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The Challenge of Obesity Strategies for Response

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The Challenge of Obesity Strategies for Response The challenge of obesity in the WHO European Region and the strategies for response for Regionandthestrategies WHO European challengeof obesity inthe The The WHO Regional Offi ce for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary respon- sibility for international health matters and public health. The WHO Regional Offi ce for Europe is one of six regional offi ces throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. In response to the obesity epidemic, the WHO Regional Offi ce for Europe held Member States a conference in November 2006, at which all Member States adopted the Albania Andorra European Charter on Counteracting Obesity, which lists guiding principles and Armenia Austria clear action areas at the local, regional, national and international levels for a Azerbaijan wide range of stakeholders. This book comprises the second of two publications Belarus Belgium resulting from the conference. It presents the many technical papers written Bosnia and Herzegovina Bulgaria for the conference and updated for publication by a large group of experts in Croatia public health, nutrition and medicine. Cyprus The Czech Republic challenge of obesity Denmark Estonia Using a wide range of evidence drawn from countries across and beyond the Finland France WHO European Region, this book illustrates the dynamics of the epidemic Georgia and its impact on public health throughout the Region, particularly in eastern in the WHO European Region and the Germany Greece countries. It describes how factors that increase the risk of obesity are shaped Hungary Iceland in diff erent settings, such as the family, school, community and workplace. Ireland Israel It makes both ethical and economic arguments for accelerating action Italy against obesity, and analyses eff ective programmes and policies in diff erent strategies for response Kazakhstan Kyrgyzstan government sectors, such as education, health, agriculture and trade, urban Latvia Lithuania planning and transport. The book also describes how to design policies and Luxembourg Malta programmes to prevent obesity and how to monitor progress. Finally, it calls Monaco for specifi c action by stakeholders: not only government sectors but also the Montenegro Netherlands private sector – including food manufacturers, advertisers and traders – and Norway Poland professional, consumers’, international and intergovernmental organizations Portugal Republic of Moldova such as the European Union. Romania Russian Federation San Marino It is time to act: 150 million adults and 15 million children in the Region are Serbia Slovakia expected to be obese by 2010. Obesity not only harms the health and well- Slovenia being of a vast proportion of the population, and generates large expenditures Spain Sweden by health services, but also has a striking and unacceptable impact on children. Switzerland Tajikistan This book uses evidence to spell out ideas and information that will enable The former Yugoslav Republic of Macedonia stakeholders across the Region, particularly policy-makers, to work to stop and Turkey then reverse the obesity epidemic in Europe. Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Offi ce for Europe Scherfi gsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: [email protected] Web site: www.euro.who.int The challenge of obesity in the WHO European Region and the strategies for response The World Health Organization was established in 1948 as the specialized agency of the United Nations respon- sible for directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health. It fulfils this responsibility in part through its publications programmes, seeking to help countries make policies that benefit public health and address their most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 880 million people living in an area stretching from the Arctic Ocean in the north and the Mediterranean Sea in the south and from the Atlantic Ocean in the west to the Pacific Ocean in the east. The European pro- gramme of WHO supports all countries in the Region in developing and sustaining their own health policies, systems and programmes; preventing and overcoming threats to health; preparing for future health challenges; and advocating and implementing public health activities. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health. The challenge of obesity in the WHO European Region and the strategies for response Edited by: Francesco Branca, Haik Nikogosian and Tim Lobstein WHO Library Cataloguing in Publication Data The challenge of obesity in the WHO European Region and the strategies for response /edited by Francesco Branca, Haik Nikogosian and Tim Lobstein 1.Obesity – prevention and control 2.Obesity – etiology 3.Strategic planning 4.Program development 5.Health policy 6.Europe I.Branca, Francesco II.Nikogosian, Haik III. Lobstein, Tim ISBN 978 92 890 1408 3 (print) ISBN 978 92 890 1409 0 (ebook) (NLM Classification : WD 210) ISBN 978 92 890 1408 3 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health in- formation, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2007 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publi- cation do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps repre- sent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distin- guished by initial capital letters. The World Health Organization does not warrant that the information con- tained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or edi- tors do not necessarily represent the decisions or the stated policy of the World Health Organization. Printed in Denmark CONTENTS Acknowledgements vi Contributors vii Abbreviations x Foreword xii 1. Current prevalence and trends of overweight and obesity 1 2. Impact of obesity on health 20 3. Economic consequences of obesity 28 4. Physical activity, sedentary behaviour, physical fitness and obesity 35 5. Dietary determinants of obesity 46 6. Effects of early nutrition on development of obesity 55 7. Dietary patterns in Europe 64 8. Microenvironmental determinants of dietary patterns 77 9. Macroenvironmental determinants of food consumption 92 10. Promotional marketing of food 112 11. Macro- and microenvironmental determinants of physical activity 138 12. Socioeconomic inequalities in obesity in Europe: issues and policy implications 152 13. Actions and policies to prevent obesity 174 14. Economic instruments for reducing consumption of energy-dense foods 197 15. Actions and policies to promote physical activity 208 16. Designing and developing a strategy to prevent obesity 225 17. Preventing obesity: selecting the best investments 238 18. Involving different stakeholders 243 19. Monitoring and evaluating policies and programmes 249 20. National policies in the European Region 259 21. Implementing the WHO Strategy on Diet, Physical Activity and Health: analysis of global progress 274 22. Effective treatment: an evidence base for the treatment of overweight and obesity 282 23. Obesity policy: the next steps 293 Annex 1. Recent reviews on obesity prevention 304 Acknowledgements We are grateful to W. Philip T. James (International Obesity Task Force, London, United Kingdom) and Kaare R. Norum (University of Oslo, Norway) for overall advice on the scientific content of this book; to Mark Petticrew (Glasgow, United Kingdom) for overall review and consistency check; to Shubhada Watson (Evidence on Health Needs and Interventions, WHO Regional Office
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