Recent data show that since 1975 obesity has nearly tripled and it now accounts for 4 million deaths worldwide every year. In 2016, over 2 billion adults (44 percent) had excess weight (overweight) or were living with obesity1.
In Europe, obesity has tripled since 19802, and in 2014 more than 224 million adults were affected by being overweight, of which almost 80 million had obesity3. Obesity is responsible for 10-13% of deaths in different parts of Europe4, making it the 4th most important risk factor for ill health and premature deaths in Europe.
Obesity also has a significant impact on economic outcomes; in the Organisation for Economic Co-operation and Development (OECD) member countries, overweight reduces the gross domestic product by 3.3% and the workforce by 28 million people per year. If obesity incidence continues at the current rate, from 2020 to 2050 OECD countries are estimated to spend 8.4 % of their health budget on obesity and related diseases5.
However, investing in prevention and treatment can have substantial economic benefits. Recent analysis shows that every dollar spent on preventing obesity generates up to a six-fold economic return6.
To address the obesity crisis, a different EU-level approach is urgently needed; one that recognises that obesity is a complex chronic relapsing disease, for which multidisciplinary, holistic strategies, policies and actions should be prioritised7 to truly change the status quo in the onset and progression of obesity as a chronic disease.
The need for EU level collaborative action
The EU Obesity Policy Engagement Network (OPEN-EU) is part of the global OPEN network, which includes national coalitions in over 15 countries including Germany, Italy, Spain and UK. All coalitions work together as well as independently to address national challenges and identify policy opportunities that will help ensure obesity is tackled as the chronic disease that it is and people living with obesity have the support needed to manage their weight long-term.
At its launch in the European Parliament, OPEN-EU, a coalition of key EU experts, policy and decision makers, is calling for a new approach and the priority actions needed to improve the treatment and management of obesity at an EU level, based on four critical focus areas.
The aim of the OPEN-EU group will be to work together to implement a cross-cutting policy approach at an EU level. A focus will be to ensure EU nations are empowered and able to provide people living with obesity access to fair, effective obesity treatment and management.
CRITICAL FOCUS AREA ONE: Obtain governmental, health system and public recognition that obesity is a chronic relapsing disease, ensuring that we move from individual to shared responsibility’
Obesity consistently appears within the top-4 causes of premature mortality within OECD countries and at an EU level, in some countries, up to 90% of the population is living with overweight or obesity. Furthermore, overweight reduces Gross Domestic Product (GDP) by 3.3% in the OECD countries.
By making obesity a Mission of the European Union in the next round, it will allow all institutional actors as well as civil society to focus on embedding a systems approach along the life course for the primary, secondary and tertiary prevention, treatment and long term management of obesity.
Furthermore, to ensure sustainable uptake and implementation of the outcomes of the Mission, an evidence-based policy framework to shape policy action at a national and regional level is necessary. Ultimately, the impact of all actors across sectors and stakeholders at EU, national and regional level will lead to National Plans for Obesity. These should be measured by health outcomes and interlinked with complications of obesity such as type 2 Diabetes, certain cancers, hypertension and cardiovascular infarction8.
Although the onset of obesity is heavily linked to biological and human exposome (environmental) factors which affect our biology, the disease progression is heavily influenced by a number of other factors which are already prioritised in the European Semester process (access to healthcare, non-discrimination, affordable self-care and self-management, educational standards, mental health and well being, innovative research to name but a few).
By embedding key outcomes such as lowering the direct economic cost of obesity from the current 3.3% GDP average and 70 billion euros per annum from the health system, the EU will contribute substantially to achieving an economy of well-being as well as realising the Sustainable Development Goal Targets for 2030.
The EPSCO Council Conclusions of 24 October 2019 specifically call for a life course approach to health and well being in general and more specifically refers to ongoing initiatives in the field of obesity. (paragraph 17) Moreover, in light of the Commission’s stated move towards evidence – and impact – driven approaches, a new approach to obesity will also substantially contribute to equitable and universal access to obesity care regardless of vulnerable status (18), a sharing of risk for financial resourcing at a societal level (19).
