The COVID-19 pandemic has taught us that while transmissible diseases remain the top priority worldwide, non-transmissible diseases such as obesity should not be neglected.
Obesity, the mother of all chronic diseases like cancers, is also among the strongest predictors of COVID-19 severity and death. Malaysia continues to grapple with obesity; the 2019 National Health and Morbidity Survey found that 50.1% of adults were either overweight or obese.
This is how you could simply determine whether you are obese or not. Measure your weight (in kg) and height (in m2) and divide your weight by height (kg/m2). This is your Body Mass Index or BMI, and if it’s 27.5 or more, you are considered obese.
You had probably heard of the phrases “you are what you eat”, “obesity doesn’t run in your family; nobody runs in your family” and “sitting is the new smoking”. Besides the usual culprits of eating too much or not right and not exercising enough, the heritability of obesity still holds, as large-scale population studies worldwide showed that genes contribute to a 40-70% variation in BMI.
Obesity is a complex, multifactorial condition, meaning that regardless of whether we are born with an obesity genetic blueprint or not, we are still able to do something to reduce our chances of being obese. One way of doing this is by reducing the obesogenic environment that we live in – an environment that promotes gaining weight and one that is not conducive to weight loss.
Some of the contributing factors to an obesogenic environment include foods that are available, affordable, accessible and promoted (think food advertisements and the boom of food delivery apps), and physical activity opportunities (think-built environment, transport systems, active recreation opportunities, screen time).
So, can the planetary health approach help to prevent an obesogenic environment and hence solve the obesity crisis? Very much indeed. Planetary health means that the long-term well-being of humans depends on the well-being of the earth, including living and non-living systems.
Professor Boyd Swinburn of the University of Auckland, New Zealand, the purveyor of the ‘obesogenic environment’ concept once said, “To me, the underlying drivers that are promoting overconsumption of food, and its resulting obesity, have the same roots as those that drive our overconsumption of fossil fuels and the resulting greenhouse gas emissions and climate change. In other words, what is good for climate change and reducing car use and overprocessing of foods and so on, will also be good for obesity.”
How is climate change linked with an obesogenic environment? Well, extreme temperatures (like heat waves and torrential rains) can reduce the frequency and duration of physical activity, and the desire to engage in exercise. Preventing and solving climate change can encourage people to be outdoors more, engaging in more physical activities.
How is sustainable and healthy road transport linked with physical activity? While shifting to electric vehicles as an important mitigation measure to reduce carbon emissions is the way to go, beyond this, the promotion of walking and cycling (i.e. active travel) could not only cut emissions but also provide enormous health dividends through the increase of physical activity.
We need to build more proper pedestrian walkways and cycling lanes. Sunway City KL has an elevated walkway (called “canopy walk”) which promotes walking to connected premises and facilities. Besides proper maintenance of recreational parks, we could emulate our neighbouring country in having an excellent walkable and cyclable system which connects the parks.
An anti-obesogenic environment should also include the adoption of healthy diets with low environmental impact, the so-called ‘planetary health diet’ (PhD). PhD involves a diet which is rich in plant-based foods and with fewer animal source foods.
How could we start incorporating PHD into our daily lives? We could adapt the Malaysian Dietary Guideline Quarter-Quarter-Half Plate concept as much as possible, by choosing a meal that composes of a quarter plate of unrefined carbs, a quarter plate of unprocessed protein-rich foods, and a half plate of vegetables and fruits. This could be achieved by prioritising brown rice, whole wheat/multigrain bread, oatmeal and bran cereal; plant-based proteins like beans and legumes (if you can’t go without animal-based foods, choose fish first, then chicken and avoid beef); and unprocessed or minimally-processed vegetables and fruits, respectively. Everyone should try a PHD sometime, and you may start small first by supporting campaigns like ‘Meatless Mondays’.
The above examples are just the tip of the iceberg on the ways to solve the obesity crisis in Malaysia. Similar to solving the environmental trash crisis, we should follow the concept of “one small step for a man, a giant leap for mankind.” It all begins with us first. Start moving and eating well today!
By Dr Say Yee How, Senior Lecturer and Programme Leader (Biomedicine) at the School of Medical and Life Sciences, Sunway University Lecturer at School of Medical and Life Sciences, Sunway University