EN    EN  COMMISSION OF THE E UROPEAN COMMUNITIES 
Brussels, 08.12.2005 
COM(2005) 637 final 
  
GREEN PAPER  
"Promoting healthy diets and physical ac tivity: a European dimension for the 
prevention of overweight, obesity and chronic diseases" 
 
EN 2   EN TABLE OF CONTENTS 
I. State of play at European Level ................................................................................... 3 
II. Health and Wealth........................................................................................................ 4 III. The Consultation Procedure......................................................................................... 4 IV. Structures and Tools at Community Level .................................................................. 5 
IV.1. European Platform for Action on Di et, Physical Activity and Health......................... 5 
IV.2. European Network on Nutri tion and Physical Activity ............................................... 6 
IV.3. Health across EU policies ............................................................................................ 6 IV.4. The Public Health Action Programme ......................................................................... 7 IV.5. European Food Safety Authority (EFSA).................................................................... 7 V. Areas for Action........................................................................................................... 7  
V.1. Consumer information, advertising and marketing...................................................... 7 V.2. Consumer education..................................................................................................... 8 V.3. A focus on children and young people......................................................................... 8 V.4. Food availability, physical  activity and hea lth education at the work place................ 9 
V.5. Building overweight and obesity preventi on and treatment into health services......... 9 
V.6. Addressing the obesogenic environment ................................................................... 10 V.7. Socio-economic inequalities ...................................................................................... 10 V.8. Fostering an integrated and comprehensiv e approach towards the promotion of healthy 
diets and physical activity .......................................................................................... 10 
V.9. Recommendations for nutrient intakes a nd for the development of food-based dietary 
guidelines ................................................................................................................... 11  
V.10. Cooperation beyond the European Union.................................................................. 11 V.11. Other issues ............................................................................................................. ... 12 
VI. Next steps................................................................................................................. .. 12 
Annex 1: Figures and Tables.................................................................................................... 13 
Annex 2: Relationship between diet , physical activity and health........................................... 17 
Annex 3: References ............................................................................................................ .... 20 
 
EN 3   EN GREEN PAPER 
“Promoting healthy diets and physical activity : a European dimension for the prevention 
of overweight, obesity and chronic diseases” 
I. S TATE OF PLAY AT EUROPEAN LEVEL  
I.1. Unhealthy diets and lack of phys ical activity are the leading causes of avoidable illness 
and premature death in Europe, and the rising  prevalence of obesity across Europe is a 
major public health concern (cf annex 2 for background information) . 
I.2. The Council has invited the Commission to contribute to promoting healthy 
lifestyles(i)1, and to study ways of promoting better nutrition within the European 
Union, if necessary by presenting appropriate proposals to that end2. The Council has 
also called upon Member States and the Commission to conceive and implement 
initiatives aimed at promoting he althy diets and physical activity3.  
I.3. The Community has a clear competence in th is area: Article 152 of  the Treaty requires 
that a high level of human health prot ection be ensured in the definition and 
implementation of all Community policies and activities. A num ber of areas of 
Community policy are relevant to nutriti on and physical activity, and the Council has 
confirmed the need to mainstream nutrition and physical activity in to relevant policies 
at the European level4. 
I.4. Action at national level may usefully be  complemented at th e Community level. 
Without limiting the scope for actions which Member States may wish to initiate, 
Community action may exploit synergies and economies of scale, facilitate Europe-
wide action, pool resources, disseminate be st practice and thereby contribute to the 
overall impact of Member State initiatives. 
I.5. The Council underlined that the multi-causal character of the obesity  epidemic calls for 
multi-stakeholder approaches5 - for which the European Platform for Action on Diet, 
Physical Activity and Health ( cf section IV.1 ) is a prominent example - and for action 
at local, regional, nati onal and European levels6. The Council also welcomed the 
Commission's intention to present this Green Paper and to present in 2006 the results of the public consultation exercise  initiated with the Green Paper
7. 
I.6. The European Economic and Social Comm ittee underlined that action at Community 
level can reinforce the effect of initiatives  taken by national authorities, the private 
sector and NGOs8. 
I.7. A number of Member States are alrea dy implementing national strategies or action 
plans in the field of diet, physical activity and health9. Community action may support 
and complement these activities, promote thei r coordination, and help to identify and 
disseminate good practice, so that other count ries can benefit from experience gained. 
                                                 
(i) References are grouped in Anne x 3 at the end of the document 
 
EN 4   EN II. H EALTH AND WEALTH  
II.1. Apart from the human suffering it causes, the economic consequences of the increasing 
incidence of obesity are of particular importa nce. It is estimated that in the European 
Union, obesity accounts for up to 7% of health care costs10, and this amount will 
further increase given the ri sing obesity trends. Although de tailed data are not available 
for all EU countries, studies underline the high economic cost of  obesity: A report 
prepared by the United Kingdom’s National Audit Office in 2001 estimated that 
obesity in England alone accounted for 18 million days of sickness absence and 30,000 premature deaths, corresponding to an annual di rect health care cost of at least GBP 
500 million. The wider costs to the econom y, which include lower productivity and 
lost output, were estimated at a further GBP 2 billion per year
11. The 2004 report from 
the United Kingdom’s Chief Medi cal Officer on the impact of physical activity and its 
relationship to health estimat ed the cost of physical inactivity at GBP 8.2 billion 
annually (including both the health care cost  and the wider cost to the economy, such 
as days lost from work)12. In Ireland, the direct cost of treating obesity was estimated at 
some €70 million in 200213. In the USA, the CDC estimated obesity-attributable health 
care costs at $75 billion14. At an individual level, studies estimate that the average 
obese adult in the United States incurs annual medical expenditures that are 37% 
higher than an average person of normal weight15. These direct costs do not take into 
account reduced productivity due to di sability and premature mortality. 
II.2. An analysis made by the Swedish Institute of Public Health conc ludes that in the EU, 
4.5% of disability-adjusted lif eyears (DALYs) are lost due  to poor nutrition, with an 
additional 3.7% and 1.4% due to obesity an d physical inactivity – a total of 9.6%, 
compared with 9% due to smoking16.  
II.3. A recent report by the Netherlands Institute for Public Health and the Environment, 
RIVM, examined unfavourable dietary co mposition and health loss. One of the 
conclusions is that an excessive intake of th e 'wrong' type of fats, such as saturated and 
trans fatty acids, increases the likelihood of  developing cardiovascul ar disease by 25%, 
while eating fish once or twice a week will reduce this risk by 25%. In the Netherlands, 
every year, 38,000 cases of cardiovascular disease among adults aged 20 and above 
can be attributed to an unfavourable composition of the diet17. 
II.4. Tackling overweight and obe sity therefore is not only important in public health terms, 
but will also reduce th e long-term costs to health serv ices and stabilise economies by 
enabling citizens to lead productive lives well into old age. This Green Paper will serve 
to determine if, by complementing Member States’ activities, action at Community level may contribute to reducing health ri sks, curbing health care spending, and 
improving the competitivity of Member States’ economies. 
III. T
HE CONSULTATION PROCEDURE  
III.1. As announced in the Comm unication “Healthier, safer, more confident citizens, a 
Health and Consumer Strategy”18, the Commission is preparin g a series of Community 
strategies to tackle the most important health determinants, including nutrition and 
obesity. In this context, the present Gr een paper aims at opening a broad-based 
consultation process and at launching an  in-depth discussion, involving the EU 
 
