Obesity and the Environment - Similarities and Differences Between 2 Countries

A quick warmup!

We’re Sophie and Tasz and we’re from 2 different places.  Tasz lives in the United Kingdom and is a 3rd year dietetic student, Sophie is a Maltese 3rd year student studying food science and nutrition. As part of our courses we have to work together to create a blog, our topic being that of the obesogenic environment that surrounds us.

Obesity and the obesogenic environment

An obesogenic environment is one that supports the development of obesity. It can be seen, for example:  in the way high calorie foods are aggressively marketed and the loss of manual labour jobs.

Obesity is having a disastrous effect on our health and our health services. We know that. We can't go 2 seconds without a newspaper or website telling us that some specific evil food or habit is going to make us overweight. So what is the reality of obesity causation?

In order to understand what is making people overweight and obese we need to know what obesity is.

Quite simply, obesity is having excessive fat on the body AND a body mass index (BMI) that is equal to or greater than 30kg/m2; being overweight is classified as having a BMI that is equal to or more than 25kg/m2. People such as: body-builders, athletes and those who have medical conditions that cause them to retain fluid may have a BMI that may indicate obesity but they may not have excessive fat accumulation and therefore they are not obese.

So how obese are we as nations?

The table below shows us that obesity rates are similar in the UK and in Malta. Unfortunately however, both our countries are more overweight than the global or European average and both our countries are ranked in the top 10 in Europe for obesity.

This isn’t isolated to just our countries, because in fact obesity has more than doubled worldwide since 1980.

Table 1: Estimates of overweight and obesity

	Worldwide	United Kingdom	Malta
% adults overweight or obese	42 (Europe 60)	63.4	64
% adults obese	13	25.5	24.7
% children overweight or obese	12-13	31.2*	33.3**
European ranking of obesity	N/A	6th	3rd

This table was constructed with information from the World Health Organisation (WHO), other organisations will have slightly different figures.

*Health and Social Care Information Centre 2015 figures for children aged 2-15

**School aged children (Grech 2007)

So what makes us overweight and obese?

Unhealthy weight gain is fundamentally caused by too many calories coming in and not enough being used by the body. In our bodies surplus calories are converted into fat and stored in the body, leading to weight gain and obesity. With this in mind we are going to talk about physical activity and diet. However, there is a vast number of factors that may increase your risk of becoming obese.

Some other factors that contribute to the development of obesity include:

• medical conditions: some medical conditions can exhibit learning disabilities and increased hunger (an example that can include both is Prader-Willi syndrome), other conditions may reduce mobility and therefore decrease physical activity;
• medications: some medications increase your appetite and increase your body’s ability to store fat;
• family: it’s not just genetics, close family members often mirror unhealthy eating and physical activity behaviours - this can be the similar amongst friends and romantic relationships;
• age: as we age, our ability to be physically active decreases, as does our metabolism;
• socio-economic status: if you don’t have much money it can be difficult to afford healthy food and access places such as the gym. Some people may also live in an area where education is poor or the area itself is not safe to exercise. People with a low socio-economic status are therefore disproportionately affected by obesity; and
• other factors: such as stopping smoking, alcohol intake, lack of sleep and pregnancy can also lead to obesity.

You might have heard the argument that we are overweight because of our genetics, but the reality is that having a genetic predisposition to obesity is not a genetic predestination to obesity. While obesity has strong hereditary factors and there have been several genes found related to an increased risk of obesity. A genetic predisposition to becoming obese is greatly amplified by an obesogenic environment. As quoted by the Today Public Policy Institute, “the genetic background loads the gun, but the environment pulls the trigger”.

Malta vs UK - Physical Activity:

In many countries, as well as Malta and the UK, the amount of physical activity performed each day is being influenced by a number of factors including:

• increased hours spent watching television and using technology;
• decreased involvement in sport;
• a decrease in the availability of manual jobs (54.7% less in the UK since 1981);
• and many others.

These factors are making it harder for people to be physical as part of their everyday life or out of choice, and this results in future generations not being made accustomed to the practice of physical activity and its’ associated consequences.

In both Malta and the UK, transport and urban development has played a significant role in reducing people’s physical activity.  In Malta, the nation’s primary method of transport is car usage. This is true for the UK too, however, more people are using public transport each year. This has resulted in a decrease in the number people who choose to commute via walking and/ or cycling.  Currently only 10% of people walk to work in the UK. It is interesting to note that the European Cyclists’ Federation (ECF) has ranked Malta as the worst country in Europe for cycling. According to the European Commision Survey only 1% of the Maltese population uses cycling as a method of transportation; in the UK this is only slightly higher at 4%.

Table 2: Physical Activity in the UK and Malta

	UK	Malta
% of adults who regularly exercise or partake in sports	10	5
% of adults who spend more than 2.5 hours in sedentary behaviour	82	68
% of adults doing non-sport physical activity	23	57

These statistics are from the British Heart Foundation 2015,  different organisational figures may vary slightly.  

What this shows is that UK population take part in exercise marginally more than the Maltese but the UK is more sedentary in general. This most likely because the Maltese population are more active at work and during day-to-day activities.  

Malta vs UK - Diet:

Since 1990 the average calorie intake per person has increased from 3240 to 3600 per day in Malta and 3240 to 3450 per day in the UK and this is due to several reasons.

Although located in the heart of the Mediterranean, Malta’s national diet is far from Mediterranean. Many contributing factors have influence the Maltese diet including globalisation, importation of food products, colonial heritage and several others. It is a diet high in sugar, fat and low quality foods (e.g. pastizzi and imqaret). At the same time it is lacking in the nutrients and fibre associated with the Mediterranean diet. Malta should be targeting the consumption of food such as fish and vegetables that would lead to a healthy balanced diet.

