Addressing the obesity paradox

People’s eating habits have changed significantly in recent decades as more food becomes available and is cheaper than ever before. This ‘nutrition transition’ is characterised by a shift from a diet featuring grains and vegetables to one high in fat and sugar. In pursuit of quantity, the quality of the food we consume has been compromised. As a result, the challenge of preventing and reducing the incidence of overweight, obesity and diet-related non-communicable diseases is becoming urgent throughout the European region. Yet at the same time, food insecurity and under-nutrition remain important issues to tackle in some countries, and among low-income/vulnerable groups in many others.

Children’s health and wellbeing depends on their having the best possible nutritional start in life. In general, breastfeeding from birth and for the first month of a child’s life is the established practice in most countries in the region. Nevertheless, despite high initiation rates, exclusive breastfeeding rates drop very quickly. WHO recommends that infants be exclusively breastfed until they are six months old, yet at six months the percentage of children who are exclusively breastfed ranges from one percent to 46 percent in countries in the region.

If breastfeeding is replaced by complementary foods of a poor nutritional quality, infants are at risk of growth retardation (stunting) and micronutrient deficiency. Growth retardation is still prevalent in many countries in the region, particularly in the Central Asian republics, Azerbaijan and rural Turkey, where it affects up to 43 percent of children under five years. Deficiencies in micronutrients such as iron, iodine, vitamin A and folate are widespread. Iron deficiency affects children’s brain development and is a major cause of anaemia. It has increased in the Central Asian republics and is also a concern in the other former Soviet republics, where 32-70 percent of children under five are affected by iron deficiency anaemia. A total of 435 million people in the European region are affected by iodine deficiency, which causes mental retardation and brain damage in children and miscarriages and stillbirths in pregnant women.

Food insecurity at home not only affects countries in Central and Eastern Europe, Central Asia and the newly independent states, which account for 23 million undernourished people in the region. ‘Food deserts’ also exist in poor communities in Western Europe. The supply of sugar, vegetable oil and meat exceeds the needs of the European population, but only a few countries are able to provide sufficient fruit and vegetables for the entire population. What people eat is strongly influenced by structural, social, organisational and financial considerations. In most countries of the region, obesity is more common among socially deprived communities characterised by lower levels of income, education and access to care.

Obesity in Europe has reached epidemic proportions. Its prevalence has tripled in the last two decades, and if no action is taken there will be an estimated 150 million obese adults (20 percent of the population) and 15 million obese children and adolescents (10 percent of the population) in the region by 2010. In most countries today, between 30 percent and 80 percent of adults are overweight.

So what is the WHO doing to help combat this rising epidemic? First, it recognises that the increasing prevalence of obesity results from changes in society. Obesity is mainly associated with unhealthy eating and low physical activity, but the problem is linked not just to individual behaviour but also, increasingly, to social and economic development and policies such as those on agriculture, transport, urban planning, the environment, food processing, distribution and marketing, and education. Blaming only individuals for their obesity is no longer appropriate or acceptable. The problem is societal and government response is needed.

Late last year, at the WHO European Ministerial Conference on Counteracting Obesity in Istanbul, Turkey, Dr Marc Danzon, WHO Regional Director for Europe, and Professor Recep Akdag, Minister of Health of the Republic of Turkey, signed an historic charter on behalf of all of the member states in the WHO European Region. The European Charter on Counteracting Obesity sets the ultimate goal of curbing the epidemic and reversing the current trend in the Region.

The Charter declares: “Visible progress, especially relating to children and adolescents, should be achievable in most countries in the next 4-5 years and it should be possible to reverse the trend by 2015 at the latest.” Specific, targeted action across many sectors is needed to achieve this, and the Charter calls for a focus on children and action that encourages them to establish healthy habits early in life, as well as protecting them from commercial influence:

“Specific regulatory measures should include: the adoption of regulations to substantially reduce the extent and impact of commercial promotion of energy-dense food and beverages, particularly to children, with the development of international approaches, such as a code on marketing to children in this area; and the adoption of regulations for safer roads to promote cycling and walking. The Charter was developed through an open consultation process, driven by member states and involving different government sectors, international organisations, experts, civil society and the private sector.”

The Charter details other key action needed to encourage healthier diets and more physical activity, including promoting breastfeeding; reducing the amount of fat, sugar and salt in manufactured products; promoting cycling and walking through better urban design and transport policies; and establishing opportunities for daily physical activity and for good nutrition and physical education in schools.

“We are all aware that obesity is one of the most serious public health challenges facing Europe today. Evidence exists on what needs to be done to reverse the trend. This Charter commits member states to put obesity high on their political agendas and calls on all partners and stakeholders to do the same. It is a guide, an opportunity and gives us the tools to take effective action,” says Dr Danzon.