Quality-adjusted life years lost to US adults due to obesity more than doubles from 1993-2008

Although the prevalence of obesity and obesity-attributable deaths has steadily increased, the resultant burden of disease associated with obesity has not been well understood. A new study published in the September issue of the American Journal of Preventive Medicine indicates that Quality-Adjusted Life Years (QALYs) lost to U.S. adults due to morbidity and mortality from obesity have more than doubled from 1993-2008 and the prevalence of obesity has increased 89.9% during the same period.

Using data from the 1993-2008 Behavioral Risk Factor Surveillance System, the largest ongoing state- based health survey of U.S. adults, Haomiao Jia, PhD, Columbia University, and Erica I. Lubetkin, MD, MPH, The City College of New York, examined trends in the burden of obesity by estimating the obesity-related QALYs lost, defined as the sum of QALYs lost due to morbidity and future QALYs lost in expected life years due to premature deaths, among U.S. adults. They found the overall health burden of obesity has significantly increased since 1993 and such increases were observed in all gender and race/ethnicity subgroups and across all 50 states and the District of Columbia.

"The ability to collect data at the state and local levels is essential for designing and implementing interventions, such as promoting physical activity, that target the relevant at-risk populations," according to Dr. Lubetkin. "Although the prevalence of obesity has been well documented in the general population, less is known about the impact on QALYs both in the general population and at the state and local levels….Our analysis enables the impact of obesity on morbidity and mortality to be examined using a single value to measure the Healthy People 2020 objectives and goals at the national, state, and local levels and for population subgroups."

From 1993 to 2008, the obesity prevalence for U.S. adults increased from 14.1% to 26.7% (89.9%). Black women had the most QALYs lost due to obesity, at 0.0676 per person in 2008, which was 31% higher than QALYs lost in black men and about 50% higher than QALYs lost in white women and white men. A direct correlation between obesity- related QALYs lost and the percentage of the population reporting no leisure-time physical activity at the state level also was found.

The prevalence of obesity increased over time for all states, while obesity-related QALYs lost tended to follow a similar pattern. However, disparities among states lessened over time, with less obese states "catching up" to more obese states and producing a greater percentage change of QALYs lost.

"Collaborative efforts among groups at the national, state, and community (local) levels are needed in order to establish and sustain effective programs to reduce the prevalence of obesity, "commented Dr. Jia. "Although the impact of current and future interventions on curtailing the burden of disease might not be available for a number of years, this method can provide an additional tool for the Healthy People 2020 toolbox by providing a means to measure objectives and goals. The availability of timely data would enable the impact of evidence-based interventions to be assessed on targeted populations and subgroups, promote continuous quality improvement through monitoring trends, and facilitate head-to-head comparisons with other modifiable health behaviors/risk factors and diseases."

More information: The article is "Obesity-Related Quality-Adjusted Life Years Lost in the U.S. from 1993 to 2008" by Haomiao Jia, PhD, and Erica I. Lubetkin, MD, MPH. It appears in the American Journal of Preventive Medicine, Volume 39, Issue 3 (September 2010). DOI: 10.1016/j.amepre.2010.03.026

Provided by Elsevier
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Technology upgrade needed to stay competitive

M'sia must catch up technologically to stay competitive in E&E sector

By EUGENE MAHALINGAM
eugenicz@thestar.com.my

PETALING JAYA: Malaysia needs to step up its pace technologically if it wants to remain competitive in the electrical & electronics (E&E) sector, according to a report by RAM Rating Services Sdn Bhd.

“Malaysia must catch up technologically to compete against players that are higher up in the value chain, as reliance on lower-end operations will keep the local E&E industry in a vulnerable position.

“In this regard, we believe that investments, which are picking up again industry-wide to revitalise earlier plans halted amid the crisis and expand into new technologies, will enable local E&E players to tap new businesses,” RAM said.

The rating agency also noted that the Government’s efforts to boost the local E&E sector, such as the development of training centres and academic programmes, as well as focus incentives towards strategic segments of the value chain such as design testing and precision machining, were steps in the right direction.

“Nevertheless, it remains to be seen whether these initiatives are sufficient for the sector to leap to the next level,” RAM said.

According to the rating agency, the E&E industry is characterised by the need for continuous capital investments as well as technology upgrades.

“E&E players are required to continually develop new features and capabilities, which require them to also attract and retain developmental talent. As such, technological capabilities and the ability to be ahead of rapid technological changes are key to the success of E&E players.” it said.

It said those that were highly skilled in technology would have a competitive edge, thus making it easier for them to maintain their market positions.

RAM also said having a wide product mix would reduce the exposure of E&E players to just a single market.
“A broader and more diversified clientele also adds strength to a company as it would then be less vulnerable to the loss of any single key customer.

“In addition, more extensive geographical coverage is viewed positively as this would reduce the company’s vulnerability to economic cycles in a particular country.”

