Preventing obesity across Europe: a call to action

Policy, research, and funding priorities for systems change

In June 2022, four European projects came together for a conference exploring future directions for nutrition and physical activity policy across Europe. The projects – CO-CREATE, STOP, Best-ReMap and PEN – are each exploring different considerations, emerging evidence and policy monitoring, for improving nutrition and physical activity to help prevent childhood obesity, other non-communicable diseases (NCDs) and improve the health of populations.

These four projects represent the largest, multi-country consortium projects focused on diet and physical activity in Europe.

In this document, we present the key achievements of the four projects date in line with the symposium discussions, as well as a collective vision for future policy, research and funding.

Successful policy actions to address physical inactivity, unhealthy diets and sedentary behaviours, all key risk factors for NCDs, are an important part of efforts to improve the health and wellbeing of populations and reduce premature mortality.

The joint project symposium included discussions on several priority policy areas for the prevention of NCDs, including childhood obesity, the impact of wider exposures and early life experiences, new monitoring and accountability frameworks and tools for tracking policies and their implementation. The need for systems thinking and approaches when developing strategies, as well as how to engage a range of sectors and actors, including young people was also discussed. It is evident that our knowledge of policies and policy implementation in this area is advancing, as is our understanding of some of the determinants of NCDs including childhood obesity. However, there is a big gap between where we are and where we need to be, and a strong, coordinated response at EU level is needed to address this.

The conference took place on the backdrop of COVID, and the increasing knowledge and evidence emerging on the wider indirect impact it has had on health and behaviours across Europe. Now, more than ever, we need strong, comprehensive policies which shape environments and improve the health of the whole population, particularly children and families.

There are a number of opportunities across Europe and the European Union to take on new and emerging knowledge and evidence to inform better policies at regional and national level, including by DG Sante (Health and food safety), Joint Programme Initiative (JPI) and Joint Research Centre (JRC), but also wider sectors including DG EAC (education, youth, sport and culture). DG Connect (AVMSD and marketing of food and beverages), DG Research (supporting knowledge development and translation) and DG Move (mobility and transport). Most concretely in health, discussions have started on a new EU Action Plan on Childhood Obesity and development of EU NCD roadmaps. In addition, this follows publication of a new report on obesity from WHO Euro, new comprehensive recommendations on the prevention and management of obesity through the life course and supporting Acceleration Plan adopted by WHO Member States, and Geneva Charter for wellbeing 2021.

Collective achievements of projects to date

We have developed tools, evidence and knowledge that now need to be used, updated, enhanced to improve health and reduce risk of disease across Europe.

Advanced understanding of the determinants of childhood obesity including interactions between environment and exposome and recognition that risk starts before birth

A series of systematic reviews on environmental determinants of childhood obesity, including pre-birth
A series of systematic reviews on the effectiveness of policies and interventions to reduce childhood obesity with a particular focus on addressing disparities

Enhanced policy auditing and monitoring of policy implementation, providing mechanisms to monitor, track and identify good practice in nutrition and physical activity

Food EPI adapted for Europe and conducted in 11 countries to facilitate monitoring of policy implementation and BIA-obesity conducted for companies in Europe
Development of PA-EPI to support advancement in physical activity policy and implementation
NOURISHING and MOVING databases to enable auditing of policies and best practice
Monitoring food marketing in 17 EU countries to help reduce the impact of marketing, including digital marketing
Advancing sustainable and higher quality food procurement in kindergartens and schools in 8 countries, through pilots

Enhanced support for policymakers for implementing policies

Set of policy briefs on key issues such as reformulation, fiscal measures, social marketing, nudges, physical activity in school and front of pack nutrition labelling

Advanced moves towards greater surveillance and policy harmonization across Europe

Launch of surveillance harmonization roadmap, using SIMPLE screeners to support policy impact evaluation
Aggregated member state data collection for JRC processed foods database to enable monitoring of the success of food policy implementation
Launched a public, searchable Indicator catalogue for policy benchmarking and surveillance

Contributed to and advanced knowledge on ways of mobilizing and engaging different stakeholders, including holding them to account

Developed methodologies for mobilizing and engaging young people in research and policy
Developed Dialogue Forum tool to facilitate dialogue between different groups
Developed strong accountability indicators for multistakeholder engagement to hold stakeholders to account for their action

Policy priorities for Europe

Drawing on the research and outcomes of the four projects, we make the following recommendations as priorities for European Commission, its relevant departments, and national governments on the issue of nutrition and physical activity policies to improve population health.

