Overview of obesity in Malaysia
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Overview of obesity in Malaysia

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Presentation at the Dietetics Update held in Putrajaya, 11 August 2014

Presentation at the Dietetics Update held in Putrajaya, 11 August 2014

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Overview of obesity in Malaysia Overview of obesity in Malaysia Presentation Transcript

  • Overview on Obesity, Aetiology and Epidemic in Malaysia: How serious is the problem? Feisul Idzwan Mustapha MBBS, MPH, AM(M) NCD Section, Disease Control Division Ministry of Health, Malaysia Clinical Dietetic Update in Weight Management 11 August 2014 Putrajaya dr.feisul@moh.gov.my Ministry of Health Malaysia
  • There are Four MajorGroupsof Non- CommunicableDiseases; Four majorlifestyles related riskfactors Modifiable causative risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Noncommunicablediseases Heart disease and stroke     Diabetes     Cancers     Chronic lung disease  2
  • 8.3 14.9 20.8 6.5 9.5 10.7 1.8 5.4 10.1 4.3 4.7 5.3 0 5 10 15 20 25 NHMS II (1996) NHMS III (2006) NHMS 2011 Prevalence(%) Prevalence of Diabetes, ≥30 years (1996, 2006 & 2011) Total diabetes Known Undiagnosed IFG Source: National Health & Morbidity Surveys (NHMS) 32.2 32.7 12.8 19.8 0 5 10 15 20 25 30 35 NHMS III (2006) NHMS 2011 Prevalence(%) Prevalence of Hypertension, ≥18 years (2006 & 2011) Total HPT Known Undiagnosed 20.6 35.1 8.4 26.6 0 5 10 15 20 25 30 35 40 NHMS III (2006) NHMS 2011 Prevalence(%) Prevalence of Hypercholesterolaemia, ≥18 years (2006 & 2011) Total HChol Known Undiagnosed 3
  • 16.6 29.1 29.4 4.4 14.0 15.1 0 5 10 15 20 25 30 35 NHMS II (1996) NHMS III (2006) NHMS 2011 Prevalence(%) Prevalence of Overweight & Obesity, ≥18 years (1996, 2006 & 2011) Overweight Obesity PrevalenceofAbdominalObesity,≥18years (2006&2011) 19.6 28.6 33.6 44.7 48.0 51.0 55.7 62.8 63.2 61.4 63.2 56.2 50.4 10 20 30 40 50 60 70 18-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ PREVALENCE(%) AGE GROUPS (years) 30.1 37.1 47.1 54.1 20 30 40 50 60 NHMS 2006 NHMS 2011 PREVALENCE(%) MALES FEMALES Prevalence of Abdominal Obesity by age groups (NHMS 2011) 4
  • Overweight in adults, ASEAN Region, 2010 5 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 Prevalence% Male Female
  • Obesity in adults, ASEAN Region, 2010 6 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 Prevalence% Male Female
  • Sub-analysis of NHMS 2011 data • At least 15% (18 years and above) already with known NCD risk factors (diabetes, hypertension or hypercholesterolemia). • Undiagnosed high blood sugar, high blood pressure or high cholesterol: 42.1% (18 years and above). • Alternatively, if include obesity: 48.3% (18 years and above). • Therefore our high risk and at risk population: 63.3% (18 years and above) 7
  • Sub-analysis of NHMS 2011 data Prevalence CI Lower CI Upper Est. population Diabetes (known) 7.2 1,247,366 Diabetes (known) only, without hypertension (total) or without hypercholesterolaemia (total) 1.22 1.04 1.43 209,532 Diabetes (known) and hypertension (total) 5.18 4.78 5.61 893,578 Diabetes (known) and hypertension (total) + hypercholesterolaemia (total) 3.31 3.00 3.64 567,494 8
  • Sub-analysis of NHMS 2011 data Prevalence CI Lower CI Upper Est. population Hypertension (known) 12.8 2,271,995 Hypertension (known) only, without diabetes (total) or without hypercholesterolaemia (total) 3.47 3.16 3.81 596,157 Hypertension (known) and hypercholesterolaemia (total) 7.62 7.10 8.17 1,338,920 Hypercholesterolaemia (known) 8.4 1,478,453 Hypercholesterolaemia only, without hypertension (total) or without diabetes (total) 2.25 1.95 2.59 386,473 9
  • Sub-analysis of NHMS 2011 data Prevalence CI Lower CI Upper Est. population Obesity 15.1 2,462,152 Obesity only, without diabetes (total) or without hypertension (total) or without hypercholesterolaemia (total) 3.72 3.35 4.12 587,966 10
  • Sub-analysis of NHMS 2011 data WHO/ISH CVD 10-year risk prediction: Risk Levels among those with UNDIAGNOSED DIABETES OR UNDIAGNOSED HYPERTENSION OR UNDIAGNOSED HYPERCHOLESTEROLAEMIA Prevalence CI Lower CI Upper Est. population <10% 85.58 84.53 86.57 6,250,178 10% to <20% 7.42 6.73 8.16 541,584 20% to <30% 2.98 2.55 3.48 217,693 30% to <40% 1.71 1.42 2.06 125,124 40% and above 2.31 1.92 2.76 168,440 11
