Obesity has been growing at an alarming rate and is the most common nutritional problem among people in developed as well as in developing countries. It is associated with significant morbidity and mortality, including cardiovascular, respiratory, gastrointestinal, endocrine and psychosocial morbidities. This unhealthy trend is expected to lead to huge economic costs in health and social security systems. This paper discusses the definition, figures of obesity in Malaysia and other countries as well as necessary interventions for this problem.
Introduction
According to Oxford Dictionary (website) obesity is the nominal form of obese which comes from the Latin obēsus, which means "stout, fat, or plump. ‘Ēsus’ is the past participle of ‘edere’ (to eat), with ob added to it.
Obesity is a condition in which there is an excess of body fat. A simple way of measuring or quantifying or quantifying obesity is by using the height and weight. The body mass index (BMI) is the commonest method used by doctors and other health care professionals and is calculated by using this formula:-
BMI(kg/m2) = Weight (kg) / Height * Height (m2)
Based on this calculated, the World Health Organization (WHO) in 1998 categorizes the weight into the following:-
Table for Caucasians and European
BMI
Classification
18.5 or less
Underweight
18.5 - 24.9
Normal range
25.0 - 29.9
Overweight
30.0 - 34.9
Obese I
35.0 - 39.9
Obese II
40 or greater
Obese III
However, the WHO (1998) classification of obesity was based on Caucasians and European data. It is now discovered that the Asian population have different body fat composition and distribution compared to the Caucasians. In Asians, morbidity and mortality is occurring in people with lower BMIs and smaller waist circumference. The Asia-Pacific perspective from the International Association for the Study of Obesity (IASO) has therefore proposed the following as classification of weight by BMI in adult Asians.
Table for Asians
BMI
Classification
18.5 or less
Underweight
18.5 - 22.9
Normal range
23.0 or greater
Overweight
23.0 - 25.0
At Risk
25.0 - 29.9
Obese I
30 or greater
Obese II
History
In several human cultures, plumpness was associated with physical attractiveness, strength, and fertility. Pre-historic Mediterranean and European cultures suggests a central role for the obese female form in magical rituals, and suggests cultural approval of this body form. This is most likely due to their ability to easily bear children and survive famine.
A large, well-fed body was occasionally considered a symbol of wealth and social status in cultures prone to food shortages or famine. Well into the early modern period in European cultures, it often served this role. But as food security was realized, it came to serve more as a visible signifier of "lust for life", appetite, and immersion in the realm of the erotic.
In modern culture, the obese body shape is widely regarded as unattractive. Many negative stereotypes are commonly associated with obese people, such as the belief that they are lazy, stupid, or even evil. Obese children, teenagers and adults face a heavy social stigma. Obese children are frequently the targets of bullies and are often shunned by their peers. Obesity in adulthood can lead to a slower rate of career advancement. Most obese people have experienced negative thoughts about their body image, and many take drastic steps to try to change their shape, including dieting, the use of diet pills, and even surgery.
What Causes Obesity?
Among the many factors which can contribute to the increasing prevalence of obesity include; people gain weight when the body takes in more calories than it burns off. Those extra calories are stored as fat.
Genes - small parts of the DNA that people inherit from their parents and can play an important role in this weight gain. Some of your genes tell your body how to metabolize food and how to use extra calories or stored fat. Some people burn calories faster or slower than others do because of their genes.
Obesity can run in families, many families eat the same foods, have the same habits (like snacking in front of the TV), and eat high calorie foods which can contribute to weight gain. An examination of the fat composition of the Malaysian urban population’s diet by chemical analysis, using a 7-day rotation menu, revealed that – on an average – the diet provided 2300 kcal derived from 66 g of total fat (51 g of vegetable fats and 15 g of animal fats), 36 g of protein and 360 g of carbohydrates. See table 1 for calorie consumptions of Malaysians:
Table 1
Sometimes emotions can fuel obesity as well. People tend to eat more when they are upset, anxious, sad, stressed out, or even bored. Then after they eat too much, they may feel bad about it and eat more to deal with those bad feelings, creating a tough cycle to break.
One of the most important factors in weight gain is a sedentary lifestyle. People are much less active today than they used to be, with televisions, computers, and video games filling their spare time. Cars dominate our lives, and fewer people walk or ride bikes to get somewhere therefore these inactive people are likely to gain weight as they do not burn up the calories gained.
