The next time Malaysia gets into a debate with its neighbours over who has the best nasi lemak or chicken rice, we would do well to remember that we’re best known for being the fattest country in South-East Asia(1).
This dubious distinction is due to the high rate of obesity among Malaysians. The national prevalence of obesity is 30.6%, which means almost a third of our population is obese(2).
Dangers of obesity
Having a body mass index (BMI) of 30 or more isn’t just about being heavier than the average person. Neither is it a question of vanity. Obesity is a serious chronic disease and a major risk factor for cardiovascular disease (CVD), diabetes, musculoskeletal disorders and certain cancers(3).
One of the biggest problems linked with obesity is diabetes. We’re stuck in a vicious cycle where rising obesity rates are contributing to the increasing prevalence of diabetes in Malaysia. Today, some 3.6 million Malaysians suffer from diabetes, the highest rate of incidence in SEA and one of the highest in the world(4).
Unfortunately, obesity and diabetes are part of the metabolic syndrome, which increases the risk of CVD such as heart disease and stroke(5). The effects of obesity don’t end there. People who are obese tend to have other complications such as osteoarthritis, which causes pain and difficulty in moving(6).
Sleep apnoea is another problem, where you have difficulty breathing while sleeping(7). Untreated sleep apnoea can lead to complications like CVD, accidental and premature death(8).
It would be easy to blame our obesity problem on the high calorie content of Malaysian food, or on the unhealthy eating habits that some Malaysians have. However, obesity is much more complex than that.
Our body weight and fat levels are regulated by a complex system of signals in the body that control appetite, digestion, energy balance and metabolism to keep body weight and fat at a steady level(9).
Not only is the relationship between food and body weight a complex one, there are multiple environmental, genetic and behavioural factors that contribute to obesity. Research increasingly suggests that some people are more likely to have a genetic predisposition towards gaining weight(10). This is why so many people struggle to lose weight.
As many as 95% of obese people who lose weight through rigorous weight-loss programmes ultimately regain their weight (or more) within two to five years(11). That’s why reducing obesity rates isn’t as simple as telling people to just eat less or exercise more.
Surgery as an option
When severe obesity can’t be treated through diet and exercise, you may want to consider bariatric surgery or weight loss surgery. There are several types of bariatric surgeries that can induce weight loss.
Sleeve gastrectomy is a procedure that makes your stomach smaller, so you eat and drink less and feel full sooner(12). Another procedure, the gastric bypass, reduces the volume of the stomach and creates a bypass from the stomach to the upper part of the small intestine, so the body absorbs fewer calories(13).
These bariatric surgeries result in significant weight loss. According to research, many people who have bariatric surgery lose about 15 to 30% of their starting weight on average, depending on the type of surgery(14).
This weight loss can help improve more than 40 obesity-related diseases and conditions such as Type 2 diabetes, heart disease, sleep apnoea and certain cancers(15/16/17). Over ver 90% of those with severe obesity are also successful in maintaining half or more of their weight loss following bariatric surgery(18).
On top of being effective, bariatric surgery is a safe procedure, as much as other commonly performed operations like gallbladder surgery, appendectomy and knee replacement(19).
While there are no standardised national statistics about bariatric surgery in Malaysia, a recent nationwide survey estimated that there were 463 procedures carried out in 2016 compared to 158 in 2010(20). This shows that there’s increased awareness of the surgery as an option.
Is bariatric surgery right for me?
If you’re struggling to deal with obesity and wondering if this is for you, bariatric surgery may be an option if you have a BMI of(21):
• 35 or more;
• 30 or more with a serious health problem linked to obesity such as Type 2 diabetes, or metabolic syndrome such as high blood pressure and high cholesterol;
• 27.5 or more with a serious health problem linked to inadequately controlled Type 2 diabetes or metabolic syndrome.
More importantly, bariatric surgery is suitable for you if you’re committed to changing your daily eating and exercise habits, and leading a healthier lifestyle over the long term.
Life after bariatric surgery
Bariatric surgery isn’t a cure for obesity. It’is a method to get you on track for a better lifestyle. After you undergo surgery, you’ll find it easier to consume fewer calories. Choosing healthier foods and beverages before and after surgery may help you lose more weight and keep it off in the long run(22).
As you lose more weight, you’ll be motivated to be more physically active. You’ll be able to burn more fat, move around better, and generally feel good about yourself.
One myth you hear about bariatric surgery is that you’ll easily regain the weight you’ve lost. This isn’t true. Weight loss from bariatric surgery also reduces hormones such as insulin and cortisol, which improves the production of other factors that reduce the uptake and storage of fat into fat storage depots(23).
