The latest study by the International Obesity Task Force among European Union member states shows that Maltese children lead the lumpy league. One study after another keeps exposing our expanding waistlines - 60 per cent of the population is either overweight or obese. Ariadne Massa wades through the fat to establish what is being done to tackle what the World Health Organisation is describing as "the epidemic of the 21st century".
A national action plan on food and nutrition involving all the stakeholders is crucial if Malta is to battle the bulge and steer clear of the serious repercussions obesity will have on the country's health infrastructure.
"Obesity has to be seen as a national agenda and everyone has to realise they have a part to play," according to Maria Ellul, Health Promotion Department principal scientific officer.
"Everyone around the globe has realised that obesity is a great economic burden - tackling the growing number of diabetes and heart disease patients, among others, will drain any country's resources. At the end of the day it all translates into pounds, shillings and pence," she added.
Malta, she felt, was failing to see the writing on the wall and to resolve this problem everybody had to roll up their sleeves.
"The writing has been on the wall since the early 1990s but there has never been a multi-dimensional strategic plan of action. We have had a nutrition policy since 1988 but try pushing it among all the social players and it gets stuck," she said.
Ms Ellul insists that education is no longer enough and the issue has now become one of behaviour and not lack of knowledge.
"People know what causes excess body fat but the hardest thing is controlling their behaviour and improving the environment around them, which is not exactly helping the situation," she pointed out.
Ms Ellul and Marianne Massa, the department's principal health promotion officer, both believe that healthy public policies have to include better urban planning, healthy food that is affordable and readily available, coupled with the possible elimination of VAT on exercise machines and gym memberships.
"Nowadays, it's a paradox to go for a 'healthy' walk along the seafront when you have to inhale all the fumes and pollution of passing vehicles," Ms Massa said.
Malta is a signatory to the WHO's Global Strategy On Diet, Physical Activity And Health, which aims to address unhealthy diets and physical inactivity that is one of the leading causes of non-communicable diseases.
The strategy's diet recommendations for populations and individuals include the following:
¤ Achieve energy balance and a healthy weight.
¤ Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards the elimination of trans-fatty acids.
¤ Increase consumption of fruits and vegetables and legumes, whole grains and nuts.
¤ Limit intake of free sugars.
¤ Limit salt (sodium) consumption from all sources and ensure that salt is iodised.
The strategy also puts a heavy accent on physical activity as the fundamental goal to achieving energy balance and weight control. At least 30 minutes of regular exercise on most days is recommended.
Another urgent matter that had to be tackled was school tuck shops, which for some strange reason fell under the discretion of the Education Ministry and not the Health Ministry.
"There are guidelines but I have witnessed tuck shops that sell burgers and fried foods, something that goes against the present policy. Apart from that there is, unfailingly, always a takeaway situated opposite schools selling pastizzi and greasy pizzas," she said.
In the UK, celebrity chef Jamie Oliver has spearheaded a concerted drive to push the government to spend more than a mere 37p per school dinner and to bin the junk food on the menu. Thanks to his determined drive the government last week agreed to spend an extra £280 million on school meals in England over three years.
His campaign included a visit to a southeast London comprehensive school where he attempted to wean 1,400 teenagers off junk food. He appalled children by demonstrating that their favourite chicken nuggets were made of a pulp of, literally, skin and crushed bones.
Chicken nuggets are a popular staple of children's diets in Malta, as are many other fat-laden products. Ms Massa, who works hard to promote a healthy lifestyle among schoolchildren, said it was shocking that Maltese 13-year-old boys and girls had eaten their way to the top and surpassed the US - a country that has long held the trophy for obesity.
Apart from this, adult-onset Type 2 diabetes was also slowly starting to manifest itself in a small number of teenagers as a result of obesity.
According to Joseph Azzopardi, head of the University of Malta's Department of Medicine, this type of diabetes still tends to strike people in their fifth or sixth decade but doctors across the world, including Malta, are very worried because more children are getting it.
Not only are those children who get diabetes likely to face a life of problems, including higher risk of blindness, heart disease and stroke, they are a warning sign that something in our way of life has gone drastically wrong.
Ms Ellul, who has just given a presentation on Tackling Globesity, questioned who was providing immediate help to these children.
"According to the US Centre for Disease Control, the life expectancy of children is estimated to see a reduction of five years because of obesity. Is this something we are going to witness in Malta?"
The minister says
Health Minister Louis Deguara is worried about the effects of obesity on the island's health infrastructure and believes there is the need for a radical change in the island's mentality towards food. He believes education is the answer. Here he explains his position:
What tangible action is the Maltese government taking to control the worrying trend of obesity in Malta?
The Health Promotion Department has a series of initiatives including a Healthy Breakfast Project in primary schools, Move for Health campaign, promoting the Mediterranean diet, media programmes and talks, among others. Plans are also underway to set up a hospital-based Paediatric Obesity Clinic to address the worrying cases of child obesity.
