PHILIP JAMES

Chairman, International Obesity Task Force

CHILDHOOD OBESITY IN EUROPE: IMPLICATIONS FOR THE FUTURE FOOD CHAIN

10

17

18

31

36

2219

18

27 15

16

18

33 2735

34

26

12

17

33

34

9

21

20

1717

22

23

25

89

17

13

1212

1811

Overweight (%)Equivalent to BMI>25

14-17 years

7-11 years

European national prevalences (%) of overweight and obesity in children aged 7-11yrs using IOTF cut-off points

Norway

Poland†Netherlands

SlovakiaBulgaria

SloveniaSweden*

Spain

ItalyCzech Rep

Ireland (Rep)

Denmark

France

Switzerland

Germany

England

Cyprus

Greece*

Portugal†

† 7-9yrs * 6-11yrs © International Association for the Study of Obesity Sept 2010

% Overweight and Obesity in children aged 7-11 years (using IOTF cut off)

0 5 10 15 20 25 30 35 40

Portugal* *

Greece*

Czech Republic

Italy

Cyprus

Ireland (Republic of)

Spain

England

Sweden*

Slovenia

Germany

Bulgaria

Slovakia

Switzerland

Netherlands

Poland* *

France

Norway

Denmark

Obese

Overweight

5 10 15 20 25 30 35

Obese

Overweight

Children’sOverweight +Obesity

Lobstein T.OECD.Sept 25th2010

Genetics influence susceptibility to prevailing dietary and activity environment

Overweight & Obesity in Children around the Globe (Based on IOTF cut off points)

05

10

152025303540

NorthAmerica

LatinAmerica

Eastern Med Europe WestPacific

South EastAsia

Africa

Region

%

Overweight

Obesity

Rachel Leach, IOTF, April 28th 2008

The natural history of childhood overweight/obesity using IOTF cut-offs in Australia over the last century and regional global increases

Wang and Lobstein, IOTF, Int J Ped Ob 2006.

20001980196019401920190019000

10

20

30

40

Year

% o

verw

eig

ht

+ o

bese

Raw data

All data

e.g. Japan

e.g. India

%%

e.g. US

e.g. S.Arabiae.g. UK

Global total now: obese 74 mil. +overwt. 287 mil.Global total now: obese 74 mil. +overwt. 287 mil.Global total now: obese 74 mil. +overwt. 287 mil.Global total now: obese 74 mil. +overwt. 287 mil.

Norton K et al, Int J Ped Ob 2006

Australia

Economic development and falling food needsEconomic development and falling food needs

3000

2000

1000

Kcals

Car Use

Mechanical aids

TVComputers

Energy needs

US Intakes

UK Intakes Increasing obesity

Economic development and ageing

? Japan

Sarah Hinde: The car-reliant environment. In: The 7 deadly sins of obesity. Univ. of NSW, Australia. 2007.

CAR-RELIANCE limits child development

Increase in traffic

Parent concern for child safety

Sedentary replaces active transport

Parents chauffeur children

Organised sport replaces play for

children

PHYSICAL INACTIVITY

The Traditional Mediterranean Diet

Corfu & Crete1960-65 Men (7

country) g/d

S. Italy1930s Household

(CNR) per caput g/d

EURATOM1960s Household

g/d/consumption unit

S. Italy1960-65 Men (7

country) g/d

0

250

500

750

1000

1250

1500

Fish

Fruit

Vegetables

CerealsFats & oils

Milk

Meat

Eggs

Alcohol

Sugars etc.

Grams

Compiled by Anna Ferro-Luzzi Institute of Nutrition Rome

The keys to success in the food business and in obesity and chronic disease prevention

• Marketing

• Availability

• Price

A quarter-pound cheeseburger, large fries and a 16 oz. soda provide:

1,166 calories 51 g fat 95 mg

cholesterol 1,450 mg

sodium

“Obesity is a commercial success. Promotional budgets and advertising markets for energy-dense nutrient-poor (junk) food and drinks hugely outweigh those for healthy food. Similarly, the budgets for inactive transport and entertainment (video games, internet, TV) morbidly outweigh those for active transport and active entertainment”Australian Prev.HlthTaskforce,Oct,2008

- Car washes- Book stores- Hardware stores (Home Depot)- Gas stations- Office buildings (vending machines)- Health clubs/gyms- Video stores- Car repair shops

Snack Foods Are Everywhere

CHIPS ARE IN SEASON!

