From overweight to healthy weight:Dutch policy to stop the obesity epidemic in children


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Although the Dutch government recognized overweight as a health and lifestyle problem in a policy document in 2001, the matter was only taken up more seriously during 2004. The policy approach chosen is that of somewhat formalized ‘covenant’ led by the ministers of Health and Education with a range of private actors such as the food industry, health insurance companies, labour unions, federations of employers etc.

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From overweight to healthy weight:Dutch policy to stop the obesity epidemic in children

  1. 1. From overweight to healthy weight Dutch policy to stop the obesity epidemic in children <ul><li>Feeding children in </li></ul><ul><li>the new parenting culture </li></ul><ul><li>Roel Pieterman </li></ul><ul><li>London, March 21, 2011 </li></ul>
  2. 2. From Overweight to Healthy Weight: Dutch policy to stop the obesity epidemic in children <ul><li>Program </li></ul><ul><li>Brief theoretical reflection </li></ul><ul><li>Dutch overweight prevalence (in global perspective) </li></ul><ul><li>A short history of Dutch overweight policy </li></ul><ul><li>Characteristics of Dutch overweight policy </li></ul><ul><li>Off Balance: the burden of overweight (White paper 2009) </li></ul><ul><li>JOGG: Youth at Healthy Weight (Healthy Weight Covenant 2010-2015) </li></ul>
  3. 3. Brief theoretical reflection <ul><li>Providing balance through consensus breads moderation. </li></ul><ul><li>Polder culture: consensus dominates Dutch policies. </li></ul><ul><li>Precautionary culture turns prevention of damage into prevention of risk or even prevention of uncertain threats. </li></ul><ul><li>In precautionary culture ecological fears centre on equilibrium and vulnerability. </li></ul>
  4. 4. Brief theoretical reflection <ul><li>Overweight policies reflect such fears: </li></ul><ul><li>At the individual level overweight is explained as an imbalance of energy intake and expenditure. </li></ul><ul><li>At the social level overweight is explained as an imbalance of food supply and energy demands; i.e. the obesogenic society. </li></ul><ul><li>At the social level overweight is seen as a threat to a sustainable medical system and to the economic system. </li></ul><ul><li>Children are seen as especially vulnerable. </li></ul>
  5. 5. Dutch overweight prevalence … <ul><li>Overweight (BMI>25) in adults (20+): </li></ul><ul><li>1980s: 34%; 1990s: 39%; 2000s: 45.7%; 2009: 47.2% </li></ul><ul><li>Obesity (BMI>30) in adults (20+): </li></ul><ul><li>1980s: 5.2%; 1990s: 7.4%; 2000s: 10,6%; 2009: 11.8% </li></ul><ul><li>Overweight in children (2-20): </li></ul><ul><li>1980s: 9.1%; 1990s: 11,6; 2000s: 12.4%; 2009: 13% </li></ul><ul><li>Obesity in children (2-20): </li></ul><ul><li>1980s: 2.1%; 1990s: 3.1%; 2000s: 2.7%; 2009: 2.1% </li></ul><ul><li>(Data: Statistics Netherlands (CBS)) </li></ul>
  6. 6. … in global perspective <ul><li>Netherlands (2009): 11.2% in men and 12.4% in women; </li></ul><ul><li>France (2007): 16.1 in men and 17.6% in women; </li></ul><ul><li>Germany (2006): 20.5% in men and 21.1% in women; </li></ul><ul><li>Poland (2005): 20.8% in men and 23.8 in women; </li></ul><ul><li>England (2009): 22.1% in men and 23.9% in women; </li></ul><ul><li>United States (2008): 32.2% in men and 35.5% in women; </li></ul><ul><li>Egypt (2008): 18.5% in men and 39.5% in women; </li></ul><ul><li>South-Africa (2003): 8.8% in men and 27.4% in women; </li></ul><ul><li>India (2006): 1.3% in men and 2.8% in women. </li></ul><ul><li>(Data from the International Obesity Task Force) </li></ul>
  7. 7. A brief history of Dutch ‘overweight policy’ <ul><li>In 1952 we attribute the improvement in life expectancy to ‘healthier food and better life style’. </li></ul><ul><li>1970s: discovery of diseases of prosperity as threats to public health. </li></ul><ul><li>1980s: promoting healthy life styles through information and education; including healthy food and more sports </li></ul><ul><li>1990s: the Netherlands Institute for Health Promotion (NIGZ) leads a coalition of similar organisations to create a European network for school health promotion. </li></ul><ul><li>NIGZ now coordinates the School Health Education Network ( ). </li></ul>
  8. 8. Making the healthy choice easy Characteristics of Dutch overweight policy <ul><li>There is long-standing general agreement: </li></ul><ul><li>about the seriousness and urgency of overweight as a social problem; </li></ul><ul><li>that a misbalance between energy consumption and expenditure is the cause of overweight; </li></ul><ul><li>about the assignment of responsibility to overweight individuals and in the case of children to their parents; </li></ul><ul><li>that individual citizens are entitled to make their own life style choices; </li></ul><ul><li>that government should not interfere with this freedom of choice, … </li></ul><ul><ul><li>however, i t should provide adequate information. </li></ul></ul>
