Non-communicable diseases - Healthy diet, physical activity and obesity trends in the Nordic countries: Status and challenges

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1 Non-communicable diseases - Healthy diet, physical activity and obesity trends in the Nordic countries: Status and challenges Prof. Knut-Inge Klepp Director General, Public Health, The Norwegian Directorate of Health

2 Burden of disease attributable to 15 leading risk factors in 2010 expressed as % of DALYs Denmark Finland The Global Burden of Disease Project

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5 Nordic Nutrition Recommendations 2012 Systematic, independent reviews of the scientific literature Recommendations regarding: Diet composition Nutrient intake Physical activity levels Reduced sedentary behavior

6 Physical activity

7 Prosent Proportion (%) reporting at least 1 hour of moderate-to vigorous physical activity per day (HBSC) Gutter Finland Norge Island Sverige Danmark Gj.snitt HBSC Land og alder Boys: age 11 and 13 years; HBSC 2009/2010 (WHO 2012)

8 Moderate-to-vigorous PA (min/day) Objectively registered moderate-to-vigorous physical activity (minutes per day) Denmark and Norway (The European Youth Heart Study) Gutter Jenter Gutter Jenter Gutter Jenter Gutter Jenter 9 år 9 år 15 år 15 år Danmark Norge Danmark Norge Average minutes per day of measured moderate-to-vigorous physical activity; the European Youth Heart Study (Riddoch CJ 2004, EYHS)

9 Self-reported physical activity: % meeting the recommendation (>7 h MVPA/wk), being somewhat active ( min MVPA/wk), or inactive (< 15 min MVPA/wk): 7-12 year olds Country N Active Somewhat active Inactive Finland Iceland Denmark Norway Sweden MVPA=Moderate-to-vigorous PA (Nordiske ministerråd, Rasmussen LB et al 2012)

10 Self-reported physical activity: % meeting the recommendation (>210 min MVPA/wk), being somewhat active ( min MVPA/wk), or inactive (< 15 min MVPA/wk): Adults year olds Country N Active Somewhat active Inactive Finland Sweden Denmark Iceland Norway MVPA=Moderate-to-vigorous PA (Nordiske ministerråd, Rasmussen LB et al 2012)

11 Prosent Sedentary behaviour watching TV at least 2 hours/day (HBSC) Gutter Danmark Finland Sverige Island Norge Gj.snitt HBSC 39 Boys: 11 and 13 years old; HBSC 2009/2010 (WHO 2012)

12 Reported daily transport by foot (by age group): Denmark & Norway Denmark (2011); Norway (2009) (Danmarks Tekniske Universitet 2012 og Transportøkonomisk institutt 2009)

13 Proportion of bike cyclists in Scandinavia (Syklistenes landsforening 2010,

14 Nutrition & healthy eating

15 Consumption of fresh fruit and vegetables kg/person/year (whole sale data) Denmark Finland Iceland Norway Sweden Nordic Statistical Yearbook

16 Proportion who reported to eat fruit, berries and vegetables 5 times a day Proportion (%) Denmark 15.0 Finland 8.5 Iceland 8.3 Norway 21.9 Sweden

17 Salt intake (grams) per person per day for adults

18 Average dietary index (range 0-12) in the Nordic Countries The index is constructed based on reported frequency of intake of fruit & vegetables, bread, fish & seafood, candy & cakes etc., fat on bread, cheese and sausages

19 Dietary index: proportion classified as having a poor diet (0-4); medium nutritional quality (5-8); or having a healthy diet (9-12) by country

20 Norway: the proportion of the adult population meeting the recommended dietary recommendations: Norkost : Men Women Vegetables 13 % 15 % Fruit and berries 34 % 41 % Whole grain 27 % 25 % Fish 39 % 31 % Fatty fish 24 % 21 % Red meat 45 % 67 %

21 Overweight and obesity

22 The WHO European Childhood Obesity Surveillance Initiative ( )

23 The WHO European Childhood Obesity Surveillance Initiative, Norway : % overweight and obese Both gender Boys Girls Girls Boys National Institute of Public Health, 2013

24 Health Behaviour in School-aged Children (HBSC) Study: Self-reported overweight & obesity Boys Girls

25 BMI: Proportion (%) reporting to be overweight or obese BMI BMI 30 Denmark 32.8 % 12.0 % Finland Iceland Norway Sweden

26 Obesity (% of pop) related to length of education Length of education

27 Prevalence of obesity among Norwegian women & immigrant groups HUBRO (age adjusted) (BMI 30 kg/m2) Kumar et al, 2009

28 WHO Marketing of foods to children

29 The Norwegian School Fruit Program ISBNPA Symposium, ECO2011, Istanbul 29

30 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)

31 Sales (NOK) of Keyhole products in grocery stores (Nielsen)

32 Active transportation, physical activity at school & available play and recreational areas within neighborhoods

33 Conclusions & future challenges We lack comparable, valid (trend) data related to the WHO NCD indicators from the Nordic countries Existing data indicate some positive trends related to diet There is no robust indication of a leveling off with respect to overweight and obesity rates in the Nordic countries A number of policy measures have proven to be promising with respect to promoting healthy diet and increased physical activity levels There seems to be an under-utilized potential for Nordic cross-country evaluation studies of public health measures

34 Thank you for your attention!