Sunday

21st Apr 2019

Focus

Europe's obesity battle, a haphazard reality

  • European governments are alarmed at obesity rates, but fight shy of imposing tough measures. (Photo: cristian)

EU states frequently express alarm at rates of obesity and complain about the burden it puts on health services, but national action to address the problem is hugely inconsistent and often consists of little more than a collection of vague goals, an investigation by this website has discovered.

EUobserver asked all 28 health ministries to provide details of their strategies on fighting obesity, and the amount of money they spend on the measures.

Read and decide

Join EUobserver today

Support quality EU news

Get instant access to all articles — and 18 year's of archives. 30 days free trial.

... or join as a group

  • In the US, obesity is already classed as a disease. (Photo: Tony Alter)

Of the 21 ministries that replied, the measures in place ranged from Malta – which has a hugely detailed 68-page action plan – to Sweden, which said it did not have any national strategy.

The amount of money allotted to fighting obesity varies from nothing at all in Cyprus, to more than €5 million in Germany.

And the commitment to data collection ranged from Luxembourg's admission that it had no computerised mechanism to monitor obesity even in children, to Italy where several different programmes provide data on all age groups.

This is despite claims from, for example, the National Health Service in England that it spends roughly €6 billion on overweight or obesity-related conditions each year. Malta says 5.7 percent of its total health expenditure is related to the issue.

Earlier this year, a group of MEPs launched a campaign for Europe to follow the US in recognising obesity as a disease, saying it costs €70 billion across Europe. Politicians and campaigners aren't shy of using the words “emergency”, “crisis” and “epidemic”. And the European Court of Justice ruled in 2014 obesity could be regarded as a disability.

Yet the answers given to this website show that EU states prefer voluntary measures and action plans over legislation or binding rules.

They generally follow a holistic “multi-sectoral” approach involving a range of government agencies, public institutions and grassroots organisations.

Nikolai Pushkarev from the European Public Health Alliance, a network of non-profit groups, said this broad-based approach was necessary owing to the nature of the problem. But he said the responses EUobserver had received suggested the approach was still at an “immature stage” in many EU countries.

“Obesity cannot only be solved only from the health ministry, there should be this transversal action, but this response is still very much in its infancy, generally speaking around Europe,” he said.

Patches of common ground

The 19 countries with strategies – excluding Sweden and Cyprus – all highlighted three main areas of action: public information campaigns on healthy lifestyles, training programmes for civil servants and teachers in promoting good health, and putting in place reliable data-gathering mechanisms.

And they all professed to be influenced by the two main international agreements on tackling obesity – the EU's Action Plan on Childhood Obesity 2014–2020 and the World Health Organisation's European Food and Nutrition Action Plan 2015-2020.

But the measures states have chosen to enforce, although they are in line with these two action plans, are among the least costly and least controversial.

More divisive measures such as dedicated taxes on sugary drinks are in force only in Finland, France and Hungary despite persistent warnings over Europeans' high intake.

The UK has a sugary drinks tax in the pipeline and Portugal, Ireland and Malta are all considering similar measures. Denmark, once at the vanguard of such measures, recently abandoned a long-standing soft-drinks levy as well as its tax on saturated fat.

Prohibitive measures also remain unpopular. Latvia's ban on the sale of energy drink sales to minors is exceptional, even though such actions are encouraged by both the EU and WHO.

Glossy but flaky

For some states, this multi-sectoral approach seems to lead to a tangle of overlapping ideas, goals and recommendations.

In Malta, the country often cited as the fattest in Europe, though Ireland also frequently carries this dubious label, it is difficult to work out the difference between what the government intends to do and what it is actually doing.

In 2012 Malta produced a national strategy called Healthy Weight for Life which outlined a lot of aims, goals and potential actions. But four years later, the status of many of these aims is unclear.

For example, in its answers to EUobserver, the ministry highlighted a plan contained in the 2012 document to “regulate audiovisual advertising, such as advertising of unhealthy foods especially that directed at children”. It commented that “adverts which are aired on TV were evaluated to identify possible action areas”.

Elsewhere, the ministry highlighted ideas to tax unhealthy food and drink, alongside seemingly unworkable ideas such as one “to encourage children and parents to use a screen time log, reduce the number of hours of watching television”, or another to promote family mealtimes over TV dinners.

