Opinion of the European Economic and Social Committee on Obesity in Europe — role and responsibilities of civil society partners
Date: 2005-09-28
Institutions: European Economic and Social Committee
Subjects: consumer information, nutritional disease, public awareness campaign, public health

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Opinion of the European Economic and Social Committee on Obesity in Europe — role and
responsibilities of civil society partners

(2006/C 24/14)

On 18 February 2005, the European Economic and Social Committee, acting in accordance with Rule 29(2)
of its Rules of Procedure, decided to draw up an opinion on: Obesity in Europe — role and responsibilities of
civil society partners.

The Section for Employment, Social Affairs and Citizenship, which was responsible for preparing the
Committee's work on the subject, adopted its opinion on 5 September 2005. The rapporteur was
Mrs Sharma.

At its 420th plenary session, held on 28 and 29 September 2005 (meeting of 28 September 2005), the
European Economic and Social Committee adopted the following opinion by 83 votes to 4 with
10 abstentions:

1. Obesity — The Responsibility of Society

— Obesity accounts for 2-7 % of a developed country's

total health care costs.

It is a very sad fact that

the two major nutritional
1.1
problems presently facing the world are that 600 million
people face starvation whilst at the same time 310 million
people face a problem of obesity.

The endless documents,

from
1.2
experts, round table meetings and prominent
international
organizations around the subjects of diet, physical activity and
obesity have failed to produce solutions or ACTION to stop
this societal and economically crippling disease.

surveys and reports

The upward trend in obesity, with all

its negative
1.5
personal and social repercussions, now demands a multi-disci-
plinary and multi-facted approach,
in turn requiring interde-
pendent action by nations, communities and individuals.
Governments having a central role, in cooperation with other
stakeholders, to create an environment
that empowers and
encourages individuals, families and communities to make posi-
tive, life-enhancing decisions on a healthy lifestyle.

Excessive food energy intake plus low energy expendi-
1.3
ture equals energy surplus, stored in the form of body fat. This
is the mechanism generating, obesity, which has accelerated
over recent decades under the impact of a series of economic,
social and psychological factors, to the point where obesity is
becoming a priority health issue.

1.4
The prevalence of obese people has increased dramati-
cally in the last 30 years. In 2000 the WHO declared it ‘the
greatest health threat facing the West’.

— 14 million overweight children including 3 million
obese rising at more than 400,000 a year, affecting
almost 1 in 4 across the EU25.

— 10-20 % of children in northern Europe are over-
weight, in southern Europe and Ireland and UK the
number is 20-35 %.

— In many EU countries more than half the adult popula-
tion is overweight, with 20–30 % of adults categorised
as obese.

— Obesity in middle age increases the risk of future

dementia.

2. Contributing factors

The rise of sedentary pursuits, an increase in the use of
motorised transport, a decrease in physical activity, and an
increase in the consumption of high-energy foods and drinks
which do not have balanced ingredients are likely to be the
major factors in the current epidemic of obesity.

2.1 General factors

Cultural and behavioural models intrinsic to the ‘comfort-
oriented civilisation’ are the primary factor in the explosion of
obesity, which can only be remedied by means of coordinated
information and prevention initiatives (at national,
local and
even personal level) which alter the most harmful cultural atti-
tudes and models of behaviour, without making the mistake of
‘over-medicalising’ obesity.

The main areas for action therefore include a closely-
sectors or activities, which may be

2.2
connected series of
summarised as follows:

— 6 out of 7 of the most important risk factors for
premature death relate to how we eat, drink and move
(the odd one out being tobacco).

— society: nutritional education (tackling the issue of the
overall nutritional value of foodstuffs, and not only the
quantitative aspects) and education for healthier lifestyles,
particularly regarding physical exercise;

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— education:

lessons on the value of food, the causes and
effects of obesity,
reinvigorated teaching of domestic
science designed to disseminate healthier lifestyles, and
including recreational,
greater appreciation of physical,
activity;

— industry: encouraging ethical practices within the food
industry, especially in marketing and mass media adver-
tising, and fostering personnel policies which support a
sound diet and appropriate physical exercise;

— transport: countering over-use of modes of

transport
which replace physical activity, and identifying policies
which do not increase the distribution costs of fresh food-
stuffs in particular;

— media: ensuring that advertising practices do not generate
excessive or unbalanced consumption, and alerting parents
to the physical risks to their children arising from excessive
and prolonged use of television, video games and internet;

— health services: supplying robust information services for
all individuals, and arranging information and prevention
campaigns rather than frequently unsuccessful treatment
which comes too late;

— policy: responsible and appropriate investment for practical
initiatives from national down to local level, targeting all
sectors of the population and particularly those groups who
are most vulnerable on account of education and income.

