https://www.um.edu.mt/library/oar/handle/123456789/754 2026-11-11T01:56:11Z https://www.um.edu.mt/library/oar/handle/123456789/150899 Title: Ten-year body weight trajectories in Maltese adults : patient-centred evidence from a health examination sub-cohort across the COVID-19 period Authors: Grech, E.; Calleja, Neville; Cuschieri, Sarah Abstract: Background: In 2016, a national Health Examination Survey performed in Malta showed that 70% of adults aged 18–70 years were overweight or obese. From a patient-centred public health perspective, understanding how body weight evolves over time, particularly during major societal disruptions such as the COVID-19 pandemic, is essential to inform effective prevention strategies.; Methods: We followed a nationally derived sub-cohort of adults (n=215) over a 10-year period to examine longitudinal changes in body mass index (BMI), COVID infection status, and selected health behaviours. Analyses focused on changes in BMI trajectories and behavioural transitions. Paired and independent T-tests were used to analyse appropriately. Tis included COVID infection status and behavioural changes.; Results: Across the 10-year follow-up, 55.81% of participants experienced an increase in BMI, 16.74% remained stable, and 27.44% showed a decrease, with an overall signifcant increase in BMI (p < 0.001). A confrmed COVID-19 infection was associated with an increase in BMI over time (p=0.037); however, this association was no longer statistically signifcant afer adjustment for age and sex in linear regression analyses (p = 0.079). Among males, an increase in BMI was associated with a signifcant shif toward more frequent alcohol consumption over time (p=0.009), whereas females with increasing BMI demonstrated a reduction in alcohol intake (p=0.004). Participants with increasing BMI also reported a decline in smoking prevalence over time, observed in both males (p < 0.001) and females (p< 0.0001).; Conclusions and Public Health Implications: Our fndings indicate that bodyweight trajectories are dynamic and shaped by interacting biological, behavioural, and contextual factors. Te observed association between COVID-19 infection and BMI over time is suggestive but inconclusive, underscoring the need for further research before informing metabolic health surveillance in pandemic preparedness and recovery planning. Te coexistence of favourable behaviours, such as reduced smoking, alongside less favourable patterns, including increased alcohol consumption among men, emphasises the need for integrated, sex-sensitive public health interventions. Malta and other European small-states with a high obesity burden require prevention strategies which adopt a life-course approach. Weight management together with broader lifestyle behaviours need to be addressed over time, ensuring that care pathways remain responsive to patients’ evolving needs. Tis will tie in to the European Union’s cardiovascular health plan: Te Safe Hearts Plan which aims to significantly reduce the burden of cardiovascular diseases in Europe. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/150898 Title: Front-of-pack food labelling as a public health tool to support healthier choices and obesity prevention : evidence from Malta Authors: Cardona, S.; Zhang, N.; Galea, K.; Cuschieri, Sarah Abstract: Introduction: Obesity represents a major public health challenge in Europe and is strongly infuenced by dietary behaviours and the food environment. In Malta, where the prevalence of obesity and obesity-related non-communicable diseases remains among the highest in Europe, population-level strategies that support healthier food choices are essential. Front-of-pack labelling (FOPL) is designed to provide accessible nutritional information at the point of purchase and has been proposed as a key policy tool to support obesity prevention. Tis study explored awareness, comprehension and attitudes towards FOPL among adults living in Malta, with a focus on its potential role in promoting healthier dietary choices relevant to obesity prevention.; Methods: A mixed-method, cross-sectional study was conducted using an anonymous online questionnaire distributed via social media. Adults aged 18 years and older were invited to participate. Te survey collected demographic information and assessed familiarity with, understanding of and attitudes towards commonly used FOPL systems in Malta, namely Nutri-Score and Guideline Daily Amounts (GDA). Participants’ ability to interpret FOPL and apply this information when comparing food products was evaluated. Statistical analyses examined associations between demographic characteristics and engagement with FOPL.; Results: A total of 600 adults participated. While most participants recognised the importance of FOPL for guiding food choices, 62.17% reported not routinely consulting FOPL during grocery shopping. Participants