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Obesity in Malaysia is a public health concern, with Malaysia ranking second in Southeast Asia for obesity rates, following Brunei, and ahead of Singapore and Thailand.[1] Obesity is characterised by an excessive accumulation of body fat,[2] which increases the risk of developing several health conditions, including cardiovascular disease, type 2 diabetes, respiratory disorders, and cancer.[2] It can also contribute to mental health issues such as depression and low self-esteem.[2]

Nasi Lemak, a traditional Malaysian dish high in calories and fat

Body Mass Index (BMI) is the standard measure for defining obesity,[3] with adjusted thresholds for the Malaysian population. A BMI of ≥ 25.0 kg/m2 classifies an individual as overweight, while a BMI of ≥ 30.0 kg/m2 classifies an individual as obese.[4] According to the 2023 National Health and Morbidity Survey (NHMS), 32.6% of Malaysian adults are overweight, and 21.8% are obese, totalling 54.4% of the country's adult population.[5] The obesity epidemic among adults is predicted to grow by 4.7% annually between 2020 and 2035.[6] This trend extends to children, with obesity prevalence rising from 9.5% in 2006 to 12.9% in 2015.[7] Shifts in dietary preferences toward processed, high-calorie foods[4] and increasing urbanisation,[3] which encourages sedentary lifestyles, have contributed to Malaysia’s rising obesity rates. Genetic factors, such as variants in the LEPR and MC4R genes,[3] further increase susceptibility to obesity, alongside lifestyle influences like smoking.[8]

Obesity imposes a burden on Malaysia’s healthcare system and economy. Treating obesity-related illnesses accounts for approximately 20% of the nation’s healthcare expenditure.[9] Beyond medical expenses, obesity-related early deaths and reduced productivity cost the country RM8.91 billion every year.[10] As Malaysia’s population grows older, these financial pressures are expected to worsen; by 2026, treatment costs could reach up to 4% of the gross domestic product (GDP),[11] which could impact the country’s economic growth and stability. To address the causes of obesity, Malaysia has implemented various initiatives, including regulations that restrict the sale of unhealthy food in schools and public awareness campaigns to promote healthy lifestyles.[12] In 2019, a sugar tax on sweetened beverages was introduced.[13] Since then, many manufacturers have reformulated their products to lower added sugar.[14]

Prevalence

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During the 1980s and 1990s, Malaysia maintained an adult obesity prevalence below 5% as many people followed an agricultural lifestyle. With rapid urbanisation, dietary and occupational patterns shifted, resulting in an obesity rate of 4.4% by 1996.[15]

Over the next two decades, obesity prevalence in Malaysia grew exponentially. Obesity prevalence tripled from 4.4% in 1996 to 14.0% by 2006.[16] By 2010, Malaysia had one of the highest obesity rates in Southeast Asia, surpassing Thailand's 8.8% and Indonesia's 5.7%. The 2015 NHMS data showed that obesity prevalence among adults rose to 17.7%, with severe obesity—defined as a BMI of ≥ 40kg/m2—affecting 1.0% of the population.[15]

Obesity prevalence stabilised in the post-2016 period as it plateaued near 20%, reaching 19.9% in 2019.[15] Projections by the World Obesity Federation suggest that without policy interventions, adult obesity prevalence could reach a critical threshold of 41% by 2035.[17]

Demographic differences

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Gender

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Females are at a greater risk of obesity compared to males, being 1.6 times more likely to be obese.[15] In Malaysia, the obesity prevalence among females is 13.8%, while it is 9.6% for males.[18] This gender disparity in Malaysia is linked to socioeconomic shifts, such as increased female workforce participation[19] and a sedentary lifestyle with insufficient physical activity.[20] Biological factors like postmenopausal hormonal changes, an increase in fat mass, and a decrease in lean muscle mass also play a role.[21] Women in Malaysia face sociocultural barriers to exercise, including a lack of support and social disapproval, which further contribute to this disparity.[22]

Age

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Obesity rates increase with age for both males and females.[18] In Malaysia, the obesity rate among children under the age of 5 was 6.0% in 2022.[23] For individuals aged 15-19, the average obesity rate for both sexes is 6.5%. This figure rises to 9.4% for those aged 20-29 and reaches 11.8% for individuals in their 30s. For males, obesity prevalence peaks at ages 40-49. For females, the highest rates are observed later, between the ages of 50-59.[18] This trend can be attributed to less active work routines and cumulative dietary influences over the decades.

