OF late, a great deal of attention has been placed on the issue of malnutrition in Malaysia. However, there has been very little discussion on its impact on mental health.
Considering that approximately one in three Malaysian adults suffer from a mental illness, the far-reaching implications of malnutrition on mental health needs to be examined closely.
Growing research literature indicates that nutrition has both direct and indirect effects on mental health, well-being and mood.
A 2017 study found the consumption of a Mediterranean-style diet for over three months was associated with improved mental health outcomes in the form of lower levels of depression and anxiety, improved ability to cope with stress and better quality of life. This diet involves a high intake of vegetables, fruits, legumes, nuts, beans, grains, fish and unsaturated fat, and low consumption of processed foods such as snacks.
Greater diversity of vegetable intake was associated with higher positive emotions and reduced depression, anxiety and negative emotions, while diversity of fruit intake was additionally correlated with better mental health, happiness, relationships and overall quality of life. Reduced intake of processed snacks was associated with improved mental health, coping skills and quality of life.
The effects of nutrition on children and adolescent mental health are especially significant. Most studies conclude that a poor diet (be it low consumption of nutritional foods or high consumption of refined carbohydrates) is linked to worsening cognition (for example, difficulty concentrating), increased risk of mental disorders and poor emotional regulation, which have long-lasting consequences in adulthood.
When one considers the extensive effects of nutrition on mental health, recent report findings on the situation of nutrition in Malaysia are particularly alarming.
The 2018 Global Nutrition Report states that Malaysia faces the triple burden of malnutrition: overweight, anaemia and childhood stunting. These conditions are being seen in both B40 and M40 population groups.
This suggests serious barriers or obstacles in accessing good nutrition among the general public, an unacceptable situation for an upper-middle income country like Malaysia.
A Khazanah Research Institute report last year showed that rising food prices resulted in lower-income households (those earning below RM5,000) spending more on food at home but affording and consuming less of it.
Choosing nutritious food is becoming increasingly costly for many. Even M40 households are struggling and have less time at their disposal for grocery shopping and food preparation. As a result, they become disproportionately vulnerable to nutritional deficiency, increasing the likelihood of mental illnesses such as depression and anxiety.
Additionally, many face long-term stressors to their mental health as a result of inequalities and poor social protections. These include lack of economic stability, societal stigma, chronic worrying and less quality time spent with family and friends.
Compounded by the lack of access to good nutrition, the cumulative damage inflicted on the mental health of these communities could lead to difficulties in sustaining jobs, social isolation, poorer health outcomes, higher rate of mortality and increased risk of mental illnesses, substance and alcohol abuse.
In general, a great deal must be done to improve food choices and increase nutritional access and mental health across communities, particularly among the B40 and M40 groups. We need to promote policies and practices that actively support and encourage personal and community responsibility for health.
Subsidising healthy food could be one approach, but incentivising individual preventive health practices could be more sustainable.
Insurance companies could offer discounts or reductions on policy premiums to reward preventive health behaviour such as healthy food and health supplement purchases, screening, enrolment in fitness classes or gyms and even for meeting daily step goals. One insurance company in Malaysia has already started this.
There should be no sales tax for sports equipment and participation in activities such as runs, marathons and races.
Dropping sales tax for health supplements and import duties on their ingredients could also help to make them more affordable and accessible.
We can improve funding and encourage the setting up of food banks and soup kitchens that serve free nutritious food and even provide dietary supplements to ensure that people get their daily required amounts of essential nutrients.
We need to target manufacturers, businesses, communities and individuals and incentivise them to invest in preventive health.
More importantly, ensuring accessibility to good nutrition and mental health requires acknowledgement of the existing societal inequalities and improvement in social protections.
Galen Centre for Health and Social Policy