Malaysia is facing an obesity crisis - ranked top of the list in Southeast Asia. But hope is on the horizon.
In this Life & Style Podcast episode, we sit down with general surgeon Dr Shukri Jahit who has transformed countless lives through bariatric surgery and celebrity chef and entrepreneur, Datuk Zamzani Abdul Wahab (Chef Zam) who underwent bariatric surgery 15 years ago.
Together, they explore the medical, personal and culinary dimensions of battling obesity, from the science behind surgery to the inspiring human journey of transformation.
This isn’t just about weight loss, it’s about fighting for a healthier, longer and more fulfilling life.
Watch on Sinar Daily now!
#LifeandStylePodcast #ObesityCrisis #BariatricSurgery #HealthMatters #MalaysiaHealth #FightObesity #ChefZam #DrShukriJahit #SinarDaily
In this Life & Style Podcast episode, we sit down with general surgeon Dr Shukri Jahit who has transformed countless lives through bariatric surgery and celebrity chef and entrepreneur, Datuk Zamzani Abdul Wahab (Chef Zam) who underwent bariatric surgery 15 years ago.
Together, they explore the medical, personal and culinary dimensions of battling obesity, from the science behind surgery to the inspiring human journey of transformation.
This isn’t just about weight loss, it’s about fighting for a healthier, longer and more fulfilling life.
Watch on Sinar Daily now!
#LifeandStylePodcast #ObesityCrisis #BariatricSurgery #HealthMatters #MalaysiaHealth #FightObesity #ChefZam #DrShukriJahit #SinarDaily
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LifestyleTranscript
00:00Malaysia on the rise, bathing obesity with bariatric surgery.
00:04Assalamualaikum and a very good afternoon.
00:06Warm welcome to all the Sina Dili Life and Star podcast listeners and viewers.
00:11Together you are with me Dr. Nurhamidzah Zulkifli as your moderator
00:15to discuss on the topic of obesity and also bariatric surgery.
00:19This month as we celebrate Merdeka Day, the month of August
00:23and we are so blessed that we are living in a country in a nation
00:27which is known as a truly is a heaven for the food.
00:32At the same time, it is a melting pot of cuisines and also cultures.
00:37But we also have to pause and ponder to reflect of an important health challenges
00:42associated with our eating habits.
00:44As we reflect back in 2023 when National Health Screening Initiative was done
00:50which revealed that more than half of the Malaysian screen
00:54which is about 53.5% is either they are obese or they are overweight
00:59where the overweight population, the percentage were about 31%
01:04and the obese population were about 22% which is very, very significantly high.
01:10So sadly, because of this, Malaysia now ranks as the number one country in South East Asia
01:17which is not good at all, Malaysians.
01:21Obesity is no longer just about appearance
01:24but it is also associated and also linked with serious conditions such as heart diseases
01:32and also diabetes as well as also hypertension.
01:36And today we are blessed to have two distinguished panelists.
01:40I have a medical expert here on my left hand side
01:43this is Dr. Syukri Jahid, Muhammad Syukri Jahid
01:47he is a consultant upper gastrointestinal and also a consultant general surgeon
01:52from Institute Cancer Negara Pucu Jaya
01:55who has vast experience in biotric surgery.
01:58He is not only dealing with biotric surgery
02:01also he is an expert in dealing with upper gastrointestinal diseases as well
02:06including cancer.
02:08Other than doing surgery, he is also an expert in advising, giving nutritional advisors.
02:16He is the president of the Parental and Entral Nutrition Society of Malaysia, PENSMA
02:21and he is an executive board member of both the Parental and Entral Nutrition Society of Asia, PENSMA
02:28and ESPN PENSMA.
02:29Welcome to our podcast Dr. Syukri.
02:32Thank you Miza, thank you.
02:33And on my left hand most, I don't think he needs any further introduction.
02:39This is Professor Datuk Zam, Zamzani, which is also knownly famously known as Chef Zam.
02:48So he is a well-known culinary figure who underwent biotric surgery almost 15 years ago, right Chef?
02:53Almost that?
02:54I did it in 2007.
02:57Okay, okay, so it's been quite a long time.
03:0117, 18 years I think.
03:02Yes, and he has lost almost about 100 kilos if I'm not mistaken.
03:06Oh no, no.
03:07It's about that or 80 kilos?
03:09About 50.
03:1050 kilos.
03:10Okay, 50 kilos that he has lost and he has been able to maintain his weight until the present day today.
03:17Thank you so much Datuk for coming for, I mean for both of our panel.
03:21I know that Mr. Syukri has been operating for the past few days, every day except for today.
03:28So we are so blessed to have these two of our panels here.
03:31So without wasting any more time, we shall dive into this important topic.
03:36We'll kick off with Dr. Syukri first.
03:37I always start the conversation with the expert panel, expert medical panels.
03:41Okay, since Malaysia has stopped the chart being the number one for the highest obesity rate in Southeast Asia,
03:49maybe Dr. Syukri can expand the health risks associated with obesity.
03:52I mean beyond the just physical appearances, like we mentioned the metabolic diseases as well, hypertension, diabetes.
04:00And also maybe you could elaborate further from your perspective.
04:03What are the main driving factors of this?
04:06Is it just because of purely the high calorie intake that the Malaysians are taking our nasi lemah,
04:12our teh tarik, and also our roti canai?
04:16Or is there other contributing factors such as genetics, Malaysian genetics,
04:20or our sedentary lifestyle and lack of exercises?
04:24Well, thank you, Miza, once again for inviting me and Sina Harian for inviting me to this podcast.
04:29Well, that is a more full kind of question that you throw to me.
04:36Well, let me start from the very beginning.
04:39Okay, there are people who are lean, I wouldn't use the word skinny lah, okay, lean, but they are not healthy.
04:50Alright, there are also people who are obese, but they are healthy.
04:55So the question here, what makes us, you know, becoming unhealthy because of the diseases that is related to either obesity or other diseases?
05:06Particularly when we are talking about diabetes, hypertension, cholesterol, issues with cancer, certain cancer that is related to obesity.
05:15So all matters accounted to this problem is actually stemmed from the problem of inflammation that arises from the fat.
05:25Okay.
05:26So we have good fat, we have bad fats, okay?
05:29So these bad fats are the one that drives the inflammation, okay?
05:34that brings about all the issues with regards to obesity-related diseases as well as cancer.
05:43There are at least 8 to 10 cancer that is related to obesity, okay?
05:47So if you have, you know, a very bad kind of cholesterol or very bad fat in your body and this inflammation continue on, you know, day-to-day, months and on yearly basis and you do not do anything about that, okay?
06:04And you must also remember that year after year, we are also aging and you are losing your muscle.
06:10So your metabolic rate, your metabolic rate is going down, your inflammation is going up.
06:17So this will end up with all this, what we call as metabolic syndrome that comprises hypertension, diabetes, hypercholesterolemia and other associated issues.
06:29And if you ignore this, definitely it will affect the other organs like your heart, you might get, you know, heart failure, heart attack, you know, kidney problem.
06:40So, again, you know, try to answer your question just now, you know, why do we Malaysians, you know, with this kind of culture, eating culture, why do we have this issue of obesity being one of the problems that drive a lot of comorbis among Malaysians?
07:01It's that I wouldn't blame the food, okay?
07:06I would say it's the lifestyle, okay?
07:11Well, food is something that is for us to enjoy.
07:15You know, God gave us the ability to eat and ability to enjoy.
07:20We have all the senses, you know, when you see the food, you smell the food, you taste the food.
07:25These are kind of enjoyment.
07:26But the thing is, we do not eat in moderation and we do not burn, you know, the excess calories that we have taken in.
07:35And to couple with this problem, the environmental factors, you know, sedentary lifestyle, inactive.
07:43We spend a lot of time in the car because of the traffic congestion.
07:48We hardly walk, okay?
07:51What more to say if, you know, whether you exercise or not.
07:55So, it has to be a balance.
07:56It has to be a balance to maintain healthy lifestyle with diet as well as physical activity and exercise.
08:04Okay.
08:05So, basically, it's like the input and output.
08:08So, whatever that goes into your body and how much the expenses in terms of you, how much calorie has been burned.
08:15So, you have to have that to achieve a healthy, I would say, body weight and healthy lifestyle.
08:21You have to have that negative.
08:22So, you burn more than what you consume.
08:24Yep.
08:24Yep.
08:25All right.
08:26Okay.
08:26So, let's move on to Chef Zam.
08:29Okay.
08:29Would you just, could you just share your, how your life was prior to, before you underwent bariatric surgery?
08:36I mean, what was your turning point that, or your main motivation that drives you to actually embark in this pediatric surgery?
08:45All right.
08:45I have always been a heavy kid since I was 10 years old or so.
08:50And I saw, as I was growing up, and I tend to, maybe, it could also be because I was a victim of a bully when I was growing up.
09:00Oh, okay.
09:00From, from primary school, it went on to the secondary school.
09:07And I think, and also, I was the youngest in the family.
09:12There are two of us.
09:13I was the youngest in the family and a little bit pampered, maybe.