3.4
The EESC believes that an ‘include all’ approach is
necessary in a strategy to combat the problem together, taking
‘top down’ policies, accompanied with bottom up strategies,
creating action horizontally and vertically, with everyone
making a commitment,
in kind.
financially,
Although far from simple, the purpose is to create an environ-
ment that supports healthy eating, with a balanced diet and
physical activity throughout Europe, without blame.

in time or

4. Obesity Check

4.1
The EESC proposal will reduce obesity through the
promotion, across Europe, of an obesity-proofing campaign —
Obesity Check — raising awareness of the benefits of a healthy
lifestyle and the responsibility of all parties in preventing
obesity. The campaign will have one simple message that over-
comes ten challenges and involves public and private sector,
civil society and citizens via their commitments to support the
campaign. The point is to promote the habits of a healthy life-
style without interfering with a citizen's personal choices.

4.2

The ten challenges are to:

— continue and improve the education process across the

population;

— work together for efficient communication and ownership;

— ensure EVERY individual across Europe is reached;

— get

everyone

to take

responsibility

and retain the

3. Stop the ‘Blame Culture’

momentum;

3.1
The current industrialised world provides an environ-
ment highly conducive to obesity. Some causes are obvious,
many less understood and most not viewed by society as detri-
mental. Of concern is the lack of foresight for future genera-
tions and the desire of no one to take ownership or responsi-
bility, but instead to blame others.

are

The underlying obesity determinants

elevated
3.2
consumption of energy-dense, nutrient-poor foods that are
high in fat, sugar and salt; reduced levels of physical activity at
home, at school, at work and for recreation and transport.
Variations in risk levels and related health outcomes can be
attributed, in part, to the variability in timing and intensity of
economic, demographic and social changes at national and
global levels.

Bringing about changes in dietary habits, patterns of
3.3
physical activity and a healthy lifestyle will
require the
combined efforts of many stakeholders, public and private,
over several decades. A change in mentality, awareness raising
and education via a combination of sound and effective actions
are needed at all levels, with psychological support, close moni-
toring and evaluation of their impact. Additionally, individuals
will have to take ownership and responsibility for change.

— convince individuals and organisations that they can influ-

ence others;

— accept that all actions have to be integrated into a wide

range of EU and national policies;

— accept this is a ‘Corporate Social Responsibility’;

— ensure a multilayered, horizontal and vertical approach at

all levels;

— ensure

transparency,

selflessness

and remove hidden

agendas;

— raise awareness that the effects of obesity on health are
reversible through healthy eating and physical exercise.

The Obesity Check campaign, to be clearly defined by
4.3
policy makers and stakeholders, led by DG SANCO, would be a
simple message clearly demonstrating to the European public a
need to eat healthily and take more physical exercise, expressed
through a commitment to ‘obesity-proof’ all parties' policies
and practices. Every relevant organisation, from the European
Commission to the individual family member, can be asked to
join the campaign to look at their own activities and see how
these could be modified to prevent the risk of obesity.

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such as

‘clunk-click’

Previous campaigns

4.4
seat belts,
tobacco control, breast feeding and no drugs in sport have
been simple yet effective and supported by all layers in society.
All have involved a successful combination of consumer educa-
tion,
community-based
changes
programmes.

legislation,

policy

and

by adopting consistent nutrition policies, and the introduc-
tion of sports facilities or gyms. For smaller companies this
could be supporting employees to consider healthier life-
styles. Working outside of their companies, particularly in
education would also be valuable. The United Nations
Millennium Declaration (September 2000) recognises that
economic growth is limited unless people are healthy.

5. Obesity Check Campaign

A questionnaire has been produced asking individuals to
commit a personally selected amount of time to spend within
their organisations, or external bodies, supporting the work of
DG SANCO in promoting the idea of obesity-proofing through
the Obesity Check campaign. (The questionnaire is attached at
the back of the opinion. It can be amended to be used by any
organisation).

Objective — to produce targeted outcomes and monitor
progress.

Short term — completed questionnaires prove a commitment
and willingness of individuals and organisations to raise aware-
ness, educate and inform others of
the need for lifestyle
changes. The target can be measured by the amount of time, or
resources pledged to the campaign. Examples of best practice
can also be collected.

