CO-CREATE is a five-year research project funded by the European Union. Its main objective is to halt the rise of overweight and obesity among children and adolescents by giving young people a voice in addressing this large health and societal problem. The Consortium includes 14 international research and advocacy organisations to work with young people to create, inform and promote policies for obesity prevention. Collectively, they look at the policies that shape the environments we work, live, and play.
As Prof Klepp rightfully highlights:
"Europe is like an elaborate laboratory, where you have so many different cultures and policy climates, and we can do some interesting comparisons between countries." Prof Knut-Inge Klepp Norwegian Institute of Public Health
So, what are the barriers to addressing childhood obesity in Europe?
Obesity is such a complex issue. We need to acknowledge the diverse range of factors shaping the problem if we are to address it successfully. And that, of course, provides opportunities.
But it also means that there are vested interests that are against any one policy measure. It is easy for decision-makers to say, ‘this is not a problem; you should look at it in the other direction’. So, to be able to have a more holistic – or what we call system approach – to prevention and to secure policy coherence across sectors is the biggest challenge.
National governments regularly launch initiatives to address childhood obesity which often fail, why do you think so many initiatives in this area are unsuccessful?
One of the main problems with the initiatives we've seen so far is that they tend to focus on strengthening the capacity of individuals, rather than looking at the social structures that facilitate long-term impact. While it is important to also strengthen the motivation and competence of individuals, to achieve a long-term impact that benefits diverse socioeconomic groups, we need to re-focus and look more at policy initiatives that help shape the environment that we live in and make it easier for people everyone to make the healthier choices.
Are there any countries that you can highlight that are developing and/or implementing innovative interventions and policies?
I think across Europe, we see several initiatives that are quite positive. Some countries are imposing taxes to limit the intake of sugar-sweetened beverages or restricting the marketing of unhealthy food and drinks to children. Others are building bike lanes and making neighborhoods more walkable for young people. But what we lack is the amalgamation of these different efforts in a more comprehensive package. I don't think we have seen it at a national level in any European country today.
Childhood obesity levels are not the same throughout Europe. For example, previous reports from WHO showed that southern European countries had higher childhood obesity rates. Why do you think childhood obesity prevalence across Europe is so varied?
I think we see a gradient in physical activity patterns, starting at a quite young age between Southern European and other European children. And we know that being physically active is very important to prevent overweight and obesity later in life. There was one interesting observation in a previous European Union research project where the environments surrounding daycare facilities in Norway was graded to assess whether they were child-friendly and promoting physical activity or not. Norwegian daycare facilities were rated as having the worst outdoor environment because it was rough and rugged.
In Norway, however, we value a green environment where children can climb trees, rocks, take some risk, and run around easily. Also, with respect to the food environment, e.g., advertising of unhealthy food and drinks, we see large differences across countries. Thus, there are some interesting cultural differences that need to be explored further.
How is the CO-CREATE evaluating policy measures to promote a healthy diet and physical activity i.e., health-related behaviors in Europe?
CO-CREATE is reviewing the published literature to see which policies have worked, or not to address obesity in the past. Our partners at World Cancer Research Fund International have created the NOURISHING and MOVING databases to capture and monitor the different obesity-related policies that have been enacted across the globe. Moreover, we work with young people through youth alliances and dialogue forums to develop and refine policy ideas and to share, learn connect, and commit to collective action.
And finally, we do sophisticated modelling exercises to look at the synergy between different types of policies and interventions that are being/or could be introduced. It’s interesting to understand the impact of policies if they were to be implemented successfully.
To end the interview, we asked Prof Klepp what he aims to achieve by the end, and beyond the CO-CREATE project:
- To give young people a voice in developing policies at local, national, and international levels
- To contribute to system thinking where we move away from looking at single policies or interventions, and instead, look at how they work together synergistically.
- To help policymakers and decision-makers see why you need to think much more coherently across different sectors and have a system approach in prevention.
- To co-create strategies and interventions that are useful for all socio-economic, ethnic groups, minorities, and so forth.
- To work with partners to create an infrastructure that will make it easier to evaluate and look at the impact of these policies in the future.
CO-CREATE (GA No 774210), a five-year (2018-2023) research project funded through an EU Horizon 2020 grant, aims to reduce the prevalence of obesity among adolescents in Europe through policy actions to promote a healthier food and physical activity environment. CO-CREATE vision is that before 2025, the rise in adolescent obesity will have come to a halt.
Visit the Website: www.co-create.eu
Follow the Twitter account: @EU_COCREATE
World Obesity Federation is responsible for ensuring the dissemination, communication and utilisation of the outputs of the CO-CREATE project. Outputs include scientific papers, professional presentations and research tools, policy databases, policy briefings and policy-relevant webinars and workshops.