When ‘chubby' turns costly: The high NCD risk behind childhood obesity

Sinar Daily

4 days ago

KUALA LUMPUR - "So cute!' This phrase still rings out at family gatherings, often directed at chubby, round-faced children with hearty appetites - signs of them being "healthy and happy'.
For generations, a little extra weight on a child was seen as a sign of well-being. But health experts warn that this mindset is outdated and increasingly risky for a child's long-term health.
Childhood obesity is far from harmless. It is a serious medical condition linked to long-term health complications, including noncommunicable diseases (NCDs), most commonly type 2 diabetes, heart disease, fatty liver and even some cancers.
As long as society continues to view chubbiness as cute and harmless, children will continue to pay the price with their health.
MALAYSIA'S NCD BURDEN
According to Dr Muhammad Yazid Jalaludin, senior consultant paediatric endocrinologist at Universiti Malaya Medical Centre (UMMC) and UM Specialist Centre (UMSC), many global organisations have recognised obesity as a disease.
Dr Muhammad Yazid, Professor of paediatrics at the Faculty of Medicine, Universiti Malaya, also said obesity is not just about size or body mass index (BMI) exceeding a certain level, but is dangerous due to its association with chronic NCDs, which can severely impact health and even be fatal.
According to the World Health Organisation (WHO), NCDs are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types of NCDs are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.
NCDs disproportionately affect people in low- and middle-income countries, where nearly three-quarters of global NCD deaths (32 million) occur.
According to a 2024 report, 'Prevention and Control of Noncommunicable Diseases in Malaysia: The Case for Investment' (jointly prepared by the Ministry of Health Malaysia [MOH], WHO and the UN Inter-Agency Task Force on NCDs), each year, NCDs in Malaysia cause 72 percent of all premature deaths.
Economic analysis of data from 2021 has estimated that NCDs cause RM64.2 billion in economic losses per year, including RM12.4 billion in healthcare expenditure and disability payments, and RM 51.8 billion in productivity losses. The total social and economic losses due to NCDs is equivalent to 4.2 percent of the nation's gross domestic product.
The 2024 report also highlighted another concern: Malaysia is experiencing the double burden of malnutrition and undernutrition, and overweight and obesity, causing diet-related NCDs.
FATTY LIVER
Dr Yazid said obese children are at risk of developing type 2 diabetes earlier than usual.
"I've treated children as young as eight years old who had type 2 diabetes, which usually affects older adults.
"These children (with diabetes) often also have cholesterol issues, putting them at risk of heart disease much earlier than other people. When we see people having a heart attack at age 40, we used to think they are too young to get it, but now people as young as 28 are having heart attacks due to severe obesity at a young age, plus cholesterol, hypertension and diabetes,' he said.
More concerning, he added, is their research showing that even children can suffer from fatty liver disease.
"If it begins too early, it can lead to fibrosis and cirrhosis, significantly raising the risk of hepatocellular carcinoma or liver cancer,' he explained.
He added that excessive obesity increases the risk of other cancers, such as colon, breast and gynaecological cancers.
"Obese children may also develop sleep apnoea, a condition where breathing (repeatedly) stops (and starts) while sleeping. This can cause the right side of the heart to enlarge or thicken, increase pressure in the lungs and potentially lead to death during sleep,' he said, adding children also risk developing bow legs due to the stress of supporting their excess weight.
LIFELONG OBESITY RISK Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva Childhood obesity is far from harmless. Photo for illustrative purposes only - Canva
The 2019 National Health and Morbidity Survey (NHMS) found that 29.8 percent of children aged five to 17 fall into the categories of overweight (15 percent) and obese (14.8 percent).
On May 24, Deputy Health Minister Datuk Lukanisman Awang Sauni was quoted by the media as saying that, based on NHMS data, the prevalence of overweight and obesity among children is continuing to rise.
"For children under the age of five, the rate increased from 5.6 percent in 2019 to six percent in 2022.