Medium term — actual action. Time commitments and
resources pledges followed through,
including organisations
‘obesity — proofing’. This would also include the publishing
and dissemination of examples of best practice collected in the
short-term. Targets can be measured by positive feedback and
follow-up on all original questionnaires, as well as monitoring
progress of the EU Platform.

Long term — assess via an opinion from EESC actual progress
in the form of a report to other EU institutions. This facilitates
the
continued
momentum.

additionally

processes

feedback

and

of

5.1 EESC

5.1.1
The EESC has a mandate to work with the Commis-
sion, Parliament and Council bringing civil society closer to the
decision making process. With such a mandate, EESC along
with all stakeholders can commit time to initiating effective
change through the voluntary action of
to
promote healthier
lifestyles. EESC members have been
requested to complete the Obesity Check and lead by example
in the following suggested ways:

its members

— Employers could consider healthier lifestyles within the
workplace, including encouraging choices of healthy foods

— Employee organisations

could

disseminate

similar
message to their members,
to empower
employees to integrate physical activity, walking or cycling,
into their daily routine. They could also be encouraged to
take the advice back to their families and communities as a
process of continued education.

for example:

a

— NGOs

could
and particularly consumer organisations
commit time with their members and possibly help spread
the message further a field to other
institutions and
communities. Youth and family organisations are valuable
in promoting balanced diets and exercise. All can promote
the affordability of healthy eating and healthy options,
together with the know-how.

The EESC works across all 25 Member States at all
5.1.2
levels of civil society. This makes a significant impact in the
transmission of the ‘campaign’ message and sets the standard
for others to follow.

5.2 EU Commission and Parliament

Members of the Commission DGs and the Parliament would be
asked to complete the Obesity Check to ‘lead from the front’.

DG SANCO is to be congratulated on the launch of
5.2.1
the newly established ‘European Platform for Action’
in the
field of obesity. It is hoped that Platform members could devise
a simple slogan/campaign message that would be used across
Europe to promote a healthy lifestyle. Consistent, coherent and
clear messages should be prepared and conveyed by govern-
ment, NGOs, grass-roots organizations, and industry. They
should be communicated through many channels and in forms
appropriate to local culture, age and gender. Behaviour can be
influenced especially in schools, workplaces, educational and
faith communities, by local leaders, and mass media.

5.2.2
The platform chairman, Robert Madelin, underlined
that ‘to be successful in its fight against obesity all actions had
to be integrated into a wide range of EU policies’. Importantly,
from all global reports, this is a long-term issue and must have
short, medium and long-term sustainable effective strategies
with actions, and a multisectoral, multidisciplinary and multi-
factor involvement, that means it must include consultation
with those most affected — families, parents and children.

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5.2.3
DG SANCO is arranging for the platform to engage in
dialogue with officials from other policy areas in the Commis-
sion: DG Agriculture, Enterprise, Education, Research and
Transport. It is vital that all interested parties are involved at
the inception stage of any strategy and once produced, a
consultative Impact Assessment should be conducted to ensure
that the strategy blames and penalises no specific institutions
but communicates clearly its proposals to involve all.

5.2.4
Based on the principles of subsidiarity and comple-
mentarity, Community-level promotional measures can rein-
force the effect of initiatives taken by the national authorities,
private sector and NGOs. Various sources of funding, in addi-
tion to national budgets, should be identified to assist in the
implementation of a strategy and the Obesity Check campaign.

for

DG Education and Culture, especially Sport will have
5.2.5
requirements
funding to develop key strategies with
national governments. However, their messages should recog-
nise that financial resources are not always required to increase
levels of physical activity, i.e. schools do not always need new
gym equipment, and many trained athletes are seeking employ-
ment and could be encouraged to work in education. Bodies
responsible for sports promotion could persuade sporting
heroes to project positive messages.

5.2.6
Extensive research has been conducted by DG EAC in
the area of youth physical activity. However, research should
also be conducted into adult recreational activity. Consideration
needs to be made in term of ‘family cross referencing’, e.g.
the weekend would take and
parents involved in sport at
encourage the children to participate, making it a family experi-
ence, and changing cultural trends.

5.2.7
DG Agriculture have a promotion budget which could
be used as an investment towards the promotion of fresh fruit
and vegetables, and this could be positively used in helping
fulfil
in the Obesity Check campaign, similarly to
previous assistance to national bodies for local promotional
campaigns for nutritional agricultural products.

its part

Consideration should also be made of the role of inter-
5.2.8
national partners in achieving the objectives. Coordinated work
is needed among the organisations of
the United Nations
system, intergovernmental bodies, NGOs, professional associa-
tions, research institutions and private sector entities.

