In Malaysia, obesity is one of the most pressing health concerns, with nearly 20 per cent of the population classified as obese. The World Obesity Atlas projects that this number could increase to 41 per cent by 2035, stressing the urgent need for comprehensive prevention and treatment strategies. This concerning trend accompanies the already alarming rise in chronic diseases, rooted in what is commonly known as the “Three Highs” — high blood sugar, high blood pressure, and high cholesterol — with over half a million Malaysian adults currently living with all four conditions.
Understanding obesity
Obesity extends beyond being just a physical issue of excess body weight — it can also impact both mental and emotional wellbeing, creating a cycle of worsening health outcomes. According to Dr Lim Kim Piow, Consultant Endocrinologist and Internal Medicine Physician at Sunway Medical Centre Velocity (SMCV), “Obesity is often associated with depression and anxiety, which can promote binge eating and lead to a sedentary lifestyle, further weight gain, and worsening the condition.”
Obesity, classified by a Body Mass Index (BMI) of 27.5 or higher, is one of the contributing risk factors for multiple health conditions, including diabetes, stroke, heart attack, chronic kidney disease, gout, obstructive sleep apnea (OSA), fatty liver, gallstones, polycystic ovary syndrome (PCOS), infertility, osteoarthritis, pelvic inflammatory disease (PID), cataracts, pancreatitis, cancers, deep vein thrombosis, depression, anxiety, and others.
Dr Lim explains that “Obesity leads to insulin resistance, causing the pancreas to work harder to produce more insulin to overcome the resistance, which results in hyperinsulinemia. This compensatory mechanism can eventually progress to prediabetes and Type 2 diabetes.”
Malaysia has one of the highest rates of diabetes globally, with over 3.6 million Malaysians diagnosed with diabetes in 2019. This figure is projected to double by 2025, impacting an estimated 7 million Malaysians, according to the Ministry of Health. Even more concerning, many Malaysians are unaware they have diabetes — statistics reveal that two in five adults and 84 per cent of young adults aged 18 to 29 are unaware they have the disease.
Beyond its impact on blood sugar, obesity can also disrupt hormonal balance, particularly in women. Those with a history of Type 2 diabetes are at a higher risk of developing PCOS, a condition often linked to obesity that causes symptoms such as irregular periods and excess facial or body hair due to elevated levels of androgens (male hormones).
Moreover, PCOS is one of the leading causes of infertility due to irregular ovulation or the absence of ovulation. Dr Lim notes, “PCOS and obesity are interconnected through hyperinsulinemia and metabolic dysfunction, which lead to abnormal ovarian function and an overproduction of androgens, contributing to the symptoms of PCOS. If untreated, it can also lead to infertility.”
Obesity can also increase the risk of cardiovascular issues. Individuals who are obese are more likely to experience heart attacks and may present with symptoms such as chest pain, body discomfort, heartburn, nausea, and shortness of breath. Additionally, obesity can lead to conditions like ischemic cardiomyopathy, where the heart muscle becomes damaged due to inadequate blood supply, and left ventricular hypertrophy, a condition in which the heart muscle thickens. Both of these conditions can result in heart failure, as noted by Datuk Dr Foo Yoke Loong, Consultant Cardiologist and Internal Medicine Physician at SMCV.
Strategies for prevention, management
The first step in effectively managing obesity is understanding its broad impact on overall health. Dr Lim underscores the importance of self-awareness, stressing that patients must recognise and accept how obesity underpins common health complications affecting the heart, brain, and kidneys.
He also highlights the significant role of genetics in obesity and related endocrine disorders, urging individuals to acknowledge these potential risks and take the necessary proactive steps to combat obesity.
“Recognising both personal habits and genetic factors may help foster a sense of determination and perseverance in their weight loss journey, turning guilt and disappointment into actionable strategies,” Dr Lim explains.
Dr Foo also highlights the importance of being vigilant for early signs of cardiovascular issues related to obesity. He notes that central chest pains, which may radiate to other parts of the body like the left hand, back, or neck, are often an early symptom of heart disease.
Another key strategy recommended by Dr Lim is meal management. He encourages following a low-calorie, low-carbohydrate diet and conducting self-monitoring by tracking food intake through journaling or by using authorised health and wellness mobile applications, as this helps maintain awareness of dietary habits.
Dr Foo supports this approach and advises consulting a dietitian to identify deficiencies or excesses in one’s current diet. Simple changes, such as reducing sugar intake by requesting less or no sugar in beverages and avoiding highly processed, sugary foods like doughnuts, candies, and ice cream, can significantly improve blood sugar levels and prevent further health deterioration.
Additionally, lifestyle changes would not be complete without regular and consistent exercise. Dr Foo encourages any form of exercise that suits one’s condition, while Dr Lim recommends setting realistic goals and participating in exercise groups to stay motivated. Cardio exercises such as jogging, swimming, and cycling are effective in improving both heart health and managing obesity.
“Swimming is an excellent universal exercise, especially for individuals with knee problems, as it reduces impact on the joints compared to running,” said Dr Foo. He added that for patients with more advanced conditions such as high blood sugar and cholesterol levels, combining lifestyle changes with medical intervention is essential for a faster recovery process.
Routine health checkups and screenings are also essential for early diagnosis and preventive care. Dr Lim shares that the frequency of health screenings should be based on an individual’s BMI, existing conditions, and family history, ranging from every three months to annually.
Additionally, Dr Foo highlights the importance of early diagnosis, noting that delays in receiving treatment can lead to increased complications and the possibility of permanent heart damage. Overall, early diagnosis allows for less invasive treatment options, reduces the risk of complications, and enhances the likelihood of successful treatment outcomes.
As the prevalence of the “Four Highs” — high blood sugar, high blood pressure, high cholesterol, and obesity — continues to rise among Malaysians, with alarming projections for the future, urgent actions are needed. Since obesity can be prevented and managed to reduce the risk of developing multiple diseases, key strategies to address this pressing issue include enhancing self-awareness, managing meals, incorporating regular exercise, seeking professional guidance, and undergoing regular health checkups and screenings.
