The Malaysian Insight

MALAYSIANS are getting fatter and opening themselves up to a slew of non-communicable diseases (NCDs) such as diabetes and cardiovascular disease, health experts warned.

They said increased obesity among adults and children are driving up the number of Malaysians with diabetes and other related diseases in the last decade.

This opens the door to other NCDs such as heart and kidney problems. A sedentary lifestyle and unhealthy eating habits increase the risk of getting these diseases.

Dr Danish Ng Ooi Yee, an endocrinologist from Prince Court Medical Centre, said around 50% of the Malaysian population are obese and are therefore at risk of contracting non-communicable diseases such as diabetes, heart and kidney ailments, among others.

“We have a very big population who are overweight or obese and they are at a higher risk of contracting NCDs (because of this),” he told The Malaysian Insight.

“Their lifestyle –a lack of exercise and an intake of food high in fat, cholesterol and sugar – is also a contributory factor.”

The National Health and Morbidity Survey (NHMS) 2019 by the Health Ministry (MOH) found that one in two adults are overweight or obese. Women make up the majority of the number with 54.7%.

To be deemed overweight is to have a body mass index (BMI) of more that 25. Someone who is obese has a BMI of more than 30.

Being overweight or obese is more prevalent among those of Indian ethnicity (63.9%) and those aged between 55 and 59 (60.9%).
 
The survey also found that one in two adults in Malaysia have abdominal obesity. For women, this means having a waist circumference of more than 80cm. For men, it is 90cm.

Abdominal obesity is most common in women (64.8%), those of Indian ethnicity (68.3%) and those aged 60 to 64 (71.5%).

The Health Ministry has labelled obesity, being overweight and abdominal obesity as the leading causes of diabetes, high blood pressure and heart disease among Malaysians.

The report by the MOH also found that 1.7 million people in Malaysia currently live with three risk factors – diabetes, high cholesterol and hypertension. Another 3.4 million have at least two risk factors.

All these in turn have led to a prevalence of cardiovascular disease in Malaysia, which the MOH says is the leading cause of death in the country.

Increased prevalence of diabetes

A less active population who are obese, coupled with the fact that Malaysia is an ageing society, also increases the risk of diabetes, said Ng.

The Health Ministry recommends 150 minutes of moderate intensity physical activity in a week for adults between the ages of 18 and 64.

“At an age of more than 60, the prevalence in Malaysia is four in 10 people (who will have diabetes). If we have an ageing population, this number will increase,” he said.

While older people are more prone to diabetes, Ng said he is seeing more and more children develop Type 2 diabetes.

“They are getting fatter due to childhood obesity. When the mother has diabetes when pregnant, this could be a factor too.

“Most of them develop diabetes when they are entering puberty. This is when they are more insulin-resistant.”

The NHMS reports showed that one in five adults in Malaysia have diabetes.

The prevalence of diabetes among Malaysian adults aged 18 and above rose from 11.2% in 2011 to 13.4% in 2015. In 2019, the figure was 18.3% or 3.9 million of the adult population.

Data from the World Health Organisation shows that about 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year.

The survey also found that Malaysians get their sugar intake mostly from sugary drinks.

Around 53.2% say that their sugar intake comes from self-prepared drinks such as coffee, tea or malted beverages. About 4.2% comes from daily carbonated and non-carbonated drinks while 6.7% say premixed drinks contribute to their daily sugary drink intake.

Burden to healthcare system

Malaysian Public Health Physicians Association president Dr Zainal Ariffin Omar said that while obesity and an unhealthy diet are the leading causes of diabetes, a lack of self-monitoring and screening are also major factors.

“It’s not only because of diabetes but complications from other diseases that affect the heart, kidney, eyes, ulcers and even nerves,” he said.

The NHMS data showed that 5.3% of those aged 18 to 29 did not know that they have diabetes. Around 8.5% of those aged 30 to 39 said they were not aware. For those aged 40 to 49 (12.4%), 50 to 59-years-old (11.3%) and those for those 6 and above, 11.1%, said they did not know that they had diabetes.

The majority of those with known diabetes sought treatment at MOH health clinics (68.2%), followed by MOH hospitals (15%), private clinics (12.1%) and private hospitals (2.8%).

About 0.4% self-medicated by purchasing medication directly from pharmacies and 0.2% sought traditional and complementary medicine practitioners.

However, about 2.1% of respondents did not seek any treatment for diabetes.

Ng said the government’s focus solely on treating Covid-19 in the past two years has also put the treatment of diabetes on the back burner.

“The main focus has been on the epidemic rather than NCDs. The promotions of diabetes and its treatments have lessened. It has been siphoned to Covid-19 management.”

To that extent, he said, many of his patients have also missed their appointments leading to their diabetes getting out of control and a slew of health problems.

“If they have uncontrolled diabetes, they can have all sorts of infections…on the skin, in their urine, in their lungs, etc.

“Complications include stroke, heart attack or failure, blindness, kidney problems and neuropathy. All these result in diabetic foot ulcers and lead to amputation.

“A smaller subset of patients will suffer from erectile dysfunction. The psychiatric component is also often forgotten. They come in a whole package.”

All this, he said, will overwhelm the public healthcare system and increase the cost borne by the government to treat these individuals.

Poor left vulnerable

Universiti Malaya economist Rajah Rasiah said the prevalence of diabetes has increased the costs borne by the government and left the B40 vulnerable.

He said the government’s recent policy of allowing withdrawals from the Employees Provident Fund (EPF) has also left the poorer segment of society vulnerable.

“While Malaysia’s lifespan has risen to 76.4 years in 2021, it is still lower than those of the developed countries, such as Hong Kong, Japan, Singapore, Switzerland, Spain, and Australia.

“Nevertheless, this is a pertinent question as the government’s policy of allowing contributors to withdraw money from their EPF savings has left a major segment of the B40 group vulnerable.”

Latest statistics show that 6.1 million contributors have less than RM10,000 while 3.6 million have RM1,000 left in their EPF accounts.

He said such low savings clearly show that 6.1 million will face serious problems when they retire.

Given that the prevalence of diseases increases with age, the government must do something to address this issue, he added.

Meanwhile, Ng added that there is a misconception that to eat healthy means to eat expensive food.

“Even normal cheap food can be healthy. While eating brown rice or basmati can be healthier than white rice, it doesn’t mean those eating white rice are automatically prone to diabetes.

“We should control the portion rather than choosing pricier products,” he said. – November 24, 2021.