By Xavier Kong
In the final part of the series, KiniBiz examines the lifestyles of two of Malaysia’s neighbours, Singapore and Japan, and compares them to a typical Malaysian lifestyle, as well as the respective governments’ initiatives on that particular aspect.
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As with many sources on the Internet, as well as the expert opinions of researchers in the field, the issue of obesity is definitely tied to the lifestyle of the individual. But how do aspects of the typical Malaysian lifestyle stack up against their counterparts from other countries? And how do Malaysian interventions against obesity in these sections stand up to those of other countries?
In matters of food, Malaysia is well known as a paradise for foodies, but this has become a roadblock in cracking down on obesity, especially since the nation’s number one breakfast is our nasi lemak. What about the number one drink, teh tarik? Dieticians have cringed, considering the drink is usually made with dollops of sweetened condensed milk, along with a generous helping of sugar.
Of course, the local government has something to say about this, and came up with the kurang manis campaign to get people to order this drink with less sugar in it. Then again, these campaigns are usually met with limited success, partly due to the easy availability of sugary drinks almost anywhere.
This plays a part in schools as well, considering that is another place governments are able to intervene against obesity, by appealing to the mould that will form the students. Locally, the government has run a multitude of campaigns for the schools in the country, from pamphlets to seminars to activity campaigns which required the compulsory participation of students, lest they faced the wrath of the teachers.
In 2011, schools were even required to place the body mass index (BMI) of students on their report cards, so that parents would be able to monitor if their children were fat or obese. This was accompanied by another intervention, which restricted the sale of unhealthy foods and drinks at school canteens.
At the same time, the Malaysian health ministry is proposing a law to aid in bringing obesity back under control. Reports have stated that the ministry aims to model the proposed law after the 2008 “Metabo Law” in Japan, which places the health and waistlines of a company’s employees under the responsibility of the employers. Employers would also face a stiff penalty should employees fail the waistline test, which limits males to 33.5 inches at the waist, and females to 34.5 inches.
This proposal was met with resistance from the Malaysian Employers’ Association, with a response that the health of employees should be their own responsibility, instead of passing on the burden to their employers. However, the proposal was supported by local dieticians, though there was also the suggestion that, while the Metabo Law was indeed good inspiration, the Malaysian version should be tailored to local flavour, rather than be an almost exact copy of the law’s implementation in Japan, which had required health checks be conducted and the waistlines of employees recorded.
“Placing the burden on employers by penalising them if employees failed to meet the standard waistline requirement, as practised in Japan, is not feasible,” said clinical dietician Ng Aia Kah.
Lion City
Across the Causeway, in the city-state of Singapore, obesity is an issue that is being faced down as well. However, the initiatives taken by the government there remain different to the approach here in Malaysia.
For one, the Singaporean government is persistent in its passing of the message. While the “kurang manis” campaign in Malaysia seems to have gone underground, Singapore has provided incentives to keep their “less oil, less salt, less sugar, more vegetables” campaign ongoing, even to this day, despite the campaign being started in 1999.
Now termed the Healthier Dining Programme, Singapore’s Health Promotion Board offers to endorse participants in the programme with stickers carrying the board’s Healthier Choice Symbol, while allowing for promotional listings on the board’s website, as well as other publicity platforms. Participants would also be able to take part in the board’s marketing campaigns.
Of course, the board would then conduct mystery audits to ensure its guidelines are being followed, where companies that do not fulfil the guidelines after implementation without a valid reason will be removed from the programme. Furthermore, companies are required to submit monthly sales reports of the total number of healthier meals upon the implementation of healthier choices in their menus.
The Health Promotion Board of Singapore also has in place a Healthier Dining Grant, where up to S$15,000 (RM39,809.30) is provided for companies to develop healthier menus, as well as market them to the consumer base.
The choice to select the healthier option is also taught to children at the schooling stage. One particular programme run by Singaporean schools was the Trim And Fit (TAF) programme. This programme was set into place by the Singaporean government upon noticing an uptrend of obese students, which led to fewer conscripts in the country’s National Service programme, as more were deemed unfit for deployment into combat service.
Students aged between nine years old, all the way to pre-tertiary education, were required to undergo annual BMI measurements, as well as take the National Physical Fitness Award test. Those students who were deemed overweight were then required to participate in additional intense exercises or physical activities at least one and a half hours a week. The students also had their food rationed, where they can only purchase up to a certain number of calories in a recess break.
While the direct impact was that there was a reduction of the obesity rate of schoolchildren from 14% in 1992 to 9.8% in 2002, there were also psychological impacts due to a segregation of the students performed by overzealous authorities hoping to shy away from ministry consultation sessions, or aiming for more of the cash incentives awarded by the government of Singapore to schools that exceeded fitness targets. This led to the TAF programme being evolved to the Holistic Health Framework programme, which encompasses all schoolchildren rather than stigmatising overweight children.
Land of the rising sun
It used to be difficult to find a fat person in Japan, but a 2008 law, the Metabo Law as mentioned above, has made it harder still. This law, which requires employers to be responsible for the health of their employees or face stiff penalties, was brought about when Japan undertook a campaign to reduce the weight of its citizenry. The campaign, according to the Japanese Health Ministry, was to keep the spread of diseases like diabetes and strokes in check.
The national law required companies and local governments to measure the waistlines of Japanese people between the ages of 40 years old and 74 years old as part of their annual checkups. Those exceeding government limits – 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks – and having a weight-related ailment were given dieting guidance if they do not lose weight after three months. If deemed necessary, they would then be steered toward further “re-education”, according to the New York Times, after six more months. The government would also impose financial penalties on companies and local governments that fail to meet specific targets.
However, critics have noted that the government’s guidelines were simply too strict, which would encourage overmedication and ultimately raise healthcare costs, rather than lower them, as was one of the objectives of the law. Another objective included reducing obesity in the country by 25% by 2015.
While Japan does have its share of unhealthy foods, Japanese citizens tended toward healthier eating in general, with a wide variety of vegetables, legumes, and beans being a large part of the Japanese diet. Food culture also tended towards moderation in quantity, focusing instead on quality and variety, compared to the meat-and-two-veg food culture typical here in Malaysia.
Part of the food culture is also in the portioning and presentation of the food, with meals served on separate small plates and bowls, rather than one big plate. According to scientists from the University of Illinois, people eat up to 45% more food when served bigger helpings. By virtue of the aestheticism of the smaller servings, Japanese food culture promotes moderation in consumption.
It needs to be done
With neighbours like these, as well as the dubious award of being the country with the highest obesity prevalence rate in Asia, Malaysia really has to buck up to tackle the issue in a more organised fashion. As mentioned in Part 1 of this series, it all comes down to math and logic. Should Malaysia not shape up, the nation might very well see itself being shipped out of being competitive in the global economy, by virtue of just having less available manpower and expertise on hand to keep it in the game.
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