Towards a new milestone in European nutrition and physical activity policies

by João Breda, WHO Regional Office for Europe

GBD – attributable for 20 RF 2010 as % DALY

15 out of 20 RF linked with nutrition and PA Lim & al. 2012

Prevalence of overweight (%) among adult men

(BMI ≥25.0 kg/m2)

1994 1997 2000 2003 2006 2009 201225

30

35

40

45

50

55

60

65

70

Prevalence of overweight (%) among adult men (BMI >25.0 kg/m2)

Austria, 20+Belgium, 18+Denmark, 16+Estonia, 16–64Finland, 15–64France, 15+Germany, 18+Ireland, 18+Italy, 18+Latvia, 15–64United Kingdom, Scotland, 16–64Lithuania, 20–64Luxembourg, 16+Netherlands, 20+Norway, 16+Portugal, 18–64Spain, 18+

Prevalence of overweight (%) among adult women (BMI ≥25.0 kg/m2)

1994 1997 2000 2003 2006 2009 201225

30

35

40

45

50

55

60

65

70

Prevalence of overweight (%) among adult women (BMI >25.0 kg/m2) Armenia, 15–49Austria, 20+Belgium, 18+Denmark, 16+Estonia, 16–64Finland, 15–64France, 15+Germany, 18+Ireland, 18+Italy, 18+Latvia, 15–64Lithuania, 20–64Luxembourg, 16+Netherlands, 20+Norway, 16+Portugal, 18–64Spain, 18+Sweden, 16–84Switzerland, 15+Turkey, 15–49United Kingdom, Wales, 16+

Ireland

Latvia

Lithuania

Norway

Czech Republic

Hungary

SloveniaGreece

ItalyMalta

Portugal

Spain0

10

20

30

40

50

6-year-olds 7-year-olds 8-year-olds 9-year-olds

Pre

va

len

ce

of

ov

erw

eig

ht

(in

clu

din

g

ob

es

ity

) (%

)

Childhood obesity prevalence in 12 countries – COSI 2010

Childhood obesity prevalence in 12 countries (trends)– COSI 2008-2010 (boys)

1 220.0

25.0

30.0

35.0

40.0

45.0

50.0Czech Republic, 7-year-olds

Latvia, 7-year-olds

Malta, 6-year-olds

Norway, 8-year-olds

Slovenia, 8-year-olds

Italy, 9-year-olds

Ireland, 7-year-olds

Italy, 8-year-olds

Lithuania 7-year-olds

Portugal, 7-year-olds

Slovenia, 6-year-olds

Slovenia, 7-year-olds

WHO COSI, round (2010):

1 in every 3 children aged 6-9 years was overweight or obese

The prevalence of overweight (including obesity) ranged from 24% to 57% among boys and from 21% to 50% among girls. Simultaneously, 931% of boys and 621% of girls were obese

1/4 in 2008 to 1/3 in 2010

THE SOCIOECONOMIC GRADIENT IN CHILDHOOD OVERWEIGHT AND OBESITY: DIVERSITY ACROSS FIVE EUROPEAN COUNTRIES (WHO COSI) – unpublished data

Austri

a

Belgium

Bulgar

ia

Cypru

s

Czech

Rep

ublic

Denm

ark

Eston

ia

Finlan

d

Franc

e

Germ

any

Greec

e

Hunga

ry

Irelan

dIta

ly

Latv

ia

Lithu

ania

Luxe

mbo

urg

Malt

a

Nethe

rland

s

Poland

Portu

gal

Roman

ia

Slovak

ia

Sloven

iaSpa

in

Sweden UK

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2010

2030

Per

cen

tag

e d

istr

ibu

tio

n

Projected obesity for 2030 WHO Modelling obesity Project 2013 together with UK Health Forum – NOPA II

Prevalence gains per 100,000 of the EU population in 2030 based on 2 scenarios WHO Modelling obesity Project 2013 together with UK Health Forum – NOPA II

0

200

400

600

800

1000

1200

Cancer CHD+stroke Diabetes Hypertension

1% decrease in obesity5% decrease in obesity

Scenario 1 – 3 Million cases avoidedScenario 2 – 9 Million cases avoided

TUR

HRVCZE SV

NROU ES

T ITA FRA LTU GBR

NORNLD FIN DEU LV

A ISR CYPARM BLR GEO KAZ

MLTMNE

RUSSR

BTK

M UZB0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Salt intake per person per day for adults in the WHO European Region from individual country-based surveys, various years