EN 5   EN institutions, Member States and the civil society, aiming at identifying the possible 
contribution at Community level of promo ting healthy diets a nd physical activity.  
III.2. The Commission calls on all interested or ganisations to submit responses to the issues 
raised in this Green Pape r, no later than 15 March 2006 , to the following address 
(preferably by e-mail): 
European Commission 
Directorate-General Health  and Consumer Protection 
Unit C4 – Health Determinants E-mail: SANCO-C4-NUTRITIONGR EENPAPER@cec.eu.int
 
Postal address: L-2920 Luxembourg Fax: (+ 352) 4301.34975 
These responses should not be scientific papers, but concrete and evidence-based 
proposals for policy building mainly at EU leve l. In particular, responses are expected 
from economic operators on issues within their specific area of interest (e. g. 
advertising and marketing, labelling…), patien t associations and health and consumer 
protection NGOs.  
III.3. Unless respondents make a declaration to the contrary, the Commission services will 
assume that they do not object to having thei r responses, or parts thereof, published on 
the Commission’s website and/or quoted in  reports analysing the outcome of the 
consultation process
19. 
III.4. Given the multifactorial nature of diseases linked to unhealthy dietary habits and 
physical inactivity, and the multi-stakeholder response needed to address them, this Green Paper includes certain issues that fa ll primarily under the competence of EU 
Member States (e. g. education, town planni ng); it should also c ontribute to determine 
where the EU could nevertheless provide added value, e.g. by supporting networking 
amongst stakeholders and disseminating good practice. 
IV. S
TRUCTURES AND TOOLS AT COMMUNITY LEVEL  
IV.1. European Platform for Action on Diet, Physical Activity and Health 
IV.1.1. In order to establish a common forum for action the Euro pean Platform for Action on 
Diet, Physical Activity and Health was la unched in March 2005. The Platform brings 
together all relevant players active at Euro pean level that are willing to enter into 
binding and verifiable commitments aimed at  halting and reversing current overweight 
and obesity trends. The objective of the Platfo rm is to catalyse voluntary action across 
the EU by business, civil society and the public sector. Members of the Platform 
include the key EU-level representatives of  the food, retail, catering, and advertising 
industries, consumer organisations and health NGOs. 
IV.1.2. The platform is to provide an exampl e of coordinated but autonomous action by 
different parts of society. It  is designed to stimulate ot her initiatives at national, 
regional or local level, and to cooperate with similar fora at  national level. At the same 
time, the Platform can create input for integrating the responses to the obesity challenge into a wide range of EU policies. The Commissi on regards the Platform as 
 
EN 6   EN the most promising means of non-legislativ e action, as it is unique ly placed to build 
trust between key stakeholders. First resu lts from the Platform are encouraging: 
involvement of other Community policies is  strong, Platform members are planning 
far-reaching commitments for 2006, and a join t meeting with US stakeholders will 
contribute to exchanging good practice. Mo reover, agreement has been secured by 
Sports Ministers to offer s upport to the Platform. A first evaluation of the outcomes of 
the Platform will take place mid-2006 20. 
IV.2. European Network on Nutr ition and Physical Activity 
IV.2.1. A network on Nutrition and Physical Acti vity composed of experts nominated by the 
Member States, the WHO and consumer and health NGOs has been established by the 
Commission services in 2003 to advise the Commission on the development of 
Community activities to improve  nutrition, to reduce and prev ent diet-related diseases, 
to promote physical activity and to fight overweight and obesity. The Network will be 
closely involved in analysing the fe edback to the present Green Paper. 
IV.3. Health across EU policies 
IV.3.1. Preventing overweight and obesity implies an  integrated approach to fostering health, 
an approach which combines the promotion of  healthy lifestyles with actions aimed at 
addressing social and economic inequalities and the physical environment, and with a 
commitment to pursue health objectives through other Community policies. Such an approach would need to cut across a number  of Community policies (e. g. agricultural, 
fishery, education, sport, consumer, enterp rise, research, social, internal market, 
environment and audio-visual policies), and to be actively supported by them.  
IV.3.2. At Commission level, a number of mechan isms are currently ope rating in order to 
ensure that health is taken into cons ideration in other Community policy areas: 
• on major policy proposals from other Commission services, the Health and 
Consumer Protection Directorate-Gene ral is systematically consulted; 
• the inter-service group on health discusses health-related issues between all 
concerned Commission services; 
• the Commission’s impact assessment procedure, which has been established as a 
tool to improve the quality and coherence of the policy development process and 
which includes the assessment of health impacts. 
Questions on which the Commission invites contributions include: 
– What are the concrete contributions which Community policies, if any, should 
make towards the promotion of healthy diets and physical activity, and towards 
creating environments which make healthy choices easy choices? 
– Which kind of Community or national measures could contribute towards 
improving the attractiveness, availability,  accessibility and affordability of fruits 
and vegetables? 
– On which areas related to nutrition, physical activity, the development of tools 
for the analysis of related disorders, and consumer behaviour is more research 
needed? 
 
