The Silent Killer

Prevalent in almost a third of the Malaysian population, obesity has our country in a chokehold.

According to the National Health and Morbidity Survey 2015, the prevalence of obesity in our nation has hit 30.6 percent. Besides problems such as cardiovascular disease and diabetes, obesity is also linked to an increased risk for infertility, strokes, depression and osteoarthritis that causes joint pain and stiffness.

Obesity isn’t just about being overweight but rather, having so much excess fat that your health and wellbeing are in danger. Tropicana Medical Centre’s Consultant Bariatric and Metabolic Surgeon, Dr. Tikfu Gee informs us on obesity, its risks and possible treatments.

Fattest in the region

Dr. Gee reaffirms the fact that obesity in Malaysia is on the rise at an alarming rate. “If we do not curb the obesity issue now, there’ll be an increase in other health problems related to obesity in the future. This will then lead to increased health expenditures for the nation.”

Malaysians are the most obese nation in Southeast Asia due to many factors. “Sleep deprivation or lack of sleep and late nights lead to abnormal changes in our hormone regulation and an increased appetite, ”says Dr. Gee. With 24-hour eateries found at most corners in Malaysia, those midnight munchies are hard to ignore.

Besides that, as a developing nation, there’s bound to be a higher amount of stress for those in the workforce. “High stress levels due to long hours at work, lead to improper eating habits and schedules. The longer we keep ourselves hungry, the less discriminatory we are in food choices and we tend to eat more in order to satiate the hunger,” points out Dr. Gee.

Bad choices

Many Malaysians lead a sedentary lifestyle and exercise just isn’t a priority. Dr Gee elaborates, “There are more deterrents compared to encouraging factors when it comes to exercise. For example, the hot and humid weather and the lack of security in public areas will discourage many from exercising. Not everyone can afford to exercise in a gym.” To be Malaysian is to love food and delicious food can be found almost everywhere. Unfortunately, this may lead to bad choices and habits. Dr. Gee says that many Malaysians have forgotten the healthy eating habits of our ancestors. “Our diet should be more balanced. It should consist of more fruits and vegetables. We also tend to eat too much food made from flour, rice, sugar, and oil because they tend to be cheaper,” he says. “There is no need for any special diets such as the Atkins, Paleo, South Beach or special diet supplements which tend to be expensive. As long as we adopt a healthy and balanced diet, we won’t have to rely on diet supplements or special diets to keep healthy.”

Survival of the fittest

One more thing that could lead to obesity is genetics. This is the only factor that people don’t have control over. “The ability to store energy efficiently was something that allowed us to survive famine and drought in the past. However, those same genes have been passed down to a lot of us who do not need them anymore,” explains Dr. Gee.

Dr Gee states that obesity is diagnosed by measuring the amount of fat in the body. “There’s no completely accurate method to measure the amount of fat in the body but we can come very close to it,” he says. “Body Mass Index or BMI tells us the weight in proportion to the height of a person but may be inaccurate if the person is muscular. Body fat analysis is also just an estimate.” Dr. Gee further explains that doctors still employ the BMI as a rough guide to a person’s fat score. For an Asian, a BMI of 27.5 and above is considered obese for both men and women.

Change your lifestyle or else...

Dr. Gee advises that prevention is the best way to fight obesity. “During the early stages of obesity, a commitment in lifestyle changes like adopting healthy eating and increasing physical activities will certainly result in weight loss,” he says. “However, for the very obese, it may be very difficult to lose weight. Some obese people may even damage their knees if they try to do certain types of sports.” Swimming is an exception because it is a low impact sport that works the whole body. Dr. Gee adds that appetite and eating habits may also be difficult to curb.

“These problems can be helped with certain types of bariatric surgeries that can alter the metabolism of the body and reduce appetite.” Dr. Gee stresses that bariatric surgery doesn’t remove fat like liposuction. “While liposuction removes fat from a specific area in the body, bariatric surgery reduces total body fat by limiting the amount of food intake and altering the body’s metabolism.”

Bypass and restrictive surgery

Many factors determine the suitability of a particular type of bariatric surgery for an individual. “For example, a bypass procedure may be more suitable for an obese patient with diabetes because a bypass has a larger impact on lifestyle – weight loss-wise. Conversely an obese person with no medical illness may be better off with just a restrictive surgery,” says Dr. Gee. “A decision needs to be made between a doctor and the patient with regards to the type of surgery that is appropriate,” says Dr. Gee (see sidebar types of bariatric surgery)

He states that bariatric surgery is recommended by world bodies and authorities when obesity has already or can potentially cause health problems. “This is also known as morbid obesity which corresponds to a BMI of 37.5 without any other illness or a BMI of 32.5 with an existing illness like diabetes.”

Dr. Gee’s take home message is that obesity isn’t just about our looks but it can lead to serious health problems like diabetes and various forms of cancer. It reduces lifespans and shouldn’t be taken lightly. “The good news is that we can reverse obesity and even diabetes with bariatric surgery. There’s no easy way out of obesity and it’s a lifelong commitment to stay healthy.”

Adjustable Gastric Band

This minimally invasive method of decreasing the size of the stomach is adjustable which means the doctor can increase or decrease the size depending on the patient’s needs. This procedure makes the stomach smaller so less food is eaten but nutrition is still absorbed by the small intestine.

Roux En Y Gastric Bypass

As shown in the image below, the stomach is stapled to create a smaller stomach so the patient doesn’t eat as much. Due to repositioning of the small intestines, less food is absorbed into the digestive system. However, a drawback would be that there’re fewer nutrients absorbed as well.

Sleeve Gastrectomy

This is a restrictive type of bariatric surgery that transforms the stomach into a sleeve by reducing the size of the stomach by 80 to 90 percent, as shown in the picture below. This limits the amount of food in the stomach and cuts down on the intake of calories.

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