Materia Medica Malaysiana

Time to tackle obesity

MALAYSIA is fast becoming a fat nation. At last count, three million Malaysians were overweight or obese, according to the Health Ministry. The figure is likely to increase because efforts to create awareness have not been successful.

Professor Mohd Ismail Noor, president of the Malaysian Association for the Study of Obesity, says a sedentary lifestyle and unhealthy eating habits are contributing to Malaysia having the highest prevalence of obesity in Asia. "Malaysians are eating too much but not getting enough exercise. In urban areas, food outlets are open 24 hours, and this, combined with the sedentary lifestyle of most Malaysians, is a recipe for disaster," he says. "Obesity will escalate unless we get our act together now." People with a body mass index of between 25 and 29.9 are considered to be overweight and those with a BMI of more than 30 are obese. Unfortunately, according to Mohd Ismail, Malaysians are not serious in tackling the issue. Obesity is associated with five of the 10 leading causes of death and disability in Malaysia, such as heart disease, Type 2 diabetes, stroke, some forms of cancer as well as hypertension.

It also substantially raises the risk of illness from high cholesterol, gallbladder diseases and arthritis.

More children are also becoming overweight or obese.

In 1990, the prevalence of obesity among children between 13 and 17 was only 0.7 per cent, but in 1997 it had increased to 5.7 per cent.

Mohd Ismail says a UKM/Nestle study of some 11,264 schoolchildren aged between seven and 12 years in four regions of Peninsular Malaysia — north, south, east and central — showed that 10.8 per cent boys and 10.3 per cent girls were overweight. Studies have shown that children who are overweight tend to be overweight adults.

Being an overweight child can have psychological effects such as low self-esteem and a sense of isolation.

Overweight children are also at risk of developing serious health problems in later life, including heart attack and stroke, Type 2 diabetes, bowel cancer, and high blood pressure. Mohd Ismail says a critical period for the development of obesity is during childhood, a period referred to as the time of adiposity rebound. The body mass index of an infant increases in the first year of life and decreases subsequently, he says.

At about five years of age, the BMI increases again. Adolescence is another critical period particularly for girls, since 30 per cent of adult obesity among women begins in early adolescence.

This is a period when patterns of fat deposition are determined by hormonal influences besides changes in eating behaviour.

"Childhood obesity is the prelude to a public health disaster that we will have to deal with. The time to act on this problem is now." "Prevention at an early age is important. Children now are eating junk food and are not involved in physical activities. Fifteen per cent of 12,000 Malaysian children are eating fast food every day." Awareness education should not only be for parents but also for teachers. "Parents and teachers should monitor what the children eat and get them to be active," he adds.

Mohd Ismail says that given the magnitude and the complexity of the problem there is an urgent need to enhance the professional understanding of prevention principles and practices.

"This can only be achieved through shared responsibility among the Government, industries and other units.

Mohd Ismail says that the association is drafting guidelines on prevention of obesity in collaboration with the Health Ministry. These will include recommendations to help prevent individuals of normal weight from becoming overweight or obese.

"The guidelines will propose strategies focusing on relevant settings such as individuals, families and communities, schools, health care, media and communication, and even the workplace." The ministry is collaborating with relevant ministries, academia and professional bodies, including the association, on the second national plan of action for nutrition.

One of the objectives of the plan is to enhance and maintain the nutritional well being for all, says Mohd Ismail.

"This includes preventing and controlling nutritional deficiencies and excesses which can cause obesity, as well as diet-related non-communicable chronic diseases."