Unlike weight loss through dietary methods, you have a higher chance of maintaining weight loss from surgery because of the hormonal changes your body undergoes(24).
Obesity is a serious health condition you can’t afford to ignore. Having surgery for weight loss is a major decision, but you shouldn’t wait until you’re severely obese before considering it as an option. Talk to your doctor about whether bariatric surgery is right for you, and get all the information so that you’re prepared for the life-changing path that lies ahead.
For more than 20 years, Ethicon has invested heavily in the development of laparoscopic surgery to transform bariatric surgery from a high-risk operation to a minimally invasive procedure for the best patient outcome.
1) Economist Intelligence Unit (2017), ‘Tackling obesity in ASEAN: Prevalence, impact, and guidance on interventions’, Available from https://foodindustry.asia/documentdownload.axd?documentresourceid=30157
2) Ministry of Health Malaysia (2015), National Health & Morbidity Survey, Available from http://www.moh.gov.my/moh/resources/nhmsreport2015vol2.pdf
4) The Star (27 Mar 2019). Malaysia has 3.6 million diabetics, says Dzulkefly. Available from https://www.thestar.com.my/news/nation/2019/03/27/malaysia-has-36-million-diabeticssays-dzulkefly#2WF0VVwoQo6HsUOC.99
5) Cleveland Clinic (2019). Obesity and Heart Disease. Available from https://my.clevelandclinic.org/health/articles/17308-obesity--heart-disease
6) Public Health England. (2016) Health risks of adult obesity. Available from: www.noo.org.uk/NOO_about_obesity/obesity_and_health/health_risk_adult
7) National Institute of Diabetes and Digestive and Kidney Diseases, NIH (2015). What Are the Health Risks of Overweight and Obesity? Available from: www.nhlbi.nih.gov/health/health-topics/topics/obe/risks
8) WebMD (2019). Causes of Obstructive Sleep Apnea. Available from: https://www.webmd.com/sleep-disorders/sleep-apnea/obstructive-sleep-apnea-causes#1
9) Johnson & Johnson Medical Devices (2019).
10) Economist Intelligence Unit (2015). Confronting Obesity in Europe. Available from https://eiuperspectives.economist.com/sites/default/files/ConfrontingobesityinEurope.pdf
11) Sjostrom, L., Narbro, K., Sjostrom, D., et al. (2007). Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. NEJM 357(8): 741-52.
12) American Society for Metabolic and Bariatric Surgery. Bariatric Surgery Procedures. Available from https://asmbs.org/patients/bariatric-surgery-procedures#sleeve
13) National Institute of Diabetes and Digestive and Kidney Diseases (2016). Types of Bariatric Surgery. Available from https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/types
14) National Institute of Diabetes and Digestive and Kidney Diseases (2016). Definition & Facts for Bariatric Surgery. Available from https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/definition-facts
15) American Society for Metabolic and Bariatric Surgery (n.d.). Metabolic and Bariatric Surgery. Available from https://asmbs.org/resources/metabolic-and-bariatricsurgery
16) Singapore General Hospital (2017). Obesity Surgery: An Evolving Field of Modern Medicine. Retrieved 9/9/2019 from https://www.sgh.com.sg/news/medical-news-singhealth/obesity-surgery-evolving-field-modern-medicine.
17) NCD Risk Factor Collaboration. (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet, 387(10026), 1377-1396.
18) American Society for Metabolic and Bariatric Surgery. Benefits of Bariatric Surgery. Available from https://asmbs.org/patients/benefits-of-bariatric-surgery
19) Cleveland Clinic (2014). Gastric Bypass is as Safe as Commonly Performed Surgeries. Available from https://health.clevelandclinic.org/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/
20) Kosai, N.R. & Rajan, R. OBES SURG (2018) 28: 2572. https://doi.org/10.1007/s11695-018-3289-6
21) Kasama K, Mui W, Lee WJ & Lakdawala M, IFSO-APC Consensus Statements 2011, (2012) 22(5): 677-684 https://www.researchgate.net/publication/221863311_IFSO-APC_consensus_statements_2011
22) National Institute of Diabetes and Digestive and Kidney Diseases (2016). Definition & Facts for Bariatric Surgery. Available from https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/definition-facts
23) American Society for Metabolic and Bariatric Surgery. Benefits of Bariatric Surgery. Available from https://asmbs.org/patients/benefits-of-bariatric-surgery
24) American Society for Metabolic and Bariatric Surgery. Benefits of Bariatric Surgery. Available from https://asmbs.org/patients/benefits-of-bariatric-surgery