Children Obesity Awareness Month

Obesity is not unfamiliar to many of us.

In 2016, more than 1.9 billion adults above age 18 worldwide were overweight and 650 million of them were categorised as obese according to the World Health Organisation (WHO).

Children are not spared from this global concern (World Health Organisation, 2018). 41 million children below 5 years old were estimated to be overweight or obese. Almost half of them are living in Asia. Up to 124 million children and adolescents from 5 to 19 are obese in 2016 (World Health Organisation, 2018). Malaysia is not excluded from this worldwide epidemic; in fact, it is still the top country in South East Asia with the highest obesity rate. Furthermore, what is more heart-breaking is the fact that Malaysian children are largely affected as well.

What is Obesity?

To the layperson, obesity is a mere word to describe people who are overweight. While that is partially true, the technical definition of obesity for adults is when one has a BMI that is greater than or equal to 30 according to the World Health Organization (WHO). On the other hand, being overweight (should not be confused with obesity) applies to adults who have a BMI greater than or equal to 25. Both overweight and obesity are characterised by an excessive accumulation of fat which impairs one's health (World Health Organisation, 2018).

* BMI: Body Mass Index is a simple index of weight-for-height to classify both overweight and obesity among adults regardless of both sexes. It is calculated by dividing a person's weight (kg) by the square of his/her height in meters. (BMI = kg/m2)

Age needs to be factored in to classify a child as overweight or obese. For children under 5 years of age and children from age 5 to 19 years, refer to the WHO fact sheet on Obesity and Overweight.

Is Obesity really that big a problem in Malaysia?

The short answer is 'yes' and here is why:

The World Population Review 2019 indicated that Malaysia has the greatest prevalence of adult obesity in South East Asian countries at 15.6%, followed by our neighbouring countries Brunei (14.1%), Thailand (10%) and Indonesia (6.9%). WHO has reported that Malaysia has the highest rate of overweight and obesity even in Asia. 64% of Malaysian men and 65% of women are classified as overweight or obese (World Health Organisation, 2019). What is equally alarming is approximately 30% of Malaysian children and adolescents are overweight or obese. This makes up almost 1 in 3 children are overweight (Hong, 2014).

According to the National Health and Morbidity Survey (NHMS) in 2019, 29.8% of children age 5 to 17 are overweight and 14.8% are obese. In the short span of approximately 8 years, we have seen a threefold increase of children obesity as it is reported in 2011 that the obesity rate among children was 3.9%. These children eventually grow into adults with the same prevalent issue, evident by the slight difference. The NHMS 2019 findings revealed that 30.4% of Malaysian adults are overweight and 19.7% are obese (The Star, 2020).

Most parents think that it is fine for children to eat more because they will 'grow out of it' when they hit puberty. While other parents think obesity happens to other children but not their own. All these misconceptions are false hopes we tell ourselves, but the statistics clearly say otherwise.

The risks and subsequent complications of obesity.

To many, obesity is but a negative phenomenon to an individual solely due to the imperfection of his or her physical appearance. The burden or frustration is usually one that is socially related. While we do not want to neglect the issues of fat-shaming, bullying and their close relationship with mental issues or disorders, obesity leads to severe physiological diseases that not only destroys a person's livelihood but causes mortality.

Here are some non-transmittable diseases that obesity contributes to:

Type 2 diabetes mellitus

– increased risk of insulin resistance.

High Blood Pressure/Hypertension

– High blood pressure over a long period of time overburdens the heart and causes further cardiovascular problems.

Liver Issues

– fatty liver among obese children may result in liver cirrhosis (liver failure).

Cardiovascular Diseases

– Atherosclerosis (the stiffening of blood vessels) leads to various heart complications like stroke or cardiac arrests.

Psychological disorders

– depression or reduced self-esteem could stem from being overweight or obese. Depression manifest itself in insomnia, inadequate rest and depressive eating which further aggravates the issue. For related guidance, see Child Low Confidence: What Parents Can Do.

For further risks associated with being overweight and obese, kindly refer to the Childhood Obesity article by MyHealth.

What can you do to protect and prevent you and your children from overweight and obesity?

Firstly, we need to understand its causes.

What are the causes of Obesity?

Obesity is caused when calorie consumption exceeds energy usage (calorie expended) which results to additional accumulation of our human body energy storage in the form of fats. The cause of obesity can be simplified to either exogenous or endogenous, with the former meaning obesity that is due to external factors such as food consumption and lifestyle, and the latter referring to obesity due to a person's genetic make-up.

Exogenous Obesity

What are the external causes that contribute to obesity?

Calories intake – excess consumption of energy-dense foods that are high in fat and sugar content.

Exercise regularity – insufficient physical activity possibly due to increased sedentary lifestyle amid growing urbanization.

