Despite health not being a direct EU competence, progress can be made on childhood obesity if collaborative and cross-sector actions based on evidence-based political choices are explored and sustained.
Obesity and overweight are among the most common non-communicable diseases (NCDs), a group of health conditions which are a leading cause of death worldwide. At present, it is estimated that around seven per cent of national health budgets across the EU are spent on diseases linked to obesity each year.
A recent survey undertaken by the EU-funded ToyBox project shows levels of obesity among pre-school children ranging from less than 10 per cent of children in Germany to nearly 20 per cent in Greece.
Primarily caused by poor diets and excess sedentary behaviour, the root causes of obesity - including childhood obesity - embrace a complex set of interrelating factors ranging from the relative price and availability of healthy and unhealthy foods, advertising and marketing to children, the attraction of screen based entertainment and the lack of safe play spaces.
"A recent survey undertaken by the EU-funded ToyBox project shows levels of obesity among pre-school children ranging from less than 10 per cent of children in Germany to nearly 20 per cent in Greece"
Policy responses to the rise in obesity in Europe have been developed in the last 10 years, with the 2006 European charter on counteracting obesity, a European commission 2006 white paper, a number of national strategy statements, and the most recent European action plan on child obesity 2014-2020. At global level, the WHO has proposed a target of 'no increase on 2010 levels of overweight in children by the year 2025', endorsed by member states at the world health assembly in 2012.
Currently, it is well-accepted that there is an urgent need for EU-wide policy actions for childhood obesity prevention. Not only because our children are gaining weight faster than ever before, or because of vast body of evidence pointing out to obesity's co-morbidity with other chronic conditions which our health services might not be able to cope with, but also because of the current economic crisis taking a heavy toll on families and children's ability to eat healthy and live healthy lives.
Therefore, the implementation of strategies for tackling the challenge of obesity in childhood requires evidence of effective interventions and evaluation of their relative cost-effectiveness. That was the main objective of the ToyBox project.
The study aimed to design and pilot the development of a supportive social and physical environment at kindergartens and at home to facilitate behaviour patterns thought to help protect young children from obesity, at low cost and with the potential to be applied across similar settings in Europe.
To conclude the study, the World obesity federation (formerly the International association for the study of obesity) published its report 'Obesity prevention in children in pre-school years: Policies and evidence'. The document outlines the early findings and related research into prevention of obesity in the child population, and provides an overview of different approaches to promoting and protecting young children's health in Europe, including the evidence available for its effectiveness in preventing weight gain. The list includes evidence of cost-effectiveness, impact on health inequalities as well as examples of implemented policies within the European region.
"Children in lower income families are more likely to be overweight or obese even at such an early life stage"
The results are quite compelling: children in lower income families are more likely to be overweight or obese even at such an early life stage. Therefore, the project focused on policies (notably, under a leadership of government at local, national, European level) that promote healthy early years development, including maternal health, breastfeeding protection and the promotion of healthy complementary feeding, such as fruit and vegetables.
Across the countries examined, interventions were feasible, well-received, achieving significant improvements in dietary and physical activity behaviour, and did not increase the risk of health inequalities among various population groups in Europe. A preliminary economic analysis indicates that those interventions cost of between €5 and €29 per child annually, and were therefore not only cost-effective and dominant - that is, the costs are significantly less than the value of the health gained.
The report also highlights the research priorities for supporting policy interventions. It highlights the need for increased data collection on health inequalities, reporting of the effectiveness of interventions among children of different socio-economic status or even ethnic groups.
A range of non-school or kindergarten settings need to be urgently included in any coherent initiatives package, ranging from family/integrated healthcare; urban planning; retailers' activities promoting products at checkouts; the urban environment for fast-service restaurants and play spaces; and the effects of parent-oriented and child-oriented marketing messages on TV, and in print and digital media.
Last but not least, the report notes how the transfer from evidence base to policy is inconsistent. Despite a strong evidence base, policy implementation may be frustrated by a lack of adequate resources, a lack of institutional capacity, or influences on policy, including national economic priorities, lobbying and political influence.
Greater attention needs to be paid to the costs of failing to act, and to the conflicting interests of stakeholders (along the food supply chain) and the development of appropriate means to resolve these.
Given the importance of children's health across the region, and value of coordinated responses by member states - especially in marketing regulations - we urge the newly elected constituency to establish a special task force for children's health, to ensure a high level of collaboration of inter-departmental policies, and the development of an EU-wide strategy for children's health and well-being.
The report Obesity prevention in children in pre-school years: Policies and evidence is available here.
Further details of the ToyBox project are available at www.toybox-study.eu