IN 1999, I published a paper in the Malaysian Journal of Nutrition titled “Nutrition of Malaysians: Where are we heading?” I highlighted the dramatic changes in dietary pattern and lifestyle of the population which resulted in significant proportions of the population being afflicted with non-communicable diseases (NCDs) associated with overnutrition, eg obesity, hypertension, heart disease and cancers. I asked, in that paper: Are we able to arrest the increase in these diet-related chronic diseases?
Today, 20 years later, the answer is clear: we have not been able to halt the rise in these diet-related diseases; the nutrition of Malaysians has deteriorated. The 2019 National Health Morbidity Survey (NHMS) report released by the Health Ministry on May 29 (“Lack of nutrition the culprit”, The Star; online at bit.ly/star_diet) revealed that the prevalence of overweight+obesity has just passed the 50% mark: every other adult Malaysian is either overweight or obese. The prevalence of adults with diabetes is 18.3% and 38.1% have high blood cholesterol. All these three parameters are about double the levels in the 1996 NHMS.
Besides these increases in over-nutrition related problems, NHMS 2019 also highlighted two worrying undernutrition problems. Stunting among children below five years of age was reported to have increased to 21.8% and almost 30% of women at reproductive age are anaemic. The population is still burdened with hidden hunger in this land of plenty.
Numerous other research findings have highlighted the deteriorating double burden of malnutrition in this country. We are saddled with the persistence of undernutrition problems, coexisting with the high prevalence of over-nutrition related diseases.
What do all this data mean – where do we go from here?
In the 1999 paper, I highlighted the importance of implementing the 1st National Plan of Action for Nutrition (NPAN) (1996-2000). This was to be the master plan for combating the double burden of malnutrition in the country. Over the 20 years, two more editions of NPAN have been formulated; but the NHMS 2019 report tells us that we have not met the target for most of the parameters. It is imperative that we identify the shortcomings of the implementation so that the next NHMS will report a better nutrition status for Malaysians.
I recall when we were planning the 3rd NPAN (2016-2025), it was identified that one of the main obstacles in implementing previous NPANs was the lack of intersectoral collaboration. It has been recognised that tackling malnutrition has to be an all-government approach. Indeed, it should go beyond the government sector. Interventions can only be effective through a strategic alliance among government, academia, professional bodies and the private sector. A multistakeholder approach enables us to harness the required expertise and resources.
Another obstacle identified was a lack of resources. Obviously we need financial resources to implement the identified programmes. We must invest in the prevention of malnutrition; there is no other way. Adequate resources also refer to enough qualified nutritionists deployed to appropriate sectors beyond the Health Ministry. Nutritionists must play key roles in the implementation of NPAN programmes. The Nutrition Society of Malaysia calls for the immediate implementation of the Allied Health Professions Act to strengthen the nutrition profession for them to play this role.
During this time of the Covid-19 pandemic, people are realising the importance of nutritional wellbeing. Antioxidants, vitamins, probiotics and prebiotics have become much sought after to boost immunity. These are indeed of importance; but eating a balanced, varied diet in moderation is not only to fight pandemics. The community must take this opportunity to adopt healthy cooking and healthy eating as a way of life for the prevention of all nutrition-related diseases.
To have the next NHMS reporting a lower prevalence of obesity and under-nutrition, it is imperative that the public invest in healthy nutrition by empowering themselves with appropriate knowledge of healthy eating and active living.
DR TEE E. SIONG
President, Nutrition Society