From overweight to healthy weightDutch policy to stop the obesity epidemic in

children

Feeding children in the new parenting culture

Roel PietermanLondon, March 21, 2011

From Overweight to Healthy Weight:Dutch policy to stop the obesity epidemic in children

Program• Brief theoretical reflection• Dutch overweight prevalence (in global

perspective)• A short history of Dutch overweight policy• Characteristics of Dutch overweight policy• Off Balance: the burden of overweight (White paper

2009) • JOGG: Youth at Healthy Weight (Healthy Weight

Covenant 2010-2015)

Brief theoretical reflection

Providing balance through consensus breads moderation.

Polder culture: consensus dominates Dutch policies.

Precautionary culture turns prevention of damage into prevention of risk or even prevention of uncertain threats.

In precautionary culture ecological fears centre on equilibrium and vulnerability.

Brief theoretical reflection

Overweight policies reflect such fears:• At the individual level overweight is explained as

an imbalance of energy intake and expenditure.• At the social level overweight is explained as an

imbalance of food supply and energy demands; i.e. the obesogenic society.

• At the social level overweight is seen as a threat to a sustainable medical system and to the economic system.

• Children are seen as especially vulnerable.

Dutch overweight prevalence …

Overweight (BMI>25) in adults (20+):• 1980s: 34%; 1990s: 39%; 2000s: 45.7%; 2009: 47.2% Obesity (BMI>30) in adults (20+):• 1980s: 5.2%; 1990s: 7.4%; 2000s: 10,6%; 2009: 11.8% Overweight in children (2-20):• 1980s: 9.1%; 1990s: 11,6; 2000s: 12.4%; 2009: 13% Obesity in children (2-20):• 1980s: 2.1%; 1990s: 3.1%; 2000s: 2.7%; 2009: 2.1% (Data: Statistics Netherlands (CBS))

… in global perspective

• Netherlands (2009): 11.2% in men and 12.4% in women;• France (2007): 16.1 in men and 17.6% in women;• Germany (2006): 20.5% in men and 21.1% in women;• Poland (2005): 20.8% in men and 23.8 in women;• England (2009): 22.1% in men and 23.9% in women;• United States (2008): 32.2% in men and 35.5% in women;• Egypt (2008): 18.5% in men and 39.5% in women;• South-Africa (2003): 8.8% in men and 27.4% in women;• India (2006): 1.3% in men and 2.8% in women.(Data from the International Obesity Task Force)

A brief history of Dutch ‘overweight policy’

• In 1952 we attribute the improvement in life expectancy to ‘healthier food and better life style’.

• 1970s: discovery of diseases of prosperity as threats to public health.

• 1980s: promoting healthy life styles through information and education; including healthy food and more sports

• 1990s: the Netherlands Institute for Health Promotion (NIGZ) leads a coalition of similar organisations to create a European network for school health promotion.

• NIGZ now coordinates the School Health Education Network (http://www.schoolsforhealth.eu).

Making the healthy choice easyCharacteristics of Dutch overweight policy

There is long-standing general agreement:• about the seriousness and urgency of overweight as a

social problem;• that a misbalance between energy consumption and

expenditure is the cause of overweight;• about the assignment of responsibility to overweight

individuals and in the case of children to their parents;• that individual citizens are entitled to make their own life

style choices;• that government should not interfere with this freedom of

choice, …– however, it should provide adequate information.

Making the healthy choice easyCharacteristics of Dutch overweight policy

Furthermore there is agreement:• that we live in an obesogenic society.• that (therefore) individual citizens can hardly be blamed

for failing to choose a healthy life style (for their children).

• that changing the obesogenic environment is a vast, complex, and long-term challenge, which calls for a comprehensive policy approach that, ...– first, requires close and persistent cooperation between

government and all relevant social organizations and that, – second, calls for comprehensive efforts that include all relevant

policy domains.• that life style interventions need to be evidence-based.• that such interventions are not (really) available.

Making the healthy choice easyCharacteristics of Dutch overweight policy

Newly developed agreements are:• Socio-economic status and ethnicity are

important.• Unhealthy life style choices are embedded in

strong socio-cultural patterns. • “The current ideals of slimness, youthfulness and

fitness are important motives for choosing a healthy life style, since health is socially expressed in these terms” (Off Balance, 2009)

Off Balance: the burden of overweight(White paper on overweight policy: 2009)

• The problem keeps growing: – “the rapid increase in overweight and obesity is both at

the global and the national level a growing threat to public health.”

• Especially in our children:– “the increase of overweight and obesity among children

is particularly worrying (… as gym teachers witness every day at school).”

• However: this does not lead to a more aggressive approach! On the contrary

Off Balance: the burden of overweight

The tone is almost defeatist:• overweight is “caused by many factors”; • government “cannot and will not solve this problem alone” • … and explicitly rejects the pretence of being able to

“solve this problem once and for all”;• the Covenant partners’ activities are appreciated but more

needs to be done; • this paper is “to show societal actors and local authorities

how they can contribute to the reduction of overweight and calls upon them to join the effort”, …

• and also to initiate a political and social dialogue about the optimal approach of overweight.

Off Balance: the burden of overweight

For adults the problem is even rather hopeless: • “in due course overweight often leads to obesity, a chronic

disease which is hard to shed once you have it”; • thus, for obese adults, “prevention of further weight gain

is the only practical option”.• However, government will “firmly invest in extra

interventions especially for children and their parents.”– All Covenant partners will join the program Youth

Attaining Healthy Weight (JOGG), which is the main focus of the Healthy Weight Covenant.

Off Balance: the burden of overweight

Reasons for the special focus on children & parents:• Children are more vulnerable to the consequences

of obesity. • They are not yet personally responsible for their

life style. • At this young age effective prevention of

overweight can be achieved. • Early prevention will continue to have effects

later in life.

JOGG: Youth Attaining Healthy Weight

JOGG is the Dutch adaptation of the French EPODE program.

Strong conviction on the JOGG website:• “Cities that join the JOGG program together with their

local partners provide children with healthier diets and more exercise. They show that the trends towards increasing levels of overweight can be stopped and turned by coordinated local effort.” (italics rp)

• In de JOGG Moodfilm we hear about the proven result of Epode with no less than a 50% reduction in overweight prevalence! (http://jongerenopgezondgewicht.nl/home)

School CovenantParallel to JOGG we find a School Covenant that embodies

ambitions such as:• promoting healthy foods in cafeteria and vending

machines; • one hour of physical activity before, during or after

school hours; • promoting the return of a specialised gym teacher.”• monitoring and evaluating [healthy behaviour] in

schools; • monitoring and referring [obese children] to youth health

care; • raising awareness in parents about their children’s need

for healthy eating and enough exercise.

‘Foucault’ in the Netherlands?!• Dutch overweight policy is very moderate:

– Covenant partners voluntarily decide whether and how they participate in activities.

– Cities voluntarily decide whether they join JOGG.– In JOGG cities schools voluntarily decide whether and how they

participate.• Nevertheless the alignment of policy efforts and the

influence of health experts, aesthetic norms and media attention is slowly disciplining parents into being responsible for their children’s life style.– Social marketing: it’s all about selling the message! – Everybody needs to hear the same message always and

everywhere!• Question 1: Is it possible to kill an elephant with cotton

balls? • Question 2: If not; is that bad?