Ireland Leads Obesity Epidemic in Europe, Others Close Behind

May 06, 2015

PRAGUE, Czech Republic — Europe is facing an obesity crisis of gigantic proportions by 2030, according to the latest projections released by the World Health Organization (WHO) here at the 2015 European Congress on Obesity.

The data highlight a serious problem for many countries: in Ireland, almost everyone — 90% of men and 85% of women — is predicted to be overweight (body mass index [BMI] > 25 kg/m2) in 15 years, compared with 74% of men and 57% of women who were overweight in 2010.

And for obesity (BMI > 30 kg/m2), almost half (48%) of Irish men and 57% of women will be obese by 2030, compared with 26% and 23%, respectively, in 2010.

Other countries facing similar crises include the United Kingdom, Greece, Spain, Austria, and the Czech Republic, as well as nations with a traditionally lower prevalence of obesity such as Sweden, which is also expected to see a sharp rise.

In fact, few countries in the WHO European region will see stable or decreasing overweight and obesity rates — overall, data show no evidence of a plateau in adult obesity in most places. Only the Netherlands appears to be bucking the trend.

João Breda, PhD, from the WHO Regional Office for Europe, Copenhagen, Denmark — who reported the findings — told Medscape Medical News: "These data do not take into account prevention efforts, so they do represent a worst-case scenario."

However, he conceded, "In adults, obesity is not yet decreasing despite plenty of initiatives. We will have to wait a few more years to see if there will be an impact."

Laura Webber, PhD, from the UK Health Forum, London, who was also involved in the research, added: "There is huge variability...but generally we are seeing an increase in all countries."

The researchers stress, however, that the strength of the projections depends highly on the quality of the available data from each country — much of Europe only has self-reported data on height and weight to determine obesity prevalence, for example.

In addition, in many of the countries, the data are not nationally representative; rather, they focus on only a few cities or regions, Dr Breda said.

Nevertheless, the forecasts indicate that "prevention is still extremely important," he stressed, emphasizing that doctors, regardless of specialty, have "an important role to play in identifying and advising" individuals at risk of or who are already overweight or obese.

"There needs to be a continuum of care, from primary care to endocrinologist, providing people with the care they need," he observed.

Is Austerity to Blame?

Dr Breda told the meeting attendees that obesity is a major risk factor for prevailing noncommunicable diseases such as coronary heart disease and type 2 diabetes and therefore has become one of the biggest public-health challenges of the century.

But how the epidemic will unfold in the next 20 years is uncertain because surveillance and monitoring data are often lacking and future projections in each country have not been conducted.

The new estimates form part of the WHO Modeling Obesity Project and were compiled by Drs Webber, Breda, and colleagues.

Using available data on BMI in adults, normal-weight, overweight, and obesity trends were projected to 2030 for all 53 countries in the WHO European region.

By 2030, overweight is predicted to increase in 41 countries, Dr Breda said, and obesity is predicted to increase in 47 and 34 countries for men and women, respectively.

Among the countries predicted to have huge increases in overweight and obesity are Greece and Spain, which, along with Ireland, have been suffering financial crises over the past few years.

The proportion of obese Greek men is set to more than double, from 20% to 44%, between 2010 and 2030. Greek women will likely see similar increases, from 20% in 2010 to 40% in 2030.

In Spain, obesity in women is projected to increase from 16% in 2010 to 21% in 2030. In men the rise will be much steeper, from 19% in 2010 to 36% in 2030.

Although Dr Breda said there is an accepted relationship between lower socioeconomic status and obesity, he told Medscape Medical News, "There are not enough data yet to establish a link between austerity and obesity."

Is the Netherlands Bucking the Trend or Not?

Other countries set to experience steep rises in obesity include the Czech Republic, host to this year’s conference, where more than one in three women (37%) is expected to be obese in 2030 compared with less than one in four (23%) in 2010. For men, the data are almost as concerning, with obesity likely to increase from 22% to 36% over these 20 years.

And in the United Kingdom, one-third (33%) of women are forecast to be obese in 2030, compared with over one-quarter (26%) in 2010, while just over a third (36%) of UK men will be obese in 2030 compared with 26% in 2010.

Even in countries with a traditionally lower prevalence of obesity, such as Sweden, obesity rates are predicted to rise sharply. An estimated 26% of Swedish men will be obese by 2030, compared with 14% in 2010, while the proportion of obese women will increase from 12% to 22%.

Only the Netherlands appears to be weathering the storm.

By 2030, less than half of Dutch men (49%) are predicted to be overweight, and just 8% obese, compared with 54% and 10%, respectively, in 2010. The proportion of overweight Dutch women will remain more or less stable over the 20 years (43% in 2030 compared with 44% in 2010). However, the obesity rate in Dutch women is predicted to fall from 13% to 9% during this period.

Dr Webber told Medscape Medical News that it isn't entirely clear why the Netherlands appears to be faring better than other countries.

However, "They didn't have high rates [of obesity] in the first place, and there is a high rate of cycling there," she noted.

More than 75 cities and towns in the Netherlands are now part of the EPODE movement, a unique strategy that attempts to bring together all sectors of the community — schools, families, and public authorities — in an integrated approach to prevent childhood obesity at a community level.

But she also pointed out that there are some concerns about the quality of the Dutch data, which was self-reported from surveys that had low participation rates, with the attendant potential for underreporting among the obese.

Dr Breda concluded: "Although this was a forecasting exercise, and therefore the data need to be interpreted with extreme caution, it conveys two strong messages: first, that the availability and quality of data in countries need to be improved, and second, these predictions show that more needs to be done in terms of preventing and tackling overweight and obesity."

Dr Webber added: "Our study presents a worrying picture of rising obesity across Europe. Policies to reverse this trend are urgently needed. Although there is no 'silver bullet' for tackling the epidemic, governments must do more to restrict unhealthy food marketing and make healthy food more affordable."

The projections are unpublished estimates that form part of the WHO Modeling Obesity Project, which is being undertaken together with the UK Health Forum as part of a collaboration between the WHO Regional Office for Europe and the European Commission. Drs Breda and Webber have reported no relevant financial relationships.


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