More and more children are becoming overweight across WHO’s European Region. Gary Humphreys and Catherine Fiankan-Bokonga report on the multisectoral approach France is taking to reverse the epidemic.
For Graham Whittington, the starting point was getting the children to slow down. “I just wanted them to take time over the first course, give the food time to settle,” he says. As the parent of two children attending the primary school in the tiny village of Rochefort-en-Valdaine in southern France, Whittington found himself in charge of the school canteen in the autumn of 2007.
“I started serving them things like grated beetroot or carrot, French staples that require chewing, but are also delicious and very good for you.” Whittington wanted to change the way things were done at the school–to educate children about the importance of local produce and encourage them to respect food traditions–and one of the things that drove him was a change he was witnessing in the children. They were getting fatter.
Whittington, a British social entrepreneur and newcomer to this part of France, was, in fact, witnessing a tiny part of Europe’s obesity epidemic that had started gaining momentum in the 1980s. The epidemic is so visible and has such alarming health consequences that it has become a major cause for concern.
Last month, health ministers from across the World Health Organization’s (WHO) European Region met in Vienna to discuss strategies for tackling obesity, which is one of the most important contributors to the two main causes of premature death in the 53-country region: cardiovascular disease and cancer.
National surveys in many of these countries reveal a picture of excessive fat intake, and low fruit and vegetable consumption resulting in an increasing level of obesity, which shortens people’s life expectancy and reduces their quality of life.
In France alone–a country famous for its strong food traditions–the number of overweight children tripled between 1980 and 2000. “In the 1980s, 5% of French children were overweight, and that rose to 16% in 2000,” says Professeur Serge Hercberg, nutritional epidemiologist and President of the National Nutrition and Health Programme (Programme National Nutrition Sante or PNNS).
“By 2007, the rate of increase was slowing down, with just 17.5% prevalence reported that year. What has happened since, no-one knows. “There are no official figures available,” Hercberg says, “and nothing will be published before 2014.”
The hope is, however, that the various initiatives taken by France in the past decade or so will bear fruit. Central among those initiatives is the national nutrition and health programme PNNS launched in 2001, a key aspect of which is changing children’ experience of food in schools.
This includes making school canteen food healthier, dropping the morning food break and, notably, banning vending machines that sell junk food and soft drinks while increasing the availability of water fountains and the distribution of free fruit.
Both programmes encourage regional involvement, and the PNNS has a charter of commitment for “active PNNS cities” that undertake to implement projects that are consistent with programme objectives. Aquitaine, in south-western France, was one of the first regions to sign up and has had its own Programme for Nutrition, Prevention and Health for Children and Teenagers in place since 2004.
Dr Helene Thibault, a paediatrician from the Children’s Hospital in Bordeaux, coordinates prevention and management of childhood obesity programmes in the Aquitaine region. “We train school doctors and nurses to screen for children who are overweight and refer them to their general practitioners,” Thibault says. “For children who are overweight, we propose a care plan that they and their families can follow–one that takes a multidisciplinary approach involving dieticians, psychologists and physical activity professionals. …