Malaysia, the “Fattest Country in Asia” in 30 Years: What does it say about locals’ health?

For years, obesity has been considered a worldwide epidemic by the World Health Organization, with more than 1 billion adults overweight and at least 300 million diagnosed as obese. Many parts of the world, including countries in Asia, are increasing awareness of the condition.

Despite that, Malaysia continues to struggle with its weight problem. Within the past three decades, Malaysia has won the title of the “Fattest Country in Asia”. Nearly half the adult population suffers from weight problems, where 30.4% categorised are as overweight and 19.7% obese. In the World Population Review of 2019, Malaysia has the highest prevalence of obesity among adults in South-East Asia at 15.6%. It is said that 1 in 2 Malaysian adults are diagnosed with the condition.

A Life Towards Obesity

Obesity does not happen overnight. It results from a series of health factors and lifestyle choices that lead us to gain excessive weight.

Age is a definitive factor with regards to weight problems. What many fail to realise is that our body’s process food differently when we grow older. Associate Prof Dr Chan Wah Kheong, gastroenterologist and hepatologist at the UM Specialist Centre (UMSC), explains the phenomenon. Our daily energy requirement increases between childhood and young adulthood. As we enter a middle and older age, how we convert food to energy declines. However, most adults still consume the same amount of food when they were younger, or even more.

Obesity is not just about biology. Aside from metabolic changes, our environment also changes as we grow older. We start to enter the working force, limiting our time to lend to physical activity. As children, we spend more time outside running and playing, while, as adults, we spend more time in front of the computer for our job. Also, the stress due to our work leads us to eat more food to relieve it. Food delivery services are also more convenient than cooking our own meals. Unfortunately, fast food meals are not necessarily the most healthy food options.

To some extent, being overweight may also be hereditary. There are cases of obesity due to genetic conditions, though rare. It is still more likely that unhealthy eating habits and lack of physical activity lead to excessive weight gain. Children who grew up with overweight or obese parents are said to be more likely to adopt their unhealthy habits.

Obesity and Its Health Risks

Obesity’s adverse effects on our health are no longer breaking news. The condition can lead to other complications such as diabetes, heart disease, stroke, cancer, hypertension, sleep apnea, severe knee and back pain, and other metabolic syndromes.

One of the more unknown yet increasingly alarming health effects of excessive weight is a fatty liver. As the name suggests, it is characterised by excess accumulation of fat in the liver, usually due to chronic weight gain. The proliferation of fat in the liver is associated with central obesity. Men who have a waistline measurement of above 90 centimetres and women above 80 cm are at higher risk.

UMSC endocrinologist Dr Jeyakantha Ratnasingam further explains the condition and links it to insulin resistance. As a person gains excessive weight, their body cannot use insulin properly, which then drives fat to the liver. This is also why the condition is linked to diabetes mellitus. A defining characteristic of diabetes mellitus includes abnormal blood glucose control due to insulin resistance.

It was found that 70% of people treated for diabetes mellitus were also diagnosed with a fatty liver. In 2015, 17.5% of the adult population in Malaysia were diagnosed with diabetes mellitus, based on the National Health and Morbidity Survey. As the obesity rates go up, so is the risk of developing the condition.

Moreover, much like obesity, age is a factor in developing a fatty liver. Male young adults and middle-aged men are prone to the condition. On the other hand, women are at higher risk of developing the disease after menopause. Estrogen protects the liver from fat accumulation. Sadly, as menopause hits, that protective effect diminishes.

As a result of the following factors, fatty liver has become an occurrence among many Malaysians. However, there’s not a high level of awareness regarding the condition.

Known as a “silent epidemic”, most people diagnosed with fatty liver are not aware of their condition as symptoms do not manifest at early stages. Most patients discover their status at its later stages. By then, they may have already developed complications of cirrhosis or the extensive irreversible scarring of the liver. Some of its complications include swollen vessels in the gullet, accumulation of fluid in the abdomen that causes swelling, yellow discolouration in the eyes and skin, and other symptoms of liver failure.

Furthermore, a fatty liver is part of metabolic syndrome, increasing the risk of developing cardiovascular diseases.

Treating Obesity in Malaysia

Despite the concerning numbers, there’s a glimmer of hope for Malaysia’s ongoing weight problem. Experts such as Prof. Dato’ Dr. Nik Rtiza, a celebrity bariatric surgeon in Malaysia, are working hard to increase awareness regarding obesity in the country and the availability of treatments for the condition.

As conditions like fatty liver do not persist until its later stages, early prevention is needed. Medical experts still recommend a change in dietary choices and lifestyle habits to help manage weight. The Ministry of Health specifically promotes the ‘Suku Suku Separuh’ (Quarter Quarter Half) eating habit. Here, each meal on a standard-sized plate must comprise carbohydrate (quarter portion), protein (quarter portion) and vegetables and fruits (half portion). Pair that with at least 150 minutes of exercise per week, then you are on the road to shedding off your excess weight.

However, not all find success with traditional means of weight loss. People diagnosed with morbid obesity find that diet and exercise alone does not give them the result they need. That’s why alternative weight loss solutions have also grown in popularity. Bariatric surgeries such as gastric bypass and sleeve gastrectomy are usually recommended for more severe cases of obesity. It eliminates a portion of the stomach or digestive tract to limit food intake, thus decreasing calorie intake.

For those looking for non-invasive weight loss treatments, then you can opt for weight loss balloons, specifically the Allurion Elipse™ Balloon.

Allurion Elipse™ Balloon is the first and only swallowable weight loss balloon in Malaysia. Unlike other weight loss balloons, Elipse™ requires no surgery, endoscopy, or anaesthesia. The inflated balloon comes as a capsule attached to a thin catheter, allowing you to ingest it with a glass of water.

The placement of the balloon is performed by a certified healthcare professional, which only takes 20 minutes. An X-ray is done to make sure that the balloon is appropriately placed inside the stomach. The capsule dissolves, and the balloon is then filled with 550ml of water, or until it is the size of a grapefruit. The healthcare professional will run another X-ray to see if it is adequately filled.

Once placed in the stomach, the balloon takes up space that food usually would. As a result, you feel full faster despite eating fewer portions of food than you usually would. It also delays gastric emptying, allowing the food to remain in the stomach and make you feel full longer. The balloon helps you lessen the amount of food you eat and, in turn, minimise calories.

The swallowable weight loss balloon lasts for 16 weeks. After that period, a time-activated release valve opens and allows the balloon to deflate, where the remnants of the balloon are naturally excreted through your bowel movement. People who use Allurion Elipse™ Balloon are said to help lose an average of 10-15% of their body weight within 16 weeks.

Gaining the title of “Fattest Country in Asia” is not something to be proud of. We need to take it upon ourselves to create changes in our lifestyle to lead a more healthy life. With that said, no one is alone in their weight loss journey. We need to build a safe environment for people to talk about their struggles regarding their weight. Let us work together to build awareness of the condition and its available treatments. Right now, let us lead a great example. Shed off our weight and strip ourselves of that title.