Green Paper - "Promoting healthy diets and physical activity : a European dimension for the prevention of overweight, obesity and chronic diseases"
Date: 2005-12-08
Institutions: European Commission
Subjects: consumer information, nutritional disease, public awareness campaign, public health

COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 08.12.2005 
COM(2005) 637 final 

GREEN PAPER  

"Promoting healthy diets and physical activity: a European dimension for the 
prevention of overweight, obesity and chronic diseases" 

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TABLE OF CONTENTS 

I. 

II. 

III. 

IV. 

State of play at European Level ................................................................................... 3 

Health and Wealth........................................................................................................ 4 

The Consultation Procedure......................................................................................... 4 

Structures and Tools at Community Level .................................................................. 5 

IV.1. 

European Platform for Action on Diet, Physical Activity and Health......................... 5 

IV.2. 

European Network on Nutrition 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 health education at the work place................ 9 

V.5. 

Building overweight and obesity prevention and treatment into health services......... 9 

V.6. 

Addressing the obesogenic environment ................................................................... 10 

V.7. 

Socio-economic inequalities ...................................................................................... 10 

V.8. 

V.9. 

Fostering an integrated and comprehensive approach towards the promotion of healthy 
diets and physical activity .......................................................................................... 10 

Recommendations for nutrient intakes and 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 

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GREEN PAPER 

“Promoting healthy diets and physical activity: a European dimension for the prevention 
of overweight, obesity and chronic diseases” 

I. 

I.1. 

I.2. 

I.3. 

I.4. 

I.5. 

I.6. 

I.7. 

STATE OF PLAY AT EUROPEAN LEVEL 

Unhealthy diets and lack of physical 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). 

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 healthy diets and physical activity3.  

The Community has a clear competence in this area: Article 152 of the Treaty requires 
that  a  high  level  of  human  health  protection  be  ensured  in  the  definition  and 
implementation  of  all  Community  policies  and  activities.  A  number  of  areas  of 
Community policy are relevant to nutrition and physical activity, and the Council has 
confirmed the need to mainstream nutrition and physical activity into relevant policies 
at the European level4. 

Action  at  national  level  may  usefully  be  complemented  at  the  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  best  practice  and  thereby  contribute  to  the 
overall impact of Member State initiatives. 

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,  national  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 Paper7. 

The European  Economic and Social Committee underlined that action at Community 
level  can  reinforce  the  effect  of  initiatives  taken  by  national  authorities,  the  private 
sector and NGOs8. 

A  number  of  Member  States  are  already  implementing  national  strategies  or  action 
plans in the field of diet, physical activity and health9. Community action may support 
and complement these activities, promote their coordination, and help to identify and 
disseminate good practice, so that other countries can benefit from experience gained. 

(i) 

References are grouped in Annex 3 at the end of the document 

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II. 

HEALTH AND WEALTH 

II.1. 

II.2. 

II.3. 

II.4. 

Apart from the human suffering it causes, the economic consequences of the increasing 
incidence of obesity are of particular importance. 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 rising obesity trends. Although detailed 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  direct  health  care  cost  of  at  least  GBP 
500  million.  The  wider  costs  to  the  economy,  which  include  lower  productivity  and 
lost output, were estimated at a further GBP 2 billion per year11. The 2004 report from 
the United Kingdom’s Chief Medical Officer on the impact of physical activity and its 
relationship  to  health  estimated  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 disability and premature mortality. 

An analysis made by the Swedish Institute of Public Health concludes that in the EU, 
4.5%  of  disability-adjusted  lifeyears  (DALYs)  are  lost  due  to  poor  nutrition,  with  an 
additional  3.7%  and  1.4%  due  to  obesity  and  physical  inactivity  –  a  total  of  9.6%, 
compared with 9% due to smoking16.  

A  recent  report  by  the  Netherlands  Institute  for  Public  Health  and  the  Environment, 
RIVM,  examined  unfavourable  dietary  composition  and  health  loss.  One  of  the 
conclusions is that an excessive intake of the 'wrong' type of fats, such as saturated and 
trans fatty acids, increases the likelihood of developing cardiovascular 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. 