The rating agency also said that the competitiveness of an E&E company was underpinned by its operational efficiency.

“Cost structure is important for E&E companies because of pricing pressures, particularly from other emerging economies like China,” RAM said, adding that constant cost-reduction initiatives could offset such pressures.

“Improved operating efficiencies can be derived from cost-efficiency drivers such as economies of scale, mechanised operations or localised benefits, such as easy access to raw materials as well as cheap and skilled labour.”

RAM said the competitiveness of local E&E players had been diminishing when compared with regional counterparts in more technologically advanced economies and countries with lower production costs.

“Malaysia’s overall market share in the global E&E industry has been sliding amid intensifying competition, with the main threat being China’s booming E&E industry.

RAM highlighted that China had evolved into the world’s largest producer of consumer electronics, with exports charting a compound annual growth rate (CAGR) of 28% from 1998 to 2008, compared with Malaysia’s CAGR of 6% during the same period.

“Furthermore, China’s exports of industrial electronics show a CAGR of some 31% from 1998 to 2008, compared with Malaysia’s 8%.”

RAM said the local E&E segment also faced a shortage of skilled personnel, such as software and design engineers, which could hinder the industry’s long-term growth and competitiveness. “Additionally, the E&E industry in other emerging economies, such as Vietnam, are picking up fairly quickly.”

The rating agency also said there was a notable “technological gap” between Malaysia and countries such as Taiwan and Singapore, especially within the electronic components segment.

Jho Low, love him or hate him

ON THE BEAT WITH WONG CHUN WAI

Malaysians, and the world, will continue to hear about Low Taek Jho if his present flamboyant lifestyle continues.

Low: Wants to bring his Hollywood friends to visit Malaysia to promote the country.

US$1m before graduation -On the best stocks he had invested in, Mr Low said 'at the end of the day, it was all about returns and diversification'. -- PHOTO: THE STAR

LET’S admit it – a lot of us would like to be in the shoes of businessman Jho Low. He is flush with cash, parties with Hollywood celebrities and rubs shoulders with the most influential and powerful.

You either love or loathe the 28-year-old businessman who has been dubbed the international mystery man by the world media for his parties with Paris Hilton and Megan Fox and his penchant for expensive champagne.

I had the opportunity to meet this chubby Penangite last week at his office in one of the top floors of Petronas Twin Towers.

He was more interested in talking about how he made his money, mostly in the Middle East, and his friendship with Arab princes who studied with him at Harrow, an English boarding school that has produced seven prime ministers, and the Wharton School of Business at the University of Pennsylvania.

I was more interested in asking him about his exploits, if the word is appropriate, with Paris Hilton and his Hollywood friends.

It was obvious that Low Taek Jho wanted to clear the many media stories, mostly fabricated, that had been reported about him.

He tried to play down the hefty bills for his champagne, his parties and the limousines at his New York apartment, which he said he shares with 11 others.

But I couldn’t help feeling that Low wanted to say that as a single, young man who has made millions, he has the right to be a party animal.

Never mind if he is using his own money – or that of his Arab friends. His lifestyle may be seen as excessive and a waste by others in conservative Malaysia.

Low, who described himself as a businessman and entrepreneur, makes his money by making money for his clients. That’s what people who handle funds do, and he has a portfolio of rich clients.

He puts deals together for businessmen and even governments, using his extensive networking and mostly friendships from his school and university days.

No one can dispute his link with powerful Arab figures like Yousef Al Otaiba, who is currently the ambassador for the UAE to the United States and Mexico.

He talked about certain Hollywood celebrities as if they are his drinking buddies, which they are.

When asked if he had invited Mick Jagger, the Rolling Stones legend, to watch the World Cup in South Africa, his reply was: “I didn’t. I invited Leonardo (Dicaprio) who in turn invited Mick Jagger.”

Are actor Daniel Craig, who plays James Bond, and multi-millionaire rapper Sean “P. Diddy” Combs his neighbours at his apartments?

His reply was: “I don’t know but I have been inside the lift with Sean Combs.”

He denied having any romantic links with Paris Hilton nor any interest in her sister Nicole, saying he was a family friend of the Hiltons and that he handled their investment portfolio.

Low talked of bringing his Hollywood friends to visit Malaysia to promote the country, saying these people had millions of followers on their Twitter.

“Can you imagine the impact they can create for tourism when they promote Malaysia on their Tweets with their millions of followers?”

That would certainly be cheaper than placing advertisements on billboards and in the media, particularly when the international media would also follow these celebrities here.

An advocate of the Blue Ocean Strategy, he has put that on his status message of his Blackberry.
He also sees West Asia and China as massive markets.

Low sees himself as a loyal Malaysian who wants to bring Arab investors to his country, including to Johor’s Iskandar Development project.

