Case Study: Obesity in The Netherlands

To get a clearer picture about the causes of obesity and what to do about, let’s zoom in on The Netherlands. Worldwide it is ranked number 99 on the obesity world list and has one of the lowest rates in Europe. Nevertheless, overweight prevalence is 50% and obesity 15% and similar to most countries, the numbers are rising.

As can be seen in previous activities of the Nutrition for Health and Sustainability course, calories going in through consumption and calories out through burning them are important to maintain a healthy weight. Let’s take a closer look at the situation in The Netherlands.

Obesity Factors in The Netherlands

Physical Activity

When we compare physical activity in The Netherlands to the rest of Europe it turns out that the ranking is very high for both physical activity and for sedentary behavior. Dutch people move the most but on average also spend 9 hours a day sitting down.

Only in Denmark using a bicycle for daily transport is more common, and The Netherlands scores highest on fun being the reason for working out. The national guidelines for physical activity for adults include 2,5 hours of moderate to intensive movement a week as well as muscle and bone strengthening exercises twice a week. Approximately half of the population reaches the norm.

Dietary habits

The Netherlands tops the rating on the “good enough to eat” index. It has the most affordable, diverse and best quality food available to eat in the world. This is especially at home, as restaurants can be expensive.

Per day, Dutch consumers eat on average 1 kilogram of foods and drink 2 liters of water during breakfast, lunch and dinner. Per person, about 350 grams of milk, 100 grams of meat, 125 grams of vegetables and 125 grams of fruit and nuts is consumed daily.

Dairy consumption is very high, yet fruits, vegetables, fish, eggs and legumes are consumed less compared to the rest of Europe and well below the daily recommended amount of 200 grams for fruit and vegetables. From a calorie perspective bread contributes most to energy intake.

Of course, not everyone consumes the same every day, there are differences based on individual habits and resources as well as the physical and the social environment. A study in the Northern Netherlands has shown for instance that in rural areas the “bread and cookies” dietary pattern is more common, whereas in urban areas the “snack” as well as the “vegetables, fish and fruit” patterns were more popular.

The individual resources include education as well as income, and like in many other countries these factors determine the socioeconomic status. Lower dietary quality and more obesity and related disease are seen when status is lower.

In urban areas the “snack” pattern is also more common among groups with low education and the healthy “vegetables, fish and fruit” among the highly educated.

The social environment also has an important role. Having obese parents is a big risk factor for becoming obese and a meal is often a social event of course, that is highly influenced by culture and our social contacts.

Individuals in The Netherlands with a low education have on average 6 years shorter to live compared to high education and even 15 years shorter in good health.

Tackling Obesity in The Netherlands

How to treat obesity? As of 2019 combined lifestyle interventions aiming to tackle obesity and type 2 diabetes development are covered by the basic health insurance that everyone is supposed to have in The Netherlands.

This treatment aims to stimulate both healthy dietary behaviour and physical activity and on permanently integrating these healthy habits in your life. Together with a lifestyle coach a 6-12-month action plan is developed and executed followed by another year of monitoring whether the changes have been adopted on the long term.

Further Obesity Factors in The Netherlands

Many factors that negatively influence body weight and disease often cluster together. High amounts of screen time for instance, often goes together with an unhealthy diet. But poverty also causes chronic stress and a social environment that often isn’t the best example of a healthy lifestyle, both making it more difficult to live healthy yourself. The latter might be one of the reasons why policies aiming at one or a few factors have been unsuccessful in the socioeconomic group that needs it the most.

Healthy Behaviour Policies in The Netherlands

Today’s policies in The Netherlands are trying to put a halt to multiple factors at the same time in a region or neighborhood. These aim to create an environment that stimulates healthy behavior by stimulating physical activity and a healthy dietary pattern, but also underlying factors, such as loneliness, poverty, stress, safety, social cohesion, etc.

Many other organisations besides the government are involved in these approaches, including medical doctors and the local community living in the area.

Altogether, despite having one of the best food environments as well as healthcare systems, chronic disease that is highly influenced by obesity is also a threat to this system in The Netherlands and its clustering makes it a tough battle that needs broad facilitation of healthy behavior.

What we would like you to do

• What’s the prevalence of obesity in your country?
• And what are the strategies put in place to treat obesity?

Author: Dr. Tim van Zutphen