Obesity is currently positioned as, at worst, a lifestyle choice and at best a lifestyle disease embedded in “eat less, move more”. As a direct result, (self-)stigma and discriminatory practices are considered acceptable in all strata of society.
There is an urgent need for a new approach to educating on the facts about obesity and changing the mindset of all stakeholders to treat those at risk of or already living with the disease with the respect and accommodation that is due to those living with any other chronic disease.
A first step in an integrated approach as part of an EU level awareness strategy is an assessment of how different policy portfolios refer to obesity. A useful outcome of the assessment can be a “Standard Operating Procedure” or a Code of Conduct which can be adopted by various institutions to address (un)conscious bias and discriminatory practices against those living with obesity.
A second pillar to changing percpetions is to ensure that discrimination on the grounds of health (with obesity specifically highlighted) is included as part of the anti-discrimination legislative package at EU and therefore Member State levels with related sanctions for non-adherence or implementation via the Equality bodies.
Data on implementation can be part of the EUROSTAT Benchmarking process which is currently under review.
Leadership at EU level is key to change attitudes, behaviour and embedded prejudices against those living with obesity. We therefore call for a disease awareness campaign which tells a more human, engaging story, and increases the understanding of the biological mechanisms that underpin obesity as a chronic, relapsing disease.
CRITICAL FOCUS AREA TWO: Review and optimize allocation of healthcare resources to secure funding for care
Both the onset and disease progression of obesity require a holistic and outcomes-driven approach for early intervention, successful long-term management and tertiary prevention of the complications of obesity. Currently, there is no systematic approach to resourcing prevention or treatment and long term management pathways. At best, the mechanics of bariatric surgery are resourced, but not necessarily the mental health, lifestyle and nutritional long term care elements pre- and post-surgery in all EU Member States. And due to a lack of chronic disease approach, no substantial and interconnected data is collected or harnessed along the life course.
The European Commission’s priorities for health lie very firmly in the “Beating Cancer Plan” and continues to place the prevention of other complications of obesity at the forefront of its chronic diseases prevention strategies at the level of Public Health. Given the direct correlation between the onset of obesity and then its complications, ensuring a holistic approach which is systematically and comprehensively assessed when considering value-added policy as well as prevention and treatment pathways could only be an advantage to addressing all major chronic diseases.
Using existing data-gathering instruments at European level, an approach is required that explores best practice examples on management / treatment policy and practice, which will inform Obesity National Plans at a national and regional level.
Although Obesity continues to be one of the EU Research Agenda priorities for Horizon Europe moving into the Financial framework 2021-2027, much remains to be done to interlink the various research strands which can impact the long term health outcomes for people living with obesity. research will be used to inform obesity strategies at an EU and national policy level.
A further step in consolidating knowledge would be to implement Obesity Reference Networks which can contribute to not only identifying treatment gaps, but will be able to act as a powerful basis for exchange of good and interesting practices cross-borders.
Finally, by establishing Obesity Registries which track along the life course and are linked with other chronic disease registries, treatment gaps can be easily identified and addressed.
Just as European Commission DG Research and Innovation is moving towards an EU health strategy, so too should there be a comprehensive blueprint for this new approach to addressing the obesity crisis across Commission services based on available science, clinical practice and patient data, which can be used as the basis for new healthcare focuses and resource allocation.
It will be important to align any new strategy on obesity with key elements related to the European Pillar of Social Rights and particularly the principles pertaining to Equal opportunities (Chapter 1.3), Secure and adaptable employment (Chapter II.5) Work Life Balance (Chapter 5.9), Healthy, safe and well-adapted work environment and data protection (Chapter II.10), Health care (Chapter III.16), Inclusion of people with disabilities (Chapter III.17) and Long-term care (Chapter III.18)
CRITICAL FOCUS AREA THREE: Integrate obesity into learning curricula across all relevant professions, to support more effective, informed care
Understanding of the underpinning causes of onset of obesity and then the disease progression process is severely misunderstood by all actors. For non-obesity specialist health professionals, it is key to fully incorporate all aspects of obesity prevention and complications prevention into their learning cycles: both at university as well as continuous education levels.
