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

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.

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.

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.

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.