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The Urgent Need to Challenge Obesity in Malaysia

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World Obesity Day falls on 4th March annually to increase the awareness of and action on obesity. This year, the theme “Everybody Needs to Act” calls for an urgent effort to drive greater action and partnership to improve the lives of people at risk and living with obesity, globally and in Malaysia.

While the World Health Organization has classified obesity as a chronic condition and considered it as an epidemic, many people still do not consider it as a disease and many more do not take it seriously. Obesity is one of the biggest public health challenges in Malaysia, which has the highest rates of adult obesity in Southeast Asia. As reported in the 2019 National Health and Morbidity Survey, 50.1% of the adult population in Malaysia were reported to be overweight (30.4%) or obese (19.7%).

Obesity is also linked to more than 200 other chronic diseases, including cardiovascular diseases, diabetes, musculoskeletal disorders and cancers and increases the risks of type 2 diabetes by sevenfold in men and 12-fold in women. The COVID-19 pandemic has also highlighted that people with obesity have a 240% increased risk of developing severe COVID-19 infections. Obesity not only impacts the health of individuals and communities but also has far-reaching complications for healthcare systems and the economy. In 2017, overweight and obesity accounted for 13.3% of total health costs and 0.54% of Malaysia’s GDP or USD 1.7 billion – not including the associated costs of reduced productivity, disability and absences from work.

As well as rising rates of adult obesity, the prevalence of childhood obesity are also increasing at an alarming rate in Malaysia, with 29.8% of children 5 to 17 years of age being overweight (15.0%) or obese (14.8%). This has far-reaching health and economic consequences for children, their communities, as well as health systems at large, due to the higher likelihood of developing chronic conditions, such as cardiovascular disease and diabetes, in childhood and also in later life. Additionally, there are negative social and developmental impacts for children living with obesity, such as lower school performance and lower self-esteem due to bullying.

Addressing obesity in Malaysia
Addressing obesity is a delicate and daunting task. It is a topic that almost everyone knows of and recognise, but many are more comfortable to either deny or ignore it. At the policy level, numerous important and necessary steps have been developed to acknowledge the shared responsibility needed to address nutrition. This includes the introduction of the sugar tax in 2019, and developing the National Nutrition Policy 2.0 in 2021 to proactively combat the future rise in malnutrition and obesity, as well as non-communicable diseases linked to nutrition, such as diabetes and high blood pressure, from a young age.

However, in terms of the care and management of people with obesity, many complexities in healthcare delivery still need to be further addressed.

“The current clinical management of obesity in Malaysia is insufficient to tackle the multifaceted nature of obesity. When people with obesity take the necessary steps to access care, they are offered a four-step cycle of therapy, which includes diet and exercise, medication, non-invasive treatment and surgery. However, there is a limited number of public hospitals that offer such obesity-related services, and as a result, patients in many communities lack the integrated care needed to manage obesity and must access different touchpoints, prolonging their access to effective care,” explained Professor Dr Rohana Abdul Ghani, Professor of Medicine and Consultant Endocrinologist at Universiti Teknologi Mara, who is also the chairperson of the Obesity Policy Engagement Network in Malaysia (MY OPEN), a platform that brings together national experts and other thought leaders in the field of obesity to improve obesity care.

She further added that healthcare professionals in primary care services often do not treat obesity. Rather they treat other chronic conditions related to obesity, such as diabetes and hypertension. This could have resulted not from a lack of knowledge but from the lack of prioritisation of obesity as a disease, inadequate training, and limitations in time, as well as resources.

The way forward
Together with preventative initiatives focused on nutrition, policies must also be designed to ensure effective management for people with obesity. We need to acknowledge that obesity is not just a lifestyle disorder, which the patient brought upon him/herself, but an actual disease that requires attention and proper management. This is a monumental task that necessitates engagement from all sectors – including governments, media organisations, private corporations, healthcare providers and individuals themselves. This aptly echoes this year’s World Obesity Day’s theme of collective efforts at various levels and between multiple stakeholders to tackle rising rates of obesity, reduce the stigma faced by people living with obesity, and improve the systems that contribute to obesity around the world.

“Obesity requires urgent action and the time to act is now. MY OPEN is calling for widespread recognition of obesity as a chronic disease at the government, clinical and public level. This will help to ensure that the responsibility of managing obesity moves from the individual to a collective level. We believe that a systemic and sustained approach is needed to address the complex burden of obesity,” Prof Rohana emphasised.

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