09:17Or it could also be an escape route.
09:22Escape route for me to get away from the elements of being bullied at school, not only by my fellow pupils, but also by teachers.
09:35Ah, so I ate, and I ate, and I ate, and there was no turning back.
09:40I remember when I, I think in, in secondary school, you know, we were reading, I remember I read this specific, this particular magazine, Remaja, if I'm not mistaken, by Karangkraf.
09:55If I'm not, yeah, if I'm not mistaken.
09:58And, um, it, there, there was a page, there was an article, uh, written about, uh, going on a diet to lose weight using, uh, a green apple.
10:10So, I cut it up, you know, I, I pasted it on the wall and tried to eat apple.
10:15Of course, it did not work lah.
10:19I mean, the influence from magazines and things like that, huh.
10:22Then after that, I kept on growing and growing and growing until, uh, there was a point that I thought, I wanted to lose weight.
10:31But one thing, and, and, uh, one thing, and needing, and whether or not you actually embark into doing it, it's two different things, kan?
10:42Yeah.
10:43So, um, I, I remember, I think when I was 15 years old, I was already 90, uh, 90 kilos.
10:50But I joined, um, aerobic classes at that time.
10:56But of course, that did not help lah.
10:57Because, like, like you, you mentioned just now, input and output, it has to be somewhat, input has to be less than the, I'm not sorry.
11:07Yeah, input has to be less than the output.
11:09You got to burn more in order for you to lose weight instead of just, you know, taking in more.
11:15Then, um, to cut the story short, I went to study in London.
11:19Then, uh, I, I, I, I, at that time, I was already, no, no, no, yes, it was in London.
11:26I was already 136 kilos, doctor.
11:30Uh, 136 kilos.
11:32I mean, when I was growing up, of course, everybody would say, oh, so cute and things like that.
11:37I mean, in a way, encouraging me to eat more, maybe, I don't know.
11:42Uh, but at the same time, I was having difficulties.
11:44Um, I was put on metaprolol for a few years and lipido for a few years.
11:50Um, then I said, well, it's time to find some alternatives instead of exercising.
11:57Because I did not exercise at all at that time.
12:00So, I googled.
12:02I googled and I found, uh, a new discovery at that time.
12:05It was in 2004, if I'm not mistaken.
12:09Ah, 2004.
12:11And there was something called, um, bariatric surgery.
12:15I am an extremist.
12:17When it comes to doing something, either, it's either I do it well or I don't do it at all.
12:23That's the, that's the kind of person I am.
12:26And the way I, I operate.
12:28So, but at that time, the cost was 5,000 pounds.
12:32That was in London.
12:33It was in London.
12:345,000 pounds.
12:36And of course, being a student, they have that much money lah kan.
12:40So, I, uh, I just buried the, the, the idea of having it done lah.
12:45So, I came back here and continued working.
12:47And there was one day that I thought, oh, that I remember the, the, the search that I did when I was, while I was in London.
12:54So, I, I googled it again.
12:57And it happened in, I'm sure you remember Professor, Dr. Jasmine Ali Yaakob.
13:02Hmm.
13:02So, I just went straight.
13:04No, no, no, no, no, no.
13:05It was Dr. Najeeha, a plastic surgeon in Hospital Besar Kuala Terengganu who referred me to Prof. Jasmine.
13:13Oh.
13:14Because I went back to Trongganu.
13:15I'm from Trongganu.
13:16I went back to Trongganu.
13:18I went and I, in a way, threatened her, please let me lose weight, help me to lose weight.
13:25Because I thought by doing laposuction, I would be able, you know, that was a wrong construction lah.
13:33I thought if she did laposuction on me, I would be able to lose weight and become normal again after so many umpteen years, kan.
13:43Well, she says that, that's impossible.
13:45Let me refer you to this doctor.
13:47Mm-hmm.
13:48At first, I was upset because she refused to do laposuction on me.
13:53Actually, she did me a big favour.
13:55So, I went to HUKM at that time.
13:58Prof. Jasmine was at HUKM.
14:00And, um, and that, the rest is history.
14:04Okay.
14:05Okay, okay, okay.
14:06But he presented to me, like, a few methods, if I'm not mistaken.
14:11But I chose the one with no point of return, which was the stomach stapling.
14:16Mm-hmm.
14:16Okay.
14:17I don't know if that is, if something new came out.
14:20Yeah.
14:20Which is more advanced, I'm sure, there are now.
14:22I did not do sleeve, I did not do balloon.
14:25I said, I want, because I, like I told you earlier, I am an extreme kind of person.
14:31If I were to do it, I'll do the, the most something that I cannot reverse.
14:36Okay.
14:36Because I know I love to eat.
14:38All right.
14:39It's like all or nothing, it's like that kind of thing.
14:41Yeah, it's all or nothing, really.
14:43Okay.
14:44You take the risk.
14:45I did.
14:46I did.
14:46I said, I'm not going to die.
14:47No, I don't care.
14:49No, you know what?
14:50I was teaching at KDU College at that time.
14:52Right.
14:52And I just went in one day.
14:55I just went in to HUKM.
14:58I checked myself in.
14:59I did not even tell anyone.
15:01And I did it the next day.
15:04I think that night, I texted my head of department.
15:08I said, I'm doing this.
15:10Are you crazy?
15:12Yeah, because at that time, I think the...
15:15It was almost unheard of.
15:17Yes, exactly.
15:18Yeah, nobody actually practiced that, especially in Malaysia.
15:21It's kind of like a new.
15:23I would just like to ask,
15:25Tushu Kee, is there still a stigma and misconception?
15:28When we talk about, when we talk about bariatric surgery,
15:31something, some people think that it's an easy way out.
15:34I mean, a short card.
15:35So what do you, I mean, how would you respond to this misconception?
15:38Oh, definitely, it's a big misconception.
15:44Because we live nowadays in a world of, you know, social medias.
15:50There's a lot of information that people can always google and search on the internet.
15:55And some are true ones, and majority are misleading.
16:00Okay.
16:01Now, when we talk about stigma and what they call this,
16:07whether this obesity is actually one problem,
16:12or is it a metabolic problem?
16:14Is it environmental problem?
16:15Is it because you overeat?
16:17It actually depends on individual.
16:19Not all people have the same metabolic endocrine and basal metabolic rate.
16:26Okay.
16:26So that's the reason why, when, in our practice,
16:30when I assess my bariatric cases,
16:34we would like to phenotype them.
16:36Phenotype means we will group them according to the type of the body,
16:41depending on the basal metabolic rate,
16:44the kind of fat they have and how good of the muscle that they have.
16:52Sometimes you have good amount of muscle,
16:55but you do not have quality muscle.
16:57Correct.
16:57Okay.
16:58Because muscle is a very important organ in the body to increase the metabolic rate.
17:02So I'm sure you have heard people who,
17:05kau ni makan banyak tapi tak gemuk-gemuk.
17:08Because they have high metabolic rate.
17:10Right.
17:11Okay.
17:11So we have to phenotype them accordingly.
17:15And not all patients,
17:16once you have grouped them according to the phenotype,
17:19not all patients will require the similar kind of treatment,
17:23be it bariatric surgery or, you know,
17:26medical treatment or any kind of treatment.
17:29But having said that,
17:30the most important thing,
17:32still lifestyle changes,
17:34healthy lifestyle and dietary modification.
17:37So these still remain the same for all type of patients,
17:43whether they are about to go for bariatric surgery,
17:46or after bariatric surgery,
17:48or even without bariatric surgery.
17:49Correct.
17:50A lot of,
17:51well,
17:52like,
17:53I totally agree with you.
17:55It's about lifestyle change.
17:58You,
17:58not,
17:58not like when you go through or undergo surgery,
18:01you can still eat like before,
18:04you still like behave like before,
18:06round food.
18:07No,
18:07you have to change everything
18:09because it's no longer the same.
18:11Same.
18:11Okay.
18:13So,
18:13I think what Dr. Shuki will try to say
18:16is that the fundamentals,
18:17the most important fundamentals
18:18that the patient should understand
18:20is who are battling with obesity
18:23is these two,
18:24which is your lifestyle modification
18:26and also your dietary eating habits.
18:28Because,
18:29whether you are embarking,
18:30I mean,
18:30it's going to go through the bariatric surgery
18:32or after bariatric surgery,
18:34or you are those group
18:36which maybe you can try
18:38with the medication
18:39and lifestyle modification,
18:40you still need these two fundamental elements
18:42to be,
18:43you have to be strong
18:44in these two fundamental elements.
18:46So,
18:47is there any other criteria
18:48when you,
18:50if someone who's struggling with obesity,
18:53what are the criteria
18:55that actually you would say
18:56or this person
18:57is suitable for,
18:59for example,
19:00medical treatment
19:00or this one
19:01would be bariatric surgery?
19:04I mean,
19:04obesity is actually a complex problem.
19:07As I mentioned just now,
19:09it's the issue of inflammation,
19:11the type of fat that you have,
19:13amount of good quality,
19:14amount of muscle,
19:16but apart from all these things,
19:18apart from dietary
19:19and lifestyle,
19:22there are other components.
