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Lectures 6 June 2008

In 2006 the number of overweight children in Europe has been estimated in around 22 millions. Of this number around one million and one half children are affected by complications such as hypertension, dyslipidemia, hepatic steatosis, in addition to orthopaedic and psychological ones. It is clear that the health promotion is strictly linked with obesity prevention. For years the preventive interventions have been focused on reinforcing the single individual to resist to the obesogenic environment, but this approach has not caused positive long term results. Since few years several countries have recognized the importance of establishing national and international policies to promote health. In this system policies need to implement strategies at national, community, and individual levels, involving all the stakeholders. Different strategies, thus, should be applied to different target groups in terms of age, socioeconomic level, and sex, in different settings (home, school, work place) using different approaches (education, mass-media, economic incentives or sanctions, and infrastructure change). In each of the setting several strategies have to be applied to counteract the risk factors. Assessing the real impact of the preventive intervention is not an easy task, especially in case of community interventions, as obesity is a multifactorial disease slowly developing. However, clear and realistic objectives have to be chosen in order to assess the the outcome. Since no country has found an effective program to prevent obesity, each action has to be adapted to the local situation and evaluated in term of cost-health gain. In a multifaceted strategy preventive actions can be described and divided as the financial portfolio in which actions are divided according their cost and impact on the population. In a portfolio approach a mix of interventions with high and low cost that can cause low or high impact on the population is performed allowing the selection of actions based on the best available evidence, mixed with promising but not yet consolidated strategies. The huge amount of preventive programs actually implemented in Europe is a clear proof of the efforts of scientists and politicians to try to stop and reverse the obesity epidemic and offers new hope to win the battle for a better children’s health.