Obesity has emerged as a big issue in most countries. Countries such as Malaysia has identified this problem as one of the burden in health care system, which it has been linked to high mortality and morbidity related disease in many private and government hospital. Formally obesity is assume as a symbol of wealth, prosperity and health, but on this day it has been an enormous threat to the future generations where most of them died of complications due to overeating and not starve to death. The prevalence of obesity realted disease in this country has leading to a rapid increase of incident in chronic disease. According to Health Ministry statistics, heart disease is the third leading cause of deaths of patients in this country. If compared to the same statistics in countries that have developed as Western Europe, the United States and Japan, the leading cause of death in their country was cardiovascular disease. This clearly indicates that we were moving towards ‘westernization’ in experiencing the same problem face by the developed countries.
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As we know obesity is a problem that will lower the quality of life and the leading causes of many chronic diseases in later life. Myres (2002) state that obesity is an excess of body fat that frequently results in a significant impairment of health. Unfortunately this problem should not be the cause of death if they have little knowledge about the disease and raising awareness about obesity. Thus it is not surprising the number of obesity has increase every year because of their ignorance and lack of public understanding about the cause of obesity.
Working with an environment that tends to lead my patients become into obese has made me aware of my responsible to take part in battling this issue before it become into a heavy burden on my health care system. Over all my paper will not only focus on my patient, but also to the society as well on the consequences of obesity in term of health and economic cost that will indeed occur if there is no immediate action taken. Besides that, I will also explore in depth on how this issue can be a complication-related lifestyle and recommendations for re-appraise our own practices accordingly.
Body
Obesity is a condition where a person has excessive body weight due to accumulation of fat in the body. Obesity results when the size or number of fat cells in a person’s body increases Myers (2004). Obesity is usually assessed by using Body Mass Index (BMI) and the level of obesity is a global standard of classification of respondents either underweight, ideal weight, overweight and obese. BMI is calculated by dividing a person’s weight in kilograms by height (in M ²). A BMI of 18.5 to 22.9 consider as normal, 23 to 27.4 as pre-obese and above 27.5 is to overweight (obese). According to BMI standards, individuals are said to be overweight when BMI is between 25.0->40kg / m² (Ismail I S elt. 2004). Generally, from the observations that has been made on my patients founds that not all of them eat more than the amount consumed by their body weight was obese, but what is for sure those who are obese eating more than what is needed by their body and most of them who are obese are more significant to get the disease-related obesity than those with normal body weight.
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World Health Organization estimates that by 2015, roughly 2.3 billion people in the world will have more weight and 700 million people worldwide will suffer obesity (National consumer Campaign 2010). More worsen, this phenomenon will continue growing into an epidemic and spread to most developing countries. Malaysia is a Southeast Asian country which has the second highest obesity in population. According to National Health & Morbidity Survey (2006) found that 29% of Malaysian adults were overweight and 14% are obese, which mean 43% of Malaysian adults (or 2 in 5) are overweight. Compared with the 10 years back the survey reported that 17% (or 1 in 5) of Malaysian adults were overweight and another 4% were obese. Through the differences over the 10-year period, the increasing of overweight among Malaysians had clearly had jumped into 70% and more surprising obesity has risen to 250%. That’s why it has become a serious concern for the ministry to confronting this issue, which it has lead to many chronic disease including renal failure in Malaysia. In my dialysis center, diabetes mellitus and hypertension were the main causes of my patients are been diagnosed with kidney disease and most of them also have excessive body weight. Although they have been diagnosed with diabetes and hypertension disease, many of them are still ignoring the daily diet and proper nutrition for them. As a result, mortality of chronic diseases becomes higher in my center.
Causes
Dealing with obesity, what actually cause the problem to occur? To answer these questions, we need to look at the factors that can cause obesity. According to health experts, based on the results of the study, obesity can be influenced by various factors. These factors are among genetic factors, gender, excessive eating patterns, lack of sports motion, emotion, and environmental factors. So far there has been no strong evidence and data available linking gender and genetic is the main contributors to obesity in my center. However through my experience which almost 10 years shows that obesity is more likely linked with the lifestyle and environment compared to other factors. Many experts believe that this factor does have a significant impact in contributor the cause of obesity in developing countries. Swallen KC, elt (2005) found the results of his research shows that obesity is closely linked with the unhealthy quality of life. WHO (2003) also noted that the leading factor are increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity. That’s why I find that excessive sugar intake in beverages and food will certainly lead to diabetes and if this problem is not treated immediately, patients may require dialysis to survive, because of kidney failure.Listen
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As the populations become urbanization, the increase in the standard of living and modernization in most countries is usually accompanied by increase in weight gain and obesity. Young people in socio-economic groups are more likely concerned with their career as demanding on hardworking has been a necessity in worldwide. At the same time, dependence on automated technology such as elevator facilities or modern transportation has reduce of their physical activity.