EN 7   EN IV.4. The Public Health Action Programme 
IV.4.1. The importance of nutrition, physical activity and obesity is reflected in the Public 
Health Action Programme21 and its annual Work Plans. Under the health information 
strand, the Programme supports activities aimed at collecti ng more solid data on the 
epidemiology of obesity, and on behavioural issues22. The Programme is putting in 
place a comparable set of indicators for health  status, including in the area of dietary 
intake, physical activ ity and obesity.  
IV.4.2. Under the health determinants strand, the Programme is supporting pan-European 
projects aimed at promoting healthy nutriti on habits and physical activity, including 
cross cutting and integrative a pproaches which foster the in tegration of approaches on 
lifestyles, integrate environmental and so cio-economic considerations, focus on key 
target groups and key settings and link work on different health determinants23. 
IV.4.3. The Commission’s proposal for a new Health and Consumer protection programme24 
puts a strong focus on promotion and prevention, including in the area of nutrition and physical activity, and foresees a new acti on strand on the prevention of specific 
diseases. 
Questions on which the Commission invites contributions include: 
– How can the availability and comparability of data on obesity be improved, in 
particular with a view to determining the precise geographical and socio-
economic distribution of this condition?  
– How can the programme contribute to raising the awareness of the potential 
which healthy dietary habits and physical activity have for reducing the risk for 
chronic diseases amongst decision makers, health professionals, the media and 
the public at large? 
– Which are the most appropriate dissemination channels for the existing 
evidence? 
IV.5. European Food Safety Authority (EFSA) 
IV.5.1. The European Food Safety Authority can make an important contribution to 
underpinning proposed actions on nutrition (e. g. on recommended nutrient intakes, or 
on communication strategies aimed at health  professionals, food chain operators and 
the general public on the imp act of nutrition on health) w ith scientific advice and 
assistance ( on the role of EFSA in the establishm ent of food-based dietary guidelines, 
cf section V.9 below) .  
V. A REAS FOR ACTION  
V.1. Consumer information, advertising and marketing 
V.1.1. Consumer policy aims to empower people to make informed choices regarding their 
diet. Information about the nut ritional content of products is an important element in 
this respect. Clear, consistent nutriti on information about foods can, along with 
relevant consumer education, act as the f oundation of informed dietary choice. With 
this objective, the Commission has submitte d a proposal for a regulation to harmonise 
the rules on nutrition on health claims25. This includes the principle of setting nutrient 
 
EN 8   EN profiles, in order to prevent foods high in certain nutrients (such as salt, fat, saturated 
fat and sugars) making claims about their potential nutrition or health benefits. The 
Commission is also considering amendments to the current rules on nutrition labelling. 
V.1.2. As far as advertising and marketing is concerned, it has to be ensured that consumers 
are not misled, and that especially the credulity and lacking media literacy of 
vulnerable consumers and, in particular ch ildren, are not exploited. This regards in 
particular advertising for foods high in fa t, salt and sugars, such as energy-dense 
snacks and sugar-sweetened soft drinks, and the marketing of such products in 
schools26. Industry self regulation could be the mean s of choice in this  field, as it has a 
number of advantages over regulation in te rms of speed and flexibility. However, other 
options would need to be considered should self-regulation fail to  deliver satisfactory 
results. 
Questions on which the Commission invites contributions include: 
– When providing nutrition information to the consumer, what are the major 
nutrients, and categories of products, to be considered and why?  
– Which kind of education is required in order to enable consumers to fully 
understand the information given on food labels, and who should provide it? 
– Are voluntary codes (“self-regulation”) an adequate tool for limiting the 
advertising and marketing of energy-dense and micronutrient-poor foods? What 
would be the alternatives to be considered if self-regulation fails? 
– How can effectiveness in self-regulation be defined, implemented and 
monitored? Which measures should be taken towards ensuring that the credulity 
and lacking media literacy of vulnerable consumers are not exploited by 
advertising, marketing and promotion activities? 
V.2. Consumer education 
V.2.1. Improving public knowledge on the relationshi p between diet and health, energy intake 
and output, on diets that lower risk of chr onic diseases, and on healthy choices of food 
items, is a prerequisite for the success of any nutrition policy, wh ether at national or 
Community level. Consistent, coherent, simple and clear messages need to be developed, and disseminated through multiple channels and in forms appropriate to local culture, age and gender. Consumer e ducation will also contribute to creating 
media literacy, and enable consumers to  better understand nutrition labelling. 
Questions on which the Commission, in view of identifying best practices, invites 
contributions include: 
– How can consumers best be enabled to make informed choices and take 
effective action? 
– What contributions can public-private partnerships make toward consumer 
education? 
– In the field of nutrition and physical activity, which should be the key messages 
to give to consumers, how and by whom should they be delivered? 
V.3. A focus on children and young people 
V.3.1. Important lifestyle choices pre-determini ng health risks at adult age are made during 
childhood and adolescence; it is therefore vital that  children be guide d towards healthy 
 
EN 9   EN behaviours. Schools are a key setting for health-promoting interventions, and can 
contribute to the protection of children’ s health by promoting healthy diets and 
physical activity. There is al so growing evidence that a healthy diet also improves 
concentration and learning ability. Moreover,  schools have the potential to encourage 
children to undertake daily physical activity27. Relevant measures could be considered 
at the appropriate level. 
V.3.2. In order to avoid that ch ildren are exposed to conflicti ng messages, health education 
efforts by parents and in schools need to be supported by effo rts from the media, health 
services, civil society and relevant s ectors of industry (positive role models…)  (for 
marketing towards children, cf section V.1) . 
Questions on which the Commission, in view of identifying best practices, invites 
contributions include: 
– What are good examples for improving the nutritional value of school meals, 
and how can parents be informed on how to improve the nutritional value of 
home meals? 
– What is good practice for the provision of physical activity in schools on a 
regular basis? 
– What is good practice for fostering healthy dietary choices at schools, especially 
as regards the excessive intake of energy-dense snacks and sugar-sweetened 
soft drinks?  
– How can the media, health services, civil society and relevant sectors of 
industry support health education efforts made by schools? What role can 
public-private partnerships play in this regard? 
V.4. Food availability, physical activity a nd health education at the work place 
V.4.1. Work places are a setting which has a st rong potential to promote healthy diets and 
physical activity. Canteens that offer h ealthy choices, and employers who foster 
environments which facilitate the practi ce of physical activity (e. g. provision of 
showers and changing rooms) can make important contributions towards health 
promotion at the workplace. 
Questions on which the Commission, in view of identifying best practices, 
invites contributions include: 
– How can employers succeed in offering healthy choices at workplace canteens, 
and in improving the nutritional value of canteen meals? 
– What measures would encourage and facilitate the practice of physical activity 
during breaks, and on the way to and from work? 
V.5. Building overweight and obesity prevention  and treatment into health services  
V.5.1. Health services and health professionals have a strong potential for improving patients’ 
understanding of the relations between di et, physical activity and health, and for 
inducing necessary lifestyle ch anges. Patients could receive  important stimuli for such 
changes if health prof essionals included in routine cont acts practical advice to patients 
and families on the benefits of optimal diet s and increased levels of physical activity. 
Obesity treatment options need also to be addressed28. 
 
