Holistic approach to obesity

A report was published last year (Eurostat, 2016) showing that one in four Maltese are obese, the highest rate in Europe.

A blunt report by the Today Public Poli­cy Institute, also published last year, famously stated that “Malta is one of the fattest, laziest and most car-dependent nations on the planet”. This report blames governmental health administration for failing to encourage healthy lifestyles.

But is this really all that is required to overcome the problem – ensuring that all the information to tackle this problem is readily available?

Everybody is by now aware that what we eat is what fattens and what eventually kills us. Our penchant for eating fatty food (pastizzi, saturated fats in cooking, etc.), has ruined our historically lauded ‘Mediterranean diet’.

Our love of sugar, cakes and particularly sweet drinks, including fruit juices, add an enormous amount of calories to our diet.

Equally significant is not just the qua­lity but also the quantity of food that we eat: we have fallen prey to the US disease of ‘supersizing’, where servings have become enormous by comparison to what was considered adequate a couple of generations ago.

It is also true, as the TPPI report states, that most Maltese seem to have a great aversion to exercise, which would help to burn some of the calories that they ingest. We need a car to cover even relatively short distances to work, play or even to attend church on Sundays. 

From the biological point of view, one could blame our genes for most of our woes. Perhaps the most significant from this point of view is the concept of ‘the thrifty gene’.

This implies that in those populations that have gone through centuries of food shortages (often combined with a need for hard manual work, as was the case in Malta until recently), those genes that are most efficient in ensuring maximum absorption and best utilisation of calories are the ones most likely to ensure the best chance of survival, and hence will multiply within a population.

When, however, conditions improve, with plenty of food being available and with most people now being economically in a position to take advantage of those conditions, the thrifty gene will keep on absorbing calories and turning them into fat.

Genes provide the basic body structure but do not control our life. They are under the control of our will power which, however, has to be trained from early on.

We have to get away from the concept that fat children are to be admired, or that a well-rounded figure is a sign of ‘strength’ (as in the old saying ‘kemm hu qawwi, Alla jbierek! Bless him, how well-built he is).

Bear in mind the fact that ‘fat children make fat adults’ – and that the reverse is also true.

We are also becoming aware of the role of education in encouraging weight control. There is a direct correlation between the tendency to overweight and obesity in those with an inadequate level of education. All over Europe, a higher education is associated with less tendency to put on weight. It is good to note that in Malta the proportion of people with a higher education has been for years one of the lowest in Europe.

Socioeconomic status is now rightly regarded as a fundamental issue that correlates with obesity: poor people are more likely to be fat, and poor environments are more likely to have a higher concentration of obese people.

All the above issues are intertwined and cannot be unravelled by picking a single strand. So the problem of obesity is not going to be solved by blaming one or other department. It is a complex problem involving biological issues, diet, education, environment and particularly socio-economic status.

An approach attacking all aspects in a holistic way is the only way to tackle this problem, which is otherwise bound to become worse in the future.

[First published on timesofmalta.com on 4 June 2017]

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