More than half of adults are overweight
Overweight and Nutrition and Control Strategies in the Czech and Slovak Republics
Von Danica Jančáryová / Schweizerisches Tropen- und Public-Health Institut (Swiss TPH)
The obesity its one of the greatest public health and socio-economic problems of our century. Its prevalence has tripled in Europe since the 1980s. The rise of obesity is especially alarming among children. This article illustrates the past and present size of the problem in the Czech and Slovak Republics and highlights recent initiatives for controlling the public health problem in these countries.
Changes in our living environment through rapid and uncontrolled development in the last years are accompanied by overnutrition, unhealthy nutritional habits and insufficient physical activity. In such environment obesity is no longer symptom of well situated social groups, but it has become more and more the problem of social weak population, particularly in countries with growing economics. The problem is aggravated by the growing production of cheep food with low quality, high fat and sugar content resulting in increased intake of such nutrients in these countries. This in turn leads to overweight and obesity accompanied by insufficient intakes of essential nutrients such as vitamins. Generally it is acknowledged, that one of the most important control strategies is the education of children and adolescents to increase their consciousness on appropriate nutrition and life style behaviour.
According to WHO prevalence of obesity has tripled in many countries of the WHO European Region since the 1980s. The number of those affected particularly among children is growing with tremendous rate. The risk to be overweight in adulthood grows with prevalence of overweight in childhood. Obesity results in various physical disabilities and psychological problems, is a chronic diseases conferring limited quality of life due to high morbidity and mortality and requires long-term care. Overweight increases the risk for heart diseases, type 2 diabetes, cancer, hypertension or metabolic diseases, and may lead to early death. The risk of developing more than one of these diseases increases clearly with an increasing body weight. Further, obesity is also responsible for growing health costs.
Causes of obesity
Unhealthy life style behaviour accompanied by overnutrition and unhealthy diet, low levels of physical activity due to our technological and material advantages, contribute to development of overweight and obesity. With parents being overweight the risk of their children to be overweight as well significantly increases: in families, where both parents are obese the risk among children aged between 6 and12 years is more than the double. Among adolescents this risk is around five time as high. Beyond the genetic factors such as heritability of fat cells and regulation of food intake which may account for up to 50% of obesity are contributing factors to the disease in adulthood more or less epigenetic factors, called early life factors, as a overnutrition or starvation in pregnancy, long gestational stage or short breast feeding period with the replacement feeding. Psychosocial stress for example related to pressure to perform, anxiety, frustration, particularly on children and adolescents, are additional social factors influencing the size of the problem.
Current situation in Czech and Slovak Republics
In the Czech Republic population more than half of adults are presently overweight (63% of men and 46% of woman). Among them one third are strongly obese, predominantly in males and the elderlies, with increasing tendencies in last decade. In Slovakia, in the population group of those 45 to 65 years old, similarly around 50% are overweight. A population based assessment of the health status of inhabitants in 2004 depicted increasing of overweight and obesity among man. Opposite, the problem has been decreasing slightly among women. In the overweight and obese zone were according to the BMI index 66.2% (obese 19.5%) of man and 58.7% (obese 20.8%) of woman.
According to several school based surveys in 2001/2002 and 2005/2006 in the Czech Republic, more than one out of ten children was overweight. The prevalence of overweight and obesity in 6 to 12 years old was about 20 %, and 11% among those aged between 13 and17 years. An anthropometric survey organised in 2001 by the Public health services office in Slovakia among school children highlights the high prevalence of overweight and obesity in school children aged 7-18 years. Indeed, 12.5% of boys and 12.1% of girls were overweight and 7.8% of boys and 6.9% of girls suffered from obesity. While the a rate of obese children was around 2% in 1951, this rate averages now around 7% in the Czech Republicand 10 % in Slovakia.
In Slovakia for many years, eating habits have been characterised by high energy intake. Specifically this has been manifested by over consumption of fats (exceeding average recommended intake by over 50%) and low intake of nutrients such as vitamins, minerals, calcium and iron. In Slovakia, by obesity affected cardiovascular diseases account for 55% of total mortality rates. Epidemiological studies that took place in the period 2003 to 2010 had shown a relation between incorrect eating and lifestyle habits with the high overweight and obesity rates evident in men in the 25-64 age group. Further, the 2007 Slovak Consumer survey indicated that more than half of the population does not engage in sport activities and only 8.4% care about a healthy lifestyle and sufficient exercise.
Long term health strategies
A long-term public health strategy, the National Health Programme for both, Czech and Slovak Republics, was approved and endorsed by the Government in 1995. The goal of the programme is to encourage individuals to actively engage for their health. Cornerstones of the program relate to the promotion of health life style at school leve as well at home and at the workplace.
