Editorial: Shifting the scales requires bold action

News that the government is considering offering free weight-loss drugs for those with a body mass index of over 35 to target the obesity epidemic was widely met with derision.

The verbal flagellation was sparked by Health Minister Jo Etienne Abela’s description of semaglutide jabs – such as Ozempic and Wegovy – as a “quick fix”. The public seemed to ignore the rest of the sentence where he stressed the need for a multifaceted approach.

And the word “multifaceted” is vital in shifting the sedentary tide, because, as Abela and Malta’s long-standing public health official Charmaine Gauci both conceded, any initiatives introduced over the past decades have failed to make a dent in the island’s chart-topping obesity figures. 

And it’s not just Malta that has failed to register much progress.

The problem is so complex that few countries have managed to cut through the fat to achieve a healthy outcome.

Additionally, the World Health Organisation is expecting the number of people with obesity to double by 2035.

Those who are blessed with a slim physique or who have successfully lost weight with great sacrifice, sometimes believe this epidemic can be resolved through self-discipline but try explaining that to somebody who has attempted every diet and battled obesity all their life, with mere blips of success.

Repeated reports and international studies show the matter is not as simplistic as a lack of will power or laziness but, rather, a complex, costly, chronic disease brought on and sustained by numerous factors that go beyond an individual’s control.

This was demonstrated by Paul Kenny’s cheesecake-loving rat experiment in 2010. When first offered an abundant supply of healthy food, the rats would eat when hungry and stop when sated. But, when exposed to a diet of fried bacon, Snickers and cheesecake, the rats went crazy. They hurled themselves into the cheesecake and gorged without any restraint – obesity rates soared within seven weeks.

When the rats were put back on a healthy diet, they lost all interest and only nibbled at it when starving. This experiment exposed the addictive effect of industrially assembled, ultra-processed food, which is robbing us of satiety and leaving us craving for more.

This is precisely what drugs like Ozempic attempt to address; to trick the brain into feeling full. True, these drugs alone are not a panacea for the obesity crisis and while they do deliver other benefits – including reducing the risk of heart attack or stroke – there are also side effects, which require careful consideration.

Which is why a “multifaceted approach”, which includes bold policy decisions to shape the food environment as well as address social and economic factors, is vital. So far, Abela seems genuinely intent on moving the needle.

Last year, as a newly anointed health minister, he called for a campaign that was as powerful as “an electoral campaign”; he has pushed for more gastric bypass and sleeve gastrectomy surgeries carried out locally; and, some days ago, announced a research programme that will focus on food labelling, supply and promotion. He has also floated the introduction of a sugar tax as part of the solution.

These are all laudable steps but slimming down the figures will require a strong political will to make obesity a national priority across different sectors, as laid out in the 2023 National Audit Office 194-page report on obesity.

This, coupled with increased collaboration with the private sector and professionals on the ground, as well as addressing gaps in policy coherence, funding, service provision and human resources, are crucial ingredients for safeguarding future generations from the weight of long-term health and economic consequences.