Thailand and the obesity epidemic

Obesity has reached alarming levels in the Asean Economic Community and especially in Thailand, where 32 per cent of the population are overweight, pushing the country into second place in terms of prevalence of obesity after Malaysia at 44 per cent and ahead of Singapore at 30 per cent. At this current rate of progression and without any vigorous intervention by the public health authorities, it is likely that half the Thai population will be overweight in the coming years. 

Obesity is defined as having an excess proportion of total body fat. To assess weight, health professionals commonly use the Body Mass Index (BMI). BMI is the weight in kilogrammes divided by the square of your height. In the western world, the BMI test is based on WHO criteria and ranges from normal (20-24.9), overweight (25-29.9) to obese (over 30). In Asian countries, the index follows the Regional Office for the Western Pacific (WPRO) standard. Due to the higher risk of developing obesity-related complications compared to the western population, its cut-off point for obesity status is a BMI of greater than or equal to 25?kg/m2. Consequently, Asians are overweight when the BMI is between 23 and 25 and obese when the BMI is equal to or above 25?kg/m2. 

It is essential to understand that excess weight is a lifestyle issue essentially related to the quantity of food ingested – not “a diet” issue per se. What overweight people need to realise is that any weight loss endeavour must come from significant and sustained motivation for behavioural changes. The diets listed in the “quick and easy weight loss” fads give rise to the illusion that eating pleasures can be maintained through a few dietary tips. By keeping the focus on the food intake, the lifestyle issue is not effectively addressed, leading to repeated diet regimen failures. 

There are many factors behind the fast-growing epidemic in Thailand. In simple terms, there is a huge imbalance between the promoters of healthy lifestyle, who include the Public Health Ministry, related medical associations and a few laudable stakeholders, and the pro-obesity advertising forces driven mainly by fast food companies and some influential media. 

Future obesity trends are exacerbated by food companies’ ads, which intentionally target all age-groups including the most influential individuals, young children. In addition, the publicity materials often display speedy meals or snacks with a smiling person quickly swallowing huge portions of food without taking the time to masticate. 

Such commercials are known to induce disturbed eating patterns that can potentially lead to excess weight. In fact, food intake needs to be progressive, at least over a 20 to 30-minute period to allow physiological control of food absorption. When the stomach stretches, specific nerves and hormones send negative feedback to the centre of satiety located in the brain, eliciting the sensation that you’ve had enough to eat. Speed eating does not trigger this feedback mechanism and leads to subdued and much higher intake of food. Skinny models are used to imply that this eating behaviour keeps you slim. 

Moreover, for the last decade, the “fat and happy” body culture has enjoyed both recognition and support. While it is of course positive that overweight people are not ostracized and can project a “feel good” attitude, the pendulum has swung too far, with a growing number of severely obese individuals seemingly not realising the grim consequences they will soon face. 

It is thus essential that the population at large becomes really aware of the long-term complications of obesity that include not only serious diseases such as diabetes, cardiovascular illnesses and an increased risk of many cancers but also lead – always and sooner than expected – to a deprived quality of life with impairment of lung and liver function as well as chronic joints and bones problems. 

Obesity is preventable and the epidemic is not fatal. In some countries such as Singapore, prolonged awareness campaigns to promote a healthy lifestyle and control obesity have already showed commendable results. 

In Thailand, it is really time to do something concrete. 

 

DR GERARD LALANDE is managing director of CEO-Health, which provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted at [email protected].