Malaysia’s Obesity Challenge Is Growing, So Are The Treatment Options

KUALA LUMPUR, Oct 7 (Bernama) -- More than half of Malaysian adults are overweight or obese, highlighting the need for a comprehensive approach to weight management beyond dietary changes and lifestyle modifications.

Sunway Medical Centre Velocity (SMCV) Consultant Physician and Endocrinologist Dr Mak Woh Wei said additional medical interventions, including GLP-1-based weight-management medicines and bariatric surgery, could be considered alongside healthy lifestyle habits, depending on the individual patient’s condition.

“Depending on the individual patient, this may include evidence-based anti-obesity medications such as glucagon-like peptide-1 (GLP-1) based treatments or, for patients with severe obesity and appropriate indications, bariatric surgery. These treatments, however, are not replacements for healthy lifestyle habits.

“Instead, they work alongside nutrition, physical activity and behavioural changes to help patients achieve greater and more sustainable weight loss and improve conditions such as type 2 diabetes, high blood pressure, sleep apnoea and cardiovascular risk,” she said in a statement today.

Dr Mak said GLP-1 is a hormone that our body naturally produces, particularly after we eat. One of its roles is to help regulate appetite, food intake and blood sugar levels.

“Medicines that act on the GLP-1 pathway essentially enhance these effects. They can help people feel fuller for longer, reduce hunger and cravings, and slow the movement of food from the stomach into the intestine. They also help the body regulate blood glucose by improving insulin secretion when glucose levels are elevated and reducing inappropriate glucagon release.

Dr Mak stressed that these medications are not a quick fix for weight loss and are considered for people who meet specific criteria for weight management. Factors such as the patient’s BMI, existing health conditions, other medications, medical history and treatment goals all come into play.

“Most importantly, medication does not replace healthy lifestyle habits. Nutrition, physical activity, sleep and behavioural support remain important parts of long-term weight management,” she said.

Dr Mak said this treatment must be medically monitored, with doses adjusted gradually based on the patient’s response and tolerance, as patients may experience side effects such as nausea, vomiting, diarrhoea, constipation, abdominal discomfort or a feeling of fullness, particularly when starting treatment or increasing the dose.

“This is why these medicines should not be started or adjusted without medical supervision. Monitoring allows us to assess how the patient is responding, manage side effects, review other medications and determine whether the treatment remains appropriate,” she said.

Dr Mak explained that taking these medications under a doctor’s supervision was a much safer approach than self-medicating through unofficial channels, where there could be risks of improper storage, contamination, counterfeit products or inappropriate dosing.

Meanwhile, SMCV Consultant General and Upper Gastrointestinal (GI) Surgeon Dr Mohanarajah Silvarajah said bariatric surgery might be considered when non-surgical treatment had not produced sufficient or durable weight loss or improvement in obesity-related diseases, and when the patient’s BMI and health risks indicated that the potential benefits outweighed the risks.

He said assessment is not based on BMI alone, with clinicians also considering other factors such as the severity and duration of obesity, previous weight-loss attempts, including appropriate medication, diabetes control and other comorbidities, eating behaviours, mental health status, alcohol or substance abuse and the patient's ability to comply with follow-ups, vitamin supplementation and lifestyle recommendations.

Dr Mohan said the two commonly performed bariatric procedures were sleeve gastrectomy and Roux-en-Y gastric bypass, which work through different mechanisms to restrict food intake and bring about metabolic changes.

“With the sleeve, about 70-80 per cent of the stomach is permanently removed, leaving a narrow, tube-shaped stomach,” he said. 

It works mainly by restricting food intake, changing appetite hormones and producing metabolic changes that can improve blood glucose and other obesity-related conditions. Importantly, the intestines are not bypassed, so there is no deliberate intestinal malabsorption. The operation is irreversible because part of the stomach has been removed.

“The Roux-en-Y gastric bypass works through both restriction and intestinal or metabolic effects. The surgeon creates a small stomach pouch and connects it directly to a lower section of the small intestine. Food therefore bypasses most of the stomach and the first part of the small intestine.

“Digestive juices are subsequently brought into contact with the food farther downstream. This means much less food can be eaten at one time, and some calories and nutrients are absorbed differently because food bypasses part of the small intestine. Changes in gut hormones and signalling can substantially affect hunger, fullness and glucose metabolism. It can be particularly effective for type 2 diabetes and often improves gastro-oesophageal reflux,” Dr Mohan explained.

He said bariatric surgery, although generally safe when performed in an experienced hospital, remained major surgery with short-term surgical risks and lifelong nutritional and metabolic consequences, including early surgical complications such as bleeding, leakage, infection or abscess formation, blood clots, anaesthetic and cardiopulmonary complications, bowel obstruction and nutritional deficiencies involving iron, vitamin B12, folate, vitamin D, calcium, thiamine (vitamin B1) and protein.

Dr Mohan said patients generally required lifelong vitamin and mineral supplementation and regular blood tests after bariatric surgery, as severe deficiencies could occasionally cause neurological or bone complications.

Whether through GLP-1 medicines or bariatric surgery, obesity treatment is ultimately about improving one’s health, not simply reducing weight. Meaningful weight loss can improve obesity-related conditions including type 2 diabetes, high blood pressure, abnormal cholesterol levels and obstructive sleep apnoea.

He said modern obesity treatment was not ‘one size fits all’, with some patients requiring only lifestyle intervention, while others could benefit from medication or surgery depending on the severity of obesity and related complications.

“The important thing is to start the conversation, get properly assessed, and choose a treatment plan that you can sustain for the long term. Obesity is treatable, and you don't have to manage it alone," he said. 

-- BERNAMA

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