Silent epidemic among urban poor

OBESITY is not just a disease of the rich. Historically, from the scarcity of food during WWII’s Japanese occupation and pre-independence in Malaya, we have moved to increase accessibility to food thanks to technological advances in food processing and giant fast-food chain investments. Now, easy access to cheap junk food has made obesity a major public health crisis, seen across all income groups not only in Malaysia but worldwide.

Obesity is a silent killer because research has shown that it can take years before its damage becomes fully evident – and, irrespective of age, being overweight or obese is strongly associated with poor health outcomes.

Shockingly, Malaysia is ranked the most obese nation in Asia. According to the 2019 National Health and Morbidity Survey, almost half of Malaysian adults (50.1%) and 30% of children (aged five to 17 years old) are either overweight or obese, with more than 95% of them not consuming the recommended servings of vegetables and fruits. These numbers are predicted to rise in the future.

Consequently, noncommunicable diseases are rising at a worrying magnitude: diabetes mellitus has increased from 11.2% (2011) to 13.4% (2015), hypercholesterolemia (high blood cholesterol) has increased from 35.1% (2011) to 47.7.% (2015) and approximately 14.1% of the population has a raised blood pressure among those with unknown hypertension.

The mindset that obesity is usually seen in the rich and urban populations while malnutrition is mainly seen among the poor and rural population must be changed. A 2018 study found that unhealthy dietary practices were common among low-income groups living in urban areas (“Does a low-income urban population practise healthy dietary habits?” published in the journal of International Health). The two major factors driving obesity are food and physical activity; ie, the imbalance between energy consumption and energy expenditure. It is undeniable that children nowadays are glued to screens – of televisions, handphones and computers. But they are merely imitating what many adults do nowadays as prisoners of technology and smartphones. What makes this situation more obesogenic for the urban poor? These factors:

  • Availability of high energy-dense food and drinks while healthy options are less available.
  • Higher-income families can participate in healthy lifestyle trends that might be difficult for the lower-income group to access.
  • Less conducive environment for physical activities and poor maintenance of areas where free exercise can be done such as parks and community exercise centres.
  • We cannot just accept this as the norm and let our future generations suffer the adverse effect of unhealthy eating and obesity. Here are suggestions of what we can do:
  • Increase parents’ awareness about the dangers of obesity with more robust and simplified health messages.
  • Teach parents to monitor children’s weight and calculate their BMI.
  • Provide face-to-face health education among the urban poor instead of depending fully on telehealth.
  • Teach children about different types of food and what is healthy and what isn’t.
  • Empower parents and children to make healthy choices.
  • All stakeholders must collaborate to conduct health education, monitor the availability of and accessibility to healthy food, conduct cooking demonstrations using less salt and sugar, and teach how to substitute healthier options for unhealthy food components.

In view of the chronic nature of most obesity-related diseases and the huge cost of treatment, we must ensure that as many people as possible have access to healthy food and take part in physical activities so our nation doesn’t fall deeper into the obesity epidemic.

And with Ramadan beginning today, everyone should prepare to resist the temptation to indulge in the many delicacies and sweet foods that Malaysia is famous for that will be coming our way.

Associate Professor Dr Hazreen Abdul Majid from the Centre for Population Health and Dr Kalaashini Ramachandran, Doctor of Public Health candidate from the Department of Social and Preventive Medicine were featured in The Star newspaper. The current obesity situation in Malaysia was highlighted and alerted to be on the rise in prevalence among the urban poor. As Ramadhan starts today, Malaysians are urged to resist all temptations from the wide variety of delicacies and sweet food easily available.

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