Obesity, Type-II Diabetes and the Use of Food Labels: A Malaysian Perspective


Diabetes, Obesity, Pharmacy, Nutritional Labels.

How to Cite

Mumtaz Hussain, & Shariza Sahudin. (2019). Obesity, Type-II Diabetes and the Use of Food Labels: A Malaysian Perspective. Journal of Pharmacy and Nutrition Sciences, 9(3), 144–151. https://doi.org/10.29169/1927-5951.2019.09.03.2


Nutritional labelling of processed foods serve to implement consumer-driven food choices in an attempt to reduce the myriad of food and obesity-related chronic diseases, including type-2 diabetes and heart disease, prevalent in modern societies and posing a significant strain on healthcare resources. Many countries, including Malaysia, have moved towards both voluntary and mandatory regulations to policy such public-health interventions, requiring disclosure of nutritional information on food labels. [1-3], often with particular emphasis on sugar, salt and fat content. The introduction of these policies demonstrates the considerable medical and economic burden of obesity and chronic diseases such as type-2 diabetes on healthcare, and recognition among policymakers of the need for dietary intervention through patient education. Various obstacles exist in ensuring consumers use nutritional labelling, including clarity of information, consumer health orientation, literacy levels, motivational factors and health education levels. It is clear however that consumers and patients need to be better informed to effectively utilise nutritional information in order to make better food choices to address the burden of obesity and non-communicable diseases such as diabetes.



Banterle A, Cavaliere A. Is there a relationship between product attributes, nutrition labels and excess weight? Evidence from an Italian region. Food Policy 2014; 49: 241. https://doi.org/10.1016/j.foodpol.2014.09.001

MacKay S. Legislative solutions to unhealthy eating and obesity in Australia. Public Health 2011; 125: 896. https://doi.org/10.1016/j.puhe.2011.06.004

The National Plan of Action for Nutrition of Malaysia III 2016-2025. Malaysian Ministry of Health, 2016, http://nutrition. moh.gov.my/wp-content/uploads/2016/12/NPANM_III.pdf. Accessed on Jan 12th, 2019.

Feisul Idzwan Mustapha, Soraya Azmi, Mohd Rizal Abdul Manaf, Zanariah Hussein, Nik Jasmin Nik Mahir, Fatanah Ismail, Azimatun Noor Aizuddin, Adrian Goh. What are the direct medical costs of managing Type 2 Diabetes Mellitus in Malaysia? Med J Malaysia Vol 72 No 5 October 2017.

Dietary Sugars Intake and Cardiovascular Health A Scientific Statement From the American Heart Association. http://ahajournals.org. Accessed on April 17, 2019.

Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009; 120: 1011-20. https://doi.org/10.1161/CIRCULATIONAHA.109.192627

Ahmad MH. Food Consumption Patterns: Findings from the Malaysian Adults Nutrition Survey (MANS) 2014. Institute for Public Health, Ministry of Health Malaysia 2015; Vol 70 (1). Available from: http://www.iku.gov.my/images/IKU/Document/ REPORT/NHMS2014-MANS-VOLUME-2-SurveyFindings.pdf. Accessed December 2015.

Amarra MSV, Khor GL, Chan P. Intake of added sugar in Malaysia: a review. Asia Pac J Clin Nutr 2016; 25(2): 227-240.

Khor GL, Food availability and the rising obesity prevalence in Malaysia. IeJSME 2012; 6 (1): 61-68.

Naidu BM, Mahmud SZ, Ambak R, Sallehuddin SM, Mutalip HA, Saari R, Sahril N, Hamid HA. Overweight among primary school-age children in Malaysia. Asia Pac J Clin Nutr 2013; 22(3): 408-15.

Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4(2): 187-192. https://doi.org/10.4103/2249-4863.154628

Anderson PM, Butcher KE. Childhood obesity: trends and potential causes. Future Child 2006; 16(1): 19-45. https://doi.org/10.1353/foc.2006.0001

SACN. The Scientific Advisory Committee on Nutrition Recommendations on Carbohydrates, including Sugar and Fibre 2015. Public Health England. Available from: https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report. Accessed April 2016.