19:23The most important thing
19:24is your psychosocial problems.
19:26Okay.
19:27So,
19:27a lot of us
19:28have issues
19:29with managing stress,
19:32having good amount of sleep,
19:34and the peer pressures,
19:38for example,
19:39in the office,
19:40even at home.
19:42Okay.
19:42Now,
19:42childhood obesity
19:43is increasing trend
19:46because of,
19:47just look at the parents.
19:48Yeah.
19:48Okay.
19:49So,
19:50most of our patients,
19:51we can see
19:52if both parents are obese,
19:54the children are
19:56almost going towards
19:58that kind of lifestyle
19:59and that kind of issues.
20:02You see?
20:02So,
20:03psychosocial problem
20:05is one of the most important thing
20:07that we need to assess
20:09and their preparedness.
20:11Okay.
20:11Okay.
20:12Sometimes,
20:13it also depends on
20:15the support
20:16that they have.
20:16you know,
20:17we have
20:18a lot of patients
20:20that comes from
20:20broken family,
20:22you know,
20:23that they do not have
20:24the support.
20:25Support doesn't only
20:26come from financial part,
20:28but it also emotional
20:30and all along the way
20:32as the patient
20:33going through
20:33this kind of treatment.
20:34Also,
20:35doctor,
20:35I think
20:36it also has got
20:38a lot
20:38to do
20:39with the
20:40social status
20:41of a family
20:43because
20:43sometimes
20:44if you are
20:47from
20:47maybe
20:48B40,
20:49I'm not saying
20:50all B40
20:50are miskin
20:52or something like that,
20:53but
20:53B40 family
20:56most of the time,
20:57they just
20:58grab whatever
20:59the camera
21:00has on.
21:01You are right.
21:02In fact,
21:02in medical data,
21:04in medical research
21:05and literature,
21:06it did mention
21:07that
21:07psychosocial status
21:09of a patient
21:10did,
21:11what you call
21:12display an important role
21:13in the development
21:14of the patient.
21:15In shaping of the
21:16that's true,
21:17that's true.
21:18Okay,
21:19so now we have
21:19known the criteria
21:20mainly in the
21:21psychosocial.
21:22This is what
21:22Dr. Chukri has
21:23mentioned,
21:23one of the most
21:24important criteria
21:25when you want
21:26to address a patient
21:27for a bariatric surgery
21:28and their preparedness
21:29mentally,
21:30emotionally,
21:30psychosocial.
21:32So,
21:32let's go into
21:33a bit more deeper
21:34in terms of
21:35technical,
21:35in terms of
21:36the,
21:37I mean,
21:38we won't go into
21:38what will be
21:40the steps of the surgery,
21:41but
21:41that will be fine.
21:42but we don't
21:44have that
21:44enough time
21:45that we could
21:45have a part
21:46two of our
21:47bariatric
21:47and so on.
21:48Maybe Dr. Chukri
21:49can elaborate
21:50on what are
21:51the different
21:52types of
21:53surgery which
21:54are available
21:54in Malaysia
21:55and also
21:57how do you
21:57tailor your
21:58patients
21:58accordingly to
21:59them?
22:00Generally
22:01in the
22:02medical field
22:02nowadays,
22:04whichever
22:04part of the
22:05world
22:05that is
22:06practicing
22:06bariatric
22:06surgery,
22:07there are
22:07two main
22:08what you call
22:09this
22:10bariatric surgery
22:10that we are
22:11practicing
22:11is either
22:12restrictive
22:13or restrictive
22:15with malabsorption.
22:17Restrictive
22:17means
22:18you just
22:19make your
22:20stomach
22:20smaller
22:21like a
22:22tube.
22:22This is
22:22what we
22:23call a
22:23sleeve
22:23gastrectomy.
22:25So it
22:26doesn't
22:26really
22:26change
22:27the
22:27overall
22:28root
22:29of the
22:29food
22:29that
22:30usually
22:30that
22:30you
22:31take.
22:31It
22:31goes
22:31into
22:32the
22:32stomach
22:32and
22:32it
22:33goes
22:33into
22:33the
22:33small
22:33bowel.
22:34It
22:34doesn't
22:34really
22:34change.
22:35It's
22:35just
22:35that
22:36we
22:36make
22:37it
22:37smaller
22:37so
22:38that
22:38you
22:38eat
22:38less
22:38because
22:39you
22:39can't
22:40control
22:41your
22:41cravings
22:42so
22:42we
22:42control
22:43it
22:43by
22:44making
22:44your
22:44stomach
22:44smaller.
22:45Mechanically.
22:46Exactly.
22:47This is
22:47what we
22:48call
22:48restrictive
22:48or
22:49sleeve
22:49gastrectomy.
22:50The
22:51other
22:51one
22:52is
22:52restrictive
22:53malabsorption.
22:55It
22:55is not
22:55really
22:55malabsorption
22:56but
22:57what
22:57we
22:57would
22:58like
22:58to
22:58call
22:59hormonal
23:00change
23:00that
23:01will
23:01appear
23:01after
23:02the
23:02surgery.
23:02This
23:03is
23:03what
23:03we
23:03call
23:03gastric
23:04bypass.
23:05What
23:06we
23:06do
23:06in
23:07gastric
23:07bypass
23:07is
23:07to
23:09make
23:09it
23:09smaller
23:10and
23:11then
23:11we
23:11will
23:12reroute
23:12the
23:13entry
23:14of
23:14the
23:14food
23:15or
23:15whatever
23:15that
23:15you
23:15have
23:15taken
23:16per
23:16oral
23:17from
23:18going
23:18through
23:18the
23:19first
23:19part
23:19of
23:20the
23:20small
23:20bowel
23:20rather
23:21than
23:21going
23:21to
23:22the
23:22first
23:22part
23:22of
23:23the
23:23small
23:23bowel
23:23it
23:23goes
23:23directly
23:24to
23:24the
23:25second
23:26part
23:27of
23:27the
23:27small
23:27bowel
23:28and
23:28this
23:28will
23:29enhance
23:30a lot
23:31of
23:31hormones
23:32and
23:32the
23:33secretion
23:34of
23:34insulin
23:34so
23:35you
23:35can
23:35control
23:36your
23:36metabolic
23:37syndrome
23:38much
23:38better
23:39so
23:39basically
23:40restrictive
23:40or
23:41sleeve
23:42gastrectomy
23:42is for
23:43those
23:43patient
23:44who
23:44doesn't
23:44have
23:45metabolic
23:45syndrome
23:46for example
23:46hypertension
23:47diabetes
23:47dyslepedemia
23:48basically
23:49it's just
23:50obesity
23:51with
23:51maybe
23:52one or
23:52two
23:52issues
23:53with
23:53knee
23:54problem
23:55back
23:55pain
23:56you know
23:56that kind
23:57of
23:57minor
23:57minor
23:58issues
23:58yes
23:59yes
23:59exactly
23:59minor
23:59issues
24:00yes
24:00and
24:01gastric
24:03bypass
24:03on the
24:03other
24:04hand
24:04or
24:04what
24:05we
24:05call
24:05as
24:05the
24:05hormone
24:06rerouting
24:07procedures
24:08plus
24:08restrictive
24:09these
24:09are
24:10for
24:10those
24:10patients
24:11who
24:11has
24:11metabolic
24:11syndrome
24:12all right
24:13all right
24:14okay
24:14so
24:15sometimes
24:16it
24:16sounds
24:16a bit
24:17scary
24:17the
24:17gastric
24:18bypass
24:19you
24:19know
24:19although
24:21we
24:21don't
24:21go into
24:21the
24:22details
24:22but
24:22yes
24:23of
24:23course
24:23it
24:24sounds
24:24a bit
24:24worrying
24:25how
24:26did
24:26actually
24:26I
24:27just
24:27want to
24:27go back
24:27to
24:27Chef
24:28Zam
24:28since
24:28he
24:29already
24:29embarked
24:29in
24:29the
24:30surgery
24:30many
24:31people
24:31might
24:31be
24:32scared
24:33of
24:33fear
24:34of
24:34surgery
24:34I
24:35don't
