Combating the persistent obesity problem

The problem of obesity among school-aged children has been highlighted in various studies along the years but despite campaigns and initiatives, a lot remains to be desired. Cardiologist Robert Xuereb maintains that the government, schools and parents have an important role to play in tackling the problem at its source.
Studies show that fat children tend to become fat adults. Photo: Shutterstock.com

Health concerns worldwide in the past few years have mostly revolved around the COVID-19 pandemic, with other less urgent health issues seemingly put on the backburner. One such health issue is obesity, which is considered a major health problem both internationally and locally. According to foreign studies, the pandemic has only worsened the situation and it’s easy to see why.

Lockdowns and social distancing measures have meant more time confined to our homes, no organised sports and closed gyms. While some had a go at online training, others were deterred from even going out for a walk due to the compulsory wearing of masks.

Children were likewise negatively affected. They did no longer have physical education classes at school and could not play with their classmates during break time, local playgrounds were cordoned off and they could no longer practise team sports. They thus spent much of their free time watching TV or playing games on their tablets.

The same goes for teens, who inevitably spent more time on social media and binge-watching shows on their favourite streaming service.

To add fuel to the fire, such prolonged screen time is very often accompanied by the consumption of junk food, snacks, sweets and sugary drinks.

The obesity ‘epidemic’ had been highlighted in various studies before the onset of the COVID pandemic.

Results from a local study carried out in 2017 by Prof. Victor Grech and his team, 40 per cent of school-aged children in Malta resulted to be overweight or obese.

According to the World Health Organisation (WHO) physical activity fact sheet in 2018, only 25 per cent of children aged 10-11 years are physically active, highlighting how poorly adherent this section of society is to international physical activity recommendations.

Robert Xuereb, chairperson of Mater Dei Hospital’s Department of Cardiology, believes that there are multiple reasons behind these sad statistics.

“Several factors related to the local culture certainly play a pivotal role,” he says.

“Although we are an island in the middle of the Mediterranean, our diet is anything but Mediterranean. Junk food shops have sprung up in every corner of every village and town. In fact, although school tuck shops no longer provide sugar- and fat-containing foods, fast food kiosks are in close proximity to school grounds.

“Along the years, there certainly has been a push to promoting exercise with children and adolescents. A lot remains to be desired, however. Only two hours a week are currently allocated to physical activity in primary and secondary schools, again highlighting that more emphasis needs to be made at an institutional level.”

Although we are an island in the Mediterranean, our diet is anything but Mediterranean. Photo: Shutterstock.com

He adds that studies also show that the lower the socioeconomic status of families, the likelier that children will be obese and that the pandemic could have only exacerbated the situation.

“Physical inactivity and the discontinuation of competitive sport during the pandemic has probably increased the prevalence of obesity in our younger population. Athletes were also not allowed to train with their peers in sporting arenas. Unfortunately, investment in social media and online platforms doesn’t help our cause,” he remarks.

Some studies have shown that boys gained more weight than girls during the pandemic, which has been attributed to increased time playing videogames. However, Xuereb notes that there are several factors that may lead to obesity.

“Sex hormones, diet, exercise and genetic make-up certainly play an important role,” he points out.

Defining obesity

So when is a child considered to be overweight or obese?

Xuereb explains that abnormal BMI cut-offs in children are set according to gender and age, based on the Centres for Disease Control and Prevention 2000 growth charts, as the amount of body fat changes with age and differs between boys and girls.

A body mass index between the 85th and 94th percentiles is defined as overweight, and a BMI ≥95th percentile is defined as obesity. Severe obesity is defined as BMI of 120 per cent of the 95th percentile. For children younger than two years, BMI percentiles are not available. Obesity in this age bracket is defined as a weight ≥95th percentile for height.

The cardiologist points out that extra kilos in children are sometimes mistaken to be ‘puppy fat’ − the fat on the body of a baby or child which disappears around adolescence.

“This is a common misconception and studies show that fat children track on in their weight to become fat adults.”

Lifelong consequences

Obesity plays a pivotal role in the general well-being of any individual. This is also the case in children.

Childhood obesity is directly linked to insulin dependent diabetes in childhood. However, the repercussions of childhood obesity appear in the long term.  Obese children tend to carry this illness with them into adolescence and adulthood.

“Obesity in adults is a risk factor for atherosclerotic cardiovascular disease, including heart attacks, heart failure, strokes and peripheral vascular disease. It is also linked to respiratory and orthopaedic problems,” Xuereb observes.

“All this has lifelong implications on a plethora of different factors such as hospitalisation, overall national expenditure on healthcare, job opportunities and health insurance cover.”

Taxing junk food

During a media breakfast, organised by Times of Malta to mark World Heart Day on September 29, 2021, Xuereb 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.

Taxes on junk food already exist obroad, such as in Hungary and Mexico, and various countries have implemented taxes on sugar-sweetened beverages, including the UK, Mexico and many Pacific islands.

“Such taxes will definitely increase awareness among parents. Furthermore, my suggestion is that the income generated from these taxes is used to subsidise healthy food,” Xuereb says.

“I strongly believe that such initiatives will encourage parents and children to shift to healthier eating and, as a result, our children will benefit from this.”

Another initiative he mentions is directed at schools: having a longer school break (at schools where breaks are too short) with a compulsory choice of sporting activities.

“For those with those with a sufficiently long break, this is already doable, given the will,” the cardiologist says.

Finally, he urges parents to encourage their children to pursue a balanced lifestyle, focusing on both studies and physical activity.

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