Experts Explain Why Thumb Sucking Can Be a Damaging Habit for Children Over 5

WORDS DR NIK MUKHRIZ NIK MUSTAPHA & DR MOHD AMIR MUKHSIN ZURIN ADNAN

FEATURED EXPERTS

DR NIK MUKHRIZ NIK MUSTAPHA
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
DR MOHD AMIR MUKHSIN ZURIN ADNAN
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
5 QUICK FACTS ABOUT THUMB SUCKING
  1. Thumb-sucking—a repetitive behaviour of sucking the thumb—is one of the behaviours referred collectively as non-nutritive sucking habits (NNSH).
  2. This behaviour has the potential to adversely affect the dentition, occlusion, and facial structures.
  3. It is prevalent among young children, particularly girls, and its occurrence tends to decrease with age. Approximately 70% to 80% of children exhibited this habit before the age of 5, with the incidence reducing to 12.1% and 1.9% beyond the age of 7 and 12, respectively.
  4. Interestingly, a higher percentage of mothers with thumb-sucking children had received some college education in comparison to mothers of children that don’t have this habit.
  5. It was also reported that the prevalence of thumb-sucking was least common among children that had favourable breastfeeding opportunities.
THUMB-SUCKING COMFORTS & SOOTHES INFANTS

The thumb-sucking reflex is one of the first sophisticated patterns of behaviour in infants, appearing around the 29th week of age.

Such reflex is considered normal, harmless, and comforting.

It helps infants to fall asleep easier as well as provide a sense of comfort, happiness, and security when they feel distressed.

COMMON FACTORS, EMOTIONS & SITUATIONS ASSOCIATED WITH A BABY’S THUMB-SUCKING HABIT
  • Fatigue.
  • Boredom.
  • Hunger.
  • Anger.
  • Fear.
  • Excitement.
  • Tooth eruption.
  • Insufficient sense of satisfaction.
  • Physical and emotional stress.
WHAT STARTED OUT AS AN EMOTIONAL COPING MECHANISM CAN BECOME A HABIT WHEN THE CHILD IS OLDER

Because thumb-sucking is a comforting coping mechanism, a child may eventually develop a strong attachment to this habit that persists at an older age.

This is the point at which problems begin to arise.

There is a direct link between the destructive effects of thumb-sucking habit and the intensity, frequency, and duration of the habit.

Having the habit for a short period will not leave much of an impact on the child.

However, continuous thumb sucking more than 6 hours daily often lead to the development of significant destructive outcomes.

Abnormal Pattern of Teeth Formation

The constant pressure and sucking motion exerted by the thumb on the teeth may interfere with a child’s normal path of tooth eruption and cause teeth to shift unnaturally. The position of the thumb within the oral cavity determines the pattern of the deformity.

A study has indicated that the incidence of tooth misalignment (malocclusion) is 3 times higher among children that exhibit thumb-sucking behaviour and other unhealthy oral habits, compared to those who do not have any such habits.

Asymmetrical Open Bite

The child’s front upper and bottom teeth do not come in contact when biting. This is usually worse on the side that the digit is sucked.

In turn, this may interfere in biting, speech, and to some extent, prevent closing of the lips.

Asymmetrical Facial Appearance

The narrowing of the palate associated with strong buccal musculature contraction and low position of the tongue can lead to the development of a posterior crossbite.

This can potentially impede the establishment of a proper bite and cause the jawbone to shift to one side, resulting in an asymmetrical facial appearance.

Increased Overjet

The tongue may push the upper front teeth forward, resulting in a ‘sticking out’ appearance while the lower front teeth is backward. The combination of these movements will result in an increased horizontal gap between the upper front and lower front teeth, a condition referred to as increased overjet.

Children with an increased overjet usually are at a greater risk of dental trauma due to the prominence of the teeth.

Speech Difficulties

Pronouncing certain words using tip of the tongue may be difficult, often with the child developing a lisp.

Skin Problems

Prolonged thumb sucking can cause skin irritation, cracked skin, and callus formation along the thumb.

Fingernail infection and eczema of the thumb may also develop.

WHEN SHOULD PARENTS BE CONCERNED ABOUT THEIR CHILD’S THUMB SUCKING?

The American Dental Association recommends intervening before a child turns 4 or, at the latest, by the time the permanent front teeth are about to erupt at the age of 5.

If the habit continues into the mixed dentition stage, past the age of 6, problems with the position of teeth might occur.

These problems can still self-correct and the child experience normal tooth growth if the habit is stopped by the age of 7.

After this age, the positions of the child’s teeth become more established and self-correction is less likely to occur. Complex orthodontic treatment is needed at this stage.

Hence, parents should aim to help their child stop the habit as early as possible, such as during preschool.

HOW TO WEAN YOUR CHILD OFF THUMB SUCKING
Psychological or Behavioural Approaches

Identify triggers. Determine the situations or times that would most likely drive your child to suck their thumb. By identifying these triggers, you can redirect their attention or provide them with alternative forms of comfort.

Positive reinforcement. Celebrate your child’s thumb-free moments. Consider setting up a reward system like a sticker chart that allows your child to visualize their progress and earn treats for sustained periods without thumb-sucking.