An examination of current curricula in multiple settings – schools, universities, hospitals, the workplace should be undertaken by EU agencies such as EuroFound and Commission Services within DG Education & Culture and DG Single Market in order to ascertain as well as the development of European, national and regional guidelines for implementation.
EU Member states should mandate inclusion of additional training relevant to effective provision of obesity prevention and obesity-related care in all relevant curricula.
Another step will be to integrate life-long learning and related professional bodies’ obesity education modules.
Furthermore, where professional competence legislation exists (eg. the recognition of professional qualifications Directive 2005), every effort should be made to ensure that all regulated professions that can have an impact on obesity are empowered to do so in their daily work and training.
In order to encourage sustainable uptake of this approach to addressing obesity as other chronic diseases, all actors will need to be health literate on the causes and potential impact on the various external factors affecting long term management of the disease.
In particular, people living with obesity should be actively engaged as part of the teaching process on obesity across relevant actors (including health care delivery sites, Schools of Public Health, medical education, patient education, healthcare Managers)
There is a need to track links between improved obesity management education and HCP and patient behaviour trends. Research and data can then be used to inform regional and national ‘multi-disciplinary’ strategies and centres of excellence.
CRITICAL FOCUS AREA FOUR: Establish and support multidisciplinary centres for the treatment of obesity, and ensure access to transdisciplinary care for people with obesity
Although there are currently over 130 Centres of Obesity Management across geographic Europe and beyond developed by the obesity scientific community, more can be done to upscale and further integrate current settings into an outcomes-driven approach both physically as well as digitally.
An outcomes approach EU-level guidelines should be developed for the establishment/ upscaling of specialist centres, which can be applied at a national, regional and cross-border level. These should have both physical as well as digital components.
Collaborating with relevant EU Cohesion policies and related regional/ municipal authorities, a holistic ecosystem should be enabled and supported at policy level to allow such integrated Obesity Management Centres to be accessible by all, including the most vulnerable, and sustainable.
Without access to connected and interoperable data by all relevant actors, addressing the longer term needs of those living with obesity cannot be successful.
In line with the Commission Communication on Digital Transformation of Health and Care in the Digital Single Market and the GDPR Regulation, all relevant stakeholders should have access to the right data, at the right time and in a format that can support co-decision making between people living with obesity and their surrounding environments.
1The World Bank. 2020. How Tackling the World’s Deadliest Diseases Can Boost a Healthy Workforce and Economic Growth [Online] Available at: https://www.worldbank.org/en/news/immersive-story/2020/02/06/tackling-worlds-deadliest-diseases-can-boost-healthy-workforce-and-economic-growth?cid=ECR_TT_worldbank_EN_EXT. [Accessed February 2020]
2E. Pineda at al. 2018. Forecasting Future Trends in Obesity across Europe: The Value of Improving Surveillance. Obesity Facts: 11: 360-371
3World Obesity Federation. 2017. Our data – World Obesity Day [Online] Available at: https://www.obesityday.worldobesity.org/ourdata2017. [Accessed September 2018]
4World Health Organization. 2020. Obesity. [Online] Available at: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/obesity [Accessed January 2020]
5OECD. 2019. The Heavy Burden of Obesity. [Online] Available at: https://www.oecd-ilibrary.org/sites/67450d67-en/index.html?itemId=/content/publication/67450d67-en#section-d1e765 [Accessed February 2020].
6OECD. 2019. The Heavy Burden of Obesity. [Online] Available at: https://www.oecd-ilibrary.org/sites/67450d67-en/index.html?itemId=/content/publication/67450d67-en#section-d1e765 [Accessed February 2020].
7Frood, S. et al. 2013. Obesity, complexity, and the role of the health system. Curr Obes Rep 2; 320–326.
8World Health Organization. 2018. Obesity and overweight. [Online] Available at: http://www.who.int/mediacentre/factsheets/fs311/en/ [Accessed October 2018].