Introduction Strategy for the Prevention of Obesity - Malaysia

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.

This document is divided into nine sections, which cover different aspects of obesity.

• Section 1 serve as an introduction which describes the term of reference of the technical committee, descriptions of each section and the major source of references used in drafting the document.

• Section 2 provides a brief background on obesity. There is strong epidemiological evidence indicating that the prevalence of obesity in developing countries often increases in communities emerging from lifestyles of subsistence into affluence. Its public health implication impose a huge burden on the human and economic resources which we can ill-afford and the challenges that lies ahead for Malaysians has never been greater.

• Section 3 examines the definition and classifications of obesity comparing WHO (1998, 2004) and WHO/IASO/IOTF (2000) reports. Defining and identifying the extent of the problem is a critical step in a coherent approach to its prevention and management strategy. The BMI classification issues were discussed together with the public health action points (WHO 2004). Waist circumference and waist/hip ratio as surrogate measures of co-morbidity are also discussed.

• Section 4 covers aspects related to the prevalence of obesity in Malaysia and the Asia-Pacific region, and its health consequences ranging from an increased risk of premature death to several non-fatal debilitating complaints that impact on quality of life. The Committee also examined economic costs of obesity, which is known to impose a huge burden on the human and economic resources of the country.This section also discusses the health benefits of weight loss.
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• Section 5 describes what is known about this complex, multi factorial disease and identifies the major factors contributing to the development of obesity. Positive energy balance is known to be influenced by powerful societal and environmental forces which may overwhelm the physiological regulatory mechanisms that operate to keep weight stable. Dietary intake of Malaysians has changed markedly over the last three decades. Malaysians are reported to have lower energy expenditure, due to lower BMR and sedentary lifestyle. This section also describes examples of energy-saving activity pattern in modern societies and the psychosocial factors contributing to obesity. 

• Section 6 is devoted to childhood obesity encompassing its definition, classification, prevalence, aetiology and guidance for obesity prevention.

• Section 7 provides recommendations for preventive strategies based on the principle of shared responsibility. Strategies for prevention of obesity involving different settings namely individuals, families and communities, schools, healthcare, media and communication and workplace have been recommended. 

• Section 8 describes research needs according to the different settings as mentioned in section 7.

• Section 9 present appendices which allow readers to obtain detailed description of actions to be taken as stipulated in the respective sections.

The following publications served as useful references in the preparation of this document:

Systematic review of relevant published literature as identified by computerized (CD-ROM) search.

Reports of other expert working parties in the same area as listed below:

• Report of a WHO Expert Consultation on appropriate BMI for Asian populations and its implications for policy and intervention strategies [WHO (2002) Singapore; Lancet (2004)]

• WHO Global Strategy on Diet, Physical Activity and Health : Western Pacific Regional Consultation Meeting Report (2003)

• WHO (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series 916, Geneva.

• The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity (US DHHS 2001)

• The Asia-Pacific perspective: Redefining obesity and its treatment (2000)

• The Malaysian Dietary Guidelines (1999) – Ministry of Health, Kuala Lumpur

• Obesity – Preventing and Managing the Global Epidemic, WHO (1998)

• Obesity in Scotland – Integrating Prevention with Weight Management (SIGN) Scottish Intercollegiate Guidelines Network (1996).

• Recommended Nutrient Intakes for Malaysia. A report of the Technical Working Group on Nutritional Guidelines (NCCFN 2005)

This document was developed through a Consensus Workshop and input from relevant Ministries and selected professionals. It serves as a guidance to help healthcare providers, other related professionals as well as educators in educating specific target groups, particularly families and communities, schools, healthcare system, media and workplaces.

Users must keep in mind that new evidence could supersede recommendations in this document. The Technical Committee propose that this document be scheduled for review five years after publication, or when new evidence are available that require substantive changes to the recommendation.