Communicate. Engage your child in age-appropriate discussions about thumb-sucking. Help them understand why they need to stop, while at the same time addressing any of their anxieties that lead them to suck their thumb.

Use visual reminders such as a band-aid on their thumb or a colourful bracelet on their wrist as a visual cue to remind them not to suck their thumb.

Distraction and substitution. Help your child find alternative ways to comfort themselves or keep their hands busy. Offer items like a soft toy, a soothing blanket, or even a stress ball. Keeping their hands occupied can divert attention away from thumb-sucking.

Seek professional help. If your child’s the thumb-sucking habit persists despite your efforts, consider consulting a child psychologist or counsellor. They can help identify any underlying emotional or psychological issues contributing to the habit and provide appropriate guidance.

Non-orthodontic Strategies

Thumb guards are devices that fit over the thumb and make thumb-sucking less enjoyable.

Other forms of physical barriers that can be used include bandages and gloves, but parents will have to monitor the child as these barriers can be easily removed by the child.

Taste-based deterrents. Apply bitter-tasting products to the child’s thumb as an immediate and often effective deterrent.

Orthodontic Strategies

Palatal crib is a dental appliance attached to the upper teeth. It prevents the thumb from comfortably resting against the roof of the mouth. Dentists often recommend the use of this appliance if the child’s thumb-sucking habit is causing dental issues.

Bluegrass appliance is designed to redirect thumb-sucking behaviour. It includes a roller or bead that the child can play with using their tongue, instead of sucking their thumb. Over time, this can help break the habit.

Quad-helix with crib attachment is recommended for more severe dental complications arising from prolonged thumb-sucking. This device corrects dental misalignments while curbing the thumb-sucking habit.

A Consultant Urologist Talks about Kidney Stones & How They Affect Children & Younger Adults

WORDS DR GOH ENG HONG

FEATURED EXPERT
DR GOH ENG HONG
Consultant Urologist
Prince Court Medical Centre

Kidney stones are formations that develop in the kidney.

The process of stone formation often begins with a blood flow issue. Such issue causes a small crystal to start to grow and eventually transforms into a stone—a kidney stone.

Kidney stones. Click on the image for a larger, clearer version.

There are typically a few types of kidney stones, with calcium stones being the most prevalent.

NOW, HOW DO THESE STONES FORM IN THE URINARY TRACT?

There are several factors contributing to their formation.

  • Structural abnormalities along the kidney tract.
  • A malfunction in the body, leading to a higher risk of stone formation in the urine.
  • Lifestyle choices.
  • It’s essential to consider the presence of other concurrent medical conditions. For instance, diabetes and cholesterol can contribute to stone formation as well.
KIDNEY STONES ARE INCREASINGLY MORE COMMONLY DIAGNOSED AMONG YOUNGER PEOPLE?

I can’t provide an exact prevalence, but it’s evident that kidney stones are becoming more frequently diagnosed in young people, especially young women.

There are several reasons contributing to this trend.

  • Improved medical care leads to more regular check-ups that detect the presence of kidney stones.
  • Modern lifestyle, characterized by the consumption of fast and convenient foods. Such processed foods tend to be high in salt content, a known risk factor for stone formation. Moreover, sugary beverages, processed drinks, and excessive sugar consumption also contribute to the risk of stone formation.

In the case of young women, several additional factors may play a role.

  • Many of them desire to maintain a lower body weight, which leads them to adopt special diets that may lack proper balance. This imbalanced diet can contribute to stone formation.
  • Their busy lifestyles and work commitments may result in reduced water intake and holding in of urine for extended period of time (finding a restroom can become inconvenient). This inadequate hydration can also lead to stone formation.
OTHER INTERESTING POSSIBLE RISK FACTORS OF KIDNEY STONES AMONG YOUNGER PEOPLE
  • Climate change. Rising temperatures lead to increased dehydration. While outdoor activities and games are encouraged, inadequate water intake during these activities can contribute to stone formation.
  • Antibiotic misuse. The direct role of antibiotics in the formation of kidney stones remain uncertain. They may affect the formation of kidney stones indirectly, probably by causing issues related to nutritional absorption in the gut.
SYMPTOMS OF KIDNEY STONES

Kidney stones can present in various scenarios. For instance, some patients may exhibit symptoms like pain, bleeding, or fever when the stone obstructs the urinary tract, causing an infection.

Alternatively, kidney stones may be detected early in some fortunate cases, while these stones are still small, and hence there are no significant issues.

So, the manifestations of symptoms of kidney stones can vary.

POTENTIAL CONSEQUENCES AND COMPLICATIONS OF UNTREATED KIDNEY STONES

The stone might not cause any significant issues to the person’s quality of life if it is quite small.

However, the kidney stone may block the ureter—the passage in which urine is expelled from the body—creating a ‘traffic jam’ that leads to kidney swelling.

If left untreated, this blockage can lead to pain, infections and even kidney failure.

KIDNEY STONES MAY COME BACK OR RECUR IF ONE’S DIET IS NOT PROPERLY MANAGED

While water intake is often emphasized in relation to kidney stones, it is essential to consider other factors as well, such as salt and sugar intake.

Without proper diet management, there is a high chance of recurrence of 50% in 5 years, with some patients experiencing kidney stone formation again only 5 years after their initial operation.

