This is ingenius - report card on obesity for children

The Star, April 17, 2011

New measures to keep children healthy

By Isabelle Lai

Body mass index to be listed in report card, unhealthy food banned in school canteens

PETALING JAYA: Students' body mass index (BMI) will be listed in their report cards while unhealthy food will be banned in school canteens effective immediately, said Health Minister Datuk Seri Liow Tiong Lai.

He said these were new measures to help parents monitor their children's health.

"By listing students' BMI on their report cards, parents have the means to know whether their child's weight is ideal, overweight or obese," he told reporters here Sunday, adding that parents could obtain advice from clinics on how to maintain a healthy weight for their children.

He said Malaysia was currently ranked sixth amongst Asian countries and first in Southeast Asia for a high percentage of obese citizens.

"Thirty percent of Malaysians are overweight, while another 30% are obese. That's 60%," he said, adding that ministry data estimated around 1.7 million Malaysians aged 18 and above to be obese.

Liow said the move to list BMI in report cards was decided at the Cabinet Committee on Non-communicable Diseases chaired by Deputy Prime Minister Tan Sri Muhyiddin Yassin on April 4.

"We have identified unhealthy canteen food such as soft drinks and others with high sugar content. These types of food are now banned from being sold," he said.

More in The Star Monday

Battling diseases on all fronts

By LOH FOON FONG
sunday@thestar.com.my 

There is a need for a multi-pronged strategy to make Malaysians take their health more seriously.

SEAH Boo Hee, 42, was diagnosed with insulin-dependent diabetes when he was 16. His kidneys failed three years ago and he now suffers bleeding in the eye due to his diabetic condition. “If I had known the severe consequences of diabetes, I would have tried harder to change my diet,” he says.

Seah admits that as a teenager, he did not know much about good diet. “My normal diet,' like most teenagers, was fast food and sometimes mamak food at night.” He also did not realise he would lose his kidneys when a doctor told him about protein leakage in his urine five years ago, he adds.

“The doctor didn't explain to me what it meant and I thought nothing was wrong because I felt fine. If I was told that it was an early sign of kidney failure, I would have done everything I could to save my kidneys.” Being saddled with many health problems, Seah who is 185cm tall and weighs 94kg is finding it hard to get a job.

Dr Ikram: ‘If they live until 65 but get diabetes at 25, that’s 40 years of diabetes. A lot of complications can set in’

“If employers know that you need dialysis and have to be away from work three days a week, your chances of getting of a job is zero,” he says. Currently jobless, this graduate used to play tennis and squash and travelled a lot. He has had to give all this up because he is not allowed to drink too much water due to his failed kidneys.

Seah's mother died of diabetic coma and one of his older sisters is also diabetic. Many patients, like Seah, do not fully understand the severe consequences of diabetic complications until one of their organs fail or when traged y strikes.

Nephrologist Dr S.S. Gill says many Malaysians think they are immune to these diseases. “They don't realise that it takes 20 to 30 years before they suffer from the effects,” he says.

Some even say they do not have chronic diseases although they are overweight. But as one ages, the risk of incidence will increase, he warns. “Our life span may now be longer, but it lacks quality.”

According to endocrinologist Datuk Prof Dr Ikram Shah Ismail, one in five Malaysians is diabetic and three quarters of deaths related to diabetes are the result of heart attack.

“This is alarming,” says Dr Ikram, who is also dean of Universiti Malaya's Faculty of Medicine. In 1996, Health Ministry data showed that 8.9% of the population were diabetic and it was predicted to reach 10% in 2020. But by 2006, the figures had shot up to 14.9% and two years ago, it reached a high of 20%.

»My ‘normal diet’, like most teenagers, was fast food and sometimes mamak food at night« SEAH BOO HEE

Health Minister Datuk Seri Liow Tiong Lai has said the rise in chronic diseases is worrying. “Those getting chronic diseases are no longer in their 50s or older. Now, people as young as 30 or 40 are getting hypertension, heart attacks, diabetes and kidney failure. Many of these illnesses ca n be prevented,” he stresses.

He points out that the number of chronic kidney patients in the country has increased from 79 per million population in 2000 to 146 per million in 2009. The National Renal Registry reveals that the total number of patients on dialysis increased from 6,689 in 2000 to 21,159 in 2009, putting a serious strain on Malaysia's health resources.

Of these, 58% have diabetes. This puts Malaysia in the unenviable position of probably having the highest percentage of patients in the world with diabetes as the cause of end-stage kidney failure, according to Liow. Seah's case reflects three things. First, the need for doctors to talk to patients in layman's terms and help them understand the implications of their actions and their medical condition.

Secondly, parents and schools must introduce healthy diets and exercise to children from a young age; and thirdly, the whole machinery of society needs to be mobilised to support every individual in fighting chronic diseases.