An increase in employment hours means people have less time to devote to food preparation, and results in the reliance upon convenience food which are either ready-to-eat or require minimal preparation. Examples of such are takeaways, aptly named fast food and ready meals. The portion sizes of which have increased over the years. There has also been an increase in high calorie snacks and confectionary available. portion sizes of most food products have risen, however in the UK many food manufacturers have began reducing their portion sizes.

Calorie dense food is now cheaper and more available than ever and the healthier versions are often more expensive and harder to obtain. People are therefore so used to easily finding cheap calorie dense food in large portions that eating otherwise is perceived as quite the challenge.

Buzzfeed video illustrating the growth of McDonalds protion sizes.

Currently in Malta, a policy is being adopted (2012-2020), it is called - ‘A healthy Weight for Life: A National Strategy for Malta’. It aims to decrease the percentage of obese and overweight adults and children in the Maltese population so as to reduce the associated negative health and wellbeing consequences. In the UK there are several government initiatives and guidelines that work with the NHS and the general public to reduce obesity. Success of such these are hard to measure however Health and Social Care Information Centre suggests that the rise in obesity is slowing down.

References:

BBC (2014). Who, What, Why: What is a ‘Obesogenic’ environment? Retrieved from http://www.bbc.com/news/blogs-magazine-monitor-27601593 on 07/03/2016.

British Heart Foundation (Worldwide) (2015). Physical Activity Statistics 2015. Retrieved from https://www.bhf.org.uk/publications/statistics/physical-activity-statistics-2015  18/03/16

Centres for Disease Control and Prevention (2012). Defining Adult Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/adult/defining.html on 07/03/2016.

CTC. Cycling statistics. Retrieved from http://www.ctc.org.uk/resources/ctc-cycling-statistics on  08/03/2016.

Department for Transport (UK) (2014). Transport Statistics. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/389592/tsgb-2014.pdf on 08/03/16

Department for Transport (UK) (2015). How people travel. Retrieved from https://www.gov.uk/government/statistical-data-sets/nts03-modal-comparisons  on 08/03/16

Food and Agriculture Organization of the United Nations (Worldwide) (2008). Food Consumption database. Retrieved from http://www.fao.org/fileadmin/templates/ess/documents/food_security_statistics/FoodConsumptionNutrients_en.xls on 09/03/16

Health and Social Care Information Centre (UK) (2015). Statistics on Obesity, Physical Activity and Diet. Retrieved from http://www.hscic.gov.uk/catalogue/PUB16988/obes-phys-acti-diet-eng-2015.pdf  on 05/03/16

Mayo Clinic (2015). Obesity. Retrieved from http://www.mayoclinic.org/diseases-conditions/obesity/basics/definition/con-20014834?p=1 on 07/03/2015.

National Institute of Diabetes and Digestive and Kidney Diseases (2014). Obesity. Retrieved from https://www.nlm.nih.gov/medlineplus/obesity.html on  07/03/2016.

National Obesity Observatory (UK) (2015) Child Obesity. Retrieved from http://www.noo.org.uk/NOO_about_obesity/child_obesity  on 08/03/16

Public Health England (UK) (2013). Obesity and the environment: regulating the growth of fast food outlets. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/296248/Obesity_and_environment_March2014.pdf  on 08/03/16

Resolution Foundation (UK) (2012). The Changing Shape of the UK Job Market and its Implications for the Bottom Half of Earners.  Retrieved from http://socialwelfare.bl.uk/subject-areas/services-activity/employment/resolutionfoundation/131865The_Changing_Shape_of_the_UK_Job_Market_1.pdf on 09/03/16

The Today Public Policy Institute. The Environmental Dimension of Malta’s Ill-Health and Action to Prevent Obesity, Diabetes, Cardiovascular Disease and Dementia. Supplement 2: Obesity and Type 2 Diabetes. Retrieved from http://www.tppi.org.mt/images/reports/supp%202.pdf on 07/03/2016.

Times of Malta (2013). Malta ranked worst EU country for cycling. Retrieved from http://www.timesofmalta.com/articles/view/20130605/local/malta-cycling.472612 on  08/03/2016.

Times of Malta (2015). Malta has highest obesity rate in the EU. Retrieved from http://www.timesofmalta.com/articles/view/20150924/local/malta-has-highest-obesity-rate-in-the-eu.585550 on 07/03/2016.

Times of Malta (2015). Maltese most obese, laziest and most car-dependent. Retrieved from http://www.timesofmalta.com/articles/view/20151216/local/maltese-most-obese-laziest-and-most-car-dependent.595862 on 07/03/2016.

Victor Grech (Malta) (2007). Childhood Obesity:  a critical Maltese health issue. Retrieved from http://www.mcppnet.org/publications/issue12-6.pdf  on 07/03/16

WHO (2012). Policy - A Healthy Weight for Life: A National Strategy for Malta. Retrieved from https://extranet.who.int/nutrition/gina/en/node/14838 on 07/03/2016.

Word Health Organisation (Europe) (2015) The European Health Report 2015. Retrieved from http://www.euro.who.int/en/data-and-evidence/european-health-report/european-health-report-2015/european-health-report-2015-the.-targets-and-beyond-reaching-new-frontiers-in-evidence.-highlights  on 10/03/16

World Health Organisation (Worldwide) (2014). Global Status Report on Noncommunicable Diseases. Retrieved from http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1  on 10/03/16

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