24:35not
24:38at
24:38all
24:38okay
24:39so
24:39because
24:39I
24:39would
24:39just
24:40like
24:40to
24:40ask
24:40whether
24:40I
24:41mean
24:41what
24:41were
24:41your
24:41biggest
24:41fears
24:42and
24:42how
24:42did
24:42you
24:42overcome
24:43that
24:43and
24:44my
24:44biggest
24:45fear
24:45when
24:45I
24:45went
24:46to
24:46HUQM
24:47there
24:47are
24:47two
24:47wings
24:47common
24:48wing
24:49and
24:50private
24:50wing
24:51my
24:51biggest
24:52fear
24:52was
24:52how
24:52was
24:53I
24:53going
24:53to
24:53be
24:53able
24:53to
24:53pay
24:54the
24:54bill
24:54remember
24:58I
24:59just
25:00came
25:00back
25:00I
25:00came
25:01back
25:01from
25:02London
25:03in
25:032005
25:04then
25:05when
25:05I
25:06came
25:06back
25:06my
25:06apartment
25:07was
25:07ready
25:07so
25:08to
25:08receive
25:09keys
25:09I
25:09had
25:09to
25:09pay
25:10money
25:10and
25:11to
25:11start
25:11to
25:12resume
25:12working
25:12again
25:13I
25:13had
25:13to
25:13buy
25:13a
25:13car
25:14and
25:15in
25:16London
25:16even though
25:17I
25:17got a
25:17teaching
25:17scholarship
25:18I
25:18had
25:19to
25:19pay
25:19my
25:19own
25:19living
25:20expenses
25:20and
25:21the
25:21exchange
25:22rate
25:22was
25:22first
25:23year
25:236.0
25:247
25:24years
25:257.0
25:25to a
25:26pound
25:27you see
25:28imagine
25:28I
25:28was
25:29like
25:29dry
25:30then
25:31at
25:31that
25:31time
25:32the
25:32surgeon
25:33said
25:33the
25:34maximum
25:34charge
25:35was
25:35only
25:3510,000
25:36I
25:37said
25:37then
25:37I
25:37did
25:38some
25:38calculation
25:39I
25:39said
25:39okay
25:40maybe
25:40I
25:40could
25:41do
25:41this
25:41and
25:42at
25:43the
25:43end
25:43of
25:43the
25:4310
25:44days
25:44the
25:45bill
25:45came
25:45out
25:4521,000
25:46and
25:48I
25:49was
25:49on
25:49the
25:49wheelchair
25:49talking
25:50to
25:51her
25:51I
25:52had
25:52I
25:53consumed
25:54I
25:54used
25:54two
25:55tubes
25:55of
25:55morphine
25:56it
25:57was
25:57very
25:57painful
25:58right
25:58so
25:58that
25:59means
25:59the
25:59money
26:00was
26:01more
26:01the
26:02biggest
26:02thing
26:02because
26:02for
26:03me
26:03I'm
26:04okay
26:04my
26:05mum
26:05used
26:06to
26:06work
26:06my
26:06mum
26:07was
26:08a
26:08hospital
26:08KKM
26:09staff
26:09I'm
26:10used
26:10to
26:10seeing
26:11people
26:12like
26:13lost
26:13their
26:13limbs
26:14or
26:14whatever
26:14now
26:14she
26:15worked
26:15in
26:15the
26:15emergency
26:16department
26:16emergency
26:17ward
26:17so
26:18nothing
26:18scares
26:19being
26:20under
26:20the
26:20knife
26:21didn't
26:21scare
26:21you
26:21it's
26:22just
26:22the
26:22first
26:22one
26:26was
26:26appendix
26:27so
26:29it was
26:29the
26:30cost
26:30rather than
26:32the
26:32post
26:32operative
26:33potential
26:34complication
26:34because
26:35I
26:35really
26:35wanted
26:36to
26:36lose
26:36the
26:36weight
26:37it
26:39was
26:39affecting
26:40because
26:40I
26:41was
26:41teaching
26:41in
26:41the
26:41kitchen
26:42for
26:42so
26:42long
26:43but
26:44I
26:44was
26:44very
26:44active
26:44though
26:45I
26:45was
26:45not
26:45the
26:46kind
26:46of
26:46fatty
26:46who
26:47moves
26:48very
26:48slow
26:49no
26:49no
26:49I
26:50wasn't
26:50like
26:50that
26:50I
26:51was
26:51very
26:51active
26:51even
26:52though
26:52I
26:52was
26:52huge
26:52that
26:54helps
26:54a lot
26:54I
26:54think
26:55but
26:55I
26:56did
26:56not
26:56expect
26:57the
26:57pain
26:58oh
26:58god
26:59we
27:00even
27:00had
27:00to
27:00do
27:00an
27:00ultrasound
27:01to
27:01make
27:02sure
27:02there
27:02was
27:02no
27:02leakage
27:03because
27:03he
27:03told
27:04me
27:04if
27:04there's
27:04a
27:04leakage
27:05you
27:05have
27:05to
27:06go
27:06in
27:06again
27:06I
27:06said
27:06no
27:07no
27:07no
27:07I
27:09need
27:10to
27:10top
27:11up
27:11on
27:11the
27:11cost
27:11again
27:11I
27:12think
27:13that
27:13was
27:13the
27:13best
27:13decision
27:14I
27:14ever
27:14done
27:15right
27:15yeah
27:15so
27:17I
27:17guess
27:17since
27:22we
27:22are
27:23talking
27:23about
27:24the
27:24very
27:24heated up
27:25discussion
27:25regarding
27:25the
27:26pre-op
27:26preparation
27:27so
27:27I
27:27just
27:28pass
27:28the
27:29second
27:29question
27:30that
27:30I
27:30want
27:30to
27:30ask
27:30you
27:30will
27:31go
27:31back
27:31to
27:31Dr.
27:31Shukie
27:32for a
27:32while
27:32could
27:33you
27:33just
27:33walk
27:34us
27:34through
27:35the
27:35pre-operative
27:37preparation
27:37for a
27:38basic
27:38surgery
27:38patient
27:39subsequently
27:40after
27:40that
27:40can
27:40you
27:41just
27:41also
27:41enlighten
27:42us
27:42regarding
27:43the
27:43long-term
27:44risk
27:44and
27:45complication
27:45short-term
27:46and also
27:46long-term
27:46or
27:47immediately
27:47post
27:47maybe
27:50what
27:51Prof Zam
27:51has
27:52actually
27:52went
27:53through
27:53is
27:54something
27:54that
27:54is
27:55in the
27:56past
27:56so
27:57nowadays
27:58we
27:58have
27:58more
27:59advanced
27:59perioperative
28:02preparation
28:02that
28:03the
28:03patient
28:03can
28:03enjoy
28:04fast
28:05recovery
28:05as well
28:06as
28:06less
28:06pain
28:07now
28:07in
28:08our
28:08practice
28:09because
28:09we
28:10practice
28:10a
28:11holistic
28:11approach
28:11in
28:12the
28:12management
28:12of
28:13our
28:14overweight
28:15and
28:15obese
28:15patient
28:15we
28:16have
28:17to
28:17put
28:18the
28:18patient
28:18through
28:18several
28:19phases
28:19we
28:20have
28:20four
28:20phases
28:21phase
28:21one
28:21phase
28:21two
28:22three
28:22and
28:22four
28:22phase
28:23one
28:24is
28:24what
28:24we
28:24call
28:25clinic
28:25and
28:26counseling
28:26so
28:26we
28:27teach
28:28the
28:28patient
28:29we
28:29counsel
28:29the
28:29patient
28:30and
28:30we
28:30coach
28:31them
28:31everything
28:32about
28:33healthy
28:33lifestyle
28:34diet
28:35modification
28:36most
28:37important
28:37thing
28:38the
28:38barriers
28:38and
28:39limitation
28:40they
28:40have
28:41experienced
28:42before
28:42so
28:43we
28:43do
28:43not
28:43want
28:43to
28:44repeat
28:44all
28:45those
28:45mistakes
28:45before
28:46and
28:47we
28:47also
28:47teach
28:47them
28:47what
28:48are
28:48the
28:48drivers
28:49of
28:49weight
28:49gain
28:50and
28:50weight
28:50loss
28:50and
28:51this
28:52is
28:52very
28:52important
28:52and
28:53this
28:53is
28:53done
28:53in
28:54combination
28:55with
28:55our
28:56other
28:57disciplines
28:58like
28:58the
28:58dietitian
28:59physiotherapist
29:00as well
29:01as
29:01the
29:01counselor
29:02right
29:02physiotherapy
29:03as
29:03well
29:03exactly
29:04and
29:05we
29:05coach
29:05them
29:05in
29:06the
29:06gym
29:06because
29:09sometimes
29:09when
29:11you
29:12have
29:13diabetes
29:13hypertension
29:14you
29:14went to
29:15clinical
29:15for example
