The danger of childhood obesity: how can we bring it down?

One in three school-aged children in the WHO European Region are living with overweight or obesity, and countries are working hard to break and reverse this trend. In this episode, Julianne Williams, WHO technical officer for Noncommunicable Diseases at the WHO European Office for the Prevention and Control of NCDs, and Mirjam Heinen, WHO consultant working for the same Office, talked to us about best evidence-based practices that can help.

LINKS

Childhood obesity in European Region remains high: new WHO report presents latest country data: https://www.who.int/europe/news/item/08-11-2022-childhood-obesity-in-european-region-remains-high--new-who-report-presents-latest-country-data

Report on the fifth round of data collection, 2018–2020: WHO European Childhood Obesity Surveillance Initiative (‎COSI)‎: Report on the fifth round of data collection, 2018–2020: WHO European Childhood Obesity Surveillance Initiative (‎COSI)‎

WHO European Obesity Report 2022: https://www.who.int/europe/publications/i/item/9789289057738

CREDITS
Hosted by: Aleksandra Olson and Igor Kryuchkov
Edited by: Igor Kryuchkov and David Barrett
Sound design by: David Barrett
Music: Science Marimba by Gavin Linnihan, Cool Cats Marimba by Howard Parker
Theme Music by: Ben King

Transcript

00:00:00:09 - 00:00:05:11
Aleksandra Olsen
Hi. You're listening to Health in Europe, a public health podcast from W.H.O., Europe.

00:00:13:02 - 00:00:21:06
Aleksandra Olsen
This episode is about childhood obesity and ways to tackle this health threat. Your hosts are Alexandra Olson and Igor Kryuchkov.

00:00:38:10 - 00:01:03:15
Aleksandra Olsen
One in three school aged children in the W.H.O. European region are living with overweight or obesity. And countries are working hard to break and reverse this trend. The danger of obesity is that it is linked to many non-communicable diseases or NCDs, from cardiovascular diseases to diabetes and cancer. The earlier a person gets obesity, the higher the risk of these chronic diseases.

00:01:03:15 - 00:01:04:12
Aleksandra Olsen
Later in life.

00:01:04:17 - 00:01:28:23
Igor Kryuchkov.
But how can we stop the so called obesity and childhood obesity epidemics? Should we all just change our diets and tell our children to do the same or are there more effective ways to solve the problem? Julianne Williams, W.H.O. technical officer at the W.H.O. European Office for the Prevention and Control of NCDs and Mirjam Heinan, W.H.O., consultant working for the same office, talked to us about the latest statistics and best evidence based practices that can help.

00:01:28:23 - 00:01:35:06
Aleksandra Olsen
And spoiler alert, telling people to eat healthier food is not the best way to reduce obesity at a country level.

00:01:35:08 - 00:02:03:22
Julianne Williams
We have data since the 1980s and what we see is in every country at the population level, so including including adults, is this rise in obesity. There's variation between countries and in the European region. We have really, really good data on schoolchildren ages around the age of seven, primary school age children. And we have really good data at the country level.

00:02:04:03 - 00:02:30:15
Julianne Williams
And so there what we see is that generally in the so-called southern European countries around the Mediterranean, we have higher levels of overweight and obesity. And in the Central Asian countries, we have much lower levels. And then we also see variation between boys and girls with slightly higher levels among boys for both for both obesity and overweight.

00:02:30:24 - 00:02:37:05
Mirjam Heinan
Basically, no country in our region is is halting the rise in obesity.

00:02:37:05 - 00:02:40:09
Aleksandra Olsen
But has it slowed down? What are the trends showing us?

00:02:40:10 - 00:03:03:17
Julianne Williams
So the voluntary target that we have in W.H.O. for obesity and overweight is to halt the rise. Just halt the rise. We're not even saying reduce it. We're just saying stop the growth. And not a single country in W.H.O., Euro or globally is on track to just have it plateau.

00:03:04:02 - 00:03:10:05
Igor Kryuchkov.
I do have an explanation why this trend is happening, why we can't bring the numbers down for now.

