- 1 week ago
1 in 3 Malaysian adults are overweight or obese, also one of the highest obesity rates in ASEAN.
Additionally, obesity-linked NCDs are already costing the economy billions in lost productivity each year.
With Obesity Management Medicines (OMMs) such as GLP-1s reshaping weight care globally and Malaysia’s obesity management market projected to nearly double by 2031 - how do we integrate these therapies safely, equitably and responsibly?
NIAGA SPOTLIGHT features Binh Thai, General Manager, Commercialization – Malaysia, Singapore and Brunei, Zuellig Pharma and Prof Dr Rohana Abdul Ghani, Consultant Endocrinologist and President, Malaysian Obesity Society (MYOS) for this timely conversation.
Additionally, obesity-linked NCDs are already costing the economy billions in lost productivity each year.
With Obesity Management Medicines (OMMs) such as GLP-1s reshaping weight care globally and Malaysia’s obesity management market projected to nearly double by 2031 - how do we integrate these therapies safely, equitably and responsibly?
NIAGA SPOTLIGHT features Binh Thai, General Manager, Commercialization – Malaysia, Singapore and Brunei, Zuellig Pharma and Prof Dr Rohana Abdul Ghani, Consultant Endocrinologist and President, Malaysian Obesity Society (MYOS) for this timely conversation.
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NewsTranscript
00:00Hello and welcome to Nyaga Spotlight with me Tamina Kaosji. Nyaga Spotlight goes through
00:15the week in economic analysis and future affairs. Now today on analysis our spotlight is firmly on
00:20transforming obesity care in Malaysia. Just as a bit of background first though, Malaysia is
00:26certainly facing a growing obesity challenge with more than half of adults now overweight or obese
00:31and quite often ranking among the highest rates in ASEAN. The consequences go well beyond health.
00:38Obesity-driven NCDs, non-communicable diseases are already costing our economy billions each year in
00:45lost productivity. At the same time, obesity management is being reshaped globally by new
00:50medications that are moving rapidly into mainstream care. So these therapies, while they are showing
00:56strong clinical results, they also do require long-term supervised use, careful oversights as
01:02well as robust systems to manage risk. Now Malaysia's obesity and metabolic management market is projected
01:08to nearly double by 2031. The question now is not whether these medicines will play a role but how
01:16responsibly they are going to be integrated in a way that supports economic sustainability together with
01:22equitable access and also of course long-term health outcomes. So that's the context of our entire
01:29discussion this morning. Welcoming to the studios for that, we have with us firstly Professor Dr. Rohana
01:35Abdul Ghani, President of the Malaysian Obesity Society and Bin Tai, who is General Manager of
01:41Commercialization for Malaysia, Singapore and Brunei with Zurich Pharma. A very good morning to the
01:46both of you. So to get the discussion started off straight, Bin, perhaps I could refer to you firstly
01:54looking towards system readiness as well as safety nets. Now Malaysia, as we all know, it's a commonly
02:01known figure. We have around 54.4% of adults either overweight or obese, highest rates in ASEAN and now the
02:09demand for these next generation obesity management medication is exploding globally. What is Zurich
02:16noticing about the Malaysian ecosystem? Perhaps you could position us first before we really dig deep.
02:22Sure. Hi Tamina, thank you for having me here today. Really a pleasure being here.
02:29So in Malaysia, weight management is sort of in a transformative stage, right? Right. We're seeing a
02:35lot of new obviously obesity medication coming to the market including GOP-1s, GIPs. And then so it's not
02:44about traditional medicine anymore or traditional interactions. It's more about how can we provide
02:50these innovative medicines in support of that, right? So I think that's an important first to acknowledge
02:55that there is now more tools available for patients. The second thing is really important is
03:02to recognize that education is really the key to the battle, to winning the battle for obesity over the
03:09next five years. And education for the patients, education for HCPs, for clinicians is an important,
03:17if you will, step to combating obesity here in Malaysia. So in regards to your question around
03:25infrastructure, is Malaysia ready for the to tackle the obesity challenge? That's right. There's certainly
03:32a, you know, a very strong infrastructure already in place here in Malaysia, right? Strong regulatory
03:37framework, strong process around pharmacovigilance, which is sort of being able to educate patients on
03:44the safety of different medications, strong infrastructure in terms of cold chain to ensure the
03:51medications going to the proper place and to the patients. And so I think the infrastructure is
03:57available here in Malaysia to support the, you know, the battle against obesity. So at Zulik Pharma,
04:03our really, our goal is to work with multiple stakeholders here in Malaysia, physicians, hospitals,
04:10clinics, individuals like Prof. Rohana, to really educate patients on the correct use of obesity
04:17medication here in Malaysia. And at Zulik Pharma, we also have a very strong infrastructure to support
04:23the, you know, the safe and effective distribution of obesity medication to the right patients.
