Dr Dzul Seeks to Fight Obesity on Multiple Fronts

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Food is a way of life in Malaysia. With its countless traditional and fusion cuisines, many of us live to eat, and not vice versa. It’s no surprise then that Malaysia is also the most obese nation in South-east Asia – about half the population is either overweight or obese. In fact, the nation is fighting against the rising number of non-communicable diseases (NCDs) – one of the biggest public health threats caused mainly by our lifestyles, where food plays such a significant part.

Penang Monthly speaks to Health Minister Dr Dzulkefly Ahmad on ways to tackle this growing menace.

Firstly, which foods do you normally start the day with?

In the mornings, usually I have my favourite capati or a simple meal like scrambled eggs with two slices of toasted bread. I like capati because it’s delicious and isn’t heavy on calories. I also often have a honey drink to accompany my meals.

What is your concept of a healthy diet? How do you keep it balanced with your hectic schedule?

A healthy diet involves “mindful eating” – it’s not just about the type of food that you eat but the portion, frequency, time and the way it’s prepared. I prioritise reducing oily foods and my salt intake.

I’m conscious not only about food, but exercise as well. I make sure that I exercise every day. It could be just a simple exercise such as running – 30 minutes alone, which is about 2km, can burn 150 calories. Even with a tight daily schedule, you can’t give yourself excuses (for failing to do so). I also take vitamins B and C supplements.

Is it possible to make our favourite Malaysian foods yummy but at the same time healthy?

Yes, of course, The Ministry of Health (MOH) has published various healthy eating guides – for example, healthy eating recipes and healthy menus for festive seasons – which are also available on the MOH website. These menus provide a healthy take on traditional Malaysian dishes.

How does your ministry plan to change the way Malaysians prepare and consume food and beverages for healthier diets and lifestyles?

We have introduced the “healthy plate” concept (suku-suku separuh), run multiple media campaigns for healthy eating and published numerous recipes. However, a living environment that promotes health is also crucial in influencing the way Malaysians prepare and consume food.

Health Minister Dr Dzulkefly Ahmad.

In December 2017 the MOH proposed 13 new policies to be implemented in 2018, out of which only four were related to food and beverages, such as limiting the operating hours of food outlets, taxing sugary beverages, enforcing bans on unhealthy food advertisements, and cultivating the habit of eating fruits and vegetables in schools and workplaces. Do you agree with all of them? Will the rest still be rolled out and implemented under the Pakatan Harapan (PH) government?

Yes, I agree with these policies and yes, they will be rolled out and implemented under the PH government. More accurately, there were 15 policies that were discussed in detail, most recently at the Cabinet Level Committee chaired by the deputy prime minister earlier in October. Of these, six are related to food and beverages. These policies and interventions are also in line with global recommendations to prevent and control NCDs.

Some say that our “mamak culture” of having access to heavy meals all day round and having meals round the clock contributes to increasing incidents of NCDs.

There are various factors that contribute to NCDs; eating behaviour is just one of them. There are many other factors that must be addressed to reduce NCDs in Malaysia, such as physical inactivity, smoking and alcohol consumption.

To be politically correct, it is not “mamak culture”, but rather the culture of 24-hour restaurants. Malaysia, being a food haven, provides easily available, good and cheap food 24 hours a day. The downside is that we tend to overeat – and at unearthly hours, when our body biorhythm cannot burn off the extra and unnecessary calories. MOH is not against the “mamak culture”, but Malaysians need to practice mindful eating, such as the healthy plate concept.

Today, approximately half of Malaysian adults are overweight and obese. The number of obese children also continues to rise.

What can your ministry do to change the culture of over-eating?

First, we start with ourselves. In my ministry we practice calorie tagging – the number of calories for food is displayed on the menu. This will remind us of the calories we consume. The ministry has also cut down on the supply of sweet beverages during events.

To encourage healthy and mindful eating, healthy cooking and menu planning are important factors to consider during festive seasons. We have been strongly campaigning to raise awareness among consumers – I know that it is an uphill task but we are trying to address the overweight and obesity issues.

It is said that practising a good diet must start from young. While parents should be tasked with the main responsibility, what role does the government, especially the MOH, have in promoting a healthy diet among schoolchildren?

I agree that good diet practices must start from young. Schools are an important setting, and the MOH is working together with the Ministry of Education to ensure that healthy and nutritious food is served to schoolchildren by implementing the Healthy School Canteen Guidelines which specify the types of foods that can and can’t be sold in school canteens.

In addition, MOH collaborated with the Ministry of Urban Wellbeing, Housing and Local Government to publish guidelines banning the sale of unhealthy food within a 40m radius of schools.

We advocate a life course approach when it comes to tackling NCD risk factors, including dietary intake. This begins at educating mothers to-be in antenatal and post-natal stages such as promoting breastfeeding, as well as promoting healthy eating for children and adolescents in schools, and adults at their work places.

