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Vivienne Lim and Tracy Low,
The New Paper
Friday, Jun 03, 2016
She is a healthcare professional, but her concern over her 63kg weight when she was 19 made her turn to slimming pills.
It landed her in hospital with internal bleeding.
Despite that ordeal, she went on another weight-loss regimen a few years later - because she wanted to be a role model for her patients.
Again, she suffered side effects.
The registered nurse, who wanted to be known only as Ms A. Cheah, 27, was among 10 women who admitted to taking slimming pills out of 170 women polled by The New Paper.
Their ages range from the teens to the 50s.
Weight-loss pills made the news again during a coroner's inquiry into the death of a 22-year-old student from China on June 28 last year.
On Tuesday, State Coroner Marvin Bay found that Ms Huang Guo had died after overdosing on slimming pills and called her "sad demise" an unfortunate misadventure.
Ms Cheah said that, as a healthcare professional, she knew the dangers of overdosing and followed the recommended dosages strictly.
Even so, her weight-loss attempts went awry.
When she was 19 and working as a nurse in a hospital, a doctor prescribed her a popular brand of slimming pills after she told him that she wanted to lose weight.
The pills contained Phentermine, also found in the pills used by Ms Huang. It is commonly used to treat obesity as it suppresses appetite.
As a result of consuming the pills and her hectic workload, Ms Cheah skipped meals and even "went without food for a few days".
After about four months, the 1.61m-tall nurse's weight dropped to 59kg.
The most satisfying results were her "ability to fit into clothes" and "a boost in self-esteem", she said.
But she eventually paid a price and landed in the National University Hospital (NUH).
She recalled: "The day before I was admitted, I experienced a sharp pain in my bladder. The next day, I passed stools that had maroon-coloured-blood - enough to fill a drink can. I fainted afterwards and was admitted. From the diagnosis, my small intestine was eroded."
After she was discharged, she put on weight and returned to her original weight.
When she was 23, Ms Cheah had a relapse after a hospital patient told her preceptor, who was obese, in front of her:
"I should be giving you healthcare advice, not you to me."
The insult, while not directed at Ms Cheah, reminded her that one of her responsibilities as a nurse was to be a role model for patients by maintaining a healthy image.
She started exercising, but found losing weight difficult.
After some time, she resorted to taking diuretics, a drug that helps rid the body of water, resulting in faster weight loss.
Ms Cheah used diuretics off and on, but finally stopped taking it recently after experiencing severe tiredness, a side effect of its use.
More importantly, she wanted to see if she could maintain her weight without the help of any medical aids.
"I have learnt that there is no shortcut for anything. When I tried using diuretics, it made me feel lethargic and unwell. Exercising, on the other hand, made me feel much better," said Ms Cheah who now weighs about 60kg.
Reflecting on her weight-loss journey, she admitted she had "abused her healthcare knowledge" by using diuretics as a weight-loss substitute, but, at the same time, she had "learnt more about herself as a person".
For example, she realised that it was due to her "lack of self-discipline" in maintaining her weight that she resorted to diuretics.
Ms Cheah said she started on slimming pills at 19 because she enjoyed eating and did not exercise.
Nowadays, she does regular exercises, such as brisk walking, and controls her diet by avoiding processed foods such as instant noodles.
Still, Ms Cheah, who has a boyfriend, would not rule out slimming pills altogether.
"Who knows, after childbirth, I may gain a lot of weight," she said, adding that her fear of being overweight continues to haunt her. Where I work, I see a weighing scale every day. It is a constant reminder of my weight."
Celebs on slimming pills experience
ANDREA DE CRUZ
'There's no fast way to lose weight'
The former actress and host said she was shocked to hear about Ms Huang Guo's death because it had been a long time since she came across such an incident.
"I'm shocked and saddened to hear about this," said De Cruz, 41, who had a bad experience with the slimming pill Slim 10 in 2002.
She suffered from liver failure after taking the product.
Her then-boyfriend, actor Pierre Png, donated part of his liver to her.
"I think I am the biggest and best example of how one could die from taking weight-loss pills bought off the shelf," she said.
"I'm thankful and grateful to be able to plant my feet on the ground each day and breathe."
De Cruz encourages exercise and healthy diet as "there is no fast way to lose weight".
"I hope girls are better educated and more aware of the dangers of pills that you can buy off the Internet or over the counter.
"Unfortunately, another life is lost. Girls need to know that they should not do things that risk their lives."
'I stopped because I couldn't sleep'
The 40-year-old ONE FM 91.3 radio presenter felt Ms Huang Guo's death is "a huge tragedy and such a waste of a young life and a beautiful person".
When Miles was in her 20s, she took weight-loss pills and was addicted to them because they gave her a "caffeine rush".
But she stopped taking the pills after three years as it affected her health.
