Tuesday

22nd May 2018

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.

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  • 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.

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