"For adolescents aged 13 to 17, the prevalence rose from 28.5 percent in 2017 to 30.5 percent in 2022, indicating that one in three children is experiencing overweight or obesity issues,' he said.
Pointing to the rising number of overweight and obese children in Malaysia, Dr Yazid said if the issue is not controlled, they will add to the nation's overall obesity statistics in adulthood.
"Statistics show that 70 to 80 percent of children aged six to eight who are overweight or obese will remain obese as adults. Out of 10 obese seven-year-olds, only three will achieve a normal weight in adulthood,' he said.
Excess weight results from consuming more calories than needed, often due to unhealthy eating and lack of exercise and physical activity, he said, adding that sleeping late or insufficient sleep can also contribute to obesity as tired children tend to feel hungrier during the day.
"When children lack sleep or have poor sleep quality, they eat more the next day due to fatigue. Like adults, they tend to choose sugary, high-calorie and fatty foods to regain energy.
"Even if they know the food is unhealthy, their brain is already wired to crave such food,' he explained.
SEDENTARY LIFESTYLE IMPACT
While genetics plays a role, Dr Yazid noted that environment and habits matter more.
He said studies show that if one parent is obese, the child's risk of obesity increases fivefold, and if both parents are obese, the risk goes up 13 times.
"Only a very small number - less than two percent - of obesity cases are due to genetic syndromes. Most cases are due to the environment (they live in) as obese parents tend to eat more and exercise less, and their children follow suit.
"In a study ('MyHeART') that we did, we assessed the fitness levels of teens aged 13, 15 and 17. Fewer than 10 percent were genuinely fit and less than 30 percent engaged in useful physical activities daily.
"Our calorie intake far outweighs calorie burn due to our sedentary lifestyle. Food is easily accessible… just order and it's delivered to your door,' he said, adding that another study has shown that Malaysian teenagers are generally not physically active.
He also pointed out a lack of awareness about the importance of Physical and Health Education (PJK) classes in schools.
"PJK is often sidelined, seen as unimportant and frequently sacrificed for other academic activities. But that short session is the only chance some students have to exercise and sweat, which is vital for their health.
"After school, many kids just spend time on their gadgets and (online) games, staying indoors instead of going to the park or playing football or cycling. When we talk about this issue, (parents) will raise concerns about safety, unpredictable weather and other things.
"This is where local authorities and the government must play a role by providing safe and well-maintained recreational areas where local communities can exercise and participate in physical activities, thus fostering a healthier lifestyle,' he said.
While the medical challenges of obesity are daunting, treatment options are available - though not without their own limitations.
METFORMIN
Rejecting claims that childhood obesity in Malaysia is only an urban issue caused by busy parents, financial status and access to food, Dr Yazid said the situation has changed.
"In the United States, many obese persons come from low-income groups because healthy, nutritious and high-quality food is expensive. In contrast, in China, it's the wealthy who tend to be obese due to access to a wide variety of food.
"In Malaysia today, those with money can afford to eat a lot, while those without money eat whatever is available, regardless of whether it's healthy, high in sugar, salt or otherwise,' he said.
Regarding appropriate weight-loss medications for children, Dr Yazid said currently, no drug has been specifically approved for those under 12.
He said metformin, a medicine to treat type 2 diabetes, has many side effects when given to children under 10, such as stomach ache, flatulence and discharge of oily stool.
"We can't give school kids this medicine as they may have an 'accident' in school and be teased by their friends,' he said.
Dr Yazid added that while metformin is "not popular for children under 12, we will consider it in certain cases'.
"Metformin is used for type 2 diabetes and can be given to children aged 10 and above who show signs of insulin resistance or prediabetes. The aim is to reverse their health issues before they develop full-blown diabetes.'
This medication is usually taken for up to a year for weight loss, but some patients may need to take it for more than a year to prevent extreme weight gain and their insulin resistance from worsening, he said, adding scientific data has shown that the use of metformin can reverse prediabetes in 50 to 70 percent of cases.