Governments have
economic, social and environmental factors.

‘joined up’

a

approach considering

5.3.1
All partners, especially governments, need to address
simultaneously a number of issues. In relation to diet, these
include all aspects of nutrition,
food security (accessibility,
availability and affordability of healthy food); and food safety.
Physical activity must be promoted in working, home and
school life, with consideration for city planning, transportation,
safety and access to physical activity during leisure time.
National circumstances will determine priorities in the develop-
ment of obesity-proofing governmental activities as part of the
Obesity Check campaign. There are great variations in and
between different countries and regional bodies should collabo-
rate in formulating regional strategies.

Support should be provided by appropriate infrastruc-
5.3.2
ture,
implementation programmes, adequate funding, moni-
toring and evaluation, and continuing research. Strategies need
to be based on the best available scientific research and
evidence, incorporating policies, action and time scales.

5.3.3
Priority should be given to activities that have a posi-
tive impact on the poorest population communities. Such
activities will generally require community-based action with
strong government support and oversight.

recreation,

Similar to the ‘European Platform’ national govern-
5.3.4
ments should establish communication channels and ‘Round-
Tables’ involving ministries, institutions responsible for policies
on food, agriculture, youth,
sports, education,
commerce and industry,
transportation, media and
finance,
communication, social affairs and environmental and urban
planning to consider combating obesity. They could include
‘parent’ and youth round tables, to include contributions from
the individuals most affected. They must have cooperation and
‘buy-in’ from all stakeholders with no hidden agendas. The
International Obesity Task Force is a research-based think-tank
with an advisory and catalytic role offering relevant data for
such discussions. These communication channels should be
extended to cover public private sector partnerships. They must
NOT waste resources by extending administrative costs or
duplicating already established bodies.

5.3 Member States

Every government department across Europe would be asked
to complete the Obesity Check. and to ‘lead from the top’.
Departments could also be asked if they could commit specific
finances towards promoting the ‘campaign’. It is essential that

5.3.5
Governments need to consider actions that will result
in the provision of simple balanced information for consumers
to enable them easily to make informed choices, and to ensure
the availability of appropriate health promotion and education
programmes. Information for consumers should be sensitive to
literacy levels, communication barriers and local culture, and
understood by all segments of the population.

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5.3.6
Governments, in the full application of the principle
of subsidiarity, have a central role, in cooperation with other
that empowers and
stakeholders, to create an environment
families and
encourages behaviour changes by individuals,
communities,
life-enhancing decisions on
to make positive,
healthy lifestyle.

5.4 Education

Across every educational establishment individuals would be
asked to complete the Obesity Check. Educational departments
could be asked if they could commit specific resources towards
promoting the campaign among their constituent bodies across
the full education spectrum

5.4.1
A life-course perspective is essential for the prevention
and control of obesity. A simple Obesity Checklist that can be
understood by minors and the elderly alike. This approach
starts with maternal health and prenatal nutrition, pregnancy
outcomes, breastfeeding and child and adolescent health;
reaches children at schools, adults at worksites and other
settings, and the elderly, encouraging a healthier lifestyle from
youth into old age.

5.4.2
Health literacy should be incorporated into adult
education programmes. Such programmes provide an opportu-
nity for health professionals and service providers to enhance
knowledge about diet and physical activity and to reach
marginalized populations. Media literacy can also be offered, to
help equip consumers to understand labels and advertisements
when making choices, as well as providing practical experience
in preparing meals.

Schools influence the lives of most children. They
5.4.3
should protect their health by providing health information,
improving health literacy, developing education in food tastes,
and promoting a healthy lifestyle. Schools must provide
students with minimum daily physical education (min. 2 hours
a week), as well as a balanced diet education, and should be
equipped with appropriate facilities and equipment. They
should recognise that even with budgetary constraints, action
can still occur with current facilities.

Expenditure on sports facilities must be carefully monitored to
ensure that the activities benefit both girls and boys, especially
as obesity rates amongst girls are rising faster than for boys.

ensure a local market for healthy foods. A consistent food and
nutrition policy should be adopted following consultations
with staff, pupils, parents and relevant authorities.

