Eat Well, Drink Well, Move…

A Small Step for You, a Big Step for Europe

A Triple A Approach Against Obesity (Awareness, Accessibility, Actions)

Bibliothèque Solvay, Brussels – 17 September 2013

CONFERENCE REPORT

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Table of contents

INTRODUCTION ............................................................................................................ 4

PROGRAMME................................................................................................................. 5

MORNING SESSION ....................................................................................................... 8

Welcome statements ................................................................................................... 8

Academic Evidence: Exploring Science, Causes and Solutions for Obesity ........................... 9

AFTERNOON SESSION ................................................................................................. 13

AWARENESS: HOW TO RAISE AWARENESS ON LIFESTYLE MODIFICATIONS? ........ 13

Testimony and promotion of a healthy lifestyle ............................................................. 15

ACCESSIBILITY: HOW TO ENSURE THAT EUROPEANS MAKE HEALTHY CHOICES? .. 16

ACTION: NEXT STEPS ............................................................................................. 17

CONCLUSIONS ............................................................................................................ 20

SPEAKERS BIOGRAPHY ................................................................................................ 21

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INTRODUCTION This one-day special event which brings together international experts, politicians, nongovernmental organizations (NGOs) and stakeholders is the result of a lengthy process.

Obesity is considered to be the public health challenge of the 21st century by the World Health Organization (WHO), and its prevalence is constantly increasing in Europe and across the globe. Our modern lifestyle is at the heart of this worldwide obesity epidemic. Processed and energy-dense foods, the overconsumption of sugar-sweetened beverages (SSBs), which are readily available, and our sedentary behaviours result in an imbalance between our increased energy intake and our reduced energy expenditure. Simple recommendations put forward by the International Chair on Cardiometabolic Risk (ICCR) such as “eat well, drink well, move” are meant to lead to the development of simple and sustainable solutions.

Abdominal obesity has now been clearly linked to a greater risk of type 2 diabetes and cardiovascular disease. However, the notion of abdominal obesity is not taken into account by politicians and most general practitioners in Europe. Most physicians focus on indices of relative weight such as the body mass index (BMI), which is a ratio of weight over height. While BMI is useful for assessing overweight or obesity, it does not reflect the location of the excess fat and its related health risk. The simple measurement of waist circumference, however, has been proven to be a strong marker for abdominal fat. Abdominal obesity not only results from the overconsumption of energy-dense foods and drinks but is also the consequence of our physical inactivity and lack of regular exercise. Thus, the ICCR wants to focus on the importance of targeting these key features of our lifestyle as means to address this obesity epidemic.

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PROGRAMME

Eat Well, Drink Well, Move... A Small Step for You, a Big Step for Europe

A Triple A Approach Against Obesity (Awareness, Accessibility, Actions)

9:00 Registration

9:30 Welcome statements

Ms. Laurette Onkelinx, Vice-Prime Minister of Belgium and Minister of Social Affairs and Public Health, on behalf of the Belgian government

Ms. Sophie Auconie, Member of the European Parliament, Committee on the Environment, Public Health and Food Safety

9:45 Academic Evidence: Exploring Science, Causes and Solutions for Obesity

Presentation of the International Chair on Cardiometabolic Risk (ICCR)

Mr. Jean-Claude Coubard, Paris, France

10:00 The Diabetes Epidemic in Europe: A “Lifestyle” Disease

Professor Ulf Smith, Gothenburg, Sweden

10:20 Diabetes: Treating the Disease or the Patient?

Professor Luc Van Gaal, Antwerp, Belgium

10:40 Heart, Liver and Visceral Fat: The Enemy

Professor Marja-Riitta Taskinen, Helsinki, Finland

11:00 A video message from Mrs. Van Rompuy

11:05 Coffee break

11:20 Obesity as a Health Hazard: More than Excess Body Weight

Professor Jean-Pierre Després, Québec City, Canada

11:40 Overconsumption of Sugar-Sweetened Beverages and the Epidemic of Obesity

Professor Frank B. Hu, Boston, USA

12:00 Sedentary Lifestyle: The Smoking of the 21st Century

Professor Robert Ross, Kingston, Canada

12:20 The Role of Governments in Addressing Obesity

Doctor Franco Sassi, Paris, France

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12:35 Round table discussion and summary of the morning session

Moderator: Mr. Jeremy Fleming, Senior Journalist, Euractiv, Brussels, Belgium

All speakers and Professor Martine Duclos, Clermont-Ferrand, France

13:00 Healthy networking lunch

14:00 Morning session summary

Mr. Jeremy Fleming, Brussels, Belgium

14:15 AWARENESS: HOW TO RAISE AWARENESS ON LIFESTYLE MODIFICATIONS?

