Newsletter 4/2017



The high level of overweight and obesity in children and young people is an area of particular concern and one of the most pressing public health issues, affecting countries at every stage of development. The latest estimates indicate approximately 1.46 billion people worldwide are overweight and 502 million of these obese. The problem also involves children: globally, 42 million of those under the age of five are estimated to be overweight. Despite various national and EU initiatives the prevalence of childhood overweight and obesity is increasing, reaching 1 out of 3 children aged 6-9 years old in Europe in 2010. In some countries where there are tentative signs that childhood prevalence may be stabilising, it is doing so at this disturbingly high level.


Furthermore, a significant correlation exists between childhood and adolescent Body Mass Index (BMI) and adult overweight and obesity. The current childhood obesity rates have the potential to contribute extensively to the health and economic burden of obesity in Europe in the future. The health burden of disease associated with obesity is driven by increased incidence of type 2 diabetes, cardiovascular diseases and some forms of cancer. Both the direct health care costs (e.g. medical and pharmaceutical costs) and broader societal costs (e.g. productivity losses associated with work absenteeism and premature mortality) are part of the significant financial burden to both public health expenditures and to the state.


Studies in the WHO European Region indicate that, in general, the direct health care costs of obesity account for 2-4% of national health expenditure. In the United States it was estimated that the direct health care costs of childhood obesity at $14.1 billion including inpatient costs of $237.6 million. The medical costs of obesity are so substantial that the rise in obesity explained 27% of the rise in health care spending between 1987 and 2001.


Should current trends continue unabated, estimates of the lifetime disease burden and economic cost of childhood overweight and obesity will provide policymakers with an idea of the potential scale of the obesity epidemic and its consequences for the Europe’s health care system, economy and citizens. This will help guide resource allocation, population health planning and the development of effective obesity prevention and health promotion programmes to curb obesity levels within European countries.

Through its Work Package 4 (WP4) “Lifetime impacts and cost of childhood obesity” JANPA will estimate the scale of the obesity epidemic and will cover impacts and costs experienced by obese and overweight children and adolescents children. It will include current as well as future impacts and costs experienced in their later lives to 2020, 2025, 2030 and beyond. JANPA WP4 will provide estimates in seven Member States (Croatia, Greece, Ireland, Italy, Portugal, Romania and Slovenia) as well as comment on the feasibility of generalizing the work to other countries.  


Work Package 4 will also model different scenarios assessing the effect of 1% and 5% reduction in the prevalence of childhood overweight and obesity on these impacts and costs. Of course governments, health policy makers, public health personnel and the food and drinks industry need agreement on how best to achieve such reductions of overweight and obesity.


Failure to tackle the increase in overweight and obesity or even stabilise the current trend, threatens to have a highly negative impact on health and quality of life and to overwhelm national healthcare systems in the near future.





Working towards our special objectives to gather national good practices and assess capacities and resources

At the end of this two-year project, the partners of JANPA will present key results to an audience of EU and national policy makers, stakeholders and partners. In particular, the JANPA partners will present the key findings and recommendations from the main deliverable of the Joint Action.







Following a first presentation made in November 2016 at the High Level Group, the methodology and results of the pilot studies of the Work Package 5: “Nutritional information” of Janpa have been presented at the reformulation group of the European Commission. This meeting took place in Brussels the 7th March 2017 in the presence of members of the EC, the JRC, EFSA (as invited expert) and Member states. The methodology of Janpa has been definitely adopted and will be implemented in 3 other countries in 2017: Cyprus, Luxembourg and Malta (the Netherlands also planned such a study in 2017). In addition, the possibility to extend the methodology to many other countries in Europe will be explored.

For further information see “The methodology of the pilot studies”.






The sooner the better: pregnancy and early childhood are decisive phases and strongly affect the health of mother and child - short, medium and long term! However, the birth of a child is often characterized by large uncertainties but also by a flood of (partly contradictory) information. Young families need easy-to-understand information, which are close to their everyday life and free of conflicts of interest.


That is why medical and scientific societies, professional organizations, and professionally oriented institutions combined together in the German-wide network “Healthy Start – Young Family Network”. A constructive and continuous cooperation between all actors with close contact to pregnant women and young families is indispensable in order to promote healthy lifestyles. The main aim of the network is to support pregnant women and young parents by providing uniform information on nutrition, physical activity and allergy prevention.


The network publishes and regularly updates recommendations on nutrition and physical activity in infants and young children and during pregnancy. The recommendations are based on the latest scientific knowledge. In order to disseminate them, the following activities are used: face-to-face trainings of health professionals, development and distribution of materials and media such as flyer, sticker, poster, and apps, as well as an extensive PR work.


What has the network achieved so far? More than 70% of the health professionals are aware of the recommendations. The level of consent with the recommendations is high (e.g. 73% with pregnancy recommendations in 2014). The network reaches more than 1.6 m parents per year with its media (flyer, sticker, apps) and via internet (data from 2016). About 4,000 health professionals participated in the standardized training seminars. 65% rated the seminars as helpful for their everyday work, 58% considered the transferability into practice very likely.