EN 10   EN Questions on which the Commission invites contributions include: 
– Which measures, and at what level, are needed to ensure a stronger integration 
aiming at promoting healthy diets and physical activity into health services?  
V.6. Addressing the obesogenic environment 
V.6.1. Physical activity can be integrated into da ily routine (e. g. walking or cycling instead of 
using motorized transport in order to get to school or work). Transport and urban 
planning policies can ensure that walking, cycl ing and other forms of exercise are easy 
and safe, and address non-motorised modes of transportation. The provision of safe 
cycling and walking paths to schools could be one means to address the particular worrying trends for overweight  and obesity in children. 
Questions on which the Commission invites contributions include: 
– In which ways can public policies contribute to ensure that physical activity be 
“built into” daily routines? 
– Which measures are needed to foster the development of environments that are 
conducive to physical activity? 
V.7. Socio-economic inequalities 
V.7.1. Food choice is determined by both i ndividual preferences and socio-economic 
factors29. Social position, income a nd education are determinan ts of diet and physical 
activity. Certain neighbourhoods could discou rage physical activity, lack recreation 
facilities and affect the disadvantaged more than those who can afford or have access 
to transportation. Lower levels of educati on and poorer access to relevant information 
reduce the capacity to make informed choices.  
Questions on which the Commission invites contributions include: 
– Which measures, and at what level, would promote healthy diets and physical 
activity towards population groups and households belonging to certain socio-
economic categories, and enable these groups to adopt healthier lifestyles? 
– How can the “clustering of unhealthy habits” that has frequently been 
demonstrated for certain socio-economic groups be addressed? 
V.8. Fostering an integrated and comprehen sive approach towards the promotion of 
healthy diets and physical activity 
V.8.1. A coherent and comprehensive appro ach aimed at making the healthy choices 
available, affordable and attractive involve s taking account of mainstreaming nutrition 
and physical activity into all relevant policie s at local, regional, national and European 
levels, creating the necessary supporting en vironments, and developing and applying 
appropriate tools for assessi ng the impact of other policie s on nutritional health and 
physical activity30. 
V.8.2. The prevalence of chronic conditions rela ted to diet and physical activity can vary 
greatly between men and women, age gr oups, and between socio-economic strata. 
Moreover, dietary habits, as well as physic al activity behaviours, are often embedded 
 
EN 11   EN in local and regional traditions. Therefore,  approaches aimed at promoting healthy 
diets and physical activity need to be sensitive to gender, socio-economic and cultural differences, and to include a life-course perspective.  
Questions on which the Commission invites contributions include: 
– Which are the most important elements of an integrated and comprehensive 
approach towards the promotion of healthy diets and physical activity? 
– Which role at national and at Community level? 
V.9. Recommendations for nutrient intakes and for the development of food-based 
dietary guidelines 
V.9.1 The WHO/FAO Report31 provides general recommenda tions on population nutrient 
intake and physical activity goals in re lation to the prevention of major non- 
communicable diseases.  
V.9.2. The Eurodiet project32 has proposed quantified populat ion goals for nutrients, and 
underlines the need for these to be tran slated into food-based dietary guidelines 
(FBDGs). FBDGs need to be based on cust omary dietary patterns, and take socio-
economic and cultural factors into account.  
V.9.3. The Commission has asked the European Food Safety Authority (EFSA) to update the 
advice on energy, macronutrients and dietary fibre. Following on from this, EFSA will also advise on population reference intakes of micronutrients in  the diet and, if 
considered appropriate, other essential subs tances with a nutritional or physiological 
effect in the context of a balanced diet . Moreover, EFSA will provide advice on the 
translation of nutrient based dietary a dvice into guidance on the contribution of 
different foods to an overall diet that w ould help to maintain  good health through 
optimal nutrition.  
Questions on which the Commission invites contributions include: 
– In which way could social and cultural variations and different regional and 
national dietary habits be taken into account in food-based dietary guidelines at 
a European level? 
– How can the gaps between proposed nutrient targets and actual consumption 
patterns be overcome? 
– How can dietary guidelines be communicated to consumers? 
– In which way could nutrient profile scoring systems such as developed recently 
in UK contribute to such developments33? 
V.10. Cooperation beyond the European Union 
V.10.1. Some reflection is currently taking place at  international level as regards the global 
involvement of Codex Alimentarius34 in the field of nutrition. In line with the request 
in the WHO Global Strategy on Diet, Physic al Activity and Hea lth, the EU supports 
the view that general consid eration should be given to how  nutrition issues should be 
integrated into Codex work, while re taining the current mandate of Codex. 
 
EN 12   EN V.10.2. Nutrition, diet and physical activity should be the subject of close cooperation between 
regulators and stakeholders in the EU and in other countries wh ere rising levels of 
overweight and obesity are of concern35. 
Questions on which the Commission invites contributions include: 
– Under which conditions should the Community engage in exchanging 
experience and identifying best practice between the EU and non-EU countries? 
If so, through which means? 
V.11. Other issues 
Questions on which the Commission invites contributions include: 
– Are there issues not addressed in the present Green paper which need 
consideration when looking at the European dimension of the promotion of diet, 
physical activity and health? 
– Which of the issues addressed in the present Green paper should receive first 
priority, and which may be considered less pressing? 
VI. N EXT STEPS  
VI.1. The Commission services will carefully anal yze all contributions r eceived in reply to 
the consultation process launched by the pres ent Green Paper. It is expected that a 
report summarizing the contributions will be published on the Commission’s website 
by June 2006. 
VI.2. In the light of the results of the cons ultation process, the Commission will reflect upon 
the most appropriate follow-up, and will cons ider any measures that may need to be 
proposed, as well as the instruments for th eir implementation. Impact assessment will 
be carried out as appropriate, depend ing on the type of instrument chosen. 
 