29:16the
29:17doctor
29:17will
29:17tell
29:18you
29:18you
29:19can
29:19exercise
29:20you
29:20can
29:20jaga
29:20makan
29:20but
29:21how
29:21exercise
29:22yes
29:22exactly
29:23so
29:24we
29:25teach
29:25them
29:25simple
29:26basic
29:26steps
29:27that
29:28incorporate
29:29both
29:29aerobic
29:30as well
29:31as
29:31resistant
29:32exercise
29:32which
29:33can
29:33be done
29:33by
29:33almost
29:34everyone
29:35correct
29:35can
29:35be done
29:37at home
29:37it has
29:38to be
29:38done
29:38at home
29:39and
29:39for
29:39those
29:40patients
29:40who
29:40have
29:40some
29:40physical
29:41limitation
29:41we
29:42will
29:43do
29:43some
29:43modification
29:44and
29:45hopefully
29:46during
29:46this
29:47phase
29:47one
29:47usually
29:47we
29:48give
29:48them
29:48about
29:48one
29:49to
29:49two
29:49months
29:49they
29:50have
29:50to
29:51have
29:51a
29:51target
29:51of
29:515-10%
29:52fat
29:53loss
29:53we
29:54do
29:54not
29:54look
29:55at
29:55the
29:55weight
29:55because
29:56everyone
29:57it
29:57could be
29:57muscle
29:58loss
29:58as well
29:58exactly
29:58and we
29:59do
29:59not
30:00want
30:00muscle
30:00loss
30:00so
30:01we
30:02are
30:02targeting
30:03the
30:03fat
30:04and
30:04specifically
30:05the
30:05visceral
30:05fat
30:05fat
30:06we
30:08don't
30:08fat
30:08fat
30:09but
30:10you
30:10can
30:10always
30:10regain
30:10your
30:11muscle
30:11post
30:13operative
30:14you
30:14have
30:14to
30:14regain
30:15your
30:15muscle
30:15now
30:16once
30:16they
30:16have
30:17targeted
30:17this
30:18they
30:18have
30:18achieved
30:18this
30:195-10%
30:20fat
30:21reduction
30:21then
30:21they
30:22will
30:22go to
30:22phase
30:22two
30:22which
30:23is
30:23the
30:24surgery
30:24and
30:25this
30:25will
30:26take
30:26about
30:26two
30:26weeks
30:27where
30:27we
30:28put
30:28them
30:28on
30:29meat
30:29replacement
30:30therapy
30:30so
30:30meat
30:31replacement
30:31therapy
30:32is
30:32just
30:32that
30:33we
30:33give
30:33them
30:34low
30:34calorie
30:34diet
30:34why
30:35do
30:35we
30:36replace
30:37their
30:37normal
30:37meal
30:38to
30:38a
30:39formula
30:39or
30:39what
30:39we
30:40call
30:41susu
30:42it
30:43is
30:43not
30:43actually
30:43susu
30:44it
30:44is
30:44a
30:45specialized
30:45formula
30:47medical
30:48formula
30:48so
30:49that
30:49we
30:49can
30:49accurately
30:50calculate
30:51the
30:52calorie
30:52but
30:52at
30:52the
30:53same
30:53time
30:53we
30:53are
30:53giving
30:53them
30:54adequate
30:54protein
30:55so
30:56this
30:56has
30:56to
30:56be
30:56done
30:57about
30:57two
30:57weeks
30:57are
30:58they
30:58trying
30:58that
30:58calories
30:59pesashi
30:59it
31:00depends
31:01on
31:01the
31:01product
31:02it
31:02depends
31:03on
31:03the
31:03product
31:03some
31:03product
31:04comes
31:04in
31:04sachet
31:05some
31:05product
31:05comes
31:05in
31:06the
31:06can
31:06some
31:06product
31:07come
31:07in
31:07ready
31:08to
31:08drink
31:08bottle
31:09so
31:09it
31:10depends
31:10so
31:11we
31:11will
31:12work
31:12together
31:13with
31:13our
31:13dietician
31:14in
31:14giving
31:15the
31:15advice
31:16to
31:16our
31:16patient
31:17so
31:17when
31:17this
31:18is
31:18done
31:18we
31:19will
31:19also
31:19incorporate
31:20further
31:21intensive
31:21exercise
31:22the
31:23exercises
31:23that
31:23we
31:24have
31:24actually
31:24taught
31:24them
31:25before
31:25we
31:25add
31:26more
31:26intensive
31:27exercise
31:27and
31:28in
31:29phase
31:29two
31:29they
31:32of
31:32their
31:32visceral
31:33fat
31:33so
31:34this
31:34actually
31:34help
31:35them
31:35to
31:35actually
31:36improve
31:36their
31:37cardiac
31:37response
31:39to
31:39the
31:40stress
31:40during
31:41the
31:41surgery
31:41and
31:42for
31:42those
31:43patient
31:43who
31:43has
31:43sleep
31:44apnea
31:44micro
31:45sleep
31:45all
31:45those
31:45issues
31:46with
31:46hypoventilation
31:48they
31:49have
31:49to
31:49be
31:49put
31:49on
31:50CPAP
31:50machine
31:51so
31:52this
31:52is
31:52the
31:52preparation
31:52on
31:53second
31:53phase
31:54and
31:54on
31:54the
31:54third
31:54phase
31:55they
31:55will
31:55definitely
31:56go
31:56for
31:56surgery
31:56and
31:58nowadays
31:58we
31:59call
31:59what
32:00we
32:00do
32:01to
32:01all
32:02cases
32:03going
32:03for
32:04major
32:04surgery
32:04is
32:05that
32:05enhanced
32:06recovery
32:06after
32:07surgery
32:07meaning
32:08that
32:09they
32:10can
32:10eat
32:10almost
32:10immediately
32:11after
32:11surgery
32:12they
32:12shouldn't
32:13have
32:13any
32:13pain
32:13they
32:14should
32:14be
32:14ambulating
32:15out
32:15of
32:15the
32:15bed
32:15almost
32:16immediately
32:16the
32:16next
32:17day
32:17sometimes
32:17when
32:18we
32:18do
32:18the
32:18surgery
32:19in
32:19the
32:19morning
32:20but
32:20evening
32:21they
32:21have
32:21to
32:22already
32:22walk
32:22so
32:24these
32:24are
32:24the
32:24recovery
32:25that
32:25we
32:25targeted
32:26from
32:27them
32:27and
32:27they
32:28need
32:28to
32:28be
32:28counsel
32:29and
32:29understand
32:30the
32:30flow
32:31and
32:31in
32:31phase
32:32four
32:32is
32:33long
32:33term
32:33follow
32:34up
32:34long
32:35term
32:35follow
32:35up
32:36is
32:36a
32:37must
32:37for
32:38everyone
32:38until
32:39when
32:40they
32:41decided
32:42that
32:42they
32:43do not
32:43want
32:43to
32:43come
32:43for
32:43follow
32:44up
32:44then
32:44that's
32:45the
32:45end
32:45of
32:46the
32:46follow
32:46up
32:46but
32:46we
32:47will
32:47usually
32:47call
32:48our
32:48patient
32:48for
32:49continuous
32:49follow
32:49up
32:50and
32:50during
32:50this
32:51follow
32:51up
32:51we
32:52rarely
32:53monitor
32:53the
32:54weight
32:54because
32:54sometimes
32:55you
32:55may
32:55gain
32:56weight
32:56because
32:56you
32:56regain
32:57muscle
32:57right
32:58so
32:59we
32:59will
32:59monitor
33:00the
33:01body
33:01fluids
33:02we
33:02will
33:02monitor
33:02the
33:03fat
33:03particularly
33:04visceral
33:04fat
33:05we
33:05aim
33:06to
33:06achieve
33:07total
33:08remission
33:08of all
33:09the
33:10obesity
33:10related
33:11health
33:11problems
33:12or issues
33:12like
33:12diabetes
33:13hypertension
33:14knee
33:15pain
33:15the most
33:16common
33:16thing
33:16knee
33:17pain
33:17tak
33:17boleh
33:17nak
33:18solat
33:18tak
33:18boleh
33:19nak
33:19tundur
33:20nak
33:20lipat
33:21kaki
33:21tak
33:21boleh
33:22all
33:22this
33:22has
33:23to
33:23be
33:23resolved
33:24almost
33:25100%
33:26lah
33:26so
33:27that
33:27is
33:27how
33:28we
33:28prepare
33:29our
33:29patient
33:29and
33:30that
33:30is
33:30how
33:31we
33:31take
33:32care
33:32of
33:32patient
33:32after
33:32the
33:33surgery
33:33wow
33:34so
33:34there
33:34are
33:34four
33:35phases
33:35as
33:36has
33:36been
33:37explained
33:37quite
33:37detaily
33:38by
33:38Dr.
