newsSpecial, June 2024 no. 837

TALKING ABOUT OBESITY GALVANIZES PEOPLE AND LEADS TO ACTION, EVERY SINGLE CHANGE IS IMPORTANT

One good reason could be that 4 March is celebrated every year as World Obesity Day. In 2024, the theme of the Day was “challenging misconceptions”. Beyond that one day, however, obesity is an issue of daily concern, global concern and of concern for all ages. While concern about obesity as an issue was first taken up by civil society, it has now been embraced by others, including the World Health Organization (WHO). The obesity epidemic has been declared as a major public health challenge for nearly every country in the world by WHO. In 2022, there were already 1 billion people with obesity. This is especially serious since obesity is a major contributor to noncommunicable diseases (NCDs) like diabetes, cancers, cardiovascular diseases, chronic respiratory diseases, and neurological and digestive disorders.

The accelerating global public health crisis driven by rapid rises in obesity presents one of the

greatest health policy conundrums of our time.The problem is universally recognized. The causes are known and understood. Many interventions needed to contain the crisis are well evidenced, available and are not necessarily resource intensive. Yet, as the crisis escalates, the concerted action needed to control the epidemic remains elusive.

There are several reasons why this is the case. The impact of obesity is not immediate or headline grabbing – at either the individual or societal level. The health and economic consequences play out over time and in complex collusion with a myriad of factors. Many of the preventive actions involve market intervention at a scale that is unpalatable for free-market democracies and unattractive for the elites in other countries. The opportunities for recruiting populations into adopting obesity preventing lifestyles are limited by the choice constraining circumstances (economic, commercial, environmental and cultural) in which people live.

THE FIRST PORT OF CALL

Dr Francesco Branca, Director of Nutrition and Food Safety at WHO. As well as being a medical doctor, he studied nutrition early in his career, obtaining a Master’s and a Ph.D. degree. Starting from his early days when working in Somalia and witnessing extreme malnutrition first hand, he expressed the challenge of his life as being to convince people, especially policymakers, on the importance of nutrition – including both undernutrition and obesity. His efforts have paid off and some progress has been made in this regard, as evidenced by the United Nations General Assembly declaring 2015-2025 as a United Nations Decade for Action on Nutrition. While some countries have established policies on nutrition, much more needs to be done. Apart from the impact of obesity on morbidity and mortality, we are also currently facing the economic consequences of the disease – global costs are predicted to reach three trillion US dollars per year by 2030.

GETTING TO KNOW THE ACCELERATION PLAN TO STOP OBESITY

Dr Francesca Celletti, who leads the WHO Acceleration Plan to Stop Obesity, and attributes the obesity pandemic to:

• obesogenic environments – with limited availability of healthy sustainable food at locally affordable prices, lack of opportunities forsafe and easy physical activity in people’s daily lives and absence of adequate legal and regulatory frameworks; and
• lack of an effective health system response, with a focus on both prevention and management of obesity.

Many countries have acknowledged that accelerated global action is needed to address the pervasive and corrosive problem of the double burden of malnutrition (whereby overweight/obesity

coexist alongside undernutrition). A significant breakthrough came at the 75th World Health Assembly in 2022, when Member States demanded and adopted new recommendations for the prevention and management of obesity and endorsed the WHO Acceleration Plan to Stop Obesity. Currently, 32 frontrunner countries are putting the Acceleration Plan into action and finally address this issue. Big steps, indeed.

TEXT FRANCESCA CELLETTI, WHO

RENU CHAHIL-GRAF, RENUWRITES.COM

PHOTO RENU CHAHIL-GRAF

THE WHO CAFETERIA,

A GOLD STANDARD?

WHO’S HUNGRY?

Capturing a few individuals with their food choices on cafeteria trays, the feedback was reassuring. Paramjit Singh, from India and working in Human Resources, and hosting a colleague from Indonesia, with a smile on his face, said he loved the variety and quality of the food. Martin Widstam, Minister Counselor from the European Delegation, looked satisfied while waiting to check out but thought that it was maybe a bit pricey – well worth the cost, he’ll discover! Niloo, from Canada and working in the Immunisation Department, while filling her bowl with healthy options, said she loved to come to the cafeteria because “the food’s pretty good”, but also for the opportunity to bump into colleagues face to face.

