Authors: Vicki Mooney, ECPO Executive Director; Euan Woodward, EASO Executive Director; Daniel Beety, Novo Nordisk, Co-chair of the Obesity Platform; Maurizio Guidi, Eli Lilly, Co-chair of the Obesity Platform.

Scientific understanding and clinical management of obesity have evolved, but attitudes, policies and societal narratives have not kept pace.

Our knowledge of the science of obesity has substantially improved in the past decade. We now understand that obesity is not simply a risk factor for diabetes, cancer and cardiovascular disease — and many other conditions — it is a multi-factorial chronic disease with genetic, environmental and psychological origins.

This view is reflected in a recent report commissioned by the European Parliament Committee on Public Health (SANT) – Current Challenges and Opportunities for Addressing Obesity – which recognises the multifactorial chronic nature of obesity. This definition is also acknowledged by the World Health Organisation and by leading scientific organisations, including the European Association for the Study of Obesity (EASO), the International Federation for the Surgery for Obesity and Metabolic Disorders (IFSO), and the World Obesity Federation (WOF).

However, while this is well accepted among leading experts, outdated views of obesity continue to inform the way we manage the disease. As a result, the cost of inaction continues to rise, with forecasts anticipating an increasing impact on the European population and health systems in the coming decades. Unless we change how we align with the science and act on obesity, we cannot expect to reverse the upward trend.

And reverse it we must. Obesity rates in the EU have risen steadily and are expected to climb further. Data from 2022 show that about 15% of people aged 18-64 live with obesity, while this rises to 20% among 65-74 year olds. By 2030, obesity rates will reach 30% of Europeans, leading to direct and indirect healthcare costs in the order of €1.6 billion unless holistic action is taken[1].

The consequences of increased prevalence of obesity will include lower quality of life and premature mortality, as well as reduced economic productivity, early retirement and greater need for health and social support. 

Time for change

Despite the complex causes of obesity, societal responses are frequently based on an outdated ‘calories in versus calories out’ model which presumes that prevention and treatment can be achieved solely by limiting consumption and maximising energy expenditure. While supporting a healthier lifestyle is a key driver of public health and has a role in a holistic policy mix, it is too simplistic to focus on calories alone.

In addition, this view fosters stigma, as it inaccurately attributes responsibility solely to individuals rather than acknowledging the genetic and biological origins of obesity or looking at the systems in which we all live, work and play. This mindset also underpins the traditional approach of some health systems which focus on managing only obesity-related complications and not obesity itself.

Promoting nutritional literacy and physical activity is fundamental to public health policy, with benefits across many disease pathways, but has so far proven insufficient as a solution to rising obesity rates. People with obesity need timely access to diagnosis and evidence-based care, just as people with cardiovascular diseases, chronic kidney disease or cancer rightly expect. Europe needs a comprehensive, holistic and integrated approach to delivering outcomes that matter to people affected by obesity.

Action on obesity

At EU level, strong policy signals can help to set the tone for a wider shift in our response to obesity. To devise a holistic response to obesity, it is vital that all stakeholders play their part in addressing a challenge that has clinical and societal elements. We are pleased to see that Members States yet again recognized the link between obesity and cardiovascular health in the recently adopted Council Conclusions on improving Cardiovascular Health in the EU, and call on the Commission to make sure this is reflected in the forthcoming European Union Cardiovascular Health Plan.

As a first step, we must work together to improve health literacy to promote accurate public understanding of obesity as a chronic non-communicable disease (NCD). This will help to address the stigma faced by people with obesity in society, the workplace and in clinical settings, all of which can contribute to poor obesity management.  We also call for a more nuanced approach to diagnosis of obesity that relies on more than Body Mass Index as a diagnostic tool.

By launching a Joint Action on Obesity to address the full pathway of the disease, from prevention to early detection and on to evidence-based management, Member States could help to raise standards across Europe. The development of National Obesity Plans, as recommended by the WHO, in every Member State would serve as a roadmap to the prevention and long-term management of obesity.

The Commission, for its part, could facilitate the exchange of knowledge and best practice by including obesity as a stand-alone working strand within the Expert Group on Public Health.

In line with calls from civil society organisations for joint heart and diabetes health checks at primary care level, we propose implementing these checks through pilot projects and the work of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI).

There is also a role for the Joint Research Centre to support professional obesity societies in developing standardised clinical guidelines and recommendations for obesity across Europe. Policymakers must ensure that evidence-based treatments, services and interventions are reimbursed and available to those who need them.

Obesity is a chronic disease and requires a multifaceted approach. There is substantial work ahead, but we have the determination to make it happen.

References:

[1] World Obesity Federation (2022). The economic impact of overweight and obesity in 2020 and 2060. Estimates for 161 countries, 2^nd edition. Available here. (Accessed 22/04/2024)