Food with low nutrition consumption

Endogenous Obesity

While endogenous obesity is the minority of the 2 types, consisting of less than 1% of children obesity cases. It can be said to be more severe due to its non-modifiable nature. Endogenous obesity cannot be solved with conventional methods such as frequent exercising and regulated and balanced diet. The reason lies in their genetics. There are genes in the human body that is responsible for obesity. With these genes turned off, it leads to a lower metabolism, which causes more fats to accumulate and to be stored up in the body (World Health Organisation, 2018). These genes are inherited from parents and will be unchanged over their lifetime (Hong, 2014). Parents who suffer with overweight or obesity tend to pass down this trait to their children as well. According to a paediatric endocrinologist from the University Malaya Specialist Centre (UMSC), children with at least one overweight parent have a 4 to 5-fold higher likelihood to develop obesity as well. When both parents are overweight, their children's obesity risk goes up to 13 times or more (Bernama, 2019).

Genetic factors interact with lifestyle. Learn how Can Personalized Nutrition Help Prevent Chronic Diseases? and Can Good Nutrition Boost the Immune System? support healthier family habits.

How to fight against obesity?

Here are some suggestions that are applicable for both parents and children in combating the epidemic of obesity.

1. Healthy Diet

We cannot stress this enough. Having a balanced diet is crucial for reducing obesity. Eat better, not less.

Reduce on consumption of energy-dense food like food that is high in fat and sugar.

Know what you consume and feed your children. Parents ought to be nutrition-literate. Replace food with saturated fats to that with unsaturated fats. Food high with saturated fat includes red meat like beef and lamb, chicken skin, whole-fat dairy products like cheese, cream or milk, butter and tropical oils like palm or coconut oil. Unsaturated fats are usually derived from plants. For example, oils from vegetables like olive, corn or sunflower oil, seeds and nuts, oily fish such as salmon, and avocado. Keep in mind that the body requires fats too and not all fat is bad, we only must select fatty food that are healthy.

Encourage yourself and your children to eat 5 servings of fruits and vegetables daily. It does not harm to make eating healthy, fun, and interesting by filling your children's plate with healthy food of various colours like tomato, capsicum, broccoli, pumpkin, corn, and carrot. Consume fresh fruits rather than juice because much of the fibre content has been removed in juice. Consider including legumes, whole grains, and nuts into your diet too.

2. Exercise

Another cliché fact that almost everyone knows (but are not doing) is exercising regularly. Many parents affirm the importance of exercising and think that the family does exercise frequently. The question lies in the word 'regularly' – How much is considered as 'regular'? It is advised for children to engage in physical activity of at least 1 hour a day to regulate their weight and reduce obesity-associated health complications, while WHO recommends for adults to exercise for at least 150 minutes across the week. Exercise do not have to be strenuous to be effective. For younger children, outdoor play is always recommended—see Why Should You Let Your Child Play Outside?.

3. Limit sedentary lifestyle and behaviours

Having entered a life of hours-long screen-time (especially since the Movement Control Order), it has become more challenging for children to be occupied with an active lifestyle. Nonetheless, instead of long uninterrupted hours on video-streaming, gaming, internet-based activities, etc., ensure time spent on such devices are confined. For screen-time guidance, see Impacts of Gadget on Your Child. Another tip is to encourage using staircase instead of the escalator or elevator.

4. Avoid skipping meals

Contrary to common beliefs, skipping meals may lead to excessive eating. Skipping meals for the purpose of diet may backfire and result in unrestraint eating.

5. Interventions

For non-modifiable or genetics-associated obesity, physiological interventions may come into play. It involves surgical procedures and anti-obesity medications. However, this measure is only undertaken when the obesity cases are chronic (Schoepp, 2017).

As a final word, we want to encourage parents out there who are already in this journey of battling against obesity among their children, to keep persevering. The journey is difficult for both parents and children, but it is one that will not be regretted upon once a healthy lifestyle is achieved and maintained. You will never regret working hard, but only giving up.

This global public health concern must come to an end, and it starts with each parents being aware first and foremost and being responsible in guiding their children to having a healthier lifestyle (The Star., 2020).

For more information, do consult a dietician.

References

Bernama (2019). Childhood obesity a growing health crisis in Malaysia. https://www.nst.com.my/lifestyle/heal/2019/07/502533/childhood-obesity-growing-health-crisis-malaysia

Hong, J. Y. H. (2014). Childhood Obesity. http://www.myhealth.gov.my/en/childhood-obesity/

Schoepp, T. N. (2017). Obesity in Malaysia: Unhealthy Eating is as Harmful as Smoking. https://penanginstitute.org/publications/issues/1029-obesity-in-malaysia-unhealthy-eating-is-as-harmful-as-smoking/

The Star. (2020). MCO diets drive up Malaysia's obesity rates. https://www.thestar.com.my/news/nation/2020/06/22/mco-diets-drive-up-malaysias-obesity-rates

World Health Organisation. (2018). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

World Health Organization. (2019). Malaysia and WHO call for more investment in primary health care the 21st century. https://www.who.int/malaysia/news/detail/08-04-2019-malaysia-and-who-call-for-more-investment-in-primary-health-care-the-21st-century