A high prevalence of obesity in Malaysia results from an interaction between an inborn metabolic willingness to fatness and changes in population's lifestyle. For example, higher energy and fat consumption, and reduced physical activity that tend to accompany economic development (Ismail, 1995). The prevalence of obesity among urban children and adults shown in Table ??
Table ?? Prevalence of obesity (%) among children and adults in urban areas.
Year
1993-19941 19982 19983 19904 19974
Male 9.5 12.5 0.7 5.7
Female 5.2 5.0
Combine sexes 9.8
Sources :
1 Bong, A.S.L., Safurah, J.(1996)
2 Tee, E.S., Safidah, A.S., Chong, C.S.M., et al (1998)
3 Ismail, M.N., Tan, C.L.(2000)
4 Ismail, M.N., Vickneswary, E.N.(1999)
An earlier study conducted by Bong, and Safurah (1996), reported that a 9.8% obesity level (sexes combined); while, Tee, et al. reported 9.5% in males and 5.2% in females (95th percentiles); although Ismail and Tan reported 12.5% and 5% in male and female (85th percentiles). Both of the later studies used World Health Organization (WHO) criteria. Ismail and Tan also reported an increase in the prevalence of obesity from 1% to 6%. In adults, a study (Table !?) done in 1993-1994, using the same WHO criteria, learnt that the overall prevalence of overweight and obesity in men was 24.0% and 4.7% while in women it was 18.1% and 7.7%. Rural to urban differences are also obvious that 5.6% of urban men were obese as compared with 1.8% for rural men and 8.8% of urban women were obese as compared with 2.6% of their rural counterparts (Ismail, et al. 1995).
A National Health Morbidity Survey (Lim, Goh, Zaki, et al. 2000) conducted in 1996 reported that 15% of males were overweight and 2.9% obese, while females were 17.9% were overweight and 5.7% obese, respectively. There is little difference in overweight and obesity prevalence between rural and urban population (Table!?).
Table!? Prevalence of overweight and obesity (%) among adults according to sex and area
Year
1993-941 1996-972
Overweight Obese Overweight Obese
Male 24.0 4.7 15.1 2.9
Female 18.1 7.9 17.9 5.7
Rural 15.2 2.2 15.5 4.3
Urban 21.8 7.2 17.4 4.5
Source :
1 Ismail, Zawiah, Chee, et al. 1995
2 Lim, Goh, Zaki, et al. 2000
Obesity can result from a minor energy imbalance leading to a gradual weight gain over a period. It is not uncommon to find energy intake insufficient to meet the recommended allowances for a given population with the inborn limitation of collecting dietary intake data in a free-living population. Physical inactivity has a major role to participate in energy imbalance leading to obesity. Results of several studies on the physical activity level (PAL) of selected population groups are pictured in Table!@. The results came up a disturbing pattern of PAL among adolescents for both sexes. inactive lifestyle, together with increased intake of energy-dense and carbohydrate foods, are a disaster recipe for this age group. The adult PAL may be grouped as moderate, based on the small segment of the population studies. The amount of motor vehicle and television ownership may be used as indicators of influences on the activity patterns of adults and children (Noor, 2002).
Table!@ Basal Metabolic Rate (BMR), Total Daily Energy Expenditure (TDEE), and Physical Activity Level (PAL)
Males Females
Age
Subjects (years) BMR TDEE PAL BMR TDEE PAL
Adolescents1 12-14 5.08 7.89 1.55 4.80 7.09 1.48
Adolescents1 16-18 5.76 8.64 1.50 5.02 7.64 1.52
Young Adults2 18-30 5.85 9.40 1.61 4.77 7.58 1.59
Adults2 30-60 5.66 9.53 1.68 4.79 8.17 1.70
Eldery3 >60 4.92 7.35 1.50 4.37 6.74 1.54
Armed Forces4 20-30 5.74 12.08 2.10 NA NA NA
Elite Athletes5 20-30 6.84 14.91 2.18 5.39 10.67 1.98
Sources:
1 Yap. 2001
2 Vicktor. 1999
3 Razali. 1996
4 Ismail, Isa, Janudin. 1994
5 Ismail, Wan, Zawiah. 1997
Health Hazard
Critics of the fast food industry point to several features that may make fast food less healthy than any other types of restaurant (Spurlock, 2004). These include low monetary and time costs, large portioning, and high calorie density of their menu items. Indeed, energy densities for individual food items are often so high that it would be difficult for individuals that consuming fast food not to exceed their average recommended dietary intakes (Prentice, Jebb, 2003). Some consumers may be particularly at risk. In two experimental trials involving 26 obese and 28 lean adults, Ebbeling, et al. (2004) compared caloric intakes on "unlimited fast food days" and "no fast food days". They found that obese adults had higher caloric intakes on the fast food days, not like the no fast food days.
The largest fast food chains are characterized by excessive marketing to children. One experimental study of young children aged 3 to 5 offered them identical pairs of foods and beverages, the only difference were that some of the foods were in McDonald's packaging. Children were significantly more into choosing items perceived to be from McDonald's (Robinson, et al. 2007).
Still, a recent review of the considerable literature about the relationship between fast food and obesity (Rosenheck,2008) expressed that "Findings from observational studies as yet are unable to demonstrate a causal link between fast food consumption and weight gain (obesity)". Most studies have longitudinal designs in which large groups of participants are tracked over a period of time, and the increase of their body mass index (BMI) are correlated with measurement of fast food consumption. In other words, these studies find a positive link between obesity and fast food consumption. However, existing observational studies cannot eliminate potential confounders such as daily exercises, consumption of highly sugar contained beverages, and so on.
