Obesity Monitor Monitoring prevention, cure,
political, social and economic facts on obesity care
Fact& Figure in Italy
Numero Speciale Marzo 2021
2021
Obesity Monitor Monitoring prevention, cure,
political, social and economic facts on obesity care
Il presente report è realizzato da: IBDO FOUNDATION; INTERGRUPPO PARLAMENTARE OBESITA’ E DIABETE; OBESITY POLCY ENGAGEMENT NETWORK - OPEN ITALY; ITALIAN OBESITY NETWORK - IO-NET; SOCIETA’ ITALIANA DELL’OBESITA’ - SIO su dati forniti e pubblicati dalla WORLD OBESITY FEDERATION
2
mêçÖÉííç=Öê~ÑáÅç=É=ëí~ãé~X= pm=pÉêîáòá=éìÄÄäáÅáí~êá=ëêä=J=dêìééç=`êÉ~íáî~= sá~=^äÄÉêÉëÉI=V=J=MMNQV=oçã~= íÉäK=HPV=MSSRTNNQM= c~ñ=HPV=MSOPPONSNNT= = Coordinamento editoriale f_al=clrka^qflk= sá~=oK=sÉåìíáI=TP=J=MMNSO=oçã~= aáêK=HPV=MSVTSMRSOP= c~ñ=HPV=MSVTSMRSRM= ëÉÖêÉíÉêá~]áÄÇçKáí
SPECIALE l_bpfqv=jlkfqlo=≠=ìå~=êáîáëí~=ëìääÛçÄÉëáí¶I=ÉÇáí~=Ç~=f_al=cçìåÇ~íáçåK= i~=êáîáëí~=çëéáíÉê¶=éÉêáçÇáÅ~ãÉåíÉI=áå=åìãÉêá=ãçåçíÉã~íáÅáI=~å~äáëáI=áåÇ~ÖáåáI=~ééêçÑçåÇáãÉåíá= É=ÇçÅìãÉåíá=êÉÇ~ííá= Ç~=ÉëéÉêíá=ÅÜÉ=çéÉê~åç=áå=ÇáîÉêëá=Å~ãéáI=Åçå=äÛçÄáÉííáîç=Çá=~åáã~êÉ=áä=ÅçåÑêçåíç=É=ä~=êáÅÉêÅ~=Çá=ëçäìòáçåá=ëìääÛçÄÉëáí¶= èì~äÉ=ã~ä~ííá~=Çá=Öê~åÇÉ=êáäÉî~åò~=ÅäáåáÅçI=ëçÅá~äÉI=ÉéáÇÉãáçäçÖáÅ~I=ÉÅçåçãáÅ~=É=éçäáíáÅçJë~åáí~êá~K=
= bÇáíçê=áå=ÅÜáÉÑ= oÉå~íç=i~ìêç= ^åÇêÉ~=iÉåòá= m~çäç=pÄê~ÅÅá~= = bÇáíçêá~ä=_ç~êÇW= sáåÅÉåòç=^íÉää~ = oçÅÅç=_~ê~òòçåá = ^äÑçåëç=_Éääá~= iìÅ~=_ìëÉííç= j~êÅç=`~éé~= j~êá~=dê~òá~=`~êÄçåÉääá= ^åíçåáç=`~êÉííç= jáÅÜÉäÉ=`~êêìÄ~= píÉÑ~åç=`á~åÑ~ê~åá= ^åå~ã~êá~=`çä~ç= iìÅáç=`çêë~êç= oçÄÉêí~=`êá~äÉëá = `ä~ìÇáç=`êáÅÉääá= açãÉåáÅç=`ìÅáåçíí~ = içêÉåòç=açåáåá= cê~åÅÉëÅç=açíí~= dáìëÉééÉ=c~í~íá= iìÅá~=cêáííáíí~= páãçå~=cêçåíçåá= bòáç=dÜáÖç= cê~åÅÉëÅç=dáçêÖáåç= iìÅáç=dåÉëëá= cêáÇ~=iÉçåÉííá= dáìëÉééÉ=j~äÑá= bÇç~êÇç=j~ååìÅÅá= dáìäáç=j~êÅÜÉëáåá= dÉê~êÇç=jÉÇÉ~= páäîá~=jáÖäá~ÅÅáç= dÉêíêìÇÉ=jáåÖêçåÉ= c~Äêáòáç=jìê~íçêá= ^åíçåáç=káÅçäìÅÅá = båòç=káëçäá = rãÄÉêíç=m~Öçííç= píÉÑ~åá~=oçëëÉííá = `~êäç=oçíÉää~= cÉêêìÅÅáç=p~åíáåá= ^äÉëë~åÇêç=pçäáé~Å~= cÉÇÉêáÅç=pé~åÇçå~êç = hÉííó=s~ÅÅ~êç= oçÄÉêíç=sÉííçê= = j~å~ÖáåÖ=ÉÇáíçêW= s~äÉêá~=dìÖäáÉäãá= = = =
3
For healthier and longer lives, we must provide the best nutritional environment possible.
prefazioni
#
Roberto Pella Presidente Intergruppo parlamentare “Obesità e Diabete” e Vicepresidente vicario ANCI
La pubblicazione del Report della World Obesity Federation rappresenta un momento importante di riflessione e di stimolo a una sempre più efficace programmazione dell’attività dell’Intergruppo parlamentare “Obesità e Diabete”. L’approvazione, a novembre 2019, della Mozione sul riconoscimento dell’obesità come malattia, presso la Camera dei Deputati, è stato il punto di arrivo di un percorso che, nelle varie tappe che si sono susseguite, ha fatto maturare la consapevolezza della necessità di una tale definizione, nel rispetto dei diritti della persona con obesità. Una consapevolezza resasi, purtroppo, ancora più evidente durante la pandemia da COVID-19, che ha trovato conferma nei dati diffusi dagli studi condotti negli ultimi mesi che rivelano come il paziente con obesità sia fragile, vulnerabile, maggiormente colpito dalla malattia. Oggi diventa imprescindibile tradurre la volontà unanime espressa dal Parlamento, insieme al conseguente impegno del Governo, in azione di politica pubblica, a tutti i livelli di governo. Il primo e prossimo passo è inserire l’obesità nella lista delle malattie croniche e, conseguentemente, nel piano nazionale della cronicità. Parallelamente, dobbiamo impegnarci affinché l’obesità sia inserita nei Livelli Essenziali di Assistenza, per garantirne cura e trattamento. Anche i Comuni potranno svolgere, specie in questa fase storica di profonda ri-programmazione e rinascita del Paese, un ruolo fondamentale nella pianificazione di contesti urbani meno obesogeni per i cittadini. 6
Il nostro obiettivo è continuare a lavorare, nel solco del percorso che abbiamo tracciato, per raggiungere insieme nuovi traguardi e migliorare la vita delle persone con obesità e dei loro cari.