AND THE GOOD NEWS IS…

Samantha Bell-Shiers, Head, Staff Health Insurance (SHI), provides some examples of obesity-related treatments that are reimbursable under the SHI Rules. For example, reimbursement of the cost of six sessions per year with a dietitian is possible when a participant’s BMI is greater than 30 and they have a prescription. In addition, reimbursement of bariatric surgery (after obtaining prior approval from SHI) is also possible. Psychiatric and psychological treatment, which can be helpful in relation to obesity issues, are also reimbursable (see SHI Rules, Part B Benefits Table for details). Samantha encourages participants to contact the SHI Medical Adviser if they have any doubts regarding related

SHI benefits. SHI closely follows the introduction of new validated treatments and preventive measures with a view to recommending the addition of new benefits to the SHI Rules in the interest of all its participants. Well done!

A SUPER-ENGAGED MEDICAL ADVISER

On top of his impressive knowledge, the empathy of Dr Eric Reymond, the WHO SHI Medical Adviser, is remarkable. Someone who really loves his job – wherever in the world it takes him. In his seven years in the organization he has had valuable experience, including working with Ministers of Health, WHO Regional Offices, country staff and local health care providers. He has found it especially motivating to work within the One UN Medevac Framework for COVID-19. While 70% of his work involves advising SHI participants worldwide, this is especially important for obesity-related issues. SHI seeks to provide access to the best care for the best cost. This can be challenging since some SHI participants may, once they present with overweight or obesity, want to immediately receive medicines or opt for surgery. But Eric emphasizes that there are many options before going for such interventions, which may not necessarily be in the best interests of the patient. There has, for example, been an increase in provision of medications – sometimes without proper, long-term follow-up by skilled health professionals – and in bariatric surgery. Since obesity is a chronic disease, it is important for the patient to understand that it’s a long journey, emphasizes Eric. Not only does this journey relate to food habits and physical activity, it also requires a sound long-term therapeutic approach around the person’s individual needs. He is also concerned about “weight stigma” and encourages staff members to participate in workshops on staff health and well-being, with an overall

broader perspective of sharing information with their colleagues, families and partners. This requires Eric to work closely with mental health colleagues. The Medical Adviser is available for any discussion and any advice. He gives it sincerely, without prejudice and with a complete understanding of the complexity of the issues. Thanks Eric, we hear you!

COURAGEOUSLY ADVOCATING FOR PEOPLE LIVING WITH OBESITY

Vicki Mooney, Executive Director of the European Coalition for People living with Obesity (ECPO), has been involved with the World Obesity Day campaign since 2016, when activities started in Europe. Over time, ECPO has expanded the narrative theme to Addressing Obesity Together, broadening stakeholder involvement. Vicki has been actively involved in bringing the “lived experience” of people living with obesity to the World Health Assembly. She has encouraged a focus on – in her words – the “biggest public health issue, obesity”. While she is fortunate not to have faced stigma in the workplace, she and fellow advocates face weight bias, stigma and discrimination. Vicki considers it essential that obesity is recognized as a complex, chronic and treatable disease, with recognition that weight bias, stigma and discrimination impact and influence the daily lives of affected people. “Let’s shift the focus from this ‘lifestyle narrative’ and ‘weight loss’ to a focus on a person's health and responsible medical treatment and management for obesity”, stresses Vicki. //

USEFUL RESOURCES

1. Global Strategy on Diet, Physical Activity and Health. Geneva: World Health Organization; 2004
2. Global Nutrition Targets 2025 Policy Brief Series. Geneva: World Health Organization; 2014.
3. NCD Global Monitoring Framework. Geneva: World Health Organization; 2011.
4. World Health Assembly. Seventy-fifth World Health Assembly: Geneva, 22-28 May 2022: resolutions and decisions, annexes. World Health Organization

THE 2024 STOP OBESITY CAMPAIGN

Using the opportunity of World Obesity Day, WHO organized a week-long campaign, from 4-8 March 2024, to address obesity prevention and management for the global WHO workforce and family members.

Key messages

• Need to adopt prevention measures starting at early stages of life.
• Breastfeed as long possible.
• Encourage children to play outdoors, limit screen time, eat healthy snacks and sleep long nights.
• Physical activity and healthy eating are important health protective behaviours.
• Adopt a personalized health journey.
• Let’s talk about holistic obesity management and not merely weight loss.
• When living with obesity, let’s adopt a comprehensive multi-modal therapy that includes lifestyle changes and – when and if indicated – associated pharmacological treatment.
• Let us all avoid stigma and discrimination.

Events

• Global webinar for all staff across the six WHO regional offices and the country offices addressing the causes, challenges, prevention and management of obesity; associated stigma and discrimination; and WHO interventions for its employees, such as workplace programmes and health insurance reimbursements for obesity and obesity-related issues.
• Information booth with physical activity, dietary counselling, patient education, information about staff health benefits and mental health support.
• Partnerships with the University Hospital of Geneva and the WHO Collaborating Centre offering videos and workshops.