Is Europe setting the table for a healthier future for our children?

In recent years, the prevalence of childhood obesity has been steadily rising across Europe, posing a significant threat to the wellbeing of the continent's younger generation. This public health crisis has prompted a concerted effort to address the root causes of childhood obesity and promote healthier lifestyles for children.

The Best-ReMaP Joint Action (JA), led by the National Institute of Public Health of Slovenia (NIJZ), stands as a testament to the power of collaboration in public health. This initiative brought together 36 partners from 24 European and acceding countries to explore the implementation potential of three key food and nutrition policies: food reformulation, restrictions on food marketing to children, and public food procurements.

The Best-ReMaP JA's 3-year journey has not only provided a trove of resources for policymakers but also provided invaluable guidance on creating a healthier food environment for future generations. This collaborative endeavour demonstrates the profound impact of pan-European cooperation in addressing complex public health challenges. We hear from the experts from NIJZ to discover why a pan-European collaboration is essential to tackle this public health crisis. 

It's no secret that childhood obesity is a growing problem, with rates of obesity rising year after year. We know that obese children will very likely become obese adults, which leads to many physical and mental health problems as they age, including forms of cancer and diabetes. Preventing young people from becoming obese is an investment in health throughout their lives.

Over the last few decades, the environments we live in have changed substantially, and we now have more unhealthy food available than ever. While the onus is often placed on individuals to make healthy choices, this is simply not possible if healthy choices are not available in their environments.

Collaborative initiative tackles childhood obesity

The growing concern over childhood obesity has prompted a concerted effort to address this pressing issue. A Joint Action (JA) - is an EU-level response to help national authorities, academics, and non-profit organisations throughout the EU work together to address a common problem - emerged as an EU-wide initiative to foster collaboration among national authorities, academic institutions, and non-profit organisations across the bloc. Seizing this opportunity, we established a consortium, JA Best-ReMaP, bringing together a diverse group of 36 partners from 24 European countries. This inclusive network encompasses entities from Ministries of Health and national health institutes to universities. But what did this diverse group have in common? They were all committed to improving children's health and nutrition.

Doing so requires that we address the obesogenic living environments that some children live in. Obesogenic environments promote weight gain by making high-energy-dense food available, accessible, and affordable, and by exposing children to the marketing of unhealthy food. At the same time, those environments make it difficult to lose weight, for instance, through limited opportunities for active transport such as biking or walking or few spaces for children to play outside.

We know that children from families with fewer resources are more likely to live in unhealthy environments, leading to higher levels of childhood obesity. Taking these factors into account, Best-ReMaP aimed to ensure that every initiative to reduce childhood obesity also reduced inequalities in obesity rates.

Act Now: Addressing Childhood Obesity

The focus of the Best-ReMaP Joint Action was on adapting, replicating, and implementing effective health interventions. We focused on practices that had been successful in several areas.

The first of those areas was the monitoring and reformulation of processed foods, which helped authorities take measures to make existing processed food products healthier. While not all processed foods are unhealthy, some—especially ultra-processed foods— tend to be extremely high in calories, sugars, and fats.

We developed and implemented a standardised European system to monitor what food is on offer and its nutritional content, as well as identify the best practices and opportunities for reformulation— changing the processing and composition of food. Measures to improve reformulation can encourage producers to change their products into healthier options.

Our monitoring showed that the collaboration in Best-ReMaP contributed to the increase in offers of healthier processed food options (by reducing salt, sugar, and fat from the processed foods) available in EU markets.

A collaboration between Best-ReMaP and WHO Europe, led to an update of the WHO Europe nutrient profile model, which helped countries develop policies to restrict the marketing of unhealthy foods to children.

Reducing exposure to food marketing

The second area addressed was reducing food marketing to children. Best-ReMaP has developed new monitoring approaches that promote a better understanding of how widely and powerfully children are exposed to harmful food marketing through a wide variety of channels, both online and offline.

