Obesity without borders

by Allison Sebolt
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With more than 50% of the adult population and an estimated 21 million children in the European Union reportedly being either overweight or obese, the E.U. is taking steps to develop specific policies to help curb the epidemic. With similar situations on both sides of the Atlantic, the U.S. and E.U. governments could learn from each other’s efforts and successes in coming years to discover what is most effective in helping their populations shed pounds.

A recently released White Paper on Nutrition by the European Commission placed a large focus on private sectors, public health leaders and the consumer sector working together to address the issue and strengthening existing efforts such as the E.U. Platform for Action on Diet, Physical Activity and Health.

The White Paper emphasized helping consumers make informed choices, ensuring healthy options are accessible and encouraging the food industry to reformulate products with a specific emphasis on reducing salt and fat levels in food.

The paper also called for specific action in developing stronger advertising codes and for sports organizations to develop advertising and marketing campaigns to encourage physical activity.

"The rise of obesity makes improving the diets and physical activity levels of Europeans a top public health priority for the E.U. in the years ahead," said Markos Kyprianou, E.U. health commissioner. "If we don’t act, today’s overweight children will be tomorrow’s heart attack victims. What consumers eat is up to them, but they should be able to make informed choices and have a range of healthy options to choose from."

The European Commission will monitor the progress of all the groups involved in the efforts with a first report to be published in 2010. There also will be collaboration with the World Health Organization to help improve surveillance of nutrition and physical activity actions and health status in the E.U.

"(The White Paper is) still placing the responsibility mainly on the consumer," said Simone Baroke, an analyst with Euromonitor International. "It’s still very much pitched at individual responsibility rather than laying the responsibility of the obesity epidemic at the door of the industry."

While steps have been taken in Europe to encourage healthier lifestyles, some evidence suggests more may be done in Europe and throughout the world. Food companies, for their part, have been working to play a role in addressing the issue.

According to a 2006 report released by City University in London, 11 of 25 of the world’s largest food companies surveyed have made commitments to promote physical activity. Additionally, the same number of companies reported policy statements on obesity, children’s food, and providing a "healthier" range of products.

At the same time, 10 out of 25 companies reported they were taking action on salt levels in foods, five were working on sugar levels, four were working on fat and eight were working on trans fat.

Two companies, Kraft Foods Inc., Northfield, Ill., and McDonald’s Corp., Oakbrook, Ill., reported taking action to reduce portion sizes. Kraft came in the best compared with all 25 companies as it reported taking action in all five areas.

Overall, the City University report stated that since 2004, the W.H.O.’s global strategy on diet, physical activity and health has placed new demands on food companies to be active in improving public health. Yet the report also concluded the world’s food companies have not yet taken action with the urgency and seriousness the situation requires, and companies should not just implement the minimally required initiatives. The report suggested company actions should move from being focused merely on improving reputations to being proactive.

On the other side of the Atlantic

Alison Kretser, senior director of nutrition and health policy for the Grocery Manufacturers Association (G.M.A.), Washington, said the efforts represented in the White Paper are remarkably similar to recommendations the Institute of Medicine set out on preventing childhood obesity in the U.S.

"All of the pieces in the White Paper looked at multi-disciplinary collaboration in order to reverse the trend," Ms. Kretser said. "That is what the effort is going to take."

The institute’s recommendations included federal, state and local governments establishing a task force to identify priorities for action, monitoring progress, conducting research and working to disseminate effective practices. Other efforts suggested working to increase access to and affordability of fruits and vegetables for low-income families, increasing the number of new industry products and advertising messages promoting energy balance at a healthy weight and increasing availability and affordability of healthful foods and beverages. The institute also recommended collaboration between the industry, the private and public sectors and the government.

According to an article published in The Journal of the American Medical Association, between 2003 and 2004, 17.1% of children and adolescents in the United States were overweight and 32.2% of adults were obese.

"The call on the industry, the task of the industry, is to reformulate and introduce healthier products, and the industry has overwhelmingly responded to that task," Ms. Kretser said.

Over 10,000 products have been reformulated to provide a better nutritional profile, Ms. Kretser said. She said this could include reformulations that include lowering calories and sugar, removing trans fat, saturated fat, or adding whole grains.

Yet even with emphasis on reformulation and portion control, at least one-fifth of shoppers who are actually overweight based on their Body Mass Index (B.M.I.) do not consider themselves to be overweight, according to a study by HealthFocus International. In fact, two out of every five shoppers strongly agree or agree that it is possible to be overweight and still be healthy. Shoppers most concerned about being overweight tend to be women, those coming from households with lower incomes, those who have less than a college education or those who have children.

According to the G.M.A.’s 2005 company health and wellness survey of 43 companies, 83% of the companies have enhanced label information and 98% have reformulated and introduced new products or were planning to do so.

In terms of advertising, while children in the United States are not seeing more advertisements for food on television than in the past, children’s ad exposure is more concentrated on children’s programming, according to the Federal Trade Commission.

The food industry has begun efforts to self-regulate advertising initiatives as The Kellogg Co., Battle Creek, Mich., recently announced it will no longer promote foods to children under 12 in media outlets unless a single serving of a food meets the following criteria:

• no more than 200 calories

• no trans fat and no more than 2 grams of saturated fat

• no more than 230 mg of sodium with the exception of Eggo frozen waffles

• no more than 12 grams of sugar not counting sugar from fruit, dairy and vegetables.

In addition, Kellogg said it will stop advertising to children under 6, not use branded toys connected to foods that do not meet the nutrition standards or use licensed characters on mass-media advertisements directed primarily to children under 12 or on the front labels of food packages unless they meet the standards.

Kraft Foods agreed to stop advertising products to children that do not meet specific nutrition guidelines in 2005, and the Walt Disney Co. developed a policy in 2006 saying it would allow its name and characters only on child-focused products meeting specific guidelines, which include limits on calories, fat, saturated fat and sugar.

Sharing efforts

Some efforts already have been taken to share successes or possible failures in reducing obesity rates between the United States and E.U.

A transatlantic conference on obesity was held in 2006, co-chaired by the European Commission and the U.S. Department of Health and Human Services, to identify good practices through discussion and exchange of information. From this effort, participants considered actions such as the development of a transatlantic database on diet, physical activity and good health practices as well as an organization of regular transatlantic thematic workshops. Other ideas included the further development of a web-library and monitoring expertise of U.S. experts and stakeholders to feed into evaluation aspects of the E.U. Platform.

In the future, Ms. Kretser anticipates possible changes to the Nutrition Facts Panel so consumers link serving size to the calories in the product in the U.S. In the E.U., Ms. Baroke said she believes more countries will implement advertising regulations on food products. Ms. Baroke said the E.U. will follow the U.S. with more efforts to regulate trans fat.


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