LIRAGLUTIDE, BARIATRIC SURGERY
Referring to a study conducted and co-authored by him together with several of the world's leading medical experts, titled "Liraglutide for Children 6 to Less Than 12 Years of Age with Obesity - A Randomised Trial' (https://www.nejm.org/doi/pdf/10.1056/NEJMoa2407379), Dr Yazid said their research involved the use of liraglutide - an injectable medication suitable for obese children aged six to under 12, to help reduce their appetite.
The study, published in 'The New England Journal of Medicine' in September 2024, found that treatment with liraglutide for 56 weeks, combined with lifestyle interventions, resulted in a significantly greater reduction in BMI compared to placebo combined with lifestyle interventions.
"Liraglutide tends to be more effective in children and youth than adults, with fewer side effects compared to other medications. We only prescribe it after all other weight loss efforts fail,' he said, adding that liraglutide costs about RM1,900 per month, making it unaffordable for many families.
As for bariatric surgery, he said it is seen as a last resort for extremely obese children at risk of developing NCDs. However, it is not recommended for children who have not reached puberty due to potential disruption to growth.
"Currently, bariatric surgery is not performed on children unless under very specific conditions, usually in cases of extreme obesity where obesity-related diseases have started to develop. It can be done for adolescents who have stopped growing and entered adulthood,' he said.
Bariatric surgery is performed to reduce the size of the stomach, making the patient feel full quickly even with small meals. However, it also reduces nutrient absorption, which can lead to nutritional deficiencies if not properly managed.
"Post-surgery, patients must continue to consult doctors and dietitians to ensure they get the right supplements. For instance, a lack of vitamin D can lead to osteoporosis, while vitamin K deficiency can cause bleeding and bruising. In the US, (there was a case of ) a patient (who) became blind after undergoing bariatric surgery due to a lack of vitamin A,' he said.
RAMPANT SALE OF JUNK FOOD
Beyond hospitals and clinics, the everyday environments children are exposed to - especially at school - also play a critical role in shaping their eating habits and long-term health.
Sharing their concerns over the increasingly rampant sale of sugary drinks, snacks and fast food, including outside school gates, several parents interviewed by Bernama described the situation as a "threat' to their children's health.
Siti Balkis, 42, a government employee, said almost every day her children, particularly the two younger ones who are in primary school, would buy ice cream, snacks or 'jelly balls' (colourful jelly candies) after school as the street vendors are just a few steps away from the school gate.
"Every time after school, they want to buy something. It's hard to stop them because the stuff is right there in front of them. Children are easily influenced, especially by the bright and attractive packaging.
"Sometimes, we as parents don't even know what our children are eating because many different types of snacks are available in the market these days,' said the mother of four.
Father of two Muhammad Saufi, 39, meanwhile, said the presence of vendors selling food high in sugar, salt and other additives outside school premises calls for stricter action from the authorities.
"The types of food being sold also need to be monitored because most of them are unhealthy. Kids may love the taste of these snacks, but they can have serious health effects,' he said, suggesting that schools work together with Parent-Teacher Associations and local councils to more closely monitor the sale of food outside school gates and promote healthier alternatives at affordable prices.
As Malaysia grapples with the long-term consequences of childhood obesity, experts stressed that treatment alone is not enough. Early prevention, public awareness and stronger enforcement of regulations are crucial to breaking the cycle before it burdens the nation further.
From sugar-laden drinks sold outside school gates to inherited risks compounded by sedentary routines, this issue demands urgent, multi-pronged actions - not just to manage weight but to safeguard the future health and productivity of the nation's younger generation.
Tomorrow: Behind every overweight child is a hidden struggle - not just with their health but with their confidence, emotions and sense of self. In Part Three, we uncover the silent mental toll of childhood obesity. - BERNAMA