弓箭步优先，因为下肢是全身最大的肌群），一周约三次，能力允许再加伏地挺身。目标是减脂、保肌——有些星期体重不动，但体脂下降、肌肉上升，那是好的一周。

抽血：基线做全血、肾功能、肝功能、血脂、空腹血糖、HbA1c、电解质、尿液、甲状腺功能。疗程结束时再验一次，停止后三个月再验一次——因为真正重要的问题是：没有药物支撑时，改善还在不在。

停药后会怎样：通常会回胖 1–2 公斤，那是水分，属正常。之后才是检验生活型态是否真的可持续。我们三个月后追踪。

一个真实案例：三十多岁女性，已自行用药五个月（只拿药、无监测），体重先掉后停，整天疲倦、怕冷、嗜睡。详细病史发现她一直都怕冷、情绪低落——抽血证实是临床甲状腺功能低下。甲状腺低下会造成水分滞留、代谢率下降。我建议她先转介内分泌科处理甲状腺，而不是减重。治疗后体重变得容易控制，她再也不需要减重药物。五个月的用药差点让她错过真正的诊断。