The main actors in the Czech system in terms of public health are the governmental organisations; the National Institute of Public Health, the Regional Public Health Authorities and the Regional Institutes of Public Health, all of them directly subordinate to, and managed by the Ministry of Health and its chief public health officer, who acts also a deputy Minister of health. In the areas of disease prevention and health promotion, the National Institute of Public Health focuses on the epidemiological surveillance of important communicable diseases and the promotion of healthy lifestyle behaviour. The organisation coordinates further between the different actors in the public health system and supports their activities in a variety of ways, such as through the elaboration and dissemination of educational support material
Among the four priority areas for public health policy in Slovakia obesity is beside cardiovascular disease and cancer the most important health problem in area non communicable diseases facing the population in Slovakia. Numerous conferences, seminars, courses and health educational sessions have been organized (World Health Day, World Environment Day, and World Nutrition Day). The Slovak Republic has adopted several national nutritional programmes aimed at addressing the negative effects of unhealthy lifestyle habits and their main risk factors. Examples included: the Programme for the Improvement of Nutrition of population of the Slovak Republic, the National Obesity Prevention Programme focusing on children, and the National Health Promotion Programm
Recent initiatives for addressing obesity
Czech Republic is among six European countries with high prevalence of obesity, involved in the European “FOOD” program. Slovakia as a seventh country was invited in 2011 to join the initiative. The key characteristic of this innovative project is to use an interactive internet application that is active over a four weeks period and includes a training programme using cognitive behavioural methods to change personal habits. The participation requires self-study and personal involvement as well commitment from its users.
The leading implementing institution of FOOD is the association STOB (Stop Obesity). The association also collaborates with the European network Edenred. Indeed Edenred is globally leading network in prepaid services to enhance individual well-being and the performance of organisations, involving companies, employees and affiliated service providers and public partners. The association Stop Obesity is part of the non-for profit and non-governmental association Hravě žij zdravě o. s. (Healthy Living the Easy Way), which aim is to promote a healthy lifestyle and prevent obesity in children and adults, with focus on the care for overweight or obese children and adults. It includes experts and lay persons. The programme “Easy live healthy” was started in 2008 and aims to support the population in lifestyle changes especially those relating weight lost and improved eating habits. An interesting part of initiative was relying on a a cooperation with Czech restaurants so to reduce the size of their portions, the share of carbohydrates and animal fats, and to increase quantities of vegetables offered to clients
In the framework of the National Programme for obesity prevention, since 2007 was established a survey, involving several thousands of school children supervised by the Faculty of Medicine, in cooperation with the Children´s hospital and Health care centre in Bratislava, capital of Slovakia, as well with Iniciative Health an Nutrition. The study detected serious deficiens in the nutritional intake during early childhood development. It was for example observed that more than a third of children are omitting breakfast, or eat incomplete lunches, insufficient fruits, vegetable and milk products. The situation is most problematic amongh teenagers. Based on these results nutritional habits of children is currently closely monitored by the Regional Public Health Authorities and the Regional Institutes of Public Health. Novel of this study is the participation of chief school catering institutions, school directors, authorities of the Ministry of Education, Science, Research and Sport of Slovak Republic, with the goal to involve the school sector and state authorities.
The lack on physical activity among children is considered as one main challenges. Indeed, investigations revealed that more and more children spend their time passively watching TV or playing computer games. Further it is being observed that parents increasingly drive their children by car to school. At the same time it was shown that those children living in urban areas with green and sport places had substantially higher activity levels than children in suburb. Further, there is also evidence that sport activities are also more frequent among children having parents with an academic degree compared to children of parents without a high school exam. While it is recommended that a minimum of 60 minutes of physical activities, in Bratislava, capital of Slovakia, 64 % of children participate only once a week in structured sport activities.
In the Czech Republic the newspaper “Obesity News” informs regularly the public about activities related to healthy life style and encourages the reduction of body weight reduction. The programme “School full of health” investigates currently school catering services and take care for physical activities at schools. One example of recent activity in Slovakia is the nation wide campaign to increase physical activity. The cornerstone of this initiative consists in encouraging the population with a minimum of 30 minutes of daily physical activity. Innovative is, that both children and their parents are actively involved and are encourage to daily monitor their activity level. This is complemented by an interactive internet application which allows to register daily physical activity, the type and duration of the activity. It is anticipated that the campaign will shows positive benefits in terms of increased physical activity and thus contribute to the prevention of non communicable diseases and promote healthy behaviours and lifestyles (e.g no tobacco use, healthy diet, reduction of violence, stress and social isolation). In the frame-work of this campaign there are a number of activities in Slovak cities so to promote healthy nutrition or physical activities complemented by competitions or courses for young mother. One of the activities in the frame of the Day against Children Obesity is focusing on menu changes in school catering services and enhancement of physical activit
This overview indicates that in Czech and Slovak Republics a number of initiatives for the control of obesity and for the increase of physical activity are under the way. The strategy in Slovakia appears to give emphasis on the participation of the population to collective actions for example through increase physical activities among children. In contrast, the Czech Republic investigates more in the production and dissemination of educational material and focuses on improvement of life style attitudes at individual level.
Eating habits have been characterised in past by an excess of energy intake of low quality. Changes in the future should focus on reduction of over consumption of animal fats, and an improvement of low intake of nutrients such as vitamins, minerals and iron. Alcohol accounts to development not only obesity due to high energy content, to malnutrition and further chronic diseases, but also to many social problems in both countries.
*Danica Jančáryová works at the Swiss TPH at the Medical Services and Diagnostic Unit (Ectoparasite Centre). After the ending of her Postdiploma Course in Human Nutrition at the ETH Zürich Danica Jančáryová’s scientific interest is focusing on nutrition in childhood and adolescence with the aim to improve the nutritional status of this population group.