Miles said: "I couldn't sleep, I experienced insomnia. There were definitely some cold turkey effects when I tried to quit it.
"I think it's important to accept and understand our body type and to equip ourselves with information about nutrition and exercise.
"Girls should accept and love themselves for who they are and not allow external pressures to make them feel the need to lose weight. People are more than just their body parts."
'Pills led to my depression'
The local singer, who took weight loss pills for eight months in 2012 when she debuted as part of the K-pop girl group Skarf in South Korea, said that cases like Ms Huang have, unfortunately, "become common over recent years".
Wong, 24, added: "It's a shame to lose lives over diet pills. I hope such cases can be a wake-up call to those who are thinking of relying on diet pills to lose weight.
"Although we cannot stop people from buying these pills, the least we can do now is to increase awareness of the harmful side effects these pills can cause."
Recalling her own experience, Wong said: "It affected my mood. It was so bad, it escalated to depression. I lost about 7kg with the help of diet pills. But after I stopped eating them, my weight rebounded even quicker."
'Do not buy pills online'
Consumers face an increased risk with weight-loss pills because they are becoming more readily available despite being controlled drugs that can be prescribed only by doctors.
Consultant endocrinologist Daniel Wai told The New Paper: "Buying things online is easy. You can find clinics and sellers from around the world selling these restricted drugs.
"However, it is dangerous and illegal, so do not buy medication online."
Dr Wai, who runs his own practice at Daniel Wai Diabetes, Thyroid and Hormone Clinic, said the right way to buy such pills is through a doctor who can assess the patient and advise accordingly.
"Taken in the right doses, it is safe most of the time," he explained.
What are the dangers of abusing weight-loss pills in general?
In Singapore, only phentermine and orlistat are licensed for the management of obesity.
As any medication has side effects, people who do not require medication should not take them.
What are the dangers of abusing weight-loss pills, specifically fluoxetine and phentermine?
Phentermine works mainly by suppressing appetite and increasing metabolism.
Even in normal doses (maximum 30mg daily), side effects such as dry mouth, restlessness, insomnia, palpitations and euphoria can occur.
In Singapore, it is allowed to be used only in obese patients (body mass index or BMI greater than 27.5) or highly overweight patients (BMI greater than 25) with complication from obesity such as fatty liver, prediabetes and diabetes.
Fluoxetine is an antidepressant and has no place in managing obesity per se.
It may cause weight gain in some patients.
What happens in an overdose of weight-loss pills?
Taking too much phentermine can lead to sympathetic overactivity, meaning that the metabolic rate goes too high, heart rate goes too high, fever, pupil dilatation with blurred vision, sweating, hyperventilation.
It can also cause rhabdomyolysis (dissolving of muscles causing kidney failure).
Death is possible.
Have you seen other cases of death as a result of weight-loss pills overdose?
Most patients are assessed by doctors for eligibility. They are informed of and monitored for potential side effects.
In the case of Ms Huang Guo, she apparently ordered the medication from a clinic in Thailand.
This should not have happened because:
There was no medical supervision.
Her BMI was normal at 22.8, making her ineligible for the medication.
She overdosed, perhaps unaware of the side effects.
It is impossible to tell the authenticity of medication bought online.
Phentermine is a controlled substance and prior approval from Health Sciences Authority is required for its consumption.
It is against the law to import it - even for your own use.
Is it rare to die from consuming weight-loss pills?
For patients who take normal doses, it is almost unheard of.
The majority of deaths are caused by overdose of phentermine.
About the case Ms Huang Guo, a 22-year-old student from China, and two housemates were at Cathay Cineleisure's K-Box for karaoke on June 27 last year when she suddenly collapsed midway through a song.
One of her housemates, Ms Fu Shiting, called the police for help at 11.50pm.
Ms Huang was pronounced dead on June 28 at Tan Tock Seng Hospital.
A forensic pathologist verified the cause of death to be from acute toxicity from two drugs, phentermine and fluoxetine.
Phentermine is a stimulant for short-term use to aid weight loss.
Fluoxetine is a prescription drug often used to treat depression and it might be prescribed by some doctors for its "off label" use in losing weight.
Ms Huang's blood had about eight times the therapeutic limit for phentermine, which puts it within the toxic range.
Her blood also had around 6½ times the therapeutic limit for fluoxetine, which is within the lethal range.
Ms Huang was 1.54m tall and weighed 54kg, giving her a body mass index of 22.8.
Forty-one packets of medication were found in her bedroom by a police investigator.
Thirteen of those packets had Thai characters on the labels.
The 41 packets contained almost 400 pills of about 10 types of drugs.
Some drugs were for weight loss while others were to prevent side effects.
Based on packaging information, the medication appears to have come from a clinic and a hospital in Thailand.