In childhood obesity is already become a serious concern in Malaysia whereby obesity related complication also on rise among the them. According to Lim Y N elt. (2008) in 2006, the dialysis incident rate for age < 15 years was 5 per million age related population, 26 for those 15 to 24 years. And that of course occurs because of some contributors, including the failure of parents to understand the actual nutritional needs of their children during the period of growth. For example, the tendencies of parents to let the children are too dependent on junk food and carbonated drinks that are known contain no nutrients needed by the body. The involvement of low physical activity also very significantly in most children today. With the advancements made by internet technology and video game industry, they seem to be addicted to spending many hours playing video game rather than doing physical activity. This notion support by report from WHO (2002), where the television and the computer are two obvious reason why they spend many hours of the day seated and relatively inactive than a generation ago. Therefore, by allowing this generation become obese is likely allowing them to get the chronic disease in the future.
Genetic factors also play a big role in contributing to the risk of obesity where it can be inherited from the previous generation to the next generation in a family. Some individuals appear to be born with a genetic predisposition to obesity that is readily nurtured by our nation’s lifestyle (Thomas A. 2002). The most prominent feature of childhood obesity are other family members also face the similar problems and this usually is caused by a genetic defect called Lawrence Moon syndrome Biedl, syndrome. However, this doesn’t mean that if there are families members who are obese and suffer from diabetes or hypertension, the other family members are not necessarily will get kidney disease.
Implication
Obesity is not a trivial issue. It’s a health hazard. One of the major problems that will faced by the obesity children are insulin resistance and metabolic syndrome as stated by Kelishadi (2007) metabolic syndrome is also higher among the adult population in Asia. WHO (2002) as well reported that overweight and obesity also lead to adverse metabolic effect on blood pressure, cholesterol, triglycerides and insulin resistance. Risk of coronary heart disease, ischaemic stroke and type 2 diabetes mellitus increase steadily with increasing BMI. This clearly shows that the obesity is one of the primary factors causing of all this chronic disease and associated with increased risk of death.
In Malaysia especially in the dialysis center, the epidemic of chronic diseases have been seen to increased rapidly than expected, which almost doubled over the last decade. I find that many of my patients have diabetes and hypertension before this and up until they had suffering from kidney failure. According to The Star (2010), there is over 14.9% of Malaysian population aged above 30 are suffer from diabetes and hypertension respectively which has increase from 8.3% in 1996. While 20.7% of adults aged over 18 will be at risk suffering from high cholesterol. Lim Y N elt. (2008) also stated that diabetes mellitus continues to be the commonest cause of renal failure and has been the cause of at least half of new dialysis patients since 2002. Hypertension was the second commonest known cause of renal failure at about 7%. However the main cause of death in renal failure patients is cause by cardiovascular disease which remained the main cause of the death in 2008, accounting for 29%. All of these scenario show that obesity is the commonest complication related to many chronic disease.