Moderator: Professor Jean-Pierre Després, Scientific Director of the ICCR and Director of Research in Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Professor, Department of Kinesiology, Faculty of Medicine, Québec City, Canada

Speakers:

• Ms. Trudy Wijnhoven, Technical Officer Nutrition Surveillance, Nutrition, Physical Activity and Obesity Programme, World Health Organisation Europe

• Doctor Claudiu Ciprian Tănăsescu, Member of the European Parliament, Committee on the Environment, Public Health and Food Safety

• Mr. Goof Buijs, Chairman of the Schools for Health in Europe Network

15:15 Testimony and promotion of a healthy lifestyle by Ms. Justine Henin, Belgian former internationally renowned tennis player and Mr. Pascal Charlier, Director of Saint-Servais Secondary School

15:30 ACCESSIBILITY: HOW TO ENSURE THAT EUROPEANS MAKE HEALTHY CHOICES?

Moderator: Professor Robert Ross, Director, Centre for Obesity Research and Education, Queen’s University, Kingston, Canada

Speakers:

• Ms. Ruth Veale, Head of Food, Health, Safety and Environment Department at BEUC - European Consumer's Organisation

• Mr. Philippe Roux, Head of Health Determinants Unit, DG Health and Consumer

• Professor Martine Duclos, Head of the Sports Medicine Service at the University Hospital of Clermont-Ferrand

16:30 Coffee break

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16:45 ACTION: NEXT STEPS

Moderator: Mr. Jeremy Fleming, Brussels, Belgium

Speakers:

• Mr. Gediminas Černiauskas, Lithuanian Vice-Minister for Health, representing the Lithuanian Presidency of the Council of the European Union

• Ms. Androulla Vassiliou, European Commissioner for Education, Culture, Multilingualism and Youth

• Mr. Jean-Claude Coubard, Executive Director of the ICCR and Chairman of the European Alliance for Lifestyle Changes

Presentation and launch of the Alliance and conclusions of the conference with the ICCR executive document entitled Preventing/managing abdominal obesity and type 2 diabetes and achieving ideal cardiovascular health by targeting eating/drinking and physical activity habits: Need for a new paradigm beyond BMI and weight loss being handed over to Ms. Vassiliou.

17:30 Networking cocktail

19:00 End of the programme

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MORNING SESSION

Welcome statements

Laurette Onkelinx Ms. Onkelinx advocates prevention as a response to obesity. She thinks that “our lifestyles lead us to adopt habits that are damaging to our health”. She is underlining the fact that prevention should start at an early age in a country where one out of two Belgians is overweight. Ms. Onkelinx then presents the 2006 Belgian Nutrition Plan which aim is to improve physical activity and offer an action plan for all government policies as well as recommendations to prevent childhood obesity. Furthermore, she emphasizes the necessity for a transversal and multidisciplinary approach that includes the private sector. She particularly focusses on how government policies can work by improving the environment, by facilitating access to healthy foods with tax-friendly advantages on fruits and vegetables, and by improving the offers in restaurants surrounding workplaces or in the cafeterias of schools and companies. In her conclusion, Ms. Onkelinx states that although it will take time to assess the results of such initiatives, prevention is the solution.

Sophie Auconie

Sharing Ms. Onkelinx’s view, MEP Sophie Auconie considers that collaboration among different sectors is imperative to fight obesity and she believes that the fight has become urgent as the healthcare cost of obesity is unsustainable for our society. She also states that “there is often a lack of political commitment, [even though] this is now changing at the highest spheres of governance” referring to the healthy lifestyle campaign led by Mrs. Michelle Obama, and the message that Mrs. Van Rompuy is about to deliver at the conference. According to Ms. Auconie, the European Union (EU) should play a pioneering role in the development of policies and regulations to address obesity as a marker of poor lifestyle habits.

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Academic Evidence: Exploring Science, Causes and Solutions for Obesity This session presents the scientific evidence for the links between lifestyle habits, abdominal obesity and their health consequences with the exploration of simple clinical and public health solutions. Speakers:

• Mr. Jean-Claude Coubard, Paris, France Presentation of the International Chair on Cardiometabolic Risk

• Professor Ulf Smith, Gothenburg, Sweden The Diabetes Epidemic in Europe: A “Lifestyle” Disease

• Professor Luc Van Gaal, Antwerp, Belgium

Diabetes: Treating the Disease or the Patient?