Who's in charge?

Another problem with the holistic approach is that it can be difficult to evaluate measures and pin down responsibility.

As the WHO's action plan states: “Experience suggests that self-regulatory, voluntary approaches have loopholes and government leadership is required to establish the criteria for policy and for independent monitoring to achieve optimal implementation.”

Yet during this survey by the EUobserver, health ministries in several countries appeared not to know which department or agency would take the lead.

The French health ministry, for example, insisted that it would be the National Public Health Agency. It took two months for the agency to respond to repeated emails, only to reply that it was in fact the ministry's responsibility. The ministry eventually promised to respond, but never did.

Similarly, the Belgian federal health ministry insisted obesity was the responsibility of the regional governments. The regions, however, insisted it was the federal government. In the end, nobody was willing or able to respond.

The multi-sectoral approach also means ministries have difficulty estimating their overall spending on anti-obesity programmes. Just nine ministries were able to give EUobserver any kind of a figure. Luxembourg, Sweden and Finland said such information was not possible to ascertain because of the way anti-obesity efforts are located within other broader programmes.

Bright sparks

There is, however, plenty of encouragement in the answers from health ministries.

Although seven countries ultimately failed to give answers (Belgium, Croatia, Czech Republic, Greece, France, Lithuania and Poland), 10 countries were able to outline a full strategy, or at least bundles of measures. Germany, Austria and Latvia were the most comprehensive.

The other nine were able to give details of programmes and initiatives, but without clear details of budget.

Some governments have harnessed the multi-sector approach with enthusiasm. For example, the Netherlands has created innovative programmes to encourage people on lower incomes to take up sport through free membership of clubs and other departments are funding the establishment of such clubs.

And obesity is likely to be pushed up the European agenda. Malta confirmed to EUobserver that it would make the issue one of its main focuses for its presidency of the EU Council next year.

The EU Commission is evaluating its action plan and hopes to have some preliminary results early next year to be discussed in Malta.

Nikolai Pushkarev's European Public Health Alliance is helping the commission to evaluate the plan. At the same time, the alliance is pushing for the EU to ban marketing of unhealthy products to children as part of its revision of the Audiovisual Media Services Directive, which would be binding on member states.

“Overall, at least from the health side, we've had a positive response in member states, but it remains to be seen whether they can convince other areas,” he said.

Pushkarev and many other experts see a direct link between childhood obesity and marketing of unhealthy food and drink.

More than mere numbers

Along with most other experts, he stressed that the foundation of all good policy in this area is high-quality data.

Some 18 EU states, including several that did not reply to the EUobserver questionnaire, take part in the WHO's European Childhood Obesity Surveillance Initiative (Cosi), which aims to standardise all data on childhood obesity to make comparisons easier and trends more clear.

In addition, 25 EU states are taking part in Janpa, a French-led initiative to gather data on obesity and feed it back into the policymaking process.

Italy's answers to EUobserver reveal a particular focus on data gathering. As well as taking part in both Cosi and Janpa, it has data-collection efforts targeting all other age groups.

Pushkarev and Euan Woodward, from the European Association for the Study of Obesity, were both encouraged by Italy's approach.

“When you think about adult obesity, all the different countries measure at different time-points, using different techniques, so it makes it very difficult to really understand the prevalence across Europe,” Woodward told EUobserver.

He wants to see every country introduce a comprehensive national strategy and have standardised monitoring similar to the WHO's Cosi for all age groups.

He says the strategies will only be effective if everyone gets involved – from the EU Commission and Parliament to member states, the WHO and local actors.

“If we work in silos, it's not going to be an effective strategy,” he added.

Warning over Europe's sugar-guzzling habits

Europeans get through a huge amount of sugary drinks, causing serious risks to their health, a study backed by anti-obesity campaigners suggests. But southern Europe has seen a marked decline in consumption.

Feature

How Denmark led the way on 'sin taxes'

Denmark ditched their fat tax and cut levies on beer, but Danes still furnish health campaigners with the bulk of their evidence for "sin taxes" on unhealthy food and drink.

Malta, Latvia, and Hungary top EU obesity charts

Age and poor education factor into high obesity rates, according to the EU's statistical office Eurostat. On Thursday, it released figures showing Malta is the most obese country, relative to other EU states.

