Saturday 19th May 2018

Tackling Obesity Together

Points that policymakers should keep in mind

Europe is facing an obesity crisis of epidemic proportions that threatens to place a tremendous burden on its healthcare systems.

  • tot-policymakersObesity has been estimated to cost the European Union €70 billion annually through healthcare costs and lost productivity. [2]
  • The European Association for the Study of Obesity (EASO) found direct obesity-related costs ranging from 1.5–4.6% of health expenditure in France to around 7% in Spain.
  • There are forecasts that suggest that if European governments devoted all existing and future resources allocated to weight management to the most cost-effective approaches [3], they could save up to 60% in some European countries. [4]

The response of European governments to obesity is not working. It’s time for a new approach.

  • People who are overweight or who have obesity are a majority today in the OECD [5] area. The obesity epidemic continues to spread, and no country has seen a reversal of the trend since the epidemic began [6]
  • Governments need to take collective action now if the WHO Global Target 2025 of ‘no increase in childhood overweight’ is to be achieved. [7]

Preventing obesity must remain a priority. However, the growing prevalence of obesity is evidence that this approach alone cannot be entirely successful. [8]

  • The European Commission has been active in raising awareness and promoting healthy and active lifestyles in EU Member States, with policies and initiatives including:
    • EU platform for action on diet, physical activity and health (2005) [9]
    • “Strategy for Europe on nutrition, overweight and obesity related health issues” (2007) [10]
    • High Level Group on Nutrition and Physical Activity (2007) [11]
    • The EU Action Plan on Childhood Obesity 2014-2020 [12]
    • The European Council adopted Conclusions on Nutrition and Physical Activity (2014) [13]
  • But while acknowledging the importance of prevention in tackling the obesity epidemic, it is also important to provide available and effective treatment for the millions of Europeans who already have obesity.

Obesity needs to be more widely recognised in Europe as a chronic disease. 

  • Obesity is recognised as a chronic disease that requires long-term management by health organisations such as WHO [14], The Organisation for Economic Co-operation and Development (OECD) [15], The American Medical Association (AMA) [16] and the Canadian Medical Association (CMA) [17].
  • However, currently Portugal is the only European country that recognises obesity as a disease. [18]
  • MEPs should support and sign the extremely important Written Declaration that has been initiated in the European Parliament calling on the European Commission and European Council to work towards Europe-wide recognition of obesity as a chronic disease.

The EU has already recognised that obesity can constitute a disability.

  • In December 2014, the European Court of Justice ruled that obesity can be a disability when it causes long-term impairment. [19]

It is a concern that obesity is not widely recognised as a chronic disease as it is the gateway to many other diseases, including most NCDs (Non Communicable Diseases).

  • Obesity plays a central role in a person’s development of a number of risk factors and chronic diseases including type 2 diabetes, cardiovascular diseases, and certain cancers. [20]
  • Overweight and obesity are responsible for about 80% of cases of type 2 diabetes, 35% of ischaemic heart disease and 55% of hypertensive disease among adults in the European region [21]
  • The risk of developing more than one of these comorbidities greatly increases when body weight is elevated (BMI over 35 kg/m2).[22]

Greater recognition of obesity as a disease is needed to precipitate a shift in thinking of obesity as just a lifestyle choice, to a disease with an obligation to treat it as such.

  • Authorities in the EU must recognise that obesity is a complex and multifactorial chronic disease with numerous causes, many of which are largely beyond an individual’s control. Causes of obesity range from genetic [23] and endocrine [24]  conditions, to environmental factors [25] such as stress, diet and increasingly sedentary working patterns.
  • This vital recognition of obesity as a disease will help to ensure more resources are dedicated to much needed research, prevention and treatment [26] [27]; that encouragement is given to healthcare professionals to recognise obesity treatment as a necessary and valued professional specialty; and that there is a reduction in the stigma and discrimination experienced by the millions of people affected.

Failing to accept obesity as a disease contributes to stigma, shame, stress and ultimately the worsening health of patients.

  • A health policy that does not recognise obesity as a disease actively worsens the health of millions of European and is therefore not fit for purpose.

Obesity management is multidisciplinary by nature.

  • Obesity management requires co-operation between healthcare professionals with complementary expertise including dieticians, doctors, nurses, physiotherapists, psychologists, exercise physiologists and specialists in numerous related co-morbidities and conditions [28]. Delivering comprehensive treatment to people with obesity represents a real challenge for healthcare systems due to there being no medical specialism in obesity. [29]
  • We therefore ask member states and Chief Medical Officers to help advance the co-ordination of obesity management and research in Europe to the benefits of citizens, society and the economy.