generally demonstrated good understanding of the Nutri- Score system, whereas interpretation of GDA labels was more variable and dependent on educational attainment. Females and individuals with higher education levels were more likely to review nutritional information. When interpreting GDA labels, participants most frequently prioritised calorie and fat content, refecting awareness of dietary factors associated with obesity risk. However, fewer than half of participants reported that FOPL information was easy to understand, highlighting potential barriers to efective use.; Conclusion: Front-of-pack labelling has the potential to support healthier food choices and contribute to obesity prevention eforts in Malta, but its impact is limited by inconsistent use and varying levels of comprehension across population groups. Strengthening FOPL literacy through targeted public health education and adopting intuitive, easily interpretable labelling formats may enhance its efectiveness, particularly for individuals living in environments with a high burden of obesity. Integrating FOPL within broader, equity-focused obesity prevention strategies may help translate nutritional awareness into sustained behavioural change. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/150884 Title: Critical evidence gaps on obesity-climate dynamics in small countries : a systematic review Authors: Cuschieri, Sarah; Scerri, K. M.; Sammut, N.; Grech Enriquez, C. J.; Sheridan, M.; Chetcuti, N.; Sigona, R.; Farrugia, M.; Shaw, C.; Camilleri, N.; Sant, D.; Cuschieri, A. Abstract: Introduction: Te parallel existence of obesity and climate change presents two escalating global threats afecting human well-being and environmental stability. Small nations face heightened vulnerability due to geographic isolation, reliance on imported food, and susceptibility to climate events. While a syndemic framework has been proposed globally, empirical data on these interactions in small states remains scarce. Tis systematic review aims to identify, and evaluate the existing evidence on the bi-directional relationship between obesity and climate change in small countries.; Methods: A systematic review (PROSPERO: CRD420251011029) was conducted following PRISMA 2020 and SWiM guidelines. Five databases were searched for studies examining the interplay between obesity risk and climate change in small countries. Eligible studies were narratively synthesized, with quality assessed using established criteria.; Results: Of 3,471 records screened, only four studies met the inclusion criteria (Figure 1, Table 1)1-4. Tese focused solely on Pacifc and Caribbean small island developing states (Table 2). Shared systemic drivers were identifed, linking the crises via disrupted agriculture, food insecurity, and reduced physical activity, while rising obesity contributes to environmental stress through demand for high-carbon, ultra-processed foods and strain on healthcare, as illustrates in reciprocal feedback loops adapted from An et al.(2017) (Figure 2).; Conclusions: Te co-occurrence of obesity and climate change in small countries functions as a syndemic, rooted in complex ecological, social, and cultural determinants. Te stark absence of research on this topic, especially outside of the Pacifc and Caribbean regions, is a critical gap that demands immediate attention. Efectively tackling this dual crisis necessitates implementing integrated and culturally appropriate policy responses aimed at restoring traditional food knowledge, encouraging sustainable agroecological practices, and designing co-beneft strategies that simultaneously advance public health outcomes and climate adaptation eforts. Future research must urgently expand to other small-countries. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/150881 Title: Front-of-pack food labelling : a tool for choice or an illusion of control? Authors: Cuschieri, Sarah; Chetcuti, Nicole; Sammut, Nicholas Abstract: The world is facing a public health crisis, with one in eight individuals living with obesity. This burden is mirrored across Europe; subsequently, cardiovascular diseases (CVD) remain the leading cause of death and disability. Without decisive action, CVD prevalence is projected to increase by 90% and mortality by 73.4% by 2050. Yet, up to 80% of these conditions are preventable through lifestyle modifications.; Among the many determinants of health, the food environment plays a central role. Within this, front-of-pack nutrition labelling (FOPL) has emerged as a key policy tool. Recommended by the World Health Organization as part of its ‘Quick Buys’ for non-communicable disease prevention, FOPL aims to simplify nutritional information and support healthier choices. Evidence suggests that interpretative, colour-coded labels can improve consumer understanding and guide purchasing behaviour. 2026-01-01T00:00:00Z