The epidemic of obesity has now reached an alarming stage with at least 2.8 million people dying each year as a result of being overweight or obese. It is now recognised as one of the most important public health problems the world faces today.
I used to think obesity was a disease of excess confined only to the developed world. We called it ‘New World Syndrome’ because it is a non-communicable disease (NCD) caused by consumption of junk food, and a sedentary lifestyle. Obesity is a disease which I never believed would happen to us Asians, because we are a bunch of toilers and I love Japanese cuisine, which is recognised as the healthiest cuisine in the world!
However, in 2010, our Ministry of Health placed adverts in the local papers stating 2 in 5 Malaysian adults are overweight or obese. My belief was shattered and our battle of the bulge began. Obesity is no longer a problem of the developed world, it is now a global concern!
Malaysians are the Most Obese in South East Asia
“Malaysia is ranked sixth in the Asia-Pacific region for obesity and tops the list in South-East Asia for both obesity and diabetes,” stated Prof Dr.Mohd Ismail Noor,the president of Malaysian Society for the Study of Obesity, during a press interview.
“Once you are obese, it will be a lifelong problem. However, we do not recognize that obesity is a disease! No one cares and think it is okay to be fat,” he continued (Edwards, 2013).
Obesity is Serious
In one of the past weekends a group of three pharmacists and I were volunteering for a health check day. We were daunted by the fact that so many of us are actually overweight or obese yet were unaware of the health consequences.
In fact, obesity can impact many different organs. The most important of these is Type 2 Diabetes (Proietto, 2009).
Malaysia has the highest obesity rate in Southeast Asia and almost every second Malaysian adult is either overweight or obese.
Malaysia Diabetes Rates Going Up, Up, Up!
The National Health Morbidity Survey found that the number of Malaysians diagnosed with diabetes has increased by two folds, from 1.5 million in 2006 to about three million in 2011.
“The daily sugar intake among Malaysians was too high, at 51g, which was above the recommendation by the World Health Organization (WHO) at 50g,” said the former Deputy Health Minister Datuk Rosnah Shirlin (Ng, Suparmaniam and Mokhtar, 2011).
What is Obesity?
Obesity is a medical condition described by the World Health Organization (WHO) as abnormal or excessive body weight in the form of fat accumulation that presents a risk to an individual’s health. However, there are no perfect measures of overweight and obesity in a clinical situation. The most useful assessment is a combination of human body measurements, which are:
- Weight (kg) and Height (m), which calculates the body mass index (BMI), and
- Waist circumference (cm)
Body Mass Index (BMI)
Body Mass Index (BMI) is the most widely used method of measuring and identifying obesity, with a formula ‘BMI = weight divided by the square of height (kg/m2)’. The classification adopted by the WHO is shown in Table 1, it is based on the international standards developed for adult people of European descent.
Asians Shoud Have Lower BMI Cut Off
However, after 20 years of research, The Nurses’ Health Study has concluded that Asians have more than double the risk of developing Type 2 Diabetes for a given level of BMI compared to people of European descent. Therefore, the study proposed a lower BMI cut-offs for overweight and obesity in these populations as shown in the table below (DJ Frenk n.d.).
|
Overweight |
Obese |
|
| Caucasians (WHO) |
>25 |
>30 |
| China and Japan |
>24 |
>28 |
| India |
>23 |
>27 |
For instance, if my height is 1.65m and I weighed 66kg, my BMI will be 66 /(1.65 x 1.65) = 24.24 (overweight!)
I am, indeed, overweight with a higher risk of prevalence for Type 2 Diabetes, cardiovascular diseases (CVD) and cancer! Thus, I should lose my weight to less than 65kg in order to gain a BMI of lower than 24.
The Limitations of BMI
BMI is highly, but not perfectly, correlated with fat mass and fat distribution. It has several limitations. Firstly, it does not distinguish fat mass from lean muscle, and hence, it is not suitable for
- Muscular individuals
- Older people
Secondly, BMI does not necessarily reflect body-fat distribution (see below); therefore waist circumference is important to complement the abdominal fat mass and disease risk measurements in individuals with BMI of less than 35.
Your Waist Circumference and How it Relates to Disease Risk
Excess fat can be deposited in different areas of the body. From a health point of view, two major types of fat distribution are important – central abdominal or waist (apple-shaped) and gluteal-femoral or buttock (pear-shaped).
Waist circumference (subcutaneous abdominal fat) has been shown to be positively associated with ‘disease risk’ such as metabolic syndrome. Similarly, it has also been suggested that a lower cut-off values of 90cm for Asian men and 80cm for Asian women are associated with a substantially increased risk of metabolic complications.
Metabolic syndrome is a disorder of energy utilization and storage, which may cause the health issues below:
Table 2. The recommendations of waist circumference cut-off points for different ethnicity:
| Ethnic group |
Waist circumference (cm), men |
Waist circumference (cm), women |
| Caucasians |
>102 |
>88 |
| South Asian |
>90 |
>80 |
| Chinese |
>90 |
>80 |
| Japanese |
>90 |
>80 |
Source: Adapted from Zimmet&Alberti (2006)
As my previous article mentioned, measuring waist circumference in combination with weight or BMI predicts cardiovascular risk more accurately than simply measuring the widely recognized indicator, BMI.
Furthermore, BMI and waist circumference can be easily done at home. If your readings are sitting at overweight or obese parameters, you may carry a higher disease risk than others (See Table 3 below). You should look for your GP or pharmacist for further advice because GPs and pharmacists are well placed to address the issue of overweight or obesity in individuals and families.
Table 3. Combined recommendations of body mass index and waist circumference cut-off points with disease risk for Asians
| Body mass index (BMI) | Disease risk (relative to normal weight and waist circumference) | ||
| Men < 90Women < 80 | Men > 90Women > 80 | ||
| Normal | < 24 | ||
| Overweight | > 24 | Increased | High |
| Obese | > 28 | High | Very high |
I will further explain the causes and the treatments of obesity in coming articles. Good luck with your measurement!
Please do not hesitate to drop me any messages at rachel_gms@hotmail.com if you have any questions.