Seah points out an important misconception diabetic patients tend to think that when they take medicine, everything will be all right. “They don't realise that if they don't take care of their diet and lifestyle, no medicine can prevent their organs from being damaged.”

Dr Ikram explains that although diabetes is an inherited disease, it does not mean it is unavoidable. “In the past, incidence of diabetes was low because people worked in the fields and they walked or cycled. Those with diabetic genes didn't become diabetic until much later in life, or totally avoided it.

“If they were supposed to get diabetes at 70, but died at 60, the diabetes did not appear in their lifetime.”

However, the life span is now longer and an unhealthy lifestyle has led those in their 20s or 30s to become diabetic, says Dr Ikram who believes that parents need to set good examples in their diet and also that schools should also provide healthier food options to children.

“You can imagine if they live until 65 but get diabetes at 25, that's 40 years of diabetes. A lot of complications can set in, like eye damage or kidney damage, and the quality of life will be poor.” Dr Ikram says people like to blame their parents for bad genes, but their lifestyle can determine whether they develop diabetes at the age of 30 or 70.

“For instance, many people say they cannot live without added sugar even when we tell them they are getting enough sugar from other food sources. People survived well without sugar in the past,” he says, adding that misplaced perception has also led many to see smoking as dangerous but do not consider their unhealthy diet as a problem. 

Losing weight and keeping oneself healthy, as many would attest, is a discipline in life that is almost unattainable for many.

“I try to bring down my weight but it's a struggle,” Seah, who is 16kg overweight, confesses. National Kidney Foundation chief executive officer Chua Hong Wee says even though Malaysians are now more affluent, their lifestyles have become worse and many are indulging in high-sugar and high-carbohydrate drinks and food, and eating late into the night.

“People are overeating, especially with easy access to food 24 hours a day. This poses a burden on kidneys because the organs have to work extra hard to remove waste,” he says.

People must make it a life-long practice to reduce intake of sugar and salt, eat more healthy and balanced meals, and exercise but not many have the stamina to do the right thing continuously, he points out.

The dire situation needs to be tackled with drastic measures, and the Health Ministry has rightly adopted a multi-pronged approach. It adopted an “all-of-government” and “allof- society” approach against non-communicable diseases (NCD) this year, which called for the collaboration of 11 ministries, the local authorities, the media, professional bodies, private sectors, communities and NGOs. As Malaysians eat out a lot, the quality of food at food outlets has to be given top-most attention.

This is where the Health Promotion Board has to step up efforts to make food manufacturers and operators offer healthier options. As pointed out in a conference in Kuala Lumpur recently, the Singapore Health Promotion Board, for instance, had encouraged a manufacturer to produce whole grain noodles that incorporate 10% of whole grain, half the recommended daily requirement.

Dr Ikram also feels the authorities should restrict the opening of food outlets to 10pm. “People should go home and sleep,” he says, adding that 24-hour food outlets are a relatively new phenomenon and which we managed to live without in the past.

Liow points out that Malaysians are consuming too much oil (2.1kg per person per month) and the Ministry is studying its impact on their health. 

Dr Gill says awareness must be created continuously.

Finland, for instance, had one of the highest rate of heart diseases but managed to bring down the numbers after 30 years, he says. Efforts have to start with the young, he stresses. “It's tough getting people to change but we have to keep trying.”

Most Malaysians lack exercise, which can easily solve half of our health problems. In Australia, the local council provides gymnasiums for the public to use for free, he adds Dr 

Ikram has called on local councils to provide clean and safe parks to attract people to go there. Companies too can motivate their staff members to exercise together and promote better work relations, he says.

Understanding human behaviour or attitude why people tend to be addicted to eating bad food and not healthy food is a mind boggling matter.

Universiti Malaya Centre of Addiction Sciences director Professor Dr Mohd Hussain Habil says the Government should give more grants for such studies and on whether excessive eating habits should be treated as a form of addiction or psychological issue. “This is a relatively new concept that should be explored since obesity is an important public health issue,” he says.

The American Journal of Psychiatry points out in one of its issues that standard interventions based on promoting lifestyle changes to reduce excessive food consumption and increase physical activity are effective but people could not sustain the efforts.

One in three Americans is obese, and this increases risk for cardiovascular disease, diabetes, cancer, and other diseases, resulting in annual healthcare costs conservatively estimated for the US at $70bil to $100bil ((RM218bil to RM302bil) a year as well as reductions in life expectancy by five to 20 years.

In South Korea, naturally-derived sugar from fruit sources are often used instead of processed sugar and much of their meals, snacks and desserts contain little salt and sugar and are free of artificial colourings or additives.

The Koreans, who are very nationalistic about their food that is mostly made up of kimchi, vegetables, seaweed and fish, really take their health into their own hands.

Malaysians should emulate the Koreans as the battle against chronic diseases must be fought by the whole nation. Only when all citizens begin to take charge of their health and moti vate others to do likewise will they be healed of self-inflicted diseases.