Can the World Halt Rising Obesity? WHO Sets Out Its Plans and Countries Tell Stories of Success
Health Ministers and Vice-Ministers (seated from left to right) Mexico, Seychelles, Philippines and Chile, expound on policy successes for obesity control
Countries have failed miserably to halt rising obesity, despite goals set by the World Health Organization (WHO) in 2018. Instead, obesity continues to rise apace.
Now, however, a new WHO strategy for accelerating action against obesity, endorsed last week by the World Health Assembly, calls for much tougher policies on food packaging, pricing and marketing which have the potential to turn the tide.
At a high-level side event on the margins of last week’s World Health Assembly (WHA), WHO officials outlined the plans and countries that have tested such policies told their stories, and how these experiences could point the way to success in the coming decade.
Speakers included health ministers and deputy ministers from five countries, including Mexico, Brazil, Chile, Seychelles, and the Philippines, who elaborated on the policies that have been implemented in their countries as well as the challenges that they still face.
One billion people living with obesity
Some one billion people around the world live with obesity and almost five million deaths are associated with obesity every year, said Naoko Yamamoto, WHO’s Assistant Director of Healthy Populations.
She was speaking at the Global Health Center event, co-sponsored by the governments of Mexico and Croatia. Croatia’s First Lady, Sanja Musić Milanović, has become an ardent champion of the issue in the European region.
“No country is immune to its impact,” Yamamoto said. “But we know what we can do to stop this pandemic.”
Naoko Yamamoto, WHO Assistant Director-General of Healthier Populations
Whole-of-government approach needed
Addressing obesity requires a “whole-of-government approach” said Francesco Branca, who leads WHO’s work on nutrition and obesity.
That approach is implicit in the new “acceleration plan” endorsed in the final days of the 75th World Health Assembly. That plan aims to halt the worldwide rise in obesity by 2030 as part of reaching the Sustainable Development Target 3.4 which calls for slashing the non-communicable disease rates by one-third by that time.
“Unless we talk about obesity, we will not reach SDG 3.4,” said Branca at the GHC event. But beyond that, “The cost of obesity is unbearable. We’re talking about $1 trillion every year, which is 13% of the global health expenditure, and 1-2.5% of GDP in different countries of the world.”
The new WHA-endorsed “acceleration” plan targets key factors that drive obesity, including diets high in fats, sugars and processed foods; lack of physical activity; and cities that make it impossible to walk and cycle to work or even exercise.
The aim is to encourage governments to move from the realm of traditional health measures that only target personal behaviour and have largely failed, to proven policies that tackle the obesogenic environment in which many people live today, Branca said.
Higher taxes on unhealthy foods; consumer and school-based policies, as well as urban planning to enable active lifestyles are among the policies endorsed in the plan, specifically:
Regulations on the harmful marketing of food and beverages to protect children;
Fiscal and pricing policies to promote healthy diets and nutrition labelling policies;
School-based nutrition (including initiatives to regulate the sales of products high in fats, sugars and salt in proximity of schools);
Breastfeeding promotion, protection and support;
Standards and regulations on active travel and physical activity in schools.
The plan also calls for stronger integration of obesity prevention and treatment into primary health care services, particularly in low- and middle-income countries where many health clinics lack even the most basic diagnostic tools for checking blood sugar levels, weight or blood pressure.
Finally, the plan calls on member states to draw up country-based road maps, bringing together stakeholders and advancing advocacy and communications.
Dr Tedros urges the implementation of NCD policies after the adoption of a slew of measures to address NCDs at the WHA.
‘Complete failure’ to achieve zero obesity increase goal
The goal of a zero increase in obesity was originally set in 2018 for attainment by 2025. But countries have failed miserably to halt current trends, leading to the adoption of a new timeline and strategy for reaching that goal, Branca said.
“The prevalence of obesity is increasing in almost all age groups,” he declared, pointing to WHO projections showing that by 2025, obesity prevalence will have in fact increased by 1.7% among children ages 5-18 and 2.3% among adults.
“That translates into about 167 million more people affected by obesity, but it also translates into a ‘complete failure’ to achieve those [2025] targets,” Branca said. “Maybe there will be some progress for children under five, but overall no progress.
As a result, member states “requested WHO to do something about it, to indicate what actions can be taken to turn the tide of obesity. And so we’ve been building on two decades of work, and recommending that we need to adopt a whole-of-government, whole-of-society approach – and work across the life course”, he added.
“Governments need to take the lead in a series of policies in multiple sectors, and civil society needs to call for that action and to hold accountable all of the actors, he said.
To measure countries’ responses, the WHO will be monitoring and measuring “some very concrete policy targets such as increasing the number of countries who are establishing regulation on marketing, food and beverages for children”.