04:29Absolutely, because clearly the obesity burden is indeed increasing. Roughly around a decade ago,
04:36it was only around 44% of Malaysians who, adults at least, who seem to be living with obesity,
04:44which brings us, of course, into the perfect segue to Prof. Rohana. So I think now is the absolute
04:50right time to interject with who exactly should these obesity management medications, OMMs, sometimes
04:58they are known more popularly as GLP-1s, who should they apply to? And also, yes, let's clear up any
05:07any myths when it comes to terminology, as well as how they are publicly known to everybody,
05:13especially with the rise of social media in all of these narratives.
05:17Okay, that's a very long question to me now. But first and foremost, thank you again for giving us
05:21the opportunity to talk about obesity as a disease which is inflicting Malaysia. We're quite in dire
05:27straits at the moment with regards to obesity. And just to reiterate in terms of numbers, we mentioned
05:3254.4%, over half of adult Malaysian populations are obese. However, if you really look at that number,
05:41is actually referring to the WHO criteria, which is BMI of more than 30 kilograms per meter squared for
05:47obesity. So that itself, if I can just simplify it for you, is one in five adult population, adult
05:54Malaysians having obesity. But however, if you look at the, if you use the Malaysian cutoff point of BMI of
06:0127.5 kilograms per meter squared, yes, which is our phenotype. And that would come up to 30, 30,
06:08approximately 36% of our adult populations are obese. So that is one in three. So obviously, you know,
06:15something really alarming. So as Bin was saying that this medications is highly effective, it's new,
06:23it's changing the whole landscape of obesity, not just in Malaysia, but globally. Absolutely. And we're
06:28very, very happy about that. But the issue really is who, who are supposed to be taking this medication,
06:34going back to your question. So the indications are that BMI of more than 30 kilograms per meter
06:40square, that's the indication, but it could be lower of 27 kilograms per meter square with comorbidities.
06:45And these comorbidities include metabolic comorbidities, including diabetes, hypertension,
06:50hypolipidemia, OSA, and those with fertility problems, PCOS, there's a whole range.
06:56Cardiovascular risk. Cardiovascular risk, because it has been proven that these medications have benefits,
07:02renal benefit, kidney benefits, as well as cardiovascular benefits, reduction of cardiovascular risk,
07:08risk for heart attacks and stroke. So overall, you know, that they do have their role in terms of
07:15reducing risk overall. But however, it is also indicated in those patients who have other issues,
07:22mental issues, mental issues, and who have tried to lose weight. And we haven't delved into that issue
07:29about how difficult it is to lose weight, just by diet and lifestyle alone. So this is where these
07:34medications come in, to be able to assist in that weight loss quite effectively.
