Battling the bulge: Why dig our own graves?

A stitch in time saves nine. Prevention is better than cure. Better safe than sorry. We have heard these sayings all our lives.

Yet when it comes to our health and lifestyles, many of us don’t take these words of wisdom seriously. Roughly three quarters of older adults have comorbidities – medical conditions that coexist alongside a primary diagnosis.

This article is not about treating comorbidities. We leave that to the doctors.

But what are we doing about these premature deaths? What can we do to save lives – our own and those of our loved ones? Treatment without prevention simply does not make sense. Why die prematurely?

In 2022, a staggering 95,266 adults aged 30-69 died due to non-communicable diseases such as cardiovascular disease, diabetes and cancer. Their lifespans were well below the life expectancy in Malaysia of 75 years. With almost 70% of the people in Malaysia falling in the 15-64 age group, aren’t these premature deaths cause for alarm?

A major cause of non-communicable diseases is obesity. This would seriously affect people’s quality of life and their physical, mental and social wellbeing, as it could lead to 65 major medical complications.

So, why dig our own graves? Why not nip the problem in the bud?

In the 2024 Budget, the government allocated a whopping RM41.2bn to public healthcare – about 10.5% of the Budget. This was an increase of 13.5% from the previous Budget.

Unfortunately, the budget for prevention efforts, such as raising awareness, promoting a healthy lifestyle and implementing regulations, was reduced.

Why? Wouldn’t prevention save us a lot of money and pain? The Ministry of Health (MoH) recently did come up with a white paper to roll out programmes for a change in mindset – from curative to preventive action. The two main schemes are “Madani” (you guessed it!) and “agenda nasional sihat” (healthy national agenda).

Sadly, these schemes were allocated a meagre budget of RM123m. Instead, the government is spending more resources on facilitating the financing by sharing costs with insurance payouts. 

The MoH budget is just 51.2% of the total healthcare cost in Malaysia. The other 48.8% is borne by the private sector through insurance claims or patients’ out-of-pocket expenses. Combined, the cost is staggering.

The government’s outgoing chief secretary Mohd Zuki Ali recently revealed that about half of all civil servants in Putrajaya are obese.

Earlier, Federal Territory Minister Dr Zaliha Mustafa pointed out that Putrajaya residents have a higher rate of obesity and high blood pressure compared to the national average. Statistics also show that Kuala Lumpur and Putrajaya residents are more prone to depression and anxiety.

Imagine the productivity levels of the already bloated civil service. Six to 12 years of a person’s productive life is estimated to be lost because of obesity.

But no fear for them, as the “Madani” (civil and compassionate) government will soon reward them with increased pay. That’s a story for another day.

Last November, Zaliha, at that time the health minister, reported to Parliament that a national health screening initiative for 2023 found that 53.5% of Malaysians screened were overweight (31.3%) and obese (22.2%). This was higher than what a national health and mobility survey had found in 2019 – that 50.1% of adults in Malaysia are obese. This is the highest in Southeast Asia and the West Pacific region.

Malaysia crossed the red line to declare obesity an epidemic a long time ago. So why are we still not taking this problem seriously? Don’t we love ourselves? How can we leave this problem unchecked?

Let’s stop deceiving ourselves. Our national pastime – our favourite dishes to pamper our spoilt taste buds – is killing us. Nasi lemak, roti canai, very sweet kuih, bubur, mee goreng, curry laksa, char koay teow, nasi kandar (from too many 24-hour restaurants), cendol, ice kacang, other hawker favourites and popular fast foods are loaded with unhealthy carbohydrates, trans fats, salt and sugar. These are poisoning us.

The national strategic plan for non-communicable diseases for 2016-2025 aimed to put greater emphasis on prevention and control by early screening services. But it has not borne fruit. Neither has the national plan of action for nutrition. Both plans have been constrained by insufficient funds to stem this burden.

Even the sugar tax – introduced a few years ago and increased from 40 sen to 50 sen per litre of sweetened beverages in the present Budget – has not produced meaningful results.

The government needs to widen its regulatory net and check on the beverages prepared in cafes and restaurants and even on the streets.

The MoH, along with several organisations working on obesity, last year came up with a second set of clinical practice guidelines to combat and manage obesity. But the earliest they expect to see some results is by 2027 – three years from now.

The emphasis, it seems, will equally be extended to the management of childhood and adolescent obesity, so that the next generation of adults will have fewer weight issues, better health and more productive lives.

The earlier clinical practice guidelines formulated 20 years ago had failed miserably – as the latest deteriorating data indicates.

Hopefully, the second set of guidelines, revised to take into account greatly improved treatment strategies and medical breakthroughs, will, with the concerted efforts of medical practitioners, achieve better results.

Being overweight and obese could lead to over 65 illnesses and complications, such as hypertension, diabetes and minor strokes. It could result in insulin resistance, sleep apnoea, coronary disease, gout, stroke, nerve damage, osteoporosis, fatty liver and damage to the eyes and kidneys.

So let’s get redouble our efforts to reduce excess weight through:

• A change in lifestyle and healthy living
• A healthy diet that requires negative energy balance and reduces calory intake
• Increased physical activity
• Pharmacotherapy or anti-obesity drugs
• Bariatric surgery

There is no other way. To put it crudely, it’s do or die.

Sarajun Hoda Abdul Hassan
Co-editor, Aliran newsletter
11 August 2024

The views expressed in Aliran's media statements and the NGO statements we have endorsed reflect Aliran's official stand. Views and opinions expressed in other pieces published here do not necessarily reflect Aliran's official position.

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