Country

Gra

ms

WHO/FAO RECOMMENDATION - <5 grams

No data

ANDSMR

BGRCZE

SVKFIN DEU EST

TKM CHEHRV

FRANOR

BLR GBRBEL

CYPAUT

AZESRB

UZBMKD

MLT ISRALB GRC

MNE0

200

400

600

800

1000

1200

Fruit and vegetable supply per person per day in the WHO European Region, 2009

Country

Gra

ms

WHO/FAO RECOMMENDATION - >600 grams

FRA

DNKAUT

NLD LVA

DEU IRLGBR

PRTPOL

ROU LTU ALBARM BLR HRV

CZE ISL KAZMCO

NORRUS

SRB

CHEMKD

TKM UZB

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Proportion of energy from saturated fatty acids among adults in the WHO European Region, 2007

Country

Ener

gy (%

)

FAO RECOMMENDATION - max. 10% energy

No data

ANDFR

ARUS

GBRBGR IRL

SVN BLR

SWE

TKM AZE CYP CHE FIN BIH NLD

MNEPOL

MKDUZB ES

PKAZ

ARMHUN

TUR

HRVDNK

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Prevalence of exclusive breastfeeding under or at 6 months of age in the WHO European Region from in-

dividual country-based surveys, various years

Country

Perc

enta

ge

No data

Inactivity status in European Region

• WHO estimates that in adults : – 63% are not reaching the minimum recommended level of physical

activity– 20% of those are rated as “inactive”– 38% are sufficiently/highly active

• 41% of adults does not engage in any moderate physical activity in a typical week

• 22% of 11-year old girls and 30% of boys report at least one hour of daily MVPA

• PA recommendations in EU Member States + Norway and Switzerland - 19 Member States

Europe: mandate for action

Overview Policy Actions Implementation 53 WHO/Europe Member States – 2012/13

Po

licy

A

ctio

ns Measures to affect food prices

Labelling - signposting

Reformulation - less sugar and salt

Promote Active Travel for school-children

Marketing HFSS foods to children - restrictions

Salt reduction initiatives

School Fruit Scheme (SFS) or similar

Programs in schools (inc. vending machines)

Baby Friendly Hospital Initiative

Physical Activity Policy incl. Guidelines

Breastfeeding promotion and protection policies

Food Based Dietary Guidelines

Labelling - nutritional information

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

No Action Partially implemented Fully implemented

Nutrition Policy 2007-2013

• 143 nutrition policies

• 39 obesity policies

• 184 physical activity policies

Nutrition Policy in 2007-2013

• For the 143 nutrition policies, 39 obesity policies and 184 physical activity policies:• Only 16 clearly focus on low income

groups• 8 address attention to health

professionals…

No action reported

Partially or fully implemented

Countries (N) 20 33

No action reported

Partially or fully implemented

Countries (N) 23 30

Great progress in certain areas

Salt reduction policies

MKT HFSS foods policies

Policy and Social Innovation:Regulation & taxes• 4 countries in the EU with bans on “trans” fat and

several others with effective self-regulatory approaches;

• Social innovation – use of taxes for PH: several countries but Hungary and Denmark most recent prominent examples: – Estimated revenue was accomplished

– No differences in social class

– 6% reduction in saturated fat

• Marketing food to children

• Mainstream food reformulation – i.e. salt

Culture, tradition… protective dietsMed diet & cognitive impairment

Psaltopoulou et al. Ann Neurol 2013 May 30. doi: 10.1002/ana.23944. [Epub ahead of print]

Consumption of saturated fat (DEN) – effect of tax. Smed et al. (do not quote)

1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 81 86 91 96 101 106 111 116 121 126 131 136 141100

150

200

250

300

350

Model without season

Model without season

Hoarding, increase by 28%

Tax, decrease by 5.8% (without hoarding effect,3.5 – 4.9%)

Country profiles as a result of EC/WHO collaboration and based on NOPA information system.

Nutrition and PA policies in EuropeHistory of success but more is needed…..

• Monitoring and surveillance

• Evaluation

• Exchange/collaboration

• More success where accountability and external pressure/evaluation exist

• Challenge to comply with Global targets…….

Vienna Declaration process

• Technical (comments)

• NGO interaction

• Political level

Way forward

• Environments/Governance mechanisms

• Life-course

• Health sector

• Monitoring and surveillance

• Forging alliances

“The current document on Nutrition and NCD’s is masterfully worded and highly consistent with the best available evidence on the critical topic”Walter Willett; 04/07/2013