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Tackling Obesity in Asia Pacific
February 2024
This article was contributed by the Sandpiper Health content team. Sandpiper Health is a specialist consultancy under Sandpiper Group, providing in-depth monitoring and analysis of the healthcare and life science sector, and helping pharmaceutical and medical technology companies, healthcare providers, patient and caregiver groups, as well as investors and professional organisations formulate effective stakeholder engagement strategies to achieve their business and communications objectives. To receive regular insights from Sandpiper Health on healthcare trends and policy updates in Asia Pacific, sign up to Asia Pacific Healthcare Outlook Monthly Newsletter.
The recent promising clinical trial results of an obesity drug called Wegovy has boosted confidence in these and similar drugs’ potential to transform the healthcare industry, sending the share prices of relevant pharmaceutical companies soaring. Even as lack of cost effectiveness has made insurance companies less inclined to cover these drugs, the attention the matter has received over the past year indicates not only how pressing the obesity problem has become, but also the potential business opportunities associated with it.
Around the world, rapidly growing percentages of populations with excess body weight are creating crises for many healthcare systems. Overweight and obesity are serious weight conditions, defined by the World Health Organization (WHO) as having a body mass index (BMI) of over 25 and 30 respectively. Obesity is a major risk factor for a host of chronic conditions, including diabetes, cardiovascular diseases, and certain forms of cancer, which places an immense burden on healthcare infrastructures.
In the Asia-Pacific region, evolving lifestyles are contributing significantly to the surge in obesity rates. Traditionally perceived as a problem confined to affluent nations, obesity is now a growing epidemic across developed and developing areas of Asia Pacific, including urban and rural regions. A variety of reasons are causing this trend, including rapid urbanisation, economic development, and the adoption of Western dietary habits, which have led to increased consumption of processed foods high in sugar and fats, replacing traditional diets that were more plant-based and nutrient-dense.
Sedentary lifestyles, fuelled by technological advancements, have also become more common in Asia Pacific, with people spending more time in front of screens and less on physical activities. This shift is evident across various age groups, including children, who are increasingly engaged in indoor pastimes. Moreover, the fast-paced nature of modern life in the region has led to a reliance on convenience foods and a decrease in home-cooked meals, further exacerbating the problem.
The implications of rising obesity rates for healthcare systems in Asia Pacific are profound. This issue explores the conditions in several highlighted countries and then highlights the related conditions that are becoming increasingly common.
Obesity: Country profiles
- Australia: In Australia, obesity has escalated into a critical public health challenge, with the nation experiencing one of the highest obesity rates globally. Currently, at least 60 percent of Australians are either overweight or obese, a figure that has more than doubled over the last decade, surging from 2.7 million individuals in 2007-08 to 5.8 million today. This rapid increase is particularly pronounced in rural, remote, and indigenous communities, contributing significantly to the health disparities faced by these populations. The economic toll of obesity is substantial, costing the Australian economy approximately AUD 11.8 billion annually, encompassing both direct healthcare costs and indirect expenses such as lost productivity. The challenges in combating obesity in Australia are multifaceted. Healthcare professionals often find themselves outmatched, lacking the specialised knowledge and tools needed to fight effectively. The Australian healthcare system struggles to provide an integrated, accessible approach to obesity management, especially in underserved areas. Treatment costs soar, societal stigma casts long shadows, and scepticism about the efficacy of weight management strategies further complicates efforts to address this issue effectively.
- China: According to experts at the China Obesity Conference (COC2023), a concerning trend has emerged, indicating a progressive surge in the obese population within China. Remarkably, more than 50 percent of adults are experiencing obesity-related concerns. It is estimated that by 2030, China’s healthcare expenditure on overweight and obesity issues will encompass approximately 22 percent of China’s overall national medical expenditure. This trend feeds into the Chinese government’s wider fears over the mushrooming expense of treating non-communicable diseases (NCDs). In China, deaths attributed to NCDs have increased from 80 percent in 2002 to 88.5 percent in 2019. Although the government announced plans to decrease the health effects of second-hand smoking, reduce obesity, increase overall physical activity, and prevent chronic diseases, China still has a long way to go in shifting its healthcare from treatment to a more cost-effective prevention model. Notwithstanding, China is making various medical advances to help treat obesity and its associated chronic diseases. China’s AI-powered drug discovery company MindRank has recently developed a weight-loss drug called MDR-001, combining the fields of generative AI and medicine to tackle obesity and related conditions, such as Type 2 diabetes. By binding to the glucagon-like peptide-1 receptor (GLP-1-R), MDR-001 stimulates pancreatic insulin release, resulting in decreased blood sugar levels and weight reduction. Through the use of AI in drug discovery, MindRank aims to deliver a cost-effective and time-efficient solution to obesity in China and worldwide.