07:40So there's certainly a role to be played. May I also ask Prof Rohana, now given, of course, the unique
07:46obesity and related NCD burden that Malaysia has already had documented for a few decades now,
07:55and also the fact that obesity management medications, they can also be prescribed for those
08:03under 18. What are some of your thoughts around that? Would that also be perhaps another inroad for
08:10Malaysia to consider that OMMs can also be applied clinically for children, especially adolescents 12
08:16and above? Yes. So you've kind of like covered a very important topic there, obesity in adolescence,
08:24which is a huge big area. It's a, you know, as you know, our patients, our diabetic patients,
08:30who used to be of older age, now are getting younger and younger. And because they start young,
08:34then their complications are a lot more. They get heart diseases, they get kidney problems at a very
08:39young age. It's the life cycle. Yeah, yeah, exactly. So the current indications for those
08:45obesity medications are obviously quite limited. So we do have one GLP-1 treatment at the moment,
08:51which is indicated in the adolescence. And as a matter of fact, they're getting younger and younger. But
08:56again, the options are very limited. So the current GLP-1 GIP are currently not yet
09:03indicated for those adolescents. However, having said that, again, emphasizing that diet and lifestyle
09:08is still the number one, the fundamental, the foundation and the basis of obesity management
09:15throughout. So this really depends on, again, highlighting the need for recognizing first and
09:20foremost that obesity is a problem. It needs to be addressed. And you know, these adolescents need to
09:25understand that. And yes, yeah, and of course, the impact on psychological issues or mental issues,
09:32again, so the benefit in terms of weight loss is enormous. So but it's just a matter of taking
09:36that first step of, you know, doing something to lose weight. And perhaps before I jump back to asking
09:44Bin, let's talk about the fact that a majority of Malaysians who may already be using some form of
09:52obesity management medication are not necessarily consulting with clinicians before they are
09:58getting on this routine. That's right. And because their motivations are different. So it's not for
10:05health. They have got other issues. They have got other reasons, not to say that they're wrong reasons,
10:10but they're valid reasons. But again, this is the opportunity to highlight that any of these
10:16obesity medications are effective, but they also come with side effects and adversities.
10:21So they need to be monitored. Especially if you're not being monitored. Yeah, exactly. So then
10:25that really underscores the need for monitoring, for proper consultation. And also, most importantly,
10:31these medications were not meant to produce rapid weight loss because rapid weight loss will result
10:37in loss of lean muscle mass or loss of muscle bulk, which slows down metabolic rate, which, you know,
10:43has other health consequences. So that's one of them. And, you know, you've got other issues,
10:48especially in the young reproductive age group. So, you know, then they are under nutrition,
10:54you know, in particular, in some of these very effective drugs, they lose, they lose appetite.
10:58So they have to be advised on the proper dietary interventions for the use, with the use of GLP-1 and
11:06GLP combinations, you know, in terms of high protein intake, ensuring adequate protein intake,
11:12adequate fiber, adequate water. Yeah, to minimize the complications. Exactly. So it clearly points to
11:18the fact that you ought to be supervised. So for anyone out there as well who's listening, that needs
11:23to be a primary consideration. Thanks, Prof. Bin, perhaps we could move into digging a little bit deeper
11:30about long-term treatment, as well as rebound risk, which has been shown already a little. So tell us
11:38a little bit about the reality of patients who may not be willing to go on OMMs long-term and what are
11:45actually perhaps some of the contraindications and also the benefits of actually long-term using such
11:52OMMs for weight management. Right. That's a very good question. I think we have to treat obesity as a
11:59disease, as a chronic disease. So like any chronic disease, it requires long-term treatment. So that's
12:06the first and foremost, that's the most important aspect of obesity, right? It's not a one-time disease
12:12and resolve it and then it goes away. And so with that, I think what we like to look at is more of a
12:18multi-stakeholder support or approach to obesity, right? So you're looking at lifestyle support,
12:24you're looking at obviously working with the clinicians to provide monitoring to ensure that
12:31the patient is really moving in the right direction for their obesity treatment. The long-term benefits
12:37of managing obesity is, as Prof. Rohana mentioned, is there. There's evidence around, of course,
12:44you know, helping with cardiovascular disease, you know, being more productive in terms of your
12:50lifestyle and also your work productivity, if you will. So I think there is, you know, a lot of
12:57evidence to prove that there is long-term benefit for, you know, for obviously staying,
13:03both a combination of medication and lifestyle changes. And I think that's the important aspect
13:10of obesity. So what we've launched recently at Azulic Pharma is a campaign around My Best Me.
