The Problem Of High Level Of Obesity In Malaysia
Overview of Obesity
According to NHMS studies from 1996-2015, the rate of obesity in Malaysia had significantly increased within these year. In term of states in Malaysia, Putrajaya recorded as the highest state that has prevalence of obesity which is 25.8% compare to Sabah that recorded as the lowest state that had prevalence of obesity which is 13.4%. Overall, prevalence of obesity in Malaysia is in the range of 13% to 25%.
Based on NHMS 2015, Indians were the highest ethnic group that have high prevalence of obesity (27.1%) followed by Malays (21.1%), Bumiputera (18%), Chinese (11.7%) and other ethnicity (7.7%). Next, adults aged 55-59 years old displayed the highest prevalence of obesity as it gradually increased from 16.9% in 2006 to 20.2% in 2011 and 22.3% in 2015. Furthermore, prevalence of obesity is higher among female compare to male and this situation is consistently the same from 1996 to 2015.
Definition of overweight and obesity
World Health Organization (WHO 2018) states that overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. To determine the individual is overweight or obese, his or her body mass index (BMI) is calculated; weight (in kilograms) divided by the square of his or her height (in meters).The person will be considered as obese if his or her BMI is 30 or above and overweight when his or her BMI is equal to 25 or above. However, according Asian BMI cut off point, the person is considered as overweight and obese if the BMI is in the range of 23-24.9 kg/m2 and 25 kg/m2 or above respectively. In addition, WHO claims that overweight and obesity are major risk factors for chronic diseases such as diabetes, cardiovascular diseases and cancer.
Apart from that, BMI itself does not give an accurate results as for a person who very muscular his or her BMI also high. Therefore, a better measurement of excess fat is waist circumference. Men with waist circumference exceed 90 cm and women exceed 80 cm are more likely to be considered to develop overweight and obesity.
Cause of overweight and obesity
Basically, cause of overweight and obesity can be divided into three parts which are poor dietary intake, physical inactivity and culture.
Poor dietary intake
As what we can see in Malaysia’s scenario, Malaysian are more likely to eat fried food such as fried chicken, fried rice and they love to eat food that cooked with coconut milk such as nasi lemak and chicken curry.
The increasing of fast food restaurants in Malaysia that providing mostly fried food may also contribute to high intake of fats among Malaysians. People are more prefer to eat there as it is convenience for them in terms of time and cost. These kind of foods contained high in fat. Some of the restaurants in Malaysia also, open for 24 hours. High intake of fats could lead to overweight or obesity as fat provide more calories compare to carbohydrate and protein. One gram of fat will provide 9kcal energy while one gram of carbohydrate and protein will only provide 4kcal energy.
Furthermore, high dietary intake of fats also produce weak satiety which can lead to overconsumption of foods. According to the study from MRC Dunn Clinical Nutrition Centre, Cambridge, UK states that proteins have greater satiating capacity followed by carbohydrate and lastly fats have the weakest of satiating effect. Furthermore, excessive intake of fats can directly be stored in the body as our body has adipose tissues that specifically store excessive fat in our body. Therefore, high fat level in body could cause weight gain.
Next, fruits and vegetables consumption among Malaysian is still low. Intake of fruits and vegetables per day still were inadequate if compared with Malaysian Dietary Guidelines among adults in Malaysia. Fruits and vegetables intake are very essential to ensure we get enough vitamins and minerals that good for our health. Chronic diseases such as heart diseases, diabetes, cancer and obesity can be prevented by practicing of minimum 400g of fruits and vegetables per day.
Nowadays, modern life is associated with sedentary lifestyle and in the end could increase the risk of obesity among Malaysians. According to WHO, sedentary lifestyle doubles the risk of getting cardiovascular diseases, diabetes, lipid disorder, obesity, high blood pressure and depression. Working on computers for long period of time, watching television, play with gadget and listening to music are several examples of inactive activities. These could lead to overweight and obesity due to reduction in energy expenditure. Supposedly, if we eat more, we need to exercise more to ensure we manage to balance energy in and energy out in our body.
Most of overweight and obese people have positive energy balance which means energy in is greater than energy out. Energy in comes from our dietary intake while energy out is doing physical activities. Most Malaysians also refused to go out to exercise as they are more comfortable to sit at home and scrolling their phone. For a person who has a career, they refused to do physical activity as they are exhausted from work and do not have much time to exercise. Apart from that, kids nowadays are preferred to stay at home and play video game. Scenario such as seeing kids playing with their friends during evening is dying out nowadays. Indirectly, these situation able to increase the risk of overweight and obesity among young people in Malaysia.
