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Obesity Part 5: the GB Obesitas Action List

By | About obesity, Body weight regulation, News, Obesity prevention

In our blog series “Obesity -who is to blame?” in Part 1, we have talked about how obesity is a disease, in Part 2 how we move around, in Part 3 processed food and the term “bliss point” and in Part 4 the costs of obesityand an example from Chile of what can be done about the problems in real life. We have now put together a variety of measures that have been tried or proposed in different places around the world.

The idea behind this is this: Obesity is not the fault of the individual – it is obesity-sensitive genes plus our obesogenic environment that creates the disease. Dealing with obesity as the “responsibility of the individual” is therefore both unfair and ineffective. As far as prevention is concerned, society is already acting in situations which in principle are similar: traffic, alcohol, tobacco. We have traffic rules, car testing and driving licences; alcohol tax, age limits and warning labels. Now we need the same in our “obesogenic” society.

Preventing overweight and treating obesity are different things

Preventing overweight and obesity from occurring (=primary prevention) is just as important as treating obesity disease in those already affected (=obesity care) -but the two situations require completely different measures. Primary prevention requires preventive community intervention, obesity care requires medical intervention. Measures in the list that are preventive are labeled “(PR)” as in primary, measures related to the care of already established obesity are labeled “(HC -health care)”.

Medical decisions and measures (HC)

  • Obesity should be considered a common, chronic and serious disease
  • Obesity disease is thus a central and mandatory subject in all healthcare educations, this needs to include knowledge about how the disease occurs, its physiology plus nutritional education. (All these things are completely underdeveloped in Swedish healthcare education today).
  • Evidence-based national guidelines
  • Patient follow up database for non-surgical obesity treatment, corresponding to the surgery registry SOReg. (We must document what care measures we do, which ones work and which do not, etc. In spite of the fact that the weight management industry in Sweden alone has a turnover of SEK 300 million per year, there is currently no patient follow up register in place.)
  • Drug subsidy for modern obesity drugs. If obesity is a common chronic and serious disease, then of course the medicine costs must be treated as all other medications -with subsidy.
  • All children with isoBMI > 30 are referred to an obesity-competent team (mandatory for the caregiver, children with obesity risk living 14 years shorter lives than their normal weight friends), these children’s parents should be involved and supported (not blamed).
  • Activities suitable for FAR (physical activity on prescription) – procured by Sweden’s regions from gyms, wellness and fitness centers and associations and then offered subsidized to those prescribed FAR by the healthcare system

School and Youth (PR)

  • Walking school buses” under municipal authority
  • Ban on fast food restaurants, soft drink vending machines etc. within 500 metres of and within schools
  • Mobile phone ban in school during all school hours including breaks (probably positive for both studies and activity).
  • Subsidies for ourdoor kindergartens and preschools
  • Guidelines+control of served food at preschool and school: -educational meals, nutritional content and portion sizes; and training in nutritional science for all staff.
  • Playgrounds with roofs that are a little more comfortable when the weather is bad.

Society (PR)

  1. Sugar tax (18% tax on high sugar drinks in Chile),
  2. Black Dot labels on foods high in sugar, salt, calories or saturated fats (i.e. up to four black “dots” per food). Foods with several Black Dot labels are sold in separate sections inside the stores.
  3. Ban on ads for high-processed junk food and sweets aimed at children, ban all TV advertising for this type of product from 06:00 to 22:00 every day.
  4. Prohibition of mascots or toys for children associated with junk food, e.g . Tony the tiger at Kellogg’s or KinderEgg.
  • Ban on sweets, soft drinks and unhealthy snacks within 15 feet of the checkouts in shops
  • Water dispensers outside all grocery stores
  • Accessibility requirements for stairs (not just escalators and elevators) in all public environments (“points of decision prompts” -signs showing the way to the right choice).
  • Guarantee of at least five public areas for physical activity within a 500 metre radius of housing in all urban areas.

Do “everything at once”

None of the above listed measures alone will have a sufficient effect on society to make a difference. We need to implement many of the measures in parallell at the same time and on a large scale. Different actors in society need to work together, led and supported by policiesand legislation. We need to monitor which measures are effective (and which are not)but avoid getting “stuck” in decision making regarding what should be prioritised or not before we even get started. The efforts will, of course, in several cases cost money. At the same time you can expect society to also save the money from increased public health – and consider that overweight and obesity already cost Sweden a staggering SEK 48.6 billion per year and 3400 deaths.

Can you come up with more smart measures to prevent obesity? Get in touch with us and we can update the list!

Feel free to share!

Food labelling Chile

Obesity -who is to blame? Part 4

By | About obesity, Body weight regulation, Food and drink, News, Obesity prevention, Online resources, Online resources | No Comments

In Sweden we have laws and regulations!

