The characteristics of an obesogenic small European country: results from a Malta cross-sectional study

Abstract

Aim:

Obesity is a chronic disease and a global epidemic. The pathophysiology is well-documented; however, different countries are faced with different obesity characteristics. The aim was to establish the adult obesity characteristics of the obesogenic European country of Malta and explore for obesity links.

Method:

A national representative health examination survey was conducted. A single-stage random stratified sample population (n = 4000) was obtained from a national register. Data on sociodemographic, comorbidities and lifestyle were collected. Body weight and height were measured, and blood collected for fasting glucose and lipid profile. Multiple binary logistic regression analyses through generalized linear models were performed to assess for associations between obesity, sociodemographic characteristics and dysglycaemic status.

Results:

Out of the study population (n = 3947), 69.75% (confidence interval (CI) 95%: 68.32–71.18) were obese, with a male predominance (55%). The obese category sub-population resided mostly (25.80%, CI 95%: 23.53–28.21) within the highly densely populated district (Northern Harbour) of Malta and had a ‘routine and manual’ social position (55.76%, CI 95%: 53.10–58.40). On multiple logistic regression modelling, an obese status was linked with males (odds ratio (OR): 1.8, CI 95%: 1.53–2.12, p < .01), age (OR: 1.01, CI 95%: 1.01–1.02, p < .01), Northern Harbour district (OR: 1.11, CI 95%: 0.91–1.36, p < .02), type 2 diabetes (OR: 2.46, CI 95%: 1.79–3.38, p < .01) and impaired fasting blood glucose (IFG: 1.31, CI 95%: 1.17–1.90, p < .01) after adjusting for confounders.

Conclusion:

Obesity is a major health concern in Malta. Social determinants of health and metabolic changes appear to have a role in the obesity phenotype. Target actions that are gender-sensitive, social groups-focused and geographically oriented may be essential. The link between obesity and dysglycaemia brings forward the suggestion for incorporation of routine dysglycaemia screening during family doctors’ consultations for patients with higher than normal body weight.

Keywords

obesity environment policy prevention Malta

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References

Friedrich

MJ.

Global obesity epidemic worsening. JAMA 2017;318(7):603.

World Health Organization (WHO). Obesity and Overweight. Available online at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (last accessed 13 April 2020).

Redinger

RN.

The pathophysiology of obesity and its clinical manifestations. Gastroenterol Hepatol (N Y) 2007;3:856–63.

Lee

Cardel

Donahoo

WT.

Social and Environmental Factors Influencing Obesity. MDText.com, Inc; 2000. Available online at: http://www.ncbi.nlm.nih.gov/pubmed/25905211 (last accessed 17 April 2020).

Cuschieri

Vassallo

Calleja

et al. The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study. Arch Public Health 2016;74:52.

Campos

Saguy

Ernsberger

et al. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiol 2006; 35:55–60.

Marmot

Bell

Social determinants and non-communicable diseases: time for integrated action. BMJ 2019;364:l251.

Marmot

Fair Society, Healthy Lives the Marmot Review: Strategic Review of Health Inequalities in England post-2010. Available online at: http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf (2010, last accessed 10 July 2018).

Cuschieri

Camilleri

Grech

University food environment, an example of health inequality?

Malta Med Sch Gaz 2019;3:24–8.

10.

Cuschieri

Cauchi

Do we practice what we preach? Assessing the food environment in Malta’s only state hospital. Eur J Public Health 2019;29:ckz186.262.

11.

Cuschieri

Vassallo

Calleja

et al. Prevalence of obesity in Malta. Obes Sci Pract 2016;2(4):466–70.

12.

Cauchi

Rutter

Knai

An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta. Public Health Nutr 2015;18(17):3211–23.

13.

World Health Organization. Growing up unequal: gender and socioeconomic difference in young people’s health and well-being. Health Behaviour in school-aged children (HBSC) study: international report from the 2013/2014 survey. Copenhagen: World Health Organization; 2016.

14.

Cuschieri

Mamo

Malta: Mediterranean diabetes hub – a journey through the years. Malta Med J 2014;26:27–31.

15.

Cuschieri

Vassallo

Calleja

et al. Diabetes, pre-diabetes and their risk factors in Malta: a study profile of national cross-sectional prevalence study. Glob Heal Epidemiol Genomics 2016;1:e21.

16.

World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva: World Health Organization; 2000.

17.

Sturm

Increases in morbid obesity in the USA: 2000-2005. Pub Heal 2007;121(7):492–6.

18.

Connelly

Gayle

Lambert

PS.

A review of occupation-based social classifications for social survey research. Methodol Innov 2016;9:205979911663800.

19.

OECD. Classifying Educational Programmes. Manual for ISCED-97 Implementation in OECD Countries. Available online at: http://www.oecd.org/education/skills-beyond-school/1962350.pdf (1999, last accessed 6 March 2019).

20.

National Statistics Office. Regional statistics Malta. Valletta: National Statistics Office; 2017.

21.

Meriwether

McMahon

Islam

et al. Physical activity assessment validation of a clinical assessment tool. Am J Prev Med 2006;31:484–91.

22.

Cirera

Huerta

Chirlaque

et al. Life-course social position, obesity and diabetes risk in the EPIC-Spain Cohort. Eur J Public Health 2016;26(3):439–45.

23.

Al-Goblan

Al-Alfi

Khan

MZ.

Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes 2014;7:587–91.

24.

Garawi

Devries

Thorogood

et al. Global differences between women and men in the prevalence of obesity: is there an association with gender inequality. Eur J Clin Nutr 2014;68(10):1101–6.

25.

El Ati

Traissac

Delpeuch

et al. Gender obesity inequities are huge but differ greatly according to environment and socio-economics in a North African setting: a national cross-sectional study in Tunisia. PLoS ONE 2012;7(10):e48153.

26.

Gale

EAM

Gillespie

KM.

Diabetes and gender. Diabetologia 2001;44:3–15.

27.

McLaren

Socioeconomic status and obesity. Epidemiol Rev 2007;29:29–48.

28.

National Statistics Office. Demographic review 2014. Valletta: National Statistics Office; 2016.

29.

Marques

Peralta

Naia

et al. Prevalence of adult overweight and obesity in 20 European countries, 2014. Eur J Public Health 2018;28(2):295–300.

30.

Popkin

BM.

Rural areas drive increases in global obesity. Nature 2019;569(7755):200–1.

31.

PricewaterhouseCoopers. National Household Travel Survey 2010. Marsa. Available online at: http://www.transport.gov.mt/admin/uploads/media-library/files/NHTS2010 Report.pdf_20120502091559.pdf (2010, last accessed 19 November 2018).

32.

Directorate-General for Communication. Special Eurobarometer 406 – Attitudes of Europeans towards urban mobility. Brussels. Available online at: http://ec.europa.eu/public_opinion/index_en.htm (2013, last accessed 19 November 2018).

33.

Nyberg

Batty

Pentti

et al. Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study. Lancet Public Heal 2018;3:e490–e497.

34.

Brandkvist

Bjørngaard

Ødegård

et al. Quantifying the impact of genes on body mass index during the obesity epidemic: longitudinal findings from the HUNT Study. BMJ 2019;366:l4067.