This is also true for children. There is always a risk of kidney stone recurrence, especially if their diet is not properly managed.

Additionally, if a child has any structural or functional body issues that have not been adequately addressed by the doctor, it can also contribute to recurrent kidney stones.

HENCE, SPECIAL ATTENTION IS NEEDED FOR CHILDREN THAT HAVE EXPERIENCED KIDNEY STONES

They should undergo thorough medical assessments to rule out any body structural defects or functional problems that could lead to stone formation.

Proper management and monitoring are also essential.

TIPS TO REDUCE THE RISK OF KIDNEY STONE FORMATION
  • Adopt a healthy lifestyle. This is crucial. It involves maintaining a balanced diet, controlling one’s body weight, engaging in regular exercise, and managing blood sugar and cholesterol levels.
  • Drink an adequate amount of water daily as it helps in both hydrating the body and flushing out stones.
  • Avoid or limit foods that are high in sugars and salt.

The Haze Is Back, and Here’s How You Can Protect Your Lungs

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KOW KEN SIONG
Respiratory, Internal Medicine, and Interventional Pulmonology Consultant
Sunway Medical Centre
WHAT, THE HAZE IS BACK?
  • The API readings for September 2023 showed alarming levels of fine particulate matter.
  • Experts predicted that the haze would persist until October.
  • Dry and monsoon seasons will further increase the risk of forest fires and haze during this period.
WHY SHOULD YOU BE CONCERNED?

Dr Kow Ken Siong tells us: “Fine particulate matters in the haze less than 2.5 microns in diameter, though often short-term, can leave a lasting impact, especially when inhaled.”

  • Short-term exposure can result in acute bronchitis symptoms like cough, phlegm, chest tightness, breathlessness, and lethargy.
  • Long term or chronic exposure can lead to respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and lung cancer.
  • Air pollution, including haze, is linked to premature deaths, infections and various diseases, with chronic respiratory illnesses ranked the third-leading cause of death globally in 2019.
  • In Malaysia, nearly 20% of hospitalizations in government hospitals and over 12% in private hospitals are due to the abovementioned respiratory diseases!

He adds that:

  • Vulnerable groups such as children, the elderly, and those with pre-existing conditions (such as asthma and cardiovascular diseases) face higher risks of worsening pre-existing chronic lung conditions, increased the risk of lung cancer, and frequent bronchitis episodes.
  • Individuals without prior health issues may develop upper respiratory symptoms and become more susceptible to viral infections.
DR KOW’S TIPS TO PROTECT YOURSELF AGAINST THE HAZE
  • Staying indoors as much as possible, especially in areas where the air pollution index is unhealthy.
  • Keep doors and windows closed to prevent indoor air pollution.
  • Use high-quality air purifiers with high efficiency particulate air (HEPA) filters, especially when natural ventilation is limited.
  • Use N95 masks for prolonged outdoor exposure, to filter out potentially harmful fine particulate matter that may be harmful.
  • Stay hydrated throughout the day.
  • Stay informed and seek medical advice. Monitor air quality through official sources, limit outdoor activities during the haze, and seek professional medical advice if experiencing lung or heart symptoms.
  • Self-medication, particularly with inhalers, is discouraged as it may lead to unwanted side effects.

Guys, Worried That You’re Shooting Blanks? Here’s Some Advice from a Fertility Specialist!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR EESON SINTHAMONEY
Fertility Specialist
Director of Sunfert International Fertility Centre

According to Dr Eeson Sinthamoney, there are various possible reasons why a man’s fertility can be affected.

“Male infertility can be attributed to various biological factors, including genetic abnormalities, hormonal imbalances, anatomical issues, and underlying medical conditions,” he says.

He adds that lifestyle choices such as smoking, excessive alcohol consumption, and poor diet can also negatively affect a man’s fertility.

“While body weight does not primarily affect infertility in men, activities such as engaging in frequent and long bicycle rides can have an impact,” he further states.

HOW CAN A MAN BE SURE THAT HE IS SHOOTING BLANKS?

“A simple sperm test serves as the initial step in assessing sperm count and overall fertility health,” says Dr Eeson.

Once the test reveals that the man has infertility issues, the fertility specialist will investigate potential underlying issues that could be the cause of these issues, such as hormonal imbalances, genetic factors, and semen parameters.

“This thorough examination enables personalized treatment approaches tailored to address the unique factors affecting male fertility,” Dr Eeson assures us.

GENETIC TESTING CAN HELP DIAGNOSE SEVERE MALE INFERTILITY?

According to Dr Eeson, genetic testing allows the analysis of an individual’s genetic material, such as DNA or chromosomes, to identify any genetic abnormalities that can contribute to infertility.

For such testing, the doctor will obtain blood sample from the man and send it to the laboratory for further analysis.

A genetic counselor will then explain the results once they are available.

Consult a fertility specialist if you and your partner have been trying to conceive a child through normal sexual intercourse but are unsuccessful after 6 months to 1 year of trying. They can help identify possible causes that are keeping you from achieving your dreams of parenthood, as well as to share fertility treatment options that can help you become a parent.