Medical problems associated with obesity
Being overweight or obese isn’t a cosmetic problem. It greatly raises the risk in people for many diseases and conditions such as:
Table 2 shows hospital admission rates due to obesity in Malaysia
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Number of hospital admission rates due to obesity
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Year
1995 1997 1998 2000 2001 2002
Admissions
Hypertension 20 509 26 876 27 415 28 904 29 252 28 226
Cancer 15 257 26 845 26 054 29 295 31 049 35 409
Diabetes 19 503 19 375 19 959 20 549 21 872 23 589
___________________________________________________ Table 2
Heart Disease
This condition occurs when a fatty material called plaque builds up on the inside walls of the coronary arteries. Plaque narrows the coronary arteries, which reduces blood flow to your heart. Your chances for having heart disease and a heart attack get higher as your body mass index (BMI) increases. Obesity also can lead to congestive heart failure, a serious condition in which the heart can’t pump enough blood to meet your body’s needs.
High Blood Pressure (Hypertension)
This condition occurs when the force of the blood pushing against the walls of the arteries is too high. Your chances for having high blood pressure are greater if you’re overweight or obese.
Stroke
Being obese can lead to a buildup of fatty deposits in your arteries that form a blood clot. If the clot is close to your brain, it can block the flow of blood and oxygen and cause a stroke. The risk of having a stroke rises as BMI increases.
Type 2 Diabetes
This is a disease in which blood sugar (glucose) levels are too high. Normally, the body makes insulin to move the blood sugar into cells where it’s used. In type 2 diabetes, the cells do not respond enough to the insulin that has made. Diabetes is a leading cause of early death, heart disease, stroke, kidney disease, and blindness. More than 80 percent of people with type 2 diabetes are overweight.
Abnormal Blood Fats
These include high amounts of triglycerides and low-density lipoprotein (LDL) cholesterol (a fat-like substance often called “bad” cholesterol), and low high-density lipoprotein (HDL) cholesterol (often called “good” cholesterol). Abnormal levels of these blood fats are a risk for heart disease.
Cancer
Being obese raises the risk for colon, breast, endometrial, and gallbladder cancers.
Osteoarthritis
This is a common joint problem of the knees, hips, and lower backs. It occurs when the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain.
Sleep Apnea
This condition causes a person to stop breathing for short periods during sleep. A person with sleep apnea may have more fat stored around the neck. This can make the breathing airway smaller so that it’s hard to breathe.
Reproductive Problems
Obesity can cause menstrual irregularity and infertility in women.
Increasing Obesity in Malaysia
The number of overweight or obese people in Malaysia has doubled in the last decade, and the country now has more fat people than any other nation in Southeast Asia, which rose to 54 (1.9 million) percent of its present population compared to 24.1 percent ten years ago, the New Straits Times reported. The New Straits Times (January, 2003) also reported that obesity is at an alarming rate within genders in Malaysia comparing to other countries. Obesity prevalence is 48 percent for men and 62 percent for women in Malaysia. This is in contrast to countries such as neighbouring Singapore, where 24 percent of men and 48 percent of women are obese. Whereas in Thailand is much lesser that is 14 percent of men and 30 percent of women are obese. Among both sexes, obesity in female is more prevalent in all the countries above and in Malaysia obesity among female is 14% more than the male. See table 3
TABLE 3 shows obesity between gender in Malaysia and neighbouring countries
Country/ Sex
MALE
FEMALE
Singapore
24%
48%
Thailand
14%
30%
Malaysia
48%
62%
The changes in dietary patterns of Malaysians towards an ‘affluent’ diet of industrialized countries especially among children and adolescents are a cause of concern. In Malaysia obesity level has increased drastically within eight years time (1994-2002) from 5% to 13% among children 0-12 years-old as in chart 1 below. The chart also demonstrate increasing prevalence of obesity with increasing age: 7% among 13-21 years old, doubled to 14%, 3% to 9% among adults of 22-40 years-old and 4% to 7% for 41 years-old and above. Obesity among the teenager, 13-21 years-old, shows the highest increment (double the amount) than the other age rates. Sweetened soft drinks and fast food is an important contributing factor to the rise of teenage obesity.
Meanwhile the adults of the age of 41 onwards has the least increment which is 3%, and this may due to their exposure to health consciousness, food consumption and regular exercises.
