Download The challenge of obesity in the WHO European Region

Overweight/Obesity
Erika Ax, Ewa Björkeson
Nutrition policy
Amanda Brunosson, Dunia Daoud
Public Health Nutrition15hp 2009
2017-07-29
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The challenge of obesity in the WHO European Region and
the strategies for response
Summary
The WHO Regional Office of Europe organized the “WHO European Ministerial Conference
on Counteracting Obesity” to address the emerging challenge of the obesity epidemic. The
conference took place in Istanbul, Turkey on 15-18 November 2006. “The challenge of
obesity in the WHO European Region and the strategies for response” was the main
background document for discussion and worked as base material for conducting “The
European Charter on Counteracting Obesity” which lists guiding principals and clear action
areas. This European action plan was approved by all participating countries. According to the
plan the ultimate goal of action in the Region is curbing the epidemic and reversing the trend
of escalating obesity. Visible progress should be achievable in most countries by year 2015.
“The challenge of obesity in the WHO European Region and the strategies for response”
recognize that the prevalence of overweight and obesity has risen threefold since the 1980’s.
The problem might be even greater since there are insecurity in the presented data. Some
countries have measured data but still the data from many countries are based on self-reports,
which generally underestimate the prevalence of obesity. Even more distressing might be that
the epidemic is proceeding with alarming rates, especially among children. The liabilities for
developing overweight and obesity starts already prenatal, where the mothers nutritional
status plays a vital role. Poor maternal nutrition might lead to underweight newborns, who
increases more rapidly in weight then normal. Also increasing numbers of children are born
with high birth weight and obesity in childhood often persists in adolescent and adult life, so
called “tracking”.
The prevalence of overweight and obesity varies both between countries and within countries
and between socioeconomic groups. A higher occurrence is noticed among socially depraved
communities. Lower income and education, female gender and less access to care seems to be
contributing factors to obesity. This indicates the importance of environmental and sociocultural factors for diet and physical activity as these are recognized as the main determinants
of obesity. At least two thirds of the adult population is insufficiently physical active and over
consumption of energy dense food and energy rich drinks are common. The consumption of
fruits and vegetables seldom reaches the recommendations. Traditional dietary patterns are
disappearing and the society is entering into “nutrition transition” where diets with grains and
vegetables are repressed and replaced by a diet high in sugar and fat, processed foods and
meals eaten outside the home. The contributing factors to this development are many and
involves all levels of society. The food environment is driven by the food market, agricultural
policies, food pricing, labelling and advertising. The trend is that the most energy dense
products are the most accessible and agricultural policies encourage the production of fat,
sugar, meat and alcohol. The importance of the built environment highly affects physical
activity level; urban planning, facility access and transport possibilities are important. The
community today obviously increases the risk for obesity by influencing the determinants diet
and physical activity. Obesity causes diseases and conditions which leads to an economical
burden for the society, both as direct medical and healthcare costs and indirect by lost
productivity.
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Overweight/Obesity
Erika Ax, Ewa Björkeson
Nutrition policy
Amanda Brunosson, Dunia Daoud
Public Health Nutrition15hp 2009
2017-07-29
----------------------------------------------------------------------------------------------------------------The evidence for effectiveness of interventions against obesity is limited as most interventions
for counteracting obesity are controlled trails in schools, workplaces and health centres. These
interventions could not be applied on other groups due to setting bias. They are also often
both costly and ineffective. Micro-scale interventions often have small effects unless
supported by macro-scale interventions. A combination of policies and population-based
programmes, regulations and coordinated actions are needed.
In treatment of obesity, moderate weight loss can be achieved and maintained by lifestyle
interventions. In adults high-quality evidence supports the effectiveness of low-energy diets
for treating obesity, although no evidence of effectiveness beyond two years are available.
Diet alone seems to have more potential then exercise alone, for weight reduction. All the
same evidence indicate that physical activity helps maintain a modest weight lost.
Unfortunately few healthcare professionals have education in the area of nutrition and
physical activity for obesity treatment. When anti-obesity drugs or behaviour therapy have
been used, they have shown modest results. The only proven intervention with long term
effect in severely obese patents is surgery.
It is of high importance in the treatment and management of obesity not only to focus on
weight reduction but also consider and treat the related diseases. As well as emphasize the
value of maintaining a healthy weight.
Most countries have recognized the escalating problem with obesity and many have
developed policies and action plans. However still no countries has been able to reverse the
trend. Therefore action needs to be taken at all levels in society and include both
governmental organisations, nongovernmental organisations (NGO) and stakeholders.
International actions are of high importance. The health minister must be the leading force
and identify action areas and involve concerned ministers to promote the development of
intersectional actions for a healthier lifestyle. Priority groups are children, young people and
subgroups with low socio-economic status and special attention should be paid to women.
Increased investments are needed and since the evidence base for obesity interventions is
insufficient a new approach is necessary. The idea is an “investment portfolio” which
evaluates results in terms such as expected health gains. This portfolio should include policies
that span across all sections and levels of society and include cultural and economical aspects.