Andrea Lenzi, Presidente OPEN ITALY, Presidente del Comitato per la Biosicurezza, le Biotecnologie e le Scienze della Vita della Presidenza del Consiglio dei Ministri
Il tema della World Obesity day 2021 è “L’OBESITA’ È UNA MALATTIA E UN FATTORE DI RISCHIO”. Sembra ovvia questa affermazione,mentre invece dobbiamo constatare come l’Obesità venga considerata a livello Istituzionale una condizione e non come una malattia che necessita di cure e trattamenti. OPEN (Obesity Policy Engagement Network) nasce a livello internazionale con la volontà precisa di stimolare il dibattito e il confronto con le Istituzioni e i Governi locali per cambiare questa deriva culturale-politica che non trova nessuna base razionale nella scienza e nella clinica e per riconoscere l’Obesità quale malattia grave e invalidante, Recentemente OPEN ITALY ha voluto segnalare al Ministero della Salute a alle Istituzioni la necessità di porre una attenzione prioritaria nella programmazione della campagna di vaccinazione anti COVID-19 alle persone con obesità, quali soggetti fragili e vulnerabili, come ampiamente dimostrato dai dati della letteratura scientifica-epidemiologica mondiale e da quelli dell’Istituto Superiore di Sanità. L’obesità si associa a un aumentato rischio di polmonite e sindrome influenzale ed è, insieme all’età, il fattore di rischio più importante per lo sviluppo di sindrome respiratoria acuta grave da Coronavirus-2 (SARS-CoV-2), COVID-19, con esiti peggiori, compresi: ricovero in terapia intensiva, uso della ventilazione meccanica invasiva e progressione della malattia. La pronta risposta positiva data dal Ministero della salute, che ha posto come le persone con obesità grave tra le categorie prioritarie da vaccinare contro il COVID-19. I dati della World Obesity Federation e dell’OMS ci indicano come nel mondo più di 1,9 miliardi di adulti sono in sovrappeso, di questi oltre 650 milioni sono obesi. L’obesità è il principale fattore di rischio per diverse complicanze tra cui malattie cardiovascolari, diabete di tipo 2, ipertensione, malattia coronarica e cancro. Sovrappeso e obesità sono presenti nella maggioranza dei pazienti con diabete di tipo 2 e si prevede che la prevalenza del diabete
correlato all’obesità raddoppierà entro il 2025. Bisogna lavorare a livello globale e nazionale per creare una ampia e condivisa opinione politico, clinica, scientifica, sociale e mediatica affinché venga riconosciuta che l’obesità sia considerata una malattia grave. OPEN ITALY, riconosce come la mozione approvata all’unanimità da Parlamento nel Novembre 2019 che con il parere positivo del Ministero della Salute sia un passo politico fondamentale La mozione impegnava il Governo in alcune azioni fondamentali per contrastare l’obesità in Italia e in particolare: ● prevedere un monitoraggio della corretta attuazione dei LEA con specifico riferimento alle malattie associate all’obesità; ●
attuare un piano nazionale sull’obesità che armonizzi a livello nazionale, le attività nel campo della prevenzione e della lotta contro l’obesità; un documento, condiviso con le regioni, che, compatibilmente con la disponibilità di risorse economiche, umane e strutturali, individui un piano strategico comune volto a promuovere interventi basati su un approccio multidisciplinare integrato e personalizzato, incentrato sulla persona con obesità e orientato verso una migliore organizzazione dei servizi e un approccio responsabilità di tutti gli attori della cura;
●
prendere iniziative volte a garantire alla persona con obesità il pieno accesso alle procedure diagnostiche per le co-morbidità, ai trattamenti e ai trattamenti dietetici e, nei casi più gravi, ad accedere a centri di secondo livello per valutare approcci psicologici, farmacologici e chirurgici; stabiliva ha cominciato a colloquiare attivamente con il Ministero della Salute, per far inserire l’Obesità tra le malattie croniche, sembra impossibile che ad oggi non lo sia, e che le prestazioni correlate siano inserite nei LEA.
Partendo da questi punti OPEN ITALY ha intrapreso di recente positive interlocuzioni con il Ministero della Salute per far riconoscere l’obesità come malattia cronica, sembra impossibile che non lo sia, e inserire le prestazioni correlate nei LEA. Anche in questo caso la positiva risposta del Ministero della Salute ci fa ritenere che #siamo-sulla-buona-strada
">$# 7 &'(&. " $A:
dáìëÉééÉ=c~í~íá=
Presidente Italian Obesity Network La “Report Card Italy” della World Obesity Federation (WOF) è una scheda di valutazione dell’obesità in Italia che ne che descrive l’impatto sulla società e sul sistema sanitario. La prevalenza di sovrappeso-obesità è più frequente negli stati socio-economici più bassi e nelle persone con più di 55 anni. I dati sono allarmanti soprattutto se consideriamo le caratteristiche della popolazione italiana. Nel 2019 sono nati in Italia 435 mila bambini, il peggior risultato dall’Unità d’Italia ad oggi. Il saldo con il numero dei morti è negativo (-212 mila unità), ridotto solo dal saldo migratorio positivo (+143 mila unità). Possiamo affermare che l’invecchiamento della popolazione è un elemento strutturale e che la persona con obesità, anziana e con un livello socioculturale non ottimale ha una polimorbilità più elevata e maggior bisogno del Sistema Sanitario Nazionale (SSN).
8
Il Documento valuta il nostro SSN attraverso indicatori specifici e accanto a elementi positivi quali la approvazione della mozione sul riconoscimento dell’obesità come malattia evidenzia aspetti negativi tipo la non rimborsabilità di molti trattamenti e lo stigma. L’obesità è una malattia cronica, risultante da una complessa interrelazione tra fattori biologici, psicosociali e comportamentali, che includono aspetti genetici, socioeconomici e culturali. La disapprovazione sociale (stigma) attraverso stereotipi, linguaggi e immagini inadatte, ritrae l’obesità in modo impreciso e negativo. Lo stigma clinico discrimina la persona con obesità nell’accesso alle cure e induce l’isolamento sociale. L’organizzazione dei servizi ne è esempio: la maggior parte delle sale di attesa non sono dotate di poltroncine adatte a sostenere i grandi obesi e gli stessi letti delle degenze sono inadeguati. La World Obesity considera la difficoltà di accesso alle cure una delle cause più importanti alla base del fenomeno obesità. La crescita esponenziale dei casi di coronavirus rappresenta un importante rischio aggiuntivo. Universalmente sono state decise politiche di riduzione delle attività assistenziali ambulatoriali, sia per la carenza di personale sanitario, sia per evitare il sovraffollamento delle sale di attesa. La Commissione
Europea nel documento 2020 Strategic Foresight Report afferma che la crisi legata alla pandemia ha messo a nudo le vulnerabilità sanitarie e sociali in Europa; COVID-19 ha catalizzato l’attenzione e distolto i decisori dalle principali sfide sanitarie come le malattie non trasmissibili, in particolare il cancro e l’obesità. È stato sottovalutato il fatto che le persone con obesità sono ad alto rischio di mortalità per infezione da COVID-19. E’ assolutamente necessario per evitare una assurda penalizzazione che l’obesità venga inserita quanto prima nella lista delle malattie croniche e, conseguentemente, nel piano nazionale della cronicità. Il sistema sanitario nazionale deve garantire alla persona con obesità l’uso di metodi diagnostici, assistenziali e terapeutici appropriati, in modo uniforme su tutto il territorio nazionale al pari delle altre persone affette da patologie croniche. Il coinvolgimento della persona con obesità nelle decisioni che riguardano la salute è una necessità sottolineata più volte dall’Italian Obesity Network. Tale principio, riferito ai portatori di patologia cronica, è presente non solo nel Piano nazionale della cronicità ma anche nella legge di Riforma sanitaria del 1978. A distanza di oltre 40 anni, la persona con obesità è al centro del sistema solo sulla carta. In realtà, vive il disagio di un servizio sanitario nazionale e regionale poco efficiente nei suoi confronti, infarcito di disomogeneità regionali e penalizzante per la assenza di terapie e farmaci disponibili con specifica indicazione e rimborsabili dal SSN.
cÉêêìÅÅáç=p~åíáåá= = Presidente della Società Italiana dell’Obesità (SIO)
L’ampliamento delle conoscenze sulle cause dell’obesità, sulle sue conseguenze in termini di salute e sulle sue ricadute in ambito sociale ed economico ha favorito lo sviluppo di una nuova sensibilità nei confronti di questa malattia, sensibilità che dal mondo scientifico si è allargata alle istituzioni e alle classi dirigenti: si sta oggi consolidando la convinzione per la quale non è più possibile assistere al dilagare del fenomeno come ad un ineluttabile costo del benessere ma è necessario ricorrere ad azioni concrete ed efficaci di sostegno delle persone affette. Lo Word Obesity Day è espressione di questa consapevolezza che, nel nostro Paese, ha iniziato a tradursi in una serie di iniziative volte al riconoscimento formale dell’obesità come malattia e all’adozione dei conseguenti provvedimenti da parte del Sistema Sanitario Nazionale, per garantire un’offerta assistenziale adeguata e fruibile da tutti, senza disparità su base geografica o di censo. La Report Card Italia fa il punto della situazione, evidenziando i risultati raggiunti e delineando gli ostacoli che si frappongono al conseguimento degli obiettivi. Il documento pone un accento evidente sulle questioni pratiche (la preparazione della classe medica, la disponibilità di risorse pubbliche) e contiene implicitamente un richiamo all’azione nei confronti di tutti gli attori coinvolti nella gestione del problema. La Report Card Italia si affianca opportunamente alla recente pubblicazione della Milan Charter on Urban Obesity, un documento nato da un’iniziativa italiana e adottato a livello europeo (1). La Milan Charter sottolinea come l’ambiente urbano rappresenti un fattore determinante per lo sviluppo dell’obesità e propone una serie di principi destinati a guidare le azioni degli operatori sanitari, degli amministratori e delle autorità politiche nella riqualificazione dell’ambiente, nello sviluppo delle strategie di prevenzione, nell’abolizione dello
stigma sociale e nella facilitazione dell’accesso alle cure per le persone affette da obesità. Tra gli attori coinvolti nell’implementazione di queste politiche, la Società Italiana dell’Obesità è chiamata a svolgere un ruolo di primo piano, in quanto espressione della multidisciplinarietà alla base del la gestione clinica dell’obesità e accreditata interlocutrice sotto l’aspetto scientifico. Tra i suoi compiti principali rientrano la costante revisione delle linee guida, l’aggiornamento professionale, lo sviluppo di proposte per l’inserimento dell’obesità nel piano nazionale delle malattie croniche e il conseguente adeguamento dei livelli essenziali di assistenza. Carruba MO, Busetto L, Bryant S, Caretto A, Farpour-Lambert NJ, Fatati G, Foschi D, Giorgino F, Halford JCG, Lenzi A, Malfi G, O’Malley G, Napier D, Santini F, Sbraccia P, Spinato C, Woodward E, Nisoli E. The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity. Obes Facts. 2021 Jan 26:1-6.
