The European Parliament published, in October 2024, a report on the current challenges and opportunities to address obesity in the Old Continent (European Union and UK). (1)
Obesity and overweight are complex multifactorial problems, with significant impact on public health and its costs, whose mitigation requires an integrated approach.
The analysis highlights the need to design environments that support prevention efforts and improve health care provided to people with obesity.
1) Obesity, introduction
Obesity is a complex multifactorial chronic disease defined by excessive adiposity that represents a health risk, caused in most cases by the interaction of genetic, metabolic, behavioral (or psychosocial) and environmental factors.
The diagnosis of obesity and overweight, usually performed on the basis of BMI (Body Mass Index), varies according to age and gender. For adults, overweight and obesity are defined by a BMI greater than 25 and 30, respectively.
The risks associated with obesity include health problems (e.g. metabolic, musculoskeletal, mental disorders), NCDs (Non-Communicable Diseases, e.g. type 2 diabetes, cardiovascular, renal and liver diseases, many types of cancer), premature mortality from all causes.
2) Obesity and overweight, prevalence in Europe
Eurostat, in the European Health Interview Survey (EHIS, 2019), found that 16,5% of the adult population in the EU suffers from obesity, while 36,2% is overweight. Excess weight is therefore a problem for more than half of the European population (53%).
WHO-Europe (2022) estimates in turn that the prevalence of obesity in the macro-region has more than doubled, between 1975 and 2015. Reaching 21%, in the decade 2005-2015 (+138%). Also noting how:
-obesity rates increase with age, peaking in the 65-74 age group;
-socioeconomic determinants (e.g. income, education, occupation, place of residence) play a significant role and contribute to inequalities in obesity prevalence;
-children are more exposed and more vulnerable to obesogenic environments. (2)
3) Human, health and social costs
Costs associated with obesity can be summarized as:
-a reduction in life expectancy of almost three years over the next three decades, according to OECD estimates;
-increase in public health spending, up to 8% of health budgets for obesity-related conditions;
-reduced performance and mental health of students and workers, increased risk of unemployment.
OECD has demonstrated that a comprehensive set of interventions can produce significant economic benefits for states while improving public health outcomes. (3)
4) Prevention, the most profitable investment
‘Every dollar spent on prevention interventions creates economic benefits up to six times higher’ (OECD, 2019). (3)
Solid prevention policies can in fact lead to an annual profit of millions of ‘disability-adjusted life years’ (DALYs) and ‘life years’ (LY), in addition to generating savings of tens of billions in healthcare spending. The following are therefore considered essential:
– nutritional labelling according to the NutriScore model (OECD, 2024); 4)
-sugar taxes and other fiscal policies (WHO, 2024); (5)
-initiatives aimed at promoting regular physical activity (WHO, 2022). (6)
5) EU strategies and action plans
‘Community Strategy for Europe on Nutrition, Overweight and Obesity related health issues’ (2007) declared the EU’s commitment on three fronts:
(a) improve consumer information (including nutritional information, media and advertising practices). This objective has been
-only partially fulfilled, with the mandatory nutritional declaration introduced by the Food Information Regulation (EU) 1169/11; (7)
-failed miserably, as far as marketing of nutritionally unbalanced foods (HFSS food); (8)
b) promote accessibility to healthy foods, including direct access and reformulation of food products. The European Parliament had also expressed its opinion on this last aspect, as we have seen. (9) However, nothing has changed;
c) encourage physical activity (including sports and the promotion of active transport). Also on this front, EU and Member States’ policies have been completely ineffective, as noted by WHO (2022). (6)
5.1) ‘Beating Cancer Action Plan’
‘Beating Cancer Action Plan’(2022) in turn recognized that obesity represents one of the main factors in the onset of cancer. The European Parliament has underlined the need to:
-introduce a FOPNL (Front-of-Pack Nutrition Labeling) system, such as Nutriscore; (10)
-review the EU scheme for fruit, vegetables and milk in schools.
