As a health professional who has dedicated his life to sports and exercise medicine, I feel it is laudable that the government and Opposition are finally in agreement about the urgent need to address the national epidemics of obesity and physical inactivity in Malta.
Both political parties were involved in important firsts in these sectors: the PN government introduced Sports and Exercise Medicine (SEM) as a stand-alone specialty, while the PL included the management of obesity and the promotion of SEM as part of its 2013 electoral manifesto.
Now it seems that both parties are progressing from paper-based promises and short-lived media exposure events to factual measures.
I have been involved in exercise prescription and obesity management programmes since the 1990s. Currently I am working on two major projects that tackle these issues directly. The first involves the military in a Gulf country, where the multi-professional and multi-centre team I work with is actively involved in tackling weight management and physical activity issues.
Hard to believe there should be an issue within physically active populations such as military personnel, but this world-wide pandemic spares no one.
That prevention is better than cure has long been preached by all. Let us practice it through evidence based, cost-effective and long-term interventions
The second undertaking I am involved with is the pan-European Exercise Prescription for Health (EPH) initiative, led by the European Federation of Sports and Exercise Medicine Associations (EFSMA).
This project aims to set up regularly updated European guidelines on exercise prescription in both clinical and non-clinical settings. EFSMA also aims to effect the provision of individually oriented educational support and training. These are primary targets for the EFSMA as a pan-European organisation fully conscious of the indispensable requisite of a structured, cohesive, affordable and effective strategy.
One burning question of great practical implication challenges the moral responsibility of withholding effort in encouraging, educating and actually assisting our patients in preventing and managing preventable disease resulting from the obesity/physical inactivity scenario.
And this moral responsibility lies incumbent on a broad spectrum of stakeholders, starting from but certainly not limited to the government.
Yet, we are in the throes of change. Round of applause! But politicians beware – there are no quick fixes in time for the next general election, or even the ones after. To stem the rising prevalence of obesity and physical inactivity and their resultant illnesses, Malta needs a genuine, well-planned and long-term approach. No simple solution can balance constructive results with cost effectiveness.
And neither can the management of obesity and physical inactivity be viewed in isolation. Hence, we speak of the need for the recognition of a number of stakeholders and their responsibilities as well as the discernment, evaluation and modification of numerous inter-linked factors ranging from road planning to facility construction, from physical trainers to SEM consultants, from local councils to Parliament.
We need not re-invent the wheel. Numerous countries and regions have embarked upon, and committed themselves to, tackling these epidemics.
Their results are mixed; fine tuning will be a must, but the need demands such commitment.
Such recognition of the problem and the urgent need to act should be both catalytic to Malta and a help in offering a basis to be modified and transplanted onto the Maltese scenario, where being small offers an advantage within the context of this discussion. One piece of advice resulting from observing such foreign initiatives is: don’t tackle the problem in piecemeal fashion. The country requires both a generalised and central plan of staged action as well as the formulation of individual realistic targets.
The politician leading the multi-stakeholding team must conceptualise a programme which is prepared to minimise the morbidity and mortality resulting from the status quo by a meaningful and realistic long term multi-tasked plan.
This is not only possible and desirable but inevitable if the government means business, which it seems to.
Formulating a realistic, structured plan with realistic targets should be the order of the day even for the clinical consultant dealing with obese and physically inactive individuals (not necessarily found together) who require a dynamic structure catering for the individual’s problems, challenges, limitations and desired end result.
A scientific evaluation of the psychological, medical, nutritional or exercise impediments is the basis of planning action. That is why schemes such as free gym memberships may be laudable but in fact laughable for they miss the crucial fact that what is required is specific exercise prescriptions planned and executed by appropriately trained individuals within properly geared establishments.
Nothing less will do and nothing less does in fact do as cast iron evidence has repeatedly shown. This, in fact, is one example of there being no quick-fix solutions to the problem, be it at individual or national level. Neither does one size fit all in the obesity and physical inactivity disease complex, which bull has far from been cornered by its horns or, indeed, by any part of its anatomy in Malta.
Although this is not the right podium to orate on the subject, a few simple facts can be mentioned to illustrate some points. Such as the fact that even if overweight and obese, people that exercise regularly are both fitter than normal-weight sedentary individuals and are also less prone to many of the health issues normally associated with being overweight.
Therefore, although optimal weight is far better than overweight, the harm of being overweight may still be mitigated by exercise.
As a corollary we are led to the second point in brief, namely that the relevant authorities must not only target an increased exercise participation and appropriate nutrition, but also specifically target the evils of sedentary lifestyle – per se and as the leading factor of obesity management.
Now that the will of the political parties seems to have been formally and officially declared, it is time both to collectively flex our muscles as well as to form our think tank.
We must help, encourage and push our nation into feeling and actually being healthier. That prevention is better than cure has long been preached by all.
Let us practice it through evidence based, cost-effective and long-term interventions related to the morbidity and mortality resulting from obesity and physical inactivity.
Other countries have and are doing just that for their own people. It is high time we did the same for ours.
sportmedicinedoc@gmail.com
Kirill Micallef-Stafrace is vice president of the European Federation of Sports and Exercise Medicine Associations.