Hurt RT, Kulisek C, Buchanan LA, McClave SA. The Obesity Epidemic: Challenges, Health Initiatives, and Implications for Gastroenterologists. Gastroenterol Hepatol 2010; 6(12): 780-792.

Zaki M, Robaayah Z, Chan SP. Malaysia Shape of the Nation (MySoN): a primary care based study of abdominal obesity in Malaysia. Med J Malaysia 2010; 65: 143-149.

Mafauzy M, Zanariah H, Nazeri A, Chan S.P. DiabCare 2013: A cross-sectional study of hospital-based diabetes care delivery and prevention of diabetes-related complications in Malaysia. Med J Malaysia 2016; 71(4): 177-185.

Abraham TM, Caroline SF. Implications of Rising Prediabetes Prevalence. Diabetes Care 2013; 36(8): 2139-2141. https://doi.org/10.2337/dc13-0792

Palaian S, Chhetri A, Prabhu M, Rajan S, Shankar P. Role of pharmacists in counselling diabetes patients. Internet J Pharmacol, 2005; 4, 1-13.

Mafauzy M, Hussein Z, Chan S. The status of diabetes control in Malaysia: Results of DiabCare 2008. Med J Malaysia, 2011; 66(3): 175-181.

Institute for Public Health (IPH) 2015. National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems; 2015. 315 p. Report No.: MOH/S/IKU/52.15.

Letchuman G, Wan Nazaimoon W, Wan Mohamad W, Chandran L, Tee G, Jamaiyah H, Ahmad Faudzi Y. Prevalence of diabetes in the Malaysian national health morbidity survey III. Med J Malaysia 2010; 65(3): 180-186.

McGovern A, Tippu Z, Hinton, W, Munro N, Whyte M, de Lusignan S. Systematic review of adherence rates by medication class in type 2 diabetes: a study protocol. BMJ Open, 2016; 6. https://doi.org/10.1136/bmjopen-2015-010469

Currie C.J, Peyrot M, Morgan C.L, Poole C.D, Jenkins-Jones S, Rubin R.R, Burton C.M, Evans M. The Impact of Treatment Noncompliance on Mortality in People with Type-2 Diabetes. Diabetes Care, 2012; 35(6): 1279-1284. https://doi.org/10.2337/dc11-1277

Muszbek N, Brixner D, Benedict A, Keskinaslan A, Khan Z. M. The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review. International Journal of Clinical Practice, 2008; 62: 338-351. https://doi.org/10.1111/j.1742-1241.2007.01683.x

Chew B.H, Hassan N.H, Sherina M.S. Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study. Patient preference and adherence 2015; 9: 639-648. https://doi.org/10.2147/PPA.S81612

Khunti K, Gray LJ, Skinner T, et al. Effectiveness of diabetes education and self-management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three-year follow-up of a cluster randomised controlled trial in primary care. BMJ 2012; 344. https://doi.org/10.1136/bmj.e2333

Drichoutis AC, Lazaridis P, Nayga Jr RM. Consumers' use of nutritional labels: a review of research studies and issues. Acad Mark Sci Rev 2006; 9: 1.

Bruno Rushforth, Carolyn McCrorie, Liz Glidewell, Eleanor Midgley and Robbie Foy Br J Gen Pract 2016; 66 (643): e114-e127. https://doi.org/10.3399/bjgp16X683509

Dhippayom T, Fuangchan A, Tunpi S, Chaiyakunapruk N. Opportunistic screening and health promotion for type 2 diabetes: an expanding public health role for the community pharmacist. Journal of Public Health, 2013; 35(2): 262-9. https://doi.org/10.1093/pubmed/fds078

Sahudin S, Hussain M, Yahaya F. A preliminary study of the potential role of Malaysian community pharmacists in type 2 diabetes medicines management clinics. J Pharm Pract Res 2018; 48: 377-383. https://doi.org/10.1002/jppr.1380

Brian L. Wilcox, PhD Dale Kunkel, PhD Joanne Cantor, PhD Peter Dowrick, PhD Susan Linn, EdD Edward Palmer, PhD. Report of the APA Task Force on Advertising and Children. [Internet

Jones C.M. The UK sugar tax - a healthy start? Bri Dent J 2016, 221, 59 - 60. https://doi.org/10.1038/sj.bdj.2016.522

Adam Smith. 1776. “An Inquiry into the Nature and Causes of the Wealth of Nations”. Library of Economics and Liberty. https://www.econlib.org/library/Smith/smWN.html. Accessed on 11th March 2017.

Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organization; 2016. Available from: http://apps.who.int/iris/bitstream/10665/204176/1/9789241510066_eng.pdf?ua=1. Accessed on 14th July 2018.

Thow AM, Downs SM, Mayes C, Trevena H, Waqanivalu T, Cawley J. Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action. Bull World Health Organ 2018; 96: 201-10. https://doi.org/10.2471/BLT.17.195982

Soft Drinks Industry Levy comes into effect. HM Treasury, 2018. [https://www.gov.uk/government/news/soft-drinks-industry-levy-comes-into-effect

Guerrero-López CM, Unar-Munguía M, Colchero MA. Price elasticity of the demand for soft drinks, other sugar-sweetened beverages and energy dense food in Chile. BMC Public Health 2017 02 10; 17(1): 180. https://doi.org/10.1186/s12889-017-4098-x

Powell LM, Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev 2013 Feb; 14(2): 110-28. https://doi.org/10.1111/obr.12002

Guerrero-López CM, Unar-Munguía M, Colchero MA. Price elasticity of the demand for soft drinks, other sugar-sweetened beverages and energy dense food in Chile. BMC Public Health 2017 02 10; 17(1): 180. https://doi.org/10.1186/s12889-017-4098-x

Rachel B. Acton, David Hammond. The impact of price and nutrition labelling on sugary drink purchases: Results from an experimental marketplace study. Appetite 2018 121 129-137. https://doi.org/10.1016/j.appet.2017.11.089

Koen N, Wentzel?Viljoen E, Blaauw R. Price rather than nutrition information the main influencer of consumer food purchasing behaviour in South Africa: A qualitative study. Int J Consum Stud 2018; 42: 409-418. https://doi.org/10.1111/ijcs.12434

Chen HJ, Weng SH, Cheng YY, Lord AYZ, Lin HH, Pan WH. The application of traffic-light food labelling in a worksite canteen intervention in Taiwan. Public Health 2017 Sep; 150: 17-25. https://doi.org/10.1016/j.puhe.2017.04.005

Pauline Castres, Informed food choices for healthier consumers. The European Consumer Organisation 2015; Ref: BEUC-X-2015-008. Available from: http://www.beuc.eu/publications/beuc-x-2015-008_pca_beuc_position_paper_on_nutrition.pdf. Accessed 2nd January 2016.

Natalie Morrison, UK traffic light labelling should be mandatory: LGA [Internet

Barreiro-Hurlé J, Gracia A, de-Magistris T. Does nutrition information on food products lead to healthier food choices? Food Policy, 2010; 35(3), 221-229. https://doi.org/10.1016/j.foodpol.2009.12.006

Neuhouser ML, Kristal AR, Patterson RE. Use of food nutrition labels is associated with lower fat intake. J Am Diet Assoc 1999: 45. https://doi.org/10.1016/S0002-8223(99)00013-9

Kim SY, Nayga Jr RM, Capps O. Food label use, self-selectivity, and diet quality. J Consum Aff 2001; 35: 346e63. https://doi.org/10.1111/j.1745-6606.2001.tb00118.x

Variyam JN. Do nutrition labels improve dietary outcomes? Health Econ 2008; 17: 695. https://doi.org/10.1002/hec.1287

Cavaliere A, De Marche E, Banterle A. Investigation on the role of consumer health orientation in the use of food labels. Public health 147 (2017) 119 e127. https://doi.org/10.1016/j.puhe.2017.02.011

Safe food (2007). Food safety in the Republic of Ireland: attitudes among industry, consumers and young people. Report to the Consultative Council of the FSAI. http://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Publications/Research%20Reports/StrategicDevelopmentReviewOfHealthBoardFoodControlLaboratories.pdf. Accessed on 12th September 2018.

