For a healthier nation

What say you on the issue below?

As a nation, we have to improve efforts to make all Malaysians healthier.

WE have just celebrated Merdeka and Malaysia Day (the nation’s birthday), and the Prime Minister surprised everyone with the suggestion to abolish several outdated laws that had made a large section of the population very unhappy for a long time.

One of my own relatives was a victim of this law, and I witnessed how his incarceration deprived his four young children of their daddy (they were just toddlers or in primary school at the time), and how the family suffered.

So I join my fellow Malaysians in applauding our PM for his brave decision, as he continues to transform our nation into a more progressive, democratic, economically competitive, eco-conscious, people-friendly nation.

To be healthy and avoid obesity, we have to change our mindset and start eating for health. For a start, we need to reduce our rice consumption.

Although there is much unhappiness about the high and continually rising cost of living, we are also enjoying a much higher standard of living and affluent lifestyle compared to our parents. We are a rich and prosperous nation.

We have reasons to be happy indeed, although we look forward to more affirmative actions to address the other outstanding grouses and issues simmering on the ground (eg rising crime, poor public transport system, etc).

As a health enthusiast, my concern is about the transformation of Malaysians’ health. We have seen the positive impact of the various transformation programmes implemented by Datuk Seri Najib’s administration.

The economic, government and social transformation plans have been put in place, but we have yet to see a major health transformation plan to improve the health of our people.

We have to make a distinction between health parameters related to clean water, clean environment, accessibility of health facilities, and prevention/control of infectious diseases, all of which have been well taken care of by the relevant authorities; versus the health parameters related to the health of the individual – that indicate overall health (or unhealthiness) and the likelihood of getting chronic diseases like obesity, hypertension, heart disease, stroke, diabetes, kidney disease, liver disease, arthritis, and cancer.

In fact, many adult Malaysians are already afflicted by one or more of these diseases.

While the government has provided us with among the best and cheapest (government clinics and hospitals) health facilities in the world, the Health Ministry’s efforts to make Malaysians healthier needs to improve. We have affordable and readily accessible health facilities which will be overburdened because we are also getting unhealthier and sicker.

Over the last three decades or so, the national health surveys have revealed that as a nation, we are getting fatter, more hypertensive, diabetic, and cancerous!

If surveys on arthritis and heart disease were done, I am sure we will be declared arthritic and heartsick as well.

The obesity plague

The Third National Health & Morbidity Survey 2006 (NHMS III) revealed that 29.1% of adults were overweight (BMI 25.0 – 29.9), with another 14% obese (BMI above 30). Obesity means gross overweight that should be treated as a chronic disease.

Altogether, about 45% of adult Malaysians were too fat. In comparison, only 21% were overweight or obese in 1996 (NHMS II – the prevalence of overweight was only 16.6%, and 4.4% were obese).

That’s more than double in 10 years.

The survey also showed that Indians had the highest prevalence of overweight, followed by Malays and Chinese, while women had higher obesity prevalence (17.4%) than men (10.0%).

While the figures are alarming, they are not surprising to me. It is obvious that our people have not yet understood the importance of a healthy lifestyle, nutritious diet, maintaining optimal weight, and adequate exercise. These are the basis of healthy living.

In this Hari Raya Open House season, I had ample opportunity to observe how fat people continue to gorge on heapfuls of food on their plates, often going for multiple servings because there is so much to choose from. Malaysia is a food haven, and also fast becoming a sick nation, if we don’t reverse the trend immediately.

I also noted with sadness that many of my former patients and staff whom I met during this festive season are now much fatter then they were before.

The most obvious are the ladies who were in their svelte teens or twenties when I first met them 10 to 30 years ago, and are now obese and rotund (in their 30’s to 50’s). I had observed that they were progressively getting bigger and bigger over the years. Some of them are now HUGE!

We eat too much

The cause for this observation? Malaysians eat too much, and we eat the wrong foods. We have delectable and delicious dishes that we are trying to promote to the world, but that does not mean delicious cannot be healthy too. If you know what to eat, you can still enjoy delightful, nutritious meals.

To be healthy and avoid obesity, we have to change our mindset and start eating for health.

For a start, we need to reduce our rice consumption. Much of the overweight/obesity problem can be blamed on this (over-consumption of rice or other processed carbohydrates like mee, laksa, roti canai, bread, etc).

