Why the concern?

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).

In adults, Ismail et al (1995) reported prevalence of overweight and obesity in men were 24.0% 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 (Lim et al. 2000). 

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, Khor et al (1999) reported 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 (Zaitun et al. 1999), the prevalence of overweight was 18.2% and obesity was 4.3%. In a later study by Suzana et al. (2003) among 820 elderly Malays from four rural areas of Peninsular Malaysia, the prevalence of overweight and obesity were 24.7% and 11.4%, respectively. 

Health Consequences of Obesity 

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 endometrium), ovaries, rectal and prostate cancers (Table 5). 

Economic Cost of Obesity

The economic costs of obesity are important issues to health care providers and policy makers alike. The economic costs of obesity have been assessed from several developed countries and range from 2% to 6% (Wolf & Colditz, 1994; Caterson & Broom, 2001) of total health care cost (Table 6). In the USA, the treatment of obesity and its primary co morbidities costs the US health-care system more than USD99 billion each year and consumers also spend in excess of USD33 billion annually on weight-reduction products and services. Moreover, obesity is associated with an increased prevalence of socioeconomic hardship due to a higher rate of disability, early retirement and discrimination. As a result of industrialisation, urbanisation and economic stability in Malaysia, significant changes in diet and lifestyle have occurred. This has had a dramatic impact on the health of the population as evidenced from the increased prevalence of obesity and chronic non-communicable diseases. Malaysia is thus entering a new era of public health where nutrition-related issues will become ever more prominent.

Benefits of Weight Loss

Overweight and obesity are known to be associated with an increased risk of disease and death (Allison et al. 1999; NIH, NHLBI 1998). Randomized controlled trials have shown that weight loss (as modest as 5 to 15% of excess total body weight) reduces the risk factors for at least some diseases, particularly cardiovascular disease, in the short term. Weight loss results in lower blood pressure, lower blood sugar and improved lipid levels (NIH, NHLBI 1998). The benefits of weight loss on health risks in obesity are shown in Table 7.

REFERENCES

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