By Professor Dr Moy Foong Ming

In the 2019 National Health and Morbidity Survey, 50.1% of our adult population are overweight or obese (30.4% overweight and 19.7% obese). This means out of two adults, one is overweight or obese. In addition, 25% of Malaysian adults are reported to be physically inactive and 95% of them not consuming adequate fruits and/or vegetables of 5 servings per day. Many people have the misperception that being overweight or obese is fine as long as we don't fall sick. However, there are strong evidences showing that overweight or obese people are at greater risks for diseases, including type 2 diabetes, high blood pressure, cardiovascular disease, stroke, and certain types of cancers. In addition, people who are overweight/obese may have poorer outcomes once they are infected with COVID-19.

People infected with COVID-19 suffer a range of mild to moderate symptoms such as fever, a persistent cough and sore throat. Many can also be without symptoms. However, for some people, COVID-19 will cause more severe symptoms, which can affect their lungs and many other body systems adversely and even cause death. Older age, people with underlying medical conditions (such as cardiovascular disease, type 2 diabetes, chronic respiratory disease, and current or recent cancer) and those with obesity are found to be more vulnerable to these severe symptoms.

The current evidence does not suggest that having excess weight increases people's chances of contracting COVID-19. However, obese people with COVID-19 are more likely to become seriously ill, need advanced respiratory support or die, compared to those with normal weight. Excess fat can affect the respiratory system and is likely to affect inflammatory and immune functions. Obesity also increases the risks of diseases like type 2 diabetes, cardiovascular disease and respiratory disease, which themselves increase the risks of complications in patients with COVID-19.

The COVID-19 pandemic has brought the health crisis caused by overweight and obesity to the forefront. Helping people living with overweight or obesity to achieve or maintain a healthier weight is complex. There is no single solution and there is little improvement with the existing health programs. At its simplest level, obesity is caused by imbalance between energy intake from diets and energy expenditure from physical activities, which over time results in excess weight gained. In addition, other drivers of obesity include environmental, behavioral, biological, societal and cultural factors.

Our environment with food available 24/7, convenient food and drinks which are unhealthy, healthy food choices which are more difficult to access and more expensive are key drivers to unhealthy eating. The food choices that people make are driven by price, availability, advertising and promotions. People's diets are also influenced by preferences and habits formed in early life, family food preferences and meal patterns. There are more food outlets than before, and takeaways and food deliveries have been made very easy with the growth of digital apps. Life is much more sedentary with easily available car ownership, the availability of good public transport system and most household chores are machine operated.

Drivers of excess calorie intakes and low levels of physical activity, within the environment will need to change at a national and local level to support population-level weight change. Existing policies on non-communicable diseases, tackling obesity and promotion of active living should be translated to more aggressive activities to increase public awareness and provide support for those who are interested to lose weight, in addition to implementing new laws such as imposing tax to discourage purchase of unhealthy foods (ie imposing sugar tax on soft drinks, which is already implemented).

Incentives should be given to industries to encourage product reformulation to be lower in energy. Low consumption of fruits and vegetables should be addressed by the government. More farmers' markets (pasar tani) should be established to encourage the public to buy direct from the farmers with more reasonable price. Encourage more shops to sell fruits and vegetables by providing tax rebate.

Existing school health programs should be more aggressive in tackling childhood obesity. There should be more stringent rules on the advertisement of foods with high fat, sugar and salt in the mass media.

Empowering everyone with the right information to make healthier choices is an important step in weight management. Ensure front of pack nutritional labeling is presented in a way that is easy to understand. Encourage food businesses (including restaurants, cafes and takeaways) to have calories labels on served food and beverages and improve the nutrient content of these food and beverages such as reducing fat, sugar and salt content. Promote the use of digital wearables among the public to track their diets and physical activities (steps walked) which will support individuals to achieve and maintain a healthier weight and lifestyle.

Learning the lessons from smoking, where GPs played a key role in increasing patients' awareness on the adverse effects of smoking and doing behavioral interventions, including referrals to stop-smoking services, we need to incorporate these types of interventions for obesity in primary care. If and when GPs can spend a few minutes on patients who are obese to reduce weight, this will at least increase their awareness that obesity is bad for their health, especially for those less educated ones. In order for this to be successful, weight management services should be provided in the local health care system.

Supporting people who are living with excess weight to lose weight in a sustainable manner, together with interventions to prevent weight gain across the population will probably reduce future population's health risks including protect against the health risks of COVID-19.

(Professor Dr Moy Foong Ming is Professor in Epidemiology) Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya.)