5.4.5 Where entrepreneurial activity is encouraged between
pupils in schools this should not be in the form of ‘tuck’ shops
where traditionally crisps and confectionery are sold. Healthy
foods could be considered as alternates.

Special consideration must also be made for

5.4.6
the
elderly as those over 60 are affected by obesity. Additionally,
the elderly have a wealth of information and experience on
traditional diets and cooking methods and can contribute to
the education of their families.

5.5 Health Services

Across every public health body individuals would be asked to
complete the Obesity Check. Departments could be asked if they
could commit
towards promoting the
resources
campaign to their constituent bodies (e.g. clinics, hospitals, staff
canteens, patient groups).

specific

5.5.1
The role of government is crucial in achieving lasting
change in public health. Governments have a primary role in
initiating and developing a strategy to reduce obesity as part of
a broader, comprehensive and coordinated public health effort.
Simple, direct messages need to be communicated on the quan-
to provide
tity and quality of physical activity sufficient
substantial health benefits. Local and regional authorities must
also be involved and participate actively in this information
process.

staff

Routine contacts with health-service

5.5.2
should
include practical advice to patients on the benefits of healthy
diet and increased levels of physical activity, combined with
support to help patients initiate and maintain healthy beha-
viours, via an Obesity Checklist. Authorities should consider
incentives to encourage preventive services and identify oppor-
tunities within existing clinical services, including an improved
financing structure to support and enable health professionals,
especially for primary health care, but also other services (such
as social services and pharmacy), to dedicate more time to
prevention. This could be a simple positive proactive message
suggesting ‘walk more-eat less’.

5.4.4
Governments are encouraged to adopt policies that
support balanced diets at school and limit the availability of
products high in salt, sugar and fats. Schools, together with
parents and responsible authorities, should consider issuing
contracts for school lunches to local food growers in order to

5.5.3
Support and information measures should begin with
parents, advising on the right and best choice on nutrition for
the youngest age group (infants and young children). There is
now good scientific evidence that breastfed infants are later in
life less obese than formula fed infants, thus prevention should
start with promotion of appropriate infant feeding.

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5.5.4
Support and information measures should also target
the elderly, particularly those living alone or those who are
poor or marginalised, so as to avoid the widespread unhealthy
food practices which often go hand-in-hand with these kinds of
hardship.

menting measures aimed at sending positive and consistent
messages to facilitate and enable integrated efforts to encourage
a healthy lifestyle.

5.6 Local Government

Obesity Check would be completed across every regional and
their
local government, suggesting actions to obesity-proof
activities and support the Obesity Check campaign. Offices and
departments could be asked if
they had specific resources
towards promoting the campaign.

5.6.1
Local authorities should encourage multisectoral and
multidisciplinary expert advisory boards to be established,
including technical experts and representatives of government
agencies. They must have an independent chair to ensure scien-
tific evidence is interpreted without any conflict of interest.

National,

regional and local governments

should
5.6.2
provide incentives to ensure that walking, cycling and other
forms of physical activity are accessible and safe; transport poli-
cies must
transportation;
labour and workplace policies
should encourage physical
activity; and sport and recreation facilities should embody the
concept of sports for all.

include non-motorised modes of

5.7 Industry

‘Industry’
together for the benefit of each other.

includes both employers and employees, working

Across industry employers and employees would be asked to
the Obesity Check
complete the Obesity Check to support
campaign. Additionally companies and trade unions could be
asked if
they could commit specific resources or capital
towards promoting the Obesity Check campaign as part of their
corporate social responsibility.

5.7.1
The private sector can be a significant player, espe-
cially as many companies operate globally and can transfer
policies at all levels and across nations within one company.
Corporate social responsibility could integrate a variety of part-
ners in working with local schools to support the educational
strategy to raise awareness of healthy eating or
increase
physical exercise. As a safeguard, consultation must initially
take place to discuss potential conflicts of interests.

The

retailers,

food industry,

5.7.2
catering companies,
sporting-goods manufacturers, advertising and recreation busi-
nesses, insurance and banking groups, pharmaceutical compa-
nies and the media all have important parts to play as respon-
sible employers and as advocates for healthy lifestyles. All
could become partners with governments and NGOs in imple-

5.8 Food industry

5.8.1
Food manufacturers have proactively worked to create
many initiatives to reduce the fat, sugar and salt content of
processed foods, to reduce portion sizes and to increase the
introduction of innovative, healthy, and nutritious choices.