• Professor Marja-Riitta Taskinen, Helsinki, Finland Heart, Liver and Visceral Fat: The Enemy

• A video message from Mrs. Van Rompuy, First Lady, European Council

• Professor Jean-Pierre Després, Québec City, Canada Obesity as a Health Hazard: More than Excess Body Weight

• Professor Frank B. Hu, Boston, USA

Overconsumption of Sugar-Sweetened Beverages and the Epidemic of Obesity

• Professor Robert Ross, Kingston, Canada Sedentary Lifestyle: The Smoking of the 21st Century

• Doctor Franco Sassi, Paris, France The Role of Governments in Addressing Obesity

Jean-Claude Coubard: Presentation of the International Chair on Cardiometabolic Risk

The ICCR was launched in March 2006. The objective of the Chair’s multidisciplinary group of experts is to stimulate and promote scientific research, medical education and public awareness around cardiometabolic risk, and to help physicians better identify and treat patients with abdominal obesity who are also at increased cardiovascular risk. With this conference, the ICCR wants to raise the awareness of relevant stakeholders on abdominal obesity and underline the importance of promoting a healthy lifestyle to reduce the burden of obesity and the societal costs of chronic metabolic diseases, and try to influence the strategies of European countries in terms of prevention.

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Ulf Smith: The Diabetes Epidemic in Europe: A “Lifestyle Disease”

Diabetes is a lifestyle disease that has severe health consequences and that also increases the risk of certain types of cancer. The prevalence of diabetes is high: between 55 and 66 million individuals have diabetes in the EU and Russia. Moreover, a steady rise in the prevalence of type 2 diabetes is being observed in countries with increasing wealth. Another problem is that “half of the people have diabetes without knowing it” when it is a major risk factor for cardiovascular disease, adult blindness, renal failure and amputations. Type 2 diabetes is clearly linked to our lifestyle and several environmental factors can increase the risk to develop the disease such as smoking and certain drugs. Family history can also affect the risk of type 2 diabetes. In Europe, almost 60% of people are overweight or obese, making them more likely to develop type 2 diabetes. Luc Van Gaal: Diabetes: Treating the Disease or the Patient?

Type 2 diabetes is essentially a lifestyle disease. Efforts should be put towards preventing rather than combating the disease with medicines, as some of them often contribute to weight gain. “We have to think beyond glucose and BMI. BMI can only provide information about the patient’s relative weight, but it does not tell where the excess weight (fat) is located. Waist measurement is a simple approach to estimate the amount of dangerous intra-abdominal visceral fat. Thus, as patients with type 2 diabetes have too much visceral fat, we should not only reduce their blood glucose, but we should also worry about their excess visceral fat, which is often a key causal factor behind their diabetes”. Therefore, waist measurement, in combination with BMI, can assess whether or not an individual is characterized by abdominal obesity. Since it is linked to lifestyle, “how we live, how we behave, how we eat is important.”

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Marja-Riitta Taskinen: Heart, Liver and Visceral Fat: The Enemy

The resurgence of an old enemy, cardiovascular disease, will become the number one killer of the 21st century. Sophisticated imaging studies have now clearly shown that where the fat is stored in the body is as important for cardiovascular disease risk as for type 2 diabetes. Fat in the abdomen (liver, heart, viscera, muscles, and pancreas) is the most dangerous fat. BMI alone does not properly capture cardiometabolic risk. We need to measure waist circumference which reflects fat distribution. Fatty liver is becoming a major concern with the increasing incidence of obesity and type 2 diabetes. Fatty liver increases the risk of cardiovascular disease, which causes 47% (52% in women and 42% in men) of all deaths in Europe and 40% in the EU. Whereas it is established that about one-third of individuals are characterized by a fatty liver, recent studies have highlighted the importance of fat around and within the heart (fatty heart).

Mrs. Van Rompuy

Mrs. Van Rompuy speaks at the conference as the wife of the President of the European Council, Mr. Herman Van Rompuy, as a local politician, and as a European citizen concerned by the problem of obesity. European approach to the problem should be rich and complex and a one-size-fits-all approach will not work. Different countries have different problems. Why is type 2 diabetes less present in Romania than in the UK? It is important to identify the most efficient practices across Europe. Academics can provide society with the facts, yet it is up to society to actually take action. From a government perspective, a combination of multiple actions such as the creation of parks and recreational sites to stimulate physical activity can help counter the problem. It is not easy to determine whether it should be a private or a public responsibility, but it is important that everyone does their share.

