Obesity is increasing. Almost three quarters of Maltese men over 20 are fat, according to a study in the medical journal The Lancet. More worrying is that obesity among children is also increasing. We are being told that obesity makes children sicker and when they are sick it costs us more money. We are also told that fat babies make fat adults.

Now one may ask: why do kids get fat? They get fat because they eat the wrong foods, especially sugar, and do not exercise. There is a safe threshold of how much sugar children and even adults should eat per day and it is assumed that they should not eat more than six to nine teaspoons of sugar per day. If we exceed this amount, bad things happen to our liver and we get sick.

Sugar is being called the alcohol of the child. If children take the right amount of sugar they need it for their metabolism. Sugar is also part of children’s lives and many of their activities involve the taking in of sugar, like parties and birthdays. There is a safe amount of sugar which children can take and still enjoy. The problem is they are exceeding all limits and sugar is becoming the staple food of children.

In the 1980s, we used to say that fat was the main culprit for our health and so we took the fat out from most of our food. But what happened was that when you take fat out of food it does not taste very good so they introduced more sugar to make it taste better. But we know that sugar is turned into fat by our bodies.

The essential thing is that a calorie is a calorie and nothing could be further from the truth. The food industry wants us to believe this, as it works in their favour. If a calorie is a calorie then why would you pick on any individual food stuff? This gives them something to hide behind in terms of culpability.

For example, if you drink orange juice, you are not drinking something healthy but you are drinking a lot of sugar. But we cannot say that if we squeeze a fresh orange and we drink its juice; it is also orange juice, it contains less sugar. So it is manufactured orange juice that is bad not natural orange juice. Do not believe what they say on the packet that it is natural orange juice.

So it is very good to take oranges to patients when you visit them in hospital but, please, no orange juice, as it can make them sick.

Another thing that many people do not know is that the good part of food is the fibre. Fibre has actually beneficial effects on its own even if the body does not absorb it. When the food does not have fibre it overloads the liver and causes many diseases. We are seeing that in toddlers, where juice consumption correlates with obesity and metabolic illnesses. We are seeing obese six-month-old babies and even obese newborn babies. This is because of the food their mother was consuming during the pregnancy.

Sugar is basically present in all foods we buy. It is not only found in the deserts and other food where we expect it to be but even in diet food items, even if in reduced amounts.

The food industry use on purpose, because they know that if they add sugar they sell more as it is weakly addictive. Some say that sugar is the tobacco of the 21st century and this is how the food industry is responding as the tobacco industry did in the past to advertise smoking.

There are three myths that need to be debunked.

The first is about obesity. It is not really obesity. It is about chronic metabolic disease and thin people get it too. It is called Tofi (thin on the outside, fat on the inside) and 40 per cent of normal weight adults in a population have this condition. They have the same diseases the obese have: they get type II diabetes, they get hypertension and they get liver disease.

Sugar, not fat, is the main culprit behind the obesity epidemic

Medical science does not know why this happens and researchers are trying to figure out what is going on. So it is a public health crisis because everyone is at risk.

The second myth is about what they say that a calorie is a calorie. This is not true. There are calories and there are calories. Sugar calories and alcohol calories are worse than standard calories.

The third myth is about personal responsibility. How can one speak of personal responsibility when babies are being born overweight?

Although each one of us is responsible for one’s own health, what we are not speaking about is that lack of corporate responsibility, which is causing all this. The food industry and multinational companies are the culprits and they need to reformulate their products and make them healthy.

My point is that the food industry is using us to sell its products, which sometimes we do not even know what exactly it contains.

Food labelling is a serious issue that is being tackled by the EU and consumers have the right to know all the information about the food they are buying. The label found on a food package should contain information about the nutritional value of the food item, the number of calories, grams of fat, nutrients, and a list of ingredients. This helps people trying to restrict their intake of fat, sodium, sugar or other ingredients.

There are then parents who are feeding or allowing their children to eat excessive amounts of sugar. There is not enough awareness about the potential dangers of excess sugar in one’s diet and we are laying more stress on obesity being the problem itself when the real problem is consuming excessive sugar.

Saturated fat is not the major issue; sugar, not fat, is the culprit.

For decades, a diet high in fat (particularly, saturated fat) has been cited as the cause of cardiovascular disease. But not everything stacks up.

Epidemiological studies of populations such as the Inuit, who traditionally survive almost entirely on animal food sources (and consume large amounts of saturated fat), have a very low incidence of cardiovascular disease.

Sugar, not fat, is the main culprit behind the obesity epidemic.

The message is that sugar seems to be culprit and medical science does not know yet why. But don’t get me wrong. I am not saying that only sugar is bad. The way our body deals with the food we eat is very complex and what applies to one person does not necessarily apply to another.

Ischaemic heart disease and circulatory disease is multifactorial in its causation and genetics is also a very important factor to consider.

Until we know more, the golden rule remains that we should eat and live in moderation, consume the least amount of sugar, avoid smoking, drink alcohol in moderation and, of course, do some exercise on a regular basis.

Mario Saliba is a specialist in family medicine.