WHO Europe published the 2022 report on obesity, childhood obesity and the predatory marketing (already reported by UNICEF, in 2020) that is its primary cause (1,2). 220 pages packed with statistical and epidemiological data, with numerous references to the scientific literature of recent decades, highlight the failure of policies adopted to date to safeguard public health.
A true epidemic, denounces the World Health Organization, with disastrous impact on the prevalence of serious and chronic diseases (NCDs, Non-Communicable Diseases) and the resulting risks in terms of disability and premature mortality. Junk food is everywhere, in an ‘obesogenic’ environment fostered by irresponsible business practices.
1) Obesity and overweight in the European macro-region.
No country in the Old Continent has so far succeeded in reversing a still rising incidence of obesity and overweight:
– obesity rate, +21% from 2005-2015, has more than doubled (+138%) in the last four decades (1975-2015),
– Obesity and overweight, cumulatively, increased at a slower rate (+8% from 2005-2015, +51% from 1975 to 2015).
1.1) Obese adults
59% of adults in the 53 countries of the European macro-region are afflicted with obesity and overweight. The Global Syndemic announced by EAT Commission experts in The Lancet (3) has its epicenter right here, where the prevalence of adult obesity is higher than in any other WHO region except the Americas.
The phenomenon has ‘epidemic proportions,’ according to WHO Europe, with a peak among adult men (63 percent) compared to women (54 percent). Obesity alone, in the Old Continent, affects nearly a quarter of adults (23%), women especially (24%). And widespread socioeconomic inequalities-income, education, employment status, place of residence-are related to it.
1.2) Child and juvenile obesity
The European epidemic does not spare the younger generation:
– up to 5 years of age, obesity and overweight affect 4.4 million children, or 7.9 percent of the considered population group,
– ages 5 to 9, nearly one in three (29.5 percent) children are overweight and/or obese, one in eight (11.6 percent) already suffering from morbid obesity,
– Between the ages of 10 and 19, the incidence is temporarily reduced. One in four (24.9%) young people is overweight and/or obese, one in fourteen (7.1%) obese.
2) Obesity, overweight and health.
More than 1.2 million deaths each year, or more than 13% of all-cause mortality in the Old World, are caused by obesity, overweight, and related diseases (NCDs). Which also represent the number one risk factor for disability and account for 7 percent of the years spent with disability.
The risk of occurrence of at least 13 types of cancers–breast (in postmenopausal women), colorectum, endometrium, kidney, liver, gallbladder, ovary, pancreas, esophagus, thyroid, multiple myeloma, and meningioma–is significantly increased by obesity. Which in Europe is now estimated to be the direct cause of at least 200,000 new cases of cancer a year, with predictions of this number growing.
3) Forecast and outlook
In the decades to come, obesity will surpass smoking as the leading preventable cancer risk factor. Features associated with obesity may worsen the consequences of Covid-19, especially respiratory tract and immunologic impairment. People with obesity are at higher risk of clinically serious disease and mortality with COVID-19.
4) Europe, an ‘obesogenic’ environment.
WHO specifically refers to Europe as an ‘obesogenic’ environment. That is, a sociocultural and economic environment that stimulates-rather than hinders-the development of obesity, childhood obesity, and overweight. Its factors are known, although completely ignored or almost ignored by policy makers, partly due to the malicious influences (4) of Big Food lobbies:
– Irresponsible marketing of ultra-processed HFSS(High in Fats, Sugar and Sodium) foods, aka junk food (or junk-food),
– prevalence of HFSS foods and their lower cost, in commercial offerings, compared to more nutritionally balanced foods.
5) Big Food, irresponsible marketing
‘Globally., the food and soft drink industries spent more than $33 billion on advertising for their products in 2020.
Exposure to the marketing of unhealthy foods and brands normalizes the consumption of unhealthy foods and influences attitudes, expectations, and purchasing and consumption behavior throughout life, particularly in children‘.
Children are under siege from Big Food ‘s obesogenic marketing in every context of daily life. First and foremost in the digital environment, as well as on TV, in supermarkets, schools and even sports facilities.
5.1) Digital obesogenic marketing
‘The digital environment food is largely absent from the public health agenda. For example, it is difficult to regulate advertising of unhealthy products because advertising has become more targeted and personal and, as a result, more difficult to monitor‘. (1)
Nevertheless, ‘the increase in unhealthy food consumption in children can be observed immediately after being exposed to unhealthy food advertisements. This effect is even stronger for children already living with overweight or obesity‘.