  9. 9. Making the healthy choice easy Characteristics of Dutch overweight policy <ul><li>Furthermore there is agreement: </li></ul><ul><li>that we live in an obesogenic society. </li></ul><ul><li>that (therefore) individual citizens can hardly be blamed for failing to choose a healthy life style (for their children). </li></ul><ul><li>that changing the obesogenic environment is a vast, complex, and long-term challenge, which calls for a comprehensive policy approach that, ... </li></ul><ul><ul><li>first, requires close and persistent cooperation between government and all relevant social organizations and that, </li></ul></ul><ul><ul><li>second, calls for comprehensive efforts that include all relevant policy domains. </li></ul></ul><ul><li>that life style interventions need to be evidence-based. </li></ul><ul><li>that such interventions are not (really) available. </li></ul>
  10. 10. Making the healthy choice easy Characteristics of Dutch overweight policy <ul><li>Newly developed agreements are: </li></ul><ul><li>Socio-economic status and ethnicity are important. </li></ul><ul><li>Unhealthy life style choices are embedded in strong socio-cultural patterns. </li></ul><ul><li>“ 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) </li></ul>
  11. 11. Off Balance: the burden of overweight (White paper on overweight policy: 2009 ) <ul><li>The problem keeps growing: </li></ul><ul><ul><li>“ the rapid increase in overweight and obesity is both at the global and the national level a growing threat to public health.” </li></ul></ul><ul><li>Especially in our children: </li></ul><ul><ul><li>“ the increase of overweight and obesity among children is particularly worrying (… as gym teachers witness every day at school).” </li></ul></ul><ul><li>However: this does not lead to a more aggressive approach! On the contrary  </li></ul>
  12. 12. Off Balance: the burden of overweight <ul><li>The tone is almost defeatist: </li></ul><ul><li>overweight is “caused by many factors”; </li></ul><ul><li>government “cannot and will not solve this problem alone” </li></ul><ul><li>… and explicitly rejects the pretence of being able to “solve this problem once and for all”; </li></ul><ul><li>the Covenant partners’ activities are appreciated but more needs to be done; </li></ul><ul><li>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”, … </li></ul><ul><li>and also to initiate a political and social dialogue about the optimal approach of overweight. </li></ul>
  13. 13. Off Balance: the burden of overweight <ul><li>For adults the problem is even rather hopeless: </li></ul><ul><li>“ in due course overweight often leads to obesity, a chronic disease which is hard to shed once you have it”; </li></ul><ul><li>thus, for obese adults, “prevention of further weight gain is the only practical option”. </li></ul><ul><li>However, government will “firmly invest in extra interventions especially for children and their parents.” </li></ul><ul><ul><li>All Covenant partners will join the program Youth Attaining Healthy Weight (JOGG), which is the main focus of the Healthy Weight Covenant . </li></ul></ul>
  14. 14. Off Balance: the burden of overweight <ul><li>Reasons for the special focus on children & parents: </li></ul><ul><li>Children are more vulnerable to the consequences of obesity. </li></ul><ul><li>They are not yet personally responsible for their life style. </li></ul><ul><li>At this young age effective prevention of overweight can be achieved. </li></ul><ul><li>Early prevention will continue to have effects later in life. </li></ul>
  15. 15. JOGG: Youth Attaining Healthy Weight <ul><li>JOGG is the Dutch adaptation of the French EPODE program. </li></ul><ul><li>Strong conviction on the JOGG website: </li></ul><ul><li>“ 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) </li></ul><ul><li>In de JOGG Moodfilm we hear about the proven result of Epode with no less than a 50% reduction in overweight prevalence! ( ) </li></ul>
  16. 16. School Covenant <ul><li>Parallel to JOGG we find a School Covenant that embodies ambitions such as: </li></ul><ul><li>promoting healthy foods in cafeteria and vending machines; </li></ul><ul><li>one hour of physical activity before, during or after school hours; </li></ul><ul><li>promoting the return of a specialised gym teacher.” </li></ul><ul><li>monitoring and evaluating [healthy behaviour] in schools; </li></ul><ul><li>monitoring and referring [obese children] to youth health care; </li></ul><ul><li>raising awareness in parents about their children’s need for healthy eating and enough exercise. </li></ul>
  17. 17. ‘ Foucault’ in the Netherlands?! <ul><li>Dutch overweight policy is very moderate: </li></ul><ul><ul><li>Covenant partners voluntarily decide whether and how they participate in activities. </li></ul></ul><ul><ul><li>Cities voluntarily decide whether they join JOGG. </li></ul></ul><ul><ul><li>In JOGG cities schools voluntarily decide whether and how they participate. </li></ul></ul><ul><li>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. </li></ul><ul><ul><li>Social marketing: it’s all about selling the message! </li></ul></ul><ul><ul><li>Everybody needs to hear the same message always and everywhere! </li></ul></ul><ul><li>Question 1 : Is it possible to kill an elephant with cotton balls? </li></ul><ul><li>Question 2 : If not; is that bad? </li></ul>