EN 13   EN ANNEX 1  
 
Figures and Tables 
Table 1 
Prevalence estimates of diabetes mellitus  
 estimate 2003  estimate 2025  
Country prevalence (%)  prevalence (%)  
Austria 9.6 11.9 
Belgium 4.2 5.2 
Cyprus 5.1 6.3 
Czech Re public 9.5 11.7 
Denmar k 6.9 8.3 
Estonia   9.7 11.0 
Finland 7.2 10.0 
France   6.2 7.3 
German y 10.2 11.9 
Greece 6.1 7.3 
Hungary 9.7 11.2 
Ireland 3.4 4.1 
Italy  6.6 7.9 
Latvia 9.9 11.1 
Lithuania 9.4 10.8 
Luxembour g 3.8 4.4 
Malta 9.2 11.6 
Netherlands 3.7 5.1 
Poland   9.0 11.0 
Portu gal  7.8 9.5 
Slovakia 8.7 10.7 
Slovenia   9.6 12.0 
Spain 9.9 10.1 
Sweden  7.3 8.6 
United Kin gdom 3.9 4.7 
source: Diabetes Atlas, 2nd edition, International Diabetes 
Foundation 2003  
 
EN 14   EN Fig. 2: Deaths in 2000 attributable to selected risk factors (European region) 
(source: World Health Report 2002) 
0 500.000 1.000.000 1.500.000 2.000.000 2.500.000
blood pressure
cholesterol
tobacco
high BMI
too low fruit + veg intake
physical inactivity
alcohol
urban air pollution
lead exposure
occupational carcinogens
illicit drugs
unsafe sex
occupational particulates
occupational injuries
 
 
EN 15   EN  
Table 2 - Overweight and obesity among adults in the European Union  
 Males Females 
Country Year of 
Data Collection %BMI
1 
25-29.9 %BMI≥30 %Com-
bined BMI ≥25 %BMI 
25-29.9 %BMI 
≥30 %Combined 
BMI≥25 
Austria 1999 40 10 50 27 14 41 
Belgium 1994-7 49 14 63 28 13 41 
Cyprus 1999-2000 46 26.6 72.6 34.3 23.7 58 
Czech 
Republic 1997/8 48.5 24.7 73.2 31.4 26.2 57.6 
Denmark 1992 39.7 12.5 52.2 26 11.3 37.3 
England2 2003 43.2 22.2 65.4 32.6 23. 55.6 
Estonia  (self 
reported) 1994-8 35.5 9.9 45.4 26.9 15.3 42.2 
Finland 1997 48 19.8 67.8 33 19.4 52.4 
France  (self 
reported) 2003 37.4 11.4 48.8 23.7 11.3 35 
Germany 2002 52.9 22.5 75.4 35.6 23.3 58.9 
Greece 1994-8 51.1 27.5 78.6 36.6 38.1 74.7 
Hungary 1992-4 41.9 21 62.9 27.9 21.2 49.1 
Ireland 1997-99 46.3 20.1 66.4 32.5 15.9 48.4 
Italy (self 
reported) 1999 41 9.5 50.5 25.7 9.9 35.6 
Latvia 1997 41 9.5 50.5 33 17.4 50.4 
Lithuania 1997 41.9 11.4 53.3 32.7 18.3 51 
Luxembourg  45.6 15.3 60.9 30.7 13.9 44.6 
Malta 1984 46 22 68 32 35 67 
Netherlands 1998-2002 43.5 10.4 53.9 28.5 10.1 38.6 
                                                 
1 BMI = Body Mass Index: a person’s weight in kg divided by (height in metres)2 ; persons with a BMI 
between 25 and 30 are consider ed overweight, persons with a BMI >30 are considered obese 
2 Data from Health Survey for England, which does  not include data for Scotland, Wales and Northern 
Ireland 
 
EN 16   EN Poland  (self 
report) 1996 n/a 10.3 n/a n/a 12.4 n/a 
Portugal 
(urban) Published 
2003 n/a 13.9 n/a n/a 26.1 n/a 
Slovakia 1992-9 49.7 19.3 69 32.1 18.9 51 
Slovenia  (self 
reported) 2001 50 16.5 66.5 30.9 13.8 44.7 
Spain 1990-4 47.4 11.5 58.9 31.6 15.3 46.9 
Sweden 
(adjusted)  1996-7 41.2 10 51.2 29.8 11.9 41.7 
Age range and year of data  in surveys may differ. With the limited data availa ble, prevalen ces are not 
standardised. Self reported surveys may underestimate true prevalence. Sources and references are from 
the IOTF database ( © International Obesity Task Force, London – March 2005) 
 
Fig. 2: Rising prevalence of overweight  in children aged 5-11 (source: IOTF) 
051015202530
1960 1970 1980 1990 2000England
Poland
German yNetherlandsSpain
France
Czech R.USA
 
EN 17   EN  
ANNEX 2 - Relationship between di et, physical activity and health 
1. The relationship between diet, physical ac tivity and health has been scientifically 
established, in particular rega rding the role of li festyles as determinants of chronic non-
communicable diseases and conditions such as  obesity, heart disease, type 2 diabetes, 
hypertension, cancer and osteoporosis36. 
2. Particularly alarming is the increase in the prevalence of diabetes  (cf table 1, Annex 1) . 
Type-2-diabetes, which accounts for over 90% of  diabetes cases worldwide, is related 
to obesity, a sedentary lifestyle and diets high in fat and saturated fatty acids. Both 
prevention and treatment of type-2 diabetes need to focus on lifestyle changes (weight 
loss, physical activity, diets low in  fat and saturated fatty acids)37. 
3. Cardiovascular diseases  (CVD) are together with cancer the most important causes of 
death and disease in Europe. Stopping smoki ng, increasing physical activity levels and 
adopting healthier diets are the most importa nt factors in the primary prevention of 
CVD. The key recommendations for CVD pr evention are maintenance of normal body 
weight, moderate physical activ ity of 30 minutes or more every day and avoidance of 
excess consumption of satura ted fatty acids and salt.  
4. Dietary factors are estimated to account for approximately 30% of all cancers  in 
industrialized countries38, making diet second only to tobacco as a theoretically 
preventable cause of cancer. Consumpti on of adequate amounts of fruits and 
vegetables, and physical activity, appear to be protective against certain cancers. Body 
weight and physical inactivity together are estimated to account for approximately one-
fifth to one-third of several of the most common cancers39. 
5. Osteoporosis  is a disease in which the density of  bones is reduced, increasing the risk 
of fracture. Around the world, it affects one in  three women and one in five men over 
the age of fifty. Although genetic factors wi ll determine whether an  individual is at 
heightened risk of osteoporosis, lifestyle factors can influence the acquisition of bone mass in youth and the rate of bone loss la ter in life. The jo int WHO/FAO expert 
consultation
40 concludes that dietary and lifestyle  recommendations developed for the 
prevention of other chronic diseases may pr ove helpful to reduce osteoporosis risk.  
6. The World Health Report 200241 describes in detail how a few major risk factors  
account for a significant proportion of all d eaths and diseases in most countries (cf 
figure 1, Annex 1) . Six out of the seven most importan t risk factors for premature death 
(blood pressure, cholesterol, Body Mass Index,  inadequate fruit a nd vegetable intake, 
physical inactivity, excessive alcohol consumpti on) relate to diet and physical activity 
(the odd one out being tobacco). Unhealthy diets and lack of physical activity are 
therefore the leading causes of avoidable illness and premature death in Europe. 
7. The underlying determinants  of the risk factors for the major chronic diseases 
portrayed above are largely the same. Dietary risk factors include shifts in the diet 
structure towards diets with a higher energy density (calories per gramme) and with a 
greater role for fat and added sugars in f oods; increased saturated fat intake (mostly 
from animal sources) and excess intake of hydrogenated fats; reduced intakes of 
complex carbohydrates and dietary fibre; re duced fruit and vegetable intakes; and 
 
