Rethinking obesity as a chronic disease through science, compassion, and medical advancesJanuary 20, 2026
Professor Emeritus Professor Dr Chan Siew Pheng explains eating behavior is controlled by brain centers governing hunger, pleasure, and self-regulation, shaping survival-driven and pleasure-driven intake.
Obesity is no longer a topic that can be discussed casually or judgmentally. As medical understanding evolves, so too must the language, attitudes, and strategies used to address it. One of the most important shifts begins with how we speak about the condition itself. The preferred and respectful terminology today is PWO — People With Obesity, rather than defining individuals by the disease.
This change reflects a deeper truth: obesity is a chronic medical condition, not a personal failure, and not something that simply appears and disappears. In Malaysia, this reality is becoming increasingly difficult to ignore. Many individuals now live with what clinicians describe as the “3 plus 1 problem” — diabetes, hypertension, hypercholesterolemia, and overweight or obesity — all present in the same person. “These conditions do not come and go,” explains Professor Emeritus Professor Dr Chan Siew Pheng, Honorary Consultant Endocrinologist, speaking at the Novo Nordisk launch event of obesity medicine Wegovy. “Obesity is a chronic problem, and it needs to be managed as such.” A growing national health challenge Data from Malaysia’s Ministry of Health paints a sobering picture. Between 2011 and the most recent national surveys — a span of just over a decade — the prevalence of overweight and obesity in Malaysia has increased dramatically, rising from approximately 40% to over 50% of the adult population. Obesity is commonly diagnosed in two main ways: through Body Mass Index (BMI) or by measuring abdominal obesity, which involves waist circumference. Both measurements are clinically important, as excess fat — particularly around the abdomen — is closely linked to metabolic diseases. Using the World Health Organization (WHO) definition, overweight is classified as a BMI above 25kg/m² but below 30kg/m², while obesity begins at a BMI of 30kg/m² and is further categorized into grades depending on severity. However, Malaysia — along with other Asian countries — has adopted lower BMI cut-off points, recognizing that Asian populations experience obesity-related complications at lower body weights. Why Asian BMI cut-offs are different Under the Asia-Pacific guidelines, overweight (or pre-obesity) is defined as a BMI of 23 to below 27.5, while obesity begins at 27.5, compared to the WHO threshold of 30. The reason is clear and evidence-based. “Core morbidities associated with body mass index increase at different cut points,” Professor Dr Chan explains. “Caucasian populations tend to see higher diabetes prevalence starting at a BMI of around 30. In South Asians, the increase begins as low as 23.9.” This is largely because Asian populations carry more visceral and abdominal fat at the same BMI, compared to Western populations. Malay and Chinese ethnic groups fall somewhere in between, which further supports the need for regional diagnostic criteria. Using Asia-Pacific cut-offs, up to 70% of Malaysian adults fall into the overweight or obese category — a statistic that underscores the scale of the problem. Awareness exists — but support is lacking ACTION Malaysia, which surveyed 1,000 people with obesity and 200 healthcare professionals, revealed a significant disconnect between awareness and action. More than three-quarters of respondents understood the health risks associated with obesity. However, many healthcare providers still viewed obesity as a result of poor discipline or unhealthy lifestyle choices alone. Nearly half attributed the condition to personal fault, reinforcing stigma rather than offering structured support. The impact of this perception is profound. Only one in three people with obesity reported being able to discuss their weight concerns with a doctor. Even more concerning, only one in ten received any form of medical therapy to address obesity. This gap between need and treatment highlights a systemic issue — obesity is recognized, but not adequately treated. Why weight loss is so difficult to sustain One of the most misunderstood aspects of obesity is the biology behind weight regain. “Don’t blame the stomach — blame the brain,” Professor Dr Chan explains. Eating behavior is regulated by multiple centres in the brain. Homeostatic eating drives us to eat when we are hungry, ensuring survival. Hedonic eating, on the other hand, is eating for pleasure. A third system governs self-regulation and decision-making. The challenge arises when weight loss triggers the body’s defence mechanisms. As individuals lose weight, the body responds by slowing metabolism, increasing hunger, and reducing feelings of fullness. In essence, the body actively fights to regain lost weight. This explains why many individuals experience yo-yo weight cycling, regaining weight despite continued effort. Studies show that up to 60% of people regain the weight they initially lose, leading to frustration, disappointment, and disengagement. A clinical approach to obesity care Modern obesity management follows structured clinical guidelines. Treatment is never about medication alone. “Drugs must always be an adjunct to lifestyle changes,” Professor Dr Chan emphasizes. Diet and physical activity remain foundational, but they are often insufficient on their own. According to guidelines, pharmacological treatment may be considered for:
For many years, available medications offered limited results. That landscape has now changed with the introduction of high-dose semaglutide. Semaglutide and the science behind Wegovy Semaglutide is not a new molecule. It has long been used at lower doses (1mg) under the name Ozempic. Wegovy, however, delivers semaglutide at a higher dose of 2.4mg, specifically approved for obesity management. This higher dose carries a Grade A recommendation, supported by robust clinical trial evidence. The medication works by enhancing homeostatic control while reducing hedonic eating — meaning hunger decreases and cravings are less intense. Clinical trials, including those involving Asian populations and patients with cardiovascular disease, demonstrate significant outcomes. Nearly 90% of participants lost more than 5% of their body weight. In some studies, one in three individuals lost over 20%, an amount comparable to weight loss seen after bariatric surgery. Crucially, this weight loss is sustained with continued treatment. Fat loss, muscle preservation, and health outcomes Weight loss is not just about numbers on a scale. Typically, when people lose weight through diet alone, approximately two-thirds comes from fat and one-third from muscle. With high-dose semaglutide, this ratio shifts dramatically. Clinical data shows up to 84% of weight loss comes from fat, with significantly less muscle loss. This addresses common concerns about weakness and functional decline. The medication also leads to substantial reductions in visceral fat, with some patients losing up to 40%. This is especially important because excess abdominal fat is strongly associated with diabetes, high cholesterol, and cardiovascular disease. Even a 30% reduction in visceral fat has been shown to improve blood sugar control, lipid profiles, and overall cardiometabolic health. Beyond weight loss: Cardiovascular benefits Real-world data shows additional benefits, including reduced food preoccupation and improved mood. More importantly, cardiovascular outcome trials have changed clinical practice. The European Society of Cardiology now includes GLP-1–based therapies in patients with overweight, obesity, and cardiovascular disease. In Malaysia, where one in three patients with heart disease dies, this is particularly relevant. Eight out of ten individuals with cardiovascular disease are overweight or obese, highlighting the strong link between excess weight and heart health. Select trial demonstrated that in patients with cardiovascular disease — even without diabetes — semaglutide reduced the risk of cardiovascular death, heart attack, and stroke. These benefits extend well beyond cosmetic weight loss. Redefining obesity care Obesity management is evolving from a focus on willpower to one grounded in biology, evidence, and compassion. The goal is no longer simply weight reduction, but improved health outcomes, reduced complications, and better quality of life. As Professor Dr Chan emphasizes, addressing obesity effectively requires understanding the disease, supporting patients without stigma, and applying treatments that work with — not against — human physiology. |
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