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net
Malaysia has the highest obesity rate in Southeast Asia and almost every second
Malaysian adult is either overweight or obese.

Credits: The New Straits Times

What is Obesity?
Obesity is a medical condition described by the World Health Organization (WHO) as
abnormal or excessive body weight in the form of fat accumulation that presents a
risk to an individuals health. However, there are no perfect measures of overweight
and obesity in a clinical situation. The most useful assessment is a combination of
human body measurements, which are:

Weight (kg) and Height (m), which calculates the body mass index (BMI),
and
Waist circumference (cm)

Body Mass Index (BMI)

Body Mass Index (BMI) is the most widely used method of measuring and identifying
obesity, with a formula BMI = weight divided by the square of height (kg/m2). The
classification adopted by the WHO is shown in Table 1, it is based on the
international standards developed for adult people of European descent.

Table 1: The WHO International Classification of adult underweight, overweight and

obesity according to BMI

Asians Shoud Have Lower BMI Cut Off

However, after 20 years of research, The Nurses Health Study has concluded that
Asians have more than double the risk of developing Type 2 Diabetes for a
given level of BMI compared to people of European descent. Therefore, the study
proposed a lower BMI cut-offs for overweight and obesity in these populations as
shown in the table below (DJ Frenk n.d.).
 Overweight Obese

Caucasians (WHO) >25 >30

China and Japan >24 >28

India >23 >27

The Limitations of BMI

BMI is highly, but not perfectly, correlated with fat mass and fat distribution. It has
several limitations. Firstly, it does not distinguish fat mass from lean muscle, and
hence, it is not suitable for

Muscular individuals
Older people
Secondly, BMI does not necessarily reflect body-fat distribution (see below);
therefore waist circumference is important to complement the abdominal fat mass
and disease risk measurements in individuals with BMI of less than 35.

Your Waist Circumference and How it Relates to Disease Risk

Excess fat can be deposited in different areas of the body. From a health point of
view, two major types of fat distribution are important central abdominal or waist
(apple-shaped) and gluteal-femoral or buttock (pear-shaped).

Waist circumference (subcutaneous abdominal fat) has been shown to be

positively associated with disease risk such as metabolic syndrome. Similarly, it
has also been suggested that a lower cut-off values of 90cm for Asian men and
80cm for Asian women are associated with a substantially increased risk of
metabolic complications.
Credits: Healthwise, Incorporated

Metabolic syndrome is a disorder of energy utilization and storage, which may cause
the health issues below:

Credits: UCTVPrime

Table 2. The recommendations of waist circumference cut-off points for different

ethnicity:

Ethnic group Waist circumference (cm), men Waist circumference (cm), women

Caucasians >102 >88

South Asian >90 >80

Chinese >90 >80

 Japanese >90 >80

Source: Adapted from Zimmet&Alberti (2006)

Furthermore, BMI and waist circumference can be easily done at home. If your
readings are sitting at overweight or obese parameters, you may carry a higher
disease risk than others (See Table 3 below). You should look for your GP or
pharmacist for further advice because GPs and pharmacists are well placed to
address the issue of overweight or obesity in individuals and families.

Table 3. Combined recommendations of body mass index and waist circumference

cut-off points with disease risk for Asians

Body mass index Disease risk (relative to normal weight and waist
(BMI) circumference)

Men < 90Women < 80 Men > 90Women > 80

Normal < 24

Overweight > 24 Increased High

Obese > 28 High Very high

Malaysians Most Obese in South East Asia. Are You One of Them?,
http://www.healthworks.my/malaysians-most-obese/ Rachel Gan MPharm (UK),
RPH, MMPS, Clinical pharmacist, proprietor of Alive Pharmacy Sdn Bhd.