While we may joke about the extra kilogramme or two that we’ve put on over MCO, the reality is that obesity is no laughing matter.

“Almost half of the adults in the country are overweight and obese^[1],” shares Dr Mustafa Mohamed Taher Al-Khafaji, consultant upper gastrointestional and bariatic surgeon at Cengild GI Medical Centre.

“We are also number one in obesity in Southeast Asia, number one in adult obesity and second in terms of childhood obesity^[2,3],” Dr Mustafa shares.

The global Body Mass Index (BMI) indicates a BMI of 30 and above as obese, but Dr Mustafa cautions that we should be careful to take into consideration our Asian stature and height that’s shorter and smaller when making these measurements. As such, according to the Malaysian Clinical Practice Guidelines of Obesity, a BMI between 27.5-31.5 is considered obesity class 1 while 32.5 and above is considered class 2, and Class Three obesity refers to those who have a BMI of 35-39.9 and more than 40^[4].

Additionally, he added that it is unwise to use a single parameter of measure, especially if patients have physical disabilities to take into account. In this instance, Dr Mustafa advises to consider another method of gauge – the waist-to-hip ratio.

Ideally, women should maintain a waist-to-hip ratio of below 0.85 and for men below 0.9^[4].

Dr Mustafa also adds, “In Malaysia, obesity usually begins at middle age. People think it’s acceptable to put on weight after pregnancies or when they hit a certain age – but that’s not right.”

Obesity: A Multi-Faceted Killer

Obesity affects much, much more than just one’s self-esteem. Dr Mustafa shares that there are many major illnesses associated with obesity that can affect patients from head to toe.

Five stand out as the most fatal: diabetes, hypertension, cholesterol, fatty liver and sleep apnea.

“Some are fatal; some, in the long run, lead to organ damage. All my patients with obesity end up with one of these,” he notes.

Obesity is also broken down into two types – central obesity and general obesity.

Central obesity, he adds, is “identified by excess accumulation of fat in the abdominal area, particularly due to excess visceral fat, is the worse of the two as it can significantly lead to other chronic conditions such as diabetes and hypertension. General obesity is no less harmful – it can cause mechanical illnesses like joint problems and back pains from the extra weight on the body.”

In Malaysia, childhood obesity is also a worrying factor.

“Childhood obesity is more dangerous because the patient’s exposure to all the effects of obesity is longer,” Dr Mustafa says. “The tissue and organ damage is higher since their body has been battling it longer. The body will try and adapt until it gives up, and this is when your body will fail.”

He cites that Malaysian foods are typically rich and heavy, high in carbs and fat, and coupled with sedentary lifestyles they contribute to the rising obesity in the country.

“People love food here, which is not a problem, but regular consumption of such an unbalanced diet is one of the main factors contributing to obesity, as well as other chronic conditions such as diabetes and high cholesterol levels,” he tells.

Don’t Hide, Get Help

For patients struggling with obesity, Dr Mustafa advises to fear not any judgement or stigma and instead, seek professional help.

“There is always a solution, you need just to ask for it,” he encourages.

Today, there are a myriad of solutions that can help. Pharmacotherapy, lifestyle change and surgical intervention can help in weight and medical problems. The important bit is to seek help from proper panel of doctors.

“There are a lot of people selling products with false promises,” he cautions, “And when people don’t get the results, they give up too easily. It’s a financial strain on them – they’re going to spend money on these products. If someone is already obese to the point of a BMI of 50, it’s unlikely that there is any over-the-counter medication that can help them.”

A little empathy also goes a long way.

“We need to increase awareness and tell people with obesity to not hide,” he says. “It’s not your fault. It’s our job to tell them there is always a solution if you seek for it and there’s no need to hide and be ashamed about it. It’s a forgivable mistake if you are serious about it.”

For those struggling with weight management, he has three tips to share that he personally practices for a healthier lifestyle.

Make exercise a lifestyle

“Exercise has to be regular in your life. Most people can’t leave the house without brushing your teeth or going to the toilet. These are necessities. Exercise needs to be the same – a necessity. There is always time.”

Choose good food

“There is a lot of good food that you can enjoy. Just change your mentality about it. Some people can’t believe they need to stay away from rice for a while. We need carbs, but we need to make up for it by working it off after. When I eat something bad on my cheat day, I will work hard to counter it. A change in diet is not the end of the world.”

Eliminate bad habits

“Health is something that needs to be earned and the work is simple – get rid of the bad habits. Things like overworking, not eating at the right times, bad sleeping patterns, just get rid of it.”

References:

1. Institute for Public Health. National Health and Morbidity Survey (NHMS) 2019: Non-communicable diseases, healthcare demand, and health literacy—Key Findings; 2020.
2. World Health Organisation. 2019. Malaysia and WHO call for more investment in primary health care the 21st century. Accessed on 13 April 2021; https://www.who.int/malaysia/news/detail/08-04-2019-malaysia-and-who-call-for-more-investment-in-primary-health-care-the-21st-century
3. The Asean Post. 11 May 2020. Malaysian Teens Are Overweight. Accessed on 14 April 2021; https://theaseanpost.com/article/malaysian-teens-are-overweight
4. Ministry of Health Malaysia. 2004. Clinical Practice Guidelines on the Management of Obesity. Putrajaya, Malaysia.