Jean-Pierre Després: Obesity as a Health Hazard: More than Excess Body Weight

A “toxic lifestyle”, which includes poor nutritional habits and physical inactivity, contributes to obesity and cardiovascular disease. Current medical methods to manage the health consequences of these lifestyle diseases are inefficient and costly. The medical system has used downstream medical treatments and procedures and has not developed prevention strategies. The focus should therefore be on primordial prevention, avoiding the development of adverse levels of risk factors. Ideal cardiovascular health is the ultimate objective of primordial prevention which can be achieved with a healthy lifestyle: physical activity, eating fruits and vegetables, and a low intake of sodium and SSBs. Again, BMI as such does not tell much about the health risk. Measuring waist is important and should be routine during medical visits. Additional health professionals must be added in primary care practice such as dietitians, kinesiologists (physical activity/exercise specialists) and behaviour specialists, and we will need to reshape our environment to make healthy behaviours (eating and drinking healthy and being physically active) the easy default behaviours for our citizens.

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Frank B. Hu: Overconsumption of Sugar-Sweetened Beverages and the Epidemic of Obesity

The overconsumption of SSBs significantly contributes to individual calorie intake and is therefore a risk factor for obesity, type 2 diabetes and cardiovascular disease. Sodas, fruit drinks (which do not include 100% fruit juice), energy drinks and sport drinks are all considered SSBs. All over the world, people, especially youngsters, tend to drink more and more SSBs, and this phenomenon contributes to the passive, unrecognized consumption of useless calories of poor nutritional value. There is robust scientific evidence linking the overconsumption of SSBs and obesity, type 2 diabetes and cardiovascular disease. It has also been shown that replacing SSBs with noncaloric beverages such as water, unsweetened coffee and tea or diet drinks reduces obesity. However, consuming diet drinks in large amount is not recommended as they may condition our taste buds to crave super sweet foods. Unfortunately, nowadays, sweet drinks are very easily accessible and portions are getting bigger. Many policy measures on SSBs have been copied from the counter-tobacco rules. For instance, in France, ads for unhealthy drinks must carry health messages. Prof. Hu’s recommendations: go for calorie-free drinks, plain water being the best.

Robert Ross: Sedentary Lifestyle: The Smoking of the 21st Century

Obesity is not a behaviour: it is a symptom of poor behaviours. Behaviours should be targeted, not obesity as such, justifying the title of the conference “eat well, drink well, move”. Inactivity causes many health issues. Physical activity does not necessarily mean going to the gym and burn calories on a massive scale; it is about walking at least 10 minutes per bout and aim for 150 minutes per week. Prof. Ross gives a simple recommendation: simple movements for which not a lot of motivation is needed such as taking the stairs instead of an escalator, walking the dog or with the family or friends is enough to counter inactivity. Government has an important role to play: it has to ensure healthy choices are easily available to all citizens.

Franco Sassi: The Role of Governments in Addressing Obesity

From an economist’s perspective, obesity is a problem that has been growing severely in the past 20-30 years. In the USA, UK or Australia, the obesity epidemic has reached huge proportions. It is legitimate for a government to intervene as the medical system cannot handle this problem and that the current food supply is obesogenic. Solutions could include increasing healthy choices, disseminating information, working on education, raising the price of unhealthy choices (tax), or banning unhealthy options altogether. However, this is not always viable. Economists use the Disability-Adjusted Life Years (DALY) standard, a measure of the positive outcomes of government health policies. However, it is hard to determine the cost-benefit effect of prevention campaigns. Another complication for measuring outcomes is the relatively long time that it takes for policy measures to become effective as it takes years or decades to observe the benefits of lifestyle changes. A measure that governments could take is to tax unhealthy ways of life, as it has been done with tobacco. However, when it comes to food, this measure is not so clear cut: food is generally insensitive to price changes. On the other hand, taxes do raise governments’ revenue which can be invested in health care. Thus, a horizontal approach to prevention that would include all stakeholders is needed.

