Malaysia is the most obese country in Southeast Asia, with 50.1 per cent of Malaysians being overweight. Childhood obesity rates have also increased significantly, from 6.1 per cent in 2011 to 14.8 per cent in 2019. Given that eating habits are formed in the early stages of life, childhood obesity is a pressing issue that needs intervention.
Causes of childhood obesity
Malaysians’ typical diet makes them predisposed to childhood obesity. The country’s rice consumption per capita reached 120kg in 2017. Furthermore, many Malaysian dishes contain coconut and deep-fried ingredients, with Malaysians also experiencing an increasingly “Westernised” diet supplied by international companies and fast food chains. With this high-carbohydrate, high-fat diet, children have become predisposed to childhood obesity.
As an upper-middle-income country, Malaysia has experienced an average growth of 5.4 per cent since 2010. This has increased Malaysians’ purchasing power, granting them access to more expensive diets and lifestyles, which tend to be unhealthier. For instance, online food delivery services have become increasingly popular since 2018, with usage further increasing during Malaysia’s COVID-19 lockdown. These unhealthier diets and sedentary lifestyles contribute to childhood obesity.
However, there are other more insidious causes. Inequality has materialised itself in the double burden of malnutrition, with both overeating and undernourishment being causes of obesity With 89.1 per cent of food and beverage items recording price increases, individuals from lower-income backgrounds struggle to have food on the table, let alone afford a balanced diet. In Malaysia, such food-insecure households adopted “income soothing” and “consumption soothing” strategies to cope, cooking self-grown starch-based plants they had at home or reducing their food intake. However, this has affected children’s nutrition, with about 20 per cent of households being unable to provide their children with a variety of nutrients, instead consuming affordable yet unhealthy food with reduced portion sizes. This unbalanced diet increases the risk of childhood obesity.
This has been exacerbated by time poverty – individuals from impoverished backgrounds work for long hours, thus having insufficient time to rest or cook. As a result, children from low-income families eat out more regularly, having unhealthily high sodium and fat intakes. In particular, fast food has become a dominant yet detrimental diet for low-income children in urban Malaysia.
The Internet has also become a significant influence, with 92 per cent of Malaysian children aged 5 to 17 using the Internet as of 2018. Consequently, children have been exposed to fast food advertisements and content from social media influencers. They may emulate online content, with those featuring food and beverage cues influencing their dietary habits, including the Mukbang culture. Mukbang, which means “eating broadcast” in Korean, refers to videos where individuals binge-eat. Research has established a correlation between mukbang viewing time and dietary behaviour, with mukbang viewers tending to have remarkably high BMI. Furthermore, children are less able to exercise self-control in regulating social media usage, making them more likely to be addicted, leading to decreased physical activity and energy output.
Existing policies
Since children spend a significant amount of time in school, educational institutions have been key stakeholders. For instance, physical education lessons are conducted for 40 minutes twice a week. By formalising this period, students are obligated to exercise, possibly improving their health and reducing childhood obesity rates. However, medical professionals argued that this duration is insufficient to reduce the incidence of other health conditions. In addition, despite prevailing national guidelines, the quality of PE lessons differed across schools, depending on the time, expertise and resources teachers have.
School feeding programmes like the Rancangan Makanan Tambahan (RMT) have also been implemented, ensuring that lower-income students have at least one nutritious meal every school day. However, the RMT has come under scrutiny after students were only served white rice with gravy. With rising costs caused by inflation, the existing RMT rate of RM2.50 to RM3 is insufficient for canteen operators. Consequently, the quantity and quality of food provided have been compromised.
Nationally, the government has adopted various public messaging campaigns. However, a study found that only 20.4 per cent of the population was aware of the Healthy Plate concept, with most of these individuals coming from urban areas. A soda tax has also been implemented to discourage soft drink consumption, causing a one-litre sugar-sweetened beverage to cost RM0.40 more if its sugar content exceeds the government-established limit. Since children have limited allowance, a hike in prices of sugar-sweetened drinks makes it difficult to consume them. However, given the addictive nature of sugar, children may turn to alternatives excluded from the tax structure.
Future steps
Childhood obesity has been a pertinent problem in Malaysia, and recent societal trends exacerbate its significance. Inequality will likely remain a significant driver of childhood obesity, placing low-income children at a disadvantage. With a Gini coefficient of 41.0 per cent as of 2015, which is likely to have increased with the COVID-19 pandemic, more children risk falling behind. Healthy diets and an obesity-free childhood are not privileges and should be accessible to all children regardless of their socioeconomic status. Tackling childhood obesity requires the collaboration of various stakeholders, including the Ministry of Health, businesses, parents, educators and social media companies, who must reach a compromise to address the issue.
Read the full case study Addressing Childhood Obesity in Malaysia written by Hannah Pang Jing Xuan, which was awarded the Merit Prize in the Case Writing Competition 2022/23 at the Lee Kuan Yew School of Public Policy.
Access more case studies from the Lee Kuan Yew School of Public Policy.