By Rob Verkerk PhD

Executive and scientific director, ANH-Intl

Anyone with a passion for natural health attending this week’s 6th Annual European Nutrition and Lifestyle Conference in Brussels would likely leave with the following daunting thought: governments, health authorities and policymakers are scraping the surface of dealing with the obesity and related chronic disease epidemics — and, as a society, unless we drastically change how we’re going about it, future generations are in real trouble.

Well, that was the sentiment that raged through my mind after the two-day conference. Among the speakers were senior officials from the European Commission, the World Health Organization (WHO) and representatives from food giants like PepsiCo, Coca-Cola and Barilla. The platinum sponsors for the event were Barilla, Coca-Cola Europe and Mead Johnson Nutrition. Even the Danish Minister of Health, Mette Gjerskov, graced the meeting with her presence, given her heavy involvement in EU health initiatives while Denmark holds the Presidency of the European Union (EU).

Most of the delegates were policy and regulatory specialists from the European Commission, national governments, big industry associations, big food companies and organisations that supposedly represent consumers, such as the BEUC and the UK’s Which? Magazine.

Admission of failure by the European Commission

Disconcertingly, 6 years into the 2007–13 EU Strategy on Nutrition, Overweight and Obesity-related Health Issues, Paola Testori Coggi, Director General, DG Health and Consumers for the European Commission, admitted that the policy had not changed the negative trends in obesity. Her keynote presentation that opened the conference had an air of resignation as she said: “The EU strategy on obesity has been going for 5 years and achieved many of its policy objectives. But the trend in obesity remains negative, and dealing with obesity is, after all, the overarching goal. This is the challenge. We need to understand why we haven’t influenced the obesity trend.”

This is akin to saying, “We’ve been ticking all our policy and bureaucratic boxes as we go along, but none of it is making the blindest bit of difference to obesity and related diseases, like type 2 diabetes, heart disease and cancer.”

Ms Coggi went on to say that the EC’s evaluation will be complete by the beginning of next year, and that it should help to identify what has and hasn’t been working. Here’s hoping.

Revolving doors and comfort zones

Being a participant in such a conference provides quite an insight into the inner workings of the public health policy machine, both within the EU and even further afield, given the WHO’s presence and inputs. There’s no doubt that this machine, as the name of the conference implies, understands the fact that nutrition and lifestyle are central to dealing with the chronic disease burden that is crippling healthcare systems the world over, and causing untold, unnecessary pain, loss and economic hardship.

But, as in most hierarchical systems, the people at the top still feel they can manage the problems using an edict created and agreed at the top, which is then disseminated to the ranks via layer upon layer of bureaucratic foot soldiers. Alongside these bureaucrats are a huddle of some of the biggest food producers on the planet; PepsiCo and Coca-Cola, for instance, were very much in evidence. Some might say, “What on earth are these companies doing in such a prominent role? Their products, and products like them, are central to the problem, rather than the solution!” Between them all, they try to do the impossible: address these chronic diseases without putting significant obstacles in the way of the preferred Big Food businesses, which, it must be remembered, trade largely in what many regard as junk foods.

In fact, a big part of the ‘solution’ being proffered is the highly critical Nutrition and Health Claims Regulation (NHCR), which they say is needed to prevent consumers from being misled by spurious, exaggerated, misleading or false claims over the health benefits of food.

Two EU policy measures that probably won’t affect obesity rates

It’s an odd thought from our perspective, but the NHCR and the Food Information for Consumers (FIC) Directive are the two key regulatory contributions that are meant to help the people of Europe develop healthy diets and lifestyles. We have challenged the former for the very reason that it works against consumer choice, and will likely reduce the ability of European consumers to discern between healthy and less-healthy foods. As for the FIC Directive, it applies to pre-packed, often processed foods, and it is their increasing contribution to our diets that seems to be at the root of the underlying problem. In short, both these pieces of law are creations of the big food corporations and their associations. Perhaps tellingly, most of the companies and trade associations present at the Brussels conference broadly agreed with the thrust of both the NHCR and the FIC Directive.

ANH on the panel

At the meeting, I represented both ANH and UEAPME (Union Européenne de l´Artisant et des Petites et Moyennes Entreprises), which is the voice of small to medium-sized enterprises (SMEs) to EU legislators. As one of the speakers on the “Implementing Health Claims: Successes and Challenges” panel, I suggested that the scale of the misleading claims issue – the driver for the NHCR – had been exaggerated in order to justify bringing in the law. We actually feel that it has now been manipulated to act as a competitive tool against the smaller players, which have been the traditional pioneers and innovators within the health food sector. How? Because these companies will either not be able to make any claim about a health benefit, or they will only be able to make one of around two to three hundred claims that are identical to the ones the big companies can make. In the former case, they lose a key factor that draws the consumer to their products; in the latter, consumers will find it difficult to differentiate their products from those of the big companies. In addition, because the smaller companies won’t be able to compete on price because they lack the economies of scale, they’ll lose market share.

More importantly, while this skirmish between 'Big' and 'Little' goes on, nothing has been done to drive people toward the healthiest foods and the healthiest diets. In the process, the obesity, diabetes, heart disease and cancer epidemics rage on unabated.

