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Vegetables
Plant-based diets are going mainstream all over the world. Cassi Camilleri sheds light on the local vegan movement and how reducing our meat consumption can benefit us all.

Some label the rise of plant-based living as evidence of ‘trend culture’. And they’re not all wrong. Traditional media bombards us with countless headlines on the topic’s pros and cons. Hard-hitting advocacy films like Cowspiracy and Forks over Knives expose the horrors of the meat industry. Social media influencers share their experiences with the diet, turning it into lifestyle content. And now the market is following suit with vegan and veggie lines and options popping up everywhere.

In 2016, an Ipsos MORI survey for the Vegan Society identified that 3.25% of adults in the UK never eat meat in any form as part of their diet, equating to roughly 540,000 people. Vegan January—commonly known as Veganuary—is growing in popularity. This year, a record-breaking 250,310 people from 190 countries registered for the month-long vegan pledge. And Malta is no exception.  

While the official number of people following a plant-based or vegan diet are unavailable, interest is clear. Facebook pages Vegan Malta and Vegan Malta Eats have a combined following of over 16,500 people. 

The reasons behind people’s decision to take up veganism are various, however three main motivators keep being cited: health benefits, ethics, and environmental concerns. For vegan business woman Rebecca Camilleri the process was natural and gradual. ‘There was no real intention behind it for me. But after a couple of months of following this diet, I noticed that my energy levels were better than before, and this encouraged me to learn more on how I needed to eat in order to nourish my body with the right nutrients to sustain my active lifestyle.’  

Researcher and nutritionist Prof. Suzanne Piscopo (Department of Health, Physical Education, and Consumer Studies, University of Malta) confirms that ‘moving towards a primarily plant-based diet is recommended by organisations such as the World Health Organization and the World Cancer Research Fund, for health and climate change reasons.’

Oxford academic Dr Marco Springmann has attempted to model what a vegan planet would look like, and the results are staggering. According to his calculations, should the world’s population switch to a vegan diet by the year 2050, the global economy would save $1.1 trillion in healthcare costs. We would also save $0.5 trillion in environmental costs, all while slashing greenhouse gas emissions by two-thirds. 

Despite all this, veganism has earned itself quite a few enemies along the way. The vitriol thrown back and forth across both camps is shocking. Relatively recently, UK supermarket chain Waitrose came under scrutiny after magazine editor William Sitwell responded to plant-based food article ideas from writer Selene Nelson with a dark counter offer—a series on ‘killing vegans’. Sitwell was since forced to resign. Nelson posited that the hostility stems from ‘a refusal to recognise the suffering of animals. Mocking vegans is easier than listening to them.’

Abigail Higgins from American news and opinion website Vox agrees that guilt plays a role in the hatred aimed towards veganism, but also proposes that the whole movement ‘represents a threat to the status quo, and cultural changes make people anxious.’ This notion is based on research on intergroup threats and attitudes by US researchers Walter G. Stephan and Cookie White Stephan. 

It however remains a reality that some of the loudest voices in veganism in the past have been militant. Some have invoked hatred and threats towards those that they perceive not to be sufficiently aggressive in promoting the cause. Piscopo calls for a respectful discussion.

‘Food is not only about sustenance and pleasure, but has symbolic, emotional, and identity value. Take meat for example. Some associate it with masculinity and virility. Others link it to food security as meat was a food which was scarce during their childhood. Some others equate it with conviviality as meat dishes are often consumed during happy family occasions. What is important is that we do not try to impose our beliefs, thoughts, and lifestyle on anyone.’

The way forward is a ‘live and let live’ approach, according to Rebecca Galea. When her journey started she had people ‘staring strangely at [her] food’. Even her family didn’t take her seriously. ‘They were very sceptical as their knowledge on veganism was very limited at the time,’ she remembers. Now, seeing the effect the switch has made to Rebecca’s life, her positive choices are naturally impacting theirs. ‘Everyone is free to make their choice,’ she says. Embodying the philosophy of leading by example, Rebecca has even set up her own business making delicious vegan nut butters, spreads, and more, to great success. ‘The more vegan options are available [in Malta], the more people will be attracted to learning and accepting the benefits of veganism. This might also lead to them following a vegan lifestyle!’

With that, and sharing valid, up-to-date research-based information, as Piscopo suggests, it seems there is no stopping this ‘trend’. And who would want to when veganism can lead to a lower carbon footprint and better health for everyone? 

Public health priority: Type 2 diabetes mellitus

Blood testing
What is Malta doing to address this very prevalent problem? Dr Sarah Cuschieri writes about a project called SAĦĦTEK.
Dr Sarah Cuschieri

In Malta, diabetes has been a health concern since 1886. In 1981, the World Health Organization performed the first national diabetes study in Malta and reported that the total prevalence of type 2 diabetes mellitus (T2DM) is 7.7% (5.9% previously known diabetics and 1.8% newly diagnosed diabetics).  

