What role is there for dietitians in tackling the growing obesity crisis in Europe?

What role is there for dietitians in tackling the growing obesity crisis in Europe?
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As obesity rates rise, Ellen Govers, of the European Federation of the Associations of Dietitians, explains how dietitians can encourage citizens to make the right food choices.

No one can escape the fact that the prevalence of obesity in Europe is still rising, with alarming figures in children especially. Despite efforts to monitor the prevalence, for instance through the COSI registration, and despite the intentions exclaimed by different governments, society as a whole has not been able to get the rise under control. The positive news is that several programmes have been developed to work with children and their families, e.g. the Joint Action on Nutrition and Physical Activity (JANPA).

What scientists and health professionals had not expected was that even in countries that have a smaller prevalence in obesity, such as the Netherlands, a rise has been reported.

Now, in the Netherlands, officially 50% of the adult population is overweight, a BMI of 25 or more. As we know that obesity leads to comorbidities such as Type 2 diabetes, cardiovascular disease, and also cancer, we must realise that action is needed, if only to control healthcare costs. The point is that explanations for this rise, which are many, evidence-based, and presented in high-quality conferences by serious scientists, have not led to effective measures to solve the problem of obesity.

What is behind the rise in obesity?

Of course, all parties involved have been working to reveal the causes, which in essence are a too large intake of calories/energy and too little energy expenditure, promoted by other factors like poverty, stress, no access to healthy food or physical exercise, and the use of certain medications promoting weight gain as a by-effect.

One of the big issues is the role of the food industry. For decades the food industry has released new food products, in attractive packaging, urging consumers to buy more or to buy it now because of the low price. The concept of food marketing has led to overconsumption and to overweight because, once an individual has bought the food, even if the portion is too big, they are likely to eat more of it. We all know that controlling food portions, and controlling eating moments, is key to any weight loss attempt.

But we also accept the fact that fast food is available everywhere, 24 hours a day. Our railway stations and airports have turned into huge food halls with numerous restaurants, urging the traveller to eat. Most of the foods offered there are high in calories, low in fibre, and rich in added sugar, salt and saturated fat instead of being low in calories, rich in fibre, sustainable, and with large portions of vegetables.

Our shopping centres show the same. Even when you want to fill the tank of your car, you can have a meal at the petrol station.

The big question is: why have we as a society let it go so far? Why have we as scientists and health professionals not been able to change this development, in order to make our populations healthier?

Free will versus food marketeers

People are led to believe that they have a free choice. Many disputes and a lot of scientific trials have been spent in the academic world on discussing and collecting evidence on the free will of the consumer when it comes to food choices. Looking back, one might say that is quite naïve. Free human will in today’s society has to fight a battle with the marketeers.

The concept of marketing implies that if you can make people think they need something, and you present a product that answers that unconscious need, they may buy it. This method was successfully introduced in the early 60s of the 20th Century and has ruled ever since, especially in the food industry. When the marketing budget of the food industry comes close to the budget spent on healthcare in a country, you know something is terribly wrong.

Making the right choice: the role of the dietitian

It is in this world that dietitians try to help their patients to make the right choices. We teach patients that, on average, a human being is nowadays confronted with food 200 times per day. And that they need to avoid as many unplanned food choices as they can. We give them self-confidence to meet the challenges, because food is everywhere.

Looking at all the food offered around us, it is almost as if the human body is not able to survive more than one hour without food, quite contrary to archaeological findings that humans in ancient history ate just 2-3 times per day, like the hunter-gatherers on our planet still do and as most generations up to the 60s of the last century did – and laboured hard on that small quantity of food and had a healthy body weight.

Dietitians teach their patients that the energy need of the body is often over estimated, that the body gives its own signals when it needs food, once you have learned again how to listen to these signals. We show our patients how emotions (grief, anxiety, anger) from the present and the past interact on the desire to eat, and how to replace that kind of eating with other behaviour. On top of that we tell them how fatigue from long working days and weeks makes you eat more to give you energy to continue. We emphasise the value of a meal enjoyed with other people that you care about – how to enjoy good, fresh food, prepared with love and dedication.

It is important to realise that there are many eating cultures that have been refined and savoured over the centuries. Dietitians tell their patients to respect the eating culture they come from, and on top of that we teach them how to deal with the pitfalls of that eating culture, in terms of large portion sizes, an abundance of calories through the use of huge amounts of fat, the role of alcohol and sweet beverages.

Dietitians cannot escape the economic situation their patients live in: insecure working conditions, low wages and high costs of living are common with our patients.

Predominantly our patients are from the low-income groups. We try to help them as best we can. Low incomes, debts, and job losses are causes for emotional eating. Fast food is often cheaper than healthy fresh food, and very tempting when you are tired and only have a few euros to spend. We cannot change their conditions, as much as we would like to, but we can stand side by side with them, in the true meaning of the word therapist, which is co-fighter. Dietitians often have long-lasting relationships with some of their patients, based on confidence and mutual respect.

We respect and support our patients in their efforts to live a healthy, sustainable life. It is therefore surprising that not every country in Europe has arranged for their citizens to have-low cost access to a dietitian to help citizens improve their health and make them and their families work on their skills to live a healthy life.

More about the EFAD

The European Federation of the Associations of Dietitians (EFAD) has created a platform where dietitians from all over Europe can meet and exchange their findings and experiences. Although all countries have different cultures the problems we meet as health professionals are quite the same. It is a tremendous advantage to share with colleagues and learn from each other. It also provides an opportunity to work with other organisations, for example the European Association for the Study of Obesity (EASO).

The European Specialist Dietetic Network (ESDN) Obesity collaborates with EASO in a commitment within the European Platform for Diet, Physical Activity and Health to develop food-based guidelines on obesity for adults and children. Recently, a position paper was issued: Dietary Management of obesity in adults: Pitfalls & opportunities in Europe. A joint position paper of the ESDN Obesity of EFAD and the NWG of EASO (Hassapidou M et al.).

Ellen Govers
Chair, ESDN Obesity
European Federation of the Associations of Dietitians
Tweet @efad_org

Please note, this article will appear in issue 8 of Health Europa Quarterly, which will be published in February 2019.

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