How to fight obesity

How to fight obesity

Is it time to introduce a tax on unhealthy foods?

A nutritious lunch of cod and vegetables. Below: What a healthy diet might look like, according to the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems.

A nutritious lunch of cod and vegetables. Below: What a healthy diet might look like, according to the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems.

One way to wean a population off unhealthy foods would be to tax them, according to a recent global report. Victor Paul Borg gets his teeth into the issue.

A major global report on diet recently called for taxes to be imposed on unhealthy foodstuffs, yet Malta appears reluctant to go down that path despite its obesity problem. 

The aim of such a measure would be to rebalance the cost of the food basket in favour of healthy foods, according to a recommendation made in a global blueprint for action published by the EAT-Lancet Commission last month.

The preeminent medical journal The Lancet teamed up with EAT, a nonprofit startup founded by a team of scientists in Sweden and France and Norway, and worked with 37 leading scientists in 16 countries to produce the first global report with global targets of its kind.

The report, Food in the Anthropocene: the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems, catalogued the ravages of unhealthy diets on health and planet.

On the one hand the obesity epidemic continues to swell – the two billion overweight people worldwide are a growing strain on healthcare systems. On the other hand, 800 million people remain undernourished, even while a third of the food that’s produced worldwide goes to waste. Agriculture is responsible for the largest share of degradation of the world’s ecosystems. 

The mission of EAT is to transform the world to a healthy diet by 2050. The EAT-Lancet Commission formulated a diet of 2,500 kilo calories daily, which can be pictured as an inverted pyramid in which vegetables and fruits make the greatest bulk.

These are augmented by whole grains, plant-sourced proteins (legumes and nuts), and unsaturated plant oils (nuts and olive oil). At the bottom sit dairy products, sugars, meats, and starchy vegetables (potatoes).

Meat-wise, observance of the diet would mean weekly consumption of not more than a quarter of a chicken breast, and not more red meat than the equivalence in weight of a burger every week.

Adopting the diet is not easy given the tantalising offers in supermarkets. Why make an effort to cook fresh fish when it’s cheaper and tastier to opt for fish fingers and fish burgers? Why cook a fresh chicken breast when more delectable and equally-priced chicken nuggets can be popped from the freezer into the deep fryer? Why make fresh vegetable soup when a plate of pasta is so easy to rustle up?

It takes resourcefulness and effort to buy fresh produce and create meals from scratch. Nuts and fish and vegetables also tend to be more expensive than bulky carbohydrates, such as pasta and potatoes, and rusk-substantiated processed meats such as sausages and other processed foods.

It’s for these reasons that experts, including the EAT-Lancet Commission, are calling for taxes on unhealthy foods, in order to shift the cost of food towards the healthier, unprocessed varieties.

Yet, while the local health authorities acknowledge this rationale, there is no sign that the government is keen to adopt such a measure in a bid to tackle Malta’s “epidemic” in obesity.

Charmaine Gauci, the Superintendent of Public Health and director of the Department for Health Regulation, was asked if legislative measures and economic disincentives were needed to change unhealthy eating habits, and specifically whether the department was advocating taxes on sugary foods and red meats as international experts are recommending.

“Country experiences have shown that the introduction of appropriate legislation in combination with other approaches is central to achieving the vision of a tobacco-free Europe, reducing the harmful use of alcohol and promoting healthy diets. However, the impact [of food taxes] on persons in lower socioeconomic strata has to be considered.”

Adopting the diet is not easy given the tantalising offers in supermarkets

Prof. Gauci said a review commissioned by the World Health Organisation (WHO) indicated that food taxes and subsidies can influence consumption and that imposing substantial taxes on fattening foods may improve health outcomes.

“Most studies show that a combination of taxes and subsidies would have the greatest effect on body weight.”

She pointed to “the enactment of the Healthy Lifestyle Promotion and Care of Non-Communicable Diseases Act”, which puts Malta at the “forefront [of] legislation for the control of non-communicable diseases and obesity”.

Her reference is to framework legislation that empowers the minister to issue regulations and to set up an Advisory Council on Healthy Lifestyles. So far, however, the only subsidiary regulation under power of the Act was on procurement of food for schools, a regulation that falls way short of the call for taxes on unhealthy foodstuffs.

With no laws or taxes on unhealthy foods in the works, Prof. Gauci instead wrote about an ongoing “national food consumption survey which will outline the baseline on eating habits [to enable us] to target priority areas and monitor trends”.

The situation in Malta is grim: Malta sits among the top countries worldwide for rates of obesity. Maltese diets have become too heavily based in carbohydrates, sugary foods, meats and dairy. Lifestyles have become too sedentary.

Although the impact of obesity on quality of life is incalculable, the direct and indirect cost of obesity in Malta has been calculated at €36 to €56 million a year in a study by the audit firm PwC.

 “Unhealthy diets,” Prof. Gauci said, “lead to a substantial burden of diseases related to obesity, diabetes, osteoporosis, cardiovascular diseases, dental diseases, and several forms of cancer.”

“Malta consistently tops the charts when it comes to obesity statistics,” says doctor and nutritionist Antonella Grima. “Although most people know what healthy food is, the regular consumption of comfort foods like chocolate, as well as large portions and general physical inactivity lead us towards the problem.”

Although most of Dr Grima’s clients’ primary objective is to lose weight, she also sees “an increasing number of individuals who wish to improve their health through food or make sure that they are eating in a healthy way”.

“Awareness of the health benefits of certain foods is increasing,” she said. “People are generally interested to find out how their health can be improved by eating healthier foods such as legumes, nuts and healthy oils for instance.”

Another nutritionist, Daniel Petre, also talks of more people becoming more aware of nutrition. Mr Petre, a Romanian who has run the Karma Clinic for more than a decade, sees a wide range of people, including sportspeople and “people in their forties who want to be fit.”

Parents also take overweight young children to the clinic. “When you discuss with parents and analyse the household situation,” Mr Petre said, “you usually find out that parents would be busy and have little time to cook, so they end up providing their children with convenient processed foods. It’s cheaper and easier to eat chicken nuggets, for example, than to shop for vegetables and make a meal out of it.”

“Tackling obesity in children calls for a lifestyle change,” Mr Petre added. “Healthy eating has to start in the family and continue in schools. It requires effort and education over a generation.”

Dr Grima said that she generally aims “towards the consumption of simple wholesome food in the right quantities, and towards achieving a balance between the different food groups.”

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