Tackling overweight and obesity therefore is not only important in public health terms, 
but will also reduce the long-term costs to health services 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  risks,  curbing  health  care  spending,  and 
improving the competitivity of Member States’ economies. 

III. 

THE CONSULTATION PROCEDURE 

III.1.  As  announced  in  the  Communication  “Healthier,  safer,  more  confident  citizens,  a 
Health and Consumer Strategy”18, the Commission is preparing a series of Community 
strategies  to  tackle  the  most  important  health  determinants,  including  nutrition  and 
obesity.  In  this  context,  the  present  Green  paper  aims  at  opening  a  broad-based 
consultation  process  and  at  launching  an  in-depth  discussion,  involving  the  EU 

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institutions,  Member  States  and  the  civil  society,  aiming  at  identifying  the  possible 
contribution at Community level of promoting healthy diets and physical activity.  

III.2. 

The Commission calls on all interested organisations to submit responses to the issues 
raised  in  this  Green  Paper,  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-NUTRITIONGREENPAPER@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 level. In particular, responses are expected 
from  economic  operators  on  issues  within  their  specific  area  of  interest  (e.  g. 
advertising and marketing, labelling…), patient 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 their responses, or parts thereof, published on 
the  Commission’s  website  and/or  quoted  in  reports  analysing  the  outcome  of  the 
consultation process19. 

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  fall  primarily  under  the  competence  of  EU 
Member States (e. g. education, town planning); it should also contribute to determine 
where the EU could nevertheless provide added value, e.g. by supporting networking 
amongst stakeholders and disseminating good practice. 

IV. 

STRUCTURES 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 European Platform for Action on 
Diet, Physical Activity and Health was launched in March 2005. The Platform brings 
together  all  relevant  players  active  at  European  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 Platform 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  example  of  coordinated  but  autonomous  action  by 
different  parts  of  society.  It  is  designed  to  stimulate  other  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 Commission regards the Platform as 

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the  most  promising  means  of  non-legislative  action,  as  it  is  uniquely  placed  to  build 
trust  between  key  stakeholders.  First  results  from  the  Platform  are  encouraging: 
involvement  of  other  Community  policies  is  strong,  Platform  members  are  planning 
far-reaching  commitments  for  2006,  and  a  joint  meeting  with  US  stakeholders  will 
contribute  to  exchanging  good  practice.  Moreover,  agreement  has  been  secured  by 
Sports Ministers to offer support to the Platform. A first evaluation of the outcomes of 
the Platform will take place mid-2006 20. 

IV.2.  European Network on Nutrition and Physical Activity 

IV.2.1.  A network on Nutrition and Physical Activity 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 prevent diet-related diseases, 
to promote physical activity and to fight overweight and obesity. The Network will be 
closely involved in analysing the feedback 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,  enterprise,  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  mechanisms  are  currently  operating  in  order  to 
ensure that health is taken into consideration in other Community policy areas: 

•  on  major  policy  proposals  from  other  Commission  services,  the  Health  and 

Consumer Protection Directorate-General 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? 

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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  collecting  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 activity and obesity.  

IV.4.2.  Under  the  health  determinants  strand,  the  Programme  is  supporting  pan-European 
projects  aimed  at  promoting  healthy  nutrition  habits  and  physical  activity,  including 
cross cutting and integrative approaches which foster the integration of approaches on 
lifestyles,  integrate  environmental  and  socio-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  action  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  impact  of  nutrition  on  health)  with  scientific  advice  and 
assistance (on the role of EFSA in the establishment of food-based dietary guidelines, 
cf section V.9 below).  

V. 

