From June next year, new guidelines apply to vendors and suppliers at Malta’s largest hospital, Mater Dei, which will see sugary and energy-rich, but nutrient-poor food disappear from its menus, vending machines and other areas. The government will issue new tenders for the shops, eateries and vending machines inside the hospital. “Let’s just hope when June 2019 comes around the country doesn’t see a rise of people flakily smuggling in tlieta tal-piżelli to their in-patient family members,” Lovin Malta wrote in reaction, as some wondered whether the new strict guidelines should really extend to the hospital’s staff and visitors.

The guidelines were prepared in cooperation with the Health Promotion and Disease Prevention Directorate, together with registered dietitians and nutritionists. Dr Mario Caruana, a registered dietitian, told Eve he is in favour of the guidelines set up by Mater Dei in line with National Health Policy. I’m not against individuals having pastizzi once in a while, but this is a medical environment. Without guidance, contractors were too tempted to go for the cheapest supplies,” he explained.

The new rules are materialising as two lists of items – permissible and non-permissible. A memo leaked to the media stated that non-permissible products include soft drinks, sugary ice teas, fatty milk, sausages, pastizzi, doughtnuts, hot dogs and more. High obesity rates in Malta are cited as one of the reasons for the health drive. Understandably, Maltese media focused on pastizzi, although, among essentially Maltese items, Kinnie might be the prime culprit. According to Harvard School of Public Health, sugary drinks are “a major contributor to the obesity epidemic,” with studies showing that soft drinks can boost genetic tendency to gain weight. Moreover, even low-calorie drinks stimulate appetite for more sugar, and what’s worse, some of them are marketed as sport or diet drinks.

Even 100% juice has sugar content equivalent to a handful of Oreos. Juices and smoothies, rich in nutrients as they are, have the sugar and calories of a meal, but without the satisfaction offered by solid food. Dr Caruana emphasises that it is important to clearly distinguish two different goals: weight control and nutrition. “Even healthy food in large quantities can impact on health. A statement we try to avoid is, this is healthy, so I can eat it unlimitedly,” he commented. “If I have a smoothie and a diabetes, it can still impact on sugar levels. As registered dietitians, we promote portion control, meal planning, and distribution of food.”

Dr Caruana emphasises that each individual has their own nutrition needs, especially when medical conditions are present. For example, high-fibre food is healthy, but some people will need low-fibre food due to their medical condition. Furthermore, although there is growing media attention to the perils of snacking, it can be inevitable to some medical conditions and lifestyles: “To have a snack is better than to get hungry before meals. It can decrease craving. In addition, under certain medical conditions such as diabetes, we recommend snacking in between meals to keep blood sugar levels at a constant level,” Dr Caruana explains. Still, setting clear boundaries in the hospital environment was necessary, as otherwise contractors are tempted to fill the shelves with the cheapest option – which often happens to be food without nutrients, full of fat and sugar.

Finally, removing pastizzi and salty pasta does not mean patients and staff must give up on local cuisine. Dr Caruana lists products that are both healthy and local: “the variety of fruit, olive oil, beans used to make bigilla, hummus from chickpeas, the diversity of meat that we have. We are surrounded by a Mediterranean diet but people need to be taught about portion sizes [to stay healthy and control their weight].”