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AFTERNOON SESSION

AWARENESS: HOW TO RAISE AWARENESS ON LIFESTYLE MODIFICATIONS? Although the current obesity epidemic is now acknowledged, we need to further emphasize that it is the driving force behind the rapid rise in the prevalence of type 2 diabetes worldwide. Until now, most of the attention has been given to raising the profile of the problem rather than establishing a sound evidence base to develop possible solutions, and raising awareness among healthcare professionals, policymakers and the general public about the real problems of obesity. Despite intensive research on obesity over the last 30 years, the problem has continued to increase worldwide. Although we know more about the biological drivers of energy balance, new paradigms are needed to combat this growing epidemic as it is a societal condition. Moderator: Professor Jean-Pierre Després: Québec City, Canada

Speakers:

• Ms. Trudy Wijnhoven, Technical Officer Nutrition Surveillance, Nutrition, Physical Activity and Obesity Programme, World Health Organisation Europe

• Dr. Claudiu Ciprian Tănăsescu, Member of the European Parliament, Committee on the Environment, Public Health and Food Safety

• Mr. Goof Buijs, Chairman of the Schools for Health in Europe Network

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Topics

1. Physical inactivity: Physical inactivity is often underestimated as a risk factor and is sometimes even considered a fait accompli. Europe and its policymakers must step up and recognize that physical inactivity is one of the causes of many hazardous conditions such as obesity, type 2 diabetes and cardiovascular disease. Increasing the level of physical activity combined with improving the quality of the diet appear to be a viable and promising long-term option. Data registries of individuals who have been successful in maintaining a reduced body weight over the years have revealed that these people had been physically active. Unfortunately, we now have more sedentary individuals than smokers worldwide and lack of physical activity has become a more frequent killer than smoking.

2. Eating habits: This issue was introduced by the public. Practitioners and scientists often refer to healthy eating yet they do not acknowledge the different patterns of food consumption (how frequently people eat and in which context, environment, with/without drinking, etc.). In addition, the various cultures must also be considered. We know that a low calorie diet can induce weight loss. Long-term maintenance of reduced body weight in a previously obese person is however a major problem. This well-established finding indicates that simply limiting the amount of calories a sedentary individual takes every day may too often represent a difficult if not almost impossible long-term goal if other contextual drivers of eating behaviours are not considered.

3. Schools: Schools have a particular role in the prevention against obesity and the education of a healthy lifestyle. The issue is how to make schools interested and involved in subjects related to nutrition as including this to the school curriculum is often considered as competing with other topics (science, history, literature, etc.). One successful approach has been to convince school boards of the benefits of a healthy lifestyle by providing them with scientific evidence that students who eat well and who are physically active perform better at school. Healthy lifestyle education could also be used as a marketing tool for private institutions to valorize the quality of their curriculum. At the European level, the STEPS program is a wellness program identified as a best practice.

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Testimony and promotion of a healthy lifestyle

Moderator: Mr. Jeremy Fleming, Brussels, Belgium Speakers:

• Ms. Justine Henin, Former internationally renowned tennis player • Mr. Pascal Charlier, Director of Saint-Servais Secondary School

Justine Henin

Physical activity is not only good for your body, but it also benefits your mental health. That is why physical activity is a primary component of every action and campaign that her foundation, Justine for kids, has organized so far. Physical activity does not have to be practiced at a professional level, but can easily be integrated into our daily lives. Personal development is more important than reaching for the top professional levels. Justine states that she is a bit worried about the future of the next generation regarding obesity. As the mother of a baby girl herself, she will take the necessary measures to teach her daughter good eating and physical activity habits. She believes that the simpler the message, the easier it is to integrate.

Pascal Charlier

School children clearly do not practice enough physical activity, and have poor eating habits. This is one of the biggest responsibilities and challenges of the school system. That is exactly why Pascal Charlier created the project Mange sain, bouge malin, en forme aujourd’hui et demain (Eat well, move, healthy today and tomorrow).

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ACCESSIBILITY: HOW TO ENSURE THAT EUROPEANS MAKE HEALTHY CHOICES? Scientific evidence demonstrates that the problem of obesity cannot be solved by just recommending to cut on calorie intake. Instead, people should eat well, drink well and move. Unfortunately, there are today more sedentary individuals than smokers worldwide and lack of physical activity has become a more frequent killer worldwide than smoking. Making healthy choices can be difficult for many people, hence the necessity to create environments that would make choices easier. Moderator: Professor Robert Ross, Kingston, Canada Speakers:

• Ms. Ruth Veale, Head of Food, Health, Safety and Environment Department at BEUC – European Consumer’s Organization

• Mr. Philippe Roux, Head of Health Determinants Unit, DG Health and Consumer • Professor Martine Duclos, Head of the Sports Medicine Service at the University

Hospital of Clermont-Ferrand

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Topics

1. Creation of a permissive environment: It appears that a large number of contextual or environmental factors may affect the quality of our diet and behaviour. A better understanding of environmental, socioeconomic and ecological influences on our physical activity/inactivity level is essential to combat the current obesity epidemic. Unhealthy behaviours such as a sedentary lifestyle at work and during leisure time, sedentary lifestyle at school, TV watching, video games and social media networks, consuming an energy-dense diet rich in fat, salt and added sugar, etc., are still the easy options for a large proportion of our population. An environment permissive to healthy behaviours should therefore be created either by the European community or through initiatives at the regional or local levels. Such initiatives can also be promoted through public educational campaigns.

