Malta needs to confront its weight problem

A parliamentary motion on obesity, tabled this week by the Opposition, may seem an unlikely initiative from a party that is still visibly trying to reassert itself after a heavy electoral defeat.

But while the topic itself may not sound very glamorous or appealing, there can be little doubt that obesity in Malta is indeed a very serious health concern, and that something has to be done about it at legislative level.

Local and international studies suggest that weight problems, in particular among children, contribute directly to a number of life-threatening conditions arising later in life, including cardiovascular disease, cancer and stroke.

But obesity is also associated with a far greater number of other health concerns. It is a little-known fact, for instance, that it can indirectly cause blindness, through a condition known as benign intracranial hypertension.

Breathing difficulties, sleep disorders, depression and low self-esteem, a wide variety of gastrointestinal complications, back problems and even skin conditions such as fungal infections can in many cases be traced directly to the single health condition known as ‘obesity’. 

Despite these concerns being widely known to researchers, to date little in the way of concrete action has been taken to address Malta’s seemingly endemic tendency towards obesity. This is surprising, as the problem is very visibly prevalent in our society and seems to be growing more pronounced over time.

A recent (2007) systematic review, comparing estimates of the prevalence of overweight and obesity in school-aged youth from 34 countries, showed that Malta topped the list with the highest prevalence of overweight and obese children at 25.4% and 7.9% respectively, followed by the United States at 25.1% and 6.8% respectively.

This seems to confirm that Maltese children enjoy the dubious honour of being the most overweight children in the world. Separate statistics meanwhile confirm that Maltese schoolchildren also have the fewest weekly school hours dedicated to physical activity in Europe. And although steps have recently been taken to ensure that food available to students at tuck-shops conforms to some basic health guidelines, to date these initiatives have been at the schools’ own discretion, and nothing resembling a national action plan to curb obesity among children has to date been forthcoming.

Quite apart from the immediate health implications for the individuals concerned, the government has every reason to involve itself in the issue. There is a hefty price tag attached to the problem in terms of public health expenditure. Unless tackled, the current Maltese obesity trends will result in an astronomical increase in morbidity and mortality, with an estimated crippling additional health budget requirement of at least €33.6 million per annum.

Over and above genetic disposition, childhood obesity is primarily caused by two main factors: poor diet, and lack of exercise.

Fast food culture is known to be a direct contributor to the former, and in some cases may also be linked to economic factors. Apart from the convenience of quickly-prepared meals on demand, fast food is also viewed as a cheap alternative which benefits from massive investment in promotion and marketing by the private companies involved.

Healthy foods may, in practice, be no more expensive than fast food; but the lack of corresponding marketing and awareness means that fewer people may be aware of the benefits of healthy eating... or, for that matter, of the dangers of over-indulgence in unhealthy, fatty foods.  

As for lack of exercise, research suggests that 30 minutes of moderate physical activity on most days of the week is the recommended minimum. However, nearly a quarter of children and nearly half of adults get no free-time physical activity at all.

Clearly, there is plenty of room for a national strategy to curb obesity, based on two all-important considerations: the need for more awareness on the subject of diet and health, which can easily be addressed through public information campaigns; and a revision to the national curriculum to increase the weekly hours dedicated to physical exercise.

Efforts are already under way to reform the education system, but the proposed changes arguably do not go far enough in redressing the imbalance between curricular and extra-curricular activities in this regard.

Elsewhere, questions remain concerning how (and to what extent) to address the problem through legislation. The private member’s bill presented by the Nationalist Party envisages an interministerial approach to promote physical education and healthy and balanced diets, with the aim of reducing the level of obesity among all age groups.

One of its proposals foresees the setting up of a consultative council on a healthy lifestyle whose members would include, inter alia, representatives of the Office of the Prime Minister, public health, education services, the police, nutrition experts and social services.

These are all valid suggestions, even though at a glance the emphasis seems to be on creating a punitive framework – the bill speaks of ‘fines’, presumably to be paid by schools and possibly even parents, for failure to comply with regulations. It remains debatable, however, whether health conditions which are also attributable to genetic predisposition should be made liable to punitive measures.

Nonetheless, the PN’s motion should certainly serve as a useful platform to launch this much-needed debate. The sooner the discussion gets under way, the better.