But he has also invited criticism with his new-found fame.

His detractors have questioned his credibility and integrity and there are unflattering comments about how he conducts himself and his business deals.

Some have said he is hardly the brilliant financial strategist he has made himself out to be, brushing him off as merely a good salesman. They were outraged by the media prominence accorded to him, including by this newspaper.

But many of these critics have also admitted that they do not know him personally but picked up the negative remarks from friends or friends of friends or the blogs.

His friends, including some powerful figures, say he does not need to open himself to these criticisms as he could choose to stay away. After all, New York and Abu Dhabi are his two working bases.

Malaysians, and the world, will continue to hear about him if his present flamboyant lifestyle continues. He will make good copy for the media.

Hate him or love him, he has attracted attention. This writer has received endless telephone calls from media and business people who want to know him personally, and they include those who hate his guts.

Interest rate hikes starting to help ringgit

Household consumption is watched even though rates rise has not affected debt repayment

WHEN Bank Negara raised interest rates for the third time this year earlier this month, expectations were that the ringgit would appreciate.

That, together with the removal of China’s yen peg to the US dollar, led to suggestions that the ringgit could regain some of the buoyancy in its value against the US dollar that had seen the local currency emerge as one of the best-performing currencies this year.

There was also the school of thought that suggested those domestic interest rate hikes had created a buffer between rates in Malaysia and elsewhere that might see the local currency becoming a carry trade currency.
While the ringgit is not yet seen as a carry trade currency, its slow ascendency against the US has been seen after the third rate hike earlier this month.

After interest rates were raised by 25 basis points to 2.75% in the July 8 meeting of the Monetary Policy Committee, the ringgit saw a brief spurt against the dollar but has since see-sawed in a narrow band.

But that has changed a wee bit as the ringgit has strengthened to its highest level this year as RM3.18 to the dollar yesterday.

That pattern of trade has somewhat broken away from the initial pattern seen after the yuan ended its peg against the US dollar last month.

After a surge, the Chinese currency has traded within a narrow band of between 6.77 and 6.78 to the dollar.
Notwithstanding the slow rise towards the year high for the local currency, the interest rates hikes in recent months, which the central bank says is a move towards normalisation, has led to money entering Malaysia.

While higher domestic rates might have been the main factor, another was the fact that selected Asian currencies were the flavour of the month, given the economic malaise in Europe and the sluggishness of the US economy.

In a response from Bank Negara to StarBizWeek, the central bank says portfolio capital flows were influenced by both domestic and external factors. Domestically, the impressive 10.1% GDP growth in the first quarter of the year, talk of a stronger economy and the transformation of Malaysia into a high-income economy have whet the appetite of investors.

The central bank said in the first quarter of 2010, portfolio inflows amounted to US$3.4bil, a healthy gain from the US$1.4bil in the fourth quarter of 2009.

“Nevertheless, the pace of portfolio flows in recent months has been relatively modest, given the volatility arising from the European sovereign debt crisis and the lingering concerns over the global economic recovery,” says Bank Negara.

“Overall, the flows have been manageable and well-intermediated by the financial system.”

Bank Negara points out that because of the strength and depth of the domestic financial system, inflows are more effectively intermediated without causing undue risk to the economy.

It cites the fact that the ringgit bond market is one of the largest in this region, with a size of 94.1% of GDP.
Furthermore, the country’s Islamic bond market is also deeper than other markets, with the highest number of sukuk issuances recorded this year thus far.

“At the same time, Bank Negara has developed a robust surveillance system that enables us to monitor capital flows on a near real-time basis and Bank Negara is equipped with a wide range of monetary instruments to sterilise these inflows,” says the central bank.

“Bank Negara’s policy is solely to maintain orderly market conditions while at the same time ensure that the ringgit is not misaligned from its fundamentals so that it will not contribute to the build-up of internal and external imbalances.”

Bank Negara adds that interest rate differentials is a determinant of capital flows, but it is not the only one.
“Some of the other factors include economic growth prospects, exchange rate expectations, anticipated returns in the equity market and other investments, as well as investor sentiments,” it says.

The central bank adds that the overnight policy rate of 2.75% was broadly in line with other regional interest rates and that there are many other countries that have higher official interest rates.

The official borrowing rates of Indonesia, the Philippines, China, India and Australia are 6.5%, 4%, 5.31%, 5.5% and 4.5% respectively.

A recent report by Morgan Stanley suggests that the interest rate hike might also have been used as a tool to attract foreign capital to bolster the country’s foreign exchange reserves, which have not kept pace with the rise seen in the reserves of Malaysia’s neighbours.

Foreign exchange reserves saw a drop in the middle of last year and has basically plateaued from the last quarter of 2009.

While the hikes would lead to more capital flowing in, which is welcomed, considering the quantum of the fall, the country is comfortable with the level of reserves as data for the middle of June says it is sufficient to finance eight months of retained imports and 4.4 times the short-term external debt.

