Obesity has become one of Malaysia’s most pressing but under-recognised health threats. More than half of Malaysian adults are overweight or obese, yet many still see it as a matter of poor willpower or lifestyle choices.

“Obesity ticks all the boxes of a disease,” said Professor Dr Rohana Abdul Ghani, President of the Malaysian Obesity Society (MYOS). “It has underlying causes, complications, and a progressive course if untreated.”

This silent health crisis increases the risk of more than 200 complications, from type 2 diabetes and cardiovascular disease to stroke, fatty liver, sleep apnoea and even cancer.

Reframing obesity as a chronic, relapsing condition is the first step towards breaking the stigma and offering patients the possibility of a better quality of life.

Malaysia’s Clinical Practice Guidelines for the Management of Obesity define obesity as a BMI of 27.5 or higher, with waist circumference cut-offs of 90cm for men and 80cm for women. But numbers alone do not capture the complexity.

Obesity involves dysfunction in adipose (fat) tissue that disrupts the body’s hormonal and metabolic balance. Genetics, brain-gut regulation, and environmental triggers all play a role.

“It’s not just about eating too much. Your family history, hormones, and even medications can tip the scale,” she explained.

The health domino effect

Here’s a fact. Obesity doesn’t exist in isolation - it drives Malaysia’s rising non-communicable disease (NCD) burden.

Two-thirds of people with diabetes are obese, while one-third of obese Malaysians also have diabetes, hypertension, and high cholesterol.

“The connection is so close that we now use the term ‘diabesity,’” said Prof Rohana, who is also a Senior Consultant Endocrinologist at Universiti Teknologi MARA (UiTM). Chronic inflammation from excess fat damages multiple organs, escalating risks of heart disease, kidney failure, and even early cognitive decline.

“It’s a systemic problem. No organ is spared from the complications of obesity.”

At the same time, the economic and personal toll brought by the disease is immense.

Direct costs include medications, gastric bypass surgeries, and treatments like Continuous Positive Airway Pressure (CPAP) machines for sleep apnoea. Indirect costs - absenteeism, fatigue, reduced productivity - are estimated to make up a shocking two-thirds of obesity’s economic burden.

For individuals, it’s about more than health statistics. “I’ve had patients tell me they feel they ‘lost their childhood’ because weight kept them from joining games and activities. The emotional toll is real,” she added.

Why weight loss is so hard

Many delay treatment because of stigma, a fear of being blamed for their weight. Others do not realise obesity is a disease at all. And because it is often symptomless in the early stages, it slips under the radar until complications appear.

On top of this, treatment costs are rarely reimbursed, leaving many without access to care. “Patients will accept medication for diabetes or hypertension,” Prof Rohana opined, “but for obesity, they feel they must hide it. That has to change.”

Even when people try, biology often pushes back. Weight loss triggers a defence mechanism known as metabolic adaptation: metabolism slows, hunger hormones rise, and satiety hormones drop.

“Your body thinks it’s under threat, so it fights to hold on to weight,” she further explained. “That’s why people feel hungrier and burn fewer calories even when they’re trying their best.”

Effective management options

The good news is effective treatments now exist in Malaysia.

• Lifestyle changes: Healthy eating, portion control, physical activity, and crucially, strength training to protect muscle mass.

• Pharmacotherapy: Evidence-based obesity management medications are important options to manage obesity, on top of lifestyle and behavioural changes. “Some of the medications, such as the new GIP (Glucose-dependent Insulinotropic Polypeptide) and GLP-1 receptor agonist (glucagon-like peptide-1), work by helping you manage appetite, satiety and fat metabolism. Studies have indicated these medications, when used as part of a lifestyle programme, can help patients achieve 10-15 percent weight loss,” she added.

• Metabolic bariatric surgery: Now minimally invasive, these procedures not only reduce weight but have been observed to put diabetes into remission in some patients.

However, the expert on obesity cautioned these treatments are not quick fixes. Rather, they should be part of a holistic approach that combines medical care with lifestyle support.

Redefining success

Instead of chasing an “ideal weight”, success ought to be measured by health gains.

“A five-percent weight loss can lower blood sugar and blood pressure, and 10–15 percent can improve fatty liver and even reverse diabetes in some cases.

“Success means being able to walk without pain, sleep better, or need fewer medications. It’s about health, not just numbers on a scale,” she emphasised.

“Food is love”

Food is deeply intertwined with Malaysian culture - it’s an expression of love and connection. While traditions cannot and should not be erased, they can be adapted to healthier choices.

That means shifting cooking methods, moderating portions, and tackling obesogenic environments like 24-hour eateries and constant office snacking. Equally, policy change, public awareness, and respectful media representation must converge to provide a lasting solution.

Breaking the stigma

Obesity is not a matter of personal weakness but a complex medical condition that is treatable. Malaysia must recognise it as a pressing public health issue and commit to addressing it with the same urgency as other national health crises.

“We need to normalise getting help,” urged Prof Rohana. “It should be no different from treating high blood pressure or diabetes. The earlier you act, the better your outcome.”

Ask your doctor about evidence-based treatments for obesity. Acting early can prevent serious illness and help you live a healthier, fuller life.

This article is part of a disease awareness programme supported by Zuellig Pharma.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.