AREAS 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  nutritional  content  of  products  is  an  important  element  in 
this  respect.  Clear,  consistent  nutrition  information  about  foods  can,  along  with 
relevant  consumer  education,  act  as  the  foundation  of  informed  dietary  choice.  With 
this objective, the Commission has submitted a proposal for a regulation to harmonise 
the rules on nutrition on health claims25. This includes the principle of setting nutrient 

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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  children,  are  not  exploited.  This  regards  in 
particular  advertising  for  foods  high  in  fat,  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 means of choice in this field, as it has a 
number of advantages over regulation in terms 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 

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? 

in  self-regulation  be  defined, 

V.2. 

Consumer education 

V.2.1. 

Improving public knowledge on the relationship between diet and health, energy intake 
and output, on diets that lower risk of chronic diseases, and on healthy choices of food 
items,  is  a  prerequisite  for  the  success  of  any  nutrition  policy,  whether  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  education  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-determining  health  risks  at  adult  age  are  made  during 
childhood and adolescence; it is therefore vital that children be guided towards healthy 

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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  also  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  children  are  exposed  to  conflicting  messages,  health  education 
efforts by parents and in schools need to be supported by efforts from the media, health 
services,  civil  society  and  relevant  sectors  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 and health education at the work place 

V.4.1.  Work  places  are  a  setting  which  has  a  strong  potential  to  promote  healthy  diets  and 
physical  activity.  Canteens  that  offer  healthy  choices,  and  employers  who  foster 
environments  which  facilitate  the  practice  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  diet,  physical  activity  and  health,  and  for 
inducing necessary lifestyle changes. Patients could receive important stimuli for such 
changes if health professionals included in routine contacts practical advice to patients 
and families on the benefits of optimal diets and increased levels of physical activity. 
Obesity treatment options need also to be addressed28. 

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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 daily 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, cycling 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  individual  preferences  and  socio-economic 
factors29. Social position, income and education are determinants of diet and physical 
activity.  Certain  neighbourhoods  could  discourage  physical  activity,  lack  recreation 
facilities and affect the disadvantaged more than those who can afford or have access 
to transportation. Lower levels of education 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  comprehensive  approach  towards  the  promotion  of 
healthy diets and physical activity 

V.8.1.  A  coherent  and  comprehensive  approach  aimed  at  making  the  healthy  choices 
available, affordable and attractive involves taking account of mainstreaming nutrition 
and physical activity into all relevant policies at local, regional, national and European 
levels,  creating  the  necessary  supporting  environments,  and  developing  and  applying 
appropriate  tools  for  assessing  the  impact  of  other  policies  on  nutritional  health  and 
physical activity30. 

V.8.2.  The  prevalence  of  chronic  conditions  related  to  diet  and  physical  activity  can  vary 
greatly  between  men  and  women,  age  groups,  and  between  socio-economic  strata. 
Moreover, dietary habits, as well as physical activity behaviours, are often embedded 

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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  recommendations  on  population  nutrient 
intake  and  physical  activity  goals  in  relation  to  the  prevention  of  major  non- 
communicable diseases.  

V.9.2.  The  Eurodiet  project32  has  proposed  quantified  population  goals  for  nutrients,  and 
underlines  the  need  for  these  to  be  translated  into  food-based  dietary  guidelines 
(FBDGs).  FBDGs  need  to  be  based  on  customary  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  substances  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  advice  into  guidance  on  the  contribution  of 
different  foods  to  an  overall  diet  that  would  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,  Physical  Activity  and  Health,  the  EU  supports 
the view that general consideration should be given to how nutrition issues should be 
integrated into Codex work, while retaining the current mandate of Codex. 

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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  where  rising  levels  of 
overweight and obesity are of concern35. 

Questions on which the Commission invites contributions include: 

–  Under  which  conditions  should 

in  exchanging 
experience and identifying best practice between the EU and non-EU countries? 
If so, through which means? 

the  Community  engage 

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. 

NEXT STEPS 

VI.1. 

VI.2. 

The Commission services will carefully analyze all contributions received in reply to 
the  consultation  process  launched  by  the  present  Green  Paper.  It  is  expected  that  a 
report summarizing  the  contributions  will be published on the Commission’s website 
by June 2006. 

