My wife, kids and I went on a little holiday the other day. Our destination was the land of the rising sun, Japan. As we landed, the change scenery and the landscape were a wonder to behold, it was snowing in Sapporo, and my kids were excited to experience snowfall for the first time.
As we wandered around Japan, my wife turns to me and highlights different type of change in “scenery” that she has noticed. No, it wasn’t the snow-capped mountains or the delightful Japanese culture. It was the people of this land. They seemed a lot leaner and in shape. We didn’t think much of it and continued about our holiday.
We did however begin to notice overweight people again at the tail end of our trip. Yup, at the very end, as we were getting ready to board the plane. Not much to our surprise, these people were boarding the plane with us, all bearing red coloured passports. Yes, they were Malaysians.
Recently, BBC reported that according to the British Medical Journal, Malaysia is the “most obese Asian country”. They went on to elaborate that more than half of Malaysians are overweight. That’s some pretty damning statistics. More than half. Obesity is calculated using one’s weight and height, using a formula to come up with the body mass index (BMI). To put it into perspective, let’s assume the average female in Malaysia to be around 160cm and the average men to be around 170cm. As a female 160cm, if you weight over 65kg or 75kg, you would be categorized as either overweight or obese respectively. For men measuring around 170cm, these numbers would be around 75kg or 85kg for overweight or obese.
Is obesity a medical concern? Yes, definitely. A person with obesity is more predisposed to numerous medical conditions such as:
Cardiovascular
One of the most well-documented effects of obesity is its contribution to cardiovascular disease, including heart disease, high blood pressure (hypertension), and stroke. Obesity raises levels of LDL cholesterol ("bad" cholesterol) and lowers HDL cholesterol ("good" cholesterol), contributing to the build-up of plaque in the arteries. This increases the risk of heart attacks and stroke.
Kidney Disease
Obesity is a major risk factor for chronic kidney disease (CKD). It can lead to a decline in kidney function and increases the risk of end stage renal disease. There are many ways where obesity can lead to a decline in kidney function including hypertension, diabetes, inflammation and glomerulonephritis. Evidence shows that the risk of CKD is 1.5 times higher in an overweight person and almost twice as high for people living with obesity.
Diabetes
Obesity is a major risk factor for type 2 diabetes, a condition where the body becomes resistant to insulin or doesn’t produce enough. Extra fat, especially visceral fat (fat around internal organs), can interfere with the body’s ability to use insulin effectively, leading to higher blood sugar levels. Over time, this can cause permanent damage to organs like the kidneys, heart, and nerves.
Sleep Apnea
Obesity is strongly associated with obstructive sleep apnea, a condition where the airway becomes blocked during sleep, causing pauses in breathing. Extra fat, especially in the neck and throat area, can obstruct the airways, leading to interrupted sleep and lower oxygen levels in the blood. Sleep apnea increases the risk of high blood pressure, heart disease, and stroke.
Cancer
Obesity is linked to an increased risk of several types of cancer. Excess fat tissue can affect hormone levels, which can increase the risk of hormone-related cancers, including breast cancer, colon cancer, endometrial and esophageal cancer.
Reproductive Health Issues
Obesity can affect reproductive health in both men and women. In women, excess body fat can disrupt the hormonal balance, leading to conditions like polycystic ovary syndrome (PCOS), irregular menstrual cycles, and infertility. In men, obesity can lower testosterone levels, which can decrease fertility and sexual drive.
Bones and Joints
As an orthopaedic surgeon, it is not unusual to encounter obesity in my day to day practise. There are many adverse effects on the health of the bones and joints. One of the most immediate and obvious effects of obesity on joints is the increased mechanical load placed on weight-bearing joints such as the hips, knees, and spine. The added body weight exerts greater pressure on these joints, accelerating wear and tear. As a result, the cartilage—the smooth tissue that cushions joints—can break down more quickly. In fact, studies show that for every 1 kg of excess weight, the knee joint experiences an additional 4 kg of force with each step. Over time, this extra stress can lead to the degeneration of the cartilage, resulting in conditions like osteoarthritis (OA).
While osteoporosis is often associated with low body weight or malnutrition, research has shown that obesity can also have an impact on bone health. Obesity can lead to an imbalance in bone remodeling, a process in which old bone tissue is replaced with new bone tissue. The excess fat tissue in obese individuals can produce hormones such as leptin and adiponectin, which can interfere with the normal regulation of bone metabolism. Over time, this may result in bone loss and decreased bone quality, increasing the risk of fractures.
Obesity not only increases the risk of developing joint and bone diseases but also directly impacts an individual’s ability to engage in physical activity. As joints become more painful and less mobile due to conditions like OA, individuals may reduce their physical activity levels. This reduction in activity can create a vicious cycle: less movement leads to weaker muscles and joints, further increasing the risk of injury and exacerbating pain. This reduced activity can also negatively affect bone health by limiting the benefits of weight-bearing exercises, which are crucial for maintaining bone density and joint function.
Mental Health Issues
The psychological effects of obesity can be profound. There is a well-established link between obesity and depression. The social stigma associated with being overweight can lead to feelings of low self-esteem and poor body image, which may contribute to depression. Obesity can be associated with anxiety, particularly in social situations or when dealing with the stigma of being overweight.
I recognize that this can be a very sensitive topic and one that I have for a long time hesitated to write about. While I believe there is no space in society for body shaming of any sorts, be it in obesity or the other end of the spectrum, one’s health should take precedence over all else. The fact of the matter is that being in decent shape has its upsides physically, mentally and emotionally. That’s a goal always worth striving for.
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