  • 65th World Health Assembly (May 2012): Decided to adopt a global target of a 25% reduction in premature mortality from NCD by 2025. 66th World Health Assembly (May 2013): Adoption of the Global Action plan for the Prevention and Control of NCDs (2013-2020), including 25 NCD indicators with 9 voluntary global targets. 12
  • Recent UN/WHO Mandates • High-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of NCDs (10-11 July 2014) • Global Action Plan for the Prevention and Control of NCDs 2013-2020 13
  • High-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of NCDs • Specific commitments on (among others): • Leadership & governance • Prevention & risk factor exposure • Health systems • Monitoring and evaluation 14
  • Global Action Plan for the Prevention and Control of NCDs 2013-2020 • Six (6) objectives • Nine (9) voluntary global targets • Appendix 3: Menu of policy options and cost effective interventions 15
  • Global Monitoring Framework for NCDs Indicator Targets 1. Premature mortality from NCD 25% relative reduction in risk of dying 2. Harmful use of alcohol 10% relative reduction 3. Physical inactivity 10% relative reduction 4. Salt intake 30% relative reduction in mean population intake 5. Tobacco use 30% relative reduction 6. Hypertension Contain the prevalence 7. Diabetes & obesity Contain the prevalence 8. Drug therapy to prevent heart attacks & strokes At least 50% of eligible people receive therapy 9. Essential NCD medicines & basic technologies to treat major NCDs Availability & affordability Note: Targets for year 2025, against baseline of year 2010. Reporting to the United Nations every five years (next will be in 2015) 16
  • Cost effective interventions to address NCDs 17 Population- based interventions addressing NCD risk factors Tobacco use - Excise tax increases - Smoke-free indoor workplaces and public places - Health information and warnings about tobacco - Bans on advertising and promotion Harmful use of alcohol - Excise tax increases on alcoholic beverages - Comprehensive restrictions and bans on alcohol marketing - Restrictions on the availability of retailed alcohol Unhealthy diet and physical inactivity - Salt reduction through mass media campaigns and reduced salt content in processed foods - Replacement of trans-fats with polyunsaturated fats - Public awareness programme about diet and physical activity Individual- based interventions addressing NCDs in primary care Cancer - Prevention of liver cancer through hepatitis B immunization - Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA]) and treatment of pre- cancerous lesions CVD and diabetes - Multi-drug therapy (including glycaemic control for diabetes mellitus) for individuals who have had a heart attack or stroke, and to persons at high risk (> 30%) of a cardiovascular event within 10 years - Providing aspirin to people having an acute heart attack
  • Objective 3 GAP NCD 2013-2020: Healthy Diet • Three (3) relevant global targets: • A 30% relative reduction in mean population intake of salt/sodium • A halt in the rise in diabetes and obesity • A 25% relative reduction in the prevalence of raised blood pressure or containment of the prevalence of raised blood pressure according to national circumstances. 18
  • Objective 3 GAP NCD 2013-2020: Healthy Diet • Promote and support exclusive breastfeeding for the first six months of life, continued breastfeeding until two years old and beyond and adequate and timely complementary feeding. • Implement WHO’s set of recommendations on the marketing of foods and non-alcoholic beverages to children, including mechanisms for monitoring. 19
  • Objective 3 GAP NCD 2013-2020: Healthy Diet • Develop guidelines, recommendations or policy measures that engage different relevant sectors, such as food producers and processors, and other relevant commercial operators, as well as consumers, to: • Reduce the level of salt/sodium added to food (prepared or processed). • Increase availability, affordability and consumption of fruit and vegetables. • Reduce saturated fatty acids in food and replace them with unsaturated fatty acids. • Replace trans-fats with unsaturated fats. • Reduce the content of free and added sugars in food and non- alcoholic beverages. • Limit excess calorie intake, reduce portion size and energy density of foods. 20