The interest rates hike, however, is seen to have an influence on the real sector as a means to cap skyrocketing property prices.

“One of the major assets facing some strong pressure has been the property market,” says RAM Holdings group chief economist Dr Yeah Kim Leng.

“We needed a tightening to prevent a further build-up in those asset prices.”

The effectiveness of a 75-basis-point rise in interest rates might not quell speculation on properties but with the household sector debt now at 76.6% of GDP, higher repayments for debt taken to buy cars, houses and for other consumption needs would bite into private consumption.

Yeah says the rate hike was a move towards a balance between consumption and savings.

The rise in household debt to GDP was partly due to the contraction of GDP of 1.7% in 2009 but authorities are confident that the financial asset side of the ledger remained sound as financial assets to debt was 2.44 times.

The ratio and growing affluence of households has allowed for increased access to financing and with gross non-performing loan ratio for household remaining low at 2.7% at the end of April 2010, over extension of debt might not be a problem just yet.

By JAGDEV SINGH SIDHU

jagdev@thestar.com.my

Tips on how to get loans

Banks tell how they rate credit worthiness of an application

EVERY year, the SMI Association of Malaysia receives complaints from its members about the difficulties of securing credit.

President Chua Tiam Wee says while companies with good track records do not face a major issue in this area, start-up companies and those with less-than-rosy track records continue to have doors shut on them.

Wee suggests two solutions. The first is his call on banks to evaluate the applications of small and medium enterprises (SMEs) carefully and to try to understand the nature of their business and industry.

The second is a call to empower SME Bank to collect deposits, along the lines of a commercial bank.
“This may then help the bank to increase lending to SMEs,” he says.

Chua says SME Bank currently relies on Government funding and its paid-up capital of about RM1.35bil is very small.

How does a bank rate the credit worthiness of an application?

AmBank (M) Bhd retail banking managing director Datuk Mohamed Azmi Mahmood says banks would generally assess five credit factors of an applicant.

These are character, capacity, capital, condition and collateral.

Azmi says character refers to the borrowers’ “willingness” to repay while capacity refers to their ability to generate adequate cashflow to repay the loan.

The remaining three factors – capital, condition and collateral – can be mitigated or compensated by the favourable economic climate and government-guaranteed schemes such as those under Credit Guarantee Corp (M) Bhd (CGC) and Syarikat Jaminan Pembiayaan Perniagaan Bhd, he says.

Azmi says borrowers must show good character, management competency and ability to repay existing loan obligations and other creditors.

“The lack of credit history for those applying for bank loans for the first time can be mitigated and compensated by relevant supporting documents such as updated financial accounts, bank statements and letter of award,” he says.

He says it is important that SMEs maintain proper book keeping to ensure that these documents are available when required, especially their audited financial accounts. “Loan applications from sectors or industries that the Government is promoting will also have a better chance of having their applications approved,” Azmi says.

He says SME loans make up a fourth of AmBank’s loan portfolio to corporates and enterprises last year.
Hong Leong Bank Bhd group managing director Yvonne Chia says loan applications that show good repayment capacity, acceptable business risks and account performance track records will be considered favourably.

She says financial assistance to SMEs comprised 40% of Hong Leong Bank’s business banking portfolio as at March 2010.

Meanwhile, HSBC Bank Malaysia Bhd deputy managing director (commercial banking and director sales) Thomas Varughese says one of the main reasons to reject an application is the lack of financial information that can show the sustainability or viability of a business.

For instance, he says, many SMEs do not pay enough attention to managing their financial position to portray a picture of success, or to show evidence of business continuity.

This makes it difficult to approve the application, Varughese says.

“Poor credit history of the SMEs, including that of its directors and/or guarantors is another issue,” he says.

Varughese says if the SMEs or their associated directors or guarantors have exhibited poor credit history, which is shown in missing payments on their existing loans including personal loans and credit cards, this will give a negative impression on the overall credit assessment.

To secure a loan, he says, SMEs should have a detailed business plan that explains why the loan is needed in the first place.

“It will also be helpful to provide information about the business (company or management profile), nature of the business and financial statements or accounts for at least the last two to three years,” he says.

Varughese says the provision of well-thought-through cashflow statements can also provide further evidence for the need for the financial assistance, adding that SMEs may visit HSBC website for guidance on how to apply for loans.

He says that as of last year, more than 22% of HSBC’s loan portfolio is SMEs loans.

Varughese says the bank is not keen to finance businesses that may be considered as unsustainable or destructive to the environment.

“At HSBC, we believe that being a sustainable business is not only about delivering profitable long-term growth, but also about maintaining a stable environment and building healthy, educated communities,” he says.

 By LEE KIAN SEONG  
lks@thestar.com.my