Policy options for responding to obesity:

1
Policy options for responding to obesity

• Hungarian findings of the PorGrow project

Zoltánné Horváth Dr. Mária Gilinger Pankotai Dr.
István Szabolcs Department of Dietetics Semmelweis
University College of Health Care Budapest,
Hungary
2
Percentage of females and males aged 15 years and
over with Body Mass Index over 30 (obese
population)
Source OECD Database
3
BMI categories by age and gender in Hungary, in
2000 and 2003
Source National Health Interview Survey 2003
Hungary, Executive Update
4
Percent of overweight and obese children by age
and gender (2002)
Source HBSC survey, Hungary, 2002
5
Changes in challenges and lifestyle
characteristics in Hungary between 1987 and 2002
6
Nutritional habits

• excessive intakes
• energy
• fat (gt36)
• animal fat
• cholesterol
• added sugar
• sugared drinks and sweets
• salt

• insufficient intake
• dietary fibres
• vegetables and fruits
• whole-meal cereals
• fish
• milk and dairy products

7
Physical activity

• The physical activity of the population in
  leisure time is not more than 10 minutes a day.
• At present, only 16 of the adult population is
  engaged in any kind of regular sports activity
• Only 23 of school-aged girls and 39 of boys
  have 5 or more active days a week
• Sedentary lifestyle become more common among
  Hungarian students in last 10 years

8
Policy debates and initiatives

• Regulation on
• school canteens
• public catering
• National Frame Curriculum
• National Sport Strategy
• Dietary recommendations for Hungarian adult
  population

9
Hungarian findings
10
Engagement with discretionary options
11
Additional options

• Increased public awareness and activity
• Psychological background
• Presenting the unhealthy consequences of obesity
• Physical fitness as a social norm when evaluating
  applications for jobs
• Occupational health care
• Calories burnt
• Veracity of claims
• The obligatory indication of the nutritional
  value of meals
• Obesity management
• An EU recommendation on proportion of expenditure
  spent on obesitology

12
Criteria in issues grouped by perspectives
Number of criteria developed by participants
grouped into perspectives in different issues
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
Thank you for your attention!
19
Core option 1 Change planning and transport
policies

• ?
• very easy to implement and has wide-ranging
  positive effects
• it would bring a permanent solution, and in this
  sense, it is the best option
• the improvement of the public transportation
  system is indispensable
• towns need to be liveable, so that children and
  adults alike dare go out to the streets

• ?
• expensive and difficult to implement
• it would only have an effect in the long run
• the problem is that those who can be prompted to
  more physical activity this way are probably
  quite healthy already
• the danger of accidents and pollution hinder the
  expansion of bicycle traffic

First the necessary conditions and the right
attitude has to be created
20
Core Option 2 Improve communal sports
facilities

• ?
• it shapes ones lifestyle at a very young age,
  and that will have long-lasting effects
• A lot could be achieved by simply using the
  existing facilities more efficiently.

• ?
• it would take a long time to convince people to
  actually take advantage of these new opportunities

21
Core option 3 Controls on food and drink
advertising

• ?
• Most parents and teachers would be happy that
  products they find harmful will not be directly
  advertised to their children
• Implementation of this option is simply a matter
  of regulation, legislation

• ?
• Children will meet food and drink advertisements
  one way or another
• Marketing experts will find the loopholes they
  will simply reallocate their advertising budgets
• Prohibition is not the solution, it does not lead
  anywhere, and on the contrary, "forbidden fruits"
  are more desirable

22
Core option 4 Controlling sales of foods in
public institutions

• ?
• This is a unique chance to change their lifelong
  attitude to healthy eating

• ?
• Prohibition never quite works (the forbidden
  fruit effect)
• It would be a difficult job to push it through

23
Core option 5 Mandatory nutritional information
labelling

• ?
• The great advantage of the traffic light system
  is its very simplicity
• A clear system, it could be very useful.
• The simpler a system is, the more effective it is

• ?
• The overly simplistic red-yellow-green traffic
  light system may be misleading in many cases
• consumers need to be taught how to interpret the
  system correctly
• The traffic light system is too simple to work
• Difficult to maintain on the long run, the
  elaboration of the system would be expensive, it
  has to be monitored all the time, clashes of
  opposing interests.

24
Core option 6 Subsidies on healthy foods

• ?
• Price changes would be very effective in
  influencing product choice
• People react quite sharply to price changes

• ?
• The implementation of the option would be quite
  expensive
• Very difficult to define which products deserve
  to be subsidised
• It may have positive effects, but at an
  incredibly huge cost

25
Core option 7 Taxes on obesity-promoting foods

• ? 
• We already have different VAT-rates for different
  classes of products, so the system could
  accommodate the implementation of the option
  Theoretically, there is nothing wrong about
  influencing people's choices through the tax
  system

• ?
• difficult to implement
• would meet resistance from several quarters
• too expensive

26
Discretionary option 10 Improved health
education (18 appraisal)

• it is crucial to find the best way of involving
  people in health education
• cooperation with local communities would be
  essential
• providing reliable, up-to-date information on
  health could be effective in fighting obesity
• health professionals can regularly brief
  journalists on issues of health
• celebrities and people of high public stature can
  be involved in information campaigns
• health education should never be conducted in a
  condescending, paternalistic way
• public opinion should be bombarded with dense,
  shocking pieces of information in order to
  achieve maximum effect
• education and the providing of information should
  be tailored to the unique needs and
  characteristics of different societal groups

27
Discretionary option 15 Food and health
education (18 appraisal)

• It would be relatively inexpensive and yet very
  effective
• Education about healthy eating is essential, and
  it should start as early as possible, since
  younger children are more open to influences like
  this than older ones.
• The actual education should be conducted in a
  practical, even playful way.
• Health issues should be integrated into the
  curricula of subjects that are already in place,
  there is no need for a new, separate subject.
• Teachers should remember that the best way to
  teach is to teach by example they themselves
  should lead a healthy life.
• This option would affect the widest possible
  range of people, as practically every child
  participates in the public school system

28
Discretionary option 8 Improve training for
health professionals (11 appraisal )

• The problem is not that physicians do not get
  the right kind of training. Rather, the trouble
  is that they do not use their knowledge, as the
  health care system provides too few incentives
  for them to do so. At present, doctors and
  hospitals are not interested in prevention since
  at present, the treatment of diseases is much
  more lucratively financed by the state health
  insurance authority than is prevention.

29
Discretionary option 14 Provide healthier
catering menus (16 appraisal)

• The main direction of this option should be the
  broadening of the range of food products offered
  by caterers.
• This should be accompanied by health education
  and information campaigns, so that there would be
  a demand for healthy dishes, which supply then
  surely would follow.
• State intervention may be necessary (in the form
  of tax cuts, say), although on this, opinions
  differed.
• Enforcing rules that are already in place is also
  important.