The network provides materials and media also in other languages (English, Turkish, Russian, Arabic). The English media can be accessed here: A short English description of the network (pdf file) can be found here:


“Healthy Start – Young Family Network” was established in 2009 and is part of the Federal Centre for Nutrition as well as of the National Action Plan IN FORM (Germany’s initiative to promote healthy diets and physical activity).




Smart Family is part of the umbrella project “One Life” organised by the Finnish Brain Association, the Finnish Diabetes Association and the Finnish Heart Association. The Smart Family has been developed to support lifestyle counselling for families with children and is based on international and national recommendations, for large-scale health check-up.

The key aim is to promote healthy lifestyle choices and give families a greater feeling of control. The need for changes arises through self-assessments made by families themselves, which means that discussions with a professional can concentrate on the themes each family considers important. It is important to help families to identify the positive and healty behaviours in the daily life and to use them as a basis for making changes.


The Smart Family continuing education has been provided to over 3,000 healthcare professionals in Finland. New education days are organised continuously. During these education days, participants make practice by using the Smart Family method, familiarise themselves with the material and receive up-to-date information on physical exercise, nutrition and counselling.


Different tools support the Smart Family method:

  1. the Smart Family Card works as a self-assessment tool for families and helps professionals to talk about lifestyle choices. It is now being used in over half of the municipalities in Finland.
  2. the Smart Family illustration folder helps to identify the themes brought up by families and incorporate them into the daily life. The folder can be used to present ideas and thoughts about the issues that are important to the family. The purpose of the illustrations in the folder is to encourage families to think about their habits. The folder contains over 70 pictures (physical exercises, nutrition, no smoking, alcohol, daily routines, sleep, and oral health). The pictures make it easy to give concrete information and illustrate choices in the family’s everyday life.
  3. the Smart Family information folder is a tool for helthcare professionals. It summarizes the information on the card and on the illustration folder. The folder contains very practical advices that are based on the knowledge of children’s development of starting to eat new foods.

The Smart Family website offers families and professionals information and support on lifestyle choices for families with children.




The global obesity epidemic has induced to increase attention on pregnancy, a period when women are at risk of gaining excessive weight. Excessive gestational weight is associated with numerous complications, for both mother and child. Preventive efforts may be more effective than the treatment of individuals who are already overweight or obese, and might be particularly timely in pregnancy, when two lives are affected. Some authors have described pregnancy as a “teachable moment”: women have a new awareness of their body and the responsibility of a new life, and are therefore more responsive to healthcare information than at other times. The WHO has listed both pregnancy and the prenatal period as key moments for lifetime risk of obesity. By preventing excessive weight gain during pregnancy, there is less risk of the mother developing obesity later in life. Perhaps more important, a lifestyle change during pregnancy has the potential to affect the health of the newborn at the earliest possible stage, while still in the uterus. By teaching women new habits, the intervention will also influence the environment the child enters after birth.


A healthy diet and exercise before and during pregnancy helps to protect both immediate and long-term health risks. The Fit for Delivery combines access to twice-weekly supervised exercise sessions with counseling on nutrition and appropriate gestational weight gain. The intervention provides concrete advice on limiting energy intake and practical training in increasing physical activity. This lifestyle intervention is simple, reproducible, and inexpensive.


The intervention was offered to all pregnant women in the municipalities participating in the project in Norway, represented both rural and urban areas. Women were involved through antenatal care, and midwives gave information to women who fitted the criteria of the intervention (18 years of age or older, of less than 20 weeks gestational age, with a singleton pregnancy, and have a Body Mass Index - BMI ≥ 19 kg/m2). The intervention is also designed so that both women who have previously been sedentary and those with an active lifestyle were able to perform the exercises and follow the nutritional advice, albeit at different levels.


For further information, see:

Sagedal et al. Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial. BJOG. 2017 Jan;124(1):97-109.

Sagedal et al. The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian Fit for Delivery randomised controlled trial. BJOG. 2017 Jan;124(1):111-121.







Reformulation in processing of food provides an opportunity for improvement of health status of population through improvement of nutrition properties of food intended for common daily consumption. Reformulation of food has a potential to reduce inequalities in the area of health, with strengthening of disadvantaged population groups and is aimed at creating healthier nutrition.


Initiatives of the European Member States (MSs), including Switzerland and Norway, are extensive and are focused on main risk factors (salt, total fat, saturated fat, sugars, energy, portions size, food labelling, etc.).


So far, MSs applied different policies in reformulation of risks in different food categories, which were reflected in national documents supported by governments, cooperation between governments and food producers, with regard to the nutritional risk factors, sources and regulation. Open issue is strengthening of activities for approximation of consistent and measurable levels of risk factors (salt, saturated fat, added sugars) and their representation in main foodstuffs or food commodities and in portion size.