00:03:11:06 - 00:03:16:17
Mirjam Heinan
Because it's really challenging. There are so many factors related to obesity.

00:03:16:24 - 00:03:18:00
Aleksandra Olsen
What are these factors?

00:03:18:03 - 00:03:47:22
Mirjam Heinan
Of course, physical activity, healthy eating behaviors, but also things such as mental health is very important. And also the environment we just live in. It's not really helping us to live a healthy life, and we only realize that now. And also, there are some genetic components as well. It's not like we can fight against it with regard to genetics, but there is some genetic components to weigh.

00:03:47:23 - 00:04:04:17
Mirjam Heinan
You know, like we used to live in the hunter gatherers area where survival was really tough and then having these types of genes that would help you to survive is really helpful. But in the environment that we're living in right now, it's not it's working against us.

00:04:04:22 - 00:04:31:17
Julianne Williams
Yeah, I think I think the more we can focus on the environment and the way our environment has changed, the way that it is really, really easy to eat many, many delicious calories very inexpensively. It's really, really easy to go through the day without moving very much. The more we focus on that environmental component, I think the more we get to the heart of the problem.

00:04:39:17 - 00:04:44:14
Aleksandra Olsen
People do need help and support in order to to tackle.

00:04:44:14 - 00:04:45:03
Mirjam Heinan


00:04:45:03 - 00:04:50:11
Aleksandra Olsen
the Obesity epidemic. It can't just be if we all individually decide to be more healthy. Right?

00:04:51:08 - 00:05:18:03
Mirjam Heinan
It's really challenging because the environment is basically inviting us to break this, to really behave in an unhealthy way. So we do need help with that. So from governments. Also, civil society can help us, you know, raising this issue. So basically everyone needs to step up and do something, but not just only the individual needs because we just need some help.

00:05:18:03 - 00:05:18:24
Mirjam Heinan
There. Yeah.

00:05:19:03 - 00:05:44:12
Julianne Williams
And one thing we see is that when you have an information campaign, which is often a pretty popular public health option, because it's cheap to give people information, is that there's not an equitable kind of uptake of of of those of that information. So you'll usually have, for example, if you have a campaign to eat lots of fruits and vegetables and to get your physical activity, you'll see people with higher levels of education.

00:05:44:13 - 00:06:15:05
Julianne Williams
People in higher socioeconomic groups are really receptive to that. But the people that we might be trying to target with lower levels of education or in lower groups where obesity levels are higher, are less able to respond to that sort of intervention. So the more we can just focus on environmental changes, things like giving schoolchildren healthy meals, subsidizing fruits and vegetables, sugary drinks, taxes, having parks and places to be active inexpensively.

00:06:15:11 - 00:06:40:19
Julianne Williams
The more we can do that, the more we can also tackle these inequalities that we see between different groups and the more we can fulfill the mission of serving the vulnerable and ensuring that we're leaving nobody behind. So the more we move away from just information for individuals to change their behavior to systemic changes to the environment, the better I think it is for everyone.

00:06:41:19 - 00:07:09:16
Mirjam Heinan
And also to make it easier for everyone in society to make this. You know, that the healthy choice is the easier choice, and especially for these groups from lower socioeconomic status studies. Very important because people from higher economic status, they have most of times money, They have the resources to really change their health, their habits. But people from lower economic status, they just need some help there.

00:07:09:23 - 00:07:25:09
Mirjam Heinan
And I think that is indeed really important through schools, healthy, you know, nutritious meals. Indeed, you know, like cheaper vegetables and fruits, If if a child, you know, doesn't really like fruits and vegetables, you're not going to spend money on that because you know it's going to be thrown out.

00:07:39:09 - 00:07:49:24
Igor Kryuchkov.
The COVID 19 pandemic that remains a challenge for health all over the world has made the situation with obesity and overweight even worse. Julianne says that the negative effect is seen at multiple levels.