Stakeholder

A touch of football at this year's G20 summit

FIFA president Gianni Infantino addressed the G20 leaders and placed football at their disposal as a powerful tool to help them address the challenges facing the world today.

Supported by

Stakeholders' Highlights

  1. Counter BalanceSign the petition to help reform the EU’s Bank
  2. UNICEFChild rights organisations encourage candidates for EU elections to become Child Rights Champions
  3. UNESDAUNESDA Outlines 2019-2024 Aspirations: Sustainability, Responsibility, Competitiveness
  4. Counter BalanceRecord citizens’ input to EU bank’s consultation calls on EIB to abandon fossil fuels
  5. International Partnership for Human RightsAnnual EU-Turkmenistan Human Rights Dialogue takes place in Ashgabat
  6. Nordic Council of MinistersNew campaign: spot, capture and share Traces of North
  7. Nordic Council of MinistersLeading Nordic candidates go head-to-head in EU election debate
  8. Nordic Council of MinistersNew Secretary General: Nordic co-operation must benefit everybody
  9. Platform for Peace and JusticeMEP Kati Piri: “Our red line on Turkey has been crossed”
  10. UNICEF2018 deadliest year yet for children in Syria as war enters 9th year
  11. Nordic Council of MinistersNordic commitment to driving global gender equality
  12. International Partnership for Human RightsMeet your defender: Rasul Jafarov leading human rights defender from Azerbaijan

Latest News

  1. Romania drafts EU code on NGO migrant rescues
  2. Bulgaria, Hungary, and Malta shamed on press unfreedom
  3. EU drafts $20bn US sanctions list in aviation dispute
  4. Brunei defends stoning to death of gay men in EU letter
  5. US Democrats side with Ireland on Brexit
  6. Wifi or 5G to connect EU cars? MEPs weigh in
  7. How Brexit may harm the new EU parliament
  8. EU parliament backs whistleblower law

Stakeholders' Highlights

  1. UNICEFUNICEF Hosts MEPs in Jordan Ahead of Brussels Conference on the Future of Syria
  2. Nordic Council of MinistersNordic talks on parental leave at the UN
  3. International Partnership for Human RightsTrial of Chechen prisoner of conscience and human rights activist Oyub Titiev continues.
  4. Nordic Council of MinistersNordic food policy inspires India to be a sustainable superpower
  5. Nordic Council of MinistersMilestone for Nordic-Baltic e-ID
  6. Counter BalanceEU bank urged to free itself from fossil fuels and take climate leadership
  7. Intercultural Dialogue PlatformRoundtable: Muslim Heresy and the Politics of Human Rights, Dr. Matthew J. Nelson
  8. Platform for Peace and JusticeTurkey suffering from the lack of the rule of law
  9. UNESDASoft Drinks Europe welcomes Tim Brett as its new president
  10. Nordic Council of MinistersNordic ministers take the lead in combatting climate change
  11. Counter BalanceEuropean Parliament takes incoherent steps on climate in future EU investments
  12. International Partnership For Human RightsKyrgyz authorities have to immediately release human rights defender Azimjon Askarov

Stakeholders' Highlights

  1. Nordic Council of MinistersSeminar on disability and user involvement
  2. Nordic Council of MinistersInternational appetite for Nordic food policies
  3. Nordic Council of MinistersNew Nordic Innovation House in Hong Kong
  4. Nordic Council of MinistersNordic Region has chance to become world leader when it comes to start-ups
  5. Nordic Council of MinistersTheresa May: “We will not be turning our backs on the Nordic region”
  6. International Partnership for Human RightsOpen letter to Emmanuel Macron ahead of Uzbek president's visit
  7. International Partnership for Human RightsRaising key human rights concerns during visit of Turkmenistan's foreign minister
  8. Nordic Council of MinistersState of the Nordic Region presented in Brussels
  9. Nordic Council of MinistersThe vital bioeconomy. New issue of “Sustainable Growth the Nordic Way” out now
  10. Nordic Council of MinistersThe Nordic gender effect goes international
  11. Nordic Council of MinistersPaula Lehtomaki from Finland elected as the Council's first female Secretary General
  12. Nordic Council of MinistersNordic design sets the stage at COP24, running a competition for sustainable chairs

Join EUobserver

Support quality EU news

Join us