EN 18   EN increasing portion sizes of food items. Other important lifestyle-related risk factors, 
apart from smoking and excessive alcohol consumption, include reduced levels of 
physical activity. Of particular concern is the increasingly unhealthy diet and physical 
inactivity of adolescents and children. 
8. As relatively few risk factors cause the majority of the chronic disease burden, the 
related morbidity and mortality is to a great extent preventable. It is estimated that up 
to 80% of cases of coronary heart disease, 90% of type 2 diabetes  cases, and one-third 
of cancers can theoretically be avoided if the whole population followed current 
guidelines on diet, alcohol, physical activity  and smoking. Addressing  lifestyle factors 
such as nutrition and physic al activity therefore has an  enormous potential for the 
prevention of severe morbidity and mortality.  
9. Obesity  (BMI42 >30) is a risk factor for many serious illnesses including heart disease, 
hypertension, stroke, type-2-diabetes, respirat ory disease, arthritis and certain types of 
cancer. The rising prevalence of obesity across Europe (cf. Annex 1, table 2) , 
particularly among young people (cf. Annex 1, fig. 2) , has alarmed health experts, the 
media and the population at large, a nd is a major public health concern. 
10. Evidence from population surveys suggests that obesity levels in the EU have risen by 
between 10-40% over the past decade, and cu rrent data suggest that the range of 
obesity prevalence in EU countries is fr om 10% to 27% in men and up to 38% in 
women43. In some EU countries more than half the adult population is overweight44 
(BMI >25), and in parts of Europe45 the combination of reported overweight and 
obesity in men exceeds the 67% prevalence found in the USA’s most recent survey46. 
Despite efforts by individuals the loss of he alth to the populati on as a whole due to 
unhealthy diets and inactivity is extraordin arily high: a small increase in Body Mass 
Index (BMI), e. g. from 28 to 29, will in crease the risk of morbidity by around 10 % 47. 
11. The number of EU children affected by overweight and obesity is estimated to be 
rising by more than 400,000 a year, adding to  the 14 million-plus of the EU population 
who are already overweight (including at least 3 million obese children); across the 
entire EU25, overweight aff ects almost 1 in 4 children48. Spain, Portugal and Italy 
report overweight and obesity levels exceeding 30% among children aged 7-11. The rates of the increase in childhood overweight and obesity  vary, with England and 
Poland showing the steepest increases
49. 
12. The factors underlying the onset of obesity are widely known (high intake of energy 
dense micronutrient poor foods or sedentary li festyles are the most  convincing factors 
determining obesity risk; high intake of suga rs sweetened soft drinks and fruit juices, 
heavy marketing of energy dense foods or adverse socioeconomic conditions are also 
probable determining factors. High intake of non starch polysaccharides and regular 
physical activity are convincing factors loweri ng obesity risk; breastfeeding and home 
or school environments supporting healthy f ood choices for children are also probable 
lowering factors). It should how ever be borne in mind that for some people it is going 
to be harder to maintain a healthy weight than for others because they are genetically 
disposed to storing fat, or  because they have genetic dysfunctions which make it 
difficult for them to control the feeling of hunger. In fact, even if some scientists50 
estimate that 40-70% of the variation in fa t mass between individuals is determined by 
genetic factors, environmental factors rema in important and determine the expression 
 
EN 19   EN of these genes in individuals; addressing the “obesogenic environment” ( cf section V.6 ) 
therefore has a strong po tential to curb obesity51. 
13. While the effects of diet and physical activity  on health often inte ract, particularly in 
relation to obesity, there are ad ditional health benefits fr om physical activity that are 
independent of nutrition and diet. Likewise, th ere are significant nutritional risks that 
are unrelated to obesity. 
14. Weight gain in an individual is the result of an excess of energy consumed as food over 
energy expenditure. There is a strong tende ncy for excess weight to continue to 
accumulate from childhood through to middle ag e. It is therefore important to achieve 
an optimum body weight throughout life through proper diet and daily physical 
activity. In addition to promoting overall f eelings of wellbeing a nd apart from weight 
management aspects, physical exercise ha s also independent positive effects on the 
prevention of diseases such as cardiovascul ar disease, type II diabetes, osteoporosis 
and depression, and contributes to maintain ing muscular strength in older age. 
15. To maintain cardiovascular health, the r ecommended daily amount of exercise is at 
least 30 minutes for most of the days of th e week. There is no general agreement on the 
level of physical activity needed  to prevent weight gain, but  a total of one hour on most 
days of the week is probably needed. Howe ver, all physical activity increases energy 
consumption and contributes to weight management52. 
16. A 2003 Eurobarometer survey53 showed that around 60 % of Europeans (EU 15) had 
no vigorous physical activity at all in a typi cal week, and more than 40 % did not even 
have moderate physical activit y in a typical week. Europe -wide, only about one third 
of schoolchildren appear to be meetin g recognised physical activity guidelines54. 
Exercising seems to be more common among people who claim they eat healthily and 
do not smoke, which is in line with the gene rally observed “cluster ing of good habits”.  
17. The WHO Global Strategy on diet, physical activity and health  was adopted by the 
World Health Assembly in May 200455 as an outcome of a global consultation process 
and consensus-building exercise. The Globa l Strategy underlines  the importance of 
achieving a balanced diet reducing the cons umption of fats, free sugars and salt, of 
increasing the intake of fruits, vegetables, legumes, grains and nuts, and of performing 
moderate physical activity during at least 30 minutes a day. 
18. The Community has actively supported th e WHO Global Strategy process since its 
beginning. The Global Strategy can serve as an extremel y valuable input in the 
development of a comprehensive Community  action on nutrition and physical activity, 
and active use should be made of th e scientific evidence underpinning it56 when 
building the rationale for a broad Community strategy in this area. 
 