Some of the measures that the WHO will be looking for are country campaigns on physical activity, and regulations on the marketing of sugary and ultra-processed foods and beverages to advance the guideline that sugar represents only 10% of food energy intake daily, added Branca.
Francesco Branca, WHO Director of Nutrition and Food Safety.
Countries tell their stories – from bike lanes to trade policies
Perhaps the most powerful testimony, however, was that of the health ministers and deputy ministers themselves. In a panel discussion they outlined what had worked well – and measures they still need to advance more.
The successes include measures taken in the Philippines to promote healthy foods in schools as well as more active transport, including more development of urban bike lanes, said Maria Rosario Vergeire, Undersecretary of Health. She recounts that some 23 million adults and 3.6 million children are obese in the island country of 115.5 million people.
The government also has adopted front-of-package labeling to warn consumers of high salt and sugar labels. It is also phasing out the sale of industrially-produced transfats. WHO recommended transfats be outlawed in foods by 2023 due to mounting evidence of cardiovascular cancer risks.
Peggy Vidot, the Seychelles Minister of Health, described how her country is using trade policies to shape healthier diets by increasing tax and customs incentives for importers of fresh foods and vegetables and fruit drinks without added sugar.
It also banned sugary drinks in schools and is rolling out higher taxes on certain foods with a sugar content above certain levels.
In parallel, the government subsidizes local farmers, as well as the fishing sector, “so that healthy food can be made available at a more affordable price”.
Chile cuts sugar consumption by 10% in just three years
Front-of-pack warning labels in Chile
In Chile, which was a pioneer on front of package labeling, 80% of processed food products sold in markets now contain food warning labels, indicating the fat and sugar content, said Chile’s Minister of Health, Maria Begona Yarza Saez.
“One of the concrete results of that is that 70% of adolescents take into account these labels at the moment that they have to make a choice about food,” she said, “and 98% of the general population understands the labelling that has been put into place.”
The exposure of small children to the marketing of unhealthy products has been reduced by 40%, she added.
These are some of the findings of research that was conducted in 2021, after just three years of having the policy in place. In addition, sugar consumption decreased by 10% and there was a 4.8% decline in global caloric intake.
“These are only interim indicators. Long term studies are needed for better results,” she added, saying that “this is clearly not enough”.
Chile aims to introduce “more structural policies” in the coming year, including taxes on unhealthy foods, with the tax revenues channeled back into supporting health services that support obesity and NCD prevention and control.
Mexico – change requires political will
In Mexico, the first soda tax was implemented in 2014, and within the first two years consumption of sugary drinks declined by an average of 7%, and more recently by as much as 12%, said Hugo Lopez-Gatell, Mexico’s Vice Minister of Health.
“Now, we implemented a year and a half ago, front-of-package label warnings. It’s not confusing labeling, it’s warning. And credit to Chile because we got inspired by Chile’s experience,” said Lopez-Gatell.
The Mexican government is working on other regulatory measures, including bylaws to promote people’s capacity to make informed decisions, as well as limits on what people actually can be offered in the market. A national law banning unhealthy foods to be sold in schools is also in the process of being drafted and approved.
“We also had a soda industry and food industry sponsoring the rebuilding of schools,” he recalled. “No more of that, we are investing directly. In addition, the government is trying to promote better access to safe, clean water in schools, as 30% of which lack that basic sustenance that can be a free, healthy substitute to packaged sodas.”
In addition, a 2019 law recognized “mobility” as a human right in the Mexican constitution which means that “now, as a Federal republic, we can supersede any limitation at the state at the municipal level … so that physical activity must be assured.”
“We believe change is possible, but it requires political will. And the political will must be steady, sturdy and continue no matter what, thinking about health, children, our youths and our future,” added Lopez-Gatell.
“We base our policies on the convictions that obesity and the full complex of NCDs are rooted in structural factors,” he added.
He recalls that Mexico’s obesity epidemic actually began in the 1980s when structural reforms were imposed by the International Monetary Fund (IMF) and other economic institutions in the Americas and around the world.
But “when economic liberalization started, we were swamped” by multinational food companies eager to sell cheap processed food products in Mexico’s large, emerging economic market, just south of the US border.
“So we were just flooded by trademarks,” he said, “and therefore policy and politics for many years in Mexico, until this current administration, were dependent on complicity with the CEOs and presidents of these companies.”
He asserted that Mexico’s current president Andrés Manuel López Obrador has sought to change that balance of economic and political power” although it has not always been easy.
“He has said it is crucial to separate economic power from political power because the political power that is elected by people should be devoted to protecting and promoting the public good. Laws need to be made in the interest of the people, and not interest groups.”
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