Starting from April 1, 2019, excise tax will be imposed on sugar-sweetened beverages. The proposed rate is RM0.40 per litre on beverages that contain sugar exceeding five grams per 100ml, as well as juices that contain more than 12 grams per 100ml. Is this policy in line with your ministry?

Yes, of course.

How significantly do soda/sugary beverages cause diabetes in Malaysia? Would people’s food consumption behaviour change because of an extra 40 sen per litre? How effective do you think this policy will be in reducing cases of diabetes?

We are hoping that this will serve as a deterrence. The consumption of sugar-sweetened beverages does contribute to diet-related NCDs by promoting weight gain and increasing the risk of overweight and obesity, which increases the risk of cardiovascular diseases and diabetes, and breast, colorectal and other types of cancer.

Today, approximately half of Malaysian adults are overweight and obese. The number of obese children also continues to rise. A survey conducted in 2017 showed that one in three (36.0%) adolescents aged 10 to 17 years old consumed at least one of these beverages daily.

The number of diagnosed diabetes patients is currently at about 1.6 million. By 2025, if left unchecked, our diabetes prevalence will increase to 31.3%, or an estimated population of about seven million. It makes sense for us to prevent that from happening earlier so that we can reduce the burden of diseases.

There is very strong evidence elsewhere to show that the implementation of sugar-sweetened beverage taxes contribute to a reduced purchase of those beverages, in turn leading to a reduction in body mass index and subsequently reducing the risk of NCDs.

The MOH plans to conduct a study together with the Ministry of Domestic Trade and Consumer Affairs on the price elasticity of demand for sugar-sweetened beverages sold in Malaysia to see the impact of the tax on the demand and consumption of sugar-sweetened beverages – especially among youths – once it is implemented.

The proposed details and mechanisms for the implementation of the sugar-sweetened beverage tax are still to be finalised. The taxation structure will be calculated based on volume, weight, specific items or origin of the product.

Currently, the excise tax seems to only cover a limited range of manufactured beverage products. Will it also apply to what is prepared and produced in F&B retail outlets or cafes and restaurants? The policy does not extend to a great variety of (solid) food items either, so for other sweetened foods, what are the policy measures being undertaken by the ministry to nudge or encourage food producers and consumers to change their sweet tooth habits?

The sugar-sweetened beverage tax is only one of the many measures that are being undertaken by the government to tackle NCDs. MOH has embarked on a multipronged effort to encourage both food producers and consumers to improve their eating behaviour, some of which I have mentioned earlier. However, this should not be MOH’s responsibility alone; other agencies also play crucial roles in influencing behaviour by modifying the availability and accessibility of unhealthy food.

Over the last few years, the ministry has been engaging the food industry to reformulate their food products to have less salt or sugar, or both. We also have the “Healthier Choice” logo which we award to a product when the sugar, salt and fats content fall below the recommended range. We hope that this logo will be used by consumers as a guide when doing their shopping if they find that the food label alone is difficult to understand.

Will the government subsidise or reduce the price of healthy drinks and foods? For example, it is always more expensive to buy brown rice/multigrain bread than white rice/bread; fresh fruit juice than soft drinks.

Personally I think it’s a good idea, but the MOH will not be recommending any subsidies at this moment. We believe that the demand for healthy food will drive the prices down when there is increased volume of production.

Healthier foods do not necessarily have to be more expensive. At MOH we promote the consumption of locally grown food produce, especially tropical fruits and vegetables. At local municipalities, there are also efforts to encourage urban home owners to set up urban gardens to improve accessibility to fruits and vegetables.

An obesogenic environment could sustain – or worse, aggravate – NCDs. A survey has shown that more than 64% of Malaysians eat at least one meal per day outside their homes. Are you worried about the food environment we have, especially regarding the number of fast food restaurants?

Yes, I am very concerned about our food environment. I agree that Malaysians are living in an obesogenic environment, which is why we believe that changing people’s behaviours involves creating a supportive environment.

At MOH, we are working very hard together with other agencies and ministries to create a better and healthier environment. This is the core principle that led to the setup of the inter-ministerial cabinet committee on health-promoting environment chaired by the deputy prime minister. The proposed 15 policies that were recently discussed at the committee will provide the foundation for creating this health-promoting environment.

The issue with fast food is about the type of food they sell and the way they advertise. The promotion of supersized meals and advertising to children are things we may need to focus on next.

Esther Sinirisan Chong is an analyst and administrator at Penang Institute in KL. She was born and raised in the Land Below the Wind. Her research interests lie in food sustainability issues; education and government policies; and history and heritage of East Malaysia.
Lim Chee Han received his PhD in Infection Biology from Hannover Medical School, Germany. He is currently a senior analyst in the politics section at Penang Institute.



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