5.2) Target children and young people
Theadvergame is one of the most pervasive online marketing techniques. These are online games developed for children to advertise certain brands of products in a positive entertainment environment. ‘Evidence shows that these games have a significant effect on unhealthy food consumption.’
‘The use of complex algorithms and new strategies such as social media influencer marketing‘ then allows Big Food to refine its advertising bombardment to most effectively influence the consumption choices of young children. It is neuromarketing that has made ‘online marketing very powerful and influential, especially for children and youngpeople.’
5.3) Social media, influencer marketing
Social media and influencers–on Facebook, Instagram, Snapchat, YouTube, TikTok–encourage children and youth to interact with content shared by online celebrities. Under the illusion that they are sharing their lives as real friends would, except instead promoting junk food, often in a covert manner as we have vainly denounced in Italy to the Italian Antitrust Authority (c.d. Antitrust). (5)
Scientific studies recalled by WHO Europe have shown how food marketing of junk food through influencers on social media has an immediate effect on children’s eating behavior. And by the way, when even the children see and understand that the content includes advertisements, they still tend to trust their favorite influencers in a desk-designed psychological dependency relationship.
5.4) Food delivery, the apps to investigate
Correlations between the use offood delivery apps (meal delivery apps) and obesity deserve further investigation. Indeed, scientific evidence shows that:
– foods prepared outside the home are generally higher in fat, sugar, salt,
– portions are often larger. This encourages excess food consumption, especially when there is little difference in price between maxi-portions and smaller ones, as is customary in fast-food restaurants,
– dinner out and the take-out meal thus add 200 kcal, on average, to the daily diet.
Food delivery can also encourage sedentary attitudes, especially when coupled with behaviors such as binge-watching on Netflix or other streaming services.
5.5) Not the means but the ends
‘Digital technologies are not necessarily a threat to public health; rather, the issue is how the technology is used-what is advertised and how the content of the ads is understood, and what is available on digital platforms that may contribute to the obesogenicity of digital food environments.’
6) Solutions to be adopted
WHO member states in the European macro-region must counter the ongoing epidemic and remove the causes of this obesogenic environment with a range of interventions that include:
– drastic restrictions on obesogenic marketing, along the lines of what has been achieved in the UK through the Health and Care Bill, (6)
– Introduction of mandatory summary nutrition labeling (FOPNL, e.g., NutriScore) on the front of packages (7,8),
– Appropriate tax measures (e.g. higher VAT rates and sugar tax), to discourage production and sales of junk-food, (9)
– Tax breaks and subsidies for low-income families to purchase healthy, natural and balanced foods,
– Promotion of healthy and balanced meals as early as schools and public institutions, (10)
– concrete interventions to promote accessibility to sports facilities in low-income groups.
#PeopleOverProfit! #SDG3, ensure good health and well-being.
Sabrina Bergamini and Dario Dongo
Cover image from Gourmandia
Notes
(1) WHO European Regional Obesity Report 2022. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO. ISBN: 978-92-890-5773-8. https://apps.who.int/iris/bitstream/handle/10665/353747/9789289057738-eng.pdf
(2) Dario Dongo. Climate, predatory marketing, and children’s health. Unicef Report. GIFT (Great Italian Food Trade). 21.2.20,
(3) Marta Strinati. Global Syndemic, the deadly mix of malnutrition and ecological crisis. GIFT(Great Italian Food Trade). 7.6.19,
(4) Marta Strinati. Nutrition and health, here’s how Big Food thwarts WHO. GIFT(Great Italian Food Trade). 3.9.20,
(5) Dario Dongo. Influencer marketing, our report to the Antitrust. GIFT(Great Italian Food Trade). 25.7.20,
(6) Dario Dongo. England, stop junk food advertising thanks to Health and Care Bill. GIFT(Great Italian Food Trade). 2.5.22,
(7) Dario Dongo. Codex Alimentarius, the NutriScore and the WHO guidelines. GIFT(Great Italian Food Trade). 29.9.21,
(8) WHO (Geneva). Nutrition labeling: policy brief. ISBN: 978-92-4-005132-4 7.6.21, https://www.who.int/publications/i/item/9789240051324
(9) Dario Dongo and Sabrina Bergamini. Sweetened and sugary drinks, sweet snacks. Studies on premature mortality and sugar tax. GIFT (Great Italian Food Trade). 10.9.19,
(10) Dario Dongo. Health in schools, fine words in state-region agreement. GIFT(Great Italian Food Trade). 10.3.19.
Journalist. Consumption, rights, nutrition, social, environment. Head of Consumers Help. She collaborated with ResetDOC, Il Riformista, La Nuova Ecologia, IMGPress.
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
