Prevalence of excess body weight and obesity in children and adolescents: fact sheet No. 2.3, May 2007

Excess body weight and obesity in children and young people are on the rise in Europe and are major risk factors for chronic disease. The indicator measures their prevalence in a standardized way. It can be analysed in relation to action indicators in order to evaluate the effectiveness of policies and make com- parisons through a commonly defined measure. It also provides useful information about the impact of addressing risk factors such as the possibility of inadequate nutrition and lack of physical activity. The definition for excess body weight and obesity is based on the percentile values of body mass index (BMI) adjusted for age and gender corresponding to BMI of 25 and 30 kg/m2 at age 18 years (2). The prevalence of excess body weight (including obesity) in 13- and 15-year-olds is unacceptably high in the Region, ranging from 5% to almost 35% in some countries. All countries show a greater proportion of boys than girls being overweight. RATIONALE Prevalence of excess body weight and obesity in children FACT SHEET NO. 2.3 · MAY 2007 · CODE: RPG2_Hous_E2 KEY MESSAGE The indicator measures the prevalence of excess body weight and obesity in adolescents aged 13 and 15 years. Data were drawn from the Health Behaviour in School-aged Children (HBSC) 2001/2002 survey (1), which covers selected countries in the WHO European Region. The data were interpreted in the con- text of the environment and the relevance and context of policies. An assessment of the situation in the Region is given. Prevalence of excess body weight and obesity in children and adolescents Fact sheet 2.3 21.05.2007 23:38 Uhr Seite 1 PRESENTATION OF DATA Figures 1a and b show the average prevalence of obesity and excess body weight in 13- and 15-year-olds in 35 countries and sub-regions in the Region that participated in the HBSC 2001/2002 survey (1). The prevalence of over- weight and obese adolescents ranges from 3% to almost 35% in 13-year-olds and from 5% to 28% in 15-year-olds. HEALTH – ENVIRONMENT CONTEXT Obesity poses one of the greatest public health challenges for the 21st century; in the Region the prevalence of obesity has tripled in the last two decades – a particularly alarming trend. If no action is taken and it continues to increase at the same rate as in the 1990s, an estimated 150 million adults and 15 million children and adolescents in the Region will be obese by 2010 (3). Assuming the trends observed in 2006 continue on a linear basis, they would give a projection of approximately 41% of children in the eastern Mediterranean region and 38% of children in the Region as a whole being overweight (4). The trend in obesity is especially alarming in children and adolescents. The annual rate of increase in the prevalence of childhood obe- sity has been growing steadily and the cur- rent rate is ten times higher than it was in the 1970s. More than 60% of children who are overweight before puberty will be over- weight in early adulthood, which is of partic- ular concern as it will probably reduce the average age at which noncommunicable dis- eases become apparent, thus greatly increas- ing the burden on health services which will have to provide treatment during much of their adult life. Unhealthy diets and physical inactivity are the main contributors to excess body weight and obesity, which are among the leading risk fac- tors accounting for the burden of noncommu- nicable diseases. Excess body weight is respon- sible for more than 1 million deaths and the loss of 12 million disability-adjusted life-years (DALYs) in the Region every year. This and obesity are responsible for about 80% of adult cases of type 2 diabetes, 35% of cases of ischaemic heart disease and 55% of cases of hypertensive disease among adults in the Region. Excess body weight is also a risk factor for colon cancer, breast cancer, endome- trial cancer and osteoarthritis. Obesity also has a negative effect on psychosocial health and personal quality of life (5). The health consequences of being overweight during childhood are less clear, but a system- atic review shows that childhood obesity is strongly associated with risk factors for car- diovascular disease and diabetes, orthopaedic problems and mental disorders. A high BMI in adolescence predicts elevated adult mortal- ity and cardiovascular disease rates, even if the excess body weight is lost. Worryingly, children are now more frequently subject to many obesity-related health conditions once confined to adults (6). Effective obesity management requires an integrated multisectoral approach, including comprehensive long-term policy measures. Nutritional interventions in the school, workplace and community have proved moderately effective in preventing obesity. Dietary control can bring several benefits, but caution must be exercised as there may be negative consequences including loss of lean body mass, reduced linear growth and exacerbation of eating disorders. Strategies need to be integrated across food services, health education, physical education, play and sport and the participants should be involved in formulating policies. Weight maintenance regimes (with nutrition coun- selling) in combination with a heightened level of activity, more walking and the devel- opment of an activity