KUALA SELANGOR, Sept 18 — Obesity in Malaysia is too often dismissed as a matter of weak willpower or poor discipline. But experts stress that it is far more complex – a chronic, relapsing disease that demands structured, long-term management, much like diabetes or heart disease.
Prof Dr Rohana Abdul Ghani, president of the Malaysian Obesity Society (MYOS) and senior consultant endocrinologist at Hospital Al-Sultan Abdullah, Universiti Teknologi MARA (UiTM), Puncak Alam, said stigma remains a major barrier. Many Malaysians living with obesity struggle despite being highly motivated.
“These are very motivated people who are debilitated by their weight,” she said in an interview with CodeBlue. “I empathise with patients who are unable to climb stairs, exhausted while working, and some already suffering complications like heart disease or sleep apnea.”
For many patients, shame overshadows treatment. “Working adults tell me: ‘I want to start medication, but I can’t be seen with it. People will think I failed at controlling my diet and lifestyle’,” she said.
The problem extends beyond adults. Children are increasingly affected, often because parents cannot control what they eat in school canteens, where calorie-dense food is easily available.
Some young patients also live with congenital conditions, which are associated with hyperphagia, i.e. an uncontrollable urge to eat that worsen with age if undiagnosed early.
“These are normal Malaysians who are struggling with obesity,” Dr Rohana emphasised.
Why Obesity Must Be Seen As A Disease
Obesity should not be reduced to a lack of self-control, she stressed. “It is a chronic, relapsing disease because it fits the criteria. It has symptoms like constant hunger, cravings, and difficulty achieving satiety; it has a combination of many causes; and it leads to multiple complications and mortality.”
Causes include genetic factors that could predispose individuals to obesity. “Unlike some cancers where a single mutation is implicated, in obesity there are many snippets of genetic variance that contribute to the development of obesity,” she explained.
Additionally, there are also the epigenetic factor, whereby the genetic architecture is modified by prolonged exposure to the environment: Living in an “obesogenic environment”, which is our daily exposure to a surrounding that promotes weight gain, could alter from normal to abnormal genetic makeup and vice versa.
Hormonal factor is another significant cause for obesity, particularly for women. Conditions such as Polycystic Ovarian Syndrome (PCOS) in adolescents or young adults, menopause in older women, are challenging medical conditions associated with weight gain. Certain medications can also drive weight gain, including steroid, some antipsychotics, antidiabetics, and insulin, if used unsupervised.
“But the biggest organ which affects obesity is the brain,” Dr Rohana said. “You have the satiety centre, the hunger centre, which are influenced by the different hormonal levels. It’s a complex interplay between the brain and the gut.”
The scale of the crisis is sobering. The National Health and Morbidity Survey (NHMS) 2023 found that 54.4 per cent of Malaysian adults are overweight or obese, based on World Health Organization cut-offs. When applying Malaysia’s own lower thresholds for Asian populations, the figure jumps to 70.1 per cent.
Yet, recognition remains limited. “Our Malaysian Clinical Practice Guidelines (CPG) clearly state obesity is a chronic disease, but that is as far as it has gone. Insurance, for example, has not followed through,” Dr Rohana said.
The consequences are severe. “Global data has shown that one-third of obese patients also have diabetes; and one-third suffer from heart disease. Local data from the National Diabetes Registry 2023 showed nearly 80 per cent of patients with diabetes are overweight or obese.”
“The link is so strong that we now use terms like ‘diabesity’, which a combination of diabetes and obesity. And increasingly we also talk about the cardio-kidney-metabolic syndrome, where patients have heart disease, kidney problems, high sugar, hypertension, fatty liver – all bound and led by obesity,” she explained.
Health Minister Dzulkefly Ahmad said last month that the Ministry of Health (MOH) would place special focus on managing obesity and diabetes in the upcoming Budget 2026, citing statistics from NHMS 2023 that 21.8 per cent of Malaysian adults, or 4.58 million people, are obese. Some 3.55 million Malaysian adults have diabetes, translating to 15.6 per cent prevalence.
Barriers To Early Intervention
Despite the alarming data, cultural attitudes and stigma prevent many from seeking help. “In Malaysia, chubby children are often seen as cute or a sign of prosperity. Parents may not realise the long-term risks, and it’s worse in children because the earlier they’re exposed, the worse the risks,” Dr Rohana said.
The burden is shifting. “Obesity used to be seen as a disease of the wealthy. But it is no longer so. Now it is a disease of the poor, driven by cheap, ultra-processed, calorie-dense food and poor nutrition.”
Stigma also persists among health care providers. “Some doctors don’t even regard obesity as a disease. How then can they comfortably and confidently talk about it when they are not convinced themselves? Many are not well equipped, partly due to gaps in the medical curriculum and lack of training or treatment options,” she added.
Therefore, one of the many objectives of MYOS is to attempt to close these gaps through increasing this awareness and providing new training modules.
Beyond Lifestyle: New Treatments Bring Hope
For decades, patients have been told to “eat less and move more.” But normal physiology makes sustained weight loss extremely difficult.
“Our physiology has not evolved as fast as our environment. When you lose weight, your body reacts defensively – lowering metabolic rate, increasing hunger hormones, reducing satiety hormones. This is metabolic adaptation,” Dr Rohana explained.
Exercise remains important, but with limitations. It accounts for only 5 to 10 per cent of daily energy expenditure. Strength training is especially crucial, she said, as weight loss often reduces muscle mass, slowing metabolism further.
This is why new treatments are transforming obesity care. “With our current understanding, diet and lifestyle alone are not enough. Pharmacotherapy and, in some cases, surgery are needed,” she said.
“While Malaysia currently has only modestly effective oral drugs, newer medications such as the injectable Glucagon-Like Peptide-1 (GLP-1) receptor agonists and dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonists, offer significantly greater effectiveness,” she added.
“These treatments have revolutionised obesity care globally,” Dr Rohana said. “For patients and doctors, it is no longer just telling people to eat less and exercise more. We can now therapeutically target the brain and gut hormones directly, with impressive results.”
Dr Rohana stressed, however, that these medications must complement, not replace, lifestyle changes. “It should be used as an adjunct to diet and lifestyle, not the other way around.”
Indications for the therapies are BMI above 30 kg/m2 or 27 kg/m2 with comorbidities, after failing diet and lifestyle changes for three to six months.
A Call for Early, Individualised Care
Dr Rohana ended on an optimistic note. “Effective treatment options now exist, supported by strong evidence. But they must be tailored to each patient and initiated early, before complications arise.
“Patients should not wait until their health deteriorates. They should speak to their doctors about the best evidence-based options for managing obesity.”
For further information, please contact your health care professional.