CHART 1
Recommendations
The best way to avoid this is to make people aware and conscious regarding the terrible effects of obesity creating serious problems affecting people’s health to a great extent and how to maintain a healthy weight. And the keys to healthy weight are healthy eating plan, physical activity and behavioural changes.
Healthy Eating Plan
A healthy eating plan gives your body the nutrients it needs every day. It has enough calories for good health, but not so many that you gain weight. A healthy eating plan also will lower your risk for heart disease and other conditions. A plan low in total, saturated, and trans fat; cholesterol; and sodium (salt) will help to lower your risk for heart disease. Cutting down on fats and added sugars also can help you eat fewer calories and lose weight. Healthful foods include:
Fat-free and low-fat milk and milk products such as low-fat yogurt, cheese, and milk.
Lean meat, fish, poultry, cooked beans, and peas.
Whole grain foods such as whole wheat bread, oatmeal, and brown rice.
Fresh fruits and vegetables.
Limiting foods and drinks with added sugars, like high-fructose corn syrup, is important. Added sugars will give you extra calories without nutrients like vitamins and minerals. Added sugars are found in many desserts, canned fruit packed in syrup, fruit drinks, and nondiet drinks. Check the nutrition label on food packages for added sugars like high-fructose corn syrup. Drinks with alcohol also will add calories, so it’s a good idea to watch alcohol intake.
Physical Activity
Staying active and eating fewer calories will help you lose weight and keep the weight off over time. In general, adults should follow these guidelines in relation to physical activity.
For overall health and to lower the risk of disease, aim for at least 30 minutes of moderate-intensity physical activity most days of the week.
To help manage body weight and prevent gradual weight gain, aim for 60 minutes of moderate-to-vigorous intensity physical activity most days of the week.
To maintain weight loss, aim for at least 60 to 90 minutes of daily moderate-intensity physical activity.
Children and teens should aim for at least 60 minutes of physical activity on most, if not all, days of the week.
If you’re obese, start physical activity slowly and build up the intensity a little at a time. When starting out, one way to be active is to do more “everyday” activities such as taking the stairs instead of the elevator and doing household chores. The next step is to start walking, biking, or swimming at a slow pace, and then build up the amount of time you exercise or the intensity level of the activity. To lose weight and gain better health, it’s important to get moderate-intensity physical activity. Choose activities that you enjoy and that fit into your daily life. A daily, brisk walk is an easy way to be more active and improve your health. For greater health benefits, try to step up your level of activity or the length of time you’re active. For example, start walking for 10 to 15 minutes three times a week, and then build up to brisk walking for 60 minutes, 5 days a week.
Behavioral Changes
Changing your behaviors or habits around food and physical activity is important for losing weight. The first step is to understand the things that lead you to overeat or have an inactive lifestyle. The next step is to change these habits.
Change your surroundings. You may be more likely to overeat when watching TV, when treats are available in the office break room, or when you’re with a certain friend. But you can change these habits.
Instead of watching TV, dance to music in your living room or go for a walk.
Leave the office break room right after you get a cup of coffee.
Bring a change of clothes to work. Head straight to the exercise class on the way home from work.
Keep a record. A record of your food intake and the amount of physical activity that you do each day will help to inspire you. You also can keep track of your weight. For example, when the record shows that you’ve been meeting your goal to be more active, you’ll want to keep it up. A record is also an easy way to track how you’re doing, especially if you’re working with a registered dietitian or nutritionist.
Seek support. Ask for help or encouragement from your friends, family, and health care provider. You can get support in person, through e-mail, or by talking on the phone. You also can join a support group.
Reward success. Reward your success for meeting your weight loss goals or other achievements with something you would like to do, not with food. Choose rewards that you’ll enjoy, such as a movie, music CD, an afternoon off from work, a massage, or personal time.
Conclusion
Obesity is considered a global epidemic because its prevalence and severity in people (both adults and children) is increasing worldwide at alarming rates. This increase has been related to an increasing sedentary lifestyle with less physical activities as well as changing dietary habits, which occur not only in affluent countries, but also in developing countries and in countries in economic transition especially in Malaysia. As Malaysia proceeds rapidly towards a developed economy status, the health of its population will probably continue to deteriorate. Therefore, a national strategy needs to be developed to tackle both dietary and activity contributors to the excess weight gain of the Malaysians; as well as the world population. If it is not treated more people will experience severe psychosocial burdens and health risks, and this will lead to huge economic costs to health and social security systems.