In 2016, European Commission sent to 28 MSs, plus Switzerland and Norway, a questionnaire prepared in framework of cooperation of “Presidency trio”, the Netherlands, Slovakia and Malta, focused on obtaining of information and best practices in the area of food reformulation. 24 Countries (22 MSs, Switzerland and Norway) responded completely or partially to the questionnaire. Slovakia during its Presidency focused on processing of provided data on best practices in food reformulation on national level.


In this respect, activities in the framework of mutual projects are important, such as JANPA, which can contribute to setting of further steps in reformulation. It is necessary to support activities for obtaining further information on how reformulated product will influence intake of risk factor, whether it is sufficiently supported by other policies, e.g. by labelling, nutrition standards, nutrition and health claims about foodstuffs, composition, etc. Best experiences, obstacles and changes for the future stated by the MSs in the questionnaire are summarised in the following table.


Strengths and weaknesses of the food reformulation

Best practices


Challenges for the future

National action plan

Cooperation with industry

Step-by step approach in the dialog with food industry

Agreement and cooperation with industry sector

Technological difficulties 

Improve the collaboration of food industry

Public awareness campaign, education of inhabitants, education campaign

Lack of resources

Close cooperation of all sectors

Legislation  policy

Conflict of interest between the economical and public health aspects

Focus on monitoring program

Using symbols - logo, labels

Increase an availability of healthier options

Monitor the action at national and local level


Lack of resources (financial, personnel)






Consumer´s unwillingness





To cope with the rise in obesity in France, the State has established a public policy of nutritional health by launching the French National Nutrition and Health Programme (PNNS). In 2007, an order of the 2004 Public Health Act required that advertisements for manufactured food products and drinks with added sugars, salt or artificial sweeteners must contain health information. This provision applies to all media (television, radio or advertising displays). These messages are now well known to the public (5 fruits or vegetables a day, etc.). However, over time, surveys show that they are attracting less and less attention and that their visibility is uneven, depending on the medium. Moreover, the method of disseminating messages generates problems of comprehension, and they are sometimes seen as an endorsement of the products shown in the advertisement.

In late 2013, Santé Publique France requested Inserm to carry out a collective expert review in order to take stock of the scientific knowledge, and to analyse the impact of health messages disseminated by the mass media on cognition, attitudes, intentions and behaviours. The review is organised into three parts: the first part provides some background on the legislation and on the impact of marketing on dietary behaviours; the second part provides an update on various aspects of assessing media-based nutrition campaigns; finally, a third part analyses the psycho-cognitive mechanisms involved in the reception and processing of health messages by individuals.


Adapted from: Press file – Inserm press room Action on dietary behaviours, a collective expert review by Inserm



MOVE Week is an annual Europe-wide event taking place in May. The objective of MOVE Week is to promote the benefits of being active and participating regularly in sport and physical activity throughout Europe. In 2017, every country can choose when to implement MOVE Week in the timeframe of 29 May - 04 June according to their specific needs. MOVE Week is financially supported by the European Union.



The informal meeting of EU Health Ministers was held in Malta (La Valletta) on March 19 and 20, 2017. As a priority during this meeting the EU Presidency discussed public health issues. Among these, in addition to the fight against HIV/Aids, the cooperation between Member States and the structured mobility of specialist doctors, also childhood obesity was greatly discussed. The Ministers of Health stressed that obesity is an increasing widespread epidemic problem in Europe and confirmed the need for a better collaboration between member states, including also a greater involvement by all sectors of the society. The importance and role of urban environment, the early mother and child nutrition and the economic and cultural inequalities were also highlighted. The European Commission declared itself ready to provide with a support to the EU countries and a platform for the exchange of experiences and good practices; the member states expressed their appreciation of the 2014-2020 Action Plan against Childhood Obesity. Among the various aspects, the importance of reducing the impact of marketing on food for children emerged in particular for Italy. For further information, see the dedicated page on the MaltaEu2017 Maltese Presidency website.




5th EUFEP Congress 2017

"Child and Adolescent Health - Merely Child's Play?"

21 - 22 June 2017

Kloster Und, Krems, Lower Austria, Austria


CIOI - International Conference on childhood obesity

5 - 8 July 2017

Lisbon, Portugal



Sustaining resilient and healthy communities

1 - 4 November 2017

Stockholmsmässan, Stockholm, Sweden


27th European Childhood Obesity Group Annual Congress


15 - 17 November 2017

Rome, Italy



Collaborated to this newsletter:

- *Kevin Balanda (The Institute of Public Health in Ireland - IPH IRL).

-**Katharina Reiss (aid infodienst / Gesund ins Leben – Netzwerk Junge Familie) and the team from Germany.

- ***Iveta Trusková (Public Health Authority of the Slovak Republic) and the team from Slovakia;

Editorial committee: Eva Appelgren, Pierfrancesco Barbariol, Chiara Cattaneo, Barbara De Mei, Lorenzo Fantozzi, Carla Faralli, Susanna Lana, Antonella Lattanzi, Paola Luzi, Angela Spinelli.



The content of this newsletter represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.