Health promotion through Obesity Prevention across Europe (HOPE) project kick-off meeting

On June 4 and 5 the steering committee (see picture) of the HOPE project met at the Erasmus University Medical Centre in Rotterdam, the Netherlands. HOPE stands for Health promotion through Obesity Prevention across Europe. More information on the project can be obtained at http://www.hopeproject.eu/. I am lucky enough to act as the coordinator of this project, assisted by two colleagues from Erasmus University Medical Centre, Willemieke Kroeze and Mauricio Avendano (the two on the right of the front row).

Obesity is one of the main health determinants in terms of burden of disease in Europe, accounting for up to 7% of all healthcare expenditures. It is largely determined by modifiable environmental and life-style factors, which offers a great potential for prevention. The fact that obesity treatment is largely ineffective in the long run, make efforts to prevent unnecessary weight gain even more important. Successful primary prevention could reduce future demands for health care associated with obesity-related chronic conditions such as diabetes, cardiovascular disease and cancer.
In order to design successful primary prevention campaigns, thorough understanding of the behavioural and environmental determinants with a potential for modification is needed. This should take into account the situation in different socio-economic groups

HOPE-project wants to bring all the scientific knowledge on overweight, obesity and their determinants together and use the expertise of researchers all over Europe to help to tackle the obesity epidemic.

HOPE was initiated together with Professor Philip James and Dr. Tim Lobstein of the International Obesity Task Force/International Association of the Study of Obesity (IOTF; http://www.iotf.org/ ; IASO; http://www.iaso.org/). HOPE brings together a core group of researchers from the Netherlands, UK, Belgium, Italy, France, Norway, Sweden with an extensive ‘Network of Networks’ with researchers, policy workers and other advocates for evidence-based action towards obesity prevention from across the Europe.

We had a successful steering committee meeting to kick start the project and the actual work is now fully in progress. Please check our HOPE project website regularly!

Smoke free and obesity

"Engeland goes smoke free" is what was announced on a typical London bus I passed when I walked on Oxford Street towards a World Cancer Research Fund Grant Panel meeting last Tuesday. Following the example of countries like Ireland, Norway and Italy, From July 31, 2007 on, England will ban smoking from all 'enclosed public places' and workplaces, including restaurants. Also in the Netherlands it has been announced that restaurants will have to become smoke free within the near future.


This is very good news for public health: people will be less exposed to second hand smoke. It is also very good news for people who enjoy eating good food in a restaurant unspoiled by a smoky environment.



Within Europe, England has one of the highest rates of overweight and obesity.

This same week the National Statistics Bureau of the Netherlands published their latest findings related to smoking and smoking cessation in the Netherlands (see http://www.cbs.nl/nl-NL/menu/themas/gezondheid-welzijn/publicaties/artikelen/archief/2007/2007-2204-wm.htm). People in the Netherlands who have stopped smoking are 3.6 K heavier than people who have continued smoking. Never-smokers are a bit heavier than smokers but have a lower mean body weight than ex-smokers.

Earlier research has shown that people who eat out more, have a somewhat higher mean body weight...


Policy measures to discourage smoking are much needed since smoking is still the most improtant determinant of preventable burden of disease. But obesity is a close runner-up. Will measures against smoking further increase obesity rates?

A strong closing and a likewise start

Today there was an important double ceremony at the VU University. Professor Houtgast gave his final lecture as professor of Experimental Audiology followed immediately by the inaugural address of Joost Festen as professor of Audiology.

The audiology research is part of the Care & prevention research track of the EMGO Institute (see www.emgo.nl).

Professor Houtgast’s lecture gave a very nice overview of how his field of research emerged and has grown over the thirteen years since he was appointed. The title of his lecture was ‘hearing loss and the beta researcher’ (Slechthorendheid en de Beta-onderzoeker), and during his speech he argued that his field of research involves more than ‘just’ beta expertise. Professor Festen’s lecture was entitled ‘the challenge of understanding’ (Verstaan als Uitdaging) and he gave further evidence that the study of hearing loss is a multidisciplinary research field, involving technical, medical and behavioural expertise. This multidisciplinary environment is exactly what the EMGO institute aims for.

I congratulate professors Houtgast and Festen with their interesting lectures.

The NHS-NRG project on obesity prevention: promising outcomes, applicable recommendations, but the Dutch government fails to meet its obligations

On May 24 the closing symposium of the Netherlands Heart Foundation NRG (NHS-NRG) project was held. NHS-NRG is a unique multi-stage and multi disciplinary project in which nutritionists, movement scientists, epidemiologists, public and occupational health experts, and behavioural scientists worked together to carefully develop, plan, implement and evaluate different projects for prevention of weight gain.

This NRG project recognised three different primary target groups: adolescents, young adults (20-40 years of age), and recently retired people, since these population groups are at high risk for unnecessary weight gain, are in a phase of the life course where important unhealthy lifestyle changes easily occur, and can be reached at settings that allow intervention activities with a high reach and sustainability, i.e. schools, work places and retirement preparation meetings.

The project included studies to identify specific risk behaviours for unnecessary weight gain, to identify important and modifiable behavioural determinants, and to implement and evaluate the intervention programs.

During this final symposium a summary was given of the most important results and conclusions. Professor Daan Kormhout, the consortium leader for this project, gave a brief overview, followed by an excellent state-of-the-art overview by professor Jaap Seidell. The two postdoc researchers of the NRG project, Drs. Tommy Visscher and Stef Kremers subsequently presented the overview of the results of the project.

