Twenty-five years ago, the US National Institute of Health declared obesity a disease. Most Western countries declared war on obesity. Many of them, including Malta, have waved the white flag and put down their weapons to end this war on obesity.
The National Audit Office (NAO) report on obesity confirms that, over recent years, overweight (pre-obesity and obesity) indicators for children, adolescents and adults registered increasing trends. The NAO report investigated whether Malta reached the four 2020 targets it had set in its Health Weight for Life Strategy launched in 2012. Only one of these targets was reached.
Malta’s overweight statistics are among the worst in Europe. This has profound implications for the public health infrastructure already creaking under demographic pressures and inadequate investment. The public health system must support a large obese population suffering from related, often chronic, diseases like cardiovascular disease, diabetes, certain cancers, liver and kidney damage and reproductive deficits.
Several powerful conditions converge to drive the obesity epidemic. Some neuroendocrine factors are difficult to manage. Still, many people now live sedentary lifestyles with readily available energy-dense food sources. As our society undergoes an economic transition towards affluence – which comes with global influences and greater access to refined goods – people increasingly live in an environment that favours calorie-rich diets.
Recent trends are increasing the risks of over-consumption of poor-quality refined foods that are cheaper than fresh foods and can even be delivered by riders anywhere on the island, including hospitals.
The NAO report makes worrying comments on why we are losing the war on obesity. The report states: “Several stakeholders observed how political influence may stall or disrupt progress against overweight, with sustainable mobility mentioned as an area that has registered poor progress due to a lack of political direction and will.”
Put simply, politicians hesitate to tackle issues that may upset voters and “reject proposals because it would lead to loss of business, loss of jobs or international implications in terms of trade”.
The failures of the current strategy to fight obesity must be revamped with initiatives to regain lost ground. Of course, sensible advice to reduce smoking, reduce salt intake, promote changes in food consumption, increase physical activity and treat diseases aggressively once they have developed needs to be reinforced.
The strategies adopted to fight smoking are not necessarily valid for fighting obesity. Taxing junk food, for instance, will, undoubtedly, be politically unpalatable as smoking is discretionary but eating is not. There is also a risk that active government intervention to impose new regulations on the food industry may create an adverse reaction as it gives rise to perceptions of interference in an individual’s lifestyle choice.
The war against obesity must be waged with a new focus on scientific insights into the importance of human development in setting the predisposition to obesity and associated diseases later in life.
Many scientists agree that the starting point must be a sharper focus on maternal health and nutrition before and during pregnancy. This strategy must be linked to promoting exercise and healthy eating in pre-school and school-aged children, including providing nutritional education.
Society must continue to care for those adults who are already ill and assist those who are far along the pathway of disease. But we must also focus more on low-cost preventive intervention by optimising the nutritional environment from birth to adulthood.