13:19It's a patient awareness campaign. You can go to obesityisadisease-my.com website to really
13:26understand how you can manage your obesity, not just with medication, but with lifestyle changes
13:32and also providing support groups, patient support groups, things of that nature to really
13:36help you manage that long-term approach to obesity. Absolutely. Now, I'm going a little deeper into
13:45the long-term approach as well, Ben. So of course, costing is another concern when it comes to long-term
13:51management, which is why quite often, presumably, it's why people look for a short-term miracle cure,
13:57right? But of course, since we want to encourage long-term management, how should Malaysia be thinking
14:03about, let's say, reimbursement, pricing, and also employer coverage? Because clearly, this is our
14:10obesity as a disease is part of not just our personal and private lives, but also professional
14:15lives and the workspace too. And perhaps could this be something that we need to bring into the workspace
14:21and the workspace too? Yeah, 100% agree. I think there's an aspect of that, that we need to have a
14:27conversation both in the workspace, but also as a society, right, in terms of how do we treat obesity
14:34in the long-term. Of course, centered around the pricing or, if you will, the cost of obesity medication.
14:42I would look at it in a little bit different way, if you will. And I would look at it from, obviously,
14:47from a reimbursement framework, how the government can support long-term care for obesity. And that's not,
14:53that's not just about the medication, that's about lifestyle changes and support, support groups
14:58around that. I would also look at, of course, how, you know, the employer can can be a big, big part of
15:04that. Wellness programs, that's a big thing that's happening in corporate, corporate corporations today
15:09around wellness programs, providing that, you know, scaling that to make sure all corporations, all workspaces
15:15have access, right? That's right. You know, have mental support, patient support, things of that nature,
15:21education. That's something that, obviously, that the corporations can can really help the patient
15:26that is, you know, obese, deal with the long-term implications of it. So what we're really talking
15:32is about the ideal interaction of all the multiple stakeholders, all at once. Looking at the fair amount
15:40of maturity that the Malaysian ecosystem has for obesity care, what would you give us, perhaps,
15:48a potential timeline whereby we could streamline obesity management medications into this ecosystem
15:55to its end of 2025 now, if you were speaking very positively? Right. I think that's a, that's a,
16:02that's the million dollar question, if you will. And Prof. Lohana probably have a better take on it
16:08than I would. But I think that's, that's something that we're going to be dealing with in Malaysia,
16:13and not just Malaysia, but across the globe for, for a number of years, right? I don't think any,
16:19any country has cracked that code, if you will, in terms of, you know, how to deal with long-term
16:24management of obesity. I, I really believe that Malaysia is going in the right direction
16:30by providing both education to the patients, education to physicians, and also stakeholder management,
16:37but also having these new medications now available to patients. So I, I believe we're going in the
16:43right direction. When, when Malaysia will get there, I think that's a, that's a question I, I,
16:48unfortunately, I, I don't have an answer to at this point, but, but certainly we're going in the
16:53right direction. I, I don't know if Prof. Lohana agrees or not. Yeah, but probably conversations like
16:57these help to anchor us better in data and also population uptake. Prof. Lohana.
17:03I just want to add to me, if you may, if you allow me to, um, there is that gap, you know,
17:09that, that we need to fill. And that is that knowledge gap to actually really look at obesity
17:14as a disease. And it's a progressive disease. It has complications, which is not seen, you know,
17:21they're, they're, they're not necessarily visible. Yeah, exactly. And what is very obvious,
17:25if you, if you just take a moment to think about it, and this is a great opportunity for us to be able
17:30to disseminate this, this awareness, if you, if you may say that, that, you know, that if you
17:35understand obesity is a disease, and it's very much similar to diabetes, the complications that
17:40these patients will, will have in the future includes heart diseases, kidney diseases, et cetera,
17:45et cetera, right. And those things are the ones which will cost money in the future.
17:50So when people talk about how expensive these drugs or these interventions are, including surgery,
17:55and, you know, you don't, you know, it's very difficult to make people realize that this is
17:59prevention of those complications that may occur in the future. Even if they may occur, it will,
18:04it will occur much later. So that the, the, the quality of life that patients will gain from the,
18:09the early intervention is, you know, it's, you cannot, you can't even quantify that.
18:14It's creating quality of life. Yeah, exactly. Exactly. Literally. So,
18:18Prof. Rahana, I thought we should now perhaps get a little deeper into looking at the gender
18:24disaggregated nuances of obesity management medication, women versus men. Now, in general,
18:32of course, societal structures, concerns about appearance, et cetera, women are the ones who are
18:37most often seeking obesity management medications. Tell us a little bit more from your working experience.