5.8.2
The industry is aware food advertising affects choices
and influences dietary habits and it must ensure advertisements
do not exploit children's inexperience or credulity. Govern-
ments should work with consumer groups and the private
sector to develop appropriate multisectoral approaches to deal
with the marketing of food to children, with such issues as
sponsorship, promotion and advertising. Together, an agree-
ment on socially responsible practices should be developed that
does not eliminate freedom of choice but accepts that children
cannot identify nutritional content.

5.8.3
Current plans to discuss rapid simplistic measures
such as ‘traffic light’ indicators on food should be discouraged.
Recommendations must be consulted with the food industry
and consumers before implementation. This can be supported
with media literacy inputs,
including information on under-
standing food labels and advertising messages provided at the
point of sale and through schools and adult education organisa-
tions.

5.8.4
Consumers require accurate, standardized and compre-
hensible information on the content of food items in order to
make healthy choices. Governments may require information
to be provided on key nutritional aspects, as proposed in the
Codex Guidelines on Nutrition Labelling.

5.8.5
As consumers' interest in health grows, and increasing
attention is paid to the nutritional aspects of food, producers
increasingly use health-related messages. Such messages must
not mislead the public about benefits or risks.

5.8.6
be supported by civil society organisations, include:

Recommendations to the food industry, which could

— promote healthy lifestyles in accordance with European

guidelines and the overall aims of the global strategy;

— limit the levels of saturated fats, trans-fatty acids, free sugars

and salt in products;

— continue to develop and provide affordable, healthy and

nutritious choices to consumers;

— provide consumers with adequate and understandable

product and nutrition information;

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— practise responsible marketing that supports Obesity Check,
particularly with regard to the promotion and marketing of
foods high in saturated fats, sugars, or salt, especially to
children;

— issue simple, consistent

food labels and evidence-based
health claims that help consumers to make informed and
healthy choices;

— provide information on food composition to national

authorities;

— assist in developing and implementing healthy eating and

physical activity programmes.

5.9 Agriculture

tuent organisations. The valuable work of such organisations at
community level is recognised and essential for any initiative to
succeed.

5.11.2 Many people believe that dealing with obesity is a
personal responsibility. In part they are right, but it is addition-
ally a society responsibility, especially at the grass-roots com-
munity level. Civil society and NGOs have an important role to
play to motivate a proactive attitude and influence action
through joined up thinking and local initiatives. These could
simply include schools using sport association facilities, local
media promoting local campaigns, local manufactures working
with local authorities to provide education support,
local
farmers providing fresh produce for schools. Their aim can be
to ensure that healthy foods are Available, Affordable, Appro-
priate and Sustainable.

National

5.9.1
food and agricultural policies should be
consistent with the protection and promotion of public health.
Policies should be considered that facilitate the adoption of a
healthy diet covering food safety and sustainable food security.

5.11.3
NGOs can support the strategy effectively if they
collaborate with national and international partners, particu-
larly in:

5.9.2
Prices influence consumption choices. Public policies
through taxation, subsidies or direct
can influence prices
pricing in ways that encourage the consumption of health-
enhancing foods.

5.10 Media

The media industry has one of the most influential
5.10.1
roles to play as it filters into everyday life, often subliminally. A
commitment from all media channels to work together on a
single European ‘campaign’ and promote it to their audiences
simply and consistently over a sustained period would ensure
that campaign message would eventually reach every indivi-
dual in Europe.

— leading

grass-roots mobilisation and advocating

that

healthy lifestyles should be placed on the public agenda;

— supporting the wide dissemination of

information on
prevention of obesity through balanced, healthy diets and
physical activity;

— forming networks and action groups to promoting the
availability of healthy foods and possibilities for physical
activity, and advocate health-promoting programmes and
education campaigns;

— organising campaigns and events that stimulate action;

5.10.2
In a society where celebrities are hailed as role
models, including Olympic champions, more can be done to
involve them in conveying the ‘campaign’ message.

— emphasising the role of governments in promoting healthy
lifestyle, monitoring progress in achieving objectives and
working with other stakeholders such as private sector enti-
ties;

New media,

5.10.3
including computer games and the
internet, have crucial roles with young audiences especially as
their use is correlated to obesity increase.

— playing an active role in fostering implementation of the

EU Obesity Check campaign;

5.10.4
Product placement and product promotion in rela-
tion to movies should be carefully considered in relation to the
likely audience. This
in children's
viewing.

is particularly essential

— contributing to putting knowledge and evidence into prac-

tice;

— promoting role models and best practice particularly in
relation to the role of families and parents. It is essential
that role models focus on positive health and not body
image.

