This article first appeared in Forum, The Edge Malaysia Weekly on October 7, 2019 - October 13, 2019

Malnutrition remains a huge challenge in Malaysian society. In a food-secure country, all should be able to eat sufficiently and healthily, not living in fear of sudden loss of access —­ physically or economically — to food.

Thankfully, food is, by and large, available and affordable to most in Malaysia. However, significant challenges remain in how and what Malaysians eat, leading to problematic nutrition outcomes.

Malaysia has long been a melting pot of different cultures, resulting in a variety of traditional foods and food customs coming together and changing through contact, technological changes and evolving demographic and environmental conditions.

However, Malaysia has also not been exempt from global trends. The current state of food and dietary culture and nutrition, including the popularity of “convenience foods”, deep-frying and sugary foods and beverages, is also a consequence of such changes in global trends.

Undernutrition, or nutrient deficiencies, remains high in Malaysia, even though rates of dietary energy undernourishment or hunger, have greatly improved since independence.

Stunting increased from 17.2% in 2006 to 20.7% of all children below five in 2016, while 13.7% of children were underweight in 2006. Micronutrient deficiencies pose a great threat but are frequently neglected.

For example, 4.9 million Malaysians are anaemic and about half of them are women between 15 and 45 years of age. The median calcium intake of Malaysians was less than half of the recommended level in 2014.

The crises of obesity, diabetes and other non-communicable diseases (NCDs) in Malaysia is much more alarming. NCDs dominate as the leading causes of premature death and disability in Malaysia. Malaysia is among the fattest countries in Southeast Asia and in the Asia-Pacific.

The prevalence of (both known and previously undiagnosed) diabetes also increased from 6.9% in 1996 to 17.5% in 2015. That same year, 30.0% of adults were overweight, with a further 17.7% considered obese.

Overweight and obesity are risk factors for NCDs such as diabetes, cardiovascular diseases and cancers. NCDs reduce individual productivity and quality of life, and unnecessarily raise health costs, both private and public, with 10% to 19% of national healthcare expenditure in 2018 spent on obesity-related matters.

Improving diets

Studies suggest that overweight and obesity do not just vary significantly with income level, but are also subject to other factors such as genetics, food intake, behaviour, physical activity, illness and globalisation — for example, the rapid spread of processed and convenience foods. Such connections are rarely linear, although consumption of dietary energy initially tends to increase with income for the poor.

However, further increases in income and food expenditure also involve greater dietary diversity and is rarely influenced by greater knowledge of nutrition, but more typically by changing dietary behavioural imperatives, for example, convenience, food cultural norms, peer influence and advertising.

Tackling the underlying factors leading to the crisis humorously referred to as the “battle of the bulge” will be crucial to ensure better health and public healthcare financing in the future.

Malaysia has progressed considerably in improving food availability, affordability and stability in the country. What remains is to improve nutrition in the country, especially in the face of undernutrition and the growth of diet-related non-communicable diseases such as obesity and diabetes. Addressing malnutrition in Malaysia should be a key priority for a healthy and more productive nation.

Malaysia’s nutrition programmes and policies have evolved over the years. Post-independence nutrition programmes focused on improving the living conditions of rural populations, which constituted about 70% of the Malaysian population between 1966 and 1970.

These included school-feeding programmes and programmes for poor and malnourished children. This evolved into the series of National Plans of Action for Nutrition, with the most recent one attempting to address the overweight and obesity crisis.

Some of these programmes have been crippled by a lack of intersectoral and multi-stakeholder coordination, sustained financing commitment, human resource capacities and capabilities as well as monitoring and evaluation mechanisms.

A holistic, National Nutrition Strategy is urgently needed to effectively tackle these issues. Sustainable food systems need to be ensured to promote healthy diets while public nutrition education needs considerable improvement and strengthening to educate children and adults on eating healthily.

Universal school feeding can be crucial for improving nutrition for children and future generations as well as food safety and farmer incomes. Such programmes can also inculcate good eating habits in children, improve socialisation and cooperation, improve academic results and physical development and transform food agriculture and production.

Misleading advertising that compromises health and nutrition, especially for children, will need to be restricted, with strict regulation on foods and beverages sold in school canteens, for example.

Anaemia in women of reproductive age needs to be given due attention by encouraging adequate micronutrient intake and temporary supplementation in cases requiring especially urgent attention, for example, for pregnant women.

Food safety will also need to be ensured, such as the reduction of the overuse and abuse of antibiotics for animals, including in fish breeding.

Jomo Kwame Sundaram, Wan Manan Wan Muda and Tan Zhai Gen are research adviser, visiting senior fellow and research associate respectively at Khazanah Research Institute

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