Childhood obesity is strongly associated with cardiovascular disease, diabetes, orthopaedic problems and mental disorders.Childhood obesity is strongly associated with cardiovascular disease, diabetes, orthopaedic problems and mental disorders.

At least 2.8 million people worldwide die every year as a result of being overweight or obese. A significant proportion of cases involve diabetes, heart disease and high blood pressure.

Obesity reduces life expectancy and quality of life and increases the risk of onset of several chronic diseases. Children are more commonly exhibiting health conditions related to obesity, including low self-esteem and mental health symptoms.

Childhood obesity is strongly associated with risk factors for cardiovascular disease, diabetes, orthopaedic problems and mental disorders.

Obesity causes a considerable economic burden on society through increased healthcare costs of treating associated diseases and costs associated with lost productivity due to absenteeism and premature death.

The excess direct cost on the Maltese health service associated with overweight and obese individuals when compared with people of normal weight was estimated to be nearly €20 million per year, accounting for 5.7 per cent of total health expenditure. This estimate does not include expenses related to medication, surgery, ancillary services and loss of income. The amount increases to over €25 million when private healthcare costs are included.

The modern environment provides a wide range of opportunities for the consumption of food and drinks that are very often unhealthy in terms of nutrient composition.

Portion sizes are another issue of concern. A UK study shows that portion sizes have doubled over the past 20 years. This, coupled with insufficient physical activity, leads to obesity. However, the situation is not so simple.

The influence of the mother’s body weight prior to pregnancy and during pregnancy has an effect on the weight of the baby. A number of studies have found that higher maternal BMI before pregnancy was associated with increased BMI in children, as well as larger waistlines, raised blood pressure and increased blood levels of insulin and fat. A high maternal weight gain during pregnancy was also a risk factor.

A major factor leading to obesity is overeating high amounts of foods high in sugar, fat and salt. Since 1990, Malta has inevitably undergone major changes in the type and quality of food products available on the market. Advertising and other marketing strategies by food companies affect consumption of energy-dense foods and drinks. Ongoing efforts by the health sector, through national health awareness campaigns and weight reduction programmes have not been enough to halt the trend.

The built environment plays an important role in influencing obesity by promoting increased energy consumption, increased consumption of foods high in sugar, fat and salt and a reduction in energy expenditure. Increased car use, sedentary behaviour and insufficient physical activity are other factors that promote obesity.

Obesity follows a socio-economic gradient in affluent countries, with higher rates in more deprived areas. The relationship between educational level and obesity was also clearly demonstrated in Malta in the Lifestyle Report, published by the Health Information and Reasearch Directorate.

The World Health Organisation recommends that measures to combat obesity need to extend into areas such as agriculture, transport, commerce and industry, education, the mass media and communication.

It is on the basis of this recommendation that the Maltese obesity strategy – Healthy Weight for Life – was outlined. Its overall aim is to curb and reverse the growing proportion of overweight and obese children and adults to reduce the health, social and economic consequences of excess body weight.

Initiatives

• To improve the availability and uptake of a healthy diet through healthy public policies.

• To work with stakeholders on consumer education about healthy eating and moderation as underlying principles of healthy eating.

• To promote exclusive breastfeeding for the first six months of life.

• To support pregnant women and new mothers to adopt healthy eating habits for themselves and their families through education and community initiatives.

• To support schools and families so that meals and snacks, including drinks, prepared for school-aged children are nutritious and appetising, without being energy-dense and/or containing excess amounts of fats, trans-fatty acids, salt and sugar.

• To regulate audiovisual advertising, such as unhealthy foods directed at children.

• To support schools to implement all the recommendations of a healthy lifestyle in collaboration with education.

• To evaluate options for the formulation of local food products so as to reduce salt, sugar, saturated and trans-fat content.

Priority areas

• To increase physical activity through healthy public policies, so that the living environment is one that promotes healthy choices.

• To increase physical activity opportunities for all schoolchildren.

• To encourage children and parents to use a screen time log, reduce the number of hours of watching TV, use of computer/video games to a maximum of two hours per day for children, and to encourage sit-down meals as family time – as opposed to TV dinners, whenever possible.

• To support local councils to increase the opportunities available for physical activity.

Strategies

• To enhance weight management classes for adults.

• To set up community initiatives such as cookery clubs and community gardens, focusing especially on lower socio-economic groups and older people.

• To increase and improve parent craft and breastfeeding services.

• To provide training and guidelines for health professionals in primary care to improve the delivery of holistic advice and management on all issues related to nutrition, physical activity and weight management.

• To work with stakeholders to develop a national curriculum and certification for facilitators of weight management programmes.

Various studies have looked at the possible economic measures which may act as motivators for healthy lifestyle choices. Feasibility studies on the introduction of sin taxes, as well as incentives and subsidies for increased accessibility and affordability of healthy food, are proposed.

The vision for this strategy is to have a society where healthy lifestyles related to diet and physical activity become the norm and where healthy choices are easy and accessible to all, to prevent disease and prolong a disability-free life.

Each individual person can do a lot themselves by becoming motivated to live a healthy lifestyle for life.

Best top tips

1. Base your meals on breads, pasta, rice, potatoes and other cereals. Choose wholemeal or wholegrain products whenever possible.

2. Eat at least five portions of fruits and vegetables every day. A portion of fruit or vegetables is equivalent to 80g.

3. Drink milk and milk products, such as yoghurt and cheese, in moderation. Choose low-fat products when possible, like skimmed milk and light yoghurt.

4. Eat meat, fish, eggs and legumes such as beans, peas and nuts in moderate amounts. Try to choose lean cuts when eating white or red meat.

5. Always choose foods low in fat, sugar and salt.

6. Enjoy your food by eating regular meals in moderate amounts.

7. Drink at least six to eight glasses of water daily.

8. Exercise for 30 minutes to an hour as often as possible, preferably daily.

9. Salt intake should be limited to not more than five grams a day. Lower salt intake by reducing or avoiding the addition of salt during cooking or at table.

10. Increase the flavour of your food by using fresh, frozen or dried herbs, spices, chilli, garlic, pepper, vinegar and lemon or lime juice.

Dr Charmaine Gauci is director, Health Promotion and Disease Prevention Directorate.

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