The bad – but nevertheless predictable – news for many of us is that the European Commission and EFSA show absolutely no desire to lighten their approach to the evaluation of health claims. Basil Mathioudakis indicated in the discussion that industry should expect around 250 health claims to make it through to the final positive list of Article 13.1 health claims – as if this was more than enough! This would suggest that they expect no more than around 30 botanicals and probiotics to gain approved health claims! It is simply staggering that this sort of number would represent the total number of health claims capable of use by the food and health food industries. This is effectively says that as far as the EU is concerned this small number represents the total number of substances that have been shown (proven?) to have a beneficial effect on human beings. The real number is likely to be in the multiple thousands, with more new ingredients being identified within foods every year, especially fruits, vegetables, herbs and spices, as having benefits for those who consume them.

Nutrient profiles – Big Food’s big worry

Another hot topic for debate was the issue of nutrient profiles. The EC was meant to have legislated on this as part of the NHCR by January 2009 (Article 4), but it has been delayed for over 3 years by kicking and screaming from industry. This is the bit that the big boys are desperate to get right. The idea is to have a model that can be used to determine if a given, pre-packed food product is healthy or unhealthy. The theory is that this can be achieved by taking into account things like sugar, salt, saturated fat and fibre – and the model is thought to be particularly effective at identifying unhealthy foods.

The European Commission is now prioritising its work on nutrient profiles, and it seems that a model might emerge sometime in 2013. In essence, the NHCR says you can only use a health claim on foods that don’t have an unhealthy nutrient profile. As such, it’s easy to see why big companies are worried that their work to get health claims on to the permitted list will be ‘undermined’ by nutrient profiles that might prevent those claims from being used. Isn’t it interesting, however, that those small businesses who supported our campaign for a veto of the health claims list, including UAPME and many natural health companies and consumers around Europe, are not worried in the least about nutrient profiles? The reason? The majority sell foods that are not at the slightest risk of being categorised as unhealthy.

Regulating for whose sake?

Julian Stowell of the Global Alliance of Probiotics (GAP) asked of Basil Mathioudakis, representing the European Commission, “Why isn’t there any mention of health promotion in the Nutrition and Health Claims Regulation?”

In answer to this, Mr Mathioudakis correctly asserted that the law was established under Article 95 of the European Treaty, and so stresses the principle of free movement of goods and the functioning of the single (EU) market. And there you have it: this, along with so many laws in the EU, exists to serve the interests of the big companies, the ones whose business model is based on selling across national borders, rather than within national ones. As I was still on the panel, I was able to remind Mr Mathioudakis, and Mr Stowell, about Article 27 of the Regulation. According to Article 27, the Commission must issue a report by 19 January 2013 at the latest, which “….shall also include an evaluation of the impact of this Regulation on dietary choices and the potential impact on obesity and non-communicable diseases.” We can only wonder what will be alluded to when the report materialises.

Is community-based, grassroots and individual action on obesity the answer?

What’s really lacking is a consistent, workable message that is inspiring to individuals, which makes them change both what they’re putting into their mouths and their levels and form of physical activity. Such a message would need to appeal to people from all socio-economic groups, as it is the most socially disadvantaged, lowest-income groups that suffer most from obesity and its related diseases.

Top-down approaches – as evidenced by the failure of the EU’s 6-year obesity strategy – just don’t work. Some possible reasons for this are alluded to above, and are linked to the intimate ties between governments and Big Food. But also involved are the far from perfect governmental nutrition advice, and precious little in the way of meaningful education emphasising the consumption of whole fruits and vegetables and home cooking. There’s also a poor marriage of nutrition and physical activity, and few attempts to incentivise the uptake and long-term adoption of healthy diets and lifestyles by individuals.

On this subject, I asked Dr Joao Breda, Programme Manager for Nutrition, Physical Activity and Obesity at the WHO Regional Office for Europe, how much work was being done in this area. The school fruit scheme, it seems, now adopted by 17 EU Member States, was the most important initiative linked to WHO nutrition policy. Dr Breda rightly says that this is a start – and so much more needs to be done. But, at the current rate of progress, outcomes in terms of obesity and related diseases won’t be affected quickly enough to avoid the collapse of the healthcare system under the strain of chronic disease and ineffective medical treatment.

In the end, perhaps we need to stop looking to others for the answers. We need to look at the local, community and individual levels. Here at ANH-Intl, we are working hard to pull together guidelines on diet and lifestyle that have been demonstrated to work exceptionally well by thousands of people who have chosen to live their lives in a different way. In the coming months, we’ll publish these guidelines and a great deal more, on a new, dedicated website and related social media. One thing is for sure: these approaches take us in quite a different direction from that recommended by our governments. They originate from the experience of thousands of integrative medicine practitioners, who put these ideas into practice on a daily basis – and then witness the results. It’s also all about our respective personal experiences, and creating a conduit for people to share their own experiences.

In the meantime, here are some pages that might be useful for those wanting to take personal responsibility for their health:

ANH Food4Health campaign page

ANH news story: Medical mavericks and heart disease

ANH news story: Government advice on nutrition: will it help you or make you sick?

ANH Feature: Dieticians and nutritionists: never the twain shall meet?

ANH news story: Managing festive over-indulgence