Before the COVID-19 pandemic, the world was already experiencing a global health epidemic which has been steadily inflating over the past couple of decades – obesity.
Obesity was labelled as a global epidemic during the late 90s when it started becoming one of the main public health issues worldwide and Malta is quite the frontrunner in this regard, as UK’s PM Boris Johnson clearly indicated during a press conference last week.
The World Health Organisation’s European Health Report from 2018 (which is based on 2016 data) shows that, unfortunately, Malta is the second most obese country in Europe with the rate sitting at a whopping 28.9%. Only Turkey registered a higher percentage of 32.1% while the UK stands in third place with a 27.1% rating.
According to professionals, this “global obesity epidemic” appears to be in fact the direct result of changes in environmental conditions as well as urbanisation, such as sedentary lifestyle and easy access to low-priced processed food.
But could there be other reasons behind the ever growing rates of obesity in Malta and across the globe?
Obesity as a result of lack of knowledge and time
Speaking to The Malta Independent Daniel Petre (above), a state registered nutritionist based in Malta, said that out of 100 clients that ask for his services, 90 are obese or overweight; the rest being healthy clients who seek advice on a balanced diet to fit their lifestyle.
He actually believes that the obesity situation is gradually starting to get better as people are becoming more self-aware about weigh gain and weight loss but the rates are still high, especially amongst children.
“What I realised is that the main reasons for weight gain are: a lack of knowledge about cooking and time restraints which make one prefer cooking fast recipes, frozen foods or pasta and become lazier. We can also add the cultural ingredient to all this; family lunches and dinners,” he said.
Asked if he thinks that people are willing to see obesity as a problem and seek help for it, Petre said that clients face different obstacles when they want to take the first step such as putting expectations and focusing on results.
“You have to be patient with yourself, it took years to accumulate all this weight so will take some time to lose,” he explained. “I you fail on your progress – don’t stop – learn from your mistakes and press on. Don’t look as a diet plan – look at it as a change in lifestyle.”
Medicalisation of obesity hindering change
On another note, Dr Gisella Orsini (above) believes that the increasing rates in obesity can be related to it being considered as a medical condition. She is a lecturer of the Department of Anthropological Sciences, and a Research Associate of the Mediterranean Institute, at the University of Malta. Her research interests include gender and health, medical anthropology, body and culture, eating disorders.
Orsini explained that it was not before 1985 that obesity has been considered as a disease and no longer as a feature related to other disorders, like diabetes. Such a fact is the result of a general process of medicalization whereby what were initially non-medical matters become defined and treated as medical problems, usually in terms of illnesses or disorders.
However, she said that the medicalization of obesity has brought a number of problems with it.
“By medicalising obesity, the biomedical establishment has decreased the individual responsibility of obese persons in relation to their condition. Obese patients are therefore seen as passive subjects of their own disease. In spite of this, most of the health care initiatives aiming to prevent and manage obesity, focus on educating individuals on healthy life-style and healthy-eating, revealing the crucial role of individual choices in relation to obesity,” she explained.
Apart from failing in diminishing the social blame towards obese people in relation to their condition, this situation also hides the socio-cultural factors leading to obesity, by conceiving it as an individual medical condition.
In other words, health policies and campaigns tend to perceive individual choices as the reflection of individual beliefs and ideas, ignoring macro-level structural inequalities.
“Such an aspect reflects, from my perspective, the lacuna in understanding the socio-cultural aspects leading to the phenomenon, which is still approached exclusively in medical terms,” Orsini said, and indicated that, in 2016, obesity cost Malta €36.3 million in both indirect and direct aid, such as pharmaceuticals, according to PWC’s obesity report released in 2017.
Obesity as both a result and a cause of social exclusion
“In addition to this, as pointed out by several scholars, and in line with the findings of my research on eating disorders, obese people are likely to experience social exclusion, bullying, depression as well as discrimination in employment practices resulting in lower wages as well as limited job choices,” Orsini said.
In turn, this increases the chances of not finding a stable source of income. In fact, Orsini explained that it has been revealed that obesity is mostly predominant among people with lower economic status and levels of education, therefore, among the most disadvantaged social groups.
“Differently from the past, when overweight bodies were perceived as physical symbols of a privileged and powerful social status, nowadays obesity appears to be a feature of the most disadvantaged social groups. In this sense, obesity tends to further marginalize and accentuate discrimination among the poorest.”
Orsini believes that further research on the socio-cultural factors leading to the phenomenon, as well as on the socio-economic consequences of obesity in Malta, is crucial in order to fill the gap in the existing knowledge on the subject (mostly based on medical studies), and to design and implement new effective strategies and policies.