Tackling childhood obesity: WHO strategies to promote healthy diets & PA - J. Breda WHO Regional Office for Europe
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Tackling childhood
obesity: WHO
strategies to
promote healthy
diets & PA
J. Breda
WHO Regional Office for Europe
Riga - February 2015
Vienna Declaration on nutrition and NCD & EU Action Plan Childhood Obesity
From Health 2020 to the FNAP & PAS
2012 2013 2014 2015
Physical Activity
Health 2020 Strategy (PAS) & FNAP
Vienna Declaration
Ministerial Conference on Nutrition & NCDs, Vienna “…contribute significantly to the reduction of NCDs by addressing …..excessive intake of energy, saturated fats and trans fats, free sugars and salt, as well as low consumption of vegetables and fruit..” “Development of a new food and nutrition action plan” “Mandate the development of a physical activity strategy”
A new European Action Plan - Vision “A European Region in which the negative impacts of preventable diet-related NCDs and malnutrition in all its forms—including overweight and obesity—have been dramatically reduced, and all citizens have healthier diets throughout their lives.”
European Food and Nutrition Action
Plan 2015-2020 – priority areas
1. Create healthy food and drink
environments
2. Promote the gains of a healthy diet
throughout life, especially for the most
vulnerable groups
3. Reinforce health systems to promote
healthy diets
4. Support surveillance, monitoring, evaluation
and research
5. Strengthen governance, alliances and
networks to ensure a health-in-all-policies
approach
Innovation: Structure • Focus on intersectoral action: 5 priority areas • Shortlist of recommendations for Member States • Focus on broad range of policy instruments: Legislation/ regulation, financial measures, organization, information/ education • Keeping up with the state of the art in research
Vienna Declaration on Nutrition & NCDs • Development, implementation and evaluation of policies across a range of areas to influence the production, promotion (marketing), price and availability of food to encourage healthy diets and limit consumption of HFSS foods • A focus on creating healthy environments at the population level • Innovative policies, including that will require inter-sectoral work within government • Investment in nutrition across life-course, particularly for vulnerable groups • Reinforce health systems to promote health • Monitoring and surveillance of population’s nutrition and physical activity status
Selected examples of policy options relevant to
nutrition in schools
Priority policy options Key components
Mandatory standards for foods available in • Food- and/or nutrient-based standards for all foods available in schools,
schools, including restrictions on specific including in cafeterias, vending machines and shops
foods • Consider exclusion zones for fast-food outlets in immediate vicinity
• Ensure drinking water is freely available
Nutrition education on school curricula • Cross-subject approach to nutrition education, aiming to stimulate literacy
and skills
• Consider activity-orientated learning, e.g. cooking, school gardens
Free school fruit and vegetable schemes • Frequent (ideally daily) distribution of fruit and vegetables
• Accompanying educational initiatives
Strong controls on the marketing of food and • Schools and other settings in which children gather should be free from all
non-alcoholic beverages in schools marketing of foods high in energy, saturated fats, trans fats, sugar or saltPrevalence of Overweight (including obesity)
in Children Under 5 in the European Union
30,0 27,5
a IOTF cutoffs
b self-reported
25,0
23,1 data
c 2 year olds
19,8 d 3 year olds
National
20,0 18,4 e 4 year olds Subnational
Prevalence (%)
16,1 f 3.5-4.5 year olds
14,3
15,0 13,5
11,4 10,8 10,8 10,2 9,0
10,0 8,3 8,0 7,0
5,1
5,5
5,0
0,0
SWEbc
LTUd
ITAe
NETb
FRAad
PORd
IREae
ROMc
POLc
GREc
DENafg
BELab
UNKad
BULc
SPAbc
CYPd
CZHc
CountryPrevalence of overweight among boys aged 7
years (COSI 2010)
60
49
50
45 45
40
34 34
32
30 29 28
30 26 25 25 24 24 24 23
%
20
10
0
GRC ITA** ESP MLT* MKD PRT SVN NOR** BGR IRL HUN LVA LTU CZE SWE BEL
* 6-year-olds
** 8-year-oldsPrevalence of overweight among boys
in COSI round 1 and 2
60
2007/2008 2009/2010
50
40
% overweight
30
20
10
0Prevalence of overweight among girls
in COSI round 1 and 2
2007/2008 2009/2010
45
40
35
overweight
30
25
20
15
10
%
5
0
8 9 7 6 7 8 7 6 7 8 9 7 7 8 7Participating countries in COSI
Austria
Poland
Slovakia
Croatia
Denmark
France
UKPrevalence of overweight (BMI -for-age +1SD) among
European adolescents (11, 13 and 15 years old boys and girls) in 2010
BMI-for-age >10%
10%≤ BMI-for-ageAdolescents - overweight (including obesity)
prevalence in youth according to “sub-region”
30
25 22,5 Sharper increase
21,3
20,2
20 18,5
17,3
15,6 16,2 2002
15,3 15,5
14,1 14,7
%15 2006
11,5
2010
10
5
0
Western Europe Southern Europe Eastern Europe Northern Europe
Overweight prevalence distribution according to geographical region in 32 countries within WHO
European Region, considering both boys and girls with 11, 13, 15 (Source: HBSC) – unpublished,
please do not quote30
20
10
0
10
20
30
0
No Data CYP CYP No Data
ITA ITA
DEN FRA
FRA POR
SWE GRE
EST DEN
GRE EST
POR SWE
LTU DEU
Activity Data (%)
MAT ROM
DEU BEL
NET HUN
BEL LTU
LVA CRO
POL FIN
SVN SVN
HUN UNK
LUX AUT
ROM MAT
CZH NET
SVK SPA
UNK POL
CRO LVA
SPA LUX
Comparing Child and Adolescent Physical
BUL SVK
FIN
CZH
AUT
BUL
IRE
IREOverview some indicators N/28 EU – 2014
National action plan/policy PA promotion for population < 18 years
Data on height and weight
Participating in COSI (as of 2014)
Policies reducing the impact (power and exposure) on children…
National or Regional food composition table
National food reformulation strategies
Nationally representative diet and nutrition surveys
Actions
Policies the eliminate or virtually eliminate trans fats
Policy
National nutrient profile model or other
Yes No 0% 20% 40% 60% 80% 100%What is the impact of school food policies?