Doubling shelf space increases sales by 40%Doubling shelf space increases sales by 40%

Gary Lineker

= potato crisps

David Beckham

= soft drinks

Marketing : celebrities and sports

OBESITY

Dietary changeDietary change

Folate, B 6 Homocysteinaemia ? Thrombosis

Saturated fats AtherosclerosisAntioxidants

Total Fat

High energy density *_ by fat & refined CHOs

Physical inactivityPhysical inactivity

DIABETES

CORONARY HEART

DISEASE & STROKE

HYPERTENSION

++

+ + +

+

+

+ +

++

*Energy density reduced by water -holding, bulky foods, e.g. tubers, cereals, vegetables, fruits, pulses.

Vegetables, fruits, pulses

SALT+

Trans Fats

N-3/N-6 fats

+

+

CANCERS

Who controls the food chain ?

Corinna Hawkes, 2006

Local markets, Local markets, roadside stalls roadside stalls and farm shopsand farm shops

Supermarkets: the "food consuming industry"

Small Small food food

outletsoutlets

Global Feed CompaniesGlobal Feed Companies

Global Food Companies

FFaarrmmeerrs s

Family and other Family and other small food companiessmall food companies P

UBLIC

The current obesity dilemma

UK Government report Oct. 2007

Obesity is a normal "passive" biological response to our changed physical and food environment

Some children/adults are more susceptible for genetic, social and economic reasons

Overwhelming environmental impact reflects outcome of normal industrial development

Obesity reflects failure of the free market

Sept.25th 2010

Why the obesity pandemic? An OECD 2010 perspective

• “ The mass production of food over time has changed both the quality and availability of food

• Falling relative food prices contributed up to 40% of the increase in BMI in the US 1976-1994….

• Convenience also played a major role, in combination with falling prices, with the spread and concentration of fast food restaurants…..

• The use of increasingly sophisticated marketing techniques is naturally associated with an increase in the supply of food….

• These effects are consistent with the patterns observed in the distribution of obesity among population groups, with more vulnerable individuals and families and those whose time available for meal preparation and cooking has become more limited being more exposed to the influence of supply-side changes.”

e.g. Any focus on Health Education selectively helps upper socio-economic groups. But need understandable food labelling; Drs have major role in identifying susceptible adults to avoid

diabetes

Individual responsibility

Changes to the "toxic" environment

Adapted from Puska P, 2001

Progressively adapt all towns/cities to favour pedestrian/cycling as norm with car restrictions

Nutritional standards for food in all government facilities/schools; eliminate trans fats; catering on Finnish scale: fruit + veg. within meal costs

Limit/abolish all marketing to children

Selectively increase costs of high fat/sugary products; soft drinks

Social/employment/medical policies for breast feeding as the norm/new nursery standards

Complementary Complementary approaches to obesity & approaches to obesity & chronic disease chronic disease preventionprevention

Complementary Complementary approaches to obesity & approaches to obesity & chronic disease chronic disease preventionprevention

US Adults Global Children

De Onis et al.Amer J Clin Nut.2010;92:: 1257-1264

Ogden et al .CDC posters 2010

Fiscal

Phys/Dieticiancounselling

Mass media

Work site

School

Food labelling

Regulation

Food advertising

Self Regulation

Physcn.Cnslng

OECD/WHO modelling

Major initiatives in France are reversing the obesity epidemic in children

• 64 Regions• Children aged 7-9yrs• IOTF cut-off points

• Prevalence s• 2000: 18.1% O/W 3.8% Obese• 82007: 15.5% O/W 2.% Obese

Data presented by the Ministry of health at the International Congress of Nutrition ,Bangkok. October 2009

Healthy Weight, Healthy Lives. Two Years on. UK March 10 th 2010

INFLUENCEINFLUENCE

-10

-- 5

0

510

INT

ER

ES

TIN

TE

RE

ST

Children

Health professionals

Advocacy orgs.

Scientists

Parents Ministry of Health

Parliament

Farmers

Media

Church

Ministries of Transport

& Agriculture

Retailers

Treasury

President

Advertising industry

Food/drink industry

Food inspectors

Ministry of Education

Teachers

0 5 10

Ministry of Trade

Lobstein T : Analyses based on The Food Commission's experience and new EU policy work.

?

5

0

-- 100 5 10

The interest and influences of different stakeholders