A Haematologist Explains Why You Should Consider Donating Your Blood

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HO KIM WAH
Consultant Haematologist and Transplant Physician
Sunway Medical Centre
BLOOD DONATION SAVES LIVES

Blood transports oxygen and nutrients to the cells in every nook and corner of your body and carries waste products away from these cells for elimination.

While this seems like a simple statement, its importance cannot be understated. Your body cannot function properly when there is not enough blood in your body to perform its life-sustaining function.

“That is why blood donation is extremely crucial, especially for those born with hereditary blood disorders or have contracted blood cancers that prevent their bone marrow from producing healthy blood cells naturally,” says Dr Ho Kim Wah.

ARE THERE RISKS OF DONATING BLOOD?

According to Dr Ho, the risk of donating blood is fairly minimal as long as the donor fulfills the qualification to become a blood donor.

You can be a blood donor if you:

  • Meet the age criteria (between 17 and 60 years old).
  • Aren’t fasting.
  • Are within your ideal body weight range.
  • Have had more than 5 hours of sleep before donating blood.
  • Are physically and mentally sound.
  • Have no chronic diseases.

There may be other criteria, but don’t worry. You will be first examined by a medical officer to determine whether you are eligible to donate blood. You can also take the opportunity to ask the medical officer about any concerns you may have.

IS BLOOD DONATION A TAXING PROCEDURE?

Not particularly. The entire process of blood donation takes only about 30 minutes or so.

Dr Ho points out that after donating your blood, you will be advised to rest for at least 10 minutes.

You should have some light refreshments and to drink plenty of water in the meantime.

You should also avoid strenuous activities in the first 24 hours after blood donation, to avoid unpredictable fainting spells that can occur as a result of these activities.

“In any case, if you develop symptoms such as fever, chills, rigours, chest pain, sweatiness, itchiness, breathlessness, or any sense of uneasiness, you should notify the nurses or doctors immediately,” advises Dr Ho.

NO, THESE WOULD NOT HAPPEN IF YOU DONATE YOUR BLOOD!

Reduce your lifespan. No, this won’t happen.

Damage your internal organs. That’s not true.

Contract infections. Stringent measures are taken to avoid this.

Have your blood discarded and hence wasted when the blood bank has too much blood stored. Any surplus in a blood bank is transported to areas that are in need of such blood.

1 BAG OF DONATED BLOOD WILL SAVE 3 LIVES

“Take a stand and save a life,” Dr Ho urges.

To donate blood, you can visit the National Blood Centre at Jalan Tun Razak, Kuala Lumpur or the state hospital nearest to you. You can also keep an eye out for mobile blood donation programmes visiting your neighbourhood from time to time.

How CEO Patricia Tan Took Her First Step to a 1,000-Mile Journey

WORDS PATRICIA TAN

FEATURED EXPERT
PATRICIA TAN
Chief Executive Officer
SCORE Sports Management
www.score.my

‘My fitness journey’, ‘my transformation’, ‘exercise challenge’—the road to the finish line always already sounds daunting, even before we can start.

While fitness is by no means a short-term journey, I have learnt over the years that it never has to be limited to the physicality, and it certainly doesn’t have to be difficult to start.

As a matter of fact, as the saying goes, it actually all begins with that first, single step.

MY FIRST STEP WAS TAKEN 10 YEARS AGO AFTER A LONG DAY AT WORK

I wanted to shake off the monotony of the day and made a spontaneous decision that set my life on a new path for good.

I went for a short run around my neighbourhood and returned feeling refreshed, rejuvenated, and more energized than I had been in a long time.

As it became part of my daily routine, I grew to love the physical benefits of consistent running.

Enhanced overall health and mobility. A strengthened cardiovascular system. The undeniable benefits of weight management. Eradicating the troublesome ailments that are often entangled with excess weight.

These tangible perks may have been the factors that first motivated me, but what has kept me here is something else entirely: it was the realization that running goes far, far beyond the physical.

What running is really, truly about is the benefits less commonly discussed, the mental and personal fortitude that carries over into almost every other area in life.

WIN AT RESILIENCE, DISCIPLINE & DEDICATION

Even small, incremental changes like more balanced meals or more leg days is an experience that ultimately homes in on discipline, focus, and perseverance.

As we consistently build these habits and regimes, the brain subconsciously taps into them to overcome other mental hang-ups in both our personal and professional lives.

The end result? It becomes much easier to stick to what it takes to achieve a goal—even if it’s something that was difficult to imagine previously!

CELEBRATE THE SMALL VICTORIES FOR YOU & YOUR CONFIDENCE

Crossing the finish line for a run is one thing and may be the easiest to focus on.

However, it is the process that truly does wonders for a personal sense of accomplishment.

It often lies hidden in the ‘sub’-achievements like managing to run a longer distance than at the beginning, or even no longer aching as much as before!

Everything comes together in a big boost for the self-esteem, a sense of pride and satisfaction, and most importantly, the motivation to tackle other challenges in life with the understanding that even a small win along the way deserves to be celebrated.

STERLING CONVERSATION STARTER & COMMUNITY CONNECTION

Just as much as running helps get us into shape, it is also a community favourite in its own way.

Being an accessible (and relatively free) form of exercise, it attracts people from all walks of life. A daily run can quickly turn into a space to meet and connect with like-minded individuals — and not just within running circles either! Sharing an interest in or goals for running can be a great ice-breaker in both personal and professional spaces.