9
mêçÑK=iìÅ~=_ìëÉííçI= Dipartimento di Medicina dell’Università degli Studi di Padova Co-Chairman della Obesity Management Task Force della European Association for the Study of Obesity.= La pubblicazione da parte della World Obesity Federation della Report Card dedicata all’Italia attualizza e conferma l’importanza che l’obesità ha nel nostro paese, sia in termini di prevalenza nella popolazione, sia per quanto riguarda le ricadute sulla salute dei cittadini, sia per quanto attiene i costi generati per il Servizio Sanitario Nazionale. Tale situazione, pur in presenza di alcune peculiarità nazionali, si iscrive in un quadro Europeo sostanzialmente omogeneo e rappresenta un ulteriore peggioramento rispetto al passato. L’obesità è quindi una patologia epidemica in peggioramento in cui gli interventi di prevenzione, fino ad ora, si sono dimostrati inefficaci perché basati sul paradigma della responsabilità personale. In questa ottica il soggetto ingrassa perché adotta per scelta comportamenti non salutari e non rispetta le raccomandazioni di prevenzione. Al contrario gli esperti sono oggi concordi sul fatto che l’obesità è una condizione complessa che deriva dall’interazione di fattori genetici, psicologici e ambientali. Una efficace prevenzione deve essere quindi articolata su base sistemica e non poggiare esclusivamente sulla responsabilità individuale del cittadino.
10
In molti casi, purtroppo, la persona con obesità è anche vittima anche di uno stigma clinico che lo discrimina nell’accesso alle cure e ai trattamenti. A livello globale molti sistemi sanitari, sia pubblici che privati, non offrono per il paziente con obesità lo stesso livello di assistenza che viene erogato per altre malattie croniche (come il cancro, il diabete, le malattie cardiovascolari e le malattie reumatiche). In Italia, l’accesso all’educazione terapeutica e a programmi intensivi di modificazione dello stile di vita è limitato nel sistema sanitario nazionale per il paziente con obesità, scarsa è l’offerta pubblica di
programmi di terapia cognitivo-comportamentale, nessuno dei farmaci disponibili con specifica indicazione nella terapia dell’obesità è rimborsato dal sistema sanitario nazionale, e infine l’accesso alla terapia chirurgica bariatrica, secondo percorsi terapeutici che garantiscono un follow-up multidisciplinare, è molto difficile soprattutto in alcune aree del paese. La presenza di questa discrepanza nella disponibilità di cure adeguate tra obesità ed altre patologie croniche appare ingiustificabile in base ai dati oggi presentati ed è indifendibile dal punto di vista etico e sociale.
m~çäç=pÄê~ÅÅá~= = Vice Presidente IBDO Foundation La fotografia fornita dalla World Obesity Federation (WOF) attraverso l’ultimo “Report Card Italy” è ricca di spunti e di chiaro-scuri per tentare di comprendere meglio l’impatto dell’obesità sulla nostra società in genere e sul sistema sanitario in particolare. La stima del raggiungimento, nel 2025, di una prevalenza di obesità che lambirebbe il quarto dell’intera popolazione è un segnale di allarme da prendere in seria considerazione. E se da un lato si può esprimere una cauta soddisfazione per il lieve decremento della prevalenza dell’obesità infantile, il progressivo invecchiamento della popolazione con valori di prevalenza combinata sovrappeso-obesità negli over 55enni che lambiscono il 70% costituisce un dato che, sommato alla polipatologia dell’anziano, rappresenta uno dei principali elementi per paventare una “tempesta perfetta” sanitaria. Molti i dati sugli stili di vita nel documento della WOF, ma certamente un’attenzione particolare va posta sui dati della prevalenza delle neoplasie maligne obesità-relate; questo è certamente un punto che merita di essere affrontato attraverso il finanziamento di progetti di ricerca tesi a comprenderne i fondamenti patogenetici. Tutto questo ci riporta alle stringenti esigenze di innalzare le capacità di contrasto all’obesità. Al di là dei programmi di sensibilizzazione e prevenzione, l’elevato numero di persone affette da obesità richiede che essa venga inserita quanto prima nella lista delle malattie croniche e, conseguentemente, nel piano nazionale della cronicità. Inoltre, la presa in carico della persona con obesità deve prevedere che i centri per la sua cura soddisfino tutti i criteri di appropriatezza clinica, strutturale, tecnologica e operativa. La tremenda pandemia di Covid-19 ha rappresentato uno stress test dal quale è emerso che
l’obesità è, insieme all’età, il fattore di rischio indipendente più importante per insufficienza respiratoria grave e per mortalità. Ed è stridente come, ciononostante, durante la pandemia l’accesso alle cure delle persone con obesità sia stato fortemente ostacolato. La WOF, alla fine del suo documento ci dà i voti; ed insieme ad alcuni apprezzamenti (p. es. approvazione della mozione sul riconoscimento dell’obesità come malattia e disponibilità di linee guida specifiche) ci sono ancora troppe insufficienze e barriere ad una gestione efficace di questa malattia: non rimborsabilità di molti trattamenti, esclusione nei corsi di studio di Medicina di un insegnamento specifico, influenza dell’industria alimentare, stigma, carenza di centri specializzati. Auspichiamo fortemente che al prossimo appuntamento alcune di queste carenze vengano sanate e le persone con obesità possano guardare al loro futuro con maggiore ottimismo.
11
12
For healthier and longer lives, we must provide the best nutritional environment possible.
declaration
däçÄ~ä=lÄÉëáíó=cçêìã=a =============Obesity=~åÇ=íÜÉ Global Obesity Forum Declaration: Global Declaration: Obesity Obesity and the rresponse esponse to Covid-1 Covid 19
The Covid-19 pandemic has shown that a societal, worldwide response to a disease is possible. Covid-19 has also exposed the imperative to address other global health challenges such as obesity1. Evolving evidence on the close association between Covid-19 and underlying obesity provides a new urgency - and inspiration - for political and collective action. Obesity is a disease that does not receive prioritisation commensurate with its prevalence and impact, which is rising fastest in emerging economies. It is a gateway to many other noncommunicable diseases and mental-health illness and is now a major factor in Covid-19 complications and mortality. There is a window of opportunity to advocate for, fund and implement these actions in all countries to ensure better, more resilient and sustainable health for all, now and in our post-Covid-19 future. This Declaration is inspired by calls from the World Health Organization (link), the United Nations (link) and the OECD (link) to ‘build back better’ from Covid-19, to improve the health of people and planet. It reflects a consensus reached at the 2020 Global Obesity Forum. pproach A ROOTS ROOTS a approach On World Obesity Day 2020, the global obesity community came together to acknowledge the complexity of obesity and to develop the ROOTS framework (link), which sets out an integrated, equitable, comprehensive and person-centred approach to addressing obesity. Building on the ROOTS framework, this Declaration sets out recommendations for immediate action across the obesity spectrum from prevention to treatment, within the context of Covid-19:
Recognise that obesity is a disease in its own right as well as a risk factor for other conditions, including significantly worsening the outcomes of Covid-19 infection. We call for: •! people living with obesity to be included among the groups prioritised for testing and vaccination ; •! spaces in which people living with obesity receive Covid-19 care to be appropriately equipped, with trained health workers free from weight bias, who have knowledge on the complexity of obesity and obesity care needs; •! the recognition that, in many contexts, Covid-19 and obesity are linked through inequity/health disparities, and strategies to address both diseases should adopt a social determinants of health approach.
