KUALA LUMPUR, March 27 — Endocrinologists have urged parents to recognise that overweight and obesity in children is not normal and are serious health conditions that may lead to other chronic conditions.
The medical experts noted that some parents who are obese themselves may mistakenly perceive their children living with obesity as having normal weight.
“When we ask parents who have kids, their perception of their kids being overweight or obese, six to seven out of ten will tell you their kids are normal,” Prof Dr Muhammad Yazid Jalaludin, a senior consultant paediatric endocrinologist at Universiti Malaya Medical Centre (UMMC), told CodeBlue.
This misperception stops parents from taking necessary actions to improve their children’s health.
World Obesity Day took place on March 4. This year’s Obesity Day shifts the focus from individuals to systems that shape our health, like health care, government policies, food environments, media, and workplaces.
The Ministry of Health (MOH) said in a Facebook post last March 5 that children living with obesity are likely to grow up into adults living with obesity. The MOH listed several measures to prevent childhood obesity, like replacing sugary drinks for children with plain water or milk or fruit juices without sugar; providing children with five servings of fruits and vegetables daily; and spending time on physical activities with your children, such as playing in the park.
According to the National Health and Morbidity Survey (NHMS) 2022, one in three adolescents in Malaysia is classified as overweight or obese.
“Four in five children are physically inactive, two in three are very sedentary. Four in five do not take enough fruits and vegetables. One in three is drinking a good amount of carbonated drinks every day. One in ten eat fast food at least three days in a week. All these are a recipe for obesity,” Dr Yazid added.
The lack of awareness among Malaysian parents regarding the serious health implications of obesity is alarming. “If people do not understand that obesity can cause you to have complications like diabetes, kidney issues, respiratory problems, and sleep apnea, they will see obesity as harmless,” said Dr Yazid.
He revealed that doctors are seeing Type 2 diabetes in children living with obesity as young as eight years old in Malaysia. Additionally, young adults at age 30 are experiencing heart attacks due to obesity.
An individual living with obesity can develop liver cirrhosis due to fatty liver, leading to liver cancer. “There are a lot of other complications that the community needs to understand. This is a serious matter. Obesity is not just about not looking nice; it’s so much more than that.”
Prof Dr Rohana Abdul Ghani, professor of medicine and consultant endocrinologist at Universiti Teknologi Mara (UiTM), explained that obesity is a progressive disease, indicating that it can only worsen over time.
“It has adverse effects such as metabolic, musculoskeletal, psychological, and cancer,” Dr Rohana told CodeBlue.
“As I often say – there’s not a single organ not affected by obesity. It can be prevented or its progression hindered, and it is treatable via lifestyle intervention, pharmacotherapy and surgery.
“There is a need to change the mindset of Malaysians that obese children are NOT cute and obese adolescents are NOT okay, or that ‘they will lose weight when the time comes’. They almost never do, unless they are supported to do so,” she added.
Dr Rohana emphasised that obesity leads to various non-communicable diseases (NCDs), stating that adolescents living with obesity have three to four times the risk of getting Type 2 diabetes, hypertension, and hyperlipidemia (high cholesterol).
“In addition, high BMI in childhood will be translated, transferred and expressed in adulthood, which will also lead to similar NCDs,” she said.
Assoc Prof Dr Azriyanti Anuar Zaini, a consultant paediatrician and paediatric endocrinologist at UMMC, noted that many parts of the world consider childhood obesity as a sign of prosperity.
“There are improved insights in recent years to recognise that obesity amongst children is abnormal, but looking at the real-world data from NHMS 2017, more than 50 per cent of overweight adolescents do not consider themselves as overweight and only 14 per cent of those obese felt that they are obese.”
Citing previous retrospective data collected in UMMC, Dr Azriyanti noted that up to 25 per cent of children living with obesity referred to the tertiary hospital were already developing complications, namely the metabolic syndrome.
“Obesity with hypertension, prediabetes, and hypercholesterolemia is known collectively as Metabolic Syndrome, which predisposes the person to early cardiovascular complications, stroke, and diabetes,” she explained.