IT’S BEEN A LONG JOURNEY, AND I WILL KEEP GOING

It’s been more than 10 years since my journey as a runner began, and it has been one which has impacted me for the better.

As we celebrate a decade of working towards a healthier, more holistic Malaysia, it is also an opportunity to look back on the process, which is something running has taught me.

My experience from a beginner to now an annual runner has bled into my enthusiasm at work as well. It shapes my many initiatives to go beyond running, to also involve other sports that contribute towards scalable fitness journeys like yoga and badminton.

Yet, no matter how far we go, running is still where our heart lies. Recognizing and nurturing the potential of running can go a long way to helping Malaysia harness its power to enhance society’s well-being and progress in body, in mind, and in the confidence that shines through every aspect of their life.

All we need to do is take that first step.

Travelling for Work or Holiday? These Tips Will Help You Stay Strong and Motivated!

WORDS WAI HOONG

FEATURED EXPERT
WAI HOONG
Fitness Coach
linktr.ee/waihoong
Tip 1
PACK LIGHTWEIGHT GEARS

Bring along a foam roller and suspension trainer. Both are lightweight equipment, versatile, and easy to pack.

You could easily hook the suspension trainer over your hotel door and attempt a variety of movements within a minimum space.

The foam roller is a lifesaver to release tight muscles particularly the hips, quads calves and back from all the walking.

Tip 2
SET 15 MINUTES ASIDE FOR A WORKOUT

Attempt a circuit training which covers the whole body.

Here’s an example.

  1. First, do 10 pushups.
  2. Next, do 10 squats.
  3. Then, do 10 burpees.

Repeat steps 1 to 3 twice or three times.

You can also include bodyweight exercises, can be attempted anywhere such as your hotel room, the hotel gym, outdoors, etc.

Examples of the different types of exercises that you should incorporate into your daily workout. Click for larger, clearer version.
Tip 3
AIM FOR 3 SESSIONS A WEEK

Always listen to your body whether to do a gentle stretch and foam roll or attempt a circuit workout.

Just a few days of workout keep you sharp and motivated as well as help you remain in the balanced healthy lifestyle zone.

Tip 4
GET ACTIVE WHENEVER YOU CAN

Plan activities that involve lots of physical movements.

Walk or bike instead of taking the bus. Use the stairs instead of taking the lift.

There are no limits to staying fit outside the gym box!

If you happened to be sore and tired from all the walking, take a break and stretch. This is also a good reason to get a full body massage which also helps to improve blood circulation and release muscle tension of the body.

Tip 5
EAT BALANCED MEALS

You can still splurge and continue to choose wholesome food everywhere you go.

Since you would be outdoors most of the day, it’s alright to enjoy some desserts and local delicacies.

Eating healthy isn’t always broccoli and chicken breast. Most delicacies in Asian countries are healthy and balanced. For example, if you are in the mood for Thai food, there are tom yam goong and khao man gai. If you crave Vietnamese food, try their spring rolls and salads.

Tip 6
STAY HYDRATED

Travelling can be physically demanding especially in a different new environment and weather conditions.

Always carry a water bottle with you and drink regularly.

If you get cramps easily, get hydration salt or electrolytes at pharmacies.

Here’s Why You Really Should NOT Extreme Diet & Severely Restrict Your Calories

WORDS LIE JIE YEE

FEATURED EXPERT
LEE JIE YEE
Dietitian and Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Over-restricting calories has become a concerning weight-loss trend in today’s society, driven by the impact of social media and influencers.

These influencers on social media promise a speedy weight loss by extreme dieting and severely restricting the amounts of calories consumed. These extreme strategies usually lure people who want to lose weight quickly to achieve their desired body shape.

But do these strategies really deliver the magical results you once believed in?

3 REASONS WHY EATING TOO FEW CALORIES CAN UNDERMINE YOUE EFFORTS TO LOSE WEIGHT
Reason 1
THE YOYO EFFECT

A successful weight loss is defined as when an individual voluntarily loses weight and keeps the weight loss for 1 year or more.

Unfortunately, most individuals fail to maintain their weight due to the yoyo effect.

Like the toy that inspires its name, the yoyo effect is a kind of weight loss phenomenon that goes up and down just like a yoyo.

Imagine that a long holiday is approaching. You think, “Beach vacay, I should get in shape!” You start a new diet, and the weight starts to come off.

But then, you get tired of the restrictive diet and bounce back to your old eating habits: desserts, fried foods, snacks…

Eventually, the kilos that you have lost start to creep back on, and you’re back where you started. You struggle to fit into your pants and decide to diet again.

This, the yoyo effect, is like a rollercoaster for your weight, but not a fun one.

Reason 2
YOUR BODY’S METABOLIC RATE GOES LOWER

Extremely cutting down on calories is basically subjecting your body to a starvation state.

Starvation is essentially a prolonged deprivation of nutrition—a state that our bodies naturally perceive as an existential threat to our survival.

To ensure that the body’s energy storage is used efficiently, the body will slow down its metabolism rate.

A lowered metabolism also delays other processes such as fatty acid oxidation, which makes weight loss harder.