In the light of the results of the consultation process, the Commission will reflect upon 
the  most  appropriate  follow-up,  and  will  consider  any  measures  that  may  need  to  be 
proposed, as well as the instruments for their implementation. Impact assessment will 
be carried out as appropriate, depending on the type of instrument chosen. 

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ANNEX 1  

Figures 

and Tables 

Table 1 
Prevalence estimates of diabetes mellitus 

Country 

Austria 

Belgium 

Cyprus 

Czech Republic 

Denmark 

Estonia  

Finland 

France  

Germany 

Greece 

Hungary 

Ireland 

Italy  

Latvia 

Lithuania 

Luxembourg 

Malta 

Netherlands 

Poland  

Portugal  

Slovakia 

Slovenia  

Spain 

Sweden  

estimate 2003 

estimate 2025 

prevalence (%)  prevalence (%) 

9.6

4.2

5.1

9.5

6.9

9.7

7.2

6.2

10.2

6.1

9.7

3.4

6.6

9.9

9.4

3.8

9.2

3.7

9.0

7.8

8.7

9.6

9.9

7.3

11.9 

5.2 

6.3 

11.7 

8.3 

11.0 

10.0 

7.3 

11.9 

7.3 

11.2 

4.1 

7.9 

11.1 

10.8 

4.4 

11.6 

5.1 

11.0 

9.5 

10.7 

12.0 

10.1 

8.6 

United Kingdom
source: Diabetes Atlas, 2nd edition, International Diabetes 
Foundation 2003 

3.9

4.7 

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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

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Table 2 - Overweight and obesity among adults in the European Union 

Males 

Females 

Country 

of 

Year 
Data 
Collection 

%BMI1 
25-29.9 

%BMI≥30  %Com-

bined 
BMI ≥25 

%BMI 
25-29.9 

%BMI 
≥30 

%Combined 
BMI≥25 

Austria 

1999 

Belgium 

1994-7 

40 

49 

10 

14 

Cyprus 

1999-2000 

46 

26.6 

Czech 
Republic 

1997/8 

48.5 

24.7 

Denmark 

1992 

39.7 

12.5 

England2 

2003 

43.2 

22.2 

Estonia 
reported) 

(self 

1994-8 

35.5 

9.9 

Finland 

1997 

48 

19.8 

France 
reported) 

(self 

2003 

37.4 

11.4 

Germany 

2002 

52.9 

22.5 

Greece 

1994-8 

51.1 

27.5 

Hungary 

1992-4 

41.9 

21 

Ireland 

1997-99 

46.3 

20.1 

Italy 
reported) 

(self 

1999 

Latvia 

1997 

41 

41 

9.5 

9.5 

Lithuania 

1997 

41.9 

11.4 

Luxembourg 

45.6 

15.3 

Malta 

1984 

46 

22 

50 

63 

72.6 

73.2 

52.2 

65.4 

45.4 

67.8 

48.8 

75.4 

78.6 

62.9 

66.4 

50.5 

50.5 

53.3 

60.9 

68 

27 

28 

14 

13 

34.3 

23.7 

41 

41 

58 

31.4 

26.2 

57.6 

26 

11.3 

37.3 

32.6 

23. 

55.6 

26.9 

15.3 

42.2 

33 

19.4 

52.4 

23.7 

11.3 

35 

35.6 

23.3 

58.9 

36.6 

38.1 

74.7 

27.9 

21.2 

49.1 

32.5 

15.9 

48.4 

25.7 

9.9 

35.6 

33 

17.4 

50.4 

32.7 

18.3 

51 

30.7 

13.9 

44.6 

32 

35 

67 

Netherlands 

1998-2002 

43.5 

10.4 

53.9 

28.5 

10.1 

38.6 

1 

2 

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 considered overweight, persons with a BMI >30 are considered obese 
Data  from  Health  Survey  for  England,  which  does  not  include  data  for  Scotland,  Wales  and  Northern 
Ireland 

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15 

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Poland 
report) 

Portugal 
(urban) 

(self 

1996 

n/a 

10.3 

n/a 

n/a 

12.4 

n/a 

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 

Sweden 
(adjusted) 

1996-7 

41.2 

10 

58.9 

51.2 

31.6 

15.3 

46.9 

29.8 

11.9 

41.7 

Age range and year of data in surveys may differ. With the limited data available, prevalences 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) 

30

25

20

15

10

5

0
1960

USA

Spain

Netherlands

Germany

England

Poland
France

Czech R.

