Quality of Life & Psychosocial FactorsResearch & InnovationPhysical Health
Written By Torie Robinson

Why Obesity is Common - and Overlooked - in Epilepsy Care - Dr. Ching Soong Khoo, Hospital Canselor Tuanku Muhriz, Malaysia

Obesity is a major but often overlooked issue in epilepsy care. Dr. Ching Soong Khoo discusses new prevalence data, links between obesity, mobility, and quality of life, and why weight is frequently missed when seizure control becomes the primary focus. The conversation also explores exercise fear, physical activity patterns, and practical guidance for supporting safe movement and healthier outcomes in people with epilepsy.

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Episode Highlights

  • Obesity prevalence in adult epilepsy populations

  • Physical activity levels and reduced mobility

  • Exercise fear and common misconceptions

  • Interpreting six-minute walk test findings

  • Diet, binge eating, and behavioural cycles

  • Using international guidance to support safe activity

About Dr. Ching Soong Khoo

Ching Soong Khoo is a distinguished Consultant Neurologist and Internal Medicine Physician from Hospital Canselor Tuanku Muhriz UKM, also serving as an Associate Professor at Universiti Kebangsaan Malaysia. He possesses deep expertise in complex neurological conditions such as epilepsy, Alzheimer's disease, and traumatic brain injury. His specialisation allows for comprehensive patient care, integrating internal medicine insights with advanced neurological treatments.

Full profile: Ching Soong Khoo

Organisations mentioned:

Topics mentioned

  • Obesity

  • Diet

  • Fitness

Related papers:

  • Trailer

    00:00 Ching Soong Khoo

    So I think the first thing is about addressing the fear. We have to really sit down and discuss what the fears are. Is there any barrier to exercise, and so on? And a lot of times I feel that these are all the myths or misconceptions about epilepsy among people with epilepsy.

    Introduction

    00:23 Torie Robinson

    Welcome to Epilepsy Sparks Insights! I’m your host, Torie Robinson, and here we talk with specialist clinicians and researchers to spark improved understandings of the epilepsies worldwide. If you’re new here, please subscribe so you don’t miss future conversations - and let’s get into today’s episode.

    Today I’m joined by Consultant Neurologist Dr. Ching Soong Khoo! In this episode, we focus on obesity in people with an epilepsy - why it’s so common, why it’s often overlooked, and what research shows about physical activity, mobility, and quality of life.

    Why obesity is overlooked

    00:52 Torie Robinson

    So why is obesity such an important but kind of generally overlooked issue for people with an epilepsy?

    00:59 Ching Soong Khoo

    It is long known that people with epilepsy have a two-fold to five-fold risk of developing comorbidities compared with those without epilepsy. Obesity is increasingly recognised as a significant comorbidity among people with epilepsy. The relationship between epilepsy and obesity is complex and bi-directional. This aspect is often overlooked during our day-to-day practice as we are so much focused on seizure control. Understanding obesity among them is crucial so that we can adopt an integrated approach in the management of epilepsy.

    Why we should be addressing obesity

    01:42 Torie Robinson

    And why is it crucial though? And why should people be looking at that at the same time? And is it clinicians who should be looking at it or people with an epilepsy as well? Or both?

    10:50 Ching Soong Khoo

    Obesity is such a global issue nowadays. We should always look at our weight, both the patients and I would say probably three parties: the patients, the caregivers and the clinicians.

    02:05 Torie Robinson

    Well, it affects quality of life as well, doesn't it? I think it's very easy for us all to put on weight slowly. And then - and I'm speaking from experience here! - and then you get to a certain stage and you're like “Oh my god…” and you have the aches, the pains, the potential stigma, the increases in risks of cancers and everything like that.

    02:27 Ching Soong Khoo

    It also serves as an reminder, for me myself, to always look at me (as a clinician), because when we talk about weight management, we must look convincing! I can't be overweight or obese while talking about the obesity issue.

    02:47 Torie Robinson

    The rules apply to all of us, to improve health, right.

    02:50 Ching Soong Khoo

    Precisely. I think as a clinician, we should set as an example, you know, to the patients and caregivers.

    Publication re epilepsy and obesity

    02:58 Torie Robinson

    So tell us about your most recent paper about the high prevalence of obesity in people with an epilepsy. And can you share some statistics about that as well, please?

    03:08 Ching Soong Khoo

    Sure, thank you for picking this manuscript which is fresh out of the oven. So the prevalence of obesity among the adult epilepsy patients at our centre is 39.2%. This is the first ever data available in our country. And I think this figure is alarming, as you pointed out, if we were to compare to the prevalence of obesity in the general adult population of Malaysia, which stands at about 21.8%... so the prevalence of the obese patients is alarming, 39.2%. If you compare to the other Asian countries, the rates have been reported between 20 and 49 percent.

    03:57 Torie Robinson

    It's a global issue that we all need to challenge, but that is very, that is alarming. You also looked at, I believe, physical activity levels, and, kind of, to compare, see if there's a correlation.