Obesity monitoring and surveillance must be enhanced to strengthen effective strategies for 14
preventing and treating obesity. We call for: •! population-wide monitoring to assess how Covid-19 has affected the risk factors for and prevalence of obesity; •! monitoring of availability and accessibility to nutritionally adequate food supplies, especially among populations vulnerable to Covid-19 including those with obesity; ############################################################# 9 #:,#2,6%',#-0,$%);#($<#!"#$%&'(#)"%*+!,-('.)",%&.%*--(/*"0(-*!-*"%*-1+2('."3%&4"#&4,+*5"('2*%!#2(&'-" 6*27**'"6(&+&.(#!+"!'0",-8#$&-&#(!+"3!#2&%-"('"&6*-&.*'(#"*'/(%&'4*'2-9"
ÉÅä~ê~íáçåW== É=êÉëéçåëÉ=íç=Covid-19= •! monitoring the impact of policies and restrictions to limit the spread of Covid-19 for their impact on people with obesity; •! monitoring of compliance with the international Code and resolutions on marketing of breastmilk substitutes, as there is evidence of violations occurring.
Obesity prevention strategies must be developed, tested and implemented across the life course, from pre-conception, through childhood, and into older age. We call for: •! primary and secondary obesity prevention efforts to be continued and enhanced for all without discrimination, as a critical means to increase population resilience to pandemics; •! co-creation and implementation of policies to reduce childhood obesity, working with young people and acknowledging that, for many children, Covid-19 control measures have increased risk; •! equity-based obesity prevention strategies focusing on populations most affected by the Syndemic interactions between Covid-19, poverty and race.
! Treatment of obesity – including behavioural, pharmacological, digital, nutritional, physical-activity based and surgical interventions – should be accessible to all people with obesity. We call for: •! routine obesity treatment and management services not to be restricted during Covid-19, but instead invested in and prioritised to enhance equitable access; •! development of novel treatment strategies (for example, tele-medicine) to include solutions co-created with the participation of people living with obesity, including those with long Covid.
Systems-based approaches should be applied to the treatment and prevention of obesity. In the recovery from Covid-19, we call for action across the following systems: Health: He alth: Cost-effective community-based prevention, including monitoring and screening •! Health: should be integrated with clinical pathways for secondary prevention, obesity management and treatment. Food: Fo od: National and local government-led action and incentives to pivot food systems •! Food: towards sustainable growth models, focusing on ‘triple win’ policy solutions to address the Global Syndemic of over- and undernutrition and climate change. T Tr Transport: ansport: Investment in active transport systems to promote physical and mental health, •! ransport: while reducing Covid-19 transmission risk and mitigating climate change. sanitation: Universal access to clean water, especially in countries where sugarnd sanitation: Water Wa ter a and •! Water sweetened beverages may be more widely available than safe drinking water. Education: Ed ucation: Provision of nutritious school meals, particularly for socioeconomically •! Education: disadvantaged children, and the replacement of such meals when schools are closed; increased physical education. Economic Ec Economic onomic Novel investment from global health donors and multilateral institutions to •! Economic: address the rising cost of obesity in lower income countries. Signatories/logos: !"#$%&'()*+,#-+&('%$()%-'#.-&-$#/%..#0,#%'1.*2,2#()#,%)3,+#)3,#)-4#-+#0-))-5#-6#)3,#2-1*5,')#7"8#
#
15
16
For healthier and longer lives, we must provide the best nutritional environment possible.
17
understanding
Report card Italy Contents
Page
Obesity prevalence
2
Trend: % Children living with overweight or obesity in Italy 2008-2019
4
Overweight/obesity by age and education
5
Overweight/obesity by education
7
Overweight/obesity by age
9
Overweight/obesity by region
11
Overweight/obesity by age and region
13
Overweight/obesity by age and socio-economic group
15
Overweight/obesity by socio-economic group
18
Insufficient physical activity
21
Sugar consumption
27
Estimated per-capita sugar sweetened beverages intake
28
Prevalence of at least daily carbonated soft drink consumption
29
Prevalence of confectionery consumption
30
Prevalence of sweet/savoury snack consumption
31
Estimated per-capita fruit intake
32
Prevalence of less-than-daily fruit consumption
33
Prevalence of less-than-daily vegetable consumption
34
Estimated per-capita processed meat intake
35
Estimated per-capita whole grains intake
36
Mental health - depression disorders
37
Mental health - anxiety disorders
38
Oesophageal cancer
39
Breast cancer
41
Colorectal cancer
42
Pancreatic cancer
44
Gallbladder cancer
46
Kidney cancer
48
Cancer of the uterus
50
Raised blood pressure
51
Raised cholesterol
54
Raised fasting blood glucose
57
Diabetes prevalence
59
Health systems
60
1
Obesity prevalence Adults, 2016-2019 Obesity
Overweight
50
40
%
30
20
10
0
Adults
Men
Survey type:
Women
Self-reported
Age:
18-69
Sample size:
129423
Area covered:
National
References:
PASSI 2016-19. Available at https://www.epicentro.iss.it/passi/dati/sovrappeso?tab-container-1=tab1 (last accessed on 25.09.20) Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
2
Children, 2019 Obesity
Overweight
30
25
%
20
15
10
5
0
Children
Boys
Girls
Survey type:
Measured
Sample size:
53273
Area covered: References:
National COSI 2019. https://www.epicentro.iss.it/okkioallasalute/indagine-2019-dati (Last accessed 10.12.2020)
Cutoffs:
IOTF
3
% Children living with overweight or obesity in Italy 2008-2019 Boys and girls Obesity
Overweight or obesity
35
% overweight or obesity
30
25
20
15
10
5
0
2008
2010
2012
2014
Survey type: References:
2016
2018
Measured 2008: Wijnhoven, T. M. A., van Raaij, J. M. A., Spinelli, A., Rito, A. I., Hovengen, R., Kunesova, M., Starc, G., Rutter, H., Sjöberg, A., Petrauskiene, A., O'Dwyer, U., Petrova, S., Farrugia Sant'Angelo, V., Wauters, M., Yngve, A., Rubana, I.-M. and Breda, J. (2012), WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6–9-year-old children. Pediatric Obesity. doi: 10.1111/j.2047-6310.2012.00090.x 2012: COSI 2012. https://www.epicentro.iss.it/okkioallasalute/IndagineNazionale2012 (Last accessed 10.12.2020) 2019: COSI 2019. https://www.epicentro.iss.it/okkioallasalute/indagine-2019-dati (Last accessed 10.12.2020)
Definitions:
IOTF Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
Different methodologies may have been used to collect this data and so data from different surveys may not be strictly comparable. Please check with original data sources for methodologies used.
