Portal de Periódicos da CAPES

Europe battles with obesity

2008; Elsevier BV; Volume: 371; Issue: 9631 Linguagem: Inglês

10.1016/s0140-6736(08)60936-8

1474-547X

Rob Hyde,

Obesity and Health Practices

The past 4 years has seen several legislative developments to tackle Europe's growing obesity problem including food labelling, controls on junk-food advertising to children, and bans on fizzy drinks in school vending machines. But critics say they are not enough. Rob Hyde reports. Humble pie is not easy to swallow, but in early 2007, the European Union (EU) health commissioner Markos Kyprianous left no uncertainties about how Europeans had to digest the unpleasant truth—more than 50% of adults in Europe were obese or overweight. In the WHO European Region, three times more people are obese today than in the past 20 years, and a staggering ten times more children are obese than in the 1970s. In 2006, the EU announced that an estimated 7% of health costs were being spent treating cases of obesity. According to Erik Millstone, who heads the nine-country EU project—Policy Options for Responding to the Growing Challenge from Obesity (PorGrow)—many governments are so concerned about the effect of the epidemic of obesity on public expenditure, it is leading to calls for tough measures. “In the UK, for example, it is the Treasury, rather than the Department of Health, which is pushing hardest for obesity to be addressed, so that NHS [National Health Service] budgets can be used to help the elderly or to fund cancer treatments rather than to maintain those suffering from avoidable obesity”, he says. To avoid obesity, fundamental changes in physical exercise and dietary behaviour are what is needed most. Changing one's diet is the most important, argues Millstone, since the amount of physical exercise required to burn off the calories from fast-food and other unhealthy substances, can be extremely high. But how to bring about both changes? “The UK government's 2004 White Paper and some parts of the British Government recognise the need for change, but there is political timidity over taking the necessary steps. Governments seem to be hoping that giving the public information, and changing the terms of the control on advertising information to children, will be sufficient. All the evidence, however, shows that solely providing information will not be sufficient to bring about the necessary changes in the behaviour of UK and European citizens.” Meanwhile, public awareness campaigns continue. The governments of Germany and Slovakia have recently had drives to promote physical exercise. Another anti-obesity measure has been the promotion of healthy eating. In September last year the EU held its European Day of Healthy Food and Cooking. For some this is the right approach. Pekka Puska is currently the Director General of the National Public Health Institute of Finland, and the former Director for Non-communicable Disease Prevention and Health Promotion at WHO. In 1972, he spearheaded the North Karelia Project, to encourage dairy farmers in eastern Finland to incorporate berries into their diet of home-made butter, cheese, and milk. By 2000, levels of heart disease had fallen by 73%. Today he argues that information is a key way in which to win hearts and minds and then bring about necessary behavioural changes. “There is no doubt that legislation and policies are extremely important but you also have to mobilise people and peoples' intentions as people push the politicians. Politicians also reflect what the public wants, regarding food, just like anything else.” Another means of tackling obesity is to push for changes in food labelling. A proposal which has seen much support across Europe has been the traffic-light scheme, which aims to make clear for consumers if a product has a low, medium, or high amount of fat, saturates, sugar, and salt, by labelling them as green, amber, and red, respectively. Under current European law, there is no mandatory nutritional labelling on products unless they make a health claim such as “low fat”, “low sugar”, or “good for your heart”. Millstone argues there is also widespread agreement across the EU that all packaged processed foods also need nutrition labelling. “Even if you went round a supermarket with a laptop and a set of scales, it would be difficult to make any sense of the information provided because simply listing all ingredients and detailing quantitative proportion does not make it useful to customers.” Some elements of the food industry fully support the traffic-light scheme but others fiercely oppose it, especially those whose products have high sugar, salt, or fat content which would most probably receive a red-label status. So far the EU has operated a voluntary scheme—the EU Pledge, in which companies have chosen to stop advertising food and drink products to children younger than 12 years, unless they are deemed to have health benefits. “The EU Commission is saying publicly that it wants these labelling changes, and other related initiatives, to occur by voluntary agreement. The problem, however, is that sometimes the food industry is then left thinking—are they bluffing? Would they actually do something to compel us?”, says Millstone. But the European Commission suggests that taking a firm approach could be counterproductive. Once a month, the EC Agriculture and Fisheries Council brings together the Ministers of Agriculture and Fisheries and the commissioners responsible for agriculture and rural development, fisheries, and maritime affairs, as well as consumer health and protection. The council spokesperson, Carole Micmacher-Grandcolas, argues that creating informed, collective political will is more effective than imposing legislation. “In the past, labelling was done to facilitate the free calculation of food within the European community. It was merely a trade issue. Now, however, we have consumers wanting rights and information. The thing to avoid, then, is to have a war between stakeholders and consumer associations. Stakeholders need lots of lobbying to allow more power to parliament to change proposals from the commission.” “Obviously we are always looking closely at public health, but we have to also