EN 20   EN ANNEX 3 – References 
                                                 
1  Council Conclusions of 2 D ecember 2003 on healthy lifestyle s: education, information and 
communication (2004/C 22/01) - Official Journal of the European Union C 22/1 of 27.1.2004 
http://europa.eu.int/comm/health/ph_determinants/lif e_style/nutrition/documents/ev_20050602_en.pdf 
2 Council Resolution of 14 December 2000 on health and nutrition (2001/C 20/01) - Official Journal of the 
European Communities C 20/1 of 23.1.2001   
3 Council conclusions on obesity, nutrition and physical activity (adopted on 03.06.2005) 
http://europa.eu.int/comm/health/ph_determinants/lif e_style/nutrition/documents/ev_20050602_en.pdf 
4 Council conclusions on obesity, op. cit. 
5 actions which include e. g. the food industry, the advertising industry, the retailers, the caterers, NGOs 
and consumer organisations, local, regional and national Governments, schools and the media 
6 Council conclusions on obesity, op. cit. 
7 Council conclusions on obesity, op. cit. 
8 Opinion of the European Economic and Social Committee on Obesity in Europe – role and responsibilities 
of civil society partners, SOC/201 , September 2005  
http://eescopinions.esc.eu.int/EESCopinionDocument.aspx?identifier=ces\soc\soc201\ces1070-2005_ac.doc&language=EN 
9 Member States launched in recent years a number of  initiatives to promote healthy nutrition and physical 
activity. Some Member States like Ireland ( http://www.healthpromotion.ie/topics/obesity/ ) and Spain 
(http://www.msc.es/home.jsp) established National St rategies to counter obesity, involving Public 
Administrations, independent experts, the food indust ry, the physical activity sector, NGOs etc. in multi-
sectorial actions aimed at promoting healthier diets and physical activity. France launched in 2001 a four year national healthy nutrition plan ( http://www.sante.gouv.fr/
), covering a wide range of measures at the 
inter-sectorial level, with the objective to reduce the prevalence of obes ity and overweight. More recently, 
in March 2005 the Slovenian Parliament approved  a National Nutrition Policy Programme for 2005–2010 
(http://www2.gov.si/mz/mz-splet.nsf ). The Netherlands integrated obesity as one of the priorities of its 
national health care prevention po licy (http://www.minvws.nl/) . Nutrition and physical  activity are also 
mentioned as an important area for public heath action in the United Kingdom’s White Paper Choosing health: making healthier choices eas ier, released in November 2004 
(http://www.dh.gov.uk/PublicationsAndStatistics/Pub lications/PublicationsPolicyAndGuidance/Publicatio
nsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4094550&chk=aN5Cor ). Germany established a 
national platform for nutrition and physical ac tivity (http://www.ernaehrung-und-bewegung.de/). 
10 Obesity – preventing and managing the global epidemic. Report of a WHO Consultation. Geneva, World 
Health Organization, 1998 (Technical Report Series, No. 894) 
11 National Audit Office (2001), Tackling obesity in England  
http://www.nao.org.uk/publications/nao_reports/00-01/0001220.pdf. 
12 Chief Medical Officer (2004) At least five a week : Evidence on the impact of  physical activity and its 
relationship to health. London: Department of Health  
http://www.dh.gov.uk/assetRoot/04/08/09/81/04080981.pdf 
13 Obesity -  the Policy Challenges: the Report of the National Taskforce on Obesity.  Dublin 2005 
14 Finkelstein, E. A. et al., (2004). State-level esti mates of annual medical expenditures attributable to 
obesity. Obesity Research, 12, 18-24 
15 Finkelstein EA, et al., (2003), National Medical Spen ding Attributable To Overweight And Obesity: How 
Much, And Who’s Paying?, Health Affairs , Vol. 10, No.1377; quoted from: Ad Hoc Group on the OECD 
Health Project, Workshop on the Economics of Prevention, 15 October 2004, Cost-effectiveness of Interventions to prevent or treat Obesity and type-2 diabetes, A preliminary review of the literature in 
OECD countries, SG/ADHOC/HEA(2004)12, 2004 
16 Determinants of the burden of disease in the European Union. Stockholm, National Institute of Public 
Health, 1997; quoted from: Food and health in Europe: a new basis for action. WHO Regional 
Publications European Series, No. 96  http://www.euro.who.int/document/E82161.pdf 
17  The RIVM report 'Measuring Dutch meals: Healthy diet and safe food in the Netherlands' recommends 
increasing fish consumption from the average consumption (1998) of 2 to 3 times per month to 1 or 2 
times per week.  It should be noted that in the Netherlands, consumption of fish (per capita consumption: 20.5 kg/head/year) is at the mid point for EU25; Austria, Germany, Ireland, the United Kingdom, Belgium 
and Luxemburg and all of the new Member States apart from Malta, Cyprus and Estonia are below the 
Dutch level of consumption.  Three Member States (Hungary, Slovakia and Slovenia) are at only one third of the Dutch consumption level. http://www.rivm.nl/bibliotheek/rapporten/270555008.html 
 
