Malta's fight against childhood obesity

The bad news, however, is that this is because the problem has worsened in countries such as Greece, Spain and Italy.

The 40 percent

In Malta, the share hovers around 40 percent, despite the fact that since 2012 Malta has been working on one of the most elaborate anti-obesity action plans of all EU countries.

Ambitions even stretch beyond its own borders: Malta made the fight against childhood obesity a priority of its current Council of the EU presidency.

The failure to shrink bulging waistlines may therefore seem rather disappointing.

Dr Charmaine Gauci, Malta's superintendent of public health, explained to EUobserver why, despite the high political profile of the problem, it was so difficult to reverse the trend.

"This is a very complex issue. We have already made huge progress in many areas, but there is need for very many people, also beyond the health sector, to work together," she said.

The point of departure for Malta's strategy has been to work with children, she added.

Virtually all schools in Malta today are teaching kids as young as five about the need to eat more healthily, although the lessons mostly resemble games.

They get to play with food, or watch puppet shows where a chef character informs children on how they should eat.

The next step is to make sure schools are sending a congruent message. Tuck shops - small, food-selling retailers - shouldn't be selling junk food, for instance.

The problem is doing this without breaking EU rules, which say public contracts should go to businesses with the cheapest offer.

Dr Gauci and her colleagues have developed a toolkit on how to formulate public tenders without breaching EU procurement rules. These could now be translated by the European Commission for use in other countries.

EU action

EU action is important.

For Malta, a densely populated limestone archipelago that imports around 80 percent of the food, it's difficult to tackle the problem alone without involving foreign food producers.

But the EU, although sympathetic, sometimes adds to the problem through well-meaning policies.

EU health commissioner Vytenis Andriukaitis suggested earlier last week to step up EU fruit, vegetable and milk schemes, under which the EU gives "free" - courtesy of tax-payers - produce to schools in a plan to promote the consumption of allegedly healthy foods.

But Malta, which bans sugary drinks in its schools, only managed to scrap fruit juices after lengthy battles, and juice is still included in other countries' schemes.

EU health ministers last week discussed the mid-term evaluation of the EU childhood obesity plan, which runs from 2014-2020 and aims to support national strategies with EU-level actions.

They found that the most progress has been made on topics such as issuing nutritional guidance, encouraging breastfeeding, banning vending machines and encouraging physical activities in schools.

Malta's minister of health, Chris Fearne, also said that it would be helpful to re-introduce the Mediterranean diet, which has been linked to good health - suggesting it's not the diet of choice in countries such as Malta, Greece and Spain today.

Many producers of fizzy drinks in Europe have also taken steps to reduce sugar content by 10 percent.

"That's good but we want more. And we certainly don't want to pass the message that sugary drinks are ok," said dr Gauci.

Sugar tax

There has been less progress on more controversial issues, such as higher taxation of products with a high level of salt, sugar or fat; food labelling and curbs on marketing of such foods. Initiatives to involve families and to help obese children are also trailing behind.

Ministers discussed whether to introduce a tax on sugar. As the EU lacks taxing capacity, such a levy would have to be introduced at national level.

Malta last year introduced a small fee on sugary drinks. But Dr Gauci said that one has to be careful before introducing these "sin" taxes. Maltese health experts are also carrying out a study of people's eating habits, to see if it would make sense to apply higher taxes to food with high fat, salt or sugar contents.

"Again, it's a complicated question. We need to make sure that such a tax doesn't hit hardest against people from a poor background," she said.

Member states are also waiting for the revision of the audiovisual media services directive (AMSD), which also regulates advertising.

"We know that publicity - not only on television, but also through tablets and mobiles - has a significant impact on children. Parties are taking steps to a stronger pledge to regulate this under the AMSD revision, and afterwards we will see if there is anything else we can do," Gauci said.

She noted that it was difficult to completely ban the promotion of certain types of food. Even the use of certain colours, such as yellow and red, in advertising, as table cloths in restaurants, or as food colouring additives, could make people feel hungrier than they really are.

"Fighting obesity is a long-term effort, and a question of employment, finances and education," she said.

Already halting the increasing rates of obese and overweight children was a success.

The ministers' discussion will feed into the upcoming council conclusions on childhood obesity, and Malta hopes that the next EU presidencies will follow up on its work.

"We hope they will continue with food guidelines for hospitals and elderly homes, for instance," she said.