EU public health approach needs urgent revamp amid rising obesity’s far-reaching fallout

Facing mounting concern from public health experts, the European Commission hosted a high-level conference on 31 January to assess the implementation of Europe’s Beating Cancer Plan three years after its adoption.

 Reflecting its EU Council Presidency’s clear focus on public health, Belgian Minister of Social Affairs and Public Health Frank Vandenbroucke delivered the event’s closing remarks alongside EU Health and Food Safety Commissioner Stella Kyriakides. Ahead of the summit, Vandenbroucke called for a “critical stocktaking exercise” of the EU’s anti-cancer crusade, noting that this “tremendous initiative” has been hindered by stagnating policy proposals, including the mandatory alcohol health warning label.

With the World Health Organisation (WHO) criticising Brussels’s perceived inaction on alcohol labelling, the Belgian Presidency has organised a high-level meeting “to create some new momentum” in this space. Yet as it looks to leave its mark on the bloc’s public health agenda, Belgium must equally address the impact of Europe’s rising obesity levels on cancer and other diseases, notably by revamping the EU-wide response to this crisis’s root causes.

Europe’s nutrition-fueled health crisis

As SAFE Food Advocacy Europe, a Brussels-based NGO, has warned, “unhealthy diets and malnutrition” on the continent are “major drivers of non-communicable diseases (NCDs),” such as cancer, cardiovascular diseases and diabetes. NCDs represent Europe’s most urgent public health challenge, representing over 90% of premature deaths and €700 billion in medical treatment every year.

While the WHO provides clear nutritional guidance to combat this proliferation of NCDs, Europeans’ dietary practices remain out of step as consumers are eating increasing amounts of high-fats, salt and sugar (HFSS) foods while reducing their intake of fruits, fibres and vegetables. This perfect storm of malnutrition has trigged a European obesity epidemic, with nearly 60% of adults as well as one in three children afflicted by an overweight and obesity crisis causing over 1.2 million deaths in Europe annually.

Obesity is Europe’s fourth-highest risk factor for NCDs in Europe, responsible for at least 13 different forms of cancer as well as 200,000 new cancer cases every year. While a medical study published in late January revealed that overall cancer death rates are dropping across Europe, overweight and obesity – together with other factors including physical inactivity and alcohol consumption – are contributing to a sharp and unprecedented rise in bowel cancer deaths for young adults.

Beyond this catastrophic health impact, the UN’s Food and Agriculture Organisation (FAO) recently sounded the alarm on the “hidden costs” of the EU agri-food system, attributing over 80% of these costs to labour productivity losses provoked by unhealthy diets and the associated impact on NCDs.

EU nutrition label not up to task

In Brussels, the EU-wide solution to this public health crisis remains a proposed front-of-package (FOP) nutrition label – the healthy diets initiative of the Commission’s ‘Farm to Fork’ (F2F) strategy. France’s controversial Nutri-Score has consistently dominated this polarising policy debate, with a growing coalition of member-states rising up against the mandatory imposition of a severely-misguided label.

Due to an imbalanced, outdated focus on individual products’ macronutritional components, Nutri-Score’s algorithm has historically dished out punitive grades for traditional European products such as French Bleu D’Auvergne cheese, Spanish olive oil and Italian prosciutto. While Nutri-Score’s founders have often dismissed all opposition as stemming from these agri-food producers’ (well-founded) criticism, the falsity of this deflection has been increasingly exposed.

In a report concluding that Nutri-Score’s adoption as the EU nutrition label “would pose major concern for public health,” SAFE Food Advocacy Europe cited scientific evidence indicating that the label’s “overly simplistic” algorithm gives EU consumers “misleading information,” particularly by poorly distinguishing between natural and artificial fibres. Reaching similar conclusions, the national competition authorities of Italy and Romania have banned Nutri-Score in their respective countries, with Switzerland possibly set to follow suit.

Launched in early January, Nutri-Score’s new algorithm continues to miss the mark. France’s own National Agency for Food Safety (ANSES) issued a scientific analysis in December which supports SAFE’s critique on the algorithm’s evaluation of fibres, adding that this updated version “deviates” from the Government’s goal of “encouraging consumers” to eat “whole starchy foods” while failing to direct consumers towards vital micronutrients, such as vitamin D, lacking in the population.

This unflattering appraisal is illustrated by the newly-lowered ‘C’ Nutri-Score for certain fresh fruit, such as French prunes and pineapple, putting them on the same level as artificial sweetener-filled Diet Coke. Nutri-Score’s undermining of F2F’s food health and transparency goals calls for a broader approach to facilitating healthier lifestyles.

Cross-cutting approach offers path forward

As WHO Europe Director Dr Hans Kluge has rightly stressed, “obesity is a complex disease,” driven by a range of factors including socioeconomic status, urbanisation and sedentary behavior, meaning that any single intervention is doomed to fail.

To tackle the wide health literacy gap separating high and low-income households, the EU should continue funding AI-driven personalised nutrition apps similar to its PROTEIN project, which innovatively integrates analysis of users’ dietary and physical activity patterns to provide highly-tailored recommendations for both macro- and micronutrient intake. Paired with strong regulations to protect citizen’s sensitive health data, the EU holds many of the levers to unlock the massive potential of AI-based nutrition.

Beyond providing simple, reliable health information, Brussels should also work with national and local governments to ramp up affordable access to nutritious foods and physical activity needed for well-balanced, healthy lifestyles. Realising the healthy free school meals commitment in the Commission’s European Child Guarantee would be a strong start.

Looking more broadly, the EU could also provide funding and technical expertise for strategic urban planning initiatives to address the infrastructural barriers cutting off low-income communities from exercise facilities and green space, while supporting local governments with additional financing to subsidise sports club and gym memberships.

With the right combination of such policy measures, the EU would help lead a holistic, cross-government effort to get the bloc’s public health agenda back on track. The Belgian Presidency’s ambition and clear alignment with WHO guidance offer encouraging signs in Europe’s crusade against cancer and NCDs, but leaving a successful legacy will require laying this foundation to turn the tide on rising obesity and unhealthy lifestyles.

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