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1. © The Economist Intelligence Unit Limited 2015
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CONFRONTING OBESITY IN BELGIUM
Taking action to change the default setting
A country case study by The Economist Intelligence Unit
As a window on Europe’s obesity epidemic, Belgium represents neither the worst-case scenario
nor the best. According to figures from the Organisation for Economic Co-operation and
Development (OECD), 13.7% of Belgian adults were estimated to be obese in 2013, compared with
an OECD average of 15.5%.1
Like its European neighbours, Belgium suffers from a growing weight problem. Unlike many of them,
however, Belgium is characterised by a number of anomalies that make the problem more challenging
to combat, experts say.
Principal among these are the country’s regional divisions between the French-speaking Walloon
Region and the Flemish-speaking parts of the country, which have traditionally resulted in different
outcomes for the country’s different populations.
Regional divisions and their impact
A 2014 study2
that examined data from four reports of the Belgian Health Interview Survey between
1997 and 2008 found that the Walloon Region had a higher prevalence of obesity than the Flemish
Region at the start of the study; however, prevalence in the Walloon Region remained stable over the
survey period, while obesity levels in the Flemish Region increased during that time.
This split has not only been the source of inequalities and economic rivalries, but it has also resulted
in a curious division of labour with regard to health policy, according to Dr Bart Van der Schueren, an
assistant professor at the University of Leuven.
“The problem, first of all, is that prevention is a regional responsibility,” he notes. “Any other
intervention—curative treatment for diabetes, for example—is federal. So the regional government
makes a certain decision, and then this is opposed by the federal government.”
This apparent disconnect is exacerbated by a financing system which, arguably, provides mixed
incentives, Dr Van der Schueren adds, noting that “bariatric surgery is fully reimbursed, while
the entire set-up around it—from dieticians to psychologists—is not reimbursed, so you have no
nutritionists to follow up.”
1
OECD, OECD Health
Statistics 2015. Available
at: http://www.oecd.org/
els/health-systems/health-
data.htm
2
Drieskens, S, Van der
Heyden, J et al, “Is the
different time trend
(1997-2008) of the obesity
prevalence among adults in
the three Belgian regions
associated with lifestyle
changes?” Archives of
Public Health, 2014 Jun
2;72(1):18, pp. 3-4.

2. 2 © The Economist Intelligence Unit Limited 2015
CONFRONTING OBESITY IN BELGIUM Taking action to change the default setting
Perceptions versus reality
This policy approach is especially notable in light of the results of a recent survey by the European
Association for the Study of Obesity (EASO) about national perceptions regarding the condition.3
More than three-quarters of Belgian respondents (77%) say they believe obesity is caused by lifestyle
choices, while just 46% describe it as a disease. However, this masks the fact that Belgians aged
between 18 and 34 are far more likely to see obesity as a genetic or psychological condition than
those over 55.
Yet some of the lack of clarity in policymaking is likely to be due in part to a lack of urgency about the
scale of the problem. The EASO survey finds that 37% of Belgian respondents who describe themselves
as overweight are actually obese, a smaller percentage than in Finland and Germany, but larger than
in France or Italy.4
As in other countries, an unhealthy diet and a more sedentary lifestyle clearly play
a role in the growth of obesity in Belgium, and once again, regional differences are a major factor.
The 2014 study that examined data from four reports of the Belgian Health Interview Survey between
1997 and 2008 found differences in health promotion and prevention at the regional level. Between
2002 and 2006 Flemish health officials launched a campaign with the main goal of strengthening
self-esteem; only after 2008 did healthy eating and increased physical activity become central to the
campaign. By contrast, campaigns in the Walloon and Brussels regions launched between 2005 and
2010 included both healthy eating and lifestyles.5
There is also a National Food and Health Plan6
, but it
focuses on nutrition rather than a comprehensive strategy to tackle obesity.
Dr Van der Schueren highlights that the lack of a more comprehensive strategy—and, notably,
the absence of incentives to encourage greater overall mobility—offer a stark contrast with other
European countries. “You need an overall policy—compare it with Netherlands, where they are all on
their bikes,” he says. “Mobility is not a priority, and sporting facilities are bad; some communities
don’t have a public swimming pool.”
The absence of a comprehensive strategy, meanwhile, extends beyond the weakness of preventative
programmes, Dr Van der Schueren adds. The Belgian government recently decided to introduce a
sugar tax on soft drinks, which is due to take effect in 2016 and will add 3 euro cents to the price of a
one-litre bottle of such drinks. The tax also applies to diet products, including those that are sugar-
free, which has led to significant debate about the goal of the policy—and in particular, whether
it is primarily about tackling obesity or intended to raise government revenue. The Belgian public
health minister, Maggie De Block—a former general practitioner, who is herself obese and, given her
position, has been the focus of controversy—has stated that it is difficult to differentiate between
soft-drink categories in the initial legislation.7
“[The government] claims it imposed the sugar tax as part of an overall approach to obesity and co-
morbidities, but you get the impression that it had a problem with the budget and quickly imposed it
for that reason,” Dr Van der Schueren says.
3
European Association for
the Study of Obesity (EASO),
Obesity, an underestimated
threat: public perceptions of
obesity in Europe, May 2015,
pp. 16-18.
4
Ibid., p. 8.
5
Drieskens et al, “Is the
different time trend
(1997-2008) of the obesity
prevalence among adults in
the three Belgian regions
associated with lifestyle
changes?”, p. 8.
7
“De Block over suikertaks:
‘Ik was van plan om te
wachten’”, Het Laatste
Nieuws, October 12th
2015. Available at: http://
www.hln.be/hln/nl/943/
Consument/article/
detail/2486781/2015/10/12/
De-Block-over-suikertaks-
Ik-was-van-plan-om-te-
wachten.dhtml
6
Federal Public Service
(FPS) Health, Food Chain
Safety and Environment,
National Food and Health
Plan. Available at: http://
www.health.belgium.be/
eportal/Myhealth/Food/
FoodandHealthPlan2/190
68277?backNode=9735#.
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