Presented by João Breda of WHO Regional Office for Europe at the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020, 4 July 2013, in Vienna, Austria

1. Towards a new
milestone in European
nutrition and physical
activity policies
by João Breda,
WHO Regional Office for Europe

2. GBD – attributable for 20 RF 2010 as % DALY
15 out of 20 RF linked with nutrition and PA Lim & al. 2012

3. Prevalence of overweight (%) among adult men
(BMI ≥25.0 kg/m2)
25
30
35
40
45
50
55
60
65
70
1994 1997 2000 2003 2006 2009 2012
Prevalence of overweight (%) among adult men (BMI >25.0 kg/m2)
Austria, 20+
Belgium, 18+
Denmark, 16+
Estonia, 16–64
Finland, 15–64
France, 15+
Germany, 18+
Ireland, 18+
Italy, 18+
Latvia, 15–64
United Kingdom, Scotland, 16–64
Lithuania, 20–64
Luxembourg, 16+
Netherlands, 20+
Norway, 16+
Portugal, 18–64
Spain, 18+
Sweden, 16–84
Switzerland, 15+
United Kingdom, Wales, 16+
United Kingdom, England, 16+

4. Prevalence of overweight (%) among adult women
(BMI ≥25.0 kg/m2)
25
30
35
40
45
50
55
60
65
70
1994 1997 2000 2003 2006 2009 2012
Prevalence of overweight (%) among adult women (BMI >25.0 kg/m2) Armenia, 15–49
Austria, 20+
Belgium, 18+
Denmark, 16+
Estonia, 16–64
Finland, 15–64
France, 15+
Germany, 18+
Ireland, 18+
Italy, 18+
Latvia, 15–64
Lithuania, 20–64
Luxembourg, 16+
Netherlands, 20+
Norway, 16+
Portugal, 18–64
Spain, 18+
Sweden, 16–84
Switzerland, 15+
Turkey, 15–49
United Kingdom, Wales, 16+
United Kingdom, England, 16+
United Kingdom, Scotland, 16–64

5. 0
10
20
30
40
50
Prevalenceofoverweight(including
obesity)(%)
6-year-olds 7-year-olds 8-year-olds 9-year-olds
Childhood obesity prevalence in 12
countries – COSI 2010

6. Childhood obesity prevalence in 12 countries
(trends)– COSI 2008-2010 (boys)
20.0
25.0
30.0
35.0
40.0
45.0
50.0
1 2
Czech Republic, 7-year-olds
Latvia, 7-year-olds
Malta, 6-year-olds
Norway, 8-year-olds
Slovenia, 8-year-olds
Italy, 9-year-olds
Ireland, 7-year-olds
Italy, 8-year-olds
Lithuania 7-year-olds
Portugal, 7-year-olds
Slovenia, 6-year-olds
Slovenia, 7-year-olds

7. WHO COSI, round (2010):
1 in every 3 children aged 6-9
years was overweight or
obese
The prevalence of overweight
(including obesity) ranged from
24% to 57% among boys and
from 21% to 50% among girls.
Simultaneously, 9 31% of boys
and 6 21% of girls were obese
1/4 in 2008 to 1/3 in 2010

8. THE SOCIOECONOMIC GRADIENT IN CHILDHOOD OVERWEIGHT AND
OBESITY: DIVERSITY ACROSS FIVE EUROPEAN COUNTRIES (WHO
COSI) – unpublished data

9. 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Percentagedistribution
2010
2030
Projected obesity for 2030
WHO Modelling obesity Project 2013 together with UK Health Forum – NOPA II

10. Prevalence gains per 100,000 of
the EU population in 2030 based on 2 scenarios
WHO Modelling obesity Project 2013 together with UK Health Forum – NOPA II
0
200
400
600
800
1000
1200
Cancer CHD+stroke Diabetes Hypertension
1% decrease in obesity
5% decrease in obesity
Scenario 1 – 3 Million
cases avoided
Scenario 2 – 9 Million
cases avoided

11. 0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
TUR
HUN
HRV
MKD
CZE
BGR
SVN
PRT
ROU
SWE
EST
ESP
ITA
LUX
FRA
CHE
LTU
IRL
GBR
DNK
NOR
AUT
NLD
SVK
FIN
ISL
DEU
AND
LVA
BEL
ISR
POL
CYP
ALB
ARM
AZE
BLR
BIH
GEO
GRC
KAZ
KGZ
MLT
MCO
MNE
MDA
RUS
SMR
SRB
TJK
TKM
UKR
UZB
Grams
Country
Salt intake per person per day for adults in the WHO European
Region from individual country-based surveys, various years
WHO/FAO RECOMMENDATION - <5 grams
No data