- India: In 2024, India is grappling with escalating challenges related to weight gain, with the National Family Health Survey (NFHS-5) data revealing that approximately one in every four Indians is obese, marking a significant increase from previous years. This trend is indicative of a broader global pattern where obesity rates have nearly tripled since 1975, shifting from affluent nations to impacting low and middle-income countries like India. As in other countries, this rise in obesity is attributed to a combination of factors, including urbanisation, changing dietary habits, and increasingly sedentary lifestyles. Research forecasts suggest that the prevalence of overweight and obesity in India is increasing at a pace faster than the global average, with significant rises noted from 1998 to 2015. This uptick in obesity rates is accompanied by an increased burden of chronic conditions, signalling a shift from communicable to lifestyle-related health issues across the nation. The dynamic simulation models predicting future trends highlight the urgent need for effective policy interventions and public health strategies to counter this trend and mitigate its impact on India’s healthcare system and societal well-being.
- Vietnam: Obesity prevalence in Vietnam is below three percent, earning this Southeast Asian nation the reputation as one of the skinniest countries in the world. The phenomenon is often attributed to a dietary landscape where major fast-food franchises struggle to get a foothold due to competition with Vietnam’s rich availability of local street food options. However, Vietnam may also be the country where obesity is rising most rapidly. Ho Chi Minh City currently accounts for 18 percent of the country’s overweight and obese population as urbanisation contributes to the adoption of sedentary lifestyles. Vietnam’s gradual eradication of malnourishment is slowly replaced by an increased consumption of processed food and sugary beverages, particularly among children. Obesity in Vietnam increased 123 percent between 2010 and 2020 among children 5-19 years old and now affects 41 percent of the country’s urban children. Acknowledging the looming crisis, Vietnam’s Ministry of Health discussed the possibility of introducing a tax on sugar-sweetened beverages in 2023, but to date, this proposition has not yet materialised.
Obesity related conditions and diseases
There are many serious conditions associated with obesity, including:
- Diabetes: One of the most common comorbidities of obesity is diabetes, a condition characterised by elevated blood glucose levels that can cause serious damage to the heart, nerves, blood vessels, kidneys, and eyes. More than 90 percent of diabetics suffer from type 2, which is associated with lifestyle factors such as diet and lack of physical activity. Being overweight is associated with a three-fold increased risk of developing type 2 diabetes. The Asia-Pacific region’s rapidly developing economies have led to increased sedentary behaviour and consumption of processed, sugar-laden food. The Organisation for Economic Cooperation and Development reported that by 2016, an estimated 227 million people in Asia Pacific were living with diabetes. One out of every four diabetics in the world is from China, and diabetes affects one in five people in Malaysia, the most diabetic country in Southeast Asia. In the prosperous city-state of Singapore, dramatic economic growth has been accompanied by a six-fold increase in diabetes over the past half-century. Six island nations in the Pacific are among the top ten diabetic countries in the world – French Polynesia, New Caledonia, Northern Mariana Islands, Nauru, Marshall Islands, and Kiribati. These islands’ remoteness and heightened exposure to climate change led to food insecurity, necessitating a reliance on processed food. Notably, South Asian nations, especially people from India, Pakistan, Nepal, Sri Lanka, and Bangladesh, have been found to have lower β-cell function and an inability to compensate adequately for higher glucose levels from insulin resistance. These factors potentially contribute to Pakistan topping several world diabetes rankings with a 30 percent prevalence.