  • Objective 3 GAP NCD 2013-2020: Healthy Diet • Develop policy measures that engage food retailers and caterers to improve the availability, affordability and acceptability of healthier food products (plant foods, including fruit and vegetables, and products with reduced content of salt/sodium, saturated fatty acids, trans-fatty acids and free sugars). • Promote the provision and availability of healthy food in all public institutions including schools, other educational institutions and the workplace. (e.g. through nutrition standards for public sector catering establishments and use of government contracts for food purchasing) 21
  • Objective 3 GAP NCD 2013-2020: Healthy Diet • As appropriate to national context, consider economic tools that are justified by evidence, and may include taxes and subsidies, that create incentives for behaviours associated with improved health outcomes, improve the affordability and encourage consumption of healthier food products and discourage the consumption of less healthy options. • Develop policy measures in cooperation with the agricultural sector to reinforce the measures directed at food processors, retailers, caterers and public institutions, and provide greater opportunities for utilization of healthy agricultural products and foods. 22
  • Objective 3 GAP NCD 2013-2020: Healthy Diet • Conduct evidence-informed public campaigns and social marketing initiatives to inform and encourage consumers about healthy dietary practices. Campaigns should be linked to supporting actions across the community and within specific settings for maximum benefit and impact. • Create health- and nutrition-promoting environments, including through nutrition education, in schools, child care centres and other educational institutions, workplaces, clinics and hospitals, and other public and private institutions. • Promote nutrition labelling, according to but not limited to, international standards, in particular the Codex Alimentarius, for all pre-packaged foods including those for which nutrition or health claims are made. 23
  • Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Three (3) relevant global targets: • A 10% relative reduction in prevalence of insufficient physical activity. • Halt the rise in diabetes and obesity. • A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure according to national circumstances. 24
  • Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Adopt and implement national guidelines on physical activity for health. • Consider establishing a multi-sectoral committee or similar body to provide strategic leadership and coordination. • Develop appropriate partnerships and engage all stakeholders, across government, NGOs and civil society and economic operators, in actively and appropriately implementing actions aimed at increasing physical activity across all ages. 25
  • Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Develop policy measures in cooperation with relevant sectors to promote physical activity through activities of daily living, including through “active transport,” recreation, leisure and sport, for example: • National and sub-national urban planning and transport policies to improve the accessibility, acceptability and safety of, and supportive infrastructure for, walking and cycling. • Improved provision of quality physical education in educational settings (from infant years to tertiary level) including opportunities for physical activity before, during and after the formal school day. • Actions to support and encourage “physical activity for all” initiatives for all ages. • Creation and preservation of built and natural environments which support physical activity in schools, universities, workplaces, clinics and hospitals, and in the wider community, with a particular focus on providing infrastructure to support active transport i.e. walking and cycling, active recreation and play, and participation in sports. • Promotion of community involvement in implementing local actions aimed at increasing physical activity. 26
  • Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Conduct evidence-informed public campaigns through mass media, social media and at the community level and social marketing initiatives to inform and motivate adults and young people about the benefits of physical activity and to facilitate healthy behaviours. Campaigns should be linked to supporting actions across the community and within specific settings for maximum benefit and impact. • Encourage the evaluation of actions aimed at increasing physical activity, to contribute to the development of an evidence base of effective and cost-effective actions. 27
  • National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014 • Presented and approved by the Cabinet on 17 December 2010 • Provides the framework for strengthening NCD prevention & control program in Malaysia • Adopts the “whole-of-government” and “whole-of- society approach” Seven Strategies: 1. Prevention and Promotion 2. Clinical Management 3. Increasing Patient Compliance 4. Action with NGOs, Professional Bodies & Other Stakeholders 5. Monitoring, Research and Surveillance 6. Capacity Building 7. Policy and Regulatory interventions 28
  • Current Approaches to NCD From Birth To Tomb Intervention Package  Health Promotion Pregnancy Pre- conception Infant/ Toddler First 1,000 Days To reduce obesity and NCDs-birth weight Lifestyle during pregnancy – fetal health Pre- School School- going Age Garispanduan Pemasaran Makanan & Minuman kepada Kanak-kanak Garispanduan Penguatkuasaan Larangan Penjualan Makanan & Minuman Di Luar Pagar Sekolah Higher Education Adults Elderly School Setting Workplace / Community Setting KOSPEN AktivitiFizikal Program Warga Aktif Warga Produktif Healthy Workplace for Healthy Workforce Garispanduan Pengurusan Kantin Sihat Garispanduan Perlaksanaan Vending Machine Makanan & Minuman Sihat dlm Perkhidmatan Awam Kafeteria Sihat Hidangan Sihat Semasa Mesyuarat Amalan Pemakanan Sihat Jom Mama Initiatives 29
  • Multi-disciplinary care team (in health clinics) Post-basic training for paramedics Clinical practice guidelines Quality improvement programs Clinical information systems Patient resource centres Community empowerment Strengthening Chronic Disease Management at the primary care level 30
  • Management of NCDs: 7 basic principles • Screening • Register • Clinical management • Complications • Rehabilitation • Defaulter tracing • Selfcare – Patient’s empowerment 31
  • Initiatives to Improve Clinical Outcome • The formation of Diabetes Team which consists of Diabetes Educator, Medical Officer, Family Medicine Specialist (FMS), Nutritionist and Pharmacist in every clinic as appropriate to their burden of diabetes patients. • FMS or senior Medical Officer in the clinic to do regular audits on green book. • Intensify and more frequent supervision especially by FMS of clinical staff to ensure compliance to CPGs and related guidelines. • Regular training and CMEs on diabetes care for all clinic staffs, and the state office to monitor the numbers of training sessions conducted. • Availability of module for health education for patients and a set of pre- and post-test for patients, as published by Disease Control Division, MOH. • The usage of the Diabetes Conversation Map. • Further development of a Peer Support Group. • Personalized care by Medical Officer in clinics with low to moderate burden of loads, as appropriate in the individual clinic settings. 32
  • Overview of a Peer Support Group • Patients becomes a trainer / facilitator, training his/her fellow colleagues with the same disease. • MOH responsible for developing the training modules, conduct training and develop the implementation guidelines. • Successful implementation of a Peer Support Group Program has been shown to: • Help patients understand their disease better; • Help patients achieve good disease control; and • Reduce rates of referral to hospitals due to complications. • Rationale – patients are more likely to accept advise from their peers or people living with the same condition. 33
  • 34 Summary
  • Thank you dr.feisul@moh.gov.my 35