towards a new milestone in european nutrition and physical activity policies
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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THE SOCIOECONOMIC GRADIENT IN CHILDHOOD OVERWEIGHT AND OBESITY: DIVERSITY ACROSS FIVE EUROPEAN COUNTRIES (WHO COSI) – unpublished data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
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