2. Supporting public health: More support should be provided to clinicians to help them reshape the lifestyle habits of their patients. In Europe today, few doctors are measuring the waist of their patients, although it has been proven that BMI alone is not sufficient to determine if a patient is obese and evaluate if he or she has excess fat in the abdomen. Most physicians do not have access to resources and additional health professionals to help their patients reshape their lifestyle habits.

3. A multisectoral approach: All actors have to work together. A multistakeholder and multidisciplinary approach is needed. The outcomes must be measurable, a timetable with deadlines has to be set and the dialogue must be kept with the food industry.

4. Schools: Schools have an important role to play in fighting childhood obesity. For instance, healthy eating and drinking choices, nutrition courses in the school curriculum and more opportunities for sports and play in general during school time could be provided.

ACTION: NEXT STEPS There is a need in Europe to develop further actions in order to fight obesity and change lifestyles. According to the ICCR, prevention is the best tool to curb obesity and educate people on how to eat well, drink well, and move. Both the European Commission and the Lithuanian Presidency of the European Council explain what has been done in the EU until now and what remains to be achieved. Moderator: Mr. Jeremy Fleming, Brussels, Belgium Speakers:

• Professor Gediminas Černiauskas: Lithuanian Vice-Minister of Health, representing the Lithuanian Presidency of the Council of the European Union

• Ms. Androulla Vassiliou: European Commissioner for Education, Culture, Multilingualism and Youth

• Mr. Jean-Claude Coubard: Executive Director of the International Chair on Cardiometabolic Risk

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Androulla Vassiliou, European Commissioner for Education, Culture, Multilinguism and Youth

More than half of the Europeans do not adopt the WHO’s recommendations on a healthy lifestyle, especially regarding physical activity, which results in higher costs for healthcare in member states. There is a cost associated with physical inactivity. Ms. Vassiliou emphasizes the EU Physical Activity Guidelines, stemming from 2008. At the end, extensive information is needed to design health policies in different sectors. It is now up to the member states to see if they want to cooperate for more concrete policies following the recommendations of the European Commission. This could happen during the Lithuanian Presidency, paving the way for implementation in 2014. The funding of the recommendations will come from the EU Health Program with sport being a new initiative under the Lisbon Council. Currently, the concept of a “European Week of Sport” is being developed in the context of the new European Commission initiative Getting people out of their chairs. It is important to raise awareness with a series of practical measures that can be implemented around Europe—based on the diversity that is present in Europe and that makes it a unique continent. The first edition of the European Week of Sport could take place in 2015. Androulla Vassiliou also advocates for cooperation with other stakeholders such as the scientific community. She congratulates the ICCR for having shared its findings, knowledge and expertise with the policymakers in Brussels.

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Gediminas Černiauskas, Health Vice-Minister of Lithuania

Health is not just a matter of cures and medicines; it starts with preventive actions in the sense of adopting a healthy lifestyle and correct eating habits. The three main health risk factors at the moment are tobacco, alcohol and obesity. With regards to obesity, there was the adoption of a White Paper on A Strategy for Europe on Nutrition, Overweight and Obesity Related Health Issues in 2007 and the creation of the EU Platform for Action on Diet, Physical Activity and Health. There are also very good practices among the member states. According to the Vice-Minister, the EU should learn from these different good practices. However, even though there has been several initiatives by the European Commission—the last one being Getting people out of their chairs—there is a need for “further development of existing strategies and legal bases both in the EU and in individual member states. The establishment of even more initiatives, and maintaining a proactive approach towards keeping everyone informed about the issue of obesity should be welcome.”

