Global Health and social care

A glimpse into Nordic obesity policies

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A close up of a woman's feet standing on scales. Photo by i yunmai on Unsplash

Obesity stands not only as a national but also an international health concern affecting an increasing number of people worldwide. Despite the welfare state status of the Nordic countries, they, too, grapple with ever-rising obesity levels. This article aims to shed light on some of the obesity policies and actions implemented in the Nordics.

Obesity in the Nordic countries – overview

Of the Nordic nations, Finns are experiencing the biggest struggle with obesity, with 27% of adult men and 30% of women grappling with a BMI of over 30. Latest statistics reveal that about 1.2 million Finns, out of a population of 5.5 million, are more than 15kg overweight. In Norway, approximately 26.6% of men and 24.8% of women have obesity. In Sweden, 16% of the adult population was obese in 2022, while Denmark’s population shows 18.4% with a BMI over 30, and in Iceland, the rate is 21.4%. The rates have been creeping up over the years; in one lifetime they’ve as much as tripled in some of the Nordic countries and are now not too dissimilar to the UK, where 25.9% of the English and 29% of the Scottish population have obesity.

Contemporary research into the causes of the crisis across the Nordic nations highlights a strong correlation between the changed food landscape and the prevalence of obesity. Many of those studies also highlight a higher frequency of obesity among those with lower education levels and in lower socio-economic groups. “We know that there are stark inequalities in obesity across Denmark”, Dr. Stine Schramm from the University of Southern Denmark told MedicalXpress. “Earlier research has shown that the proportion of obesity is almost three times higher in Danish adults with a low level of education (elementary school, 27%) compared to those with the highest education level (undergraduate degree or higher; 10%). Even though multiple studies have been identifying causes and various tested measures to curb obesity levels, there has been no definite plateau or pointing down of the curve  – rather, most projections estimate obesity to affect more people in the years to come.

Nordic solutions to the obesity crisis

The Nordics have experimented with both national but also regional actions aiming to combat the rising levels of obesity. The nations have all taken part in implementing nutrition guidelines – some of which have trickled down from the EU level – such as the “School Fruit, Vegetables and Milk Scheme”, which essentially aims to “encourage children to follow a healthy diet and lifestyle”, and Nordic Nutrition Recommendations, which has been in use since 1980 and has since shaped national dietary guidelines across the region.

Certain approaches to obesity set some Nordic nations apart from other European nations, and showcase the large-scale, global difficulty in addressing the complex epidemic.

Denmark’s fat tax

Denmark, now a hub for the development of the newest weight loss drugs, made headlines a decade ago with a controversial policy to curb saturated fat consumption—the “fat tax”. The tax on foods with a high saturated fat content was implemented in October 2011 and aimed to reduce the consumption of unhealthy foods and address public health concerns related to obesity and cardiovascular diseases. It applied to products containing more than 2.3% saturated fat, including certain dairy products, meats, and processed foods. It was not a well-received policy, however. Already before and right after its implementation, the fat tax faced criticism and challenges from both the public and the food industry. Critics argued that the tax was regressive, disproportionately affected low-income individuals, and that it led to unintended consequences, such as cross-border shopping. Additionally, there were concerns about the huge administrative burden that enforcing the tax turned out to be.

As a response to the criticisms and challenges, the Danish government decided to repeal the fat tax in November 2012, just over a year after its introduction. The scrapping of the tax came alongside a broader package of measures that also included shelving plans for a sugar tax. Mette Gjerskov, the minister for food, agriculture and fisheries at the time even admitted that “the fat tax is one of the most criticised policies we have had in a long time”. However, following the scrapping of the tax, some studies showed results indicating the fat tax had led to a decrease in the consumption of certain high-saturated fat products – but the extent varied across different food categories. The failed attempt also led to many studies concluding that “​​effect of such policies on calorie consumption and obesity is likely to be minimal,” and encouraging caution in implementing anything similar in the future.