00:07:50:07 - 00:08:16:09
Julianne Williams
But what we found with COVID is that there were problems for for the for the problem of obesity and overweight on a few different levels. So one of those is that, for example, for children, if schools if school attendance was interrupted, they didn't get those health conferring benefits of schools. So the physical education classes, the school meals you might get the active travel to and from school, that all kind of stopped.

00:08:16:20 - 00:08:47:16
Julianne Williams
And many children were put in front of a screen and doing remote learning. So so physical activity may have deteriorated, dietary quality may have deteriorated, deteriorated, did especially with lower income, lower socioeconomic groups. The other issue that we saw is that those who may be living with overweight and obesity no longer had access to care for that. For that, you know, those that weight management service, whether it's senior dietician or physiotherapist.

00:08:48:24 - 00:09:15:00
Julianne Williams
So that became interrupted. No more care. And the third kind of issue that came up with the COVID was just that those who did contract COVID, who were living with overweight and obesity had much more serious outcomes from COVID. So so they were likelier to be admitted to the intensive care unit, and they were likelier to have mortality from from from COVID 19.

00:09:15:18 - 00:09:38:17
Julianne Williams
So it really paradoxically, this infectious disease taught us really sobering lessons and that in some ways, if if we had managed to get the levels of overweight and obesity in countries lower earlier on than maybe the the deaths that we saw from COVID 19 might not have been as high.

00:09:39:00 - 00:09:56:09
Igor Kryuchkov.
For Mirjam, the data we have now on childhood obesity looks worrying. But at the same time, this data can help us find the correct ways to tackle harm inflicted by COVID 19 and overcome a position of the industry that produces and aggressively advertises foods high in trans fats and sugars.

00:09:57:06 - 00:10:38:09
Mirjam Heinan
We're currently collecting data in our own Childhood Obesity Surveillance initiative, and it's really on behavior. So have behaviors changed in children eating behaviors, physical activity? And also some of this is also connected then to weight and height. So to BMI. So hopefully we can see what is happening and also compare it to before COVID, the data. But we also already saw from example from the United Kingdom, from UK there as somebody already been some BMI measurements done in children and there we saw an increase during COVID, quite a sharp increase.

00:10:38:09 - 00:10:39:15
Mirjam Heinan
So it was a bit worrying.

00:10:39:21 - 00:10:44:16
Aleksandra Olsen
Which is that all the countries of the region that participate in this surveillance survey.

00:10:45:02 - 00:11:09:03
Mirjam Heinan
In Childhood Obesity Surveillance Initiative - or COSI - that's how we call it. We have 45 countries that are now part of this network, and we did invite them all to participate in this data collection that includes data on on COVID. But not all countries are able to collect this year, but definitely 30 countries, I think, and maybe even more.

00:11:09:09 - 00:11:16:19
Igor Kryuchkov.
Do we have kind of an understanding what should be done to to get out of this trend?

00:11:17:00 - 00:11:46:01
Mirjam Heinan
It needs to be comprehensive, at least for governments. We suggest three policies that they should start with, which is restricting marketing in children the the SSB tax. So the sugar sweetened beverage tax, if they don't have it in a country and focusing on childhood obesity or like obesity management in general. But there are many other policies that really need to be put in place if they really want to tackle this.

00:11:46:08 - 00:11:56:13
Aleksandra Olsen
Do you have any any good practices or any success stories from countries where some of these policies have been implemented or some other policies have shown an effect?

00:11:57:00 - 00:12:23:09
Julianne Williams
Some really, really good examples, for example, around marketing have been seen. We've seen successful sugary drinks, taxes and what nearly a dozen countries in the region now. But fierce, fierce pushback from industry on those. And we haven't seen yet a strategy where all of the policies have come together to successfully lead to a halt in the rise in obesity.

00:12:24:02 - 00:12:52:21
Julianne Williams
One thing that wasn't mentioned earlier that also is really important and often overlooked with obesity and overweight is actually breastfeeding. So W.H.O. recommends that babies are exclusively breastfed, receiving nothing but breast milk for the first six months of life and then breastfed for up to two years and beyond. Alongside appropriate complementary feeding. And we know that this has loads of benefits for the mothers protection against ovarian and breast cancer, but also for children.