Ethnicity

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Obesity prevalence among ethnic groups in Malaysia differs. Malays have the highest rate at 13.6%, closely followed by Indians at 13.5%. At the other end of the spectrum, the Bumiputera Sabah population have the lowest rate at 7.3%, while Chinese individuals have a slightly higher rate of 8.5%.[18] These variations reflect the unique cultural and lifestyle factors shaping obesity in Malaysia.

Causes

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Dietary habits

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In Malaysia, shifts in dietary habits over the past decades have contributed to the rise in obesity. The traditional diet, rich in complex carbohydrates like cereals, declined from 60% of total caloric intake in the 1960s to 40% by the 1990s. This decline has led to increased consumption of energy-dense foods, including oils, fats, meats, and sugars. Diets high in such foods are associated with obesity, as they induce weaker satiation[4] compared to carbohydrates, leading individuals to consume larger quantities of food to feel satisfied.

The Westernisation of the Malaysian diet,[24] characterised by a higher intake of fast food and carbonated beverages,[25] has fuelled the obesity trend. In 2022, Malaysia had 7,720 fast-food outlets,[26] with 1 in 10 people in Malaysia consuming fast food at least three days per week, according to an NHMS survey.[27] Fast foods are high in saturated and trans fats, sodium, and calories, while lacking essential micronutrients,[28] contributing to excessive calorie intake and increased obesity risk. This trend is particularly evident in lower-income families, who prioritise cheaper, less nutritious foods due to financial constraints, resulting in nutrient-poor dietary choices.[29]

Physical inactivity

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Malaysia's obesity epidemic is exacerbated by physical inactivity.[30] The National Health and Morbidity Survey 2019 reported that 24.6% of Malaysian adults[31] were physically inactive, exceeding prevalence in other Asian countries, including China, India, and Hong Kong.[32]

Traffic police regulating traffic in Kuala Lumpur, Malaysia

Automobile dependency has contributed to a sedentary lifestyle. With 36.3 million registered vehicles in 2023,[33] Malaysia is the second-highest country in Asia for automobile ownership.[34] This transportation pattern has reduced daily walking, creating environmental conditions conducive to weight gain. The average daily step count in Malaysia in 2024 was 3,963 steps, positioning it as the third least active nation globally[35] in terms of walking habits. This figure falls below the globally recommended 10,000 steps per day, which is considered essential for maintaining optimal health,[36] as walking is a form of cardiovascular physical activity that increases heart rate.[37]

Lack of motivation is also correlated with lower physical activity levels in Malaysia[30] as individuals struggle to initiate or maintain active lifestyles.

Genetic and Environmental factors

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Monogenic obesity is a rare form of obesity caused by mutations in single genes,[38] leading to disruptions in energy homeostasis independent of environmental influences. The leptin receptor, encoded by the LEPR gene, regulates energy homeostasis and promotes satiety.[39] In Malaysian populations, the LEPR variant K656N has been associated with obesity.[40] Another gene, the melanocortin 4 receptor gene (MC4R), which governs food intake and energy homeostasis,[41] has variants including MC4R rs571312 and rs2229616 that are also associated with obesity-related traits in Malaysians.[40]

Other genetic variants implicated in obesity include:

  • LEP G2548A, linked to obesity in Indian males[40]
  • UCP2 45 bp I/D, linked to adiposity in Malaysian women[40]
  • DRD2 polymorphism, linked to alterations in dietary behaviour[40]

Polygenic obesity involves multiple genes, each contributing a small effect to obesity risk.[38] This form of obesity is common and interacts with environmental factors that may amplify genetic predispositions.[40] For example, 40% of obese individuals in Malaysia are smokers, compared to a lower smoking prevalence among non-obese individuals.[8]

Cost of Obesity

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Obesity is a major driver of chronic non-communicable diseases (NCDs), such as hypertension, type 2 diabetes, coronary artery disease, and various cancers.[42] These illnesses not only increase medical costs but also place a burden on Malaysia’s healthcare system and economy.

