Obesity's toll on children's mental, emotional health

Sinar Daily

3 days ago

KUALA LUMPUR - "Do you want the 30 sen change or sweets?' a female vendor, who was selling homemade ice cream for 70 sen a stick, asked a schoolboy who handed her RM1.
"Sweets,' replied the boy before walking away with his ice cream and sweets.
Vendors selling candies, sweets, light snacks, fast food, ice cream and carbonated drinks are a common sight outside school gates. A random survey of several primary schools in Kuala Lumpur and Negeri Sembilan by Bernama recently found that the vendors turn up every school day without fail, with pupils scrambling to buy their favourite drink or snack as soon as school ends.
At one school, one student was seen rushing to help his father sell carbonated drinks after school.
These beverages, commonly known as air gas and sold at RM1 a cup, come in a variety of colours - red, green, purple, orange and black - and flavours. With a few ice cubes added, they become the perfect thirst quencher on a scorching hot day.
But little do the children know the "hidden cost' of consuming the sugar-laden air gas almost on a daily basis.
CONSUMING CARBONATED DRINKS DAILY
According to a press release dated May 2019 by the United Nations Children's Fund (UNICEF) Malaysia, Malaysians' consumption of sugary drinks has increased dramatically over the past 15 years, in tandem with rising incomes.
More than one-third (36 per cent) of students have sugary drinks at least once a day, and the average daily sugar intake for adolescents has increased from seven teaspoons in 2012 to 10 teaspoons in 2017, which is more than the recommended limit for adults. On average, Malaysians consume around three kilogrammes of sugar per year in the form of sugary drinks.
UNICEF Malaysia also said taxation of sugary drinks has consistently been shown to reduce sugar consumption and improve health outcomes.
For example, in the Philippines, sugar-sweetened beverage taxes have reduced consumption of sugary drinks by 8.7 percent, and a study found that they could prevent 24,000 premature deaths related to diabetes, stroke and heart diseases.
In Malaysia's case, it introduced an excise duty on sugary drinks in Budget 2019 at 40 sen per litre, which was increased by 10 sen to 50 sen in Budget 2024.
An additional 40 sen was added through Budget 2025, bringing the total excise duty to 90 sen per litre. The tax applies only to three categories of ready-to-drink sugary beverages manufactured locally or imported.
According to the Ministry of Health Malaysia (MOH), the implementation of the sugar tax in 2019 has shown a reduction in the consumption of sugar-sweetened beverages among teenagers - from 36.9 percent (according to the National Health and Morbidity Survey [NHMS] 2017 findings) to 16.4 percent (data from a 2022 study to assess the impact and effectiveness of Malaysia's sugar-sweetened beverage tax).
"Young people and the lower-income group (B40), who are the highest consumers and spend the most on sugary drinks, have benefited positively from this tax,' the ministry said.
COMPLY WITH GUIDELINES?
However, sugary beverages are not the only concern.
Unhealthy eating habits among children are further reinforced by the widespread availability of fast food and processed snacks sold not only in shops but outside school gates as well.
Despite regulations in place, vendors continue to operate near schools, offering children easy access to calorie-dense, low-nutrient options - often without their parents' knowledge. But are these vendors even allowed to operate outside schools?
According to the Guidelines on the Ban on Sale of Food and Beverages Outside School Gates (2021 Edition) enforced by local authorities, food premises such as static, mobile and temporary hawkers are strictly prohibited from operating within 40 metres of the school perimeter.
However, existing licensed static hawkers and stall operators are allowed to operate within the 40-metre boundary, but they are not allowed to sell food and drink items mentioned in the List of Prohibited Food and Beverages for Sale in Schools issued by the Ministry of Education Malaysia (MOE).
Meanwhile, Mahani Mohd Baseri, senior assistant for student affairs at Sekolah Kebangsaan King George V, Seremban, Negeri Sembilan, said food and beverages sold by vendors operating outside the school compound do not come under the school's jurisdiction, noting that the responsibility lies with the local authority, in this case, the Seremban City Council.
"As a school, we can issue directives for hawkers to stay 40 to 50 metres away from the school entrance, as outlined in the MOE guidelines. We also issue warning letters to hawkers who remain defiant,' she said, adding the school has also filed reports with the local authority concerned to address non-compliant hawkers.
Mahani emphasised that all food items sold in school canteens comply with guidelines set by MOE.
"School canteens are prohibited from selling snacks, fast food or processed food such as sausages and nuggets. We regularly monitor what is being sold in our canteen and we also maintain a self-inspection file with inspections done by canteen workers and overseen by teachers,' she said.
A study titled 'Fast-Food Consumption among Children According to Shari'ah Perspective', published in July 2021, stated that fast food consumption among children is becoming increasingly worrying due to its association with unhealthy nutrition and long-term health effects.
Children aged 12 to 15 years in Malaysia consume fast food twice a week on average. Different factors influence fast food intake, including a rise in advertising, the growing number of fast food restaurants and changing modern lifestyles, especially in terms of food choices.
BIG BUT FEEL 'SMALL'
Linking obesity to more than just the risk of developing noncommunicable diseases (NCDs), Dr Muhammad Yazid Jalaludin, Professor of Paediatrics at the Faculty of Medicine, Universiti Malaya, said obese children are also at high risk of experiencing emotional and mental health challenges.
He said stress and depression are often silent struggles faced by many overweight and obese children.
"They feel very 'small' despite their large body size. Usually, when obese children feel down, they turn to food and the cycle continues without solving the problem.
"If stress and depression are identified (among obese cases), we begin treatment using psychological methods for therapy and motivation. However, if that fails, we would get psychiatrists involved and begin medical treatment to help them,' said Dr Muhammad Yazid, who is also a senior consultant paediatric endocrinologist at Universiti Malaya Medical Centre (UMMC) and UM Specialist Centre (UMSC).
Sharing his experience treating an 11-year-old obese boy, he said the child was brought in by his grandfather because he was unable to undergo circumcision due to his excess body weight, which led to a condition called buried penis.
