By Dr Kalaashini Ramachandran / Associate Professor Dr Hazreen Abdul Majid

Obesity is not just a disease of the rich.

Food shortage throughout history has led to the implication that being 'fat is good' because only the rich and wealthy can afford to purchase food or indulge in mouth-watering dishes, until in the late 19th century when obesity was stigmatized and was later found to be a major contributing factor to non-communicable diseases globally¹.

From scarcity of food during the Japanese occupation and pre-independence to technology advancement in food processing methods, giant fast food chain investments and easy accessibility to junk food have now made overweight and obesity a major public health crisis, seen across all income population groups, not only in Malaysia but a worldwide phenomenon.

Many might wonder why we name obesity as the silent killer. Researches have shown that it will take years before its damage becomes fully evident, and irrespective of age, being overweight or obese is strongly associated with poor health outcome².

It is very shocking to know that we are ranked first i`n being the most obese nation in Asia, where two out of three individuals are overweight.

According to the National health and Morbidity Survey 2019, almost half of our Malaysian adults (50.1%) and 30% of children (aged 5 to 17 years old) are either overweight or obese, with more than 95% of them not consuming the recommended servings of vegetables and fruits, and these numbers are predicted to rise in the future.

The other non-communicable diseases that are rising at a worrying magnitude are diabetes mellitus which has increased from 11.2% (2011) to 13.4% (2015), hypercholesterolemia has increased from 35.1% (2011) to 47.7.%(2015) and approximately 14.1% of the population has a raised blood pressure among those unknown hypertension.

Our mindset that obesity is usually seen among the rich and urban population while malnutrition is mainly seen among the poor and rural population must be changed.

The two major factors are food and physical activity making the main drivers of obesity is the imbalance between the energy consumption and energy expenditure³.

Our MOH has a very good and comprehensive dietary guidelines but how many of us practice this.

A recent study found that unhealthy dietary practices were common among low-income groups living in urban areas⁴ and it is undeniable that our children nowadays are glued to their television, handphones and computer games.

Can we just blame the kids because in our modern world even the adults are becoming prisoners to technology and smartphones? Children tend to follow in their parent's footsteps, and it is also an important window of opportunity for parents to change their lifestyle characteristics in an attempt to encourage their children to follow.

What makes this situation more obesogenic for the urban poor?

1. Availability of high energy dense food and drinks while the healthy options are not so easily available.

2. Higher income families can enroll into healthy lifestyle programs which might be difficult for the lower income groups.

3. Less conducive environment for physical activities and poor maintenance of parks and exercise centers.

So, what can we do? We cannot just accept this as the norm and let our future generations suffer the adverse effects of unhealthy eating and obesity.

1. Increase parents' awareness in more robust and simplified health messages.

2. Parents should be taught to monitor their children's weight and calculate their BMI.

3. Face-to-face health promotion and health education must be conducted among the urban poor and not depend fully on telehealth.

4. Teach children the different types of food, what is healthy and what is unhealthy.

5. Empower them to make healthy choices.

6. Effective collaboration with all stakeholders to conduct health education, monitor the availability and accessibility of healthy food choices, conduct cooking demonstration classes using less salt and sugar, and teach our community to substitute their food components to healthier options.

In view of the chronic nature of most obesity-related diseases and the huge cost of treatment, we should ensure our community has access to healthy food and gets involved in physical activities, so that our nation won't fall deeper into the obesity epidemic.

With Ramadhan just around the corner, we should be prepared to resist or control our temptation with the many delicacies and sweet food that Malaysia is famous for and will be coming our way.

The preconceived notion that obesity is a disease of the urban rich must be changed and the rising magnitude affecting the urban poor must be highlighted. We should build a fairer and healthier world for everyone.

References:

¹ Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, 587–591.

² Senthilingam, M. (2021). Covid-19 has made the obesity epidemic worse but failed to ignite enough action.

³ Romieu, I., Dossus, L., Barquera, S., Blottière, H. M., Franks, P. W., Gunter, M., Hwalla, N., Hursting, S. D., Leitzmann, M., Margetts, B., Nishida, C., Potischman, N., Seidell, J., Stepien, M., Wang, Y., Westerterp, K., Winichagoon, P., Wiseman, M., Willett, W. C., & IARC working group on Energy Balance and Obesity (2017). Energy balance and obesity: what are the main drivers? Cancer causes & control: CCC, 28(3), 247–258.

⁴ Azizan, N. A., Thangiah, N., Su, T. T., & Majid, H. A. (2018). Does a low-income urban population practise healthy dietary habit? International health, 10(2), 108–115. 

(Dr Kalaashini Ramachandran, Doctor of Public Health candidate and Associate Professor Dr Hazreen Abdul Majid, Department of Social and Preventive Medicine, University Malaya.)