Malaysia is well-known to the world for a number of reasons. These include being a popular food haven and tourist destination, as well as a melting pot of different cultures. Unfortunately, Malaysia has also earned itself the label of the “Most Obese Country in Southeast Asia”, with 50.1% of the country’s adult population being overweight and obese, according to latest National Health and Morbidity Survey 2019. What’s worse, it has also been reported that a substantial number of Malaysia’s obese population are below the age of 40 and suffer from a number of obesity-linked health problems.

These include hypertension, joint pains, hormone-related problems, as well as primary infertility in women. Obesity can also cause a number of non-medical implications, such as “fat-shaming” and social stigma, and mental health problems such as anxiety disorders and depression.

In that regard, let us dive into a deeper understanding of obesity in the hope that it will help us to relook our lifestyle habits and prevent a further increase of obesity cases in Malaysia.

What is Obesity?

Obesity can be defined as a precursor for a few different medical and non-medical implications. It is a chronic disease and can be distinguished by several different classes – overweight, Class One, Class Two and Class Three obesity.

The most common way to determine if you experience obesity is to identify your Body Mass Index (BMI), which is a measurement of your body weight in kilograms (kg) divided by your height in metres squared (m²).

According to the Malaysian Clinical Practice Guidelines of Obesity, an individual is considered to be overweight if they have a BMI of 23-27.4 kg/m2. Class One obesity, on the other hand, refers to patients who have a BMI of 27.5-34.9, whereas Class Two obesity and Class Three obesity refers to patients who have a BMI of 35-39.9 and more than 40, respectively.

A normal BMI reading for individuals of Asian ethnicity is typically between 18.5-22.9. In Malaysia, however, the majority of obese patients have a BMI of more than 35, which is particularly unique to Class Two and Class Three obesity.

What are the Causes of Obesity?

One of the reasons as to why obesity occurs is because a patient’s daily consumption of calories is not matched by an equal amount of calorie burn, either through performing daily activities or exercise. For example, a healthy individual requires approximately 2,000 kilocalories per day. If that same individual orders a basic Nasi Kandar set that consists of white rice, a chicken dish, kuah campur and vegetables, he or she will consume approximately 900 kilocalories. Coupled with a glass of iced Milo or teh o’ ais limau, it will bring the individual’s calorie intake to a whopping 1,200-1,300 kilocalories, all in a single sitting!

Also, obesity is particularly prevalent amongst the Malaysian population because there is a lack of awareness regarding the dangers of obesity. This is evident from a large number of advertising billboards on highways promoting fast foods and food delivery services, but very little promotion, in comparison, to healthy eating habits. In addition, certain individuals are also genetically predisposed to having a lower metabolic rate, which increases their risk of excessive weight gain.

What are the Risk Factors for Obesity and Who Is Most at Risk?

The most common risk factor for obesity is a sedentary lifestyle, which is particularly common amongst individuals who do not have an active daily work schedule. Similarly, another risk factor for obesity is a lack of physical activity, which is typical amongst individuals who lack a scheduled and disciplined exercise regime. In that regard, everyone is at risk of becoming overweight or obese, especially if they fail to make regular physical activity or healthy eating practices a priority.

How are Patients with Obesity Being Managed in Malaysia?

Until very recently, obese patients in Malaysia did not have access to a central obesity clinic that could help them manage their condition effectively. Fortunately, over the last five years, the field of bariatric medicine has evolved tremendously, thus enabling trained professionals to customise weight loss plans according to the individual requirements of each patient.

Most patients typically go through a four-step cycle – diet and exercise, medication, non-invasive treatment and surgery – when attempting to treat obesity. Having said that, we do see that patients oftentimes fail at managing their condition through healthy eating and exercise as it is no secret how difficult it may be to commit to these. For that reason, a bariatric specialist may look towards prescribing medical therapy, which can help patients to achieve positive results without them having to go through the pain of a surgical procedure. A bariatric specialist may also look towards prescribing non-invasive measures such as initiating pharmacotherapy or even intragastric balloons to manage a patient’s condition effectively.

Alas, there are a few barriers that still need to be overcome to make obesity treatment easily accessible for patients. These include the limited number of hospitals in the public sector offering bariatric and obesity services, which makes it difficult for patients to treat or manage their condition effectively as it may require them to travel to a different state. In that regard, it is crucial that the stakeholders – insurance agents, non-governmental organisations, governmental organisations and the private sector – come together and find a way to make treatment more accessible for obese patients.

It is also equally important to provide more public awareness about the dangers of obesity to general health. The two driving points of this awareness should include information pertaining to why obesity is recognised as a serious medical condition and why an obese population will become more costly to manage in the future.

What Can Be Done to Improve the Diagnosis and Treatment Management of People with Obesity?

One of the ways that a diagnosis for obesity can be improved is for healthcare professionals to develop a more comprehensive screening mechanism. For instance, when a patient walks into a clinic, a doctor should not only measure their blood pressure, but their BMI as well. Subsequently, if a patient is discovered to be obese, they must be provided with a referral to an obesity clinic for treatment. Patients who are in the B40 – low-income bracket – should also be given priority access to treatment as they are most likely to have difficulty accessing medical care on a frequent basis.

What Can Be Done to Reduce the Risk of Obesity?

The first step towards reducing an individual’s risk of obesity is for them to recognise that it is, in fact, a chronic health problem. Next, they should educate themselves on what constitutes healthy eating as this is a very important factor in helping them to keep their BMI in check. Alternatively, if an individual falls under either obesity classes, they should equip themselves with knowledge of the treatment options available as this will help them to make an informed decision on how best to tackle the problem.

It is a given that a more aggressive approach is needed to address obesity at the root. This starts with addressing the need for more capable professionals – namely, physicians and surgeons – to be trained in managing obese patients. That said, obese patients should take comfort in knowing that healthcare professionals are ever-ready to help them achieve their weight loss goals and live healthier lifestyles. These include private practitioners and government clinics who may provide them with exercise and nutrition tips, as well as bariatric surgeons or physicians who may prescribe them with more advanced forms of treatment.

The Obesity Agenda: A Malaysian Context