16 August 2010

Overweight and obesity increases the risk of many chronic diseases.

THE bad news is: overweight and obesity increases your risk to coronary heart disease, stroke, diabetes, and high blood pressure. It also aggravates arthritis and breathing problems. More bad news is that overweight and obesity causes certain cancers.

The good news is: overweight and obesity is largely preventable. There is therefore no option – measures must be taken to prevent overweight or obesity. It is particularly important to prevent our children from excessive weight gain. An overweight child is more likely to become an overweight or obese adult. Prevention must therefore start from childhood.

The solution is: maintain body weight in a healthy range. This is the second key message of the Malaysian Dietary Guidelines (MDG) 2010 and is the focus of this instalment of NutriScene.

The MDG 2010 is a set of advisory statements that aim to promote appropriate food habits, physical activity, and wiser food choices.

Overweight and obesity in Malaysia

Available data show that overweight and obesity rates in Malaysia has been on the rise. The nationwide Third National Health and Morbidity Survey (NHMS III) conducted in 2006 showed that 29.1% of the adult population studied was found to be overweight (BMI 25.0 to 29.9). The prevalence of obesity (BMI >30) was reported to be 14.0%.

The proportion of the adult population that are overweight and obese is therefore 43.1%. This means that almost half of the adult population in the country could be overweight or obese.
This rate of occurrence of overweight and obesity is much higher than the rates found in the Second National Health and Morbidity Survey (NHMS II) carried out in 1996. Overweight in NHMS II was 16.6% while obesity was 4.4%. The percentage of adults that were overweight and obese in 1996 was 21.0%.

Comparing the data for 2006 and 1996, it is clear that the current prevalence of overweight is at least 1.8 times higher than that 10 years ago. Furthermore, the rate of obesity is now 3.2 times higher than that a decade ago. The combined problem of overweight and obesity is now two times higher than in 1996.

NHMS III also included children below 18 years in the survey. The prevalence of overweight among children was 5.4%. There was a slightly higher prevalence of overweight among boys (6.0%) compared to girls (4.7%). The proportion of overweight children in urban areas (6.3%) was higher than that observed for rural areas (4.0%). NHMS II in 1996 did not include children in that survey. Recent studies among primary school children have reported high prevalences of overweight and obesity of over 20%.

Causes of overweight and obesity

We take in energy from food and drinks, which is used to carry out a variety of body functions and physical activity. If we take in more energy than we use, we are said to be in a positive energy balance, and we gain weight. Excess energy is stored mostly as body fat laid down at various sites around the body. This excess energy can come from carbohydrates, fats, or proteins contained in the food we eat. Yes, it can also come from ethanol in the alcoholic drinks.

Positive energy balance can also be caused by a sedentary lifestyle or lack of physical activity. I do believe that in the case of Malaysians, the problem of overweight and obesity is largely due to overeating and eating too much energy-dense foods, combined with lack of physical activity.

We need to achieve energy balance by adopting an appropriate dietary pattern and an active lifestyle. We will then be able to maintain our body weight in the healthy range.

What is a healthy weight range?

One of the easiest ways to check if you’re in the healthy weight range is by calculating your Body Mass Index (BMI). This indicator calculates the range of healthy weights for different heights and is a useful guide for most adults. Follow the simple procedures below:

1. Weigh yourself in kilograms (kg) and measure your height in metres (m).

2. Divide your weight by your height squared. This figure is your BMI.

For example, if a person is 1.6 m tall and weighs 65 kg, your BMI would be 25.4.

If your BMI is less than 18.5, you are underweight and your risk of weight-related illness is low.

If your BMI is from 18.5 to 24.9, you are in the normal range and your risk of weight-related illness is average.

If your BMI is From 25.0 to 29.9, you are overweight and your risk of weight-related illness is increased.

If your BMI is 30 or above, you are obese and your risk of weight-related illness is moderate to severe.

Hence, for the example above, the person is said to be overweight and is not in the healthy weight range. His risk to various weight-related problems is increased.

It must be noted that the above guide to interpretating BMI is only for those 18 years and above. For children and adolescents, a different BMI cut-off value must be used for each age group. Furthermore, it should be noted that BMI may not be a suitable indicator for athletes, elderly people, and pregnant women.

The emphasis on overweight and obesity and its related health hazards should not overshadow the fact that the other extreme of weight problems can also occur and should not be ignored. When a person uses up more energy than he takes in, he is said to be in negative energy balance and loses weight.

A low body weight is also unhealthy because it increases the risk of other clinical conditions. Severely underweight persons often have poor nutritional status and are prone to infections, low immune status, anaemia, low bone mass, and difficulty recovering from illnesses.

Hence, it is important for all Malaysians to maintain a healthy body weight range throughout life.

Take action

Key message two of the MDG provides guidelines for maintaining a healthy weight range. It has five key recommendations, and within each of these, the MDG has provided several tips on how to achieve these recommendations.

1. Maintain body weight in the healthy range by balancing calorie intake with physical activity.

● Eat according to calorie recommendation by age, sex and physical activity level.

● Be physically active everyday

● Reduce sedentary activities.

2. Weigh yourself regularly, at least once a week.

● Use a suitable weighing scale.

● Weigh in light clothing and without shoes.

● Weigh yourself at the same time of the day, preferably before breakfast.

3. If you are an adult, prevent gradual weight gain over time.

● Reduce intake of high calorie foods.

● Eat smaller portions of high calorie foods.

● Increase physical activity to increase daily energy expenditure.

4. If overweight, aim for a slow and steady weight loss.

● Set a realistic weight loss goal of ½ to 1 kg per week.

● Decrease calorie intake without sacrificing other nutrients.

● Increase daily physical activity to 90 minutes gradually.

5. If underweight, increase energy intake as recommended.

● Eat three main meals and one to three snacks in a day.

● Choose foods with higher calorie content.

● Eat larger portions of food.

Take charge today

Maintaining a healthy weight range must become the goal of all Malaysians at all stages of life. It is important to minimise the risk of chronic diseases in adults. Maintaining a healthy weight throughout childhood may reduce the risk of becoming an overweight or obese adult.

It is not about looking good. It is about being healthy.

I do believe that the recommendations above are achievable – we just have to tune our mind towards believing in them and actually doing them. Every Malaysian should know his body weight. He should monitor this weight regularly and take steps to maintain it within a desirable range.

For those who are overweight or obese, use these guidelines to help you reduce body weight and maintain it at the healthy range. Losing excess body weight is notoriously difficult. It is nevertheless possible; what is required is determination and discipline. There are no short cuts or quick ways to losing the extra kilos. Do be wary of the various programmes that promise quick weight-loss, that do not require any diet control or exercise.

This article was first published in www.thestar.com.my on 18 July 2010.