Culture is the biggest influence of our behavior. For some culture in Malaysia, overweight is favorable such as overweight kid. This is because they think, the kid look cute in that particular way. However, this actually can lead to weight gain. The parents keep feeding their children with a lot of food without thinking about the consequences.
Next, culture also influences what and how we eat. Some ethnic groups in Malaysia, their food are mostly based from oils and fats, high amount of sugar, as well as high amount of carbohydrate based. These kind of food could lead to weight gain as it is high energy dense food. For example, nasi lemak is the populist dishes in Malaysia. The components in this dishes have high amount of oils and fat contents such as the rice itself is cooked with coconut milk, sambal is cooked by using quite large amount of cooking oil and lastly fried egg. These components already contributed to high amount of oils and fats. Beside that, it gets worse when Malaysian love the combination of high energy dense food with sweet beverages. For instance, nasi lemak with teh tarik, roti canai with kopi o ais and many more. Some Malaysians also love to drink carbonated drinks that contained high amount of sugar. These dietary practices, definitely could cause overweight and obesity if we do not control it or do not being physically active.
Furthermore, currently food that sold in the restaurant and streets offers large portion size of food. For example, triple stacked cheeseburgers and large mug of sweet beverages. Eating large portion size of food could lead to overweight as this can lead to excessive intake of energy. A study from Delibiti et al, 2004 state that, increased portion size leads to increased energy intake in a restaurant meals. One of the reason Malaysians love to eat large portion size of food is because they want to follow the trends. They easily influenced by the social media when people posting about ‘hipster’ food and beverages that available in the market.
Overweight and obesity are associated with the development of non-communicable diseases (NCDs) that are very alarming all over the world. The NCDs are hypertension, diabetes, and cardiovascular diseases.
Hypertension is the condition where the blood pressure is elevating in the body. It happens as overweight and obese person has high excessive amount of adipose tissues in the body. These tissues require sufficient supply of nutrients and oxygen to survive, so it requires more blood circulation to the tissues. As a result, it causes heart to work harder to pump blood in order to supply sufficient amount blood to the tissues. At the same times, this can elevate the pressure at the artery wall which can cause high blood pressure.
Diabetes is closely related to obesity in Malaysia. The increase prevalence of overweight and obesity has accompanied the rise of type 2 diabetes. Another name for type 2 diabetes is insulin resistance. For normal person, his or her pancrease able to produce enough insulin to reduce the blood sugar level in a body while for a person suffered with diabetes type 2, his or her pancrease cannot produce insulin sufficiently to reduce the blood sugar level to a normal state.
Overweight and obesity can cause heart disease due to the accumulation of fat at the artery wall. Fats are deposited at the wall and cause the arteries become narrower. As a result reduce the blood circulation to the heart which can lead to chest pain or more severe heart attack. Beside that, if the blood cannot pass through the arteries, this can cause blood clot whih could lead to stroke. All of these implication can contribute to metabolic syndrome. Metabolic syndrome is a condition where can cause a person to a severe health problems. It is a cluster of conditions such as excess body fat at the abdominal area and waist, high blood pressure, abnormal trigliyceride and cholesterol levels and high blood sugar level. However, it does not mean that when a particular person is identified with one of the criteria, he or she has a metabolic syndrome. But, if a particular person is diagnosed with all the criteria, he or she definitely to change his or her lifestyle to delay the development of severe health diseases.
Besides that, being overweight or obese also could affect the quality of life of a person. This is because, these can limit their daily activities. For example, they become easily exhausted when doing extra work as their body weight limits the movement of their body. Therefore, it is hard for them to be physically active as they hate of being tired and it gets worse when people discriminate them such as overweight and obese person is a lazy person. Indirectly, these can affect their mental health as well. For example, this can contribute to stress and depression.
In conclusion, the prevalence of overweight and obesity are getting higher from day to day. It not only involves adults population but also children and adolescent. As a future nutritionist, I should come out with an effective intervention program to tackle these serious issues. This is because, if Malaysia manages to have healthy people, this indirectly could increase the productivity of our country.
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