For more information please also see the EASO Milan Declaration: A call to Action on Obesity.

 

References

[1] http://www.who.int/nutrition/topics/obesity/en/

[2] The University of Reading (UK), Research and Enterprise Services; European Commission Eatwell Report: http://cordis.europa.eu/result/rcn/53206_en.html

[3] The approaches examined were commercially provided behavioural based treatments that help people make and sustain changes to lifestyle and weight

[4] Erixon, F, Brandt, L et al, “Investing in Obesity Treatment to Deliver Significant Healthcare Savings: Estimating the Healthcare Costs of Obesity and the Benefits of Treatment,” ECIPE Occasional Paper, No. 1/2014. http://ecipe.org/publications/investing-obesity-treatment-deliver-significant-healthcare-savings-estimating-healthcare-costs-obesity-and-benefits-treatment/

[5] The Organisation for Economic Cooperation and Development has 34 Member countries that span the globe, from North and South America to Europe and Asia-Pacific. They include many of the world’s most advanced countries but also emerging countries like Mexico, Chile and Turkey.

[6] OECD Obesity update 2014. www.oecd.org/els/health-systems/Obesity-Update-2014.pdf

[7] L. Webber, D. Divajeva, T. Marsh et al, ‘The future burden of obesity-related diseases in the 53 WHO European-Region countries and the impact of effective interventions: a modelling study’, BMJ Open (2014) 4(7): http://bmjopen.bmj.com/content/4/7/e004787.full

[8] The question of the effectiveness of the obesity prevention strategy has been raised by MEP Hugues Bayet (S&D, BE) in a written question to the Commission, highlighting the fact that this is becoming a political issue.  4

[9] http://ec.europa.eu/health/nutrition_physical_activity/platform/index_en.htm

[10] http://ec.europa.eu/health/nutrition_physical_activity/policy/strategy_en.htm

[11] http://ec.europa.eu/health/nutrition_physical_activity/high_level_group/index_en.htm

[12] http://ec.europa.eu/health/nutrition_physical_activity/docs/childhoodobesity_actionplan_2014_2020_en.pdf

[13] http://www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/143285.pdf

[14] “Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting children as well as adults.” World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Technical Report Series 894, 2000; page 1 http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/

[15] OECD Obesity update 2014. www.oecd.org/els/health-systems/Obesity-Update-2014.pdf

[16] America Medical Association, ‘AMA Adopts New Policies on Second Day of Voting at Annual Meeting’, (2013): http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page

[17] https://www.cma.ca/En/Pages/cma-recognizes-obesity-as-a-disease.aspx

[18] https://www.dgs.pt/doencas-cronicas/a-obesidade.aspx

[19] European Court of Justice: http://curia.europa.eu/jcms/upload/docs/application/pdf/2014-12/cp140183en.pdf

[20] http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_part2.pdf. Page 17

[21] World Health Organisation. The challenges of obesity in the WHO region and the strategies for response, 2007

[22] Ikramuddin, S. Roux-en-y Gastric Bypass vs Intensive Medical Management for the control of type 2 diabetes, hypertension and hyperlipidemia: The Diabetes Survey Study Randominzed clinical trial. JAMA 2013 http://jama.jamanetwork.com/article.aspx?articleid=1693889

23] Genetics of obesity and the prediction of risk for health, Andrew J. Walley, Alexandra I.F. Blakemore and Philippe Froguel, 2006

[24] Obesity and endocrine disease, Kokkoris P, Pi-Sunyer FX. 2003

[25] http://www.who.int/mediacentre/factsheets/fs311/en/

[26] Healthcare matters are primarily the responsibility of EU member states and there is no unified law dictating that member states must treat recognised diseases, however recognition of obesity as a chronic disease would bring it under the purview of existing ‘chronic disease strategies’, and their associated budgets. At an EU level this would result in greater funding opportunities from EU initiatives and Joint Action under the Health Programme, particularly for research and innovation and more specific recommendations from the EU on addressing chronic diseases in Member States.

[27] http://www.idf.org/sites/default/files/Council_conclusions_7%20Dec%202010_Chronic%20Disease.pdf

[28] General practitioners’ and district nurses’ conceptions of the encounter with obese patients in primary health care

[29] European Association for the study of Obesity. An EASO position statement on multidisciplinary obesity management in adults.2014