1970

1980

1990

2000

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1. 

2. 

3. 

4. 

5. 

6. 

7. 

ANNEX 2 - Relationship between diet, physical activity and health 

The  relationship  between  diet,  physical  activity  and  health  has  been  scientifically 
established, in particular regarding the role of lifestyles as determinants of chronic non-
communicable diseases and conditions such as obesity, heart disease, type 2 diabetes, 
hypertension, cancer and osteoporosis36. 

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. 

Cardiovascular diseases (CVD) are together with cancer the most important causes of 
death and disease in Europe. Stopping smoking, increasing physical activity levels and 
adopting  healthier  diets  are  the  most  important  factors  in  the  primary  prevention  of 
CVD. The key recommendations for CVD prevention are maintenance of normal body 
weight, moderate physical activity of 30 minutes or more every day and avoidance of 
excess consumption of saturated fatty acids and salt.  

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.  Consumption  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. 

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  will  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  later  in  life.  The  joint  WHO/FAO  expert 
consultation40 concludes that dietary and lifestyle recommendations developed for the 
prevention of other chronic diseases may prove helpful to reduce osteoporosis risk.  

The  World  Health  Report  200241  describes  in  detail  how  a  few  major  risk  factors 
account  for  a  significant  proportion  of  all  deaths  and  diseases  in  most  countries  (cf 
figure 1, Annex 1). Six out of the seven most important risk factors for premature death 
(blood pressure, cholesterol, Body Mass Index, inadequate fruit and vegetable intake, 
physical inactivity, excessive alcohol consumption) 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. 

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  foods;  increased  saturated  fat  intake  (mostly 
from  animal  sources)  and  excess  intake  of  hydrogenated  fats;  reduced  intakes  of 
complex  carbohydrates  and  dietary  fibre;  reduced  fruit  and  vegetable  intakes;  and 

EN 

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8. 

9. 

10. 

11. 

12. 

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. 

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  physical  activity  therefore  has  an  enormous  potential  for  the 
prevention of severe morbidity and mortality.  

Obesity (BMI42 >30) is a risk factor for many serious illnesses including heart disease, 
hypertension, stroke, type-2-diabetes, respiratory 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, and is a major public health concern. 

Evidence from population surveys suggests that obesity levels in the EU have risen by 
between  10-40%  over  the  past  decade,  and  current  data  suggest  that  the  range  of 
obesity  prevalence  in  EU  countries  is  from  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  health  to  the  population  as  a  whole  due  to 
unhealthy  diets  and  inactivity  is  extraordinarily  high:  a  small  increase  in  Body  Mass 
Index (BMI), e. g. from 28 to 29, will increase the risk of morbidity by around 10 % 47. 

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  affects  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 increases49. 

The  factors  underlying  the  onset  of  obesity are  widely  known  (high  intake  of  energy 
dense micronutrient poor foods or sedentary lifestyles are the most convincing factors 
determining obesity risk; high intake of sugars 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 lowering obesity risk; breastfeeding and home 
or school environments supporting healthy food choices for children are also probable 
lowering factors). It should however 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 fat mass between individuals is determined by 
genetic factors, environmental factors remain important and determine the expression 

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13. 

14. 

15. 

16. 

17. 

18. 

of these genes in individuals; addressing the “obesogenic environment” (cf section V.6) 
therefore has a strong potential to curb obesity51. 

While the effects of diet and physical activity on health often interact, particularly in 
relation  to  obesity,  there  are  additional  health  benefits  from  physical  activity  that  are 
independent of nutrition and diet. Likewise, there are significant nutritional risks that 
are unrelated to obesity. 