18:43Right. You are right, actually. In both of my working experience, as well as from literature,
18:47it has been shown that women tend to come for treatment. So it's the ratio, ratio is probably
18:53two third versus a third. So most men think that they can handle it and most men will not see it
18:58as a problem. So women with, again, for, for different reasons, they social peer, peer pressure,
19:04you know, appearances, health benefits, et cetera. So they tend to come for treatment. But however,
19:09in terms of medication, it may actually be, be equal in terms of gender, um, and it really,
19:15a prescription and it really depends on which part of the, of the globe that you are in. So
19:20perhaps in the, in the Western side, uh, women are more, um, are probably getting more of it. But
19:26from the Asian side, um, men seems to have the advantage of, of, of receiving it. Perhaps it's
19:32because they are the earners, you know, and women have other obligations, family, children, and they've
19:38got other excuses, you know, like they've got a lot of housework to do, et cetera, et cetera. So they
19:42don't come for follow-ups, et cetera. So again, I think it really depends on where you are. And it's
19:47very, very strongly influenced by culture. Um, you know, so, and, and the environment. So that is very
19:54difficult to actually pinpoint, but whatever it is, it has been proven that obesity in women is more
20:00prevalent. So, and women have a unique, um, presentation or unique, um, complication risks
20:08for obesity. And that's the reason why MYOS, Malaysian Obesity Society, um, have embarked on this program,
20:15which really highlights, uh, the, the obesity in women. So we've got a guideline on the, um, on how to
20:21manage obesity in women. And, uh, we, uh, um, and this, this program or this, this, this curriculum that we
20:29hope to disseminate among our primary care physicians and because they are the, the, the
20:33fundamental, um, you know, step in terms of the, the first contact with the community, the stepping
20:38stone. Yeah. Yeah, exactly. Exactly. And, um, uh, speaking about the fact that not just obesity, uh,
20:45care, but also OMMs are becoming increasingly, uh, well-known, uh, would you say that it would be time
20:52for a national registry to come into place and how would that assist clinicians as well as
20:58of course, overall multi-stakeholder understanding of the context. So we can have a far more
21:05actionable, uh, roadmap, perhaps not today, but in the very near future, right? Yes, absolutely.
21:12And you said it all. That is exactly what we need. But this, because of the prevalence is so high.
21:17Yes, there are nuances to the data collection too. Yes, that's right. So, you know, and, and involves a
21:23quite a substantial amount of, um, financial support. So it has become, um, you know, we're
21:30working on it. We're working on it because if we have the national diabetes registry, so surely we
21:34can have the national obesity registry, but we are slow in doing that because we are currently, um, yet
21:41to establish obesity as a disease in the country. So even to be, to be fair. The recognition. Yeah,
21:46the recognition because it has implications. We talk about remunerations, right? So that is probably one of
21:52the main reasons why it's a bit, um, people are, all parties are a bit hesitant because it has
21:57implications, economic, social implications on recognizing obesity as a disease. But as clinicians,
22:03that is all that we talk about. You need to be able to see this as a, as a disease, which has
22:09complications, which is even more, um, than any of the other metabolic problems, diabetes, hypertension,
22:16hypolipidemia. Exactly. Um, naming and, uh, identifying the issue really, um, finitely ought not to be so
22:23problematic. Um, thanks for that, Prof. Um, Bin, perhaps, uh, digging a little deeper from your
22:28perspective, uh, and an industry standpoint, looking at some concrete guardrails, which would be
22:34necessary to ensure that the more, uh, off-label usage of, uh, obesity management medications don't,
22:42uh, don't very quickly outpace those who actually require it for actual health and longevity reasons.