33:39Shukri
33:39so
33:40next
33:40since
33:41we
33:41already
33:41know
33:42what
33:42is
33:42the
33:42preparation
33:43prior
33:43to
33:44the
33:44operation
33:44so
33:45what
33:45after
33:45this
33:46risk
33:47and
33:47also
33:47the
33:47possible
33:48complications
33:48that
33:49the
33:49patient
33:49when
33:50we
33:51counsel
33:51them
33:52so
33:52what
33:52are
33:52the
33:52things
33:53that
33:53we
33:53know
33:54the
33:54most
33:55common
33:56complications
33:56are
33:57malnutrition
33:58correct
33:59after
33:59the
34:00surgery
34:00and
34:01that's
34:01the
34:01reason
34:01why
34:02during
34:02the
34:02phase
34:02one
34:03and
34:03phase
34:03two
34:04we
34:04put
34:04high
34:06priority
34:06on
34:07their
34:07acceptance
34:09and
34:10preparedness
34:10with
34:11regards
34:11to
34:12understanding
34:13the
34:13importance
34:13of
34:14nutrition
34:14right
34:15you
34:15can
34:15imagine
34:16after
34:16the
34:16surgery
34:17you
34:17have
34:18to
34:19eat
34:19less
34:19because
34:20that
34:20much
34:20only
34:21your
34:21stomach
34:22can
34:22accommodate
34:23the
34:23new
34:24pouch
34:24in
34:24my
34:25case
34:25was
34:25only
34:2550
34:26cc
34:26well
34:27it
34:27depends
34:27on
34:27the
34:28surgeon
34:28who
34:28operating
34:28on
34:29you
34:29there
34:30is
34:30no
34:30standard
34:31no
34:31there
34:32is
34:32no
34:32standard
34:32and
34:33it
34:33also
34:33depends
34:34on
34:34you
34:34only
34:36you
34:36will
34:37know
34:38how
34:38much
34:38you
34:38can
34:39eat
34:39so
34:39what
34:40we
34:40normally
34:41do
34:41is
34:41that
34:42we
34:42will
34:42give
34:42a
34:42patient
34:43immediately
34:43after
34:43the
34:44surgery
34:44a
34:44glass
34:46where
34:47we
34:47will
34:47measure
34:4825,
34:4950,
34:4975,
34:50100
34:50we
34:51put
34:51in
34:52the
34:52cup
34:53in
34:53the
34:53measured
34:53cup
34:54water
34:54and
34:55we
34:55ask
34:55the
34:56patient
34:56to
34:56drink
34:56at
34:56one
34:57go
34:57until
34:58they
34:59feel
35:00it
35:00is
35:00up
35:01till
35:01the
35:01esophagus
35:02that
35:02means
35:02that
35:03is
35:03the
35:03amount
35:04of
35:04stomach
35:05pouch
35:05so
35:06from
35:06there
35:07we
35:07tell
35:08the
35:08patient
35:08look
35:08if
35:09your
35:09capacity
35:10in
35:10the
35:10stomach
35:11now
35:11is
35:1275
35:12mils
35:13and
35:13that
35:13is
35:13how
35:14big
35:15the
35:15portion
35:15of
35:15your
35:16plate
35:16will
35:16be
35:16so
35:18they
35:18have
35:18to
35:18always
35:18remember
35:19that
35:19because
35:20failure
35:21to
35:21understand
35:23the
35:23capacity
35:23they
35:24will
35:24have
35:25reflux
35:25which
35:26is
35:26a
35:26common
35:27problem
35:27after
35:28bariatric
35:28surgery
35:29in
35:29majority
35:30of
35:30patients
35:31in
35:31Malaysia
35:31they
35:31are
35:32having
35:32this
35:32reflux
35:32I'm
35:32still
35:33having
35:33it
35:33sometimes
35:34when
35:34you
35:34overeat
35:35yes
35:36when
35:36you
35:36overeat
35:37definitely
35:37you
35:37will
35:37have
35:38reflux
35:38and
35:38because
35:38of
35:39the
35:39reflux
35:39they
35:39will
35:40have
35:40malnutrition
35:40so
35:41the
35:42state
35:42of
35:42nutritional
35:43intake
35:44and
35:44the
35:45vitamins
35:46has
35:46to be
35:46follow up
35:47to ensure
35:48that
35:48they
35:48do
35:49not
35:49have
35:49deficiencies
35:51okay
35:52so
35:54mainly
35:54it's
35:55the
35:55malnutrition
35:56the
35:56most
35:57important
35:57thing
35:58that
35:58we
35:58have
35:58already
35:58highlighted
35:59as
35:59the
35:59complications
36:00and
36:00also
36:00the
36:01reflux
36:01so
36:01whatever
36:02the
36:02amount
36:03that
36:03you
36:03are
36:03supposed
36:03to
36:04eat
36:04post
36:04surgery
36:05you
36:05have
36:05to
36:05comply
36:06to
36:06it
36:06because
36:06if
36:07not
36:07then
36:07you
36:07will
36:07be
36:07suffering
36:08about
36:08the
36:08reflux
36:08in
36:09my
36:09case
36:09I
36:10was
36:10only
36:10given
36:11permission
36:14to
36:14eat
36:14half
36:15of
36:15biskut
36:16Mary
36:16after
36:1710
36:17days
36:17that's
36:18the
36:18problem
36:19nowadays
36:20a lot
36:20of
36:21patients
36:21when
36:21they
36:21undergo
36:22surgery
36:22they
36:22are
36:23not
36:23told
36:24to
36:24measure
36:24their
36:25capacity
36:25and
36:26therefore
36:27when
36:27they
36:27eat
36:28because
36:28we
36:29come
36:29from
36:29different
36:29cultures
36:30and
36:30different
36:31type
36:32of
36:32food
36:32that
36:33is
36:33available
36:33at
36:33home
36:34and
36:35majority
36:35of
36:36Asian
36:36we
36:37eat
36:37a lot
36:38of
36:38carbs
36:38carbohydrates
36:39and
36:40carbohydrates
36:40when
36:40you
36:41drink
36:41when
36:42you
36:42mix
36:43carbohydrates
36:43and
36:44water
36:44it
36:45will
36:45actually
36:45double
36:46up
36:46and
36:46that
36:47will
36:48actually
36:48limit
36:48the
36:49intake
36:50of
36:51the
36:51other
36:52micronutrients
36:53and
36:53that's
36:54how
36:55you
36:55lose
36:56your
36:56muscle
36:56that's
36:57how
36:57you
36:57become
36:57malnourished
36:58true
36:59true
36:59like
37:00for me
37:01there's
37:02side
37:03effects
37:03like
37:04dry
37:05skin
37:05dry
37:06and
37:07I
37:07look
37:07so
37:08so
37:11worn
37:12out
37:12I
37:13look
37:13much
37:14older
37:14it
37:15took
37:15me
37:15like
37:15a few
37:16years
37:16to
37:17regain
37:17the
37:18in a way
37:19freshness
37:19the glow
37:20even
37:22my
37:22late
37:23brother
37:23in-law
37:23says
37:23he
37:24was
37:24picking
37:24me
37:24up
37:24from
37:25the
37:25airport
37:26he
37:26says
37:26losing
37:30hair
37:31and
37:31everything
37:32these
37:32are
37:32all
37:32signs
37:33of
37:33protein
37:34deficiencies
37:35and
37:36micronutrient
37:36deficiencies
37:37so
37:37it
37:38will
37:38take
37:38actually
37:38a
37:38while
37:39until
37:39you
37:39can
37:39recover
37:40from
37:40that
37:40so
37:41that's
37:41the
37:41reason
37:41why
37:42the
37:42preparation
37:42from
37:43the
37:43very
37:43beginning
37:44understanding
37:45the
37:45balanced
37:46diet
37:47good
37:47amount
37:48of
37:48macronutrients
37:49and wild
37:49macronutrients
37:50in a
37:51very
37:51small
37:51proportion
37:51is
37:52very
37:52important
37:52I
37:53was
37:53not
37:53I
37:55remember
37:55prior
37:56to
37:56being
37:57discharged
37:57from
37:58the
37:58world
37:58a
37:58dietitian
37:59or
37:59nutritionist
38:00came
38:00over
38:00to
38:00my
38:00room
38:02and
38:03just
38:04told
38:04me
38:04that
38:05you
38:05have
38:05whatever
38:06you
38:06eat
38:07or
38:07maybe
38:07eat
38:08bubur
38:08first
38:09but
38:10you
38:10make
38:10sure
38:10that
38:10you
38:11blend
38:12the
38:12bubur
38:12well
38:13and
38:13you
38:13have
38:13to
38:14strain
38:14it
38:15well
38:15before
38:16you
38:16makan
38:16I
38:17went
38:17home
38:18nobody
38:18was
38:19at
38:19home
38:19I
38:19masak
38:19me
38:20gimme
38:20only
38:22one
38:22food
38:23full
38:23but
38:23in
38:25your
38:25case
38:26I
38:26think
38:26you
38:27know
38:27as
38:28a
38:28chef
38:28you
38:29know
38:30what
38:30to
38:30eat
38:30you
38:31know
38:31what
38:32is
38:32healthy
38:32food
38:32but
38:33again
38:33when
38:34I
38:34true
38:34that
38:35is
38:35very
38:35true
38:36but
38:36again
38:36at
38:37the
38:37same
38:37time
38:37I
38:38just
38:38had
38:38whatever
38:39that
38:39was
38:39available
38:39to
38:40me
38:40at
38:40that
38:41time
38:41I
38:42went