Reason 3
YOUR MUSCLES BREAK DOWN AND YOUR HORMONES ARE AFFECTED TOO!

While people aiming for weight loss usually strive to increase muscle mass and reduce fat, this aftermath might not be appealing to you.

Similar to the mechanism above, our body needs to provide sufficient energy for survival during starvation.

Therefore, when the glucose reservoir is depleted, this is where our muscles start to break down to provide us with the energy we need.

This could lead to severe muscle loss as well as hormonal changes, which could affect our mood or menstrual cycle.

SO, WHAT SHOULD YOU DO INSTEAD TO LOSE WEIGHT?

It is important to keep in mind that a long-term weight loss journey should be slow, steady, and determined.

A reasonable calorie deficit targeting 500 to 1,000 kcal would allow one to lose 0.5 to 1 kg per week.

Do seek advice from a nutritionist or dietitian for an effective and personalized weight loss regime.

References:

  1. Contreras, R. E., Schriever, S. C., & Pfluger, P. T. (2019). Physiological and epigenetic features of yoyo dieting and weight control. Frontiers in genetics, 10, 1015. https://doi.org/10.3389/fgene.2019.01015
  2. Farhana, A., & Rehman, A. (2023). Metabolic consequences of weight reduction. In StatPearls. StatPearls Publishing.
  3. Olson, B., Marks, D. L., & Grossberg, A. J. (2020). Diverging metabolic programmes and behaviours during states of starvation, protein malnutrition, and cachexia. Journal of cachexia, sarcopenia and muscle, 11(6), 1429–1446. https://doi.org/10.1002/jcsm.12630

Getting the Timing Right: Sleep and Meal Strategies for Weight Management

WORDS VOON SUK CHEN & DR FATIN HANANI MAZRI

FEATURED EXPERTS

VOON SUK CHEN
Nutritionist and Student of Master’s in Clinical Nutrition
Universiti Kebangsaan Malaysia (UKM)
DR FATIN HANANI MAZRI
Lecturer of Dietetic Programme
School of Healthcare Sciences
Universiti Kebangsaan Malaysia (UKM)

When it comes to managing one’s weight, most people tend to think about watching their calories. But do you know that the timing of your sleep and meals is just as important?

Your body follow a natural rhythm that controls all sorts of stuff happening inside you. It’s time to uncover the secrets of your body clock and how they can help you keep your weight in check.

WHY TIMING MATTERS

Have you ever wondered why you consistently feel sleepy as night approaches and your stomach starts growling around the same time each day?

It’s all thanks to your body’s internal clock, known as circadian rhythm.

Our internal clock

The term ‘circadian’ originates from ‘circa’ meaning ‘cycle’ and ‘diem’ meaning ‘day.

It represents the daily oscillation of various molecular, physiological and behavioural processes, including the sleep-wake cycle.

This helps to induce and promote sleep, ensuring that your sleep patterns align with the 24-hour day-night cycle.

How does the internal clock work?

Your internal body clock synchronizes with the day-night cycle through light signals.

During the day, it receives light signals, like sunlight, through retina receptors in your eyes. This stimulates metabolism and physiological processes that promote wakefulness.

As night falls, the body clock detects weaker light stimuli, triggering night-time activities and inducing sleepiness, aided by the release of melatonin.

By aligning your circadian rhythms with the day-night cycle, your internal clock ensures sufficient rest for daytime productivity.

How the internal clock affects our eating-fasting cycle

The eating-fasting cycle is also orchestrated by the internal body clock.

During the daytime, digestive system is optimized for efficient nutrient absorption and energy utilization, while hunger hormones are regulated to promote appetite and energy intake.

Whereas at night, your physiology is geared towards rest, and your digestive system slows down.

Ideally, based on the internal clock, you are meant to be physically active and eating during the day, and sleeping and fasting at night.

However, your internal body clock cycle can be disrupted by erratic 24-hour day-night activities, such as:

  • The modernization of our lives.
  • Exposure to artificial light around the clock.
  • High calorie food being accessible 24-hours.

This disruption can have adverse effects on your efforts to maintain our health, which includes weight management.

THE LINK BETWEEN THE TIMING OF OUR SLEEP & EATING AND OBESITY

Sleep-wake and eating-fasting cycles are 2 vital physiological and behavioural activities that are regulated by internal body clock, and they influence one another.

Staying up late can lead to late-night snacks and weight gain

Eating closer to bedtime, when your internal body clock is telling us that it’s rest time, it can mess with the normal rhythm of internal body clock and eventually promote weight gain.

Picture this: you had dinner at 7.00 pm, and you’re still awake at 1.00 am. That’s a long stretch to feel hungry and be tempted to snack. Staying up late gives you a large window of opportunity to eat, especially if there’s a big gap until bedtime.

Those late-night munchies can easily lead to unwanted weight gain.

Eating 2 to 3 hours before bedtime can lead to weight gain

Your internal body clock will stimulate the production of melatonin, a hormone that make you feel sleepy, 2 to 3 hours prior to usual bedtime.

Eating close to the onset of melatonin production has been associated with insulin resistance as well as greater body fat percent and waist circumference.