The treatment of obesity-related NCDs consumes a portion of Malaysia’s healthcare funding. The Institute for Public Health found that individuals with obesity spend 2.5 times more on medical expenses than individuals with a healthy weight.[43] According to the Ministry of Health, Malaysia spends around RM4.2 billion annually on obesity-related healthcare costs, accounting for 10% to 20% of total health spending in Malaysia.[44]

Obesity-related issues in Malaysia lead to productivity losses. Each year, Malaysia loses RM8.91 billion due to absenteeism, reduced efficiency at work due to presenteeism, and premature deaths linked to obesity.[45] These factors raise the total financial impact of obesity, including indirect costs, to over RM13.11 billion annually, which is about 0.65% of Malaysia’s GDP. Beyond direct financial costs, obesity-related NCDs impose intangible losses, such as disability and reduced healthy life years, estimated at RM100.79 billion or 7.35% of GDP.[10]

The aging population issue in Malaysia exacerbates the cost of obesity. In 2019, the economic impact of overweight and obesity in Malaysia was estimated at US$5.68 billion. By 2060, these costs are projected to rise to US$104.55 billion, representing 4% of the GDP and an 18.5-fold increase in total costs.[11]

Anti-Obesity efforts

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In response to rising obesity, the Ministry of Health Malaysia has formed a multi-sectoral task force comprising government ministries, professional bodies, and NGOs. This task force aims to address the underlying causes of obesity by evaluating 48 policy options, such as regulations and educational interventions, targeting food and physical activity in schools, workplaces, and communities. These efforts align with the goals of the National Plan of Action for Nutrition of Malaysia (NPANM) and the National Strategic Plan for Non-Communicable Diseases.[12]

School Settings

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Children playing parachute games in physical education class

Regulations have been implemented to ban the sale of unhealthy foods and beverages in school canteens, as well as their marketing within a 50-meter proximity of schools.[12]

Physical education is mandatory in schools, requiring 48 hours per year for primary students and 64 hours for secondary students in Physical and Health Education.[46] Schools are encouraged to provide a variety of physical activities[12] to accommodate different interests and abilities, promoting student engagement.

Higher Learning and Workplace Settings

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Nutrition Programs

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Food outlets in the government sector are mandated to sell fruits, while private sector outlets are encouraged to do the same. Providing healthier food choices in canteens is also required,[12] ensuring that individuals have access to nutritious dietary options.

Physical Activity Programs

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Government institutions must promote physical activity by establishing sports and welfare clubs[12] that offer various recreational opportunities.

Structured physical activity programs after working hours are required by Government institutions to engage individuals in regular exercise. These institutions are also encouraged to offer incentives to those with a healthy BMI[12] to encourage healthy lifestyles.

General Population

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Dietary Measures

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To improve dietary habits within the general population, initiatives are being implemented to increase access to affordable fresh produce. For instance, the number of Pasar Tani (farmers' markets) is set to increase,[12] facilitating connections between consumers and local farmers while promoting the consumption of fresh fruits and vegetables.

Regulatory Measures

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Regulatory measures include a Sugar-Sweetened Beverage (SSB) tax, which imposes a charge of 40 cents per litre on drinks containing more than 5 grams of sugar per 100 ml and on fruit juices with over 12 grams of sugar per 100 ml.[13] Advertisements for high-sugar or high-fat food are also banned[12] to reduce their promotion to children.

Promotion of Physical Activity

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Initiatives to encourage physical activity involve the development of community facilities, including parks, cycling paths, and other recreational areas. For example, by 2028, the Kuala Lumpur Pedestrian and Cycling Masterplan (KLPCM) aims to increase the city's cycling lanes from 32.9 km in 2019 to 96.3 km.[47]

Word Count: 1937

See also

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Obesity

Epidemiology of obesity

References

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Further reading

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Prevalence of overweight and its associated factors among Malaysian adults: Findings from a nationally representative survey

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