Source: www.hellawella.com
We all have heard the news: Malaysia is the fattest nation in the whole South East Asia. And this is not exactly a flattering achievement. Obviously, we need a fix for it. But in order to fix it, we must first understand what the big deal obesity is about, why it is happening, and how we can reduce or prevent it.
The Impact of Obesity
There are many chronic illnesses associated to obesity, from diabetes mellitus to coronary heart disease, from osteoarthritis (joint pains) to cancer. Prominently, obese people are at great risk of poor blood sugar control and elevated cholesterol levels. The World Health Organisation (WHO) came up with obesity health problems listed by its relative risks:
|
Greatly Increased Risk |
Moderately Increased Risk |
Mildly Increased Risk |
|
|
|
(WHO, 1998)
Obesity is often a result of a very high body fat composition. Having high body fat composition will reduce body cells sensitivity to hormones, which explains the various metabolic disorders associated to obesity, chiefly diabetes mellitus and infertility. Higher body fat content also creates a mild oxidative condition and this leads to cancer.
Having a higher body mass also means a higher burden to the body, leading to more exertion and hence breathing difficulties. At the same time, the high body mass burdens lower limbic joints, especially to the knees and hips. And this particular scenario I personally dubbed a double-whammy; as obese people often have joint pains, they will exercise less and continue to gain weight without burning off excess calories.
The Causes of Obesity
To know if one is obese or not, one must determine personal body mass index (BMI). BMI is a screening tool used to identify if our weight is appropriate to our height, be it underweight or normal or overweight. It is calculated via a simple formula (weight in kg/ (height in m)2. In Malaysia, the WHO Classification is used but also acknowledges a new classification for public health action as follows:
|
Body Weight Classification |
BMI Cut-Off Point For Definition | BMI Cut-Off Point For Public Health Action |
Co-Morbidities Risk |
|
Underweight |
< 18.5 |
< 18.5 |
Low |
| Normal weight |
18.5 – 24.9 |
18.5 – 22.9 |
|
| Overweight |
≥ 25.0 |
23.0 – 27.4 |
|
| Pre-Obese |
25.0 – 29.9 |
27.5 – 32.4 |
Moderate |
| Obese Class I |
30.0 – 34.9 |
32.5 – 37.4 |
High |
| Obese Class II |
35.0 – 39.9 |
≥ 37.5 |
Very High |
| Obese Class III |
≥ 40.0 |
(WHO, 1998; WHO Expert Consultation, 2004)
To understand obesity, we must first look into the energy equilibrium concept. Energy is quantified by calorie, and its equilibrium refers to the balance of input versus output. To simply put, energy input is calorie intake or the amount of food that we eat, meanwhile energy output is calorie expenditure or the amount of calories burnt. If energy input is more than output, this becomes a positive energy balance that leads to weight gain. On the other hand, if output is more than input, this will cause a negative balance and allows for weight loss. Essentially, to lose weight, we should consume less (low energy input) and burn more calories (high energy output).
In 2011, the obesity rate among Malaysian adults increased from 14.0% in 2006 to an alarming 27.2%. Overeating is one of the main causes of obesity. As we all know, Malaysia is a potluck of ethnicities and cultures, as well as the variety of delicacies that come with them to tempt the appetite. It would be easy to pin the blame of this rising rate of obesity on our Malaysian food culture but that is not necessarily the case. A survey conducted in 2003 showed that an average Malaysian adult typically consumes about 1,600 kcal, which is about 500 kcal lesser than the national recommendation. Interestingly, this survey also found that Malaysians generally lead a sedentary lifestyle with little participation in sports and other vigourous physical activities. The real culprit here, it seems, is a poor physical activity level among Malaysians.
Source: www.adelaidenow.com.au
The Fight against Obesity
Realistically, combating obesity requires participation from everyone all the way from the individual level to community to the government. Policies must be laid out to encourage a shift towards an active, healthy lifestyle. At community level, support groups are found to be more efficient at promoting weight loss, while a personal commitment is necessary to discipline oneself to maintain this healthy lifestyle.
My personal mantra is small, gradual and realistic steps. Changing lifestyle requires a huge commitment, no denying that. Hence I find that taking baby steps towards a whole change is more sustainable and achievable. There are many ways, tricks and tips to lose weight and I recommend a visit to a dietitian to sort out this detail for a more individualised assessment and intervention.
One of the best and easiest ways to lose weight is to take 500 kcal lesser than the usual intake. 500 kcal can be in the form of 3 cups of rice or 2 pieces of croissant or 1 large fries from McDonalds. Taking 500 kcal lesser daily will translate to ½ kg weight loss every week, which is proven to a sound long-term strategy to lose weight. Again, consult a dietitian to know more on this.
At the same time, it is recommended to increase physical activity. Try to commit to exercise at least 30 minutes each session, 3 times a week. This allows for maintenance of a moderate physical activity level. Try to pick up sports. Do various activities, not just constrained to activities in a park. Consider outdoor activities such as jungle trekking and rock climbing. Exercise can be fun if you get creative with it. Find company if need be.
Be wary of the serving size of food. Read the food label. Identify how much a serving size is and try to consume within the recommended size. Quite often that people ignore this and consume more than they should, especially junk food. Knowing your serving size also helps you to count calories, so that you know much you have been eating for the day. Controlling serving size was also found to aid in body weight control as you get to control how much you can eat.
And always remember the food pyramid. Eat within the recommended amount from all food groups. Keep your diet balanced and moderate. Eating healthily should not be a fuss. You just need to be creative with it.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
Mr. Brian Lian Ding (BHSc) (Dietetics) is a qualified dietitian working in Sarawak. He believes a proper diet and nutrition is important to combat the ever increasing cases of non communicable diseases like diabetes and cardiovascular diseases.
References:
- Mirnalini K et al. (2008). Energy and nutrient intakes: Findings from the Malaysian Adult Nutrition Survey. Malaysian Journal of Nutrition, 14(1): 1-24.
- Poh BK et al. (2010). Physical activity pattern and energy expenditure of Malaysian adults: Findings from the Malaysian Adult Nutrition Survey. Malaysian Journal of Nutrition, 16(1): 13-37.
- Ministry of Health Malaysia (2010). Malaysian Dietary Guidelines, 1st publication.
- Ministry of Health Malaysia (2011). 4th National Health and Morbidity Survey 2011, fact sheet.