4
Overweight/obesity by age and education Men, 2014 Obesity
Overweight
70 60 50
%
40 30 20 10
Level 5-8
Level 3-4
Age 65-74
Level 0-2
Level 5-8
Level 3-4
Age 55-64
Level 0-2
Level 5-8
Level 3-4
Level 0-2
Age 45-54
Age 75+
Self-reported
Area covered: References:
Level 5-8
Survey type:
Level 3-4
Age 35-44
Level 0-2
Level 5-8
Level 3-4
Age 25-34
Level 0-2
Level 5-8
Level 3-4
Age 18-24
Level 0-2
Level 5-8
Level 3-4
Age 18+
Level 0-2
Level 5-8
Level 3-4
Level 0-2
0
National Eurostat Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
5
Women, 2014 Obesity
Overweight
60
50
%
40
30
20
10
Level 5-8
Level 3-4
Age 65-74
Level 0-2
Level 5-8
Level 3-4
Age 55-64
Level 0-2
Level 5-8
Level 3-4
Level 0-2
Age 45-54
Age 75+
Self-reported
Area covered: References:
Level 5-8
Survey type:
Level 3-4
Age 35-44
Level 0-2
Level 5-8
Level 3-4
Age 25-34
Level 0-2
Level 5-8
Level 3-4
Age 18-24
Level 0-2
Level 5-8
Level 3-4
Age 18+
Level 0-2
Level 5-8
Level 3-4
Level 0-2
0
National Eurostat Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
6
Overweight/obesity by education Adults, 2016-2019 Obesity
Overweight
60
50
%
40
30
20
10
0
None/Primary
Incomplete secondary
Complete secondary
Survey type:
Degree or above
Self-reported
Age:
18-69
Sample size:
129423
Area covered:
National
References:
PASSI 2016-19. Available at https://www.epicentro.iss.it/passi/dati/sovrappeso?tab-container-1=tab1 (last accessed on 25.09.20) Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
7
Children, 2014 Obesity
Overweight
35
30
%
25
20
15
10
5
0
Primary/none
Degree
Survey type:
Measured
Age:
8-9
Sample size:
48426
Area covered: References:
A-levels
National P. Nardone, M. Bouncristiano and L. Lauria. OKkio alla SALUTE: risultati 2014 sugli stili di vita dei bambini. Available at http://www.salute.gov.it/imgs/C_17_notizie_1899_listaFile_itemName_3_file.pdf (accessed on 18/05/2015)
Cutoffs:
Other
8
Overweight/obesity by age Adults, 2016-2019 Obesity
Overweight
50
%
40
30
20
10
0
Age 18-34
Age 35-49
Age 50-69
Survey type:
Self-reported
Sample size:
129423
Area covered:
National
References:
PASSI 2016-19. Available at https://www.epicentro.iss.it/passi/dati/sovrappeso?tab-container-1=tab1 (last accessed on 25.09.20) Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
9
Children, 2012-2013 Obesity
Overweight
45 40 35
%
30 25 20 15 10 5 0
Boys
Girls
Boys
Age 8
Girls Age 9
Survey type:
Measured
Sample size:
8yrs 29045 9yrs 16502 Both genders
Area covered: References:
National WORLD HEALTH ORGANIZATION. (2018). WHO European Childhood Obesity Surveillance Initiative: overweight and obesity among 6–9-year-old children. Available: http://www.euro.who.int/__data/assets/pdf_file/0010/378865/COSI3.pdf?ua=1. Last accessed [Accessed 28th Aug 2018].
Notes:
WHO cut-offs used.
Cutoffs:
WHO
10
Overweight/obesity by region Adults, 2016-2019 Obesity
Overweight
45 40 35
%
30 25 20 15 10 5 0
Center
North
Survey type:
South & Islands
Self-reported
Age:
18-69
Sample size:
129423
Area covered:
National
References:
PASSI 2016-19. Available at https://www.epicentro.iss.it/passi/dati/sovrappeso?tab-container-1=tab1 (last accessed on 25.09.20) Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
11
Boys, 2014 Obesity
Overweight
40 35 30
%
25 20 15 10 5 0
Ab
Ba Ca Ca E F La z sili lab mp milia riuli ca VG io ria an zo Ro ta ia ma gn a
ruz
Lig uri
a
Lo Ma Mo P P Pie S Sic mb ilia r lise A Bo A Tr mo arde ard che en gn nte lza t a ia o no
Survey type:
To
sca
na
Um
bri a
Va
lle
Ve n d’A eto os ta
Measured
Age:
8-9
Sample size:
48426
Area covered:
National
References:
Okkio all Salute
Cutoffs:
Other
12
Overweight/obesity by age and region Men, 2014 Obesity
Overweight
70 60
%
50 40 30 20 10
Towns and suburbs
Rural areas
Age 65-74
Cities
Towns and suburbs
Rural areas
Age 55-64
Cities
Towns and suburbs
Rural areas
Age 45-64
Cities
Towns and suburbs
Rural areas
Cities
Towns and suburbs
Age 45-54
Survey type:
Age 75+
Self-reported
Area covered: References:
Rural areas
Age 35-44
Cities
Towns and suburbs
Rural areas
Age 25-34
Cities
Towns and suburbs
Rural areas
Age 18-24
Cities
Towns and suburbs
Rural areas
Age 18+
Cities
Towns and suburbs
Rural areas
Cities
0
National Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1u&lang=en (last acces
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
13
Women, 2014 Obesity
Overweight
60 50
%
40 30 20 10
Towns and suburbs
Rural areas
Age 65-74
Cities
Towns and suburbs
Rural areas
Age 55-64
Cities
Towns and suburbs
Rural areas
Age 45-64
Cities
Towns and suburbs
Rural areas
Cities
Towns and suburbs
Age 45-54
Survey type:
Age 75+
Self-reported
Area covered: References:
Rural areas
Age 35-44
Cities
Towns and suburbs
Rural areas
Age 25-34
Cities
Towns and suburbs
Rural areas
Age 18-24
Cities
Towns and suburbs
Rural areas
Age 18+
Cities
Towns and suburbs
Rural areas
Cities
0
National Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1u&lang=en (last acces
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
14
%
Overweight/obesity by age and socio-economic group Adults, 2014
5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile
15
2nd quintile
National Area covered:
1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile
Self-reported Survey type:
Age 75+ Age 65-74 Age 55-64 Age 45-54 Age 35-44 Age 25-34 Age 18-24 Age 18+
5th Quintile 4th quintile
Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed References:
3rd quintile 2nd quintile 1st Quintile 0
Overweight Obesity
60
50
40
30
20
10
25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
40
%
Men, 2014
5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile
16
2nd quintile
National Area covered:
1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile
Self-reported Survey type:
Age 75+ Age 65-74 Age 55-64 Age 45-54 Age 35-44 Age 25-34 Age 18-24 Age 18+
5th Quintile 4th quintile
Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed References:
3rd quintile 2nd quintile 1st Quintile 0
Overweight Obesity
70
60
50
30
20
10
25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
30
%
Women, 2014
5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile
17
2nd quintile
National Area covered:
1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile 5th Quintile 4th quintile 3rd quintile 2nd quintile 1st Quintile
Self-reported Survey type:
Age 75+ Age 65-74 Age 55-64 Age 45-54 Age 35-44 Age 25-34 Age 18-24 Age 18+
5th Quintile 4th quintile
Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed References:
3rd quintile 2nd quintile 1st Quintile 0
Overweight Obesity
60
50
40
20
10
25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
Overweight/obesity by socio-economic group Adults, 2016-2019 Obesity
Overweight
50
40
%
30
20
10
0
Economic difficulties - a lot
Economic difficulties - some
Survey type:
Economic difficulties - none
Self-reported
Age:
18-69
Sample size:
129423
Area covered:
National
References:
PASSI 2016-19. Available at https://www.epicentro.iss.it/passi/dati/sovrappeso?tab-container-1=tab1 (last accessed on 25.09.20) Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².
18
Boys, 2014 Overweight or obesity
20
%
15
10
5
0
Low
Medium
Survey type:
High
Self-reported
Age:
11-15
Sample size:
15035
Area covered: References:
National Lazzeri G, Dalmasso P, Berchialla P, Borraccino A, Charrier L, Giacchi MV, Simi R, Lenzi M, Vieno A, Lemma P, Cavallo F.Trends in adolescent overweight prevalence in Italy according to socioeconomic position. Ann Ist Super Sanita. 2017 Oct-Dec;53(4):283-290. doi: 10.4415/ANN_17_04_03.
Notes:
11,13 & 15 Years (12 & 14 yrs not included)
Cutoffs:
Other
19
Girls, 2014 Overweight or obesity
18 16 14
%
12 10 8 6 4 2 0
Low
Medium
Survey type:
High
Self-reported
Age:
11-15
Sample size:
15035
Area covered: References:
National Lazzeri G, Dalmasso P, Berchialla P, Borraccino A, Charrier L, Giacchi MV, Simi R, Lenzi M, Vieno A, Lemma P, Cavallo F.Trends in adolescent overweight prevalence in Italy according to socioeconomic position. Ann Ist Super Sanita. 2017 Oct-Dec;53(4):283-290. doi: 10.4415/ANN_17_04_03.
