Obesity and the Circulation: Why Vascular Surgeons Want Earlier Treatment
Dr Andrew Choong was one of the experts quoted in a Medical Channel Asia feature, Obesity: The Missing Link in Singapore’s Heart Health Strategy, published on 29 September 2025. This post, added to the blog in October 2026 so that the feature sits in the media archive, summarises the vascular side of the argument.
Every day in Singapore, around 22 lives are lost to cardiovascular disease, and the feature opens with the projection that this could nearly triple by 2050. Age and genetics play their part, but one of the largest and least treated contributors is obesity. The article brings together a cardiologist’s view of what excess weight does to the heart and a vascular surgeon’s view of what it does to the rest of the circulation.
What does a vascular surgeon see?
The arteries and veins outside the heart are where the consequences of obesity, high blood pressure, diabetes and high cholesterol eventually show. Dr Choong’s point in the feature is about timing: by the time most patients reach a vascular clinic, the damage has already been done. Legs are already swollen with venous disease, arteries are already hardened by peripheral arterial disease, and the kidneys may already be failing. “The tragedy is not just the disease, but the delay,” he says. “We are intervening too late.”
Why does obesity matter for the arteries and veins?
Fat stored around the abdomen and internal organs is metabolically active. As the cardiologist quoted in the feature explains, it drives inflammation, insulin resistance, abnormal blood lipids and high blood pressure, and all four accelerate the narrowing and stiffening of arteries. The same process that causes a heart attack in the coronary arteries causes a stroke in the carotid arteries, claudication and non-healing wounds in the leg arteries, and weakening of the aortic wall that can lead to an aneurysm. Excess weight also raises pressure in the leg veins and is one of the recognised risk factors for deep vein thrombosis.
What is the argument for earlier treatment?
The feature argues that obesity should be recognised as a chronic, relapsing medical condition rather than a personal failing, and treated with the same structure as high blood pressure or diabetes: early screening of at-risk groups, a proper medical and metabolic assessment, and sustained support with nutrition, physical activity and, where a doctor considers it appropriate, medical therapy. The aim, in Dr Choong’s words, is “lifelong cardiovascular health and freedom from disease”, so that fewer people reach the stage of bypasses, dialysis or amputations.
“In vascular medicine, we never wait for a stroke before treating high blood pressure, and we never wait for a heart attack before lowering cholesterol. Obesity should be no different.”
Dr Andrew Choong, Medical Channel Asia, 29 September 2025
What does this mean for you?
If you carry extra weight and also have high blood pressure, diabetes or high cholesterol, the arteries in your legs and neck are under the same strain as the arteries of the heart, and they can be checked without any radiation or injection. A duplex ultrasound scan shows whether the leg and carotid arteries are narrowing and whether the leg veins are working properly, long before symptoms force the issue. Warning signs that should not wait include calf pain on walking that eases with rest, a foot wound that is slow to heal, a swollen or painful leg, and any brief episode of weakness, numbness or loss of vision, which can be a warning stroke.
Read the full feature: Obesity: The Missing Link in Singapore’s Heart Health Strategy (Medical Channel Asia, 29 September 2025). Other media features are collected on the In the Media page.
Preparing for a vascular review
A vascular review looks at the whole circulation outside the heart: the carotid arteries, the aorta, the leg arteries and the leg veins. The peripheral arterial disease page explains how poor leg circulation is assessed, the aortic awareness page covers who should be screened for an aneurysm, and the vascular ultrasound page describes the scan itself. To make an appointment, use the contact page.