A Research Study into Consumers’ Attitudes to Food Labelling, Food Safety Authority Ireland. https://www.fsai.ie/workarea/downloadasset.aspx?id=8900. Accessed on 28th November 2018.

Enright G, Good H, Williams N. Qualitative research to explore people's use of food labelling information: final report. Prepared for Social Science Research Unit, Food Standards Agency. Ipsos MORI. Unit Report 5 2010.

Cavaliere A, De Marchi E, Banterle A. Healthy/unhealthy weight and time preference: is there an association? Appetite 2014; 83: 135. https://doi.org/10.1016/j.appet.2014.08.011

Cha E, Kim KH, Lerner HM, Dawkins CR, Bello MK, Umpierrez G, Dunbar SB. Health literacy, self-efficacy, food label use, and diet in young adults. American Journal of Health Behaviour 2014; 38(3): 331-339. https://doi.org/10.5993/AJHB.38.3.2

Huizinga MM, Carlisle AJ, Cavanaugh KL, et al. Literacy, numeracy, and portion-size estimation skills. Am J Prev Med 2009; 36(4): 324-328. https://doi.org/10.1016/j.amepre.2008.11.012

Emma Tonkin, John Coveney, Samantha B. Meyer, Annabelle M. Wilson, Trevor Webb. Managing uncertainty about food risks: Consumer use of food labelling. Appetite 2016; 107: 242-252. https://doi.org/10.1016/j.appet.2016.08.015

Grunert KG, Wills JM. A review of European research on consumer response to nutrition information on food labels. J Public Health 2007; 15: 385-399. https://doi.org/10.1007/s10389-007-0101-9

Sing Chuan Kok, Che Wan Jasimah Mohamed Radzi. Accuracy of nutrition labels of pre-packaged foods in Malaysia, 2017. British Food Journal, Vol. 119 Issue: 2, pp.230-241. https://doi.org/10.1108/BFJ-07-2016-0306

Halit Tanju Besler; Zehra Buyuktuncer, PhD; Muhammad Fatih Uyar, PhD. Consumer Understanding and Use of Food and Nutrition Labeling in Turkey J Nutr Educ Behav 2012; 44: 584-59. https://doi.org/10.1016/j.jneb.2012.01.005

Food Standards Agency. Qualitative Research to Explore Peoples Use of Food Labelling Information. IPSIS MORI. Unit report 5 2010. Available from: https://www.food. gov.uk/sites/default/files/multimedia/pdfs/qualilabelres.pdf . Accessed 12th December 2017.

FDA Food and Diet Survey. Center for Food Safety and Applied Nutrition. Food and Drug Administration. May 6, 2016. https://www.fda.gov/downloads/food/foodscience-research/consumerbehaviorresearch/ucm497251.pdf. Accessed on December 21st 2018.

Cecchini M, Warin L. Impact of food labelling systems on food choices and eating behaviours: a systematic review and meta?analysis of randomized studies. Obesity Reviews 2016; 17(3): 201-210. https://doi.org/10.1111/obr.12364

Antúnez L, Giménez A, Maiche A, Ares G. Influence of interpretation aids on attentional capture, visual processing, and understanding of front-of-package nutrition labels. Journal of Nutrition Education and Behavior 2015; 47(4): 292-299. https://doi.org/10.1016/j.jneb.2015.02.010

Anne O. Peschel, Jacob L. Orquina, Simone Mueller Loose. Increasing consumers' attention to capture and food choice through bottom-up effects. Appetite, Volume 132, 1 January 2019, Pages 1-7. https://doi.org/10.1016/j.appet.2018.09.015

Central Connecticut State University, World's Most Literate Nations, http://www.ccsu.edu/wmln/rank.html. Accessed on 4th of March 2019.

Soederberg Miller, L. M. Nutrition Label Literacy: The Intersection of Health Literacy and Food Label Reading Research Findings and Implications for Educators. AADE in Practice 2016; 4(4): 38-42. https://doi.org/10.1177/2325160316650253

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