respect member states' sovereignty with regard to national policy, social, and health policy. We can recommend schemes, assess the benefits of information campaigns, coordinate campaign action, collect data and share it, but we will not automatically issue law.” Over the years, many member states have taken their own measures to restrict access to high sugar, salt, and fat products for children younger than 12 years. In 1987, Sweden, for example, enforced an outright ban on the advertising of junk food and today Denmark, Finland, the Netherlands, and the Flemish region of Belgium, all severely or totally restrict advertising in programmes targeting children aged 12 years. Outside of Scandinavia and the Benelux countries, Ireland has just proposed changes to its Children's Advertising Code to prohibit advertising high sugar, salt, and fat products. Meanwhile, the UK has just announced it will copy France's 2006 ban on fizzy drink and junk food in school vending machines. But although it is unable to dictate member states' health policy by imposing harsh laws, the EU has long argued it is helping to promote Europe-wide schemes of healthy living by supporting, for example, the subsidiary of milk in schools. The EU pays an amount of aid defined for 0·25 L of milk per pupil, per day during the school week. Member states can then opt to top-up the EU aid, so that the products will be cheaper for the pupils, or even free, and currently 26 member states participate. But some have their doubts about the scheme, which is part of the European Common Agricultural Policy (CAP). Many, including WHO, feel that CAP schemes such as milk in schools are really just politically motivated and are more linked to questions of sales and industry. Schemes sometimes just pass on a fat problem to other people, such as by selling surplus butter to eastern Europe, says Puska. Another view, however, is that since CAP has such a strong pan-EU reach, it could one day be correctly harnessed by the medical community and used as a vehicle to achieve a more collective legislative approach to tackling obesity. “Many public-health analysts, including myself, would therefore like considerations of public health to be included in the reform agenda of the Common Agricultural Policy”, says Millstone. “It is a massive task, and in this field we need to combine cynicism with optimism. I think it is do-able, but it will not be easy.” PanelLegislative developments 2004–08January, 2004: A WHO Resolution on a global strategy on diet, physical activity, and health is adopted by member states.June, 2004: Fourth European Ministerial Conference on environment and health officially adopts the Children's Health and Environment Action Plan for Europe.November, 2006: The European Charter of counteracting obesity adopted at the WHO European Ministerial Conference on counteracting obesity says “progress, especially relating to children and adolescents, should be achievable in most countries in the next 4/5 years.”April, 2007: EU Commission Green paper—A European dimension for the prevention of overweight, obesity and chronic diseases—is officially acceded.Jan 23, 2008: The UK aims to “be the first major nation to reverse the rising tide of obesity and overweight in the population”. It sets the aim of reducing the level of obese children to 2000 levels by 2020.Jan 30, 2008: The EU commission proposal on food labelling recommends that total calories, fat, saturated fat, carbohydrates (specifically sugars and salt per 100 mL/g) should be made clearly visible.Feb 17, 2008: The International Obesity Task Force calls for a change in food production and peoples' environments to reduce obesity.May, 2008: The European Congress on Obesity publishes a report showing that in 23 of 27 EU countries, most adults are overweight. The exceptions were Estonia, Latvia, Romania, and Switzerland.Late May, 2008: The European Committee on the Environment, Public Health and Food Safety calls for lower VAT on fruit and vegetables in all EU countries, more research into the links between obesity and chronic diseases such as diabetes and cancer, a EU-wide ban on artificial trans-fatty acids, restricted advertising of unhealthy food to children, compulsory front-of-pack labelling with colour coding, and more pressure placed on the food industry to provide small portions. January, 2004: A WHO Resolution on a global strategy on diet, physical activity, and health is adopted by member states. June, 2004: Fourth European Ministerial Conference on environment and health officially adopts the Children's Health and Environment Action Plan for Europe. November, 2006: The European Charter of counteracting obesity adopted at the WHO European Ministerial Conference on counteracting obesity says “progress, especially relating to children and adolescents, should be achievable in most countries in the next 4/5 years.” April, 2007: EU Commission Green paper—A European dimension for the prevention of overweight, obesity and chronic diseases—is officially acceded. Jan 23, 2008: The UK aims to “be the first major nation to reverse the rising tide of obesity and overweight in the population”. It sets the aim of reducing the level of obese children to 2000 levels by 2020. Jan 30, 2008: The EU commission proposal on food labelling recommends that total calories, fat, saturated fat, carbohydrates (specifically sugars and salt per 100 mL/g) should be made clearly visible. Feb 17, 2008: The International Obesity Task Force calls for a change in food production and peoples' environments to reduce obesity. May, 2008: The European Congress on Obesity publishes a report showing that in 23 of 27 EU countries, most adults are overweight. The exceptions were Estonia, Latvia, Romania, and Switzerland. Late May, 2008: The European Committee on the Environment, Public Health and Food Safety calls for lower VAT on fruit and vegetables in all EU countries, more research into the links between obesity and chronic diseases such as diabetes and cancer, a EU-wide ban on artificial trans-fatty acids, restricted advertising of unhealthy food to children, compulsory front-of-pack labelling with colour coding, and more pressure placed on the food industry to provide small portions.