Several years ago, a local newspaper reported that a Malay lady lost 180kg (yes, one hundred and eighty kilograms!) in just one year without going through a torturous regime like starvation diets or The Biggest Loser competition. She did so just by avoiding rice and the carbohydrate substitutes.

She ate plenty of vegetables, some fruits, fish and nutritional supplements to ensure that she was well-nourished.

After one year, she dropped from 260kg to 80kg, and also cured herself of hypertension and diabetes. She did not spend thousands of ringgit at slimming salons. Her success was solely due to her determination, perseverance, discipline, and the correct understanding of what makes a healthy, balanced diet.

Although her story is an extreme case, we can learn from her that over-consumption of rice causes obesity, and reduction (or avoidance as in her case) of rice consumption can indeed reduce weight.

Remember that a small cup of rice has the fattening calorie-equivalent of about 10 teaspoons of sugar, while a large bowl of rice (and this is the standard serving in many Mamak restaurants) equals about 20 teaspoons of sugar.

I would also like to share that many of my patients who reduced their rice intake reported that their waists became slimmer faster than when they tried to exercise the belly fat away. This has important health implications, because central obesity (fat accumulation around the belly) predisposes to diabetes and heart disease.

A healthy, balanced diet

A healthy, balanced diet should provide energy, essential fats, proteins, plenty of other nutrients, and sufficient water for all our metabolic needs.

Those of you who are overweight/obese already have too much calorie-energy stored in your body, so you don’t even need to worry about this.

Just a small portion of carbohydrate (eg rice/bread) daily is sufficient. There will be plenty of unhealthy “hidden” fats in your food. The protein is best sourced from eggs, fish or beans. Most of the nutrients we need should come from fruits and veggies.

Malaysians generally do not take enough veggies. In fact many deliberately avoid them. It is a pity since veggies provide many important vitamins, minerals, antioxidants and other phytonutrients.

We are also blessed with a rich variety of fruits, which also provide ample health-enhancing and disease-preventing nutrients.

While you can take as much of the leafy veggies as you like (they are low-calorie nutrient-dense foods), however, you must be cautious about eating too much fruits because they also have plenty of sugars/calories.

For fruits, the rule is – go for variety, but not quantity. For veggies – go for variety and quantity.

If you are like the majority who don’t take enough fruits and veggies, you should consider supplements to provide the important nutrients not adequately provided by your diet.

I recommend whole-food supplements (extracts from whole fruits, veggies, greens, grains, grass, legumes, etc) instead of the artificially formulated supplements, which may not necessarily give the promised the health benefits.

Whenever possible, I begin my meals by stuffing myself with veggies, followed by some fruits, then only the meal “proper”, so that even if there are delicious dishes (that are often unhealthy), I am assured that the protective nutrients have already gone in, and because my stomach is already full of veggies and fruits, I will not be able to binge on the unhealthy dishes.

Sometimes I am already satiated after the veggies and fruits, and the junk food does not get in. And I try to avoid the sweets/desserts, but not always!

A call for health transformation

That is my personal diet transformation. For a total health transformation, it will have to include maintaining a healthy weight and exercising more as well. To preach health, I have to start with myself.

When the NHMS III results were released, the researchers (from the Health Ministry and universities) jointly made this statement: “This alarming trend calls for serious re-examination of public health programmes for more effective reduction of obesity among Malaysian adults.” (http://psasir.upm.edu.my/6543/)

Five years down the road, I don’t see any improvement as far as obesity reduction is concerned. In fact it is worsening. With it comes the worsening statistics for diabetes, heart disease, stroke, arthritis, kidney disease, liver disease, cancer and many other chronic lifestyle diseases.

I call upon the government to embark on serious and effective health programmes to combat this obesity plague before we become a totally fat and sick nation.

All our successes with the other transformation programmes will come to naught if so many of us become crippled by chronic diseases, or die early.

I acknowledge that there have been many health campaigns and programmes implemented by the Health Ministry in the past, but we have yet to see their effectiveness, at least when it comes to combating obesity and the chronic diseases, or even smoking. Obviously we must do something different to achieve results.

Let us work together towards a healthy, happy 1Malaysia.