Notes:
11,13 & 15 Years (12 & 14 yrs not included)
Cutoffs:
Other
20
Insufficient physical activity Adults, 2016 45
% insufficient physical activity
40 35 30 25 20 15 10 5
Cyprus
Portugal
Germany
Malta
Italy
Hungary
Greece
United Kingdom
Belgium
Romania
Slovakia
Ireland
Poland
Slovenia
Estonia
Czech Republic
Croatia
Austria
Latvia
France
Denmark
Luxembourg
Netherlands
Spain
References:
Lithuania
Sweden
Finland
0
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214109X(18)30357-7
21
Men, 2016 40
% insufficient physical activity
35 30 25 20 15 10 5
Germany
Cyprus
Portugal
Malta
Italy
Greece
Hungary
Romania
United Kingdom
Poland
Slovakia
Belgium
Estonia
Ireland
Czech Republic
Slovenia
Luxembourg
Austria
Croatia
Denmark
Latvia
Netherlands
France
Lithuania
References:
Spain
Sweden
Finland
0
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214109X(18)30357-7
22
Women, 2016
% insufficient physical activity
50
40
30
20
10
Cyprus
Portugal
Malta
Italy
Germany
Hungary
Greece
Belgium
United Kingdom
Slovakia
Romania
Ireland
Slovenia
Croatia
Estonia
France
Czech Republic
Austria
Poland
Latvia
Denmark
Spain
Luxembourg
Lithuania
References:
Netherlands
Sweden
Finland
0
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214109X(18)30357-7
23
Children, 2010 90
% insufficient physical activity
80 70 60 50 40 30 20 10 0
Ire
Au Cz Fin Sp Slo Lu U C P L S R H N M B G L G E S P F D It e a s l va xem nited roat olan atvia love oma ung ethe alta elgiu erm ithua reec ston wed ortu ranc enm aly nia kia ia d tria ch R and in e ia d en ga nia ary ark rla m any nia e bo K l ep n i urg ng ds ub do lic m
lan
Age: References:
11-17 Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:
% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:
% Adolescents insufficiently active (age standardised estimate)
24
Boys, 2010 90
% insufficient physical activity
80 70 60 50 40 30 20 10 0
Ire
Au Fin Sp Cr U C S R L H P S L B N G M L P G E S F D I oa nite zec lova om uxe ung olan love atvi elgi eth erm alta ithu ortu ree ston wed ranc enm taly a s l tia c an um erl d K h R kia ani mb nia a d tria and in a e ia d en ark an any ia gal e a ou ry ing epu ds rg do b m lic
lan
Age: References:
11-17 Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:
% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:
% Adolescents insufficiently active (age standardised estimate)
25
Girls, 2010 90
% insufficient physical activity
80 70 60 50 40 30 20 10 0
Ire
C S L L P N S M A U S F C L H B G R S E D G P F I lan zec lova uxe atvi olan eth pain alta ustr nite love inlan roat ithu ung elgi erm oma wed ston enm reec ortu ranc taly erl h R kia mb a an d K nia ga ia ia d ary um an e ia d nia en ark e d an i y l a ou ep i ng ds rg ub do lic m
Age: References:
11-17 Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:
% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:
% Adolescents insufficiently active (age standardised estimate)
26
Sugar consumption Adults, 2016 10
Number of portions
8
6
4
2
0
Fin N G D S S P F A U Ir B It lan ethe erm enm wed pain ortu ranc ustr nite elan elgiu aly dK d ga a ia e ark en d rla m l nd ny ing s do m
Ro
S C P S G C H E L L ma love zech olan lova reec roat ung ston ithu atvia an kia ia ary ia e nia nia Re d ia pu bli c
References:
Source: Euromonitor International
Definitions:
Sugar consumption (Number of 500g sugar portions/person/month)
27
Estimated per-capita sugar sweetened beverages intake Adults, 2016 70
Number of portions
60
50
40
30
20
10
0
La
tvi
a
Lit
Slo Es Fin Sw Gr Ro D C U N I S P C P H A F I t e ma enm roat nite ethe relan lova ortu zech olan ung ustr ranc taly an veni onia land eden ece dK kia ga d ary ia e nia ark ia r Re d a ia l ing land pu do s bli m c
hu
References:
Sp
ain
Be
Ge r um man
lgi
y
Source: Euromonitor International
28
Prevalence of at least daily carbonated soft drink consumption Children, 2014 40
35
30
%
25
20
15
10
5
0
Fin Es S D G L S L Ir It Cz U A P S G P C S R F H L N M ec nite ustr ortu pain erm olan roat lova oma ranc ung uxem ethe alta lan ton wed enm reec atvia love ithua elan aly hR d nia kia ga ia an ia ary ia d en nia e ark e d nia d bo rlan y l ep King urg ds ub lic dom
Survey type: References:
Measured World Health Organization. (2017). Adolescent obesity and related behaviours: Trends and inequalities in the who european region, 2002-2014: observations from the Health Behavior in School-aged Children (HBSC) WHO collaborative cross-national study (J. Inchley, D. Currie, J. Jewel, J. Breda, & V. Barnekow, Eds.). World Health Organization. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org
Notes: Definitions:
15-year-old adolescents Prevalence of at least daily carbonated soft drink consumption (% of at least daily carbonated soft drink consumption)
29
Prevalence of confectionery consumption Adults, 2016
Number of portions
20
15
10
5
0
Ro
P G I ma ortu reec taly e nia gal
Hu S C P L L C S F S B E D N S F U A Ir G ng pain roat olan ithua atvia zech love ranc lova elgiu ston enm ethe wed inlan nite ustr elan erm d K ia kia ia an d ary e ia d en ark rla d nia m Re nia y n i n pu ds gd bli o m c
References:
Source: Euromonitor International
Definitions:
Prevalence of confectionery consumption (Number of 50g confectionery portions/person/month)
30
Prevalence of sweet/savoury snack consumption Adults, 2016
Number of portions
20
15
10
5
0
La
tvi
a
Lit
Po Hu Ita l r an tuga ngar y ia y l
hu
Es G R S P C C F G A D S B F S N S U I ton ree om love olan roa zec ranc erm ust enm lova elgi inla wed eth pain nite relan an tia ce hR dK d an ria e ia d en erla ark kia um nd ia nia y ep n ing ds ub do lic m
References:
Source: Euromonitor International
Definitions:
Prevalence of sweet/savoury snack consumption (Number of 35g sweet/savoury snack portions/person/month)
31
Estimated per-capita fruit intake Adults, 2017 200
g/day
150
100
50
Luxembourg
Greece
Italy
Denmark
Austria
Ireland
Slovenia
Spain
Netherlands
Sweden
Portugal
Croatia
France
Survey type:
Malta
Cyprus
United Kingdom
Finland
Belgium
Germany
Estonia
Romania
Lithuania
Czech Republic
Hungary
Slovakia
Poland
Latvia
0
Measured
Age:
25+
References:
Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:
Estimated per-capita fruit intake (g/day)
32
Prevalence of less-than-daily fruit consumption Children, 2014 Age 12-17
Age 15
% < daily consumption
40
30
20
10
0
Fin La S E L G P N H S S F C C It Ma Ge Un Ro L Slo Po I De Au r rela m ux rm nm str i lan tvia wed ston ithua reec olan ethe ung lova pain ranc roat zech aly lta v ia an ted K ania emb enia tuga nd e ia d en ark ia d rla ary kia nia e Re y l o nd i n urg pu g s do bli m c
Survey type: References:
Measured Global School-based Student Health Surveys. Beal et al (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:
Prevalence of less-than-daily fruit consumption (% less-than-daily fruit consumption)
33
Prevalence of less-than-daily vegetable consumption Children, 2014
% < daily consumption
40
30
20
10
Netherlands
Ireland
Denmark
United Kingdom
France
Sweden
Romania
Luxembourg
Greece
Lithuania
Hungary
Measured
Age: References:
Malta
Survey type:
Austria
Poland
Croatia
Portugal
Finland
Czech Republic
Slovenia
Slovakia
Italy
Latvia
Germany
Estonia
Spain
0
12-17 Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:
Prevalence of less-than-daily vegetable consumption (% less-than-daily vegetable consumption)
34
Estimated per-capita processed meat intake Adults, 2017 20
g/day
15
10
5
Sweden
United Kingdom
Lithuania
Germany
Latvia
Luxembourg
Estonia
Netherlands
Denmark
Italy
France
Belgium
Spain
Survey type:
Finland
Malta
Ireland
Slovenia
Slovakia
Czech Republic
Austria
Romania
Hungary
Cyprus
Poland
Greece
Portugal
Croatia
0
Measured
Age:
25+
References:
Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:
Estimated per-capita processed meat intake (g per day)
35
Estimated per-capita whole grains intake Adults, 2017 45 40 35
g/day
30 25 20 15 10 5
Ireland
Czech Republic
Austria
Germany
Slovenia
Luxembourg
Romania
Estonia
Netherlands
Spain
Lithuania
Finland
Poland
Survey type:
Croatia
Belgium
Sweden
Slovakia
Portugal
Hungary
United Kingdom
Latvia
Denmark
Cyprus
France
Greece
Malta
Italy
0
Measured
Age:
25+
References:
Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:
Estimated per-capita whole grains intake (g/day)
36
Mental health - depression disorders Adults, 2015 6
% of population
5
4
3
2
1
Estonia
Portugal
Greece
Lithuania
Finland
Spain
Germany
Czech Republic
Slovenia
Slovakia
Poland
Malta
Italy
Hungary
Cyprus
Croatia
Austria
Romania
Luxembourg
Denmark
Sweden
Latvia
Ireland
France
References:
Belgium
Netherlands
United Kingdom
0
Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BYNC-SA 3.0 IGO.