programme can increase the effectiveness of obesity therapy. Even when these do not reduce obesity, they may reduce morbidity. Parental involvement in treatment programmes is necessary for successful weight loss among young children and, to a lesser extent, adolescents (7). Fig. 1a. Prevalence of excess body weight (including obesity) among 13-year-olds in countries of the WHO European Region, 2001/2002 0 5 10 15 20 25 30 35 Prevalence of excess body weight (%) Ukraine Lithuania Russian Federation Latvia Netherlands Denmark Switzerland Estonia Poland Sweden Czech Republic Belgium (Flanders) Croatia Belgium (Wallonia) France Ireland Germany Israel Austria Norway Hungary Slovenia Finland TFYR Macedonia* United Kingdom (Scotland) United Kingdom (England) Greece Portugal Italy United Kingdom (Wales) Spain Malta *TFYR Macedonia = The former Yugoslav Republic of Macedonia Source: Health Behaviour in School-aged Children (1). 13-year-old girls 13-year-old boys Fact sheet 2.3 21.05.2007 23:38 Uhr Seite 2 In 2004, the World Health Assembly in reso- lution WHA57.17 adopted the global strategy on diet, physical activity and health (8). The strategy contains recommendations for WHO and its Member States, international partners, nongovernmental organizations and the private sector to develop, implement and evaluate activities to combat the rise in noncommunica- ble diseases through a healthier diet and increased physical activity. The results of the implementation of the global strategy were pre- sented at the World Health Assembly in 2006. In 2004, the Fourth Ministerial Conference on Environment and Health adopted the Chil- dren’s Health and Environment Action Plan for Europe, which includes four regional priority goals to reduce the burden of environmental- related diseases in children (9). One of the goals (RPGII) aims to reduce the prevalence of excess body weight and obesity by implementing health promotion activities in accordance with the global strategy on diet, physical activity and health. The European Charter on counteracting obesity (10), adopted in November 2006 at the WHO European Ministerial Conference on Counter- acting Obesity, recognized the importance of both healthy nutrition and physical activity for preventing and reducing excess body weight and obesity. The Charter endorsed a vision of societies “where healthy lifestyles related to diet and physical activity are the norm” and “where healthy choices are made more accessible and easy for individuals”. Translated into action, this means not only the classic health promo- tion approaches but also the creation of oppor- tunities for daily physical activity, for example through the promotion of cycling and walking by better urban design and transport policies, or for balanced nutrition in school cafeterias. The Regional Office will also present the Sec- ond Action Plan on Food and Nutrition Policy to the WHO Regional Committee in September 2007 (11). This will address obesity and nutri- tion-related chronic diseases, micronutrient deficiencies, food insecurity and malnutrition and foodborne diseases. In 2005, the European Union (EU) launched the green paper (COM (2005) 637 final) on Pro- moting healthy diets and physical activity: A European dimension for the prevention of over- weight, obesity and chronic diseases (12) together with a consultation on the issues raised by the green paper, with the aim of identifying the possible contribution at Community level of promoting healthy diets and physical activity. The EU has also launched a platform for action on diet, physical activity and health (13). Under the leadership of the European Commission, the platform brings together stakeholders from commercial, professional, consumer and other civil organizations to take voluntary action to halt and, hopefully, reverse the rise in obesity, particularly among children. The spirit of the platform is to work under the leadership of the Commission and to provide an example, which others will choose to follow across Europe, of coordinated but autonomous action by differ- ent parts of society to deal with the many aspects of the problem. ASSESSMENT The prevalence of obesity and excess body weight ranges from 3% to 34% in 13-year- olds and from 5% to 28% in 15-year-olds across the Region. Boys have a higher preva- lence than girls in almost all European coun- tries, except for among 15-year-olds in Ireland where girls have a slightly higher prevalence. On average, the prevalence of obesity and excess body weight in 13-year-olds in the Region is 14.4% among boys and 9.3% among girls, and 8.2% and 6.0% among 15- year-olds, respectively. The high and increasing prevalence of excess body weight and obesity in children points to the need for comprehensive strategies to address the main driving forces of this health burden, including nutrition, physical activity and lifestyle. Action is needed at different lev- els: regional and international frameworks, social policies and national legislation, organi- zational and commercial practices, planning controls and regional strategies, community and cultural traditions, school and work prac- tices and peer influence, family habits and choices, and individual action. Fig. 1b. Prevalence of excess body weight (including obesity) among 15-year-olds in countries of the WHO European Region, 2001/2002 0 5 10 15 20 25 30 35 *TFYR Macedonia = The former Yugoslav Republic of Macedonia Source: Health Behaviour in School-aged Children (1). Prevalence of excess body weight (%) Lithuania Ukraine Russian Federation Poland Latvia Estonia Netherlands Ireland Switzerland Belgium (Wallonia) France Belgium (Flanders) Czech Republic Austria Israel Denmark United Kingdom (Scotland) Sweden Norway TFYR Macedonia* Hungary Germany Croatia United Kingdom (England) Portugal Finland Slovenia Italy Spain United Kingdom (Wales) Greece Malta 13-year-old girls 13-year-old boys POLICY RELEVANCE AND CONTEXT 15-year-old girls 15-year-old boys Fact sheet 2.3 21.05.2007 23:38 Uhr Seite 3 DATA UNDERLYING THE INDICATOR Data source HBSC survey 2001/2002 (1). Method of calculating the indicator The prevalence of excess body weight and obe- sity is calculated as the percentage of adoles- cents reported to be in the weight categories corresponding to adult BMI values of > 25.0 and > 30.0 kg/m2 according to the cut-off points developed by Cole et al (2). From these findings, subjects were further subdivided into pre-obese and obese groups, corresponding to adult BMI values of 25.00–29.9 kg/m2 and > 30 kg/m2. Excess body weight is defined as a BMI of > 25.0 kg/m2. Geographical coverage The 2001/2002 survey was conducted in 35 countries and regions (Fig. 1). Period of coverage Data from the 2001/2002 survey. Frequency of update HBSC surveys are carried out at four-year intervals. The 2001/2002 survey was the sixth and most recent in the series and was conduct- ed in 35 countries and regions. The data are collected in all participating countries and regions through school-based surveys, using the international research protocol. References 1. Currie C et al., eds. Young people’s health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey. Copenhagen, WHO Regional Office for Europe, 2004 (Health Policy for Children and Adolescents, No. 4; http://www.euro.who.int/Document/e82923.pdf, accessed 21 February 2007). 2. Cole TJ et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. British Medical Journal, 2000, 320:1–6. 3. WHO Global InfoBase online [online database]. Geneva, World Health Organization, 2007 (noncommunicable diseases, comparable esti- mates; http://www.who.int/ncd_surveillance/infobase/web/InfoBaseCommon, accessed 8 April 2007). 4. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity, 2006, 1:11–25. 5. James WPT et al. Overweight and obesity (high body mass index). In: Ezzati M et al., eds. Comparative quantification of health risks: global and regional burden of disease attribution to selected major risk factors. Vol. 1. Geneva, World Health Organization, 2004:497–596 (http://www.who.int/publications/cra/en, accessed 7 December 2006). 6. Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics, 1998, 101:518–525. 7. The challenge of obesity in the WHO European Region and the strategies for response. WHO European Ministerial Conference on Counteracting Obesity, Istanbul, Turkey, 15–17 November 2006 (http://www.euro.who.int/Document/NUT/Instanbul_conf_edoc06.pdf, accessed 8 April 2007). 8. World Health Assembly resolution WHA57.17 on a global strategy on diet, physical activity and health. Geneva, World Health Organization, 2004 (http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_R17-en.pdf and http://www.epha.org/a/1253, accessed 8 April 2007). 9. Children’s Environment and Health Action Plan for Europe. Fourth Ministerial Conference on Environment and Health, Budapest, 23–25 June 2004 (http://www.euro.who.int/document/e83338.pdf, accessed 2 March 2007). 10. European charter on counteracting obesity. WHO European Ministerial Conference on Counteracting Obesity, Istanbul, Turkey, 15–17 November 2006 (EUR/06/50627008; http://www.euro.who.int/Document/E89567.pdf, accessed 9 April 2007). 11. Proposed outline for the second action plan for food and nutrition policy. The challenge of obesity in the WHO European Region and the strategies for response. WHO European Ministerial Conference on Counteracting Obesity, Istanbul, Turkey, 15–17 November 2006. http://www.euro.who.int/document/nut/Instanbul_conf_edoc09.pdf 12. Green Paper. Promoting healthy diets and physical activity: a European dimension for the prevention of overweight, obesity and chronic diseases. Brussels, Commission of the European Communities, 2005 (COM(2005) 637 final; http://europa.eu.int/eur-lex/lex/LexUriServ/site/en/com/2005/com2005_0637en01.pdf, accessed 9 April 2007). 13. EU platform on diet, physical activity and health. Brussels, European Commission, Directorate-General for Health and Consumer Protection, 2005 (http://ec.europa.eu/health/ph_determinants/life_style/nutrition/documents/eu_platform_en.pdf, accessed 9 April 2007). Author: Maria Jose Carroquino, Institute of Health Carlos III, Madrid, Spain. © 2007 World Health Organization All rights reserved. The views expressed do not necessarily represent the decisions, opinions or stated policy of the European Commission or the World Health Organization. For further information, see the web site of the WHO European Centre for Environment and Health, Bonn www.euro.who.int/ecehbonn. World Health Organization · Regional Office for Europe Scherfigsvej 8 · DK-2100 Copenhagen Ø · Denmark · Tel.: +45 39 17 17 17 · Fax: +45 39 17 18 18 · postmaster@euro.who.int · www.euro.who.int Fact sheet 2.3 21.05.2007 23:38 Uhr Seite 4