Jean-Claude Coubard, Executive Director of the ICCR and Chairman of the European Alliance for Lifestyle Changes Mr. Coubard thanks the representatives of the Council of the EU for their support of the ICCR initiative. Mr. Coubard then launches the European Alliance for Lifestyle Changes. Adopting a multidisciplinary approach, the objective of the Alliance is to favour the interaction between scientists and politicians, relevant stakeholders and NGOs in the EU. The ICCR executive position document presented at the conference officially marks the beginning of its action. The document is handed over to Commissioner Vassiliou. The Alliance will not compete with other existing European organizations, as it is meant to fill the gap between the scientific evidence and the various public health actors.

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CONCLUSIONS The ICCR aims to raise awareness on one of the most severe health problem in Europe, obesity, and particularly, abdominal obesity and its consequences: type 2 diabetes and cardiovascular disease. This goal was served at this conference through bringing all relevant actors in the same room: scientists who provided the academic evidence that abdominal obesity is the result of our poor lifestyle habits, politicians, policymakers and other major stakeholders who called upon action. There is now considerable evidence supporting the notion that overconsumption of specific foods and drinks heightens the risk of obesity. However, increasing the level of physical activity combined with improving nutritional quality appears as a more viable and promising long-term option than going on a diet focussing on caloric restriction alone. During the conference, the ICCR advocated for simple recommendations accessible to everyone: eat well (less energy intake), drink well (avoiding the overconsumption of the SSBs), and move (taking the stairs instead of the elevator, walking, etc.). In a nutshell, everyone can act and make positive changes in his or her lifestyle through these simple recommendations. The EU and its member states, policymakers, scientists, NGOs and relevant stakeholders should all join forces in the fight against obesity. This is the purpose behind the European Alliance for Lifestyle Changes.

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SPEAKERS BIOGRAPHY

WELCOME STATEMENTS Laurette Onkelinx Ms. Onkelinx is a Belgian politician, currently Vice-Prime Minister for Social Affairs and Public Health. For several years, she has been involved in the fight against obesity, notably through her project Priority to chronic diseases! Every year, she is presenting her proposals to the Belgian chronic diseases associations. Sophie Auconie

Ms. Auconie is a French politician and Vice President of the Union of Democrats and Independents. She has been Member of the European Parliament since 2009 and is Member of the Committee on Environment, Public Health and Food Safety. She participates actively to the Intergroup Water and represented the European Parliament in Marseille for the 6th World Water Forum. She is also President of the group Friends of Sport in the European Parliament to promote a European sport policy.

ACADEMIC EVIDENCE Jean-Claude Coubard Mr. Coubard’s professional focus has always been on the field of metabolism, atherogenic dyslipidemias and their cardiovascular consequences in particular. After speaking with Prof. Jean-Pierre Després—a world-renowned expert in abdominal obesity and its cardiovascular consequences—the decision was made to create the International Chair on Cardiometabolic Risk. Jean-Claude Coubard now puts his expertise to use for this new international Chair as Executive Director. Ulf Smith

Professor Smith is an expert in the pathogenesis of insulin resistance and type 2 diabetes. He focuses primarily on the role of adipose tissue in insulin resistance and the factors that contribute to the increase in cardiovascular disease in patients with insulin resistance. He is Director of the Lundberg Laboratory, Vice Chairman of the Departement of Molecular and Clinical Medicine, The Sahlgrenska Academy, Gothenburg University, Sweden and Vice President of the European Association for the Study of Diabetes.

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Luc Van Gaal Professor Van Gaal’s main clinical and research interests are related to obesity, type 2 diabetes and lipid metabolism. He is a member of many scientific, national and international societies and a member of the Editorial Board of a series of scientific journals. He is a board member of the Belgian Association for the Study of Obesity and Past-President of the Belgian Diabetic Society. He is the running secretary of the Belgian Endocrine Society. Prof. Van Gaal is professor of Medicine at the Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium. Marja-Riitta Taskinen

Professor Taskinen’s longstanding original and important observations have contributed significantly to the understanding of lipoprotein abnormalities, genetics and pathophysiology in type 2 diabetes, insulin resistance and the metabolic syndrome. Prof. Taskinen has been actively involved in activities of the European and International Atherosclerosis Societies, as well as those of the European Association for the Study of Diabetes and International Diabetes Federation. She is Professor of Medicine, Department of Medicine, Cardiology Division, University of Helsinki, Finland.

Ms. Van Rompuy Key figure in the European Union, Ms. Van Rompuy is the First Lady of the European Council. She is also a Belgian politician, currently the only Flemish deputy burgomaster of Rhode-Saint-Genèse, one of the six municipalities around Brussels-Capital. Jean-Pierre Després

Professor Després is a world-renowned expert in abdominal obesity and its cardiovascular consequences and Director of Research in Cardiology at Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec. Prof. Després is also the Scientific Director of the International Chair on Cardiometabolic Risk, and professor of kinesiology at the Faculty of Medicine, Université Laval, Québec City, Canada.

