Public health actions needed to stop the obesity epidemic

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1 Public health actions needed to stop the obesity epidemic Knut-Inge Klepp Director General, Public Health, The Norwegian Directorate of Health 10 Year Anniversary Symposium for the Morbid Obesity Center, Larvik, November 14, 2014

2 What can we learn from other Public Health policy areas?

3 Cigarette smokers proportion young men and women (16 24 year olds) smoking daily

4 ISBNPA Symposium, ECO2011, Istanbul 4

5 A fine balance. A small energy imbalance per day (equivalent to the energy content of less then half an apple or a bite (1/10) of a hot dog ) will cause a 1 kilo increase in body weight/year A 1 kilo body weight per year is 10 kilos over 10 years and 20 kilos over 20 years. 5

6

7 The causal chain Social determinants: Income Education Work Lifestyle & environment Health care

8 The Public Health Act Data collection Data analyses Building competency & capacity Evaluation 30 og 5 Overview 5 Implementation 4 and 7 Strategic planning 6 Folkehelsekommuner.no (Public health municipalities) Policy & Action plans 6 8 Tone P. Torgersen folkehelsekonferansen 4. okt

9 The WHO European Childhood Obesity Surveillance Initiative: Norway Both gender Boys Girls National Institute of Public Health, 2013

10 Proportion (%) of overweight boys- Survey- The results ENERGY study Brug et al. PLOS One 2012

11 Systematic reviews related to nutrition and overweight among school children Peters et al.: Effective elements of school health promotion across behavioral domains: a systematic review of reviews. BMC Pub Health, 2009 Brown & Summerbell: Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity. Obes Rev, 2009 Gonzalez-Suarez et al.: School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med, 2009 van Cauwenberghe et al.: Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and 'grey' literature. Br J Nutr, 2010 De Bourdeaudhuij et al.: School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obes Rev, 2011 van Stralen: What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms. Int J Obes, 2011

12 Systematic reviews - overweight among school children: Most recent Cochrane review Authors' conclusions: We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years Promising policies and strategies: school curriculum that includes healthy eating, physical activity and body image increased sessions for physical activity and the development of fundamental movement skills throughout the school week improvements in nutritional quality of the food supply in schools environments and cultural practices that support children eating healthier foods and being active throughout each day support for teachers and other staff to implement health promotion strategies and activities parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities Waters E et al: Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue 12.

13 Promoting Healthy Weight Development U N I V E R S I T Y O F O S L O FACULTY OF MEDICINE

14

15 WHO publications on food marketing to children

16 Matbransjens Faglige Utvalg (MFU): Klageordning Ivareta at alle kan klage inn markedsføringsaktiviteter som strider mot retningslinjer og veiledning til MFU Sørge for at klager er anonym i all videre klagebehandling Sørge for at klageordningen fungerer godt og at tiltak fattet i MFU offentliggjøres Food and Drink Industry Professional Practices Committee (MFU)

17 The Norwegian School Fruit Program ISBNPA Symposium, ECO2011, Istanbul 17

18 FV intake (portions/day) Free fruit 2,6 Free fruit 2,4 2,2 2 Control 1,8 1,6 1,4 Δ=0,63, p=0,02* Δ=0,52, p=0,03* sep.01 may 02 may 03 * Linear mixed models adjusted for baseline scores, gender and nesting of pupils within schools. Bere et al., Elling Bere

19 Cost-effectiveness of a free school fruit program Providing a free school fruit program to all students grade 1-10 would be cost-effective if it resulted in a lifelong increase in mean fruit and vegetable consumption of only 2.5 g/day (or 25 g/day among 10 % of the students) Norwegian Directorate of Health; Report IS-1281, 2005

20 Free school fruit: Does it help prevent future weight gain? % overweight students It appears that those receiving free school fruit during the school year were less likely to be overweight in 2009 However, low participation rate in 2009 and no baseline measures of height and weight are limitations of this study % Free fruit Control group Vik et al.,

21 Tax on non-alcoholic beverages with added sugar or artificial sweetener As of January 1, 2009 the added tax on non-alcoholic beverages with added sugar or artificial sweetener was increased to the same level as that of beer with low alcohol content (i.e. alcohol content between 0,7 and 2,7 volume percentage)

22 Sales (NOK) of Keyhole products in grocery stores (Nielsen) Nøkkelhullsomsetning utgjør ca 23 % av totalomsetningen for meieriprodukter, ferskmat, dypfryst og langtidsholdbar mat i

23 Yours30 (Dine30) - Every move counts! «Small steps - large difference» «Små grep stor forskjell»

24 Nordic Nutrition Recommendations 2012 Systematic, independent reviews of the scientific literature Recommendations regarding: diet composition nutrient intake Physical activity levels Reduced sedentary behavior

25 National guidelines for the prevention, detection and treatment of overweight and obesity

26 Healthy Life Centers

27 Future challenges Improved monitoring system Systematic implementation of the Public Health Act within municipalities stronger support for active transportation Committed collaboration with food industry and non-governmental organizations Improved implementation of the national guidelines for prevention, detection and treatment of overweight and obesity within the health care sector Building a stronger knowledge base through evaluation of ongoing and innovative efforts

28 Thank you for your attention!

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