Malaysia's silent epidemic: the staggering cost of unhealthy lifestyles

Introduction Malaysia faces a large and growing burden of non-communicable diseases (NCDs) linked to modifiable behavioural risk factors, with substantial implications for healthcare spending and economic productivity. This paper quantifies the current NCD burden attributable to major lifestyle risks in Malaysia and estimates the avertable health and economic gains from aligning population behaviours with World Health Organization (WHO) recommendations. Methods Using the Preventable Risk Integrated ModEl (PRIME), we model the annual number of disease cases attributable to eight behavioural risk factors, including diet (salt, fats, fibre, fruit and vegetables, and free sugars via an energy intake and BMI pathway), physical inactivity, alcohol and tobacco consumption. We then monetise the resulting disease burden using disease-specific direct treatment costs and indirect productivity losses from absenteeism and presenteeism. Results Our estimates indicate a larger NCD-related economic burden than reported in previous Malaysian assessments, although differences in coverage and productivity valuation limit direct comparability. Our research implies that approximately 7.7 million annual disease cases are attributable to the behavioural risks considered, corresponding to a principal estimated economic burden of about USD 41.9 billion (USD 14.8 billion in direct costs and USD 27.1 billion in indirect costs). Excess sugar intake, high salt consumption, and smoking account for the largest shares of this attributable burden. Under a counterfactual in which dietary and activity patterns meet WHO guidelines and smokers fully substitute combustible cigarettes with lower-exposure non-combustible alternatives, we estimate that roughly 647,000 disease cases and USD 3.7 billion in annual costs could be averted. Discussion The results highlight the concentration of prevention potential in a small set of risks, providing a granular evidence base to prioritise interventions targeting sugar, salt, and tobacco smoking. The findings suggest that existing policy approaches-largely based on uniform taxation, information campaigns, and regulatory restrictions-may not be sufficient to induce substantial behavioural change at the population level. To enhance policy effectiveness, a complementary policy logic warrants consideration: guided choice intervention, aimed not only at reducing overall consumption, but at shifting consumption towards lower-risk product profiles within the same category.