Definitions:
% of population with depression disorders
37
Mental health - anxiety disorders Adults, 2015 6
% of population
5
4
3
2
1
Netherlands
Ireland
France
Germany
Cyprus
Italy
Portugal
Malta
Luxembourg
Greece
Denmark
Austria
Sweden
Belgium
United Kingdom
Spain
Slovakia
Poland
Hungary
Slovenia
Czech Republic
Croatia
Romania
Lithuania
References:
Latvia
Finland
Estonia
0
Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BYNC-SA 3.0 IGO.
Definitions:
% of population with anxiety disorders
38
Oesophageal cancer Men, 2018 18 16
Incidence per 100,000
14 12 10 8 6 4 2
Netherlands
United Kingdom
Lithuania
Latvia
Denmark
Hungary
Slovakia
Ireland
Belgium
Portugal
Germany
France
Czech Republic
Age:
Luxembourg
Estonia
Slovenia
Austria
Poland
Croatia
Spain
Sweden
Romania
Finland
Malta
Italy
Greece
Cyprus
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000
39
Women, 2018 6
Incidence per 100,000
5
4
3
2
1
United Kingdom
Ireland
Netherlands
Denmark
Belgium
Germany
France
Luxembourg
Czech Republic
Hungary
Finland
Sweden
Austria
Age:
Slovenia
Poland
Croatia
Lithuania
Spain
Slovakia
Estonia
Cyprus
Malta
Latvia
Italy
Romania
Portugal
Greece
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000
40
Breast cancer Women, 2018
Incidence per 100,000
150
100
50
Belgium
Luxembourg
Netherlands
France
United Kingdom
Italy
Ireland
Sweden
Finland
Denmark
Malta
Hungary
Germany
Age:
Cyprus
Spain
Austria
Portugal
Czech Republic
Greece
Croatia
Slovenia
Latvia
Estonia
Lithuania
Slovakia
Poland
Romania
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000
41
Colorectal cancer Men, 2018 120
Incidence per 100,000
100
80
60
40
20
Hungary
Slovakia
Slovenia
Portugal
Croatia
Denmark
Spain
Netherlands
Belgium
Latvia
Czech Republic
Ireland
Poland
Age:
United Kingdom
France
Romania
Italy
Malta
Lithuania
Estonia
Cyprus
Greece
Luxembourg
Germany
Sweden
Finland
Austria
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000
42
Women, 2018 60
Incidence per 100,000
50
40
30
20
10
Hungary
Denmark
Slovakia
Netherlands
Portugal
Belgium
Latvia
United Kingdom
Ireland
Estonia
Slovenia
Luxembourg
Croatia
Age:
France
Czech Republic
Italy
Sweden
Spain
Malta
Poland
Lithuania
Germany
Finland
Greece
Romania
Austria
Cyprus
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000
43
Pancreatic cancer Men, 2018 25
Incidence per 100,000
20
15
10
5
Latvia
Estonia
Hungary
Slovakia
Czech Republic
France
Croatia
Slovenia
Lithuania
Malta
Belgium
Romania
Austria
Age:
Greece
Germany
Luxembourg
Finland
Poland
Sweden
Italy
Denmark
Spain
United Kingdom
Portugal
Cyprus
Netherlands
Ireland
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000
44
Women, 2018 16 14
Incidence per 100,000
12 10 8 6 4 2
Hungary
Belgium
Austria
Slovakia
Germany
Czech Republic
France
Finland
Denmark
Sweden
Malta
Latvia
Slovenia
Age:
Netherlands
Luxembourg
Italy
United Kingdom
Croatia
Lithuania
Estonia
Romania
Poland
Ireland
Greece
Spain
Cyprus
Portugal
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000
45
Gallbladder cancer Men, 2018 6
Incidence per 100,000
5
4
3
2
1
Slovakia
Slovenia
Hungary
Czech Republic
Croatia
Spain
Poland
Italy
Netherlands
Estonia
Greece
Germany
Ireland
Age:
Austria
Sweden
France
Romania
United Kingdom
Belgium
Denmark
Cyprus
Lithuania
Finland
Portugal
Luxembourg
Latvia
Malta
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000
46
Women, 2018 8 7
Incidence per 100,000
6 5 4 3 2 1
Slovakia
Slovenia
Hungary
Czech Republic
Poland
Sweden
Italy
Ireland
Croatia
United Kingdom
Estonia
Netherlands
Finland
Age:
Spain
Cyprus
Germany
Denmark
Austria
France
Lithuania
Greece
Romania
Portugal
Belgium
Latvia
Luxembourg
Malta
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000
47
Kidney cancer Men, 2018 35
Incidence per 100,000
30
25
20
15
10
5
Estonia
Czech Republic
Lithuania
Latvia
Slovakia
France
Hungary
Croatia
Slovenia
Ireland
Greece
United Kingdom
Spain
Age:
Denmark
Italy
Belgium
Germany
Poland
Malta
Netherlands
Finland
Austria
Luxembourg
Sweden
Portugal
Romania
Cyprus
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000
48
Women, 2018 18 16
Incidence per 100,000
14 12 10 8 6 4 2
Latvia
Lithuania
Estonia
Czech Republic
Slovakia
Hungary
France
United Kingdom
Croatia
Ireland
Belgium
Malta
Poland
Age:
Finland
Italy
Denmark
Slovenia
Luxembourg
Germany
Austria
Netherlands
Sweden
Spain
Greece
Romania
Portugal
Cyprus
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000
49
Cancer of the uterus Women, 2018 40
Incidence per 100,000
35 30 25 20 15 10 5
Latvia
Estonia
Romania
Lithuania
Hungary
Slovakia
Ireland
Denmark
Czech Republic
Poland
Sweden
Portugal
United Kingdom
Age:
Greece
Croatia
Belgium
Germany
Slovenia
Italy
France
Netherlands
Cyprus
Luxembourg
Austria
Spain
Finland
Malta
0
20+
References:
Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:
Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000
50
Raised blood pressure Adults, 2015
% raised blood pressure
30
25
20
15
10
5
Croatia
Slovenia
Romania
Hungary
Latvia
Lithuania
Poland
Slovakia
Czech Republic
Estonia
Portugal
France
Luxembourg
Italy
Austria
Denmark
Germany
Cyprus
Ireland
Malta
Finland
Sweden
Spain
Greece
References:
Netherlands
Belgium
United Kingdom
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:
Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).
51
Men, 2015 40
% raised blood pressure
35 30 25 20 15 10 5
Croatia
Latvia
Lithuania
Hungary
Slovenia
Romania
Poland
Czech Republic
Slovakia
Estonia
Portugal
Luxembourg
France
Denmark
Italy
Austria
Malta
Germany
Sweden
Finland
Cyprus
Spain
Netherlands
Ireland
References:
Greece
Belgium
United Kingdom
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:
Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).
52
Women, 2015
% raised blood pressure
25
20
15
10
5
Croatia
Romania
Slovenia
Hungary
Lithuania
Poland
Latvia
Slovakia
Czech Republic
Estonia
Portugal
Italy
Austria
Ireland
France
Luxembourg
Germany
Cyprus
Greece
Denmark
Spain
Finland
Sweden
Netherlands
References:
Malta
Belgium
United Kingdom
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:
Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).