Development of new action plans/roadmaps to help address childhood obesity and support healthier populations

A new Food sustainability system indicator developed for the EU Semester
A new EU Action plan on childhood obesity including development, implementation, monitoring and evaluation

Transformed systems and strengthened food and physical activity policies to shape environments across Europe

Food and physical activity policies which are evidence-based and equitable, focused on improving environments, shifting consumer behaviour and altering food and beverage products available, including through fiscal policies
Systems approaches explored to conceptualize the problem, evaluate policies and identify beneficial interactions between interventions to help improve likely impact
Recognition that health policies are an investment not a cost, incorporating this into the interpretation of economic analyses of policies and cost-effectiveness studies

Prioritization given to addressing inequalities and supporting young people

Young people and families, low socio-economic groups and high-risk communities made central beneficiaries of all policies
Policies focused across the life course, from pre-natal and early exposures through to later in life, taking into account new research on early determinants, and tailoring policies where appropriate to local contexts

Harmonization of data, evidence generation and full realisation of impact

Enhanced harmonized measurement and data collection across Europe, including building consensus about the mutual long-term aims for measuring health indicators, and drawing on the newly developed surveillance roadmap and harmonized processed food database
Enhanced accountability and monitoring of policy impact at the national and European level, as well as of stakeholder actions, drawing on international best practices and benchmarks and existing frameworks and tools, such as Food- EPI and PA-EPI, MOVING and NOURISHING and new searchable catalogue of indicators

Strengthened stakeholder engagement in policy development, implementation and evaluation

Meaningful engagement and participation of young people, people with lived experience and target communities, using existing tools such as Dialogue Forum to facilitate this
Multi-stakeholder forums to support policy development underpinned with strong accountability indicators and processes to manage potential conflicts of interest
Active partnerships with civil society and researchers to support sharing of best practices, advancement of knowledge and evidence, and to provide independent accountability mechanisms for policy action and stakeholder engagement according to developed indicators

Research priorities for Europe

The following research and funding priorities for continued research and collaboration across Europe have been identified by our four projects. These are vital for ensuring that research continues to be innovative, cutting edge, participatory and engaging, and to help better understand the potential and actual impact of policies and interventions

Investment in health research, including long-term funding and project continuation recognising that results and systems change takes time

Investment in research on understanding the determinants of health, lived experience, policy processes, policy evaluation and the collection of national and regional data systematically, at fixed intervals.

Investment in new and existing methodologies to advance our knowledge of policy implementation and impact

Investigation into the value of implementation science and natural experiments to advance knowledge and understanding of policy impact and to support policy impact evaluations
Build on the tools and frameworks developed for monitoring and auditing policies, investing in roll out, updates, expansion and communication using the data collected to increase impact
Expand and invest in the development of pan-European studies, surveillance and data collection, using novel and innovative methods, including digital tools which are currently underutilised
Development of processes for pragmatic piloting and testing policy feasibility to support policy impact assessment and understanding of effectiveness in different contexts

Focus on and inclusion of high-risk communities in research

Investment in the early determinants of childhood obesity and other diseases, from pre-conception through the rest of the life course
Social inequalities prioritised, including research on the impact of different policies and how the implementation may be tailored to address high-risk and vulnerable communities
Inclusion of young people and under-represented communities in research prioritisation, design and delivery

Find out more

Click on the links below to visit the projects' website

Joint Action on Implementation of Validated Best Practices in Nutrition (JA BestReMaP)

Confronting Obesity: Co-creating policy with youth (CO-CREATE)

Policy Evaluation Network (PEN) – Public policies addressing health-related behaviours in Europe

Science and Technology in childhood Obesity Policy (STOP)

Acknowledgements

This statement was written by Hannah Brinsden with contributions from Wolfgang Ahrens, Franco Sassi, Mojca Gabrijelcic, Albert Zoltán Aszalós, Knut Inge Klepp, Catherine Woods, on behalf of the STOP, CO-CREATE, Best Re-Map and PEN consortia