00:12:53:05 - 00:13:28:08
Julianne Williams
It protects against obesity and overweight later in life. And I think this is this is an area that often gets overlooked. And also the fact that the W.H.O., European region of the six regions, it has the lowest levels of exclusive breastfeeding at six months. So that's one area where individuals can make choices. But also governments have really important responsibilities for ensuring and protecting that opportunity for a woman to breastfeed her baby, whether it's maternity leave, giving space in the workplace to breastfeed.

00:13:28:17 - 00:13:36:17
Aleksandra Olsen
Julianne also told us about breastmilk substitutes and how that industry can interfere with breastfeeding practices if it isn't regulated properly.

00:13:36:21 - 00:14:05:22
Julianne Williams
So the WHO has something called the International Code of Marketing of Breastmilk substitutes. It's a voluntary sort of set of recommendations that countries can can adopt. But one of those includes some of these messages to what the code, as it's shortened to be called, does, is it tries to ensure that parents and the population gets impartial information free from from commercial interests on the benefits of breastfeeding.

00:14:06:09 - 00:14:27:24
Julianne Williams
So so for example, one problem that we see a lot in the WHO European region is that foods are advertised as as appropriate for from five months of age, from four months of age, and that's actually a violation of the code, we think governments have probably the most important role in this in this problem of obesity and overweight, but also what can individuals do?

00:14:28:10 - 00:14:52:08
Julianne Williams
And since we're talking about children and and some of us have families, I think we can also think about just the environments that we're creating. So also so the school environment is often regulated, but in our home environments, accessible fruits, accessible vegetables, opportunities for physical activity, I think a limitation sometimes on the screen time sleep is really important.

00:14:52:21 - 00:15:28:20
Mirjam Heinan
And very importantly, parents are very important role models. So they have to do the same thing as well, ideally to help the children to adapt, because if they see the parents do eat fruits and vegetables, they are automatically more inclined to do so themselves. So that's really, really important. We see that in many fruits and vegetables, projects and programs that are really effective if they have good role models at home, if and also teachers at schools, they're really more inclined to do so themselves.

00:15:28:20 - 00:15:37:11
Mirjam Heinan
And if they develop that habit, then at an early age, again, it will trek into adulthood and they will keep continuing doing that. So it's very important to.

00:15:45:01 - 00:16:05:04
Aleksandra Olsen
To inspire countries and decision makers of the future European region and consolidate much needed political efforts in fighting childhood obesity. A summit of spouses of the European leaders was organized to take place in Zagreb this May. The participants are creating a high level network that can change people's lives in the region for the better.

00:16:05:13 - 00:16:37:12
Julianne Williams
The aim of this summit, which is now in May in Croatia, is to raise the profile of child obesity and really to to to advocate for for some of these political actions that can be taken and and to just ensure that children in the European region are given given the best possible start in life. So so really trying to use this influential platform in order to to to get more attention.

00:16:37:12 - 00:16:41:10
Julianne Williams
I think for many of the existing ongoing W.H.O. recommendations.

00:16:41:19 - 00:17:03:21
Igor Kryuchkov.
W.H.O. published this European obesity report in 2022. It showed that 60% of adults and one in three children in the European region are living with overweight and obesity. The summit that Julianne mentioned is a great opportunity to follow up from the report and create a high level network that can change people's lives for the better and to give our children a healthier future.

00:17:15:22 - 00:17:23:14
Aleksandra Olsen
Thanks a lot to Julianne Williams and Mirjam Heinan for contributing to this episode. Thank you for listening to the Health in Europe podcast.

00:17:23:21 - 00:17:30:18
Igor Kryuchkov.
You can find other episodes of the podcast on your favorite streaming platforms. Stay tuned for more episodes and stay healthy.

00:17:30:19 - 00:17:45:13
Aleksandra Olsen
This episode was developed as part of a podcast series on non-communicable diseases, and kids are largely preventable and are responsible for 90% of early deaths in the W.H.O. European region. Follow Health in Europe for more.