Eating more later in the day can lead to more weight gain

Several studies reported that your body burns less calorie (diet-induced thermogenesis, DIT) during dinner compared to breakfast.

The decrease in DIT reflects a reduction in energy expenditure from digestion, absorption, and metabolism of the nutrients ingested.

Therefore, if you eat more of calories towards later in the day, you are more likely to gain more weight compared to those that eat earlier in the day.

Lack of sleep can make us hungry and eat more than we should

Not getting enough sleep due to late sleep can mess with important hunger hormones like leptin and ghrelin, which can leave you feeling hungrier and more likely to overeat.

On top of that, it affects your brain’s ability to make healthy choices and control cravings.

Studies have shown that sleep-deprived individuals have poor food choices, and they tend to go for high calorie and unhealthy foods.

5 WAYS TO ALIGN YOUR BEHAVIOURS WITH YOUR INTERNAL CLOCK & OPTIMIZE YOUR WEIGHT MANAGEMENT EFFORTS 
  1. Sleep early. Don’t let late nights tempt you into reaching for those late-night snacks. Aim for an early bedtime, ideally aligning with the natural day-night cycle.
  2. Have an adequate amount of sleep. The National Sleep Foundation and the Sleep Health Foundation recommend 7 to 9 hours of sleep for adults.
  3. Maintain a consistent sleep schedule. Stick to a routine, even on weekends, to keep your circadian rhythm on track and promote better sleep quality.
  4. Have regular meals and avoid late-night eating. Establish regular mealtimes and try to avoid eating close to bedtime. Give yourself at least a three-hour gap between your last meal and sleep.
  5. Eat more calories earlier in the day. Follow the age-old wisdom of “eat breakfast like a king, lunch like a prince, and dine like a pauper.” Focus on consuming a substantial portion of your daily caloric intake during breakfast and lunch.

Aligning your sleep and eating patterns with circadian rhythms is important for effective weight management. So, the next time you find yourself struggling with your weight, remember that it’s not just about calories.

Take a moment to listen to your body’s natural rhythm, prioritize adequate and quality sleep, stick to consistent sleep and meal schedules, and avoid late-night eating.

These small adjustments can help maintain a healthy weight and achieve a healthier you. Your body and waistline will thank you for it!

References:

  1. Al Khatib, H. K., Harding, S. V., Darzi, J., & Pot, G. K. (2017). The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. European journal of clinical nutrition, 71(5), 614–624. https://doi.org/10.1038/ejcn.2016.201
  2. Bacaro, V., Ballesio, A., Cerolini, S., Vacca, M., Poggiogalle, E., Donini, L. M., Lucidi, F., & Lombardo, C. (2020). Sleep duration and obesity in adulthood: An updated systematic review and meta-analysis. Obesity research & clinical practice, 14(4), 301–309. https://doi.org/10.1016/j.orcp.2020.03.004
  3. Boege, H. L., Bhatti, M. Z., & St-Onge, M. P. (2021). Circadian rhythms and meal timing: impact on energy balance and body weight. Current opinion in biotechnology, 70, 1–6. https://doi.org/10.1016/j.copbio.2020.08.009
  4. Chaput, J. P., McHill, A. W., Cox, R. C., Broussard, J. L., Dutil, C., da Costa, B. G. G., Sampasa-Kanyinga, H., & Wright, K. P., Jr (2023). The role of insufficient sleep and circadian misalignment in obesity. Nature reviews. Endocrinology, 19(2), 82–97. https://doi.org/10.1038/s41574-022-00747-7
  5. Dashti, H. S., Gómez-Abellán, P., Qian, J., Esteban, A., Morales, E., Scheer, F. A. J. L., & Garaulet, M. (2021). Late eating is associated with cardiometabolic risk traits, obesogenic behaviors, and impaired weight loss. The American journal of clinical nutrition, 113(1), 154–161. https://doi.org/10.1093/ajcn/nqaa264
  6. Mazri, F. H., Manaf, Z. A., Shahar, S., Mat Ludin, A. F., & Abdul Basir, S. M. (2022). Development and evaluation of integrated chrono-nutrition weight reduction program among overweight/obese with morning and evening chronotypes. International journal of environmental research and public health, 19(8), 4469. https://doi.org/10.3390/ijerph19084469
  7. Richter, J., Herzog, N., Janka, S., Baumann, T., Kistenmacher, A., & Oltmanns, K. M. (2020). Twice as high diet-induced thermogenesis after breakfast vs dinner on high-calorie as well as low-calorie meals. The Journal of clinical endocrinology and metabolism, 105(3), dgz311. https://doi.org/10.1210/clinem/dgz311

You Aren’t Alone When It Comes to Infertility, Experts Say, So Here’s What You Can Do About It

WORDS DR KHINE PWINT PHYU & ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN

FEATURED EXPERTS

DR KHINE PWINT PHYU
Senior Lecturer in Obstetrics and Gynaecology
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN
Head of School
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
THE INCIDENCE OF INFERTILITY IS ON AN UPWARD TREND WORLDWIDE
  • Infertility is defined as not being able to conceive after 1 year of unprotected sexual intercourse.
  • In women above 35, this duration is sometimes shortened to 6 months.
  • The World Health Organization estimates that 1 in 6 people are affected by infertility.
  • In Malaysia, there is a drop in fertility rates from 4.9 children per woman of childbearing age in 1970 to 1.7 in 2021.
CAUSES ARE VARIED, INVOLVING ISSUES IN EITHER PARTNER OR BOTH AND IN SOME CASES, THE CAUSES ARE DIFFICULT TO IDENTIFY