Since then, we have seen that percentage increase through self-reported questionnaire studies such as 2008’s Maltese European Health Interview Survey, which reported a T2DM prevalence of 8.3% in the population aged between 20 and 79. In 2010, it rose again to 10.1%, according to the Maltese European Health Examination Survey. And while this information is definitely useful, it cannot help researchers and doctors investigate what elements contribute to the diabetes epidemic in Malta.  

The economic boom over the last four decades has permanently changed the Maltese Islands. With it came a change in lifestyle habits, like car use and diet, and an influx of different cultural and ethnic populations settling on the islands, which meant that it was time to update our understanding of T2DM in Malta; its prevalence, determinants, and risk factors. 

I undertook the project “SAĦĦTEK – The University of Malta Health and Wellbeing study” to find out more about T2DM in Malta. SAĦĦTEK was a cross-sectional study that will effectively act like a snapshot in time.

The study population included a randomised sample of adults that had been living in Malta for at least six months and held a permanent Maltese identification card, irrelevant of their country of origin.

How is your health? 

Top row: Ayrton Borg Axisa, Bernard Schembri, Ryan Camilleri Middle row: Bader A. Ali, Russell Bonnici, Andrew Chilton Bottom row: Angeline Sapiano, Sarah Cuschieri, Fatemah Abdullah

The survey took place between November 2014 and November 2015, and involved 4,000 people (18 to 70 years of age) who were statistically chosen from the national registry. We set up examination hubs in each town where the participants came in to complete socio-demographic questionnaires. While participants were there, we also took several measurements, including blood pressure, weight, height, and waist circumference. Finally, we took blood samples to check for their glucose levels during fasting periods, genetic analysis, and lipid profile (cholesterol and fats in the blood). 

In the end, 47.15% of the invited adults actually attended the health survey. From these, we found that the prevalence of type 2 diabetes was 10.39%, with males being more affected than females. From the total T2DM group, 6.31% were known diabetics, while the remaining 4.08% were newly diagnosed with T2DM during the study. The numbers mean that over the past couple of decades there has been a rise in the diabetes rate in adults. Higher levels of T2DM mean that related diseases, such as obesity and heart problems, will also be more common. 

In fact, study participants were often overweight (35.66%) or obese (34.11%). The weight increase is very relevant because it puts pressure on the body’s organs, including the pancreas, which has a direct link to T2DM development.

An increase in weight increases waist size, and this too comes with its own set of problems called the metabolic syndrome—increased blood pressure being one of many. A third of survey participants reported a high blood pressure (30.12%), again with a male majority.

Tobacco smoking was also prevalent at 24.3% (male majority). Smoking is linked to T2DM development, increased blood pressure, and stroke.

What are the implications?

The survey results are a major public health concern. An unhealthier population means higher demands on Malta’s healthcare services.

In 2016 diabetes cost Malta an estimated €29 million, while obesity cost an estimated €24 million. The increased disease rate identified means that Malta’s bills are set to rise.

Men seem to have a worse health profile than women. Older males with a high body mass index (BMI) were more likely to suffer from high blood pressure. The majority had normal levels of glucose but abnormal lipid profiles, so even though the sugar levels were normal, they were still at risk when it came to acquiring diseases such as heart problems. Those diagnosed with a metabolic syndrome were five-fold more likely to also have T2DM. There is no denying—the gender gap is a concern.

The survey shows that more public health research is in dire demand. Malta’s underlying problem appears to be the increasing overweight-obesity problem. A number of initiatives have already been put in place by the Health Promotion and Disease Prevention Directorate as well as the establishment of “Dar Kenn Għal Saħħtek”, but there is more to be done.

Gender sensitive action is needed. Government, private entities, communities, and NGOs all need to work together to change the harmful lifestyle choices that have become the norm today. Sedentary lifestyles need to change and high intakes of fat, sugar, and salt need to decrease to alleviate Malta’s weight and diabetes problem. A diabetes screening programme also needs to be introduced to help citizens help themselves. 

Early diagnosis of this disease will benefit all of Malta’s health and wellbeing and safeguard its health services. What more could we hope for? 

Read more:

Cuschieri, S., Vassallo, J., Calleja, N., Pace, N., & Mamo, J. (2016). Diabetes, pre-diabetes and their risk factors in Malta: A study profile of national cross-sectional prevalence study. Global Health, Epidemiology and Genomics, 1. https://doi.org/10.1017/gheg.2016.18

Cuschieri, S., Vassallo, J., Calleja, N., et al. (2016). The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study. Arch Public Health; 74: 52.

Cuschieri, S., Vassallo, J., Calleja, N., et al. (2016). Prevalence of obesity in Malta. Obes Sci Pract 2016; 2: 466–470.