Campaign Strategies

A CAMPAIGN TO PREVENT OBESITY – ‘Eat Well, Live Well’

Advancing Malaysia’s Destiny to Healthy Weight of Life

Background

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 under nutrition 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.

Almost 30 years ago, we have been reminded by Professor Waterlow’s statement in his report to the Department of Health and Social Security/Medical Research Council, United Kingdom in 1976, which still holds true up till today. He stated “We are unanimous in our belief that obesity is a hazard to health and a detriment to well-being. It is common enough to constitute one of the most important medical and public health problems of our time, whether we judge importance by a shorter expectation of life, increased morbidity, or cost to the community in terms of both money and anxiety” (Waterlow 1976). 

Obesity is a condition of excess body fat and in most cases obese people are so because the energy intake in their diet has, over a period of time, exceeded their energy expenditure for metabolism, physical activity and growth. Obesity continues to be a prevalent public health problem in the developed countries, while 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. Obesity is a public health concern because of its association with a number of medical complications that lead to both increased morbidity and mortality. The most common complications are type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease (CVD), gallstones and cholecystitis, respiratory dysfunction and certain cancers (WHO 1998). These diseases represent far too great a burden for policy-makers, healthcare providers and researchers to ignore.

The current trend in developed countries is the enormous cost of high technology and tertiary healthcare needed to diagnose and manage the high incidence of obesity-related complications. Similar demands in Malaysia will impose a huge burden on the human and economic resources of the country and are liable to disturb priorities in the healthcare or other sectors. The question is “Can we afford it?” In this context, it is in Malaysia’s best interest to intervene early before a typical dietary pattern associated with obesity becomes widespread and established within our population (Ismail 1998). Similarly, we need to curb the sedentary lifestyle pattern and physical inactivity that is evident among Malaysians in all age groups. Considerable advances have been made to treat obesity either through diet, exercise and behavioural modifications. 

However, despite this progress, prevalence of obesity has risen sharply over the last decade. Commercial weight loss products and programmes have gained popularity among Malaysians despite the fact that most of them have not been thoroughly evaluated for effectiveness and safety. The challenge to public health workers and scientists in this area has never been greater.

Why the Concern in Malaysia – Issues Rising 

The global burden of overweight (BMI 25.0 – 29.9) and obesity (BMI³30.0) 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.

Prevalence of obesity and overweight in men24.0% and 4.7% while in women were 18.1% and 7.7%, respectively. Among the Malaysian women, ethnic differences were evident, with Indians (16.5%), Malays (8.6%) and Chinese (4.3%). Rural-urban differences are also evident, 5.6% of urban men were obese as compared to 1.8% for rural men while 8.8% urban women were obese as compared to 2.6% of rural women. The National Health Morbidity Survey (1996) reported that in males, 20.1% were overweight and 4.0% obese while in females, 21.4% were overweight and 7.6% obese. It also reported that there is little difference between rural and urban populations and that there are more obese Malays and Indians as compared to Chinese.

Even among rural communities, the problem of overweight and obesity is also large. In a nationwide study of 4,600 rural villagers throughout Peninsular Malaysia, a prevalence of 19.8% overweight amongst men and 28.0% amongst women. The prevalence of obesity was 4.2% amongst men and 11.1% amongst women. Overweight and obesity are also a concern among the older populations in this country. In a study among 945 elderly people, mostly Malays, from major functional groups in Peninsular Malaysia, the prevalence of overweight was 18.2% and obesity was 4.3%. In a later study, among 820 elderly Malays from four rural areas of Peninsular Malaysia, the prevalence of overweight and obesity were 24.7% and 11.4%, respectively.

The health consequences of obesity are many and varied, ranging from an increased risk of premature death to several non-fatal but debilitating complaints that impact on immediate quality of life. Obesity exacerbates numerous health problems, both independently and in association with other diseases (WHO 1998). In particular, it is associated with the development of diabetes mellitus, coronary heart disease, hypertension, obstructive sleep apnoea and osteoarthritis of large and small joints. In comparison, obese individuals showed an increased incidence of certain form of cancers such as gallbladder, biliary passages, breast (postmenopausal), uterus (cervix and endometrial), ovaries, rectal and prostate cancers.

In Malaysia, a changing environment and increasing affluence have widened food options and changed eating habits. Groceries and supermarkets stock their shelves with a greater selection of foods. Fast foods and soft drinks which are high in calories, from either fat or sugar, are more accessible. It is also becoming a trend that more restaurants are extending their business hours to late night or to 24 hours encouraging late night suppers. Malaysians may be eating more during a meal or snack because of larger portion sizes. People, who frequently skip meals, especially breakfast, are more likely to overeat at other times. All of these are unhealthy dietary practices that would result in excessive energy intake and thus overweight problems. Other unhealthy dietary practices that lead to obesity include binge eating, which if uncontrolled can escalate into binge eating disorder (BED). BED is defined as eating large amounts of food while feeling a loss of control over their eating behaviour. Among mildly obese people, 10 to 15 percent have binge eating disorder and this disorder is even more common among those with severe obesity.

Objectives

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

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

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

4.    To conduct various campaigns and activities regarding ‘Eat Well, Live Well’

5.    To encourage and promote a healthy diet among Malaysians for a healthy way of life

Strategies of the Campaign

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.

1.    Public health prevention (directed at everyone in the population)

2.    Selective prevention (directed at subgroups of the population with an above average risk of developing obesity).

3.    Targeted prevention (directed at high-risk individuals with existing weight problems but who are not yet obese).

The key components of the strategies are education and action. Education involves providing information and tools to motivate and empower decision makers at the governmental, organisational, community, family, and individual levels who will create change toward the prevention and decrease of overweight and obesity. Action refers to interventions and activities that assist decision makers in preventing and decreasing overweight and obesity, individually or collectively. The strategies are centred on activities and interventions in five key settings: families and communities, schools, health care, media and communications, and workplace. The key actions discussed are presented for each of these settings. Many of these actions can be applied in several or all settings.

CAMPAIGNS – Shared Responsibility ‘We Care We Share’

We will collectively build on programs in both the public and private sectors, identify current gaps in action, and develop and initiate actions to fill those gaps. Public private working groups should be formed around key themes or around the major settings in which obesity prevention and treatment efforts need to take place. The design of successful interventions and actions for prevention and management of overweight and obesity will require the careful attention of many individuals and organizations working together through multiple spheres of influence.

Action Fund Campaign ‘For a Better Policy’

The Action Fund Campaign ‘For a Better Policy’ advocates for changes in federal policy that will enable more Malaysians to eat healthy and be active, as well as those that provide appropriate medical treatment for patients.  In its work, the Campaign to End Obesity Action Fund convenes leaders from across industry, academia, patient and disease communities and public health to speak with one voice for measures to reverse the obesity epidemic and promote healthy weight in children and adults.

Reaching Out Digitally and Globally, Social Media Campaign – ‘Twt4Obesity’

Social media may be untapped potential when it comes to helping kids’ battle obesity, according to the American Heart Association (AHA). In a new scientific statement published in the journal Circulation, the group calls for more research into how to incorporate social media into programs fighting childhood obesity. Here in Malaysia, we are driven to share the information regarding Obesity through social media, mainly on Twitter Inc. in sharing relevant information and advises by using hash tag #Twt4Obesity.