Female factors of infertility

  • Anovulation, or ovulation disorders, are situations where no eggs are released from the ovaries during the menstrual cycle. These disorders can be caused by:
    • Hormonal imbalances such as seen in polycystic ovary syndrome (PCOS) and excessive prolactin secretion.
    • Eating disorders.
    • Extremes of body weight.
    • Strenuous exercises.
    • Stress.
    • Chronic illnesses.
  • Blockage of fallopian tubes, caused by previous pelvic infections, inflammation of tubes, and pelvic adhesions which may be related to past surgery at the abdomen and pelvis. When the tubes are blocked, it will affect the transport of sperm to meet the eggs to achieve successful implantation and pregnancy.
  • Endometriosis, which is the presence of tissue that is normally found in the inner lining of the uterus, outside the uterine cavity, which may affect the function of the ovaries, uterus, and fallopian tubes.
  • Congenital abnormalities (malformations that develop before birth) of the uterus.
  • Uterine fibroids (non-cancerous growths which develop in and around the womb).

Male factors of infertility

  • Low sperm count, which can be seen in men with genetic defects, chronic health problems such as diabetes, liver or kidney diseases, or sexually transmitted infections like gonorrhoea. Abnormalities such as undescended testis and varicoceles (swollen veins within the scrotum) can also be causes.
  • Premature ejaculation.
  • Blockage or injury to the reproductive organs.
  • Usage of certain medications can affect sperm movement, quality, or lead to coital dysfunction.
  • Environmental and lifestyle factors such as use of tobacco, heavy alcohol, marijuana or steroids, exposure to toxins and exposure of the external genitalia to high temperatures.
BOTH PARTNERS NEED TO BE INVOLVED WHEN IT COMES TO FERTILITY TREATMENT

To support health education and increase awareness regarding numerous infertility issues faced by couples across the globe, World Infertility Awareness Month is observed every year in June. Many couples are not even aware they are infertile; hence this month serves to alert them of issues that may affect them as well as their available solutions.

While the causes of infertility are varied and can affect both partners, the burden and stigma are often shouldered by the female partner. In our part of the world, both issues are particularly pronounced.

Couples with fertility issues should therefore see a doctor in a timely manner to receive a proper assessment and effective treatment. As age is an important factor in conceiving, early medical intervention often leads to positive outcomes in a couple’s fertility journey.

Both partners should be involved in fertility consultation and management. The primary issues to address include if the woman is ovulating regularly, if the sperm cells in semen are healthy, if there are coital issues and any problems with fertilization and implantation, and if the woman is able to maintain the pregnancy.

To answer these questions, thorough evaluation should be done through taking a detailed medical and personal history, sexual history and performing a physical examination for both partners. The next steps would then be to test the couple with baseline investigations as well as specific evaluations.

Some common assessments include tests to ensure the fallopian tubes are patent (open and lacking blockage), tests to confirm ovulation, sperm counts, and ultrasound to look for abnormalities in the uterus, fallopian tubes, and ovaries.

MANAGING & TREATING INFERTILITY

Sometimes, simple lifestyle modification measures such as weight management, adequate exercise, cessation of smoking, and the limitation on alcohol consumption can solve infertility.

As for natural methods, frequency of sexual intercourse can be an issue and it is recommended that at least 3 times a week increases the probability of conceiving.

Timed intercourse during a women’s fertile period may be a strategy as well. Women usually ovulate about 12 to 14 days before the start of a next menstrual cycle and the fertile period is the five days before ovulation, the day of ovulation, and the day after ovulation.

The treatment for fertility issues depends on the cause. For women who experience problems with ovulation, medications to induce ovulation may be employed. As for women with endometriosis, fibroids, or other tubal diseases, surgery may also improve outcomes. For men, prescribing medications to improve sperm quality may help and surgery may be employed for men with structural abnormalities in their reproductive system.

When more simple methods are not successful, more complex procedures may be employed such as intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI). For couples with unexplained infertility, increasing coital frequency in combination with IUI often results in successful pregnancies.

References:

  1. Ferlin, A., Raicu, F., Gatta, V., Zuccarello, D., Palka, G., & Foresta, C. (2007). Male infertility: role of genetic background. Reproductive biomedicine online, 14(6), 734–745. https://doi.org/10.1016/s1472-6483(10)60677-3
  2. Lipshultz, L. I., Howards, S. S., & Niederberger, C. (2009). Infertility in the male (4th ed.). Cambridge University Press. http://dlib.sbmu.ac.ir/site/catalogue/134959
  3. Krausz C. (2011). Male infertility: pathogenesis and clinical diagnosis. Best practice & research. Clinical endocrinology & metabolism, 25(2), 271–285. https://doi.org/10.1016/j.beem.2010.08.006
  4. Poongothai, J., Gopenath, T. S., & Manonayaki, S. (2009). Genetics of human male infertility. Singapore medical journal, 50(4), 336–347.