EN 21   EN                                                                                                                                                             
18 COM (2005) 115 http://europa.eu.int/eur-lex/lex/LexUriServ/site/en/com/2005/com2005_0115en01.pdf    
19 A report on the contributions recei ved will be published on the Commi ssion’s website at the following 
address: 
http://europa.eu.int/comm/health/ph_determinants/life_ style/nutrition/green_paper/consultation_en.htm 
20 Further information on the work of the Platform is available at the following internet 
address: http://europa.eu.int/comm/health/ph_determinants/life_style/nutrition/platform/platform_en.htm  
21 More information on the scope of the Public Health  Action Programme, the conditions for participation in 
the calls launched under the Programme, and on projects financed so far can be found at the following 
internet address: http://europa.eu.int/comm/health/ph_programme/programme_en.htm .   
22 i. a. the Working Party 'Lifestyle and other Health  Determinants' aims at improving the availability of 
comparable information on nutritional habits and ph ysical activity levels in Europe. Its Scientific 
Secretariat can be contacted at [ public.health@mailbox.tu-dresden.de] 
23 Numerous Commission financed projects in particul ar under the former Can cer, Health Promotion and 
Health Monitoring Programmes have developed activities in the field of nutrition, physical activity and 
health. An overview of these initiatives is set out in the Status report on the European Commission’s work 
in the field of nutrition in Europe , 2002  
(http://europa.eu.int/comm/health/ph_determinants/lif e_style/nutrition/documents/nutrition_report_en.pdf) 
24 http://europa.eu.int/eur-lex/lex/LexUriServ/site/en/com/2005/com2005_0115en01.pdf  
25 Proposal for a regulation of the European Parliament and of the Council on nutrition and health claims on 
foods COM (2003) 424 final; 16/07/2003 
26 cf Gerard Hastings et al: Review of research into the effects of food promotion to children - Final Report 
Prepared for the Food Standards Agency; 22 September 2003 
http://www.foodstandards.gov.uk/multimedia /pdfs/foodpromotiontochildren1.pdf 
27 cf also Universität Paderborn, et al. (2004): "Study on young people’s lifestyles and sedentariness and the 
role of sport in the context of education and as a means of restoring the balance" 
http://europa.eu.int/comm/sport/documents/lotpaderborn.pdf 
28 these include dietary ther apy (instruction on how to adjust a diet to reduce the number of calories eaten), 
physical activity, behaviour therapy (acquiring new habits that promote weight loss), drug therapy (to be 
used in high BMI patients or patients with obesity-re lated conditions together with appropriate lifestyle 
modifications and under regular medical control), and surgery (in extremely high BMI patients or patients 
with severe obesity-related conditions, used to modify the stomach and/or intestines to reduce the amount 
of food that can be eaten) 
29 Food and health in Europe: a new basis for action, WHO regional publications. European series  No. 96, 
2004 
30 Information and communication technologies can play an important role in health promotion by providing 
sound and high-quality information on lifestyle and diet . This can be done, for example, through personal 
devices highlighting individualised health information that can give feedback, guidelines, forewarning, 
and can help to avoid acute events  resulting from unhealthy lifestyles. A number of Community supported 
projects have developed information systems relating to health and diet, such as VEPSY UPDATED 
(http://www.vepsy.com/index.htm) and MYHEART  
(http://www.hitech-projects.com/euprojects/myheart/) 
31 Diet, Nutrition and the Prevention of Chronic Diseases, op. cit . The recommendations include: Achieve 
energy balance for weight control; Substantially incr ease levels of physical ac tivity across the life span; 
Reduce energy intake from fat and shift consumption from saturated fats and trans-fatty acids towards unsaturated fats; Increase consumption of fruit and vegetables as well as legumes, whole grains and nuts; 
Reduce the intake of “free” sugars; Reduce salt (sodium ) consumption from all sources and ensure that 
salt is iodized. 
32  EURODIET core report, op. cit.   
(http://europa.eu.int/comm/health/ph_determ inants/life_style/nutrition/report01_en.pdf) 
33 cf Mike Rayner et al: Nutrient profiles: Options for definitions for use in relation to food promotion and 
children’s diets; Final report; British Heart Foundation Health Promotion Research Group, Department of 
Public Health, University of Oxford; October 2004  
 http://www.food.gov.uk/multimedia/pdf s/nutrientprofilingfullreport.pdf  
34 The Codex Alimentarius Commission was created in 1963 by the Food and Agriculture Organisation 
(FAO) and the World Health orgnisation (WHO) to develop food standards, guidelines and related texts such as codes of practice under the Joint FAO/WHO Food Standards Programme. The main purposes of 
this Programme are protecting health of the consumers and ensuring fair trade practices in the food trade, 
 
EN 22   EN                                                                                                                                                             
and promoting coordination of all food standards work undertaken by international governmental and non-
governmental organizations. http://www.codexalimentarius.net/web/index_en.jsp 
35 In this context, the scope for more proactive EU-U S cooperation will be examined, and a major review of 
best practices in EU and US will be organised early  2006 with relevant US administration counterparts. 
Also, the broad regulatory EU-US dialogue which has star ted in this field will be intensified. Moreover, a 
plenary meeting of the European Platform for Action on Diet, Physical Activity and Health will be 
convened together with representatives of the US Administration, the American food industry and 
consumer organisations. 
36 cf Diet, Nutrition and the Preven tion of Chronic Diseases , Report of a Joint WHO/FAO Expert 
Consultation, 2003 (http ://www.who.int/dietphysical activity/publications/trs916/ download/en/index.html) 
37 cf Diabetes action now: an initiative of the World Health Organisation and the International Diabetes 
Federation, 2004 
38 Doll R, Peto R. Epidemiology of cancer. In: W eatherall DJ, Ledingham JGG, Warrell DA, eds. Oxford 
textbook of medicine. Oxford, Oxford University Press, 1996:197—221; quoted from: Diet, Nutrition and 
the Prevention of Chronic Diseases, op. cit.  
39 Weight control and physical activity. Lyon, Interna tional Agency for Research on Cancer, 2002 (IARC 
Handbooks of Cancer Prevention, Vol. 6); quoted from: Diet, Nutrition and the Prevention of Chronic 
Diseases, op. cit.  
40 Diet, Nutrition and the Prevention of Chronic Diseases, op. cit.  
41 World Health Organization. The World Health Report: 2002: Reducing risks, promoting healthy life , 
Geneva: World Health Organisation, 2002 
42 BMI = Body Mass Index: a person’s weight in kg divided by (height in metres)2 ; persons with a BMI 
between 25 and 30 are consider ed overweight, persons with a BMI >30 are considered obese 
43 International Obesity Task Force EU  Platform Briefing Paper, March 2005 
44 The European Health Report, World Health Organisation, 2002 
45 Finland, Germany, Greece, Cyprus, th e Czech Republic, Slovakia and Malta  
46 International Obesity Task Force EU  Platform Briefing Paper, op. cit. 
47 Fogel, R. W. (1994), ‘Economic growth, population theory, and physiology: the bearing of long-term 
process on the making of economic policy’, The American Economic Review, 84(3): 369–395; quoted 
from: Suhrcke M. et al, The contribution of h ealth to the economy in the European Union, 
http://europa.eu.int/comm/health/ph_over view/Documents/health_economy_en.pdf 
48 Childhood Obesity Report, International Obesity Task Force (IOTF), May 2004 
49 International Obesity Task Force EU Platform Briefing Paper, op. cit.  
50 G Barsh, IS Farooqi and S O’Rahilly: Genetics of body weight regulation; Nature 2000;404:644-651 
51 DIABESITY project funded under the EU’s 6th RTD Framework Programme:  
http://www.eurodiabesity.org/ 
52 Diet, Nutrition and the Prevention of Chronic Diseases, op. cit.  
53 European Commission (2003) Physical Activity. Special Eurobarometer 183-6/ Wave 58.2- European 
Opinion Research Group (EEIG.  
http://europa.eu.int/comm/public_opini on/archives/ebs/ebs_183_6_en.pdf) 
54 Health Behaviour in School-Aged Children survey, 2001/2002 
55 http://www.who.int/gb/ebwha/pd f_files/WHA57/A57_R17-en.pdf 
56 Diet, Nutrition and the Prevention of Chronic Diseases, op. cit.