This document summarizes the results of a Nordic monitoring system that tracks diet, physical activity, and overweight/obesity among children and adults in Nordic countries. The monitoring system was developed to assess progress towards goals in the Nordic Plan of Action to reduce unhealthy lifestyles and overweight. The summary shows that while some health behaviors improved modestly in children from 2011-2014, rates of unhealthy diet and inactivity increased in adults. Key challenges include high rates of unhealthy diet and overweight among boys, girls, and those with low education. Overall, the development for children is more positive but still needs improvement, while trends for adults are concerning and moving in the wrong direction.

1. Health behaviour related
to overweight & obesity in Nordic children
The Nordic Monitoring System
on diet, physical activity and overweight
Senior adviser Sisse Fagt on behalf of the Nordic Monitoring group,
Division of Risk Assessment and Nutrition,
Technical University of Denmark
sisfa@food.dtu.dk

2. Aim: Reduce overweight, obesity and unhealthy
lifestyles in the Nordic countries
Development of a common monitoring system in
the Nordic countries (DK, FI, SE, IS, NO) was an
important part of the Nordic Plan of Action
A joint Nordic method to assess diet and physical
activity was developed and validated in 2008-2010
First systematic monitoring in 2011 and 2014 of
both adults and children in the Nordic countries
Background
The Nordic Plan of Action on Better Health and Quality of Life through diet
and Physical Activity (Nordic Council of Ministers, 2006)

3. Objective
• To provide status and temporal trend data of diet, physical activity and
overweight among adults and children in the Nordic region and in the
Nordic countries
• Compare results between countries
• Examine social inequality in diet, physical activity and overweight
• Evaluate results against Goals 2011 and Visions 2021 in the Nordic
Plan of Action on better health
– Goals 2011 (development) and Visions 2021 (status) focus on reducing
unhealthy lifestyles and overweight in the Nordic countries

4. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Methods

5. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Study design
• A simple, low cost monitoring system obtaining self-reported data on
health behaviour and weight status among adults and children in the
Nordic countries
– First systematic monitoring of both adults and children
• Nationally representative population samples
– Data have been collected in 2011 and 2014 among 17.775 adults
(18-65 y) and 4.949 children (7-12 y) in the five Nordic countries
• Data collection within same survey year and same time a year in all the
Nordic countries
– Invitation letter and telephone interview lasting 15-20 min.
• Data collection every third to sixth year

6. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Questionnaire
Sociodemografic Sex, age, education, urbanisation, household
composition
Diet (FFQ) Intake frequencies of fruits, vegetables, bread, fish,
cheese, sausages, sugar-rich foods and beverages. Fat
quality (fats used as spread and for cooking)
Overall dietary quality score is calculated
Physical activity Moderate and vigorous physical acitivity (MVPA), level
of leisure-time physical activity
Sedentary behaviour Screen-time (TV and computer) (>4h/wk)
Weight status Height, weight (BMI)
Questionnaire relatively short and easy to comprehend.
Children: 32 items (parents answer on behalf of their children)

7. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Results on key variables
Unhealthy diet, inactive, high screen time, overweight, obesity

8. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Nordic region key variables: 2011 to 2014
Children
15,4
60,3
17,3
15,1
3,0
15,6
59,1
15,5 15,4
3,2
0
10
20
30
40
50
60
70
Unhealthy diet Inactive High screen time OW/OB OB
Children
Percent
2011 2014

9. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Source: Olsen et al, 2006. Epidemiology 17, 3, pp.
292-95
Prevalence of obesity fluctuates…..
Diet fluctuates as well – low
carb, high fat, sugar focus etc.

10. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Dietary quality children: Nordic region: 2011 to 2014

11. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Status

12. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Most favorable Least favorable
Diet
Unhealthy diet (%) -
Fruit & vegetables (freq./day)
Fish (freq./day)
Whole-grain bread (freq./day) Ic
High intake of foods rich in saturated fat (%) -
High intake of sugar-rich foods (%) -
Physical activity and sedentary behaviour
Inactive (%)
High recreational screen time (> 4h/day) (%) -
Weight status
OW/OB (%) - -
OB (%) - -
Nordic countries: Most and least favourable health
behaviour and weight status among children: 2014

13. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Ranking from lowest to highest prevalence of OW/OB and
OB among children in the five Nordic countries. NORMO
2014
Country OW/OB (%) Country OB (%)
Denmark 11.6 Finland 2.3
Finland 15.6 Norway 3.0
Norway 16.7 Sweden 3.2
Sweden 16.8 Iceland 3.2
Iceland 20.0 Denmark 4.2

14. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Development: 2011 to 2014

15. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Goals 2011
Diet The consumption of fruits and vegetables has increased
The consumption of fish has increased (suggestion)
The consumption of whole-grain bread/cereals has increased
The intake of fat, especially saturated fat and trans fatty acids,
has been reduced
The intake of added sugar has been reduced.
Physical activity The current trend, where an increasing proportion of children
are physically inactive, has been brought to a halt and at best
reversed
Overweight/
Obesity
The continuing increase in the proportion of the overweight and
obese children has been stopped and at best reversed
Social inequality in
overweight/obesity and
diet and physical activity
Existing differences between different social groups with regard
to overweight, obesity, unhealthy diet, and physical inactivity
have not deepened further and at best have been reduced
[1
The Nordic Plan of Action – Goals 2011

16. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Nordic
region
DK FI SE IS NO
Diet
Unhealthy diet (%) Unchanged Unchanged Favorable Unchanged Unchanged Unchanged
Fruit & vegetables (freq./day)
Favorable Unchanged Favorable Favorable Unchanged Unchanged
Fish (freq./day) Favorable Favorable Favorable Unchanged Favorable Unchanged
Whole-grain bread (slices/day)
Unfavorable Unchanged Unchanged Unchanged Unfavorable Unfavorable
High intake of foods rich in
saturated fat (%) Unchanged Favorable Unchanged Unchanged Unchanged Unchanged
High intake of sugar-rich foods (%)
Favorable Unchanged Unchanged Unchanged Unchanged Unchanged
Physical activity and sedentary
behaviour
Inactive (%) Unchanged Unchanged Unchanged Unchanged Unchanged Favorable
High recreational screen time
(> 4h/day) (%) Unchanged Unchanged Unchanged Unchanged Unchanged Unchanged
Weight status
OW/OB (%) Unchanged Unchanged Unchanged Unchanged Unchanged Unchanged
OB (%) Unchanged Unchanged Unchanged Unchanged Unchanged Unchanged
Diet, physical activity and overweight
Children: 2011 to 2014

17. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Social inequality
Children - Nordic region
Social diff.
2014
Develop.
2011-2014
Goal 2011
Fulfilled
Diet
(unhealthy diet)
Large Increase
(large)
No
Physical act.
(inactive)
Small No change Yes
Overweight
(overweight/
obese)
Moderate Decrease
(large)
Yes
Relative difference (%) = [(value High education group – value Low education
group)/value High education group]*100.
Small diff.: ≤ 10%
Moderate diff.: 10-20%
Large diff.: ≥20%

18. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Social difference in diet (unhealthy diet)
Children Nordic region: 2011 to 2014
12,2 13,6
24,4
10,6
0
5
10
15
20
25
30
35
40
Low High Low High
2011 2014
Percent
-133%10%
*
*

19. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
22,1
11,2
16,4
13,8
0
10
20
30
40
50
60
70
Low High Low High
2011 2014
Percent
-19%-98%
Social difference in overweight (OW/OB)
Children Nordic region: 2011 to 2014
*

20. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Nordic region
Goals 2011 fulfilled
(development)
Fruit and vegetables
Fish
Added sugar
Physical activity
Overweight
Goals 2011 not fulfilled
(development)
Wholegrain bread/cereals
Saturated fat
Visions 2021 currently fulfilled
(population goals)
Wholegrain bread/cereals
Visions 2021 currently not fulfilled
(population goals)
Fruit and vegetables
Fish
Saturated fat
Added sugar
Physical activity
Overweight
Evaluation of Goals 2011 and Visions 2021
Children

21. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Public health challenges - 2014
Gender differences in health behaviour
among children
Boys
Nordic region
Girls
Nordic region
Unhealthy diet (%) 18 14
Inactive (%) 54 64
Sedentary behaviour (%) 18 13
Overweight/
Obese (%)
15 16
Obese (%) 3 4

22. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Public health challenges
Children - status 2014
Nordic region
Unhealthy diet Boys
Low and medium educated
Inactive Girls
Medium educated
Sedentary behaviour Boys
Overweight/obese
Medium educated

23. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
18,2
33,2
28,6
46,6
11,4
21,5
33,6
30,0
46,7
12,7
0
10
20
30
40
50
60
70
Unhealthy diet Inactive High screen time OW/OB OB
Adults
Percent
2011 2014
*
*
*
Nordic region: 2011 to 2014
Adults

24. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
Conclusion
The development is heading in the wrong direction among adults
in the Nordic region, while the development among children is
more encouraging, but improvements are still needed
Nordic region Adults (%) Children (%)
Unhealthy diet 22 16
Inactive 34 59
Overweight/obese 47 15

25. Sisse Fagt, November 2016DTU Food, Technical University of Denmark
The Nordic monitoring group:
• Adviser Heléne Enghardt Barbieri, National Food Administration, Sweden
• Senior researcher Katja Borodulin, National Institute for Health and Welfare, Finland
• Professor Lene Frost Andersen, University of Oslo, Norway
• Project Manager Holmfridur Thorgeirsdottir, Directorate of Health, Iceland
• Senior adviser Jeppe Matthiessen, senior researcher Ellen Trolle & senior adviser Sisse Fagt, Technical University
of Denmark, Denmark
• Data handling: Datawarehouse manager, Karsten Kørup, Technical University of Denmark, Denmark
• Statistical support/weighting data: Associate Professor Anders Stockmarr, Technical University of Denmark,
Denmark
• Collaboration on smoking: Project Manager, Sveinbjörn Kristjánsson, Directorate of Health, Iceland
Thank you for your attention!