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Sugar tax may not solve Malaysia’s obesity crisis

Food companies in spotlight as debate continues on how to tackle epidemic

Mahathir Mohamad, who swept to power at the age of 92 in Malaysia in a surprise election victory last May, is determined to do things differently from his predecessor. One thing he has set his sights on is the nation’s waistline. Malaysia has become one of Asia’s most obese countries, according to a study published in medical journal The Lancet in 2014, with almost half the population either obese or overweight, according to the ministry of health. Last November, following the example of other countries in the region, Kuala Lumpur announced it would impose a tax on sweetened beverages with effect from the beginning of April. But while the move has been welcomed by health officials, some say it might not go far enough to counter the problems the country is facing. “Malaysia is one of the fattest countries in the world. What is more alarming is that overweight in children and adolescents are on the rise,” says Ying-Ru Jacqueline Lo, the World Health Organization (WHO) representative to Malaysia, Brunei Darussalam and Singapore. Malaysia is targeting obesity as part of a national plan to tackle the sharp rise in non-communicable diseases, and wants more employers to promote healthier lifestyles as well as encouraging local communities to provide more opportunities for physical activity.

The health implications of Malaysia’s rapid rise in obesity — a condition that is strongly associated with diabetes — has prompted a search for culprits. The Medical Journal of Malaysia published a review of adult obesity research in Malaysia in 2016. The paper, which surveys 15 years of research, refers to national health and morbidity surveys that found 16.6 per cent of Malaysians were classified as overweight (defined as having a body mass index equal to or greater than 25) and 4.4 per cent were classified as obese (a BMI equal to or over 30) in 1996, but that these rates had jumped to 30 per cent and 17.6 per cent, respectively, by 2015.

The paper discusses risk factors, including increased urbanisation, falling poverty rates and a decline in physical activity, but reserves most of its firepower for an examination of changing dietary habits, particularly an increased consumption of sugar. “For a long time, while the price of sugar rose in the world market, its price to the consumer in Malaysia was kept low by a hefty subsidy from the government which was only removed in 2014,” the paper says. But the paper also surmised that Malaysians’ overall intake of calories had increased. Malaysians, the scientists seemed to agree, had simply been eating too much. Some commentators, however, have rejected the idea that greed is the only important factor influencing weight gain and instead see global populations as victims of more sinister efforts by multinational food and drink companies to encourage overindulgence and thereby maximise their profits. In 2016, Margaret Chan, then WHO director-general, warned of the “terrifying speed” of the rise in global obesity rates. She pointed to the “international food system” and alluded to “heavy advertising, also to children, politically powerful lobbies, and money invested to distort the scientific evidence”.

Reprising this theme, an article published in The New York Times in December 2017 about the role of food giants in Malaysia sparked much debate both in and outside the country. The journalists accused food and beverage multinationals, including Nestlé, PepsiCo and Danone, of funding work by a prominent Malaysian nutritionist, Tee E Siong, who has advised the Malaysian government on health policy. Some were quick to defend Tee: the author of one letter to The Star Online, an English-language news site, condemned the article as defamation and argued there was no evidence that corporate influence had tainted Tee’s research.

More than a year later, the multinationals are still keen to emphasise that they do not try to influence policy or scientific research. PepsiCo and Danone confirm that they remain corporate members of the Malaysia-based Southeast Asia Public Health Nutrition Network (SEA-PHN), a research and lobbying group mentioned in The New York Times article. Tee is chairman of the group, which also includes representatives from nutrition societies based in Indonesia, the Philippines, Thailand and Vietnam.

A spokesperson for Danone explains that the company has been a member since it was invited to join at SEA-PHN’s formation in 2014. “There is no direct (commercially exploitable) return for our company, and there is no product promotion at all in the programme,” the spokesperson says. A PepsiCo spokesperson says its membership is focused on its Quaker Oats brand. “Our engagement with SEA-PHN enables us to learn best practices and have dialogues with experts on issues surrounding health and nutrition,” the spokesperson says. “You can connect to five countries at once, as opposed to going to different countries, and learn best practices and dietary guidelines governments are putting forward.”

Nestlé, whose long-term involvement with Malaysia, particularly through the success of its prominent Milo chocolate-malt powdered drink brand, took up a good deal of the New York Times piece, issued a long statement on its position. It said it ended its membership of SEA-PHN in 2018 “because the budget for the membership was diverted for other purposes”. “In Malaysia we are involved in collaborations with the ministries of sports and education on our programmes to support sports, exercise and good nutrition,” the Nestlé Malaysia statement adds. “We are proud of the efforts of the Milo brand to promote physical activity to support active lifestyles,” the statement continues. It explained that each 30g/200ml serving contains less than 20 per cent of the recommended daily added sugar intake of a child.

“Where we work with researchers, we meet all requirements for neutrality, openness, effectiveness and transparency,” Nestlé Malaysia says. Keen to emphasise its points, Nestlé’s global head office in Switzerland also got in touch once it heard that its Malaysia office had been asked for comment. It sent a link to a rebuttal that Nestlé has published on its website, arguing that the New York Times article had left “a misleading impression of how Nestlé is serving people worldwide”. The online statement explained that the company had provided funding for a Nutrition Society of Malaysia study called MyBreakfast. This involved 2,065 primary school children and found that consuming malted drinks was associated with “higher micronutrient intake and higher levels of physical activity, but not with body weight status”.

“As the world’s largest food company, good nutrition has always been at the core of Nestlé,” the global head office wrote in an email. Tee, who in addition to his stewardship of SEA-PHN is head of the Nutrition Society of Malaysia, was unwilling to give a long interview. But he pointed to online statements in which he said he applied “strict ethical standards” to remain independent of corporate partners. Amar Singh, a senior consultant paediatrician and researcher in Malaysia, says the causes of Malaysia’s obesity crisis are more complicated than they might seem. “The crisis is far bigger and multi-factoral. I wouldn’t blame corporations per se,” he says. “Malaysians don’t move much any more — they’re addicted to transport. Levels of physical movement have crashed in children.” Singh finds it odd, however, that malted drinks such as Milo could be described as healthy. “ is not a healthy option because it is high in carbohydrates, and sugar content is very high. It is something you would drink very minimally or cautiously. But it is a favoured drink of Malaysians.”

If the recollections of one 30-year-old Malaysian, who asked not to be identified, is typical, then Milo’s popularity might be easy to explain. “Milo is very close to a lot of Malaysian people. When we were in school we had Milo trucks come to our school, especially on sports day, to give out free Milo to everyone. It’s a very authentic childhood memory, a very nostalgic memory.” The WHO’s Lo says she has no knowledge of whether Malaysian health policy has been influenced by corporations, but she says any agency which advises on national policy should be careful with corporate partnerships. “It is a fundamental conflict of interest. Industry would like to make profits,” she says. Derek Kok, nutrition research associate at the Malaysia-based think-tank Jeffrey Cheah Institute on Southeast Asia, points out that corporate money might be hard to resist in funding-starved Malaysian academia. “When a private company offers to fund your research, it’s definitely an opportunity that you don’t want to miss,” he says of the dilemma facing many Malaysian academics. Whoever is to blame for the obesity crisis facing Malaysia, there is broad support for the sweet drinks tax, even if there is some scepticism on how effective it might be. “Whether it will have impact, we won’t really know,” says Singh. “Malaysians have a sweet tooth and it’s not going to go away any time soon. Tax is not enough. The battle will only be won when we move our addiction away from motorised transport.”

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This article first appeared in Financial Times on 17 January 2019.