More than half of Malaysia’s children at risk of obesity

SATURDAY, MAY 04, 2024

When it comes to Malaysia’s growing obesity problem, children – especially boys – are the most at risk.

Available statistics show that six out of 10 children in the country are at risk of being overweight or obese by 2035, with boys facing a higher prevalence of obesity.

According to Malaysia’s National Health and Morbidity Survey (NHMS) 2022, adolescent males have a higher prevalence of obesity at 17.1%, compared with 11.4% for females.

Younger adolescents may be at a higher risk, as there is a higher prevalence of obesity among students in Form One (17%), followed by Form Two (15.3%) and Form Three (13.6%).

This problem may become even worse in the future.

According to the World Obesity Atlas 2024 report, it is estimated that a total of 4.99 million or 65% of Malaysia’s children will have a high body mass index (BMI) in 2035, compared with an estimated 2.85 million or 36% in 2020.

This is a projected 3.8% annual growth rate.

Meanwhile, 20 million adults in the country are expected to have a high BMI by 2035, with an annual growth of 3.7%.

In most South-East Asian countries, the growth rate in the projected number of children having obesity or being overweight surpasses adults.

Health experts warn that obese children risk becoming obese adults.

Currently, half of Malaysian adults are overweight, while two out of 10 adults are obese.

Why boys are more prone to obesity

Universiti Kebangsaan Malaysia (UKM) health economics and public health specialist Prof Dr Sharifa Ezat Wan Puteh said research shows that boys have a greater prevalence for obesity among children aged 5-19 in most high and upper middle-income countries worldwide.

“This usually start with excessive feeding since small and a typical family pattern of excess food consumption,” she said.

As mentioned above, according to the NHMS report, adolescent boys have a higher prevalence of obesity at 17.1%, compared with 11.4% among their female counterparts.

Meanwhile, females have a slightly higher prevalence to being overweight, at 16.5% compared with males (16%).

Increasing access to processed foods, a diet high in meat and calorie-dense foods, coupled with the lack of physical activities are among the factors leafing to obesity.

Prof Sharifa Ezat said differences in the obesity prevalence between girls and boys may be driven by gender-related influences.

These include societal ideals about body weight and parental feeding practices, as well as sex-related influences, such as body composition and hormones.

“Boys who are obese may have early puberty and testicular enlargement occurring significantly earlier compared with their normal weight peers.

“Girls who are consistently overweight or obese have the highest risk of early breast development, while girls that are transiently overweight or obese have the highest risk for early menses,” she added.

She said children with obesity or who are overweight have a higher risk of high blood pressure, high cholesterol, fatty liver, Type 2 diabetes, obstructive sleep apnoea, certain cancers, arthritis, gall bladder diseases, metabolic diseases in adulthood, flat feet and mental health issues such as increased stress.

Based on the World Obesity Atlas 2024, among the early signs of non-communicable diseases (NCDs) attributed to a high BMI among children are high blood pressure, hyperglycaemia, and low high-density lipoprotein (HDL) cholesterol.

HDL cholesterol is known as "good" cholesterol because it helps remove other forms of cholesterol from the bloodstream.

In 2035, an estimated 10.6% or 528,584 children in Malaysia with high BMI are expected to have low HDL cholesterol.

Meanwhile, 7% or 526,068 children with high BMI will be at risk of developing high blood pressure, and 3.6% or 180,749 children are at risk of suffering hyperglycaemia.

Globally, 10% of deaths were due to the consequence of obesity, which was almost double the share in 1990, according to Our World in Data.

In Malaysia, 9.7% of deaths are due to obesity as an attributing risk factor, with a growth of 2.9 points from 1990.

This includes ischaemic heart disease, stroke, cancer (neoplasms) and diabetes mellitus.

Growth spurts among girls

Malaysian Medical Association (MMA) president Dr Azizan Abdul Aziz said adolescent girls may have a lower prevalence of obesity due to an earlier female pubertal growth spurt.

“Boys and girls are the same in their height gain or velocity prior to the onset of puberty, but girls grow faster once they reach puberty – which can happen as early as the age of eight.

“Height gains for girls during puberty may have some positive impact on the BMI. This may explain the prevalence of obesity among those within the ages of 10-19 years,” she said.

She said obesity is thought to be the main cause for early puberty in girls, apart from exposure to endocrine disruptors.

“The consequence is that they are maturing earlier with advanced bone age. They could also start to get their period earlier, and some could have compromised adult height.”

The crucial role of schools

UKM’s Prof Sharifa Ezat said early intervention is needed to prevent obesity among children from progressing which could lead them to carry serious health risks into adulthood.

“Body weight screening can be done at schools where interventions can then be done. We also need to promote healthy eating among children.”

She said schools should encourage children to exercise and be active in sports.

She said the policy imposed on school canteen food vendors are also important to ensure that only healthy, safe and nutritious food are sold.

“Assistance to low-income families should also be channelled as they are more prone to be overweight or obese,” she said.

Societal pressures and parental roles

Prof Dr Moy Foong Ming from Universiti Malaya's Department of Social and Preventive Medicine said gender differences in obesity and overweight prevalences may be influenced by societal pressures.

“Parents tend to be more concerned about weight status in their daughters than sons, while sons are usually encouraged to eat more,” she said.

The NHMS findings, she said, show that there are more adult men who are overweight, while more adult women are obese.

“The reason men are less likely to become obese could be because of a higher level of physical activity due to their occupations that are less sedentary, and men could be more likely to engage in sports activities,” she said.

She said mothers should adopt early precautions such as ensuring appropriate weight gain during pregnancy, practise exclusive breastfeeding in the first six months after birth, and continue breastfeeding until 24 months or more.

She said parents should also encourage children to eat healthily and do physical activities, aside from limiting screen time and the consumption of sweetened beverages and energy-dense food.