The War on Sugar: A Pharmacist’s Take on Tackling Malaysia’s Silent Health Crisis
As a pharmacist who has witnessed the devastating impact of sugar-related diseases firsthand, I can tell you that we Malaysians love our sugar – it’s deeply embedded in our culture, from the beloved teh tarik at mamak stores to traditional kuih-muih.
For many, sugar consumption has evolved beyond occasional treats into a daily habit, accumulating quickly through soft drinks, pastries, bubble tea, and even savory dishes like curry.
The Scale of Sugar Consumption
The statistics are alarming: we consume an average of 43 kg of sugar annually, equivalent to 29.5 teaspoons daily [1]. This amount triples the World Health Organisation’s recommended daily intake of 10 teaspoons or 10% of daily energy consumption. Unfortunately, this love affair with sugar rarely ends sweetly.
The Growing Health Crisis
In my years of practice, I’ve seen how excessive sugar intake has fueled the surge in non-communicable diseases (NCDs). The National Health Morbidity Survey 2023 confirms what I’ve observed on the ground [2]:
- 2.3 million Malaysian adults now live with three NCDs: diabetes, hypertension, high cholesterol and/or obesity.
- Diabetes prevalence has slightly decreased from 1 in 5 (NHMS 2019) to 1 in 6 Malaysians (NHMS 2023), possibly due to COVID-19-related mortality. However, 1 in 6 is still a staggering number!
- 84% of young adults with diabetes do not know they have it.
- The percentage of overweight and obese adults has increased from 50% to 54.4%
I expect these numbers to rise further because we’re not doing enough to prevent them. We’re less physically active now, 95% of us don’t eat enough fruits and vegetables, and 2 in 5 of us don’t undergo health screening.
The Hidden Impact of Diabetes: What I’ve Witnessed
During my time as a ward pharmacist and Diabetes Medication Therapy Adherence Clinic Pharmacist at Kulim Hospital Kedah, I observed a deeply concerning trend – diabetes increasingly affecting younger Malaysians, including those in their 30s and even teenagers. These weren’t Type 1 diabetes cases but Type 2 – directly linked to lifestyle and diet.
The implications extend beyond mere statistics; they’re personal and tragic. While diabetes might not seem alarming initially – after all, people with diabetes don’t immediately feel pain or struggle – what often goes unseen is that diabetes is a gateway to life-threatening complications. I’ve watched patients with uncontrolled diabetes suffer strokes, heart diseases, kidney failure, and in severe cases, undergo amputations.
Later, as CEO of the National Kidney Foundation of Malaysia, I witnessed a similar trend with younger patients requiring kidney dialysis. Diabetes remains the primary cause of kidney failure in over half of new dialysis patients [3].
For every individual who loses mobility due to amputation, becomes bed-bound from a stroke, or faces thrice-weekly dialysis treatments, there are tremendous emotional and financial impacts on families. Imagine needing RM 4,000 monthly for dialysis alone – even most T15 households would struggle with this burden, let alone B40 families barely covering daily expenses.
Current Government Policies: Progress and Limitations
Sugar Tax Initiative
The government’s recent Budget 2025 proposes increasing the sugar tax from 50 cents to 90 cents per liter on sugar-sweetened beverages [4]. While I welcome this 80% increase, I see several limitations that we ought to continue to address:
- The World Health Organization advised that a tax on sugar drinks that raises prices by 20% can lead to a 20% reduction in consumption
- The price increase with the new sugar tax may not sufficiently deter consumption
- A 1.5-liter soft drink would only increase by RM 0.60 (14%)
- A 320ml can would increase by just RM 0.13 (6%)
- The tax only applies to beverages containing over 5g of sugar per 100ml
- Many manufacturers simply reduce sugar content slightly to avoid the tax
Lastly, the majority of Malaysians consume sugar from various other sources that the policy doesn’t address, such as freshly made beverages at local eateries. We love our teh tarik, kopi peng, and Milo dinosaurs, all loaded with condensed milk and sugar, along with pastries, fast food, and carbo-rich staples like nasi kandar and roti canai.
The Sugar Subsidy Paradox
Ironically, while implementing sugar taxes, Malaysia maintains substantial sugar subsidies (RM 600 million annually), keeping prices among the world’s lowest [5]. From my perspective in healthcare, these funds could be better allocated to strengthening public health initiatives, primary care, health awareness, lifestyle education, and early diabetes intervention for better primary and secondary prevention of diabetes and other NCDs.
Health Screening Programs: Promise and Gaps
I appreciate the government’s efforts in establishing various screening initiatives:
- SOCSO/PERKESO’s Health Screening Programme for employees aged 40+ [6]
- Protect Health’s PEKAB40 for B40 citizens [7]
- Basic screening at government clinics
- NGO-led screening programs, namely National Kidney Foundation of Malaysia, National Cancer Society Malaysia and others [8,9]
However, through my experience, I’ve observed a critical gap between screening and follow-up care. Many individuals, even after detecting risk factors, don’t pursue treatment, leading to delayed intervention and worse outcomes.
There may be multiple reasons for this behavior, including fear of addressing the disease, inconvenience in accessing consultations, lack of awareness about the importance of early intervention, and more. Therefore, it is crucial to close the gap between screening and follow-up care, ensuring that screenings lead to effective treatment and prevention!
Shaping a Healthier Future Together
Now, in my role within the pharmaceutical and nutraceutical industry, I continue championing lifestyle changes and sustainable health solutions. I believe the War on Sugar is a fight for our nation’s and our children’s future, requiring participation from all sectors – the Rakyat, parents, families, communities, government, and industry players.
The solution isn’t as simple as organizing nationwide health awareness campaigns. We need to address all aspects affecting health outcomes, including where people live, play, stay and work, their socioeconomic factors, physical environment, health behaviors, and access to affordable healthy options and quality healthcare.
Healthy living shouldn’t be a short-term trend or an optional choice, but a natural part of Malaysian life.
References
[1] Helgi Library. “Sugar Consumption per Capita: Malaysia” https://www.helgilibrary.com/indicators/sugar-consumption-per-capita/malaysia/
[2] National Health Morbidity Survey 2023. Institute for Public Health, Ministry of Health Malaysia https://iku.nih.gov.my/images/nhms2023/key-findings-nhms-2023.pdf
[3] Malaysian Dialysis and Transplant Registry 2023. 31st Report https://www.msn.org.my/nrr/31st-report-of-the-malaysian-dialysis-and-transplant-registry-2023/
[4] Sugary drink tax to be raised to 90 sen per litre next year, from 50 sen now (https://theedgemalaysia.com/node/730731)
[5] Malaysiakini (2023). “Malaysia’s Sugar Subsidies Analysis” https://www.malaysiakini.com/announcement/722931
[6] SOCSO/PERKESO Health Screening Programme HSP 3.0 https://www.perkeso.gov.my/en/perkhidmatan-kami/perkhidmatan-lain/belanjawan-2023/program-saringan-kesihatan-hsp3-0.html
[8] National Kidney Foundation of Malaysia. Prevention Activities https://nkf.org.my/prevention/calendar-activities/
[9] National Cancer Society Malaysia. Cancer Screening Clinics https://cancer.org.my/get-screened/cancer-screening-clinics/
Khor Xin Yun
Registered Pharmacist | CEO of Pharm-Dx