A buried penis, which can occur due to several factors including obesity, aging or injuries that cause excess skin or fat to cover the penis, can make certain medical procedures difficult.
"If a child has a buried penis, circumcision cannot be performed using laser or clamp methods due to the high risk of infection if the circumcision wound cannot be properly cleaned,' he said, adding his young patient was given a diet and physical activity plan, which he followed strictly.
Eventually, the boy lost weight and was able to undergo circumcision like other children.
"His grandfather came back to see me and cried. This shows how excess weight and obesity can impact not only the child emotionally but also family members who worry deeply about their condition,' he said.
Pointing to a study he carried out with his team of researchers, the findings of which were published in January this year, Dr Muhammad Yazid said 22,816 primary and secondary schoolchildren from selected government schools in Kuala Lumpur, Selangor and Negeri Sembilan were screened, and 29.4 percent of primary schoolchildren and 26.8 percent of secondary students were found to be overweight and obese.
He said the findings reflected the urgency for effective intervention, leading to the development of the 'My Body is Fit and Fabulous at School' (MyBFF@school) programme, funded by MOH.
"MyBFF@school is a school-based intervention programme developed to tackle childhood obesity in Malaysia. It combines physical activities, nutritional education and psychological support to help schoolchildren adopt healthier lifestyles.
"The programme includes structured games, health talks and motivational sessions aimed at improving both physical fitness and mental well-being,' he said.
WHEN JOKES BECOME TRAUMATIC
Meanwhile, child psychologist Dr Noor Aishah Rosli, who is also managing director of CPC International, said there are obese children who feel ashamed and stressed about their body size and lack self-confidence. Hence, they avoid socialising and isolate themselves.
She said this eventually makes them feel left out and affects their emotional and mental state, which can ultimately impact their academic performance.
"The most common psychological effect experienced by obese children is their sensitivity about their physical appearance, including what they wear, because society generally perceives fat and obese people as unattractive. They are also afraid to socialise for fear of being bullied, either verbally or physically, which worsens their emotional state.
"We often see, not just in schools, that children with larger body sizes are made fun of, whether intentionally or otherwise, through body shaming and other means. I once handled a case of a 10-year-old girl who refused to go to school because her friends called her 'elephant' due to her obesity.
"It was heartbreaking. She had just transferred to a new school and was trying to adjust. Other children laughed at her and didn't want to befriend her. She felt stressed and cried every time she came home from school. So, through mental therapy, we helped her to develop a more positive mindset to deal with the situation,' she said.
WHAT CHILDREN NEED MOST
Dr Noor Aishah added that early signs of mental health problems among obese children include depression, changes in sleep patterns, irregular appetite, irritability, increased sensitivity and being easily offended even over small matters.
According to her, weight-loss programmes are particularly challenging for obese children aged seven to 12 who are still in the "fun' stage of eating, compared to teenagers aged 16 to 18 who are already motivated to look good, stay fit and be free from obesity.
"Another challenge is the pressure from family members who often make sarcastic comments or jokes about a child's body. Some obese children starve themselves for up to two days because they are stressed and believe they can lose weight quickly, but that won't happen because losing weight healthily takes time.
"I've also treated obese children who had difficulty sleeping or suffered from insomnia, prediabetes and high blood pressure. With these conditions, it's hard for them to enjoy school activities like sports and cocurricular activities,' she said.
SWEET, CHEAP, DANGEROUS
Commenting on the wide availability of unhealthy snacks, Consumers Association of Penang (CAP) education officer N.V. Subbarow said hundreds of snack and drink products are sold in the market today, with many imported from neighbouring countries and specifically designed to attract children.
These items, especially confections and colourful beverages, are often sold for as low as 60 to 70 sen, making them even cheaper and more appealing than local products.
He noted that the packaging and bright, rainbow-like colours are deliberately designed to catch children's attention, while the products themselves contain high levels of sugar and little to no nutritional value.
"This is a serious concern. Parents have told us their children are rejecting vegetables and fruits in favour of these sugary treats. Some kids won't even drink plain water anymore - they only want coloured drinks with high sugar content,' he said.
Subbarow called for immediate regulatory intervention to halt the import and widespread sale of such products, especially near schools and in supermarkets, mini markets and night markets.
"If this continues unchecked, these highly processed products will flood the market. Without regulation, our children will develop serious health risks at a very young age and we are already seeing it happen,' he warned.
He also urged MOH and other authorities to regularly organise nationwide health campaigns, not just in the media but also in schools, employing visual materials like posters and streamers to educate both children and parents about the dangers of sugar-heavy diets and childhood obesity.
As Malaysia tackles the childhood obesity crisis, experts emphasise that it is not just about managing weight, it is also about protecting a child's self-worth.
Many of these children tend to isolate themselves, carrying deep emotional wounds from being teased and shamed by others. Beyond healthier eating habits and lifestyle changes, they also need empathy, understanding and the chance to be accepted for who they truly are, not just how they look.
Next week (Monday): In the final part of this series, Bernama seeks feedback from experts and the Ministry of Health Malaysia regarding the immediate actions and measures taken to address the issue of childhood obesity in the country, including from the perspective of regulations and specific legislation.
(This story was produced under the "Communicating Noncommunicable Diseases' Media Fellowship by Probe Media Foundation Inc. [PMFI], Reporting ASEAN [RA] and World Health Organization [WHO]. The views and opinions expressed in this piece are not necessarily those of PMFI, RA and WHO.) - BERNAMA