5.11 Society

NGOs and civil society organisations would be asked
5.11.1
to complete the Obesity Check. Organisations could be asked if
they could commit
including in kind,
specific resources,
towards promoting the campaign to their members and consti-

5.11.4
Patterns of physical activity and diets differ according
to sex, culture and age. Decisions about food and nutrition are
often made by women and are based on culture and traditional
diets. National strategies and action plans should thus be sensi-
tive to such differences.

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6. A Future without Action

6.1 The Human Cost

Childhood obesity is one of the most serious public
6.1.1
health problems facing the developed and,
increasingly, the
developing world. The obesity prevalence is increasing in chil-
dren of all ages.

6.1.2
Obese children suffer from a host of comorbidities,
some are immediately apparent and others serve as warning
signs of future disease. Although primary prevention is ulti-
mately the most effective strategy in curbing the epidemic,
treatment of those children who are currently obese is needed
to improve both their
immediate and long-term health
outcomes.

6.1.3
Obesity in youth is associated with a range of psycho-
social and medical complications. The most common conse-
quences are those related to psychosocial dysfunction and
isolation. Cross-sectional studies show an inverse rela-
social
tionship between weight and both self-esteem and body image,
particularly in adolescents. In adolescent girls, fear of excess
weight is related to body dissatisfaction, drive for thinness, and
bulimia.

6.1.4
The most important disease is type 2 diabetes —
causing circulatory disorders, kidney failure and blindness.
Some cancers (particularly breast cancer), cardiovascular disor-
ders including hypertension, respiratory disorders including
sleep apnoea, liver disease, depression, joint and skin problems
are all resultants of increased body fatness.

6.1.5
be reversible if the person loses weight.

Some effects of obesity on health outcome appear to

6.2 The Financial Cost

6.2.1
Obesity imposes a significant economic burden on
already strained health systems, and inflicts great costs on
society. Health is a key determinant of development and a
precursor of economic growth. The UK National Audit Office
quantifies the economic consequences to be circa £500m
annually in direct health costs and a further £2billion in wider
costs to the economy.

6.2.2
Obesity is widespread across the social classes, but is
especially common among socially disadvantaged groups, who
may have the least access to safe streets and parks, and who
may eat the lowest cost food products, which are often foods
with the most fats and sugars.

6.2.3
In developed societies, women who were overweight
in late adolescence and early adulthood are more likely to have
lower family incomes and lower rates of marriage. Further-
more, obese individuals may experience social rejection and
discrimination in the workplace.

6.2.4
Proactive actions and education now can ensure the
financial costs are reduced in later years to be invested for the
sustainable development of Europe.

6.3 Moving towards social responsibility

Anti-obesity measures are part of a move towards accepting
different levels of society share responsibility with due respect
for individual freedom. For example:

6.3.1 A t a p oli ti ca l le v e l

— An EU Commission and Member State governments with
bilateral communication strategies, responsible investment
or action-focused initiatives to discourage obesity.

— Education systems promoting healthy lifestyles.

— Health Services with resources to promote good health.

— Planning authorities promoting cycle route, green parks and

sports facilities.

6.3.2 In i ndu str y

— A food industry driven by consumers' need for affordable

nutritious foods.

— Retail trends which ensure good food is available to all,

even in deprived communities.

— Agriculture which provides abundant, affordable fresh and

wholesome produce.

— A transport industry which discourages excessive car use

and encourages safe walking and cycling.

— A media culture which discourages passive consumption

and promotes physical activity.

6.3.3 In soc i e ty

— A family-oriented culture where meals can be cooked and
shared at home, along with healthier meals in schools,
hospitals,
establishments and workplace
canteens.

service

social

— A change to sustainable consumption patterns, conserving

natural resources and promoting physical activity.

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— Safer urban environments with less crime and controlled

8. Questionnaire — Supporting EESC Own Initiative

traffic.

Opinion

— Greater equality and social inclusion to ensure every home

has access to healthy foods and safe leisure resources.

Obesity — A Society Responsibility

— Support for parents and carers to ensure they can make

healthy choices for themselves and their children.

This questionnaire is currently for research purposes only but
completion and its return is appreciated.

Governments are elected by the people; people are
6.3.4
major influencers in societies, as individuals, groups or organi-
sations, and can make a difference. The costs do not always
have to be financial. Together change can be made once the
blame stops and responsibility is accepted.

