Civil society steps in to fight rising obesity
By Paula Dear
A recent investigation by EUobserver unearthed the extent to which EU states’ policies to tackle obesity can be inconsistent, vague and poorly-measured.
In the absence of a coherent strategy, it’s often civil society that steps in to try to deliver results in this crisis of global health.
Whether it’s a grassroots community effort to distribute free fruit in a shopping centre, a project to educate schoolchildren on reducing the sugar they consume, or a federation of NGOs advocating on public health policy - civil society is dealing with a problem that currently affects around one fifth of Europe’s population.
It’s estimated that more than 50 percent of people in Europe will be obese by 2030, with all the health risks - such as diabetes and heart disease - and the associated costs that come with it.
Speaking to EUobserver, Nikolai Pushkarev from the European Public Health Alliance (EPHA) - a network of public health NGOs, patient groups, health professionals and disease groups - said that while civil society has a valid role in the fight against obesity, it can also be a “double-edged sword”.
"It’s true to say we want a multi-sectoral approach, but sometimes people use it to take the responsibility away from them".
"It becomes ‘it’s not only us who are responsible, so you do it’," he says, which makes it too easy to pass the buck.
However, when people do get on with things in the absence of an official order, it can lead to unexpected results, says retired primary school headteacher Elaine Wylie.
Five years ago, after a volunteer pointed out how physically unfit her Scottish school’s pupils were, she came up with a basic, cost-free policy that went on to be named The Daily Mile and is now practised in 18 countries.
The concept was simple: every day, at a time of the teacher’s choosing, each class was to go outside in the clothes they were already wearing and spend 15 minutes running a mile and socialising in the fresh air.
A mile a day
Within six months, the whole school was running daily and none of the year-one children that year were categorised as overweight by the school nurse.
Attainment started to rise, behaviour improved, and parents said their children were more alert. Within two and a half years, the school's obesity rate dropped down to half of what the national obesity rate was for kids, says Wylie.
The Daily Mile now operates in around 700 schools in Belgium (under the name One Mile a Day) and has been adopted in the Netherlands by the government-supported JOGG initiative to reduce childhood obesity.
It’s also being rolled out across the rest of the UK, in France and Spain, and is expected to start soon in Italy and Germany.
“I’m not sure it could have been designed in advance - it evolved. Then once it got out there, it took off like we could never have imagined,” added Wylie.
“We tend to fall into the trap of thinking there needs to be complication, over-organisation or expensive equipment to address this obesity problem. People forget that children know how to run. With this, it’s industrial quantities of children - it can be scaled up from a school, to a local authority, to a country, and not cost a penny.”
Many schemes prioritise the issue of childhood obesity, which the EU’s 2014-2020 action plan calls “worryingly high” and rising.
One new project funded by the Wallonia-Brussels Federation - set up by the independent non-profit Safe Food Advocacy Europe (SAFE) - is running workshops in Brussels schools to teach youngsters how to look out for sugar in their diet and what the risks of over-consumption are.
"Désucrez-vous! Du sucre, oui, mais pas trop" ["Unsweeten yourself! Sugar, yes, but not too much"] is part of SAFE’s broader ‘Sugar Project’, which also includes lobbying agro-food firms to get them to lower sugar content and campaigns for EU food information regulations to be improved.
There can be friction over the perception that overweight people are being lectured to, but some of the most passionate advocates within civil society have suffered from obesity themselves, like Alexandra Fraisova, who coaches in an organisation called STOB in the Czech Republic.
STOB runs educational and motivational projects to both assist people with obesity and work on prevention. This year they are running a Healthy Year programme, with each month dedicated to one issue, such as added sugars, vegetables or exercise.
Participants get points for taking on challenges, using new recipes, and reading and commenting on articles.
“I am a patient, obesity being one of my illnesses due to health problems,” says Fraisova. “I’ve learned that it is easier and cheaper to try and find a way of living that’s sustainable. And I strive to get the information and education to others.”
For similar reasons, Marina Biglia became involved with the Italian non-profit, Amici Obesi, which uses the arts - such as photo exhibitions - to promote self-help, break down taboos and give patients a voice.
“Speaking about obesity is now the job of too many people, and most of them understand nothing about it. The big problem is that governments don't listen to patients - they don't put those who are obese at the centre of care,” says Biglia.
She then argues that “politicians can’t work well if they don’t understand that obesity is a multifactorial and global emergency that we have to fight together.”
Other civil society organisations, such as the European Association for the Study of Obesity (EASO), focus on changing the wider policy environment to make the fight against obesity a more coherent, collective effort.
EASO, which has organised an annual European Obesity Day since 2010, is focusing its efforts this year on getting obesity officially recognised by EU states as a chronic disease.
“Community initiatives supporting healthy eating campaigns or local cycling-for-fitness efforts are excellent and should be applauded and supported. But we also need national and international efforts to improve the food system, promote active transport and incentivise healthy behaviours," said EASO communications director Sheree Bryant.
“If obesity is officially recognised across Europe as a chronic disease it would have a huge impact on the way member states invest in it,” she added.
Last year, EASO collected 144 signatures in the European Parliament supporting the move, but Portugal is currently the only European country to recognise obesity in this way.
The change came from civil society, after national publicity campaigns - run by Portuguese patient organisation Adexo - involved posters urging people to see their doctor if their waistline increased, and declaring obesity as a potentially fatal public health issue.
The organisation coordinated a strategy to get the topic into the media every 15 days, regardless of whether the story was positive or negative, to "put obesity on the public agenda", and held public screenings in seven cities during one week in 2003.
Their actions led to the Ministry of Health's decision, in the following year, to recognise obesity as a chronic disease.
Adexo has also successfully campaigned for laws to regulate the operation of treatment centres and a national registry of patients who are overweight or obese.
It’s evident that civil society groups can work effectively, but ultimately there are blockages to real progress that need to be overcome, says EPHA’s Pushkarev.
He goes on to say that “there are two approaches to finding solutions - what can individuals do within the given situation, and how can we change the situation for individuals?"
“On both sides, the role of civil society can be important… but the bigger effect lies where you change the environment so it becomes conducive to better outcomes - making things easier for people to make the choices they actually would want to make," Pushkarev argues, adding that “here our role is as a catalyst for policy change. We don’t just sit back and accept that policy isn’t doing anything.”
EPHA’s current focus is on influencing the revision of the EU’s audiovisual media services directive (AVMSD), which governs EU-wide coordination of national legislation on all audiovisual media, including TV broadcasts and on-demand services.
The European Parliament's culture committee will be voting on the AVMSD in April.
EPHA is pushing for a ban on television advertising of unhealthy food to children during peak viewing hours and to strengthen rules on product placement.
“It should also be possible to have this kind of watershed ban implemented on social media,” Pushkarev says.
He explains that “one of the main stumbling blocks is the preference for a self-regulatory approach, where advertisers and companies make pledges to restrict their own marketing practices. We feel we need to be setting policy in relation to the need, not in relation to how fast companies are willing to travel.”
The vast power of marketing and lobbying by private firms, a lack of coordination and funding from governments, an individualistic mindset around the obesity debate and the relative lack of a social movement on the issue means civil society groups are often battling to be heard, he argues.
Bryant from EASO agrees, saying that without comprehensive, integrated obesity strategy plans by national governments, only so much can be done. She adds that “civil society has stepped in to fill the breach, but it isn't enough.”