Sugar tax in Norway and Finland

Denmark is not alone in trying out fiscal measures to address eating habits; Finland and Norway have also introduced taxes specifically aimed at curbing the consumption of sugary confectionery and drinks, but again with mixed results. Norway paved the way for sugar tax on a global scale – the nation first introduced tax on chocolate and sugary products in 1922 (this was not uncommon in Europe as they were deemed luxury items). The tax evolved over time, remaining in place but not without opposition.  One of the criticisms again surrounded the cross-border shopping which the tax seemed to encourage, and in 2018, Norway made headlines around Europe with the Norwegians flocking to neighbouring Sweden in the pursuit of satisfying their sweet tooth for cheaper goods. In 2018, the sugar tax was increased by 80% to its highest level yet – 36.92 Norwegian krones (£2.7) per kilogram. The levy was subsequently reduced before being repealed altogether in 2021 when the conservative government took power. In Spring 2023, the ruling government started conversations to reintroduce the tax – albeit in a more controlled manner.

Sugar and confectionery products have been taxed more intensely than other foods in Finland throughout history, and like in other nations, the Finnish government’s 2011 tax on confectionary proved divisive. This tax, representing higher rates than any of previous national measures, was criticised from the beginning as simply a fiscal measure to fatten the state purse rather than address a public health concern, and led to its scrapping in 2016. A separate tax on sugary soft drinks, however, persisted. Now, the government is looking to strengthen the soft drinks levy. The tax on soft drinks will be graduated based on the sugar content of the drink instead of the current two tax categories to six tax categories. The lowest tax category is levied on sugar-free drinks, and rises in increments regardless of whether the drinks contain added sugar or only natural sugar. The aim of the tax changes is to direct consumption and production from drinks with a high sugar content to drinks with less sugar. However, the decision makers have not tried to hide the fact that these measures also add to tax revenues.

Sweden – highest rate of bariatric surgeries

Sweden has gained a reputation for not being afraid to take a different approach in handling national health crises. The welfare state boasts the lowest rates of obesity in the Nordics, and though the implementation of different nutritional and healthy lifestyle guidelines vary across the country’s regions, the state-funded healthcare system does seem to serve at least some people with obesity better than in other countries. When it comes to spending on any number of bariatric surgeries performed in the world, it hovers at the top of the list. In Sweden, nine bariatric surgeries are performed per 10,000 people – a percentage only the US tops. For comparison, in the UK the figure stands at 15 per 100,000 per year in women and 3 per 100,000 per year in men.

In Sweden, individuals are eligible for bariatric surgery if the disease has not responded to nonsurgical therapy and the patient has severe obesity or a BMI > 35 kg/m2 in addition to a major obesity-related comorbidity. This is much in line with the requirements in other countries – but perhaps advantageously, Sweden has a universal healthcare insurance system, which means that financial resources should not be a barrier for obesity surgery, and according to Swedish law, the tax-financed healthcare service should be provided on equal terms for the entire population and those who are in the greatest need of health care should be prioritised. But as 90% of patients with obesity get their surgery paid through their national health insurance, the waiting lists have also gotten lengthy, meaning that fewer patients get seen within a reasonable time.

Comment

The above examples are only a few from the Nordic region, and at the time of writing, the conversation surrounding obesity as a national health crisis is active. It’s increasingly one that political parties and decision-makers are required to acknowledge and take action. However, as seen from the few examples above, the action is scattered, and though none of the Nordic nations deny the prevalence of obesity and its impact on national economies, some measures are still being judged on a fiscal rather than a public health scale. In addition, introducing fiscal measures such as sugar or fat taxation can cause a considerable dent on the national economy – Denmark’s fat tax was blamed for helping inflation rise to 4.7 per cent in a year. Conversely, Novo Nordisk, manufacturer of the most well-known modern obesity medicines, in 2023 had a stock market value of £340bn which exceeded Denmark’s entire economic output of £323bn for the same period. It is uncertain what measures work best in treating obesity – and medicine will likely be a core part of those going forward. Sweden, with its high bariatric surgery rates and low obesity levels is perhaps only one example of an approach that is supported by the national health system, but even that doesn’t come without its faults.



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