Non-communicable diseases - Healthy diet, physical activity and obesity trends in the Nordic countries: Status and challenges

Non-communicable diseases - Healthy diet, physical activity and obesity trends in the Nordic countries: Status and challenges

Prof. Knut-Inge Klepp

Director General, Public Health, The Norwegian Directorate of Health

Burden of disease attributable to 15 leading risk factors in 2010 expressed as % of DALYs

Denmark Finland

Nordic Nutrition Recommendations 2012

• Systematic, independent reviews of the scientific literature

• Recommendations regarding:

– Diet composition – Nutrient intake

– Physical activity levels

– Reduced sedentary behavior

Physical activity

Proportion (%) reporting at least 1 hour of

moderate-to vigorous physical activity per day (HBSC)

Boys: age 11 and 13 years; HBSC 2009/2010 Gutter

0 10 20 30 40

11 13 11 13 11 13 11 13 11 13 11 13

Finland Norge Island Sverige Danmark Gj.snitt

HBSC Land og alder

P ros e nt

(WHO 2012)

Objectively registered moderate-to-vigorous physical activity (minutes per day) – Denmark and Norway ( ^The

European Youth Heart Study )

0 25 50 75 100 125 150 175 200

Gutter Jenter Gutter Jenter Gutter Jenter Gutter Jenter

9 år 9 år 15 år 15 år

Danmark Norge Danmark Norge

Average minutes per day of measured moderate-to-vigorous physical activity; the European Youth Heart Study

(Riddoch CJ 2004, EYHS)

Moder at e -to -vig or ous P A (min/da y)

Self-reported physical activity:

% meeting the recommendation (>7 h MVPA/wk) , being somewhat active (15-419 min MVPA/wk),

or inactive (< 15 min MVPA/wk) : 7-12 year olds

Country N Active Somewhat active Inactive

Finland 500 56 43 1

Iceland 518 52 47 1

Denmark 609 45 53 2

Norway 353 33 64 4

Sweden 499 28 68 4

(Nordiske ministerråd, Rasmussen LB et al 2012)

MVPA=Moderate-to-vigorous PA

Self-reported physical activity:

% meeting the recommendation (>210 min MVPA/wk) , being somewhat active (15-209 min MVPA/wk), or inactive (< 15 min MVPA/wk) :

Adults 18-65 year olds

Country N Active Somewhat active Inactive

Finland 1835 70 22 8

Sweden 1782 69 22 9

Denmark 2098 66 23 11

Iceland 1866 65 21 14

Norway 1019 61 26 13

(Nordiske ministerråd, Rasmussen LB et al 2012)

MVPA=Moderate-to-vigorous PA

Sedentary behaviour – watching TV at least 2 hours/day (HBSC)

Boys: 11 and 13 years old; HBSC 2009/2010 Gutter

0 10 20 30 40 50 60 70

11 13 11 13 11 13 11 13 11 13 11 13

Danmark Finland Sverige Island Norge Gj.snitt

HBSC 39

P ros e nt

(WHO 2012)

Reported daily transport by foot (by age group):

Denmark & Norway

Denmark (2011); Norway (2009)

(Danmarks Tekniske Universitet 2012 og Transportøkonomisk institutt 2009)

Proportion of bike cyclists in Scandinavia

(Syklistenes landsforening 2010, http://www.tiltakskatalog.no/b-3-1.htm)

Nutrition & healthy

eating

Consumption of fresh fruit and vegetables kg/person/year (whole sale data)

1995 2000 2005 2010 2012

Denmark -- -- -- -- --

Finland 101 113 117 103 109

Iceland 76 74 100 105 115

Norway 106 119 126 129

Sweden 100 114 121 -- --

Nordic Statistical Yearbook 2013

Proportion who reported to eat fruit, berries and vegetables ≥ 5 times a day

Proportion (%)

Denmark 15.0

Finland 8.5

Iceland 8.3

Norway 21.9

Sweden 13.2

Salt intake (grams) per person per day for adults

↑ ↑ ↑ ↑

Average dietary index (range 0-12) in the Nordic Countries

The index is constructed based on reported frequency of intake of fruit & vegetables, bread, fish &

seafood, candy & cakes etc., fat on bread, cheese and sausages

Dietary index: proportion classified as having a poor diet (0-4); medium nutritional quality (5-8); or having a ‘healthy diet (9-12)

by country

Norway: the proportion of the adult population meeting the recommended dietary recommendations:

Norkost 2010-11:

Men Women

 Vegetables 13 % 15 %

 Fruit and berries 34 % 41 %

 Whole grain 27 % 25 %

 Fish 39 % 31 %

 Fatty fish 24 % 21 %

 Red meat 45 % 67 %

Overweight and obesity

The WHO European

Childhood Obesity Surveillance

Initiative (2009-10)

The WHO European Childhood Obesity Surveillance Initiative, Norway 2008-12: % overweight and obese

Both gender Boys Girls Girls

Boys

Health Behaviour in School-aged Children (HBSC) Study:

Self-reported overweight & obesity

Boys Girls

BMI: Proportion (%) reporting to be overweight or obese

BMI 25-29.9 BMI ≥ 30 Denmark 32.8 % 12.0 %

Finland 37.2 14.0

Iceland 39.3 17.8

Norway 36.1 8.7

Sweden 34.2 10.2

Obesity (% of pop) related to length of education

Length of education

Prevalence of obesity among

Norwegian women & immigrant groups

HUBRO 2000-02 (age adjusted)

(BMI ≥ 30 kg/m ² )

WHO – Marketing of foods to children 2004-12

2006 2004

2007

2007

2009

2010

2012

The Norwegian School Fruit Program

Tax on non-alcoholic beverages with added sugar or artificial sweetener

As of January 1, 2009 the added tax on non-alcoholic

beverages with added sugar or artificial sweetener was

increased to the same level as

that of beer with low alcohol

content (i.e. alcohol content

between 0,7 and 2,7 volume

percentage)

12 041 524

13 651 470

17 062 046

- 2 000 000 4 000 000 6 000 000 8 000 000 10 000 000 12 000 000 14 000 000 16 000 000 18 000 000

2011 2012 2013

Sales (NOK) of Keyhole products in grocery stores 2011-2013

(Nielsen)

Active transportation, physical activity at school &

available play and recreational areas within

neighborhoods

Conclusions & future challenges

• We lack comparable, valid (trend) data

related to the WHO NCD indicators from the Nordic countries

• Existing data indicate some positive trends related to diet

• There is no robust indication of a leveling off with respect to overweight and obesity rates in the Nordic countries

• A number of policy measures have proven to be promising with respect to promoting

healthy diet and increased physical activity levels

• There seems to be an under-utilized potential

for Nordic cross-country evaluation studies of

public health measures

Thank you for your

attention!