Frank B. Hu Professor Hu’s research has focused on diet and lifestyle determinants of type 2 diabetes and cardiovascular disease. He is currently Director of the Harvard Transdisciplinary Research in Energetics and Cancer (TREC) Center, Harvard School of Public Health as well as Co-Director, Program in Obesity Epidemiology and Prevention, Harvard School of Public Health, Boston, MA, United States.

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Robert Ross

Professor Ross’ field of research focuses on the characterization and management of obesity and related comorbidities in adults. He is now Director of the Centre for Obesity Research and Education, Queen’s University, Kingston, Ontario, Canada; Queen’s University Research Chair, and President of the Canadian Society for Exercise Physiology.

AWARENESS Ms. Trudy Wijnhoven Ms. Wijnhoven has a Bachelor's degree in Dietetics (Arnhem-Nijmegen University of Professional Education, Netherlands) and Master's degrees in Human Nutrition (Wageningen University, Netherlands) and Epidemiology (London School of Hygiene & Tropical Medicine, UK). She has been working since 1996 for the World Health Organization at various duty stations, and currently is the technical officer, nutrition surveillance, at the WHO Regional Office for Europe. Claudiu Ciprian Tănăsescu

Mr. Tănăsescu is member of the Group of the Progressive Alliance of Socialists and Democrats in the European Parliament and member of the European Parliament, Committee on the Environment, Public Health and Food Safety.

Goof Buijs As the Chairman of the School for Health in Europe Network, Mr. Buijs is involved in health education. He has extensive experience in the healthcare sector as he is also Senior Consultant at the Dutch Institute for Healthcare Improvement (CBO) and used to work at the Netherlands Institute for Health Promotion and Disease Prevention (NGIZ).

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Justine Henin

Ms. Henin is a Belgian World Tennis player. From her professional beginnings in 1999 to her decision to retire, Justine Henin won 41 titles, 7 of which were Grand Slam tournaments (4 Roland Garros titles, 2 US Open titles and 1 Australian Open title), 2 Masters, 1 Fed Cup and 1 Olympic Gold Medal won in Athens in 2004. Ms. Henin is the founder of Justine For Kids, an organisation which main objective is to help the sick children in Belgium. Justine for Kids organizes entertaining activities all year round (outing, field trips, travels), finances and develops projects related to the hospitalisation, to support families and education.

Pascal Charlier Mr. Charlier is Director of the Saint-Servais secondary school where he started to promote a better lifestyle.

ACCESSIBILITY Franco Sassi

Mr. Sassi is a Senior Health Economist at the Health Division of the OECD and a former lecture at the London School of Economics and Political Science. His research interests focus on the economic analysis of health services and, regarding obesity, on the economic burden of the disease.

Ruth Veale She is Head of the Food, Health, Environment and Safety department of the European Consumers Organisation BEUC. Having an educational background in nutrition, and being working at the BEUC on Food issues for many years, she has extensive knowledge of European nutrition and food policies.

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Philippe Roux

Mr. Roux is Deputy Head of Unit in DG Health and Consumers, European Commission. He is the Co-Chair of the EU Platform for Action on Diet, Physical Activity and Health and is highly involved in obesity and nutrition issues. He is in charge of organizing, coordinating and lead the work of the “Nutrition and Physical Activity” section of the Unit.

Martine Duclos Professor Duclos leads the research on sport training and on the relationship between muscles, metabolism and hormones at the Centre of Research on Human Nutrition (CRNH, INRA – Université d’Auvergne). Author of many publications, she is Member of the Committee “Physical Activity, Health Sport” at the French Society of Medicine for Physical Exercise and Sport (SFMES). She is Head of the Sports Medicine Service at the University Hospital of Clermont-Ferrand.

ACTION Gediminas Černiauskas

Mr. Černiauska is a Lithuanian politician, and currently Health Vice-Minister. He represents the Lithuanian Presidency at the Council of the European Union.

Androulla Vassiliou Ms. Vassiliou is a Cypriot politician, Commissioner for Education, Culture, Multilinguism and Youth and is also active at the UN level. She served as Commissioner for Health, from February 2008 to end of 2009. Ms. Vassiliou studied law and international affairs in London and practiced law in Cyprus for 20 years (1968-1988).

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