Being overweight or obese is a growing epidemic, with Malta certainly no exception – in fact it is topping the charts in Europe. This issue has been a priority for the country for the past few years, leading to the development of Malta’s obesity strategy entitled The Healthy Weight for Life Strategy.
This umbrella strategy targets the whole population in a bid to address the growing problem of overweight and obesity in all of life’s stages. It aims to halt the rising overweight and obesity rates and eventually reduce the number of people suffering from this condition. This would in turn reduce morbidity and mortality from related conditions, resulting in an improved quality of life, as well as cutting healthcare and productivity costs.
The challenge being faced is a big one, and many countries are struggling to tackle it. There are multiple factors to consider, both individual and environmental. An in-depth study carried out in 2014 showed that Malta’s obesity rates may be the result of an ‘obesogenic environment’ characterised by limited infrastructure for active living combined with an energy-dense food supply.
The Maltese population has drifted from traditional eating habits and to more fast food consumption which are high in fats, salt and sugars. This is evidenced by the amount of fast food outlets mushrooming in our country. Various studies have shown a direct correlation between the density of fast food outlets and the obesity prevalence of the country. A clearer picture is expected to emerge from the results of the national food consumption study which is currently being carried out.
Malta also features among countries with high consumption of sugar-sweetened beverages. The Health Behaviour study of school children carried out in 2014 shows that it is top in terms of soft drink consumption for 11-year-olds and 15-year-olds, and third highest for 13-year-olds. The rate of consumption of soft drinks is much higher than the participating countries’ average. When compared to 2010 data, there was a decrease in consumption for all ages and gender, except for 15-year-old boys which saw an increase.
Culture plays an important role in eating patterns. The Maltese population has been found to have a higher preference for large portion sizes and a tendency to eat out when socialising. Marketing has an enormous impact on children. Local research suggests that a majority of primary schoolchildren regularly exert pressure on parents to purchase foods advertised on TV. A local study analysed the content of food advertising on Maltese TV stations during children’s viewing hours. This showed there was a high proportion of adverts promoting fast foods, breakfast cereals, fruit squash mixers and confectionery items.
The Maltese population has been found to have a higher preference for large portion sizes and a tendency to eat out when socialising
Various factors influence physical activity levels, including a fast society with more tendency to use cars, more sedentary types of work and less free time for leisure and play. The environment also plays a major role in enabling physical activity.
Inequalities affect how health risk and disease are distributed in a population and Malta is no exception, with greater prevalence of overweight and obesity in deprived social groups. Acknowledging the social determinants of health and well-being and addressing poverty-related health challenges are therefore important in facing the problems presented by obesity. Over the past 20 years, Malta’s efforts to curb the rising trend in obesity levels have been mostly directed by health education initiatives and broad public campaigns. These were primarily aimed at increasing awareness and knowledge of the health benefits of physical activity and a healthy diet, especially the Mediterranean diet.
These efforts are now accompanied by new efforts aimed at changing behaviour, with initiatives within schools, communities and workplaces. They include the targeting of pregnant women through parentcraft classes, promotion of breastfeeding, a lunchbox campaign, Schools on the Move, as well as individual interventions through weight management classes and lifestyle clinics.
Further action is required through a whole-of-government and whole-of-society approach throughout the lifespan. To support this approach, the Healthy Lifestyle Promotion and Care of Non-Communicable Diseases Act was passed last January.
The purpose of this law is to establish and ensure an inter-ministerial lifelong approach in favour of physical education and healthy balanced diets, for a healthy lifestyle and reduction of non-communicable diseases.
Most of our food is imported so we rely on the quality of food and actions taken in other countries. Hence the Ministry for Health has identified childhood obesity as a priority area for Malta’s EU presidency next year.
Tackling the problem of obesity needs a multipronged approach with cooperation from all sectors. As many interventions as possible must be delivered to have significant impact. A holistic approach by the public, private and third sectors is the best way forward.
Charmaine Gauci MD is designate Superintendent of Public Health.