As mentioned earlier this obese subjects also had a significant impact on the economy which, the government have to bear the increasing budget and long-term financial burden to organize the health programs and such medical treatment. According to WHO (2003), Obesity accounts for 2-6% of total health care costs in several developed countries; some estimates put the figure as high as 7%. The true costs are undoubtedly much greater as not all obesity-related conditions are included in the calculations. Cost to be borne by the patient to get dialysis treatment is also very high compared with other diseases as they requiring dialysis treatment for a lifetime. Kasemsup V elt. stated, in government perspective, the average cost for hemodialisis would be approximately 49 USD per session and total costs for access to HD (without erythropoietin injection) would range from 5,140 to 7,160 USD per case per year. Total costs for PD (without erythropoietin injection) would range from 4,640 to 7,280 USD per case per year. The estimates of costs for HD and PD are similar to costs for RRT in Malaysia. As well asListen
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health care today is also considered costing a lot of cost where as health care has been made as an economic activity. For young women, obesity becomes a problem serious enough, because of their desire to be perfect and slim is a dream for them. As a result, thousands dollars of money spent on diet, medications, and treatments for losing weight. As young men they are also afraid to be fat. For them, the fat man would be experiencing problems severe enough to attract the opposite sex. This of course will require a lot of money to be spent on a diet, buy slimming drugs and sports equipment just to reduce weight. Although they had to bear the burden in the battle against obesity and the disease, with the rapid economic growth and variety of health program organized by the government, has given them a better quality of life than the past.Listen
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Policy
Implementation of policy is very important in preventing this problem before it become into a catastrophic especially for the younger generation. Working in dialysis department has many advantages and potentials that can be done for patients to strengthen and maintain their healthy lifestyle. One of the programs in our policy here is health education, which it has a significant impact on their lifestyle. We always diversify the programs and measure they basic knowledge about the diseases and complication so they can make the wise decision to make changes in their cultural lifestyles and get help or counselling to deal with the problem of obesity. Greater emphasis on patient care also done through plan, organize, analyze and evaluate patient’s blood test results to determine the level of sugar and foods intake such as phosphate and potassium. The results of blood test are important to us to know their eating habits and thus the nutritional assessment can be made.
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The health system launched by the Ministry of Health Malaysia also very brave in implementing total transformation or make changes to the comprehensive strategy approach to combating the obesity of lifestyle. Promoting and improving weight management through programme Healthy Lifestyle Campaigns by the government has been running since 1991. However the most significant government policy in health promotion today is improving and focusing on the important of excercise, dietary habits and nutritional status under the National Nutrition Policy with the collaborations 10-year National Plan of Action for Nutrition from years 2006 to 2015. The government also has outlines the objectives, to plan and implement health promotion programmes and activities for the benefit of the community with a particular focus on youth. To fund and support sporting, recreational and cultural organizations to promote healthy lifestyles and healthy environments (Malaysian Health Promotion Board Act 2006).
Recommendation
Dealing to address the obesity should be made through the various aspects of approaches. Controlling eating and lack of exercise alone to achieve weight loss is not only the solution. From my past experience of public participation, it was found that the response of my patients and as well as the public to participate and understand the health programs that have been organized is very poor. The structure and guidelines with the goals, objectives and policies in form of a statement is often difficult to understand by them. As a result, their respond is very low in participation and certainly this implementation process will brings into questions on the effectiveness of health programs that can make aware of the community. Therefore, the existing campaign must be improved and intensified to convince them of the importance of health care. Health programs need to be restructured and reorganized in order to expand to the whole community, especially for the target group. Health policy should be reviewed immediately in line with the increase of the disease and for a better outcome. To be more effective, I also recommend to my hospital for providing exercise facilities or fitness centres and free medical check up to attract them.
Apart from that the Ministry must provide a large amount of expenditure for the purposes of promoting programs such as advertising programme, which its has own way in getting people excited about healthy lifestyle. The advertising programs that aim to reduce this burden also should be expanded and made easier for all levels of community to understand the message.Listen
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But for the advertising of a variety of snack food products should be prohibited by the Ministry. Concerned about a ‘toxic’ environment such as urban planning and junk food in schools only the act or the law alone can change the environment into a healthier and safer for the community.
However, some of the contributing factors such as ‘fat gene’ the thing that cannot change but of course they can work even harder to control their way of lifestyle. But what is the most important part of all is the involvement of all parties in addressing this epidemic become more wide.
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Conclusion
Generally, this disease has become a huge burden in my work place as well as in my country. With the available data, show that this issue frequently occur in developing country. By knowing the most common cause and incidence of the disease, we can understand how dangerous this scenario to the society. The high prevalence rate of this problem gave a lot of negative implications on health and economy, as the society are suppose to be the ‘economic power’ and energetic generation in the future.
However government has reinforced their strategy and target in combating this problem. Meanwhile health policy also should be reviewed immediately to improve for better public health outcomes. If these problems are not prevented from the very beginning can weaken the structure of society and become be a heavy burden on health care system as most young people will suffering many of the chronic disease. Therefore, obesity must be tackled as soon as possible before more and more Malaysians will experience it.
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