38:42back
38:42home
38:42there
38:43was
38:43nobody
38:43at
38:43home
38:44because
38:44I
38:44asked
38:44my
38:44mother
38:45to
38:45go
38:45back
38:45so
38:46that
38:47she
38:47doesn't
38:47see
38:47me
38:48so
38:49whatever
38:50that
38:50was
38:50available
38:50after
38:51leaving
38:51the
38:52house
38:52for
38:5210
38:52days
38:52nothing
38:53much
38:53fresh
38:54just
38:55the
38:55instant
38:56noodle
38:56same
38:58thing
38:58goes
38:58to
38:59whatever
38:59I
38:59said
38:59about
39:00B40
39:00group
39:01just
39:01now
39:01whatever
39:02that
39:02is
39:03available
39:03so
39:06like
39:06Chef
39:06some
39:06have
39:06mentioned
39:07some
39:08sort
39:08of
39:08side
39:08effect
39:08that
39:09he
39:09encountered
39:10that
39:10he
39:10looks
39:11a bit
39:11worn
39:11out
39:12not
39:12a bit
39:13was
39:13a lot
39:14and also
39:15palpitation
39:16before going
39:18to bed
39:19sometimes
39:19you just
39:20try to
39:22lose
39:24off
39:24suddenly
39:24you get
39:26cold sweat
39:26then I
39:27will run
39:28down
39:28and eat
39:29something
39:29sweet
39:30maybe
39:30fruits
39:31watermelon
39:33whatever
39:34after a few
39:35pieces
39:36and it
39:37will be
39:38okay
39:38again
39:38palpitation
39:41you cannot
39:42ignore
39:43and slip
39:43it off
39:44you cannot
39:44it will
39:45not go
39:46away
39:46until
39:46you eat
39:47something
39:47until now
39:49sometimes
39:49it happens
39:50sometimes
39:51it happens
39:52so other
39:53than physical
39:53changes that
39:54you notice
39:54how about
39:55emotionally
39:56I mean
39:56oh I feel
39:57pretty
39:57inside you
40:00feel you're
40:00glowing
40:01yes I
40:02feel more
40:02confident
40:03I was
40:04you know
40:05what I
40:05would rather
40:06be
40:06I would
40:07rather be
40:08dead
40:08than having
40:09somebody call
40:10me in the
40:11public
40:11call my name
40:11in the public
40:12you know
40:13what I mean
40:13but I think
40:16America also
40:16changed me
40:17I was very
40:19very shy
40:20I was very
40:20you know
40:21Humpty Dumpty
40:22being called
40:23at school
40:23you know
40:24and always
40:25had a very
40:26very low
40:27service
40:28it was beyond
40:28help
40:29feeling insecure
40:31very insecure
40:32and fat
40:34ugly
40:34and all
40:36those sorts
40:36of things
40:37but when
40:38I went to
40:39America
40:39before the
40:40UK
40:40when I
40:41went to
40:41America
40:41America
40:42changed me
40:42a lot
40:43but losing
40:44weight
40:45through
40:46gastric bypass
40:47surgery
40:48really boost
40:49up my
40:50confidence
40:50and at
40:51that time
40:51I was
40:52already
40:52a celebrity
40:53chef
40:54that gives
40:55me
40:56and you
40:56know
40:56what
40:56the best
40:58part was
40:58after I
40:59lost my
40:59weight
40:59like
41:00maybe
41:0110 20
41:0230 kilos
41:02I was
41:03engaged
41:03by many
41:03more
41:04health
41:05related
41:05FNCGs
41:07more
41:09rezeki
41:09to make
41:12up for
41:12the
41:1221,000
41:13you make
41:17even
41:17more
41:17but I
41:20negotiated
41:21I got
41:21it at
41:2118
41:22now
41:24it's
41:2524,888
41:26you can
41:27withdraw
41:28from
41:28KWSP
41:29account 2
41:29you're
41:32giving
41:32all the
41:32tips
41:33I
41:33think
41:37having
41:38said
41:38that
41:39that
41:39would
41:39be
41:39the
41:39most
41:40rewarding
41:40throughout
41:41the
41:41journey
41:42that
41:42you
41:42felt
41:43more
41:43confident
41:43plus
41:44I
41:44can
41:44buy
41:45whatever
41:45clothes
41:45I
41:46wanted
41:46last
41:46time
41:46no
41:47last
41:48time
41:483XL
41:50and I
41:51could
41:51only
41:51buy
41:51things
41:52from
41:52the
41:52US
41:53it
41:54was
41:54almost
41:55impossible
41:56for me
41:56to
41:56walk
41:56into
41:57any
41:57departmental
41:58stalker
41:59and
41:59get
42:00to
42:00get
42:01my
42:01size
42:01impossible
42:02so
42:03maybe
42:04before
42:04we
42:04end
42:05maybe
42:05a
42:05chef
42:06could
42:06actually
42:06tell
42:07us
42:08how
42:08did
42:09you
42:09able
42:09to
42:10maintain
42:10your
42:11weight
42:11for the
42:11past
42:1110
42:12years
42:12me
42:13I
42:13am
42:13not
42:14a
42:14very
42:14disciplined
42:15person
42:16I
42:16will
42:16eat
42:17whatever
42:17I
42:17want
42:18to
42:18eat
42:18even
42:19before
42:19we
42:19came
42:20here
42:20so
42:20I
42:20had
42:20a
42:21little
42:22piece
42:22of
42:22chocolate
42:23white
42:23chocolate
42:23not
42:24very
42:24good
42:24but
42:26I
42:26will
42:26eat
42:26whatever
42:26doctor
42:27but
42:27because
42:28the capacity
42:29is very
42:30limited
42:30not
42:31as
42:32much
42:32as
42:32before
42:32even
42:33though
42:33it
42:34is
42:34now
42:34the
42:35portion
42:35size
42:36I
42:36could
42:36eat
42:36is
42:36a
42:36bit
42:37larger
42:37than
42:38maybe
42:38the
42:38previous
42:3910
42:40years
42:40you
42:41know
42:41I
42:43will
42:43gain
42:43weight
42:45now
42:46I
42:46will
42:46still
42:47gain
42:47weight
42:471
42:482
42:483
42:48even
42:494
42:49kilos
42:49sometimes
42:50not
42:51because
42:51of
42:52the
42:52main
42:52meal
42:53that
42:53I
42:53eat
42:54because
42:54whenever
42:54I
42:54eat
42:55the
42:55main
42:55meal
42:55it's
42:56only
42:56a
42:56little
42:56bit
42:56nasi
42:57is
42:57just
42:58but
43:00they
43:00are
43:00also
43:01amazingly
43:02I
43:02don't
43:02know
43:03what
43:03happens
43:04sometimes
43:04I
43:05can
43:05eat
43:05a
43:05lot
43:05really
43:06you
43:06know
43:07but
43:08I
43:08will
43:08only
43:09gain
43:09weight
43:10I
43:10think
43:11from
43:11all
43:12this
43:12junks
43:13chocolate
43:14ice
43:14cream
43:15all
43:15pastries
43:16cakes
43:17you
43:18know
43:18that
43:18kind
43:18of
43:18things
43:19that
43:19makes
43:19me
43:19gain
43:20a
43:20bit
43:20more
43:20weight
43:21because
43:22if
43:22I
43:22am
43:22not
43:22disciplined
43:23but
43:23at
43:24the
43:24same
43:24time
43:24I
43:25counter
43:25by
43:25going
43:26to
43:26the
43:26gym
43:26everything
43:27that's
43:27the
43:28most
43:28important
43:28point
43:29for
43:31the
43:31audience
43:31out
43:31there
43:32well
43:33this
43:33week
43:33I
43:34don't
43:34go
43:34because
43:34I
43:34just
43:35had
43:35some
43:36PRP
43:37and
43:37exosome
43:39injection
43:39yesterday
43:40so
43:41I
43:41will
43:41have
43:42to
43:42rest
43:42for
43:42the
43:42whole
43:43week
43:43I
43:44go
43:44every
43:45single
43:45day
43:46that's
43:46good
43:47because
43:47I
43:48want
43:48to
43:49eat
43:49that's
43:53actually
43:54the
43:54main
43:54thing
43:54that
43:54Dr.
43:55Huthi
43:55has
43:55mentioned
43:56the
43:56post
43:56surgery
43:57these
43:57are
43:57the
43:58things
43:58that
43:58we
43:58have
43:58to
43:59follow
43:59up
43:59it's
43:59not
43:59just
44:00doing
44:00surgery
44:00and
44:01then
44:01after
44:01that
44:01you
44:02just
44:02can
44:02eat
44:02whatever
44:02you
44:03want
44:03just
44:03be
44:03active
44:03yes
44:04be
44:04active
44:05yes
44:05again
44:07I
44:08am
44:09a strong
44:09believer
44:10you
44:11eat
44:11you
44:12get
44:12out
44:12so
44:13meaning
44:13to
44:13say
44:13whatever
44:14you
44:14can
44:14eat
44:14whatever
44:15you
44:15want
44:15but
44:16you
44:16have
44:16to
44:16burn
44:19indulge
44:21life
44:22don't
44:23limit
44:23yourself
44:23but
44:24be
44:24responsible
44:25exactly
44:25okay
44:26so
44:27before
44:27we
44:28end
44:28our
44:28session
44:29for
44:29today
44:29I
44:30think
44:30just
44:30the
44:31final
44:31question
44:31for
44:31Dr.
