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A blueprint for tackling Europe’s obesity pandemic

Obesity carries a huge financial and human cost while relying on individual initiative is ineffective – coaching people and paving the road towards a healthier life is the way forward – writes Dr Pedro Marques-Vidal

Obesity is taking over the European population and their wallets. According to the International Association for the Study of Obesity between one tenth and one quarter of the continent’s adult population is obese. If being overweight is also taken into account, then in several countries less than four out of 10 men – and less than half of women – achieve a normal weight. Worryingly, this trend is not expected to slow down.

Obesity is defined based on the body mass index. To calculate one’s body mass index, divide your weight in kilograms by your height in metres raised to the square. Therefore, in an ideal world a man weighting 84kg and measuring 1.74m will have a body mass index of 84/(1.74×1.74)=27.7kg/m. Obesity is present if the BMI is more than 30 kg/m and people are considered overweight if they have a body mass index between 25 and 29.9. In this example, the man is overweight.

The direct and indirect annual costs related to obesity in 15 European Union member states have been estimated at £32.8bn. This corresponds to £89.8m per day, more than an Airbus 321. Within each European country out of every £100 spent on healthcare, £2 is spent on obesity or related diseases. Waiting for the tide to recede is just not feasible. Action is needed now. Obesity is the result of the imbalance between gains and losses in calories. If an adult consumes more calories than she or he can spend, the extra energy is stored as fat and obesity develops. This simple equation can be extended in multiple ways.

Excess caloric intake can occur when caloric-dense and fat-rich foods are preferred to less caloric foods. Actually, it is very difficult to evaluate how many calories we eat: the spread on your bread might contain more calories than the slice of bread itself; a can of soda might contain more sugar than you will ever be able to add to a similar volume of water. In Europe, caloric foods are affordable, easy to find, ready to consume and palatable due to their high fat and salt content – so why restrain ourselves? Social pressure adds to this trend and no social event is successful if food is scarce. Who managed to restrain themselves during Christmas and New Year?

Decreased energy expenditure occurs when people tend to adopt a sedentary lifestyle. Climbing four floors daily makes you physically fit but how many people actually take the stairs when a lift is available? And even if someone wants to run or bike, how can they if no facilities are available; and when cycling is life endangering in most cities? Contrary to popular belief, there are no foods with negative calories and no miracle products that make you slim while eating whatever you want. Although fashionable, epi-genetics have brought little to the battle against obesity. Genetic manipulation might protect mice from becoming fat but who in Europe wants their child to become a genetically modified organism?

Prevention of obesity should associate individual and social interventions. Social interventions should aim at facilitating the right decision for individuals, with minimal effort. Social interventions should help the individuals help themselves. The state should be a coach, not a nanny.
Healthy eating can be promoted by appropriate legislation regarding food production and advertising.

Coordination with food producers should be encouraged in order to implement informative food labeling and to increase the availability, and affordability, of healthy produce. Promotion of locally produced environmentally-friendly crops is desirable. Balanced meals should be provided in schools, universities and public institutions as well as private institutions – promoting healthy eating could obtain fiscal benefits. Taxation of nutrient-poor, sugar or fat-rich foods could improve local or national budgets.

Physical activity can be promoted via improved public transports and commuting, pedestrian streets, playgrounds and increased facilities in kindergartens, schools and universities. Public buildings should have areas where officials could exercise before or after work. Legislation to make stairways more accessible than lifts in public buildings should be enforced.

Pedestrian streets promote shopping and decrease pollution due to road traffic in city centres. For young people, three hours of physical activity per week should be implemented in the curriculum and after school physical activities should also be proposed. Good public parks and playgrounds do favour sociability while improving the quality of life; a tourist will visit a nice public park, not a nice car park. Obesity carries a huge financial and human cost. Relying solely on individual initiative has proven ineffective. Coaching people and paving the road towards a healthier life is the way forward.

Dr Pedro Marques-Vidal is deputy head of clinic at the Institute of Social and Preventive Medicine in Lausanne, Switzerland and a spokesman on prevention for the European Society of Cardiology

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