BECA moreover, to date, it has not had any application. And the Parliament itself has denied its own decisions, as regards the ‘warning labels’ on alcoholic beverages. (11)
5.2) ‘EU Action Plan on Childhood Obesity 2014-2020’
‘EU Action Plan on Childhood Obesity 2014-2020′, in turn, had foreseen a series of interventions that included educational programs and reforms aimed at ensuring nutritional information and restrictions on the marketing of HFSS (High in Fats, Sugar and Sodium).
This plan too, unfortunately, has tragically failed. As expected, after the stakeholders withdrew from the ‘EU Platform for Diet, Physical Activity and Health’. (13) The data from WHO-Europe (2022), moreover, show the worsening of childhood obesity. (2)
5.3) EU Research Projects
The Horizon Europe programme (2023-2024) has co-financed some research projects in various fields, such as:
– understanding obesity and NCDs (Science and Technology in childhood obesity policy – STOP; Horizon Europe’s Prevention of obesity throughout the life course), including the use of ‘big data’ and AI (BigO programme; Integrated surveillance system to prevent and reduce diet-related NCDs; Trustworthy tools to predict the risk of chronic non-communicable diseases and/or their progression);
-food reformulation (EU Reformulation Monitoring EUREMO; Best-ReMap; Joint Action Prevent NCD; Joint Action nutrition and physical activity);
-marketing practices (Best-ReMap; JA Prevent NCD; EU Code of Conduct on Responsible Food Business and Marketing Practices);
-regulation and taxation of products, including food and beverages, which give rise to NCDs (JA Prevent NCD; Study Mapping of pricing policies and fiscal measures applied to food, nonalcoholic and alcoholic beverages);
-food labelling (JA Prevent NCD; Food and Beverage Labels explorer).
6) Nutritional labelling, Nutri-Score
The report under consideration focuses on the need to introduce a FOPL (Front-of-Pack Nutrition Labelling) system, to encourage informed purchasing choices and promote on this basis the improvement of the diet of populations in the European Union. A system like NutriScore, launched in 2017 in France and already widely spread in other European countries. Belgium, Switzerland, Germany, Spain, the Netherlands and Luxembourg, now also Romania (14,15).
Green – ‘The debate on the possible introduction of an EU-wide FOPNL has been ongoing for many years, while the benefits of the introduction of the Nutri-Score is preferably used for public health have been evaluated by several studies.’(1)
Nutri-Score is based on a scale of five colors, from dark green to dark orange, to which the letters from A to E correspond. The attribution of a color and a letter to each food comes from the application of an algorithm that considers the nutritional profile of the product. The algorithm – developed by the Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), at the Centre de Recherche en Epidémiologie et Statistiques (CRESS) of the University La Sorbonne in Paris – was updated in 2022 by a Scientific Committee of independent experts (16,17).
7) Integrated local interventions
The interventions community-based integrated venues have also gained popularity, as they focus on the causes of obesity at the social level. In France – following a study conducted in 1992 in two cities, where a school-based nutrition education program was followed by broader population involvement with community interventions – the EPODE method (Ensemble Prévenons l’Obésité Des Enfants) was launched in 2003.
EPODE aims to address and improve the health of disadvantaged populations through tailored interventions. It is based on four key pillars: political commitment, resources, support services and evidence of effectiveness.
The programs EPODE-based approaches seek to change the environment to impact unhealthy behaviors in the long term, without stigmatizing any culture, individual, dietary habits or behavior. They are characterized by the involvement of local communities and collaboration between public and private actors. Partnerships involving private actors help keep public costs low, while respecting an ethical charter. (18) As of 2015, the EPODE method has been applied in 42 countries.
8) Develop environments conducive to balanced nutrition
‘Food environment’ is defined by FAO as ‘the interface between food systems and people’s diets’, through ‘collective physical, economic, political and socio-cultural contexts, opportunities and conditions’ which influence people’s purchasing and consumption patterns. (19)
Availability and accessibility of more or less healthy foods; commercial spaces but also family, school, work, recreational spaces; marketing and rules; digital ‘food environment’. (20) Each of these factors, or dimensions, must be considered to develop an effective obesity prevention strategy.
