MELAKA, March 11 — Some Malaysian children carry more than just extra weight, showing signs of serious health problems that often go unnoticed, says Dr Ng Hui Ying, consultant paediatrician at Oriental Melaka Straits Medical Centre. This extra weight amounts to childhood obesity, appearing even in preschool and primary school children, often affecting sleep, attention, and learning.

American Academy of Paediatrics (AAP) reported that there are 14.4 million children and adolescents are obese, making it one of the most common chronic conditions. A 2025 meta analysis in Malaysia by Chua et al in Clinical and Experimental Paediatrics shows prevalence of obesity rose from 8.4 per cent in 1990 to 14.5 per cent in the 2020s, with 30 per cent of children considering having excess weight, roughly around one in three adolescents are obese or overweight. 

“Malaysia’s children are facing early-onset obesity, even before primary school. Weight is still a sensitive topic for families, and avoiding the discussion can delay screening and intervention. Infants or young children who gain weight rapidly may need evaluation for underlying risk factors,” Dr Ng said.

Paediatricians use body mass index (BMI) charts to identify weight. For children under five, overweight is more than two standard deviations above the WHO growth median, while obesity is more than three. For ages five to 19, overweight is more than one standard deviation above the WHO reference median, while obesity is more than two. Obese children should be screened, while overweight children with two or more risk factors may need further evaluation, the expert explained.

Risk factors include high blood pressure, appearance of darkened skin patches in skin folds, excessive thirst, passing urine too often, snoring at night with daytime somnolence and difficulty paying attention. Children are at higher risk if they have a family history of diabetes, hypertension and heart attack, maternal diabetes during pregnancy and abnormal birth weight. If left untreated, obesity can lead to heart disease, diabetes, liver problems, and emotional challenges. 

Signs of obesity include high blood pressure, darkened skin patches, and attention difficulties. Children with a family history of diabetes, maternal diabetes during pregnancy, abnormal birth weight, excessive thirst, or daytime sleepiness are at higher risk. If left untreated, obesity can lead to heart disease, diabetes, liver problems, and emotional challenges. 

Research shows children with overweight or obesity are more likely to be bullied at school and face higher risks of depression and anxiety, highlighting the importance of early intervention (Cheng et al, 2022; Papadimitriou et al, 2025).

Dr Ng added that most cases are driven by lifestyle factors shaped by the child’s environment, but genetic, hormonal, or metabolic causes must also be considered, particularly in children under five, citing the American Academy of Paediatrics Childhood Obesity Guideline 2023 and Malaysia’s Clinical Practice Guidelines for Management of Obesity 2nd Edition 2023.

She also points to everyday habits driving obesity, including diet, screen time, and physical activity The AAP found children who watch more than two hours of TV daily face a 42 per cent higher risk of obesity, as screen time encourages sugary and processed foods, reduces activity, and shortens sleep duration. Screen time exposure affects families’ food choice and eating habits. Local data are also concerning: The NHMS 2024 shows only half of children eat all five food groups daily, 63 per cent of adolescents drink more than one sugary beverage a day, and 75 per cent exceed fat intake. Two in five eat both dinner and a heavy supper weekly. Children with shorter sleep duration shows higher risks of obesity.

“Family habits matter just as much. Children are more likely to reach a healthy weight when parents respond to hunger and fullness cues, model good habits, and maintain routines. Encouraging balanced meals and regular physical activity helps them self-regulate eating, stay active, and offset the risks of sedentary behaviour and high-calorie intake (Hampl et al, 2023),” Dr Ng elaborated. 

At the same time, routine paediatric check-ups provide opportunity to assess weight, identify underlying causes, and plan interventions. “Obesity is a chronic condition that needs ongoing care,” she said. Families must be involved from the first consultation to make lifestyle changes sustainable for both the child and the household. Early detection and family-based lifestyle changes can prevent lifelong health problems, so parents should not delay conversations about weight, sleep, and nutrition with their child’s doctor.