Malaysia’s CPG Recommends Anti-obesity Medication, in addition of Lifestyle Changes

The escalating worldwide prevalence of obesity is a cause for concern, and Malaysia is no stranger to this trend. According to the extensive National Health Morbidity Survey (NHMS) 2019, which involved 16,888 respondents, the prevalence of overweight and obesity in Malaysia stood at 32.3% and 33.7%, respectively, as measured by the body mass index (BMI) based on Asian cut-off scales. The prevalence of overweight and obesity in 2,221 adolescents between the age of 12 to 18 years were 17.0% and 14.9%, respectively.

Obesity As a Disease

Obesity poses a significant health risk, elevating the likelihood of various chronic conditions such as type 2 diabetes (T2DM), fatty liver, cardiovascular disease, obstructive sleep apnea (OSA), stroke, dementia, and cancer. Furthermore, obesity leads to mechanical issues, causing pain in hip and knee joints. Reproductive challenges, including infertility and the risk of miscarriage, are also associated with obesity in both men and women.

Impact of weight loss on medical conditions

Weight loss reduces cardiovascular risk factors, leading to lower illness and death rates. A modest weight loss of 5% to 10% is associated with improvement in blood pressure and high-density lipoprotein (HDL) cholesterol. Weight loss of between 10% to 15% is needed to improve other clinical conditions such as OSA, osteoarthritis and steatotic hepatitis.

Lifestyle Modification

  1. Calorie restriction- tailored to individual needs, considering factors such as age, gender, activity level and existing health conditions. Strategies to achieve initial weight loss of 0.5-1kg per week:

    • 1,200-1,500 kcal per day for women • 1,500-1,800 kcal per day for men • Reduce daily energy by 500-750 kcal from the usual daily intake

  2. Intermittent fasting- time restrictive diets (restricting the number of hours of eating per day) or alternate day fasting (restriction of calorie consumed during fasting and non-fasting days)

  3. Targeted exercise training programme- at least 150 minutes of aerobic physical activity is required to achieve weight loss

CPG Recommends Anti-obesity Medication

Pharmacotherapy should be considered when weight loss goals or weight maintenance cannot be achieved with lifestyle interventions alone.

Indications for anti-obesity treatments:

  1. BMI of 27.0-29.9 kg/m2 with associated risk factors: type 2 diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea

  2. BMI of ≥30 kg/m2 with or without risk factors

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References

CLINICAL PRACTICE GUIDELINES MANAGEMENT OF OBESITY 2ND EDITION (2023)