World Digestive Health Day 2021: The European Obesity Crisis

Helena Cortez-Pinto, highly respected gastroenterologist and hepatologist and Vice President of United European Gastroenterology (UEG), discussed the alarming trend of obesity across Europe and its harmful impact on a range of chronic digestive diseases.

The European obesity epidemic is one of the most significant and greatest public health challenges that we face today. Over the past few decades, we have seen a stark increase in obesity and now over half of the EU’s population are considered either overweight or obese¹. This brings a huge burden with suffering and loss of life and it is vital that we unite and act now to reverse this trend and protect future generations.

There are a multitude of digestive and liver diseases that are associated with overweight and obesity. For example, almost 75% of obese individuals have a fatty liver, increasing the prevalence of non-alcoholic fatty liver disease (NAFLD). Additionally, obesity is fast becoming a health risk that is overtaking tobacco as the leading preventable cause of cancer, with evidence showing increased colorectal, pancreatic, oesophageal, gastric and liver cancer rates in obese people. Combined, these five cancers are responsible for over 365,000 deaths per year in the EU, representing almost one in three cancer-related deaths.

As well as affecting the health and wellbeing of individuals, obesity places a substantial strain on public healthcare systems, with both direct and indirect costs having an evident effect on society. Estimated to cost the EU over €70 billion annually through healthcare costs, obesity is a driver of lost workplace productivity and stretched healthcare services².

Equally alarming is that there is little expectation that obesity figures will decrease, or even plateau, in the near future. Recent studies have reported that one in three children in Europe between the ages of six and nine are either overweight or obese. Childhood weight problems continue throughout later life too, with evidence showing that four in five obese adolescents continue to have weight problems as adults³.

Like in adults, paediatric fatty liver disease is emerging as one of the most significant complications of childhood obesity. Studies in Germany, for example, have shown a 30% prevalence of NAFLD in overweight and obese children and adolescents⁴.

So, what can be done? Promoting the adoption of healthy lifestyle choices is key in tackling rising adult and childhood obesity rates, especially in tackling high consumption of processed and ultra-processed foods, which are often high in salt, sugar and fats. Consumption of ultra-processed foods has dramatically risen in recent decades, with consumers opting for ‘fast food’ items including soft drinks, confectionary, and frozen ready meals instead of home-cooked meals, that are usually healthier.

To limit the consumption of these unhealthy foods, the European Commission and national governments must do more to increase the availability of quality healthy foods, at a lesser price, to influence consumer choices. The taxation of unhealthy food, like sugar-sweetened beverages (SSBs), has been shown effective in reducing the consumption in Portugal⁵, and could be a measure to be further implemented. On the opposite there is need of state economic support for the production and sale of fruit and vegetables. Also, campaigns to increase the availability and reduce the cost of water, such as the “Drink Up” campaign, can be very significant in reducing obesity⁶.

Promoting a change in eating culture, from ‘on-the-go’ food consumption to nutritious cooked meals, can be achieved through adopting policies that restrict the marketing of unhealthy foods and encourage the reformulation of products to reduce fat and sugar content. Policies that restrict the marketing of unhealthy foods, especially to children, and public health educational programmes can also be enhanced to inform what constitutes a healthy diet.

There is an immediate requirement across our continent for a drastic change in attitudes, approaches, and behaviours towards food consumption. Due to the level of change required, it can only be shifted if there are coherent EU and Member State plans. Through this, we can achieve a new environment for members of the public to be encouraged to, and want to, make healthier and more informed choices related to food consumption.

If we do not change our approach now, the burden of obesity on chronic digestive diseases is only going to become greater, with higher disease prevalence, death rates and economic costs as a result.

Commenting on the obesity epidemic, Sarah Wiener MEP, states: “Obesity is one of the most significant health challenges of the 21st century in Europe, and the burden on healthcare systems, the economy and society at large continues to grow. We need to drive holistic policies that facilitate a European-wide transformation to healthier lifestyles. This demands immediate action and support from Governments to ensure we enable and empower European citizens to make this crucial change, as we seek to turn the tide against obesity.”

Stella Kyriakides, European Commissioner for Health and Food Safety, adds: “Reversing the rise in obesity rates and change of consumption patterns across the EU is critical – for the health of our citizens and continent but also for our resilience to pandemics⁷.”