5.13. Overweight, obesity and other conditions related to an imbalanced nutrition

Overweight, pre-obesity and obesity are associated with excessive food consumption and with the intake of excessive (as compared to physiological needs) energy-dense food (i.e. food containing large amounts of saturated fats and free sugars), often cheaper than good quality food. The prevalence of overweight and obesity is also growing rapidly in many European countries for both women and men. According to WHO estimates, excessive body weight derived from excessive food consumption and inadequate physical activity, is responsible for more than 1 million life-years of ill health every year in the WHO Europe region.

Current EU environments favour overweight and obesity. There is an abundance of food in Europe that, while energy-rich, is often poor in nutrients. Food portion sizes are growing, though people with sedentary lifestyles actually need less energy. Social and economic pressures can mean that both work and leisure hours offer decreasing opportunities for physical activity. There are distinct differences in the Northern and Southern (Mediterranean) food cultures. Nevertheless, it has been seen across all Member States that it is the least educated who consume fewer vegetables and are on average shorter and more obese than the most educated, though the dimension of these differences can vary between men and women and in accordance with the drinking and diet culture (European Commission, 2003).

Excess body weight associated with excess energy intake poses one of the most serious public health challenges for the 21st century in particular parts of the world, including the Member States of the European Union (EU) (Commission of the European Communities, 2005; WHO, 2000). A body mass index (BMI) above the optimum level of 21 kg/m² is among the five global disease burden risk factors closely related to diet and physical activity; these are high blood pressure, high blood cholesterol level, high BMI, low fruit and vegetable intake and physical inactivity (James et al, 2004; WHO, 2002; WHO Regional Office for Europe, 2005).

Lifestyle factors, including eating habits and levels of physical activity/inactivity are often adopted during the early years of life. Childhood obesity is an important predictor of obesity in adulthood (Branca et al, 2007a; Branca et al, 2007b). The best time to address the problem is early in life. Moreover, a systematic review shows that childhood obesity is strongly associated with risk factors for cardiovascular disease and diabetes, orthopaedic problems and mental disorders. A high BMI in adolescence predicts elevated adult mortality rates and cardiovascular disease, even if the excess body weight is lost. Many obesity-related health conditions once thought to be applicable only to adults are now being seen among children and with increasing frequency (Dietz, 1998). A true epidemic of overweight is progressing in the WHO European region (53, Member States) among children and adolescents. It is predicted that about 38% of school-age children will be overweight by 2010 and that more than a quarter of these children will be obese.

Apart from the health consequences, overweight and obesity also impose an economic burden on society through increased medical costs to treat the diseases associated with it (direct costs); lost of productivity due to absenteeism and premature death (indirect costs); missed opportunities, psychological problems and poorer quality of life (intangible costs) (Branca et al, 2007a; Branca et al, 2007b). It is estimated that in the EU, obesity accounts for up to 7% of health care costs and this amount will further increase given the rising obesity trends (Commission of the European Communities, 2005). In 2002, the total direct and indirect annual costs of obesity in the EU15 (EU members before 2004) were estimated to be €32.8 billion per year (Fry and Finley, 2005). The WHO Regional Office for Europe prepared a compilation of direct cost studies worldwide including those carried out in the EU (Branca et al, 2007a; Branca et al, 2007b): health expenditure per inhabitant attributable to obesity ranges between US$ 17 (Germany, 2001) and US$ 202 (France, 1992).

In spite of the excessive food consumptions occurring in very large population groups throughout Europe, some nutrients ( e.g. folate, calcium, iodine and iron and specific vitamins) are not ingested in sufficient quantities by specific population groups; this originates diseases such as neural defects, osteoporosis, goiter, anaemia and hypovitaminoses. The prevalence of these diseases is particularly significant in certain risk groups among elderly, children, pregnant and lactating women.

The above-mentioned diseases are dealt with in Chapter 10.2.1.7 in view of the close connection of these diseases with excessive food intake and unbalanced nutrition.

For the quoted references, see Chapter 10.2.1.7.