By some strange coincidence, the Today Public Policy Institute (TPPI – a Maltese think-tank) document on Maltese obesity and its serious health, longevity and public health service costs consequences, was published practically at the same time as a New York Times feature on Malta’s non-Mediterranean diet and its dire sequelae.
More worryingly, the American article quotes International Diabetes Federation statistics putting the prevalence of diabetes in Maltese adults (20 to 79 years) at almost 14 per cent, and highest in 56 European countries. Quoting a World Health Organisation report, the American feature noted the Maltese were more obese, suffered more deaths from heart disease and enjoyed less longevity than their Mediterranean neighbours in Italy, Spain and Cyprus.
The International Diabetes Federation (IDF) figure of around 14 per cent Maltese adult diabetes prevalence is almost 50 per cent higher than the prevalence of about 10 per cent our statistics have quoted these last few decades.
Knowing that the prevalence of diabetes type 2 has been rising around the world, it’s probably fair to assume that our diabetes type 2 prevalence has also risen (along with our obesity rates) and that the IDF figure is more accurate.
Besides the number of established cases of diabetes type 2, one always has an unknown number of individuals suffering from a pre-diabetic state, and so a recent US survey has predicted that almost half its population could be at risk of diabetes – a prospect of serious chronic disease of worldwide epidemic proportions. The TPPI documents the complications of obesity and diabetes in detail and also the enormous and increasing Maltese public health costs implications. It’s easy to lambast the government’s preventive medicine department – changing peoples’ dietary preferences and lifestyle is not so easy. Although individuals’ metabolism varies and is at least partly inherited, obesity is largely blamed on acquired dietary factors and lack of exercise.
The connection between exercise and increased longevity is scientifically established, but also established is the fact that exercise alone is not enough to tackle obesity and related chronic diseases. The only controversy about exercise is whether sustained strenuous exercise diminishes, rather than increases, longevity. Walking is reckoned to be the safest exercise.
The relationship between diet, obesity and diminished longevity is far more complex and controversial. Probably the only two scientific certainties in the area of nutrition and longevity are, (1) the more calorie consumption, the less longevity (proven consistently in animal experiments), and (2) the four human population groups with the highest longevity are all vegetarian.
Controversy still reigns as to whether fats or carbohydrates need to be restricted to combat obesity and for general health.
Fats come in two broad types, those of animal origin (in meats and milk products) and those of plant origin (usually oils). Fats have been blamed for obesity because of higher calorific value than carbohydrates, but this is scientifically mistaken, and calorie-counting regimes are flawed.
Carbohydrates come in two broad types, ‘simple’, as found in sugars, refined grains (white bread, white pasta, white rice) and starches (potato), and ‘complex’ as found in vegetables and fruits.
‘Simple’, refined (‘bad’) carbohydrates are stripped of all nutritive value (vitamins, minerals and protein) and produce only blood sugar after ingestion.
A surge in blood sugar makes the pancreas secrete insulin to push blood sugar into muscles but, if muscles are not being used much (as in “couch potatoes”), insulin will store blood sugar as body fat.
That’s the most important mechanism of body fat accumulation – too much bad carbohydrate consumption. Complex carbohydrates (vegetables, including beans and lentils, fruits and nuts) contain fibre and many vital nutrients, produce insignificant blood sugar and insulin spikes, and insignificant body fat accumulation.
The term ‘junk’ or ‘fast’ has obesity and negative health connotations and, more often than not, associated in peoples’ minds with hamburgers
Fats do not produce blood sugar and insulin spikes. When the diet is very low in bad carbohydrates and rich in protein and fat, blood sugar level may need to be maintained by converting body fat to blood sugar, which is how more weight loss is achieved by a low bad carbohydrate diet.
Obviously, protein and fat consumption should be reasonable.
Animal fats, fresh meats and eggs have been demonised for over 59 years by vested interests and bad science, and driven down the throat of both doctors and the general public (more on this in a future article). The saturated fat in meats, butter and cheese raises HDL, the “good” cholesterol, and the connection of saturated fat consumption with heart disease and obesity is based on old, discredited medical research.
More recent research blames bad cholesterol levels and heart disease on bad carbohydrates rather than saturated fat. Unfortunately, many institutions, including our government’s health promotion department, are still peddling obsolete, wrong nutritional information.
The Times of Malta leader (December 31) seemed to criticise the TPPI document on this saturated fat controversy, adding that wholegrains are one dietary component that “helps ward off diabetes and heart disease”.
This is a mistaken concept.
Whole grains contain fibre, some protein and minerals (good stuff), but they should be consumed diligently (particularly by diabetics) because they are a carbohydrate that produces blood sugar, albeit with less vigour than refined grains.
The term “junk” or “fast” has obesity and negative health connotations, and more often than not associated in peoples’ minds with hamburgers. Junk food is bad because it contains too much sugar, salt and refined carbohydrate and starch, and hardly any nutrients. White bread, white pasta, white rice, pizza, potato, pastries (pastizzi) and sweats are all junk food. The New York Times Malta feature made the point that this junk food is the staple diet of too many glutinous Maltese in love with huge food portions, and that it is not only tasty but far cheaper than vegetables, fruits, meats and fish.Surveys in the UK and US reveal higher rates of obesity in their lower income areas.
Tackling obesity is therefore no easy task. Public education (with the right information) is crucial, but studies indicate that the obese need not only occasional, brief media education but also regular out-patient consultation providing health monitoring, encouragement and individualised advice.
Whether our public health service has, or will ever have, the manpower to meet these requirements is another matter.
Albert Cilia-Vincenti is a former scientific delegate to the European Medicines Agency.