The problem with ‘fat’ and why a weight score-card for children is a sensitive issue

A proposal to combat childhood obesity with an annual assessment for school children’s dietary goals, has been slammed as “fatphobic” by the Green Party candidate Mina Tolu.

The proposal has been floated by the Nationalist Party MP Clyde Puli as part of a raft of measures on childhood obesity, promoting healthy lifestyles and physical activity.

The PN wants a re-evaluation of the country’s National Obesity Strategy to see where it has failed and where it reached its targets.

The Malta Childhood National Body Mass Index Study published in 2019 found that approximately 40% of school-aged children in Malta were overweight or obese – a total of 41,343 students from 145 schools, ranging from four- to 17-year-olds.

The results confirmed that Malta suffers from high levels of obesity in Malta children, and there was a notable difference between the north and south which should be addressed by public health.

Puli has called for a new strategy, but said the PN wants to see before- and after-school fitness programmes for children, with a PE teacher allocated to every school rather than having just peripatetic teachers shuttling around schools. “The discipline of physical education is no longer respected…  the Sports Promotion Unit at Sport Malta has been virtually dismantled,” Puli complained.

But it was his proposal for a yearly assessment of dietary goals that has attracted more criticism. The ADPD candidate Mina Tolu said the PN’s proposal was a slide “further to the right” and which betrayed intolerance non-conforming bodies “be they fat and queer and migrant and disabled – disguised as concern for children.”

“But on a more tangible level, the proposal of a ‘strategy to fight obesity’ is misguided in and of itself and will always be doomed to fail, while causing increased fatphobia and stigma of fatness. Because being fat – and I use the word with a lot of intent – does not equate with health,” Tolu said.

Puli however says he is merely suggesting that children’s progress be monitored, together with discussing dietary habits and their implications with children and their parents. “After all, apart from literacy and other academic aspects, our education system already professionally watches out and monitors other social, psychological and emotional conditions and referrals are done where necessary. Should we not monitor these aspects because of the fear of stigmatisation? Of course not, but of course we need to be sensitive and caring,” he said.

Puli dismissed the argument that monitoring food intake at school would lead to food competition among children.

“It is our duty and responsibility to educate the younger generation of what should a healthy diet include just as we strive to impart positive values. We are clearly aware of the issue, and we must be proactive in carrying out the necessary remedy. This should not be a competition – there is nothing to compete about. It is a matter of changing a culture.”

Psychotherapist Maria Lisa Gilson, who specialises in eating disorders, said weighting children, a practice that already takes place in schools, could be harmful to students and lead to feelings of shame or embarrassment.

Gilson said she understood why it was easier to weigh children at school for research purposes as it cut out the middleman and prevents data from getting lost when parents don’t participate.

But Gilson also said she understood that being weighed at school could harm students as it could lead to feelings of shame or embarrassment.

Parents in the UK recently objected to their children being weighed in school, in reaction to the UK government announcing they would be weighing children for a national study on the effects of COVID-19 on the school-age population.

“I’m not against children being weighed. But there needs to be more sensitivity at school. One way to go about it would be not telling children the weight – that would elevate embarrassment. I think monitoring and research are important, as long as it’s done right.”

Besides not sharing weight with child when measured to elevate shame, Gilson said schools should also have a multidisciplinary team, including a paediatrician, nutritionist, and psychologist to discuss children’s weight with their families and forge an individual plan for each child.

“Obesity cannot be understood only as excess of food intake, it may at times be linked to family adversity, limited finances and other stressors,” Gilson said.

Gilson also stressed that BMI as a standalone index does not accurately depict when a person is obese – as it doesn’t consider the bone density of a person and gender. “People can get fixed on a number; it can harm their mental health. BMI is just one measure and should be paired with multiple tests, not taken as a standalone figure.”