Weight gain in an individual is the result of an excess of energy consumed as food over 
energy  expenditure.  There  is  a  strong  tendency  for  excess  weight  to  continue  to 
accumulate from childhood through to middle age. It is therefore important to achieve 
an  optimum  body  weight  throughout  life  through  proper  diet  and  daily  physical 
activity. In addition to promoting overall feelings of wellbeing and apart from weight 
management  aspects,  physical  exercise  has  also  independent  positive  effects  on  the 
prevention  of  diseases  such  as  cardiovascular  disease,  type  II  diabetes,  osteoporosis 
and depression, and contributes to maintaining muscular strength in older age. 

To  maintain  cardiovascular  health,  the  recommended  daily  amount  of  exercise  is  at 
least 30 minutes for most of the days of the 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. However, all physical activity increases energy 
consumption and contributes to weight management52. 

A 2003 Eurobarometer survey53 showed that around 60 % of Europeans (EU 15) had 
no vigorous physical activity at all in a typical week, and more than 40 % did not even 
have moderate physical activity in a typical week. Europe-wide, only about one third 
of  schoolchildren  appear  to  be  meeting  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 generally observed “clustering of good habits”.  

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  Global  Strategy  underlines  the  importance  of 
achieving  a  balanced  diet  reducing  the  consumption  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. 

The  Community  has  actively  supported  the  WHO  Global  Strategy  process  since  its 
beginning.  The  Global  Strategy  can  serve  as  an  extremely  valuable  input  in  the 
development of a comprehensive Community action on nutrition and physical activity, 
and  active  use  should  be  made  of  the  scientific  evidence  underpinning  it56  when 
building the rationale for a broad Community strategy in this area. 

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ANNEX 3 – References 

1  

2 

3 

4 
5 

6 
7 
8 

9 

10 

11 

12 

13 
14 

15 

16 

17  

information  and 

lifestyles:  education, 

Council  Conclusions  of  2  December  2003  on  healthy 
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/life_style/nutrition/documents/ev_20050602_en.pdf 
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   
Council conclusions on obesity, nutrition and physical activity (adopted on 03.06.2005) 
http://europa.eu.int/comm/health/ph_determinants/life_style/nutrition/documents/ev_20050602_en.pdf 
Council conclusions on obesity, op. cit. 
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 
Council conclusions on obesity, op. cit. 
Council conclusions on obesity, op. cit. 
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 
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  Strategies  to  counter  obesity,  involving  Public 
Administrations, independent experts, the food industry, 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 obesity 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  policy  (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 
2004 
health: 
(http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/Publicatio
nsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4094550&chk=aN5Cor).  Germany  established  a 
national platform for nutrition and physical activity (http://www.ernaehrung-und-bewegung.de/). 
Obesity – preventing and managing the global epidemic. Report of a WHO Consultation. Geneva, World 
Health Organization, 1998 (Technical Report Series, No. 894) 
National Audit Office (2001), Tackling obesity in England 
http://www.nao.org.uk/publications/nao_reports/00-01/0001220.pdf. 
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 
Obesity -  the Policy Challenges: the Report of the National Taskforce on Obesity.  Dublin 2005 
Finkelstein,  E.  A.  et  al.,  (2004).  State-level  estimates  of  annual  medical  expenditures  attributable  to 
obesity. Obesity Research, 12, 18-24 
Finkelstein EA, et al., (2003), National Medical Spending 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 
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 
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 

