The high incidence of obesity in the Maltese population, especially among children, is a slow-burning health issue. It is putting increasing pressure on a strained public health system.

The illusion that, as a Mediterranean country, we benefit from the famous healthy Mediterranean diet needs to be banished. The staple food of too many Maltese abounds in the consumption of junk food, food that contains too much fat, calories, sugar and salt.

The chairperson of Mater Dei Hospital’s Department of Cardiology, Robert Xuereb, has proposed introducing a fat tax to serve as an incentive to people to consume less junk food and more healthy food, which could be subsidised.

Steven Fava, chairperson of the Department of Medicine, agrees with this proposal which, in the words of Xuereb, could be “a major game-changer in terms of encouraging people to shift their eating habits”.

But does a ‘fat tax’ really encourage people to consume less junk food? A 2003 World Health Organisation report proposed that the cost and pricing of health foods were key considerations in preventing obesity.

The inexpensiveness of unhealthy foods relative to fresh produce is thought to be an important contributor to the overconsumption of junk food.

Denmark was the first country to introduce a fat tax in 2011. However, the Danish government repealed the tax in 2012 as Danish shoppers had found ways to circumvent the controversial tax by purchasing taxed items across the border.

Other countries, like Hungary and France, have introduced some taxes on certain high-calorie fast foods.

Various studies come up with similar conclusions on the likely effect of introducing a fat tax to fight obesity, even if much of the evidence in favour of or against a tax on unhealthy food is derived from incomplete information.

One such study was reported in an article in the Medical Journal of Public Health of the US National Institute

of Health. The research, conducted in 2013, concluded that small taxes on junk food are likely to yield substantial revenue but are unlikely to affect obesity rates.

High taxes are likely to impact weight in at-risk populations directly but are less likely to be politically palatable or sustainable.

There are also some valid social arguments against the introduction of a fat tax. Its critics argue that a fat tax is regressive as it takes a higher percentage from low-income groups.

The costs of administration are also likely to be high.

Also, nutrition science is still a relative infant in medical knowledge.

New schools of thought often put in doubt tenets about healthy eating that have long been taken for granted. Controversies abound among experts on whether all fat is unhealthy, for example, or whether a low-salt diet is always healthy, or whether food choices should be more individualised.

Promoting good eating habits through educational programmes, in theory, sounds like the silver bullet to fight obesity. But the spending power of the junk food industry for marketing fast foods will always be much more effective.

The main obstacle to tackling the obesity crisis is the lack of political will to research and conduct pilot pricing interventions in a specific setting to understand the actual effects of a tax on obesity at the population level.

The introduction of a fat tax should not be discarded prematurely.

Similar taxes such as cigarette taxes have been widely accepted and contributed to a long-term fall in cigarette smoking rates.

However, more research is needed to find the best way of changing the food consumption habits of people at risk of obesity.

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