What exactly is obesity? And is there more than meets the eye to this prevalent medical problem in Malaysia today?
Here to answer these questions is Dato' Dr Nik Ritza Kosai Nik Mahmood, associate professor and head of the Upper Gastrointestinal, Obesity and Metabolic Surgery unit at Universiti Kebangsaan Malaysia's (UKM) Faculty of Medicine. A respected voice in the medical community on obesity research, Dato' Dr Nik has headed this prestigious unit at UKM since 2011, which has performed over 1,500 bariatric and metabolic surgeries in Malaysia.
Already a serious health issue for the nation before the coronavirus pandemic, obesity leads to other major medical problems, making patients three to five times more vulnerable to the risk of Covid-19-related complications, according to Dato' Dr. Nik.
Dato' Dr. Nik shares his observations about the prevalence of obesity in Malaysia, how it affects society as a whole and why early diagnosis and treatment are so crucial.
How do you define obesity in Malaysia?
In Malaysia, the Ministry of Health defines obesity based on the Body Mass Index (BMI) classification of two guidelines; the World Health Organisation (WHO) (1998) and the Malaysian Clinical Practice Guidelines (CPG) of Obesity (2004). The higher the class of BMI, the higher the risk that obesity poses.
The WHO classified obesity into three classes—obese class I starts at a BMI of 30.0-34.9 kg/m2; obese class II at 35.0-39.9 kg/m2; and obese class III at 40 kg/m2 and above. On the other hand, the Malaysian obesity CPG has a lower cut off range for obese class I at 27.5—34.9 kg/m2, while obese class II and III ranges follow the same as the WHO’s.
How serious is obesity in Malaysia?
The prevalence of obesity is very high in Malaysia. The National Health & Morbidity Survey (NHMS) 2019 shows us that one in two of the Malaysian adult population is obese, and much worryingly, one in two of the Malaysian population has central obesity. We’re talking here about visceral fat in the body, which causes various metabolic problems.
What are the medical problems and complications that result from obesity?
Obesity attracts major medical problems—in particular hypertension and diabetes. According to our NHMS 2019, the prevalence of diabetes in Malaysia has increased from 13.4 per cent in 2015 to 18.3 per cent in 2019. Basically, that’s about one in five Malaysians have diabetes, the majority being Type 2 because of obesity. In terms of hypertension, it is currently prevalent in 30 percent of Malaysian adults.
Getting obese patients to understand that they are at very high risk of other diseases, that their lifespan can be significantly shortened compared to the non-obese population, and to give them insight that they need treatment, is a challenge.
How much more at risk are obese patients to Covid-19 compared to others?
Covid-19 is a virus, and generally, the body produces good immunity against any viral infection. If you’re healthy and don’t have any medical problems, then your body immunity will be able to focus more on just fighting Covid-19, as opposed to if you have obesity and other acquired obesity complications like diabetes, hypertension or OSA (obstructive sleep apnea); all of which reduce your oxygen level and affect your immune system's ability to fight infection. We know that patients with obesity increase their risk of Covid-related complications by at least three to five-fold. Secondary infection in an unfit person who develops Covid-19 is very grave.
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