There is also economics literature on obesity, reviewed by Philipson and Posner (2008). Economic studies place changing amounts of emphasis on increased caloric consumption as a primary cause of obesity (a trend that is steady with the increased availability of fast food). Lakdawalla and Philipson (2002) concluded that about 40% of the increase in obesity from 1976 to 1994 is likely to lower food prices and increased consumption while the remainder is due to reduced exercise activity in market and home. Bleich et al. (2007) test data from some developed countries and concluded that increased caloric intake is the main contributor of obesity. Cutler et al. (2003) examine food diaries as well as time use data from the last decades and conclude that increasing number of obesity is linked to increased caloric intake and not to reduced energy expenditure.
They suggest that the increased caloric intake is from frequency of having snack, and not from increased portion sizes at regular restaurant or fast food restaurant. They further suggest that technological change has lowered the time cost of food preparation which has lead to more consumption of fast food. Finally, they speculate that people with self control problems are over-consuming the fattening meals. Cawley (1999) explains a similar behavioral theory of obesity as a consequence of addiction.
While many of the ingredients in fast food have come under attack over the years, much attention has been committed recently to the fact that fast foods are usually high in trans fats. Trans fats are not only bad in themselves but can increase "bad" cholesterol (LDL) and lower "good" cholesterol (HDL), increasing the chances of having a heart attack. Trans fats are widely used in fast -food restaurants because they are: Cheap, Can be stored easily for long periods of time, The oils that include them are very easy to work with(Sawyer,2006).
While some countries (example: Denmark) have approved laws limiting the amounts of trans far in food, the United States has relied on fast-food restaurants simply to provide information to consumers on the quantity of trans fats in their menu items. McDonald's, however, has been slower than many of its competitors in eliminating trans fats (Deardoff, 2006). However, by early 2007 even McDonald's had developed on a new trans-fat-free formula for cooking its french fries, although it may not be used throughout the American market for a year or two (Horovitz,2007).
The depressing impact of fast food on health is not limited to the United States. The growth of fast food restaurants, as well as the stress on ever-larger portions, is helping to lead to increasing health problems (example: diabetes) in various parts of the world, including the Far East in general, and Vietnam in particular (Laurance, 2006). A comparative study of 380 regions in Ontario, Canada, showed that the regions with more fast food services were likely to have higher rate of sharp coronary disease and a higher death rate from coronary disease (Alfer, and Eny, 2005).
By helping create poor eating habits in children fast food restaurants contribute to the development of various health problems. By targeting children, fast food restaurants are creating not only permanent fan of fast food but also people who are addicted to diets high in salt, sugar, and fats (Spencer,1983). An interesting study discovered that the health of immigrant children get worse when the longer they are in the United States, in large part because their diet begins to more closely be like the junk food diet of most American children(Hernandez, and Charney, 1998). In fact, Disney ended its long-term, cross-promotional relationship with McDonalds's because of the rising concern about the link between fast food and childhood obesity (Abramowitz, 2006). A sociologist associated with the study of immigrant children stated: "The McDonaldization of the world is not necessarily progress when it comes to nutritious diets" (Stearns, 1996).
Attacks against the fast-food industry's damaging effects on health have gone up over the years. Many of the franchises have been forced to respond by offering more and better salads, although the dressing for them are often full with salt and fat. Still, most consumers order the typical McDonald's meal of a Big Mac, large fries, and a shake, which totals more toward larger and larger portions, has only increased the problem. The substitution of a chocolate triple shake for a regular shake in that McDonald's meal increases the total to 1,690 calories. Burger King's Double Whopper with cheese has 960 calories, and 63 grams of fat (Stearns,1996).
McDonaldization create even more immediate health threats. Regina Schrambling links outburst of disease such as Salmonella to the rationalization of chicken production:
Salmonella proliferated in the poultry industry only after beef became a four-letter word to many and Americans decided they wanted a chicken in every pot every night. But birds aren't like cars: you can't just speed up the factory line to meet demand. Something has got to give, and in this case it's been safety. Birds that are rushed to fryer size, then killed, gutted, and plucked at high speed in vast quantities are not going to be cleanest food in the supermarket.(Schrambling,1991)
Schrambling also associates Salmonella with the restructured production of eggs, fruits, and vegetables(Schrambling, 1991).
Outbreaks of E.coli infections have also been growing in recent years, and the fast food industry would do well to take note of this fact. Indeed, the first reported outbreak in the United States was lead to McDonald's in 1982. More recently, Hudson Foods, a meatpacking company that supplied meat to McDonald's and Burger King, among others, was forced to close their business because an outbreak of E.coli was traced to its frozen hamburgers (London, 1997). Hamburger is a particular problem because E.coli can be passed from steer to steer, and ultimately the hamburger from many steers, some of it infected, is mixed together. That meat is then turned into patties and frozen, and those frozen patties are distributed broadly. The fast food industry did respond to the danger of E.coli by cooking their hamburgers at a higher temperature to kill the bacterium, but E.coli is finding its way into an ever-larger number of highly McDonladized foods (example: bagged salad and spinach), (Allday, 2006).
The developed countries are making great efforts to correct the dietary excesses and errors to which their populations fall in their early years of growing (Noor, 2002). Unfortunately the current nutrition and health scenario reveals that Malaysians have not worth from Western experiences. The growth of nutrition-related chronic degenerative diseases, once was an urban phenomenon, has now been spreading to the rural population at an alarming rate. As Malaysia goes rapidly towards a developed economy status, the population's lifestyle will continue to change. Malaysia may have to re-examine its present policies and strategies, determine their limitations, and action of promoting healthy nutritional for its population.
