The Greek Presidency “Nutrition and Physical Activity” conference of 24-25 February, saw the launch of the EU Action Plan on Childhood Obesity, initiated a year ago under the Irish Presidency of the EU. The Plan attempts to take into account the political complexity of all 28 EU Member States and aims to “demonstrate a shared commitment of addressing childhood obesity” by setting out eight priority areas for action “possible measures for consideration” while respecting countries’ “roles and freedom of action in counteracting” the obesity problem in the child population.
In recognition of the growing health challenge for the EU of rising childhood obesity, a new EU Action Plan on Childhood Obesity was agreed by the High Level Group on Nutrition and Physical Activity (although opted out by the Netherlands and Sweden). The idea of an EU-wide action plan on childhood obesity came about under the Irish Presidency informal meeting of EU Health Ministers in Dublin in March 2013.
At present, it is estimated that around 7% of national health budgets across the EU are spent on disease linked to obesity each year. According to estimates from the WHO Childhood Obesity Surveillance Initiative (COSI), around 1 in 3 children in the EU aged 6-9 years old were overweight or obese in 2010. The Plan talks about the health effects of childhood obesity, poor diet and physical inactivity, multi-dimensional aspects of obesity, and how these are put into an EU perspective under the EC Strategy for Europe on Nutrition, Overweight and Obesity-related Health Issues (2007), as well as the Council of the EU’s Recommendation on Health-Enhancing Physical Activity across Sectors (2013).
The overarching goal of the Action Plan on Childhood Obesity is to contribute to halting the rise in overweight and obesity in children and young people (0-18 years) by 2020 (halting, not reversing). To achieve this goal, the Plan sets out eight priority areas for various stakeholders to:
– Support a healthy start in life This includes from pre-conception, during pregnancy and breastfeeding (but with no indication of exclusivity or length) and underlines healthy lifestyles in early years, education and training of health and child care professionals and the importance of primary prevention
– Promote healthier environments, especially in schools and pre-schools (limiting exposure to less healthy food options, meals provided in schools are healthy, nutritional quality of any other foods sold in schools (and in proximity?) is improved, reduce food waste, promote good habits from an early age, provide vulnerable children and young people in socially disadvantaged communities with healthy (and nutritious?) foods, promote sufficient and high quality physical education lessons a well as physical activity friendly environments)
– Make the healthy option the easier option (provide appropriate information to consumers to identify nutritious, affordable and convenient (?) options; access to and improved supply of healthy offer in supermarkets, local producers and markets, restaurants and other retailers, and schools made easier (?); use nutritional criteria (regional, local, seasonal, organic?) in food service procurement and the provision of nutrient and energy content information for non-prepacked food; make healthy options more affordable and attractive – default option, redesign food displays, tap water including at schools, reformulation of less healthy food options and taking nutritional objectives into consideration when defining taxation, subsidies or social support policies; promote drinking water to support health as a substitute for sugar-sweetened beverages, and similarly (?) – “the EU School Milk Scheme promotes consumption of milk as an alternative to sugar-sweetened beverages” (currently: ‘fruit‘ or cocoa-flavoured and sugar-sweetened milk drinks instead of plain low-fat milk?)
– Restrict marketing and advertising to children (stress out children and young people particularly vulnerable to messages that may lead to the development of unhealthy dietary preferences (and behaviours such as overconsumption?), no preference given to whether to mandatory regulate or co-regulate exposure to food and drink marketing aimed at children and young people under 12 years of age (recent research contest the age limit and recommends higher threshold))
– Inform and empower families (habits play a major role in determining life-long preferences and health behaviours, “parents are responsible for shaping their children first food choices and play an influential role in the formation of eating and activity habits (role of enabling or inhibiting physical and social environment, the industry, the media?), nutritional information more useful and easy to understand for everyone)
– Encourage physical activity (active lifestyle encouraged as early on as possible in childhood, change the design and layout of urban areas)
– Monitor and evaluate (monitor the health status and behaviours of children and young people, monitor the nutritional quality of food, assess social inequalities related to obesity and overweight in children and young people, evaluate the impact of actions in these areas; the Plan to be consistent with the WHO Action Plan for Implementation of the European Strategy for the Prevention and Control of Non-communicable Diseases 2012-2016; the Action Plan to be revisited after three years)
– Increase research (improve systematic data collection, coordinate at both national and European level, disseminate research finding, inspire innovative actions).
It is important to look into who the main actors would be and what the share of main competences is likely to be. The Plan identifies three main types of stakeholders: the 28 EU Member States, the European Commission and international organisations, such as WHO and civil society (NGOs, industry and research institutes). An important role has been also assigned to national, regional and local authorities (with responsibilities beyond the area of health directly).
Also, it is important to note that the Plan strongly emphasises Member States exclusive competence in defining national health policies; that is to say that EU-level action “will not define the specific content of health policies”. The EU Member States did ask the European Commission, however, to take responsibility for three key priorities regarding the Plan:
– To continue providing support and coordination through the High Level Group on Nutrition and Physical Activity and the EU Platform for Action on Diet, Physical Activity and Health, and to further facilitate exchange of information and guidance on best practices;
– To promote better utilisation of the existing instruments, namely the EU Health Programme and the Horizon 2020 growth strategy;
– To strengthen its aim to integrate the issue of health in other EU policy areas such as those relating to urban mobility, media, education, physical activity, sport and the common agricultural policy (CAP).
Still, the major ‘modus operandi‘ for the industry, including the retail, catering and agricultural sectors is placed in self-regulation, through voluntary commitments and initiatives in areas such as marketing, food reformulation, food distribution, catering and physical activity.
Based on the EU Action Plan, each EU Member State (the Netherlands and Sweden declined to approve the plan) can develop, implement and/or evaluate their own national action plan on childhood overweight and obesity. Member states can share good practices and develop compatible tools to monitor their national policies through a Joint Action.