9) Provisional conclusions
The need to reverse the ever-increasing trend of obesity, overweight and related diseases (NCDs) is increasingly clear, the tools to be adopted are also known.
Politics must now take responsibility for implementing the necessary measures, without further delay or concessions to economic interests opposed to public health.
Dario Dongo
Footnotes
(1) Policy Department for Economic, Scientific and Quality of Life Policies
Directorate-General for Internal Policies. Olivia Aouati et al. (2024). Current challenges and opportunities for addressing obesity. European Parliament. PE 754.218 https://tinyurl.com/mc5nn2ht
(2) Sabrina Bergamini, Dario Dongo. Obesity, childhood obesity and marketing. WHO Europe 2022 report. GIFT (Great Italian Food Trade). 16.6.22
(3) OECD (2019), The Heavy Burden of Obesity: The Economics of Prevention, OECD Health Policy Studies, OECD Publishing, Paris https://doi.org/10.1787/67450d67-en
(4) Marta Strinati. NutriScore and three other nutrition labels compared. OECD study. GIFT (Great Italian Food Trade). 16.2.24
(5) Dario Dongo. Fiscal policies for balanced nutrition, WHO recommendations. GIFT (Great Italian Food Trade). 4.7.24
(6) Marta Strinati. Physical activity extends life, but governments are still immobile. UN report. GIFT (Great Italian Food Trade). 2.11.22
(7) Dario Dongo. Nutritional declaration on the label. The ABC of EU rules. GIFT (Great Italian Food Trade). 30.10.16
(8) Dario Dongo, Andrea Adelmo Della Penna. ‘Audiovisual Media Services Directive’ and protecting minors from junk food marketing. GIFT (Great Italian Food Trade). 25.11.23 h
(9) Dario Dongo. Farm to Fork, Nutri-Score and product reformulation. GIFT (Great Italian Food Trade). 25.10.21
(10) Dario Dongo. Beating Cancer Plan. Pesticides, toxic chemicals, alcohol, junk food are all on the index. GIFT (Great Italian Food Trade). 6.2.22
(11) Isis Consuelo Sanlucar Chirinos. Alcoholic beverages, EU Parliament deletes proposed label warning on alcohol and cancer risks. FT (Food Times). 18.2.22
(12) European Commission (2014). EU Action Plan on Childhood Obesity 2014-2020 https://tinyurl.com/3cfarcvf
(13) Dario Dongo, Giulia Caddeo. Obesity, everything to be redone. Civil society abandons the Brussels platform. GIFT (Great Italian Food Trade). 6.7.19
(14) Ana-Maria Baciu, Cristina Stoica, Iulia Dobre. Cine ține scorul? We propose legislation to regulate the Nutri-Score labeling system. Juridice Romania. 27.9.24 https://tinyurl.com/3mz7j2nd
(15) NB: only 18 months earlier, Romania had banned the use of NutriScore on labels. See Anda Simion. România, printre ţările din UE care se opun etichetelor alimentary Nutri-Score.
(16) Dario Dongo. NutriScore, evolution of the science-based algorithm. FT (Food Times). 1.9.22
(17) Dario Dongo. NutriScore, algorithm update for beverages. FT (Food Times). 25.4.23
(18) Slot-Heijs JJ, et al. (2020). The training and support needs of 22 program directors of community-based childhood obesity interventions based on the EPODE approach: an online survey across programs in 18 countries. BMC Health Serv Res. doi: 10.1186/s12913-020-05709-1
(19) FAO (2016). Influencing food environments for healthy diets. Reports http://www.fao.org/3/a-i6484e.pdf
(20) Granheim et al. (2021). Mapping the digital food environment: A systematic scoping review. Obesity reviews. https://doi.org/10.1111/obr.13356
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
