Maltese schoolchildren may be the most overweight and obese in Europe but they are in denial over their chubbiness and very few think they are "too fat", a new report reveals.
Maltese 15-year-olds - 32 per cent of boys and 28 per cent girls - hold the title for being the fattest in 41 countries, even surpassing the US, according to the latest Health Behaviour of School-Aged Children Study.
The study also places Malta second to the US for overweight or obese 11-year-olds (30 per cent boys, 25 per cent girls), and 13-year-olds (31 per cent for both boys and girls) according to their body mass index.
The World Health Organisation recognises that the levels of overweight and obese children have reached epidemic proportions in most industrialised countries but Malta takes the biscuit.
WHO stresses that a high BMI during childhood and adolescence is associated with an increased risk of adult obesity and premature death.
Despite Malta's heavy proportions, children seem to think their weight is normal and they are blissfully unaware of their situation. When asked if they thought they were "too fat", few thought their weight was a problem.
The study shows how just 21 per cent of girls and 16 per cent of boys aged 11 thought they were too fat (ranking 35th out of 41 countries), exposing similar rankings among those aged 13 and 15.
Marianne Massa, principal investigator of the HBSC survey in Malta, believes this mentality is tied to the cultural mores where the family tends to see children, especially "big boys", as a sign of health and strength.
The study points out that being slim was greatly valued in society, especially for females, and the stigma of those who were overweight appeared to be increasing, creating a public health concern.
The HBSC study, which is carried out in Europe and North America every four years, delves into the social background, body image and health behaviours of schoolchildren aged 11, 13 and 15. A sample of 1,500 students was taken from each group. The three age groups represented the onset of adolescence, the challenge of physical and emotional changes and the middle years when important life and career decisions begin to be made.
The study also delves into eating behaviours, with a focus on breakfast (defined as more than a glass of milk or fruit juice), which is considered an important factor in a healthy lifestyle.
Malta has the third lowest rate of 11-year-olds who eat breakfast every school day (52 per cent boys and 53 per cent girls), surpassing Greece and Slovenia. The Netherlands lead with over 90 per cent of children who eat a nutritious meal before school.
Daily breakfast eating decreases as the children grow older, especially among girls. When it comes to Maltese 13-year-olds, 41 per cent of girls and 49 per cent of boys have breakfast, a rate that dwindles to 38 per cent for 15-year-old girls and 46 per cent boys.
Missing breakfast influences cognition and learning and has been associated with health-compromising behaviours, such as high levels of smoking and alcohol, and more sedentary lifestyles.
Maltese schoolchildren are also huge guzzlers of non-diet soft drinks with 13-year-olds ranking second to Bulgaria - 37 per cent of girls and 47 per cent of boys glug down soft drinks every day. Maltese 11-year-olds ranked third and 15-year-olds placed fifth.
The amount of sugar consumption through soft drinks can lead to dental disease and, despite the universal recommendations to brush twice a day, Maltese schoolchildren, aged 11 and 15, failed to meet the basics in oral hygiene to brush more than once a day, placing last from 41 countries.