The European Commission has been talking about Europe’s “obesity epidemic” since the 2000s. Talk at the World Health Organization of a worldwide epidemic has been going on for even longer. But as any epidemiologist will tell you, every epidemic eventually peaks.
To take two other modern scourges as examples, the worldwide HIV/AIDS epidemic peaked at the end of the 20th century and Europe’s tobacco smoking epidemic peaked 30 or 40 years earlier than that. Whether or not the EU achieves its goal of halting the rise in childhood obesity by 2020, the rise will end at some point.
What will EU health policy-makers do then?
The European Union’s response to obesity has focused very much on prevention among children and young people (i.e. under 18 year olds). The stated rationale for this is that if you prevent people becoming obese when they are young, then they are likely to remain at a healthy weight when they are adults. Another reason, though, is that it is politically more acceptable to produce measures to “protect” young people from unhealthy food – or encourage them to take more exercise – than intervening in the lives of adults. Europeans still tend to believe that adults should be responsible for their own decisions about what they eat and how much exercise they take.
For the past decade or more there has been no shortage of studies, of varying quality and credibility, looking at the expanding waistline of Europe’s children. These have usually been accompanied by dire predictions for the future. The media and the public have generally gone along with this, happy to blame modern parents and their feckless offspring for Europe’s weight problem. The truth, though, is that in the early 2000s most European countries did not collect data on the size and weight of their children and young people. Where data was collected, it was sometimes in a haphazard way. This meant estimates of prevalence and trends in childhood obesity were based on extrapolations from limited datasets. Or to put it more bluntly, the estimates contained a good dollop of guesswork.
Earlier this year a consortium of public health experts produced a draft report for the European Commission on Implementation of the EU Action Plan on Childhood Obesity 2014-2020. This was presented to an informal meeting of EU health ministers hosted by the Maltese EU Presidency in February. Most of the report is devoted to analysing Member States’ policies on preventing childhood obesity and how they fit with the EU Action Plan. But the key finding in the section looking at prevalence of obesity is “firm conclusions about trends cannot be drawn from these data”. Some of the initial data analysed suggests obesity rates may have plateaued, or even declined, among primary school children. Other data suggests adolescents in many countries might be becoming more overweight. There are methodological and statistical issues around both sets of data, so we need further rounds of data collection and more analysis.
It could take many more years, and many more studies, until health authorities in Europe are willing to say, “we have started winning the battle against childhood obesity”. It has been a useful way to gain attention and mobilize action, so it would be a mistake to declare victory too soon. But at some point Europe’s health ministers will need to turn their attention to adults who are overweight or have obesity. And they will also need to move on the policy debate from prevention to treatment.
One important lessons from the smoking and HIV/AIDS epidemics is that treatment reinforces prevention. Offering support and treatment (e.g. nicotine patches) via health systems increased the number of smokers who quit the habit. Reducing the number of adults who smoke made the habit less “normal” and so fewer young people started smoking in the first place. Meanwhile, treating HIV positive people not only prolonged their lives: it also made them much less likely to pass on HIV to their sexual partners.
In a similar way, aiming prevention campaigns at adults can reinforce prevention efforts among children and young people. Young people often aspire to act like the peer groups above them. Teenagers will often be receptive to messages aimed at people in their 20s. Indeed, there is a theory (with some evidence to support it) that aiming prevention messages just at children can be counterproductive. For example, smoking prevention campaigns aimed only at children and young people were often seen as “hypocritical” by their target audience when large number of adults smoked. Conversely, the more adults adopt healthy behaviours the more children are inclined to follow them.
Targeting obesity prevention measures at adults, and helping people who already have obesity to lose weight would strengthen the fight against childhood obesity. Just as importantly, health systems should support people in staying at a healthy weight throughout their lives, and not just in their early years.