12. 0
200
400
600
800
1000
1200
AND
M…
SMR
GEO
BGR
LVA
CZE
MDA
SVK
LTU
FIN
TJK
DEU
POL
EST
KGZ
TKM
RUS
CHE
ISL
HRV
UKR
FRA
SWE
NOR
NLD
BLR
KAZ
GBR
HUN
BEL
SVN
CYP
ROU
AUT
ESP
AZE
DNK
SRB
IRL
UZB
LUX
MKD
BIH
MLT
ITA
ISR
PRT
ALB
TUR
GRC
ARM
MNE
Grams
Country
Fruit and vegetable supply per person per day
in the WHO European Region, 2009
WHO/FAO RECOMMENDATION - >600 grams

13. 0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
FRA
BEL
DNK
FIN
AUT
SWE
NLD
GRC
LVA
HUN
DEU
SVN
IRL
LUX
GBR
ITA
PRT
ESP
POL
MLT
ROU
EST
LTU
BGR
ALB
AND
ARM
AZE
BLR
BIH
HRV
CYP
CZE
GEO
ISL
ISR
KAZ
KGZ
MCO
MNE
NOR
MDA
RUS
SMR
SRB
SVK
CHE
TJK
MKD
TUR
TKM
UKR
UZB
Energy(%)
Country
Proportion of energy from saturated fatty acids among
adults in the WHO European Region, 2007
FAO RECOMMENDATION - max. 10% energy
No data

14. 0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
AND
EST
FRA
MCO
RUS
SMR
GBR
GRC
BGR
ITA
IRL
LUX
SVN
BEL
BLR
AUT
SWE
GEO
TKM
ISR
AZE
NOR
CYP
ROU
CHE
SRB
FIN
LVA
BIH
CZE
NLD
UKR
MNE
ISL
POL
DEU
MKD
TJK
UZB
LTU
ESP
SVK
KAZ
PRT
ARM
MLT
HUN
ALB
TUR
MDA
HRV
KGZ
DNK
Percentage
Country
Prevalence of exclusive breastfeeding under or at 6
months of age in the WHO European Region from
individual country-based surveys, various years
No data

15. Inactivity status in European Region
• WHO estimates that in adults :
– 63% are not reaching the minimum recommended level of physical
activity
– 20% of those are rated as “inactive”
– 38% are sufficiently/highly active
• 41% of adults does not engage in any moderate physical
activity in a typical week
• 22% of 11-year old girls and 30% of boys report at least
one hour of daily MVPA
• PA recommendations in EU Member States + Norway
and Switzerland - 19 Member States

16. Europe: mandate for action

17. Overview Policy Actions Implementation
53 WHO/Europe Member States – 2012/13
Policy
Actions
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Measures to affect food prices
Labelling - signposting
Reformulation - less sugar and salt
Promote Active Travel for school-children
Marketing HFSS foods to children - restrictions
Salt reduction initiatives
School Fruit Scheme (SFS) or similar
Programs in schools (inc. vending machines)
Baby Friendly Hospital Initiative
Physical Activity Policy incl. Guidelines
Breastfeeding promotion and protection policies
Food Based Dietary Guidelines
Labelling - nutritional information
No Action Partially implemented Fully implemented

18. Nutrition Policy 2007-2013
• 143 nutrition policies
• 39 obesity policies
• 184 physical activity policies

19. Nutrition Policy in 2007-2013
• For the 143 nutrition policies, 39 obesity
policies and 184 physical activity policies:
• Only 16 clearly focus on low income
groups
• 8 address attention to health
professionals…

20. No action
reported
Partially or fully
implemented
Countries (N) 20 33
No action
reported
Partially or fully
implemented
Countries (N) 23 30
Great progress in certain
areas
Salt reduction policies
MKT HFSS foods policies

21. Policy and Social Innovation:
Regulation & taxes
• 4 countries in the EU with bans on “trans” fat and several
others with effective self-regulatory approaches;
• Social innovation – use of taxes for PH: several countries
but Hungary and Denmark most recent prominent
examples:
– Estimated revenue was accomplished
– No differences in social class
– 6% reduction in saturated fat
• Marketing food to children
• Mainstream food reformulation – i.e. salt

22. Culture, tradition… protective diets
Med diet & cognitive impairment
Psaltopoulou et al. Ann Neurol 2013 May 30.
doi: 10.1002/ana.23944. [Epub ahead of print]

25. Country profiles as a result of EC/WHO collaboration and based on
NOPA information system.

27. Nutrition and PA policies in Europe
History of success but more is needed…..
• Monitoring and surveillance
• Evaluation
• Exchange/collaboration
• More success where accountability and
external pressure/evaluation exist
• Challenge to comply with Global targets…….

28. Vienna Declaration process
• Technical (comments)
• NGO interaction
• Political level

29. Way forward
• Environments/Governance mechanisms
• Life-course
• Health sector
• Monitoring and surveillance
• Forging alliances
“The current document on Nutrition and NCD’s is
masterfully worded and highly consistent with the
best available evidence on the critical topic”
Walter Willett; 04/07/2013