53
Raised cholesterol Adults, 2008 70
60
% raised cholesterol
50
40
30
20
10
Luxembourg
Germany
Denmark
United Kingdom
Ireland
Belgium
Italy
France
Netherlands
Austria
Malta
Finland
Poland
Cyprus
Estonia
Slovenia
Spain
Portugal
Latvia
Hungary
Lithuania
Czech Republic
Slovakia
Sweden
References:
Croatia
Greece
Romania
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:
% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).
54
Men, 2008 70
% raised cholesterol
60
50
40
30
20
10
Germany
Luxembourg
Denmark
Ireland
United Kingdom
Belgium
France
Netherlands
Italy
Austria
Malta
Poland
Spain
Cyprus
Finland
Portugal
Slovenia
Sweden
Estonia
Hungary
Latvia
Lithuania
Czech Republic
Slovakia
References:
Greece
Croatia
Romania
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:
% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).
55
Women, 2008 60
% raised cholesterol
50
40
30
20
10
Luxembourg
Denmark
Italy
Germany
United Kingdom
France
Belgium
Ireland
Finland
Netherlands
Austria
Malta
Estonia
Cyprus
Slovenia
Latvia
Portugal
Lithuania
Hungary
Poland
Spain
Czech Republic
Slovakia
Croatia
References:
Sweden
Greece
Romania
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:
% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).
56
Raised fasting blood glucose Men, 2014 7
% raised fasting blood glucose
6
5
4
3
2
1
Lithuania
Slovenia
Poland
Hungary
Latvia
Czech Republic
Estonia
Romania
Malta
Slovakia
Croatia
Greece
Spain
Cyprus
Portugal
Ireland
United Kingdom
Italy
France
Finland
Sweden
Luxembourg
Germany
Netherlands
References:
Belgium
Denmark
Austria
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:
Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).
57
Women, 2014 9
% raised fasting blood glucose
8 7 6 5 4 3 2 1
Malta
Lithuania
Hungary
Spain
Portugal
Poland
Czech Republic
Croatia
Cyprus
Slovakia
Latvia
Estonia
France
Slovenia
Romania
Ireland
Greece
Italy
Luxembourg
United Kingdom
Finland
Germany
Sweden
Belgium
References:
Denmark
Austria
Netherlands
0
Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:
Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).
58
Diabetes prevalence Adults, 2017 10
% diabetes prevalence
8
6
4
2
Portugal
Romania
Cyprus
Malta
Germany
Hungary
Slovakia
Slovenia
Spain
Czech Republic
Denmark
Austria
Poland
Finland
Croatia
Netherlands
Latvia
Sweden
Italy
France
Greece
Luxembourg
Belgium
United Kingdom
References:
Estonia
Lithuania
Ireland
0
Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org
Definitions:
Diabetes age-adjusted comparative prevalence (%).
59
Health systems Economic classification: High Income
Health systems summary Italy has had a National Health Service (NHS) since 1978. The Italian NHS covers all citizens and legal residents automatically and is considered to be fairly comprehensive (the minimum benefit package is decided upon by the national government). Most of the funding comes from public sources, namely corporate tax, general tax and regional taxes. However, it is said that there are large regional disparities in funding and quality of care in the highly decentralised health system. Public funding is supplemented by several co-payment charges, and while there is no annual cap on out of pocket (OOP) spending, there is a ‘ceiling’ for individual co-payments. OOP spending is relatively high in Italy at 24% of total health spending. Very few have voluntary health insurance in Italy, which can be obtained corporately or non-corporately and can provide complementary or supplementary coverage.
Indicators Where is the country’s government in the journey towards defining ‘Obesity as a disease’? Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a
Defined as disease Some progress
disease’? Is there specialist training available dedicated to the training of health professionals to
No
prevent, diagnose, treat and manage obesity? Have any taxes or subsidies been put in place to protect/assist/inform the population around
Some progress
obesity? Are there adequate numbers of trained health professionals in specialties relevant to obesity
Yes
in urban areas? Are there adequate numbers of trained health professionals in specialties relevant to obesity
No
in rural areas? Are there any obesity-specific recommendations or guidelines published for adults?
Yes
Are there any obesity-specific recommendations or guidelines published for children?
Yes
In practice, how is obesity treatment largely funded?
Out of pocket
60
Perceived barriers to treatment Cultural norms and
High cost of out of
traditions
pocket payments
Influence of food industry
Lack of training for healthcare professionals
Stigma
Lack of political will, interest and action
Lack of treatment
Poor health literacy
facilities
and behaviour
Lack of opportunity for physical activity
Summary of stakeholder feedback While there was some disagreement among stakeholders about the extent to which the Italian government recognised obesity as a disease, stakeholders agreed that there was more consensus among healthcare providers and professionals. It was reported that many were particularly receptive to defining obesity a disease because of its relation to cardiovascular issues. Since the conduction of the interviews and surveys with these stakeholders, however, there has been official parliamentary recognition that obesity is in fact a chronic disease. Stakeholders reported that individuals typically entered the system via the gatekeeping general practitioners and paediatricians and from there they would be referred onto specialists (such as endocrinologists, nutritionists and dieticians). As investment into obesity prevention and treatment was reported to be poor (particularly for childhood obesity) and there was poor coverage of treatment and diagnostic exams, it was suggested that treatment was mostly paid for out of pocket or via private health insurance. The exception to this was bariatric surgery, for which there is public coverage but long waiting lists. Stakeholders said people tended to fall out of the system because they do not or stop losing weight and because of the lack of clinical care pathways and specialised obesity clinics. There appears to be no specialist obesity training available in Italy but stakeholders reported that is a reasonable number of health professionals capable of treating obesity in urban areas but insufficient numbers in rural areas. Italy has several obesity guidelines available included one that is endorsed by the Italian Obesity Society. Based on interviews/survey returns from 4 stakeholders
Last updated: June 2020 PDF created on December 10, 2020
61
Atlas of Child Obesity Scorecard: Italy CHO risk score
Chance of meeting WHO 2025 target
8/11
21%
Latest survey: % infants overweight
n/a
2016: % boys aged 5-9 with obesity
20.5
2016: % girls aged 5-9 with obesity
14.9
2016: % boys aged 10-19 with obesity
11.5
2016 % girls aged 10-19 with obesity
8.1
2010: % adolescent boys insufficient physical activity
91
2010: % adolescent girls insufficient physical activity
92.6
2016: % women with obesity
20.4
Latest survey: % early initiation of breast-feeding
n/a
2020 estimate: % women smoking
19.6
Latest survey: % infants with stunting
n/a
Predicted 2030: % children aged 5-9 with obesity
21.2
Predicted 2030: % children aged 10-19 with obesity
12.9
Predicted 2030: number of children aged 5-9 with obesity
574,134
Predicted 2030: number of children aged 10-19 with obesity
733,632
Predicted 2030: number of children aged 5-19 with obesity
1,307,765
Existence of any policies on marketing of foods to children, 2017 4
Existence of policies to reduce physical inactivity, 2017 4
Existence of policies to reduce unhealthy diet related to NCDs, 2017 4
n/a = data not available For colour coding criteria and further sources see full report PDF created on October 3, 2020
Obesity: Missing the 2025 targets Scorecard: Italy Prevalence (%) of adults with obesity and severe obesity 1995-2015 Men BMI 30+
Women BMI 30+
Men BMI 35+
National obesity risk
6/10
Women BMI 35+
Moderate risk
20
%
15
10
5
1995
2000
2005
2010
2015
Obesity: 2010 target and 2025 predicted prevalence and number of cases 2010 %
2025 %
2025 cases (thousands)
Men
18.5
25.5
6,035.6
Women
19
22.9
5,821.2
Children 5-19
11.4
14.5
1,234.7
Chance of meeting UN adult obesity targets for 2025
Rate of increase in adult obesity in two decades 1995-2015
Men
2% (very poor chance)
Men
2.4% (rapid growth)
Women
9% (very poor chance)
Women
1.4% (rapid growth)
Health coverage indicator
Cases attributed to overweight and obesity 2016 Condition
Diabetes deaths per 1000 cases
Cases (thousands)
Diabetes
1,724.6
Hypertension
2,942.3
Ischaemic heart disease
4.3 (good availability)
156.8
Health care costs attributed to obesity 2016 US$ millions
16,502.0
n/a = data not available For colour coding criteria and further sources see full report PDF created on January 24, 2021
18
For healthier and longer lives, we must provide the best nutritional environment possible.
19
nutrition
2021
Con il contributo non condizionato di