44:32Shukri
44:32what
44:33advice
44:33would
44:34you
44:34give
44:34to
44:34the
44:35someone
44:36who
44:36is
44:36considering
44:37for
44:37breast
44:37surgery
44:38but
44:38is
44:38still
44:38hesitant
44:39I
44:39mean
44:39they
44:40want
44:40to
44:40do
44:40it
44:40but
44:41they
44:41are
44:41not
44:41so
44:42because
44:42of
44:42fear
44:42I
44:43mean
44:43finances
44:44WSP
44:44well
44:46yeah
44:48I
44:49think
44:49of
44:49course
44:50the
44:50cost
44:50is
44:51one
44:51of
44:52the
44:52issues
44:53that
44:53will
44:55determine
44:55whether
44:55you
44:56actually
44:57go
44:57for
44:58your
44:58bariatric
44:59surgery
44:59or not
44:59but
44:59the
45:00most
45:00important
45:00thing
45:00is
45:01that
45:01you
45:01have
45:01to
45:02understand
45:02the
45:03journey
45:04that
45:04you
45:04are
45:04going
45:05to
45:05go
45:05through
45:05nowadays
45:06we
45:06have
45:07a
45:07lot
45:07of
45:07bariatric
45:08group
45:08support
45:09you
45:10can
45:10always
45:10engage
45:11with
45:11them
45:11I
45:11don't
45:12want
45:12people
45:12to
45:12ask
45:13me
45:13any
45:13mud
45:13because
45:14I
45:15have
45:15so
45:15many
45:16inquiries
45:16can
45:16you
45:16please
45:17tell
45:17me
45:17maybe
45:18not
45:18chef
45:18we
45:21have
45:25a lot
45:25of
45:26bariatric
45:26support
45:26group
45:27who
45:27have
45:28actually
45:28undergone
45:29various
45:29kind
45:30of
45:30surgery
45:30and
45:31therapy
45:31from
45:31various
45:32doctors
45:32in
45:32Malaysia
45:33you
45:33can
45:33ask
45:34them
45:34to
45:35ask
45:35their
45:35experience
45:36social
45:36media
45:37support
45:37groups
45:37as
45:38well
45:38yeah
45:38exactly
45:38and
45:39from
45:39them
45:40from
45:40that
45:41you
45:41choose
45:41one
45:42doctor
45:42or
45:43one
45:43institution
45:44for
45:44you
45:44to
45:44have
45:45a
45:45follow
45:45up
45:45and
45:46maintain
45:47their
45:47follow
45:47up
45:48maintain
45:48your
45:48follow
45:49up
45:49and
45:49of
45:50course
45:50you
45:51must
45:51be
45:51prepared
45:52mentally
45:53physically
45:54and
45:55with
45:55or
45:56without
45:56the
45:56advice
45:56from
45:56the
45:56doctor
45:57you
45:57must
45:57make
45:58sure
45:58you
45:58have
45:59to
45:59change
45:59your
45:59lifestyle
46:00be
46:01active
46:01engage
46:02with
46:02some
46:02kind
46:03of
46:03exercise
46:03that
46:04you
46:04can
46:04consistently
46:05doing
46:06it
46:06throughout
46:08your
46:08journey
46:08in
46:09this
46:09bariatric
46:10treatment
46:12anything
46:13else
46:14of
46:14course
46:16there
46:16are
46:16some
46:16failure
46:17fail
46:18cases
46:18but
46:19due
46:19to
46:20whatever
46:20reason
46:21but
46:21never
46:21mind
46:21if
46:24you
46:24fail
46:25in
46:25your
46:25effort
46:27to
46:27reduce
46:27your
46:28weight
46:28do
46:28not
46:29shy
46:29away
46:30please
46:31come
46:31back
46:31and
46:32see
46:33us
46:33there
46:33are
46:34various
46:34means
46:34and
46:35ways
46:35how
46:35we
46:35can
46:35actually
46:36help
46:36you
46:37and
46:37there
46:37are
46:37actually
46:38one
46:38or
46:38two
46:39things
46:39that
46:39we
46:39need
46:40to
46:40mitigate
46:41so
46:41that
46:41you
46:42are
46:42back
46:42on
46:43track
46:43right
46:43you
46:44know
46:44what
46:44it
46:44will
46:44be
46:45it
46:45is
46:45very
46:46very
46:46exciting
46:47when
46:48you
46:48after
46:49you
46:49you
46:50you've
46:50done
46:50your
46:50surgery
46:51you
46:51see
46:52that
46:53your
46:53scale
46:53is
46:53going
46:54down
46:54and
46:54that
46:54should
46:55motivate
46:55you
46:56more
46:56true
46:57you
46:57know
46:58like
46:58I
46:58could
46:59lose
46:59a
46:59few
46:59kilos
47:00within
47:00the
47:01first
47:01week
47:02or
47:02second
47:02week
47:02or third
47:03week
47:03you know
47:03it
47:04keeps
47:04going
47:04down
47:04but
47:05at
47:05the
47:05same
47:05time
47:06after
47:06a while
47:07it
47:07will
47:07be
47:07stagnant
47:09yeah
47:09again
47:09it
47:10will
47:10stop
47:11you
47:11will
47:11stop
47:11losing
47:12weight
47:12but
47:13that's
47:13when
47:13you
47:13have
47:13to
47:14control
47:14take
47:15charge
47:15all
47:16right
47:16okay
47:17thank
47:17you
47:17so
47:17much
47:18to
47:18Dr.
47:18Shukri
47:18and
47:19also
47:19Dato
47:20Shafzam
47:20yeah
47:21okay
47:22so
47:22I
47:22think
47:23there's
47:23a few
47:23key
47:24principles
47:25and
47:25also
47:25main
47:26key
47:26points
47:27that
47:27I
47:28would
47:28like
47:28just
47:28to
47:28summarize
47:29number
47:30one
47:30of course
47:30the
47:31input
47:31and
47:31output
47:32that
47:32you
47:32are
47:32taking
47:33whatever
47:33you
47:33consume
47:34and
47:34also
47:35how
47:35much
47:35calories
47:36that
47:36you
47:36burn
47:36after
47:38that
47:38is
47:38very
47:38important
47:39to
47:39maintain
47:40a
47:40healthy
47:41weight
47:41and
47:41also
47:42a
47:42healthy
47:42lifestyle
47:43also
47:43engage
47:44yourself
47:45in an
47:46active
47:46just
47:46choose
47:47whatever
47:47maybe
47:48sports
47:49whatever
47:50activities
47:50nowadays
47:51they have
47:51pickleball
47:52they have
47:52a lot
47:52of
47:53futsal
47:53whatever
47:53it is
47:54just
47:54but
47:55not
47:55majung
47:55lah
47:56majung
47:58karen
47:58doesn't
47:59work
47:59anything
48:01that
48:01you have
48:01to
48:01sweat
48:02and
48:02move
48:03around
48:03and burn
48:03calories
48:04which
48:04is
48:04very
48:04important
48:05nowadays
48:06and
48:06if
48:07you
48:07have
48:07any
48:08doubts
48:09or
48:09inquiry
48:09just
48:10please
48:10get
48:11to
48:11the
48:11real
48:12I mean
48:12I would
48:13say
48:13the
48:13reliable
48:14sources
48:14like
48:15Dr.
48:15Shukri
48:16which
48:16is
48:16in
48:16IKN
48:17or
48:17any
48:17other
48:19I would
48:20say
48:20health
48:21support
48:22professional
48:22yes
48:24and also
48:24don't
48:25just
48:25rely
48:25on
48:26what
48:26you
48:26read
48:26on
48:27the
48:27social
48:28media
48:29because
48:29of course
48:30we have
48:31to
48:31understand
48:31a lot
48:32of
48:32things
48:32are
48:32not
48:32very
48:33true
48:33inside
48:33it
48:34so
48:34you
48:34have
48:34to
48:35get
48:35direct
48:35to
48:36the
48:36experts
48:37like
48:38Dr.
48:38Shukri
48:38he's
48:39in
48:39Institut
48:39Cancer
48:39Negara
48:40and
48:41support
48:41group
48:42like
48:42what
48:42has
48:42been
48:42mentioned
48:43please
48:43block
48:44me
48:44okay
48:48so
48:49to
48:50all of
48:50our
48:50audience
48:51I hope
48:51you have
48:51enjoyed
48:52our
48:52session
48:52for
48:53today
48:53don't
48:53forget
48:54to
48:54follow
48:54all
48:55Sina
48:55daily
48:55social
48:56media
48:56platforms
48:57and
48:57download
48:57Sina
48:58daily
48:58new
48:59and
48:59improved
48:59mobile
49:00application
49:00stay
49:01tuned
49:01for
49:02our
49:02next
49:02episode
49:02next
49:03month
49:03till
49:03then
49:04take
49:04care
49:04stay
49:05healthy
49:05and
49:05don't
49:06forget
49:06to
49:06count
49:07your
49:07calories
49:07let's
49:08fight
49:08obesity
49:09and
49:09metabolic
49:10syndrome
49:10together
49:11towards
49:12a
49:12healthy
49:12nation
49:13hopefully
49:13next
49:14year
49:14will
49:14be
49:15no
49:15longer
49:16number
49:16one
49:16hopefully
49:16Mr. Shukri
49:17alright
49:19so I'll see you guys again
49:20next month
49:21Assalamualaikum
49:22bye
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