Focus should be shifted from an evidence based to a population based perspective. It is also
necessary to develop new methods to monitor and evaluate policies and actions on a national
level.
Actions needs to be taken in all areas which affects the determinants of obesity and at all
stages at life. To promote healthier diet the demand and supply for healthier food-products
needs to be increased. This could be achieved by developing new agricultural policies and by
influencing the production of healthier food-products. Strategies affecting food-pricing,
distribution, marketing, advertising and promotion as well as labelling should be considered.
Schools, kinder gardens, workplaces, hospitals and caterings should encourage healthier food
choices. The need of education and information at all levels should be emphasized and
international food dietary guidelines should be standardized. Guidelines for infant feeding
should be provided and exclusive breastfeeding should be promoted and supported. As for
physical activity society needs to be design to promote and facilitate an active living. Schools,
kinder gardens and workplaces should provide better opportunities for physical activity. All
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Overweight/Obesity
Erika Ax, Ewa Björkeson
Nutrition policy
Amanda Brunosson, Dunia Daoud
Public Health Nutrition15hp 2009
2017-07-29
----------------------------------------------------------------------------------------------------------------health workforce needs to be educated in obesity treatment and prevention. Public sector
should only use diagnostic practises and dietary prescriptions that are supported by scientific
literature.
On the “WHO European Ministerial Conference on Counteracting Obesity” the ministers and
delegates present recognized the increasing problem with obesity and acknowledge that the
epidemic is reversible. They adopted “The European Charter on Counteracting Obesity”
with goals, principles and framework for actions, based on the conference background
document “The challenge of obesity in the WHO European Region and the strategies for
response”. The ultimate goal of action is to reverse the trend at the latest by year 2015. As the
outcome of reduced obesity and related diseases will take time to manifest, monitoring
progress on long term basis is essential. The conference established that on the WHO
European level three-year progress reports should be presented and recognized that visible
progress should be seen within four to five years.
Discussion
The occurrence of overweight and obesity is frightening but even more frightening when
thinking about that the prevalence probably is even greater then recognized, due to lack of
data and lack of quality in reported data. This could mean that the costs associated with
obesity in the society might be even greater than recognized and become indefensible in the
future. The costs and insets for combat this situation will probably escalate.
On individual level overweight and obesity highly affects life quality. Often the already more
socially depraved groups in society are the ones affected the most, leading to an increased
segregation. Therefore the aim of the interventions must be to target the more exposed groups,
avoiding that the gap between subgroups increases and that we create a society with an elitist
healthy group.
Since women with low education is a highly affected group and also has a potential role for
influencing the next generation, the importance of target interventions to this group should be
emphasized. The reverse is also possible where interventions in schools could educate
children and influence their families and older generations to better habits.
In the aim of reversing overweight and obesity one must consider the heterogeneity of society,
where cultural and religious values must be taken into account. In some cultural groups
chubby children are equal to healthy children. And in many cultures physical activity is not
even on the agenda. Different countries of the Region must adapt interventions and strategies
based on their cultural values to affect the determinants and combating obesity.
Still, going into “nutrition transition” divergences are diminishing unfortunately leading to a
loss of culture food tradition. These changes in food behaviour has, especially in certain
groups, occurred rapidly which has contributed to the obesity situation.
Unfortunately the agricultural policies of today contributes to unhealthy dietary patterns and
counteracts the aim to lower overweight and obesity, by encouraging the production of fat and
sugar. Governmental authorities need to feel a mutual responsibility and cooperate to form
common approaches.
3
Overweight/Obesity
Erika Ax, Ewa Björkeson
Nutrition policy
Amanda Brunosson, Dunia Daoud
Public Health Nutrition15hp 2009
2017-07-29
----------------------------------------------------------------------------------------------------------------As economic interests rules the market economy, food producers, retailers etc. will always
prioritize the company profit before public health. For example by developing more and more
refined marketing methods and targeting vulnerable groups such as children. To manage this
situation one approach, as also discussed in the documents, could be legislation. Also
important is to raise the general knowledge in society to create demand for healthier products,
thereby influencing the food market.
It is positive to see that in the approved document the ministers recognize that the problem
involves and affects all levels of society and that a holistic view is vital. They highlight the
fact that all need to take part in this challenging action and that increasing investments are
needed. The idea of an investment portfolio is appealing. This new approach, thinking in
economic and politic terms regarding public health might help us to reach impact in
combating obesity. Reaching a higher level of knowledge in society, especially in the health
sector is a positive focus.
“The European Charter on Counteracting Obesity” seems well-reasoned and the approach is
attracting but is it realistic? In the way the society is structured today this degree of
cooperation and working across sections might be hard to reach. Even if this goal is mutual
the individual interests of participating actors are diverse. The question is also who will take
the costs and who will benefit?
Will we reach the goal in 2015? It will be interesting to see if progress has been achieved
when the first three-year progress report is due in the next year, 2010.
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