Do you believe this is enough? The British Parliament has recently called for compulsory labelling of foods: red, amber or green, depending on their calories. Would the Maltese government consider a similar move in Malta?
Colour coding is nothing more than a means of education and we are focusing on campaigns that sensitise people and make them more aware of what they eat. The colour code system could have its flaws because something that is low in fat is not necessarily low in calories or sugars. However, we are keeping our options open and do not exclude such a system. What we are focusing on is education and harping on the facts that fat does not mean healthy and that fat babies equal fat adults.
The British government is considering slapping a tax on fatty foods. Would you consider such a move?
A tax on fatty foods is not the solution. Research shows that taxes on cigarettes have not been a deterrent to smokers; they are only effective in dissuading first-time smokers. The best answer is education and targeting young generations.
Facts and figures
¤ Sixty per cent of the population is either overweight or obese, with an average male weighing 78.5kg, compared to the EU average of 78.8kg, and an average female weighing 65.8kg, surpassing the EU average of 65.4kg, according to the Lifestyle Survey 2003 released by the National Office of Statistics.
¤ To exacerbate health problems, the Maltese do not have the height to compensate for their weight. Maltese men have an average height of 169.9 cm, towering slightly over the Portuguese, who are the shortest males in Europe at an average 169.4 cm. The EU average is 175.3 cm. Meanwhile, Maltese women are the shortest in Europe with an average height of 159.9 cm, compared to 164 cm in the EU.
¤ The European Commission estimates that in some of its member states obesity costs between five to 10 per cent of the health budget.
¤ The Body Mass Index (BMI) of Maltese 13-year-old boys is 34 (obese); that in Greenland is 29.5 and in the US 26.8, according to a report on Young People's Health in Malta carried out by Marianne Massa.
¤ Girls fare no better and according to the same report the BMI of 13-year-old girls puts them again in the lead with 30.7.
¤ Another report by the International Obesity Task Force shows that Maltese children aged between seven and 11 are the most obese and overweight in the EU.
¤ The European Commission has threatened to ban the advertising of junk food to children, unless the food industry exercises some form of self-regulation. The Malta Chamber of Commerce and Enterprise favours self-regulation over legislation.
¤ The EU Platform for Action on Diet, Physical Activity and Health has just been launched bringing together the key EU-level representatives of food, retail, catering and advertising industries, consumer organisations and health non-governmental organisations.
Calculate your state
The healthy weight range is based on a measurement known as the Body Mass Index (BMI). This can be determined if you know your weight and your height. To calculate your BMI just follow these three steps.
1. Work out your height in metres and multiply the figure by itself.
2. Measure your weight in kilogrammes.
3. Divide the weight by the height squared (i.e. the answer to Q1.) For example, you might be 1.6m (5' 3") tall and weigh 65 kg (10 stone).
The calculation would then be: 1.6 x 1.6 = 2.56. BMI would be 65 divided by 2.56 = 25.39. Then check your answer with the chart below:
BMI Weight status
BMI less than 18.5 UnderweightBMI 18.5-25 Ideal
BMI 25-30 Overweight
BMI 30-40 Obese - should lose weight
BMI greater than 40 Very obese - lose weight now
Small steps for big gains
The keys to healthy weight are no secret. With regular exercise and good eating habits you can lead a better life. To stay active, try to exercise 30 - 60 minutes every day. If you're not the type to join the gym take advantage of the nice weather and go for a walk - it is the most underrated way of shifting the pounds. Try these activities to get moving:
¤ Go outside for a walk.
¤ Take the stairs instead of the lift.
¤ Park a few blocks away from your destination and walk the rest of the way - every bit counts.
¤ Get off the couch and tackle those household chores, such as vacuuming, washing the car or cleaning the bathroom - they all burn calories.
¤ If you get bored easily change your exercise regime and alternate between running, cycling or skating.
¤ Eating well does not mean dieting. Make healthy eating a way of life.
¤ Soft drinks, fruit juices and sports drinks are loaded with sugar. Drink fat-free, low-fat milk or water instead.
¤ Eat at least five servings of fruit and
¤ Avoid fast-food outlets. If you cannot resist choose grilled chicken or salads. And stick to regular servings, don't go supersize!
¤ Keep healthy snacks at hand to avoid succumbing to chocolates and crisps.
¤ Eat when you are hungry and enjoy the taste, texture, and smell of your meal as you eat it. Remember, it takes approximately 15 minutes for your stomach to signal your brain that you are full.
¤ Eat a healthy breakfast every day. This is the most important meal. Skipping it will only slow down your metabolism.
¤ Help your children make healthier eating choices by involving them in grocery shopping and cooking meals.
¤ Don't use sweets as treats for children. Give them a healthier alternative.