    Lack of vigorous activity, reasons

    04:05 Ching Soong Khoo

    We observe a lack of vigorous physical activity in the obese group. They commute less by active transportation and they prefer light to intense activities (compared to those non-obese). We are also interested in the six-minute walk test and it's found that the mean six-minute walk distance in the obese group is about 322 meters. And for your information, a healthy adult is expected to achieve between 400 and 700 meters. So they walk less.

    04:40 Torie Robinson

    Did you find out the reasons why for this or this is just identifying the patterns?

    04:46 Ching Soong Khoo

    Well, there are reasons to it. We also assess this in different ways. So one of the things is actually to score them according to their activity. So, we find out that the majority actually prefer light activities. So when something like moderate to intense activities, we find that they are not so interested. And in fact, they actually score zero! So they don't prefer to moderate to intense activities.

    05:19 Torie Robinson

    There can be many reasons for that as well and that’s maybe that's another another paper, but it's not… I think some people presume it's laziness that people don't exercise but the reasons can be far deeper than that.

    05:29 Ching Soong Khoo

    That's right. So I think this is something that I hope in the future we can have a sub-study. So there are many reasons to it. And of course, one of the reasons, for example, if a patient has a trauma, for example, traumatic brain injury or a cortical stroke resulting in seizures, so what we expect them to move, you know, there will probably, you know, be bad reason, you know, or, you know, moving less compared to those without a cortical stroke or a traumatic brain injury.

    06:07 Torie Robinson

    Makes perfect sense and I think it's the same if you're depressed, which many people with an epilepsy are, it can be so much harder just to not even go for a walk sometimes [but] to leave the house. So there can be many factors coming into why a person, actually, not just exercises less, but also eats differently, and it's the food that actually contributes more to a person's weight  than the exercise.

    So heaps of people with an epilepsy, and this will go for their caregivers often as well, can really worry about exercising. They think “Oh my goodness, am I gonna have a seizure when this happens? Am I gonna get too stressed? Or is the sport that I like to do, is it quite extreme and maybe I shouldn't do it?”. What do you say to somebody who wants to become more active but is nervous about doing it?

    Addressing fear of physical exercise

    06:56 Ching Soong Khoo

    So I think the first thing is about addressing the fear. We have to really sit down and discuss what the fears are. Is there any barrier to exercise, and so on? And a lot of times I feel that these are all the myths or misconceptions about epilepsy among people with epilepsy. One of the ways we can overcome this is actually to refer to a special report which was published by the ILAE Task Force on Sports and Epilepsy in 2016, which actually offers very clear guidance concerning participation of people with epilepsy in sports activities. So, having such a handout explaining what they can or cannot do is helpful.

    07:49 Torie Robinson

    And I think that would be very helpful also for any patients or caregivers that are interested in reading it. Just have a look and the link to that is below this recording or on the website as well. what about tips for altering one's diet. Because again, diet is the main cause of obesity in those who are obese. We can't look at just changing exercise patterns. What about the food that we consume?

    Managing the food we consume

    08:16 Ching Soong Khoo

    That's a good question. We should avoid a food that is rich in high calorie, high carbohydrate. As you know, you're probably aware that one of the ways to control seizures through a ketogenic diet, so meaning that low sugar is always good, and we all know low sugar is always good for your brain health in general - regardless of any neurological disorders. So I think this is one of ways to, probably one of the easiest ways to overcome this problem. And I think because of the mechanism of epilepsy, a lot of people actually tend to binge food.

    09:03 Torie Robinson

    I've certainly been there!

    09:04 Ching Soong Khoo 

    Either just as a habit or just acute boredom, especially when, you know… so it works like a vicious cycle. So you don't move, you stay at home, you get nothing to do. Like, what I usually do… that's why I like to, I like being busy. If I have nothing to do, I'll just sit on the sofa, watching Netflix and finding some nuts and snacks… just to cue my boredom.

    09:26 Torie Robinson

    Or chocolate or crisps…

    09:27 Ching Soong Khoo

    Yeah, whatever, you know, for me, have a sweet tooth, so I have to control myself. So I think sometimes, some patients with epilepsy probably do not have this mechanism to control, you know, the food-binging desire. So it can be very dangerous. So it's like a vicious cycle. You don't move, you don't exercise, and you keep eating, and that's how…

    09:56 Torie Robinson

    And then you feel worse, you feel more depressed, you feel more self-conscious and then…

    09:59 Ching Soon

    Exactly.

    09:59 Torie Robinson

    … “Okay, I'll eat some more…”. 

    10:01 Ching Soon

    The other factors, together, yeah.

    Final thoughts

    10:03 Torie Robinson

    Thank you so much to Ching Soong for sharing his insights. In this episode, we’ve focused on why obesity in people with an epilepsy is so common, why it’s often overlooked, and what the research tells us about physical activity and health.

    In the next episode, we’ll continue our conversation by focusing on what can actually help - including safe exercise, diet, and multidisciplinary care, plus, we’ll speak about how clinicians can better support long-term physical and mental health.
    If you found our chat helpful, please give it a like and subscribe, and hit the bell so you are notified when new episodes drop. I’d love to hear your thoughts or experiences in the comments below. If you’d like to support Epilepsy Sparks, mugs and T-shirts are available - it’s entirely optional, and you’ll find the link below.See you next time.

Torie Robinson
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