The industrialised world in the twenty-first century provides an
environment highly conducive to obesity. Some causes are
obvious, many are less understood, most are not viewed by
society as detrimental. Of greatest concern is the lack of fore-
sight for future generations and the desire of no one to take
ownership or responsibility, but instead to blame others.

7. Conclusion

— 14 million overweight children including 3 million

obese in EU25

— In many EU countries more than half the adult popula-
tion is overweight, 20-30 % of adults are categorised as
obese

Obesity is a ‘Gordian knot’ mixing psychological, sociological,
economical, cultural, historical aspects and individual beha-
viours.

— The number of EU children affected by overweight
and obesity is rising at more than 400,000 a year and
affects almost 1 in 4 across the entire EU25

In 1997 the WHO declared morbid obesity a disease and in
2005 classed obesity as a disease. Morbid obesity and obesity
are associated with increased mortality due to comorbidities
like type II diabetes, hypertension and heart disease.

A unique opportunity exists to formulate and imple-
7.1
ment an effective strategy for substantially reducing deaths and
disease by improving diet and promoting physical activity.
Evidence for the links between these health behaviours and
later disease and ill-health is strong. Effective interventions to
enable people to live longer and healthier lives, reduce inequal-
ities, and enhance development can be designed and imple-
mented through a simple and clear campaign that involves, and
includes, everyone, and which will be subject to a posteriori
assessment.

7.2
Bringing about changes in dietary habits, patterns of
require the
physical activity and a healthy lifestyle will
combined efforts of many stakeholders, public and private,
over several decades. A change in mentality, awareness raising
and education via a combination of sound and effective actions
are needed at all levels, with psychological support, close moni-
toring and evaluation of their impact. Additionally, individuals
will have to take ownership and responsibility for change.

7.3
By mobilising the full potential of civil society together
with the major stakeholders, this vision can become a reality.
‘You must be the change you want to see’ Gandhi.

— 10-20 % of children in northern Europe are over-
weight, in southern Europe and the UK the prevalence
is 20-35 %

In the short term — completed questionnaires prove a commit-
ment and willingness of individuals and organisations to raise
awareness, educate and inform others of the need for lifestyle
changes. Targets can be measured by the amount of time, or
resources pledged to the campaign. Examples of best practice
can be forwarded to the rapporteur.

in a
The EESC opinion takes an approach to ‘include all’
strategy to combat the problem together. To take ‘top down’
policies, accompanied with bottom up strategies, creating
action horizontally and vertically, with everyone making a
commitment, financially, in time or in kind.

I would like to gauge your commitment, and that of your orga-
nisation's and would welcome you forwarding this to others
who may wish to comment/commit.

Please return the questionnaire to madi.sharma@esc.eu.int or
fax to 0115 9799333, or mail Madi Sharma, EESC, c/o 40
Ridge Hill, Lowdham, Notts. NG14 7EL, UK.

The following questionnaire has been produced to ask indivi-
duals and organisations
to commit a personally selected
amount of time, or resource, to spend within their organisa-
tions, or external bodies, supporting the work of DG SANCO
in promoting a campaign to raise the awareness of a healthy
lifestyle. It is important that this can be quantified to monitor
progress.

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For example:

— Employers and employer organisations could consider heal-
thier lifestyles within the workplace, including encouraging
choice of healthy foods, especially for vending machine
produce, and the introduction of sports facilities or gyms.
this could be supporting and
For
smaller companies
encouraging employees
lifestyles.
to consider healthier
Working outside of their companies, particularly in educa-
tion would also be valuable. A time commitment of x
hours per month.

— Trade unions and employee organisations could disseminate
a similar message to their members, to empower employees
to integrate physical activity, walking or cycling, into their
daily routine. Additionally, they could take advice back to
their families and communities.

— NGOs

and particularly consumer organisations
could
commit
time with their members and help spread the
message further a field into other institutions and commu-
nities.

— Individuals can commit to lifestyle changes as role models
via increased physical exercise, or healthier eating options.
This can be promoted by word of mouth and encouraging
others to also try changes. This would be particularly bene-
ficial within the family environment. Dedicate 15 minutes a
month to sharing your changes with others.

I am committing 30 minutes a month to work with schools to
raise the awareness of a healthy lifestyle and with women's
organisations to help spread the message to parents. I am also
promoting my lifestyle changes having lost 10kg through
walking and nutritional monitoring.

Brussels, 28 September 2005.

The President

of the European Economic and Social Committee

Anne-Marie SIGMUND