Who has power over obesity?

Fighting against obesity is more than just personal willpower to eat less or move more. (This image is human-created, AI-aided)

If plans announced by Prime Minister Datuk Seri Anwar Ibrahim for Budget 2025 go ahead, Malaysian taxpayers could soon be “paying” for sugar in multiple ways – both good and bad for our health.

First, through subsidies that keep sugar prices artificially low (which is bad).

Second, through the resulting rising cost of obesity, diabetes and dental disease that fall on the public health system (also bad).

Third, through the sugar-sweetened beverage tax itself (which is good).

And fourth, through the potential ­opportunity cost of seeing that tax revenue channelled into treatments, rather than invested in prevention and the reshaping of food environments to stop obesity at its source, as treatment still currently takes priority over prevention in our healthcare system (which is bad).

This contradiction in fiscal and health policy is not just contradictory, it is unsustainable.

It also reveals a deeper problem: we have built systems that promote poor health, and we have allowed powerful interests to shape those systems.

A systemic issue

Globally, more than one billion people are now living with obesity.

In Malaysia, the situation is particularly stark: more than half of adults are overweight or obese, and if current trends ­continue, more than 40% of adults will be obese by 2035.

That carries a projected ­economic cost of nearly 3% of GDP (gross domestic product).

Behind these figures are lives cut short, families struggling with illness and a health system under mounting strain.

For too long, the story we have told about obesity has been one of personal responsibility.

Eat less. Move more. Try harder.

But the truth is that individual choices are heavily shaped by ­systems: what food is cheap and available, how our cities are designed, what advertising surrounds our children, and how our health sector allocates resources.

To fix the problem, we must fix the systems.

And to fix the systems, we must confront power.

Redirecting the subsidy

Food and agriculture policy is a powerful driver of obesity.

In the United States, over half a trillion dollars in subsidies have flowed to corn, soy and wheat since the mid-1990s, ­feeding the rise of cheap sugars and oils – the raw ingredients of ultra-­processed foods.

Meanwhile, the relative price of fresh fruits and vegetables has gone up.

Malaysia faces its own version of this subsidy trap.

The sugar industry receives around RM500-RM600 million a year in subsidies, keeping ­sweetened drinks affordable and fuelling overconsumption.

This runs directly against international recommendations.

Instead of subsidising sugar, Malaysia could redirect support towards padi farmers and vegetable growers – strengthening local food systems, while improving diets.

Better city design

The way we build cities is another system that shapes health.

In Malaysia, passenger cars jumped from about 11 million in 2010 to over 17 million in 2023.

Kuala Lumpur is dominated by highways, while pedestrian walkways and cycling routes remain scarce.

When sidewalks are missing and crossings are unsafe, walking to the shop or cycling to work is simply not an option.

The result is more sedentary lives and higher rates of obesity.

But cities can be redesigned.

Singapore shows how housing and transport planning can embed walkability, with over 60% of trips made by public transport.

Seoul in South Korea famously dismantled a highway to restore a stream, creating a pedestrian corridor used by 60,000 people daily.

Bogotá in Colombia closes more than 100km of streets every Sunday for cycling and walking, drawing more than a million residents.

Malaysia, too, can design healthier cities – but only if ­citizens and professionals push back against entrenched industry lobbies.

Real marketing effects

Food and beverage companies spend billions to make sure unhealthy products dominate our diets.

This spending is no accident – it is central to the business model that keeps demand for sugary drinks, snacks and instant noodles growing.

Children are the most vulnerable targets.

“Advergames”, influencers and cartoon characters online create constant engagement, fuelling “pester power” and brand loyalty from a young age.

This has real consequences: childhood obesity in Malaysia more than doubled between 2010 and 2020.

Voluntary industry codes are not enough.

Chile, Mexico and Peru have shown that statutory bans on junk food marketing to children can work, and Malaysia should follow suit.

Healthier school food

Schools and media should be sources of protection, not ­disease promotion.

Yet in the US, “pouring rights” contracts give Coca-Cola or Pepsi exclusive sales in schools, directly increasing sugary drink consumption.

Malaysia is not immune.

Despite healthy school canteen guidelines, enforcement remains patchy and fast-food outlets cluster near schools.

Alternatives exist.

Brazil requires that 30% of food served in schools be ­procured from family farmers.

Evaluations show improved diets for children and stronger local economies.

Malaysia could strengthen its own canteen rules, and civil ­society groups are pushing in this direction.

Profit in treating obesity

The healthcare system itself also risks complacency.

Pharmaceutical companies are making extraordinary profits from new weight-loss drugs.

These may benefit individuals, but they do nothing to address the upstream drivers of obesity.

Hospitals, insurers, and even medical careers, often profit from treating obesity-related diseases.

Without strong leadership, we risk creating an “obesity-­industrial complex” that thrives on sickness while neglecting prevention.

Practical, tested steps

So, what would it look like to get serious about prevention?

First, Malaysia should redirect subsidies from sugar and cheap calories to healthy, local produce.

Second, the government should require the principle of considering “obesity in all policies”, ensuring that transport, housing, agriculture and finance all take into account the impacts of obesity in their individual ­sectors.

Third, comprehensive bans are needed on junk food marketing to children across all media.

Fourth, public procurement and zoning can shape healthier food environments, from school canteens to neighbourhoods.

And fifth, conflicts of interest must be managed, so corporate actors do not dominate the policy table.

These are not radical ideas.

They are realistic policies, already tested in other countries.

Obesity is not about fixing ­people; it is about fixing systems.

And systems are about power: who designs them, who benefits and who has the courage to change them.

For now, that power lies largely with commercial interests.

It is time to reclaim it – for the health of Malaysians, for the ­sustainability of our health ­system and for the future of our children.

Dr Kent Buse is a professor of health policy at Monash University Malaysia and chair of the World Obesity Federation’s Policy and Prevention Committee. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.