Dr Azriyanti added that Malaysia is seeing an increase in Type 2 (T2) diabetes among children living with obesity, especially those who are not managed and treated early. She cited a 2022 systematic review and meta-analysis study at the global level that showed more than 75 per cent of children with Type 2 diabetes are living with obesity.
“These children were found to be more obese than the adults with T2 and the prognosis of having T2D early during adolescence is poorer compared to adult onset T2.”
Causes Of Childhood/ Adolescent Obesity: Genetic Predispositions, Lifestyle Choices
The causes of childhood obesity are multi-faceted, often intertwined with societal and environmental factors. Dr Yazid explained that both genetic predispositions and lifestyle choices are critical contributors.
“If a parent is overweight or obese, the risk of the child becoming overweight or obese is five times. But if both parents are overweight or obese, it can go up to thirteen times,” he said.
“It isn’t surprising if the parents themselves say that these children are normal weight, even when they are overweight or obese because they don’t realise that they themselves are obese, so they perceive that their children are not.
“If the parents think that their children are unwell or obese, they are going to bring the child to a doctor to avoid these children becoming like them. But many times, parents think that this is nothing and tell the doctor that the child is normal weight. They also say that the child will grow up and lose weight like the other siblings did.”
The societal shift towards unhealthy eating habits also exacerbates this issue. Dr Azriyanti noted that excessive caloric intake and sedentary lifestyles are primary contributors to obesity among children.
“Limiting sugar intake, reducing meal portions and focusing on healthier options are necessary to prevent further weight gain,” she stated.
Dr Yazid explained that our body does not know how to store excess carbohydrates, which will all be turned to fat, leading to increased visceral fat around the abdomen—a significant risk factor for metabolic diseases.
Multi-Faceted Approach To Childhood/ Adolescent Obesity: Education, Lifestyle Change, Medical Interventions
Addressing childhood or adolescent obesity requires a comprehensive approach that includes education, lifestyle changes, and, when necessary, medical intervention.
Dr Yazid advocated for preventive measures starting in pregnancy.
“We have seen cases where mothers who gained so much weight during pregnancy can have children that are overweight or obese,” he said, warning that children who are fed more than their necessary intake after delivery will grow up into adults living with overweight and obesity.
Dr Rohana stressed the importance of lifestyle changes and dietary restrictions as fundamental aspects of managing obesity.
“Adolescents respond better because of their high basal metabolic rate. However, there are significant challenges including underlying hormonal imbalances (PCOS, genetic diseases), family eating patterns, peer pressure, social media influences, teen psychological issues and more,” she said.
Health care providers must play an active role in monitoring children’s growth and addressing any concerns early on. Dr Yazid insisted that screening for metabolic diseases should begin as early as eight years old for children with a family history of obesity.
“Parents must not wait until the children are 10 years old or in adolescence. If there is a strong family history of obesity, the child should try to avoid things that can lead to obesity, which include high intake of food or a very sedentary lifestyle.”
In terms of treatment options, pharmacotherapy may be necessary for some adolescents struggling with severe obesity. Dr Rohana noted that injectable GLP-1 receptor agonists have proven effective in preventing future complications for this group.
Ultimately, addressing childhood obesity is crucial for preventing lifelong health complications and improving quality of life for future generations.
Dr Yazid concluded that if adolescent obesity is not tackled, these teenagers will grow up into adults living with obesity. “They are at a higher risk of diabetes, hypertension, cardiovascular disease, cerebrovascular disease, cancers and more.”
Dr Rohana shared a poignant remark from a friend who grew up obese and only managed to lose weight in early adulthood: “I will never get my childhood back.”
“That profound statement is something that should be shared widely and highlighted,” Dr Rohana said. “We need to do more for our children instead of paving the way for them directly towards debilitating NCDs, cardiovascular disease, and cancers.”
This disease awareness message is brought to you by Novo Nordisk Malaysia. For any medical inquiries or emergency, please consult a qualified health care professional.
