Greater attention should be given to strategies aimed at preventing weight gain and obesity. These are likely to be more cost effective and have a greater positive impact on the long- term control of body weight than strategies designed to deal with obesity once it has fully developed. 

The Committee adapted relevant strategies recommended by WHO (1998) and the Surgeon General’s Report (US DHHS 2001) for this section.

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The prevalence of child obesity is increasing rapidly worldwide (WHO 1998). It is associated with several risk factors for later heart disease and other chronic diseases including hyperlipidaemia, hyperinsulinaemia, hypertension and early artherosclerosis (Berenson et al. 1998). In view of its public health importance, the trends in child obesity should be closely monitored. Trends are, however, difficult to quantify or to compare locally and internationally, as a wide variety of definitions of child obesity are in use, and no commonly accepted standard has yet emerged (Cole et al. 2000).

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Energy Balance in the Development of Obesity

Obesity can result from a minor energy imbalance, which lead to a gradual but persistent weight gain over a considerable period. Some researchers have hypothesized that energy imbalance is the result of inherited metabolic characteristics; whereas others believe it is caused by poor eating and lifestyle habits, that is “gluttony and sloth”. 

Positive energy balance occurs when energy intake is greater than energy expenditure and promotes weight gain (Figure 4). Conversely, negative energy balance promotes decrease in body fat stores and weight loss. Body weight is regulated by a series of physiological processes, which have the capacity to maintain weight within a relatively narrow range (stable weight). It is thought that the body exerts a stronger defence against under nutrition and weight loss than it does against over-consumption and weight gain. 

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Prevalence of Obesity

The global burden of overweight (BMI 25.0 – 29.9) and obesity (BMI≥30.0) is estimated at more than 1.1 billion. There is evidence that the risk of obesity related diseases among Asians rises from a lower BMI of 23.0 (James et al. 2002). If this were adopted as a new benchmark for overweight Asians, it would require a major revision of approaches in the Asian sub- regions, where a significant proportion of the 3.6 billion population already has a mean BMI of 23.4. In the Asia Pacific region, the prevalence of obesity in men is between less than 1% in China to about 58% in urban Samoa. In women, obesity prevalence is between less than 2% in China to about 77% in urban Samoa. Available local data on prevalence of obesity reveals that the problem faced in Malaysia is more serious than those reported in other Asian countries (Figure 3).

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Obesity is often defined simply as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired. However, obese individuals differ not only according to the degree of excess fat, which they store, but also in the regional distribution of the fat within the body. Indeed, excess abdominal fat is as great a risk factor for disease as is excess body fat per se (WHO 1998).

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In some communities even till today, weight gain and fat storage have been viewed as indications of good health and increasing wealth. As the standard of living continues to rise, weight gain and obesity has emerged as one of the most common and serious nutritional problems confronting many communities all over the world today. Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting all age groups. Indeed, it is now so common that it is replacing the more traditional public health concerns, including undernutrition and infectious diseases, as one of the most significant contributors to ill health (WHO 1998). The problem may stem from the limited knowledge of the health impact of obesity compared with such fatal conditions as stroke and coronary heart disease. 

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This document describes recommendations to affect a combined approach to prevent overweight and obesity. It was initiated by the Malaysian Association for the Study of Obesity (MASO) in collaboration with the Ministry of Health, Malaysia.

The terms of reference are as follows:

To provide a detailed overview of the problem of obesity including its definition,causes and consequences

To provide an overview of the severity of the problem of obesity in Malaysia.

To recommend appropriate strategies for the prevention of obesity focussing on the whole population as well as specific target groups.

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