The Obesity Conference, Oslo, 29. October 2003

Minister of Health, Norway - Dagfinn Høybråten
Control against performance

Introduction

Ladies and gentlemen, speakers and participants –

Obesity - or overweight - is one of the major challenges we are facing today concerning public health, both in our society and in a global perspective. Thus it is important that you, the audience here today – researchers and professionals – take this challenge seriously. It is also of great importance that the group that I represent – the politicians – really understand the graveness of the development that we here see.

I wish to concentrate on this latter point: Overweight as a political challenge. Let me first stress how important it is that you provide us politicians and the population with the latest knowledge, and that you, by coming together in conferences like this, make sure that this knowledge is spread to those who need it.

In general, Norway has a population with good health. Obesity and overweight have been less of a problem for us than in many other countries of the western world. Currently, we are witnessing a change. A 40 year old Norwegian male today weighs nine kilos more than he did only a few decades ago, and overweight is also a problem on the increase among children. This is a situation we have to address now. We are in a hurry to stop this development.

In January this year, the Government that I represent, presented a White Paper to the Norwegian Storting - the Parliament - that we called “Prescriptions for a Healthier Norway”. In this White Paper we presented a broad public health policy and strategies for the coming years. The objective is a healthier population through a policy which contributes to:

• More years of healthy life for the population as a whole
• A reduction in health disparities between social classes, ethnic groups and the sexes

This strategy gained widespread support in the Storting.

One main point in the White Paper is that we want to make it easier for the individual man and woman to take responsibility for his or her own health. It must be easy to make positive health choices – and we, the politicians, have certainly a job to do. We must take as a starting point those structures of society that influence people’s choices. We must contribute to making the healthy choices more attractive.

But how can we do this?

Overweight is not only an individual problem. It is also a problem for the society as a whole. We know that daily physical activity or exercise is important. But what if it is risky or unpleasant to walk along the road where you live? Or what if it is impossible for you to go to work by bike, although you would have liked to do just that? Similarly, we see that easier access to calorie-rich foods and sugary soft drinks, lead to a higher consumption.

A cross-sectoral approach is needed, and I’m quite happy about how we deal with this now. As a Minister of Health I have to work together with other Ministers responsible for other sectors of importance to public health. Almost all Ministries and several government services are currently involved in a major cooperative project aimed at bettering public health. Both regional and municipal authorities are involved. Various non-governmental organizations are also working together with us. In this way we are in the process of creating a broad alliance – a partnership - for better health!

During the conference today you will listen to and discuss many issues related to overweight and obesity, issues related to the two main perspectives – prevention and treatment.

Prevention is one of the most important keyword in my work. By preventing more, there will be less to repair!

And when it comes to prevention of obesity, we know that preventing children from developing overweight is one of the most important tasks. We know that children who are overweight very often remain overweight as grown-ups. In this area the development has gone in the wrong direction: Children and young people are far less physically active today than they were only a few decades ago, and soft drinks and high calorie foods are more easily available than ever before. So – we need to do something. This must be done in cooperation with parents of course, and with those working in the school and education sector.

A higher consumption of fruit and vegetables is important to ensure good health. Norwegian schools are to an increasing extent introducing different arrangements that give children and young people access to fruit and vegetables at school – as canteens and the school fruit programme. These are excellent measures, and we will continue the work to strengthen these arrangements. Another very important objective is to increase the amount of physical activity during the day at school, and we are now considering how to do this. Many schools are already doing things in a very positive way, and we need to learn more from their experience.

I know you will come back to several other aspects concerning diet and physical activity later today, during this conference.

The other main keyword concerning overweight and obesity is treatment. We must not forget all those who are already overweight.

First of all: It should not be necessary to say this - but I want to make it clear: overweight individuals must be met with respect and understanding. Over the years I’m afraid that many overweight patients have been met with patronizing attitudes and a lack of adequate medical care. Therefore it is of great importance that we strengthen the public health workers’ competence on overweight and on illnesses that are related to overweight. In this context we also have to include the aspect of mental health.

There are many commercial actors working in the area of overweight. Some of these actors work seriously, and my opinion is that they can give a positive contribution to the prevention of obesity. At the same time we need to be aware of all the products that claim that they can make dieting to be trouble-free and easy. People are willing to pay large amounts of money for products that far too often turn out to give – at best – a short-term loss of only a very few kilos. We know that some products are sold without scientific documentation.

Unfortunately, it seems to me that the public health service has not an adequate treatment to offer to people who are overweight or obese. Furthermore, there are no national guidelines on how to treat and follow up children or grown-ups with an overweight problem. We are now working on how to deal with these questions.

Concerning obesity, we have to strengthen our effort to offer treatment at an early stage – even though it is also a need to have treatment in hospitals for those who need it. A group of professionals that play a central role in this work are the doctors – the general practitioners. General practitioners have a long-standing tradition of repairing damages, and treating the symptoms. In general, I want to involve general practitioners much more than today in the work on preventing lifestyle related illnesses.

Two weeks ago, I had the pleasure of introducing an entirely new measure in Norwegian health policy – called the “Green Prescription”. This prescription is an alternative to the drugs prescription. The Green Prescription means on the one hand that the doctor gets a new payment rate meant to stimulate him or her into guiding the patient to get a healthier life style. This rate can be used by the doctor when prescribing the Green Prescription as an alternative to medication. On the other hand the arrangement also comprises information and instruction material – both printed and on the internet – that the doctor can use in his consultations. This way Norwegian doctors have got an entirely new instrument that will better enable them to support the patients own effort in changing their health behaviour.

We have started off with the diagnoses high blood pressure and diabetes type II. The experience we will gain from this initial period will tell us whether we should also extend the arrangement to other diagnoses. Obesity might be one of such diagnosis.

One of the main challenges in public health work is to reduce social inequalities in health. Since it is the group with the lowest education and income that has a lifestyle with the highest risk of illness, it is essential that we reach this group. I believe that arrangements like the Green Prescription can be one way of reaching these groups as well.

Before I conclude:

I know that you have many ideas and many proposals concerning what I can do concerning prevention and treatment of overweight and obesity. One proposal that has been forwarded to my office is to establish some kind of a “national centre” for treatment and research in the field of obesity. Another proposal is focusing on the need for more positions at the local level, for nutritionists and other professionals working with obesity. I have also been told that it is a need to reintroduce the weighing and measuring of children in public health centres and school health services that we used to have some years ago. These are all proposals worthy of serious consideration.

To conclude: We know a lot about what should be done and how to do it. But there is also much that we do not know and much that we know too little about. We are not certain that all we do is right. Therefore we need more knowledge. That is what you, the researchers and professionals, can give us.

I promise you that I will continue to focus on these challenges.

Let me extend to you my wishes for a successful conference!