November 

healthier 

released 

making 

choices 

easier, 

in 

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18 
19 

20 

21 

22 

23 

24 
25 

26 

27 

28 

29 

30 

31 

32  

33 

34 

in 

the 

internet 

following 

the  work  of 

information  on 

is  available  at 

the  context  of  education  and  as  a  means  of 

COM (2005) 115 http://europa.eu.int/eur-lex/lex/LexUriServ/site/en/com/2005/com2005_0115en01.pdf   
A  report  on  the  contributions  received  will  be  published  on  the  Commission’s  website  at  the  following 
address: 
http://europa.eu.int/comm/health/ph_determinants/life_style/nutrition/green_paper/consultation_en.htm 
Further 
the  Platform 
address:http://europa.eu.int/comm/health/ph_determinants/life_style/nutrition/platform/platform_en.htm 
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.   
i.  a.  the  Working  Party  'Lifestyle  and  other  Health  Determinants'  aims  at  improving  the  availability  of 
comparable  information  on  nutritional  habits  and  physical  activity  levels  in  Europe.  Its  Scientific 
Secretariat can be contacted at [public.health@mailbox.tu-dresden.de] 
Numerous  Commission  financed  projects  in  particular  under  the  former  Cancer,  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/life_style/nutrition/documents/nutrition_report_en.pdf) 
http://europa.eu.int/eur-lex/lex/LexUriServ/site/en/com/2005/com2005_0115en01.pdf 
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 
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 
cf also Universität Paderborn, et al. (2004): "Study on young people’s lifestyles and sedentariness and the 
role  of  sport 
the  balance" 
http://europa.eu.int/comm/sport/documents/lotpaderborn.pdf 
these include dietary therapy (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-related  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) 
Food and health in Europe: a new basis for action, WHO regional publications. European series  No. 96, 
2004 
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/) 
Diet, Nutrition and the Prevention of Chronic Diseases, op. cit. The recommendations include: Achieve 
energy balance for weight control; Substantially increase levels of physical activity 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. 
EURODIET core report, op. cit.  
(http://europa.eu.int/comm/health/ph_determinants/life_style/nutrition/report01_en.pdf) 
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/pdfs/nutrientprofilingfullreport.pdf 
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, 

restoring 

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and promoting coordination of all food standards work undertaken by international governmental and non-
governmental organizations. http://www.codexalimentarius.net/web/index_en.jsp 
In this context, the scope for more proactive EU-US 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 started 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. 
cf  Diet,  Nutrition  and  the  Prevention  of  Chronic  Diseases,  Report  of  a  Joint  WHO/FAO  Expert 
Consultation, 2003 (http://www.who.int/dietphysicalactivity/publications/trs916/download/en/index.html) 
cf  Diabetes  action  now:  an  initiative  of  the  World  Health  Organisation  and  the  International  Diabetes 
Federation, 2004 
Doll R, Peto R. Epidemiology of cancer. In: Weatherall 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. 
Weight  control  and  physical  activity.  Lyon,  International  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. 
Diet, Nutrition and the Prevention of Chronic Diseases, op. cit. 
World  Health  Organization.  The  World  Health  Report:  2002:  Reducing  risks,  promoting  healthy  life, 
Geneva: World Health Organisation, 2002 
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 considered overweight, persons with a BMI >30 are considered obese 
International Obesity Task Force EU Platform Briefing Paper, March 2005 
The European Health Report, World Health Organisation, 2002 
Finland, Germany, Greece, Cyprus, the Czech Republic, Slovakia and Malta  
International Obesity Task Force EU Platform Briefing Paper, op. cit. 
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 health to the economy in the European Union, 
http://europa.eu.int/comm/health/ph_overview/Documents/health_economy_en.pdf 
Childhood Obesity Report, International Obesity Task Force (IOTF), May 2004 
International Obesity Task Force EU Platform Briefing Paper, op. cit. 
G Barsh, IS Farooqi and S O’Rahilly: Genetics of body weight regulation; Nature 2000;404:644-651 
DIABESITY project funded under the EU’s 6th RTD Framework Programme: 
http://www.eurodiabesity.org/ 
Diet, Nutrition and the Prevention of Chronic Diseases, op. cit. 
European  Commission  (2003)  Physical  Activity.  Special  Eurobarometer  183-6/  Wave  58.2-  European 
Opinion Research Group (EEIG. 
http://europa.eu.int/comm/public_opinion/archives/ebs/ebs_183_6_en.pdf) 
Health Behaviour in School-Aged Children survey, 2001/2002 
http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_R17-en.pdf 
Diet, Nutrition and the Prevention of Chronic Diseases, op. cit. 

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