Speciale Obesity Monitor VOD

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

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For healthier and longer lives, we must provide the best nutritional environment possible.

prefazioni

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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.

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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;

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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

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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).

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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.

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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.

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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.

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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

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