A collaboration between Best-ReMaP and WHO Europe, led to an update of the WHO Europe nutrient profile model, which helped countries develop policies to restrict the marketing of unhealthy foods to children. Vulnerable children were a particular focus of the updated model. Another result of Best-ReMaP’s efforts was that a code of conduct was adopted by a few EU Member states.

 

Utilising public procurement

The third and final area of focus was the public procurement of healthy food in public settings, which includes all purchasing of food and contracting of catering services by public bodies. Public procurement influences both food consumption and food production patterns and could improve the food environment for children in public institutions, such as schools.

To improve practices, Best-ReMaP partners started with an analysis of the procurement situation in their own countries. The findings were used to establish an intersectoral working group in participating Member States.

We also built knowledge, implemented and tested the good practices, and drafted minimum criteria for sustainable, social, and environmentally friendly local food environments. To summarise all the work on public procurement, we produced an overview of case studies with lessons learned.

(Re)mapping achievements and looking forward

Looking back on Best-ReMaP’s work, we are proud of the successful national implementation of best practices in all three policy fields. Our commitment to reducing health inequalities was a red thread that linked all of Best-ReMap’s work.

In all three policy areas, our collaboration developed and improved framework models with the very concrete public health-driven actions that were identified. Best-ReMaP’s two most promising sustainability actions are the food information database, which has been branded by the EU Joint Research Council, and the food system sustainability scoreboard for the EU Semester. The collaboration with various stakeholder initiatives at both EU and national levels helped and will continue to maximise the impact of these tools.

All Best-ReMaP results were included in a 'Final Integration and Sustainability Plan', which summarised proposed policies and ways to modify existing actions at the European and Member State levels. The report and options for implementation were discussed with various stakeholders at the EU and national levels.

Most importantly, we are pleased to see that Best-ReMaP practices in all three areas will be taken forward at the EU level by the upcoming Joint Action PreventNCD from January 2024 until the end of 2027.

The Best-ReMaP Joint Action stands as a good example of European collaboration to improve children's health and nutrition through joint learning on good practice implementation. Actions and outcomes of Best-ReMaP support the EU4Health programme, the EU's Healthier Together initiative, the EU's Beating Cancer Plan, and the EU's Farm to Fork strategic directions.

Dr. Mojca Gabrijelčič Blenkuš
Senior Adviser at NIJZ, the Slovenian National Institute of Public Health | + posts

Dr. Mojca Gabrijelčič is a medical doctor, specialist of public health, holding PhD in social sciences. Her fields of interest and expertise are health promotion approaches, public policies, health equity and wellbeing economy, nutrition and physical activity, aging and frailty and quality of life. Mojca was the scientific coordinator of the JA Best-ReMaP 2020 – 2023 and she will be the WP coordinator for policy sustainability in the new JAPrevent NCD 2024 – 2027.  As EuroHealthNet's former President,  she is Honorary Advisor to the Executive Board of the EuroHealthNet Partnership.

Petra Ožbolt
Healthcare Assistant II at Health National Institute of Public Health, Slovenia | + posts

Petra Ožbolt is a junior researcher working at the Institute at the Centre for Knowledge Research and Development. Petra has a Master's degree in Nutrition from the Faculty of Biotechnology in Ljubljana, Slovenia. She is working on the Best-ReMaP initiative and will be involved in a Joint Action Prevent NCD starting in 2024 (areas: Physical Activity and on Work Package 4 tasks on policy sustainability).

Monika Robnik Levart
Sanitary Engineer at NIJZ, the Slovenian National Institute of Public Health | + posts

Monika Robnik Levart studied Sanitary engineering at the Faculty of Health Sciences at the University of Ljubljana. In 2017, she received her master’s degree. Currently, Monika works at the National Institute of Public Health (NIJZ) as a sanitary engineer. She is especially interested in the areas of ageing, inequalities, and nutrition.

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