We have traffic legislation: we drive on the right, we have to take a test for a driving licence, have the car inspected regularly, drive sober, wear a seat belt and comply with speed limits. We even have special traffic police. The cars themselves are made increasingly safe, they are also crash tested.

We also have alcohol legislation; with age limits, Systembolaget, alcohol tax, warnings in alcohol ads. Tobacco is the same: age limits, warnings on packaging, tobacco tax and recent ban on smoking in outdoor dining areas. Drugs are completely criminalized.

 

Why do we have all this?

Couldn’t people just “take responsibility” and discipline themselves?

We have it because we know that without all this, people would be in harm’s way:

In Sweden, 324 people died and 2195 were seriously injured in traffic in 2018 (Swedish Transport Agency). Approximately 12,000 people die from smoking each year, while 100,000 fall ill with smoking-related disease (National Board of Health and Welfare/Public Health Agency of Sweden). About 2,000 people die as a direct effect of alcohol per year, in addition, alcohol caused just over four percent of the total burden of disease in 2017 (data from the international global burden of disease(GBD) project).

Society/the government thus chooses to take responsibility for the population as a group through legislation, to steer it in the right direction. One can have political opinions on the details of the above, but no one would want to abolish all the laws and regulations. Right?

 

How much does overweight and obesity cost? More than you know

At the same time, obesity disease causes at least 3,400 deaths in the country per year. The total cost of overweight is SEK 23.4 billion per year, obesity an additional SEK 25.2 billion (report IHE). Every other adult Swede is currently overweight or has obesity(Public Health Agency of Sweden).

In response to this overweight and obesity epidemic, Swedish society is currently doing -what?

Almost nothing. (Well, we have a 15-year age limit if you want to buy a can of Red Bull and there are certain rules for what advertising to children may look like.) If we translate this approach to traffic, it would be equivalent to having right-hand traffic -but forget the rest (driving licence, speed limits, alcohol, seatbelt, traffic lights)…

We have petrol, alcohol and tobacco taxes. “Fetmainitiativet” (the obesity initiative) proposed a Swedish sugar tax, but this was dismissed by the then responsible minister,who instead wanted to see a “holistic approach”. There is still no sign of this “grip”.

On the contrary, we are unbridledly exposed to advertising of high-processed foods, snacks and sweets almost everywhere. (Public service even allowed Melodifestivalen to have pure junk food as its main sponsor this year). In my large supermarket at home you have to step 20 steps(!) from the checkout to get out of the “zone” with nothing but sweets, chocolate, chips and snacks -there is now even a mini shelf at the checkout between the merchandise band and the customer with small pieces of chocolate (just at eye level for accompanying children). No warnings, no age limits. Nothing.

The same government and society that otherwise impose traffic rules, age limits, extra taxes and warning labels choose to watch passively while the population becomes increasingly exposed to highly processed foods that we know lead to obesity disease. So now we as citizens are suddenly supposed to “discipline ourselves” and take responsibility ourselves, apparently?

This is unreasonable and in every way illogical. In addition, the problem already costs us 3400 deaths and SEK 48.6 billion every year. (Let that sink in).

 

Then why doesn’t anyone do anything?

No one “knows” exactly, but let’s speculate:

Do people realise that obesity is a disease, or do they think it is a poor lifestyle choice made by the patient? Considering Swedish healthcare professionals are basically not educated about obesity disease at all, then how much do our politicians and decision-makers know? Do they think high-processed food is harmless? How strong is the food industry’s own lobbying (quite strong, one might suspect)? How much public opinion is there to help people avoid overweight or obesity?

 

The Four Black Dots

In the next part of the series we will list our proposals for society measures, but you will get a little sample here: in Chile you have a pronounced overweight and obesity problem (75% of the adult population is overweight or obese). Since 2016, there has been an action plan in place to tackle this at the community level. The reason for this: Senator Guido Girardi, who is also a trained physician.

Chile has introduced a number of interesting reforms in this area:

Soda tax: sweetened beverages have an 18 percent tax.

The four Black Dots. If a food item is unhealthy in terms of sugar, salt, caloric content or saturated fat respectively, each of these categories results in a black stop-shaped label being put on the packaging. The customer can thus directly see if an item has zero, one, two, three or, in the worst case, four black dots. The effect is obvious and immediate: no more guessing what the small print in the table of contents really means, and extremely difficult for the producer to get around the problem via misleading advertising or the like.

Result: accompanying children often point out to mom or dad themselves that they don’t want food with black stop signs on -and the industry self-adapts to avoid the black labels. (Read more in the New York Times atricle.)

– ban on junk food advertising on radio and television between 6 a.m. and 10 p.m.

– ban on mascots and cartoon characters linked to junk food (e.g. Tony the Tiger at Kellogg’s).

So it is possible to make changes -if only the will to do so is there.

In the next blog section we will list our suggestions for action – follow us!

/Carl-Magnus