- Fatty liver disease: The relationship between obesity and fatty liver disease, particularly non-alcoholic fatty liver disease (NAFLD), is becoming increasingly evident in the Asia-Pacific region. NAFLD, a major cause of chronic liver disease worldwide, is closely associated with obesity and metabolic syndrome. The region accounts for a significant portion of the global incidence and deaths attributable to NAFLD-related liver complications, highlighting the growing health burden. From 2009 to 2019, Asia experienced a rise in disability-adjusted life years (DALYs) attributable to liver complications from NAFLD, signalling an increasing impact of this condition on public health. Efforts to address this escalating issue include various policy responses aimed at controlling obesity and NAFLD. These include promoting healthy lifestyles, regulating the food industry, and implementing government policies to limit alcohol consumption, which is also a contributing factor to liver diseases. However, the policy response to liver diseases, including those exacerbated by obesity, has been described as inadequate and underfunded in most parts of the Asia-Pacific region. A renewed focus on prevention, early detection, and timely referral is essential, alongside research into effective health interventions.
- Strokes: Strokes are another health condition that is often correlated with obesity. Strokes often occur among patients afflicted by obesity due to the tendency for obesity to lead to other risk factors, such as high blood pressure, high cholesterol levels, and diabetes. These additional risk factors substantially heighten the likelihood of developing cardiovascular diseases, including strokes. Moreover, obesity is commonly correlated with other comorbidities, such as sleep apnoea and atrial fibrillation, further compounding the risk of strokes. Research highlights that Asia-Pacific countries bear a disproportionate share of the burden of stroke, with obesity emerging as a prominent causal factor. Consequently, the same research recommends governments raise people’s awareness regarding the relationship between obesity and the occurrence of strokes, discouraging habits such as excessive salt intake and lack of physical activity. By implementing these measures, Asia-Pacific countries can take a step further to mitigate the impact of obesity-related strokes, fostering a healthier community.
- COVID-19: In the shadow of the COVID-19 pandemic, a parallel crisis has silently amplified its grip: the obesity epidemic. This duo of health challenges is intricately linked, with obesity emerging as a significant risk factor for severe COVID-19 complications. Extensive research has consistently demonstrated that obesity not only predisposes individuals to numerous chronic diseases but also significantly elevates the risk of acute illness from COVID-19, including a threefold increase in the likelihood of hospitalisation. This heightened risk stems from obesity’s association with chronic inflammation, compromised immune function, and comorbidities such as diabetes and hypertension, which exacerbate COVID-19 severity. Moreover, the pandemic has indirectly exacerbated obesity rates, particularly among primary school children, with reported increases of 45 percent during lockdown periods. Factors contributing to this surge include reduced physical activity, unhealthy dietary patterns, the suspension of organised sports, and elevated screen time.
Undernutrition and obesity
While undernutrition and obesity may seem like two contrasting health conditions, it is common for the two conditions to coexist. Many individuals within the overweight and obese population also suffer from undernutrition due to insufficient intake of essential micronutrients and consumption of low-quality food. A prevalent health condition in the Asian region is Normal-Weight Obesity (NWO), characterised by excessive body fat despite a normal BMI. This unique body composition phenotype often arises from an imbalanced diet with a lack of nutrients, characterised by high carbohydrate intake and low protein consumption. Consequently, individuals with NWO exhibit higher levels of body fat and lower muscle development, increasing the risk of insulin resistance and diabetes. While NWO is frequently overlooked in the healthcare industry as it cannot be easily diagnosed by BMI, its impact on health conditions is severe. This indicates the importance of encouraging the community to maintain a healthy diet that ensures balanced nutrient consumption, ultimately preventing obesity and its associated health risks.
Looking ahead
Obesity’s economic impact is serious and extends beyond direct healthcare costs, affecting workforce productivity and economic growth. The increased prevalence of obesity-related illnesses necessitates significant investments in healthcare services, from preventive measures and public health campaigns to the management of chronic diseases and associated complications. As the Asia-Pacific region grapples with this complex health challenge, it becomes imperative for policymakers, healthcare providers, and communities to collaborate in implementing comprehensive strategies aimed at curbing the obesity epidemic and mitigating its impacts on the region’s healthcare systems and broader societal well-being. MNCs with obesity related products should closely monitor developments in this domain.
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