• Changes to school food environments can be effective in influencing
consumption of healthier foods and caloric intake:
• Increase consumption of healthier foods
• Mandatory standards = decreases in calories across the whole day when
implemented with a “whole of school approach” – with no loopholes
• Restrictions HFSS foods can help prevent learning of unhealthy habits
• School fruit schemes are most effective when provided free and on a daily
basis:
• School fruit schemes can increase total fruit and vegetable intake
• Frequent exposure helps reinforce preference learning
• Supporting educational measures are important
• Free schemes help overcome access barriers for low SES groupsProgress across the WHO European Region
• All EU countries indicate that they have a school food policy in place, while 15 EU
countries have mandatory standards
• 26 + countries provide fruit and vegetables in school, either as part of EU School Fruit
Scheme or with similar national programmes
• Some countries have policies specifically addressing SSBs and vending machines – the
objective being to reduce consumption and also to reduce opportunities for marketing
• Monitoring of school food policies varies; possible indicators include food provision (e.g.
availability), consumption during school hours and children’s nutrition
Source: NOPA Database; JRCSelected examples of policy options relevant to physical
activity in schools
Priority policy options Key components
Physical education in schools • Ensure regular provision of PE lessons
• Focus on integrating a variety of activities and skills:
• Knowledge of the benefits of physical activity
• Mobility and key movement skills
• Team work and competitive aspects of sport
• Ensure adequate training and support to teachers
Active commuting to/from school • Support for biking, including infrastructure at schools to allow secure parking
• Support and coordination of “walking buses”
• Explore action to reduce volume and speed of traffic in vicinity of schools
Infrastructure to support physical activity in • Ensure there is space for recreation and active play, including playgrounds
school settings
Support for extra-curricular physical activity, • Support sports clubs, scouts and other youth clubs, running, hiking and other
incl. sport outdoor pursuits.
• Promote and support age- and gender-relevant forms of activityChildhood obesity: a multi-stakeholder
approach - POR
81% children,
all from poor
families
achieved a BMI
reduction after
6M
Rito et al. PHN 2013Monitoring school environments - COSI
• Individual energy intake and expenditure are
affected by a wide range of environmental
influences, including the school environment
• COSI provides opportunity to:
– obtain data and categorise schools
according to their food and physical activity
environments, using standardised criteria
– Explore any relationships between levels of
overweight and obesity at school level and
school environment characteristics• We developed an index of 18 school environmental
characteristics (indicators):
– availability of fresh fruit and vegetables, drinking water, sugar-
sweetened beverages and sweet or salted snacks
– provision of physical education lessons (more than 60 mins per week)
and availability of recreation areas on school premises
• A scoring system was then devised awarding either 1 or 0 points to a
school for each indicator, which allowed a composite score
• Schools in 11 of the countries participating in COSI provided information for
COSI Rounds 1 & 2Findings on environments - COSI
• A large variability in relative school nutrition environment
scores was found across countries: low and high scoring clusters
identified
• BUT also high variability in scores between schools within the
same country, with both high- and low-score schools identified
– So a low school nutrition environment score can relate to the
absence, or inadequate implementation of, national policies
• At this stage we could not demonstrate an association between the
school nutrition environment score and the school BMI score.
Probably due to the short time span of the study period.In summary • Some good progress (regulations, guidance…SFS) • We can do better in schools… better food, more PA – NP, PA curricula, recreation…. • We do need more and better data: fine-tune indicators and data validation with countries / smart policies • Scarcity and heterogeneity of data shouldn’t stop us..
Interventions for better childhood
obesity prevention
• Investment (particularly in children)
• Enlightening policy frameworks
• Tangible effective actions -
• Innovation
interventions that work (innovation and
• Evidence technology)
• Political will • Surveillance and better data
• Intersectoral coordination • Reaching most difficult groups
• Sustainability • Inspiring guidelines/guidance & tools
• Training and capacity buildingYou can also read
