By: Dr Wong Ping Foo, Dr Nalini M Selveindran and Professor Dr Rohana Abdul Ghani
Obesity is on the rise globally and efforts to address it are challenging due to misconceptions about obesity and the role it plays in a person’s health. The theme of this year's World Obesity Day, ‘Changing Perspectives: Let’s Talk about Obesity’, highlights the need to shift the conversation surrounding obesity. Obesity is often stigmatised and seen as a personal failure, but it is a complex issue that requires a more nuanced approach.
Obesity and overweight issues have been at the centre of Malaysia’s health agenda for many years. The latest National Health and Morbidity Survey (2019) revealed that 50.1 per cent of Malaysians are overweight and obese. More alarming is the rising childhood obesity - 29.8 per cent of children aged 5 to 17 are overweight or obese1. The World Obesity Federation predicts that 41 per cent of the country’s adults will be obese by 2035 if this disease is not addressed2. Other than being the root cause to more than 200 life-altering diseases, overweight and obesity are expected to impact Malaysia’s GDP as much as RM3.2 trillion (2.8 per cent) by 20352.
Malaysia has to act fast and make fundamental changes. The urgency to do so has never been more dire than now. The allocation of RM332 million in the 2023 budget, aimed at encouraging more active, healthy lifestyles among Malaysians3, should just be the start.
As the first point of contact for many individuals, primary care providers have a unique opportunity to screen for obesity and provide early intervention and support. By routinely measuring and monitoring weight, providing counselling on healthy lifestyle behaviours, and referring to appropriate resources, primary care providers can help to prevent and manage obesity in their patients.
One of the leading contributing factors for obesity is urbanisation. Malaysia is one of the most urbanised countries in Southeast Asia, with a majority of its population living in urban areas. This rapid urbanisation has led to significant changes in lifestyle, dietary habits, and physical activity levels, contributing to the rise in obesity rates in the country.
The increasing availability of fast food and convenience stores in urban areas has led to higher consumption of calorie-dense and nutritionally-poor foods.
Combined with the decrease in physical activity levels, the increasing reliance on private vehicles and the lack of safe walking and cycling infrastructure in urban areas, people are less likely to engage in physical activities like walking, cycling, or jogging.
This sedentary lifestyle, coupled with poor food habits has led to a significant rise in obesity rates in Malaysia.
We need to change the way we see obesity. People generally think that if a person is obese then it is their responsibility to lose weight.
However, that is a misconception. It is a societal issue that impacts everyone. Obesity is a result of the complex interplay between individual behaviours, environmental factors, and social determinants of health.
Therefore, combating obesity requires a comprehensive, multi-sectoral approach that involves individuals, families, communities, schools, workplaces, and policymakers at all levels.
The first step towards managing this is to destigmatise obesity which will encourage a positive environment for self-acceptance creating a safe space for people to speak up about being obese.”
Childhood and adolescent obesity are also a growing concern in Malaysia and urgent action is of paramount importance to safeguard the health of the new generation.
According to data from the National Health and Morbidity Survey conducted in 2019, the prevalence of obesity among children in Malaysia was 14.8 per cent, up from 3.9 per cent in 2011 – a three-fold increase in less than 10 years.
Parents and extended family members in the same household play a major role in ensuring obesity in children is not normalised.
While it may be tempting to view overweight children as adorable and cuddly, this can be harmful to their health. Obese children tend to become obese adults, and there are many medical issues associated with obesity that can have a significant impact on the quality of life.
Serious health problems
Children who are obese are susceptible to developing serious health problems in early adulthood such as Type 2 diabetes, high blood pressure, high cholesterol, liver disease and sleep apnea. They have an increased risk of psychological comorbidities, including poor self-esteem, increased risk of depression and anxiety and in some cases may be victims of bullying.
One of the most important steps in dealing with childhood obesity is promoting a healthy lifestyle that encourages regular physical activity, healthy eating habits, good sleeping habits and structured use of screen time.
By eating healthy meals together and engaging in physical activities as a family, children are more likely to adopt and practice healthy habits and maintain them over time. Healthcare providers and nutritionists can be helpful in developing a personalised plan for managing childhood obesity providing guidance on healthy food choices, portion sizes, and physical activities appropriate for the child’s age and fitness level.
It’s important to remember that addressing childhood obesity is a journey that requires patience and dedication. However, by involving the family, school, and the community in the process and seeking professional help when needed, children can achieve a healthy weight and reduce their risk of health problems later in life.
In Malaysia, the lack of recognition of obesity as a chronic disease has significant implications on the way obesity is treated and managed in the country. Changing perspectives on obesity involves recognising that obesity is not simply a matter of willpower or personal responsibility. Rather, it is a multifactorial issue influenced by genetics, environment, and lifestyle factors.
When we think of or talk about obesity, we often think about appearance, public conception and its effect on the individual’s confidence. While that is true, the impact of this disease goes way beyond that. Obesity can have significant economic implications, including increased healthcare costs and lost productivity.
In addition, individuals with obesity may face discrimination and stigma, which can have negative impacts on their social and emotional wellbeing.
There needs to be a clear awareness when it comes to differentiating between body shaming and being able to talk about obesity. It is an important conversation to have when it comes to addressing public health concerns and promoting healthy lifestyles. Obesity is a serious disease that needs to be addressed urgently. However, it is important to do so in a way that is respectful and non-judgmental, and that considers the complex social, cultural, and environmental factors that contribute to obesity.
Negative attitudes, discrimination harmful
We must move beyond blaming individuals and instead focus on creating supportive environments that promote healthy behaviours and sustainable lifestyles. Negative attitudes and discrimination towards people living with obesity can have harmful effects on their mental and physical health, making it harder for them to access healthcare and seek support.
It is time to challenge harmful stereotypes and promote empathy and understanding towards those living with obesity.
As a nation, there’s an urgent need to prioritise the prevention and management of obesity by promoting healthy eating habits, increasing physical activity, and creating supportive environments that make the healthy choice the easy choice. This requires a multi-sectoral and multi-level approach that involves collaborations between government, healthcare providers, educators, and the private sector to address the root causes of obesity and create sustainable solutions for a healthier Malaysia.
To this end, professional associations such as the Malaysian Obesity Society (MYOS) have a key role to play.
Our aim is to increase the share of voice for obesity awareness and management in Malaysia.
By creating a platform to share knowledge and expertise, MYOS and its members are seeking more effective collaborations with other medical societies, policy makers, and patient-advocacy groups with similar objectives relevant to obesity awareness and management, towards making a change for a healthier nation.
Dr Wong Ping Foo is Family Medicine Specialist, Malaysian Obesity Society exco member
Dr Nalini M Selveindran is Paediatric Endocrinologist, Malaysian Obesity Society exco member
Professor Dr Rohana Abdul Ghani is Professor of Medicine and Consultant Endocrinologist, Universiti Teknologi Mara and President, Malaysian Obesity Society