Overweight and obesity increasingly prevail in the ASEAN region. Using the WHO criteria for overweight (BMI 25-29) and obesity (BMI 30 and greater), countries in the region are reporting rising rates of overweight and obesity. Consider the data from the Western Pacific Region1: Malaysia (1996) reports overweight rates of 21.4% in women and 20.1% in men, and obesity rates of 7.6% in women and 4.0% in men. Myanmar (2009) reports 30.2% in women and 17.7% in men being overweight, and 8.4% in women and 4.3% in men being obese. Singapore (1998) reports overweight rates of 20.3% in women and 28.6% in men, and obesity rates of 6.7% in women and 5.3% in men. Indonesia (2001)2 reports overweight rates 17.4% in women and 10.2% in men, and obesity rates of 4.5 % in women and 1.3 % in men.

The 2008 National Nutrition and Health Survey of the Philippines3 reports that the prevalence of obesity in 2008 was 5.2% (3.7% and 6.6% for male and female, respectively). Based on WHR, the prevalence of obesity in males in 2008 was 11.1% (12.1% in 2003 and 7.9% in 1998). With a lower, stricter cut-off of ≥ 0.85 in females, the prevalence was 65.5% (54.8% in 2003 and 39.5% in 1998).

The Clinical Practice Guideline (CPG) for Malaysia is a comprehensive guideline developed in 2004 and emphasizes the need for a multidisciplinary approach to the prevention and control of obesity. Childhood or adolescent obesity is recognized as an emerging concern, and specific recommendations to address this is included in the practice recommendations.

The CPG for Myanmar highlights the use of the Myanmar diet where most carbohydrates are derived from grains, potatoes, starchy vegetables and refined grains. These constitute 70% of the Myanmar diet. Importantly, it emphasizes age-specific recommendations for physical activity. This CPG includes prevention strategy recommendations particularly for children and adolescents.

The CPG for Singapore was developed by a multidisciplinary work group in collaboration with the Health Promotion Board of Singapore, drawn from best available evidence in 2004. It is a comprehensive set of guidelines, incorporating contributions from para-clinical disciplines, also recognizing the need for specific guidelines for children and adolescents. It emphasizes the importance of quality indicators to evaluate the success of weight management programs. It also includes a user-friendly algorithm, with Asian BMI cut-off points. Meanwhile, the authors indicate a need to review these guidelines, with the influx of new data since 2004.

Indonesia describes the clinical practice guidelines in use at a hospital, Cipto Mangunkusumo, as reviewed by the local Obesity Cluster Team. It includes a comprehensive review of basic clinical evaluation and weight management programs that include pharmacotherapy and bariatric surgery. A treatment algorithm derived from the US NHLBI Obesity Education Initiative completes the recommendations.

The Philippine group reviews the obesity practice recommendations of the Philippine Association for the Study of Overweight and Obesity (PASOO) and the obesity guidelines of the Family Medicine Research Group (FMRG) of the University of the Philippines – Philippine General Hospital. Conclusions derived from this review include: (1) The obesity recommendations need to be modified and updated to fulfill important requirements for high-quality recommendations backed by a strong Philippine evidence base; (2) Collaboration among important stakeholders in the prevention and control of obesity and other noncommunicable diseases (NCD) is essential to arrive at an integrated approach. In addition, the PASOO has embarked on an obesity research agenda prioritization plan, after extensive search of all existing literature carried out among Filipinos within the Philippines and internationally. The research agenda is intended to prioritize research work on urgent questions, without unnecessary duplication in a resource-poor country like the Philippines, with the ultimate objective of translating this research into national health policy and clinical practice.

What outcomes can be expected with the current programs in place in ASEAN? There is a need for country specific efforts, spearheaded by the national government in collaboration with various stakeholders, to provide a long term plan that will allow individuals to eat better and find opportunities to increase physical activity. Research needs to be enhanced in ASEAN to help us better understand the etiology of obesity and to face the challenge of obesity occurring side-by-side with undernutrition in certain sectors of the population. Many of the ASEAN countries continue becoming more Westernized in lifestyle, with fast food outlets rapidly outgrowing the local restaurant facilities. Here high fat, easy to consume, affordable foods become part of the individual country’s staple foods and become daily source of nutrition especially for the younger segment of the population. More technology gadgets take children, adolescents and young adults from outdoor physical activities to indoor sedentary activities. And are these perceived as progress?

The epidemic is upon us. And unless we put our act together to arrest obesity, particularly in children, the burden of the consequences of obesity, diabetes and cardiovascular disease will become inevitable and will take a great toll in our region for many years. The challenge of malnutrition confronts us. We ask AFES to take up this challenge.

Prevalence of overweight and obesity in the Western Pacific Region (National Data), World Health Organization-Western Pacific Regional Office. http://wpro.who.int/nr/rdonlyres/cb02460d-bc81-47fb-a09f-3792508398f2/0/tableobesity.pdf. Accessed October 3, 2011.

International Association for the Study of Obesity (IASO) World Map of Obesity. http://www.iaso.org/publications/world-map-obesity/?map=adults. Accessed October 3, 2011.

Rody G. Sy, MD, Dante D. Morales, MD, Antonio L. Dans, MD, Elizabeth Paz-Pacheco, MD, Felix Eduardo R. Punzalan, MD, Nelson S. Abelardo, MD, Charmaine A. Duante for the Philippine National Nutrition and Health Survey 2008 working group. Manuscript in preparation. For publication.