22:51I think there's really, um, education is key in providing those guardrails, right? Uh, education
22:58to two parties, if you will. The first is patients, um, making sure that they have project, uh, proper
23:04awareness of the disease, proper awareness of, of the treatment options available to them. Uh, so, um,
23:10we've, we've launched recently a disease awareness campaign called My Best Me, and, um, that, that
23:16allows the patient to really educate themselves on, on, you know, on what, what is obesity and what are
23:21the options available to you. So that's, that's one aspect of it, of, you know, ensuring there's a
23:26strong guardrail there. The second aspect is education to clinicians, um, prescribers or physicians,
23:33if you will. Uh, so as a healthcare service provider, Zooli Pharma, you know, it's our responsibility
23:38to make sure that we, we, we do proper marketing and patient, uh, sorry, uh, product education to the,
23:45to, to the prescribers within the label, uh, providing very transparently the safety data,
23:50the, uh, the clinical studies that are available. So making sure that we, we, we promote on label
23:55and not, and not off label. That's very important for us as a company, uh, to, so that the prescribers
24:01know and the physicians know the proper use of, of these new medications. Absolutely. Because
24:06clearly, uh, what's spreading, um, quite rapidly is the exposure of, um, the general public to what
24:13is also termed an entertainment slash, uh, uh, publicity circles as, for example, quote, unquote,
24:20ozempic body. Celebrities in particular public figures, especially women who have had drastic amounts
24:26of weight loss, which of course then is unfortunately quite often seen as aspirational too.
24:32Um, so rounding out the discussion as well then, Prof Rohana, uh, let's talk about the broader
24:37considerations, um, specifically for women, especially those of reproductive age, uh, first
24:43and perhaps also ending on the crescendo of looking at, uh, postmenopausal women too,
24:49since these also form the bulk of the age groups of women who are seeking, uh, OMMs.
24:55Right. Okay. Um, and we had alluded to that earlier, right? Yes, that's right. Yeah. So,
24:59and that, that kind of summarizes why women are unique, um, you know, in the need for this
25:06obesity medication. So for the younger population, they are seeking, uh, weight loss for those with
25:11PCOS, the polycystic ovarian syndrome, because it affects fertility. Correct. And, you know, and these,
25:16these women, uh, women have struggled for years to, to have a child. So, you know, it definitely has a
25:22place, but however, again, it has to be definitely be assisted or be, um, as an adjunct, only as an
25:29adjunct to diet and lifestyle changes to maintain muscle mass and, uh, adequate protein intake,
25:33adequate nutrition in preparation for pregnancy. For the postmenopausal, um, population. And again,
25:39these are women who, you know, they, they, they eat the same, they exercise the same, but just the
25:44weight just, just piles up. And that is because of the hormonal deficiencies that they experience. So,
25:49again, so there is a role for this, um, for these medications. So, but, but overall,
25:53I think at the end of the day, it's about health. So it's not, it shouldn't be about appearances. And
25:58when it, when it, and it's manipulated by both parties, the seeker as well as the provider. Right. So,
26:06you know, because there's a demand versus, um, supply, then there is always this, this going to be
26:12continuous, um, dynamics of this, this abuse of medications. How do we, um, reconcile it now
26:18that we've been able to also recognize it very early given the unique, uh, properties of, uh,
26:24obesity as a disease condition too? Right. So I think, um, again, it's not so simple. It's a very
26:31complex relationship between these two parties. So, but I think patients need to understand that
26:36the med, um, weight loss is beneficial. Yes, but it should be done gradually and effectively so that
26:42you can sustain it over time because the weight gain is real. It will come back once you stop the
26:47medications and that's what we want. And on the other hand, the healthcare providers should also
26:51be responsible to ensure patient safety, patient efficacy, you know, the, the, the efficacy of the
26:58weight loss and make sure that it's sustained over time, you know, and with the, with the understanding
27:03that, um, you know, this is a progressive condition and, you know, really to take responsibility on,
27:08to explain and to have an informed consent to really make the patient understand what the,
27:12what the journey is about. Exactly. It's not an overnight journey. It's a lifelong journey.
27:17So, you know, I think that should be emphasized. Yes, which also then, of course, points to the fact
27:22that, um, properly administering the OMMs in the first place is both in the interest of the provider
27:28as well as the patient themselves. Thanks very much, Prof Rahana, as well as Bin, for the most insightful
27:33conversation. Well, as Malaysia confronts our escalating obesity burden, OMMs do offer a real
27:39promise but not a shortcut. They are powerful clinical tools that can improve health outcomes
27:44when used responsibly. And that's all we have time for today on Niagara Spotlight with me,
27:49Tamina Kaosji. Here's to a productive week ahead and we'll see you again next time.
28:03Tamina Kaosji.
28:04Tamina Kaosji.
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