The study results confirm the importance of identifying specific obesogenic behaviours and obesogenic environments to develop better targeted intervention programs. The studies also indicate that such well-planned and targeted interventions can initiate and help to sustain important changes in obesogenic behaviours and/or indicators of overweight and obesity.

Based on the project’s results recommendations for overweight prevention programs were provided. In summary, these recommendations state that prevention for overweight should focus on specific energy-balance related behaviours, should include strategies to improve motivation, abilities and environmental opportunities, and should be combined with long-term monitoring to further study the effects and learn for future initiatives. These recommendations are in line with earlier statements, but are now based on better evidence.

In the second part of the symposium, representatives of four organisations responsible for policy and implementation related to prevention of overweight (the Netherlands ministry of Health, the Netherlands Nutrition Foundation, the Netherlands Organisation for Promotion of Physical Activity, and the Netherlands Heart Foundation gave their reactions to the recommendations presented. These reactions were discussed with the audience of scientists, policy makers, and public health professionals.

The NRG recommendations were well received among the three implementation organisations. However, more negative news was heard from the representative of the Ministry of Health. She stated that the budget for prevention in general and obesity prevention in particular will most probably be further cut, and that collaboration with other ministries with important tasks related to providing opportunities for an energy-balanced lifestyle (e.g. Infrastructure, Food and Agriculture) was hindered by lack of willingness to seriously collaborate. This despite the fact that obesity rates in the Netherlands still grow to further unacceptable levels in all age groups and social classes, and despite the fact that the Dutch government has signed the European Charter for counteracting obesity. Signing this charter obligates countries to intensify their activities to prevent obesity (www.ijbnpa.org/content/4/1/11).

The impact of computer-tailored health education

Recently some new and exciting papers on the impact of computer-tailored health education were published. Computer-tailored health education is a way to use ICT to mimic personal health behaviour counselling. Computer-tailoring programs use (electronic) questionnaires to assess respondents' health behaviours and behavioural determinants and provide tailored, personalised and individualised feedback and advice. Computer-tailoring was originally applied with paper-and-pen questionnaires and print feedback, and a systematic review of the literature clearly indicates that this form of health education is superior to more traditional, generic forms of health education (see Kroeze, Werkman & Brug, Ann Beh Med 2007;31:205-223). More recently studies have been conducted and reported that applied web-based tailoring (see for example Brug et al. Eur J Clin Nutr 2005;59:S130-S137) and applied computer-tailoring among various target populations, such as children and adolesents. Leen Haerens of Ghent University recently published one of the first papers to test school-based computer-tailored nutrition education among adolescents. Her study published in Public Health Nutrition (2007;10:443-449) indicates that computer-tailored education alone is not enough.

Corneel Vandelanotte published a paper in Annals of Behavioral Medicine (2007;33:213-219) that for the first time reports a study on the longer-term (2 year follow-up) of his diet and physical activity computer-tailored intervention. His study indicates that effects of computer-tailoring can be sustained. (see www.leefgezondcoach.nl for a Dutch example of a web-based computer-tailored life style intervention for diabetes prevention).

Should we promote fruits and vegetables?

In yesterday’s edition of ‘De Volkskrant’, a leading national newspaper in the Netherlands, professor Martijn Katan posited that fruit is an overrated icon of healthful nutrition (see http://www.falw.vu.nl/Onderzoeksinstituten/index.cfm for the article with additional background information). Martijn Katan is professor of nutrition at the Institute of Health Sciences of the VU University Amsterdam.

Katan describes how fruit came to be one of the foods to be promoted by nutrition educators: based on observational studies preliminary evidence indicated that high intakes of fruit contributed to cancer prevention. However, more recent more robust studies indicate that the inverse association between fruit intake and cancer risk is much weaker than the initial studies suggested. Furthermore, Katan describes that fruit juice may contribute to tooth decay and overweight among youth similarly as soft drinks may do: fruit juice contains similar amounts of sugar and has a similarly low PH value.

Fruit and vegetable may on the other hand contribute to obesity prevention because fruits and vegetables have a lower energy density than many other foods. If children eat fruit and vegetables instead of chocolate bars, cookies, savoury snacks and other ‘junk foods’, fruit and vegetable intake may lead to lower energy intake, but there is not yet convincing evidence available to support this.

Nevertheless, most nutrition authorities across Europe think that the evidence for the health promoting properties of fruits and vegetables is still strong enough to include fruits and vegetables promotion in their official dietary recommendations. Later this year the World Cancer Research Fund will publish their new comprehensive report on nutrition and cancer risk, which will include the latest reviews of the scientific literature on fruits, vegetables and cancer risk.

For information on a cross-European project to promote fruits and vegetables among schoolchildren: see http://www.prochildren.org/.

Exploration of economic measures to promote healthful eating

A recent paper in the International Journal of Behavioral Nutrition and Physical Activity explores important 'economic environment' intervention possibilities to promote healthful dietary habits. This approach is much debated, and this paper sheds some empirical light on the issue. The paper is 'open access' and can be found at http://www.ijbnpa.org/content/pdf/1479-5868-4-10.pdf ; see www.ijbnpa.org for more intresting papers.
This paper by Danish researchers Jensen and Smed addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.