More than a billion people worldwide are living with obesity and the situation in Belgium is no small concern. But addressing the problem comes at a cost that for many of the country's most vulnerable is too high.
Between 1990 and 2022, obesity rates more than doubled among women (8.8% to 18.5%) and nearly tripled in men (4.8% to 14.0%), a study by the WHO revealed. Belgian data on the health problem dates back to 2018, when Sciensano carried out a national health survey.
"Even though these figures date back several years, they still reveal a clear increase," Professor Doctor Roman Vangoitsenhoven, an endocrinologist and obesity expert at UZ Leuven, told The Brussels Times.
In 1998, around 40% of adults in Belgium were overweight (a body mass index or BMI over 25) and around 10% obese (BMI over 30); 20 years later this rose to 50% and 16%, respectively. Objective measurements were even higher, with as much as 55% of the adult population classed as overweight and 21% living with obesity.
"It is striking that, even then, more than half of adults were overweight, which means half the population weighs more than what we would call a normal weight. We find ourselves in a situation where normal no longer describes the majority, which is kind of strange."
(Human) cost
Although awareness of the health problem has increased, the impact is still underestimated. Obesity can be considered a gateway disease: patients have a higher risk of developing many chronic diseases, such as cardiovascular disease, type 2 diabetes and kidney diseases, but also sleep apnoea and strokes.
"But obesity can also have a huge negative impact on the self-image and the psychological state of the patient," Vangoitsenhoven said. "Very often this goes hand in hand with depression. Patients are then less motivated to exercise, which then results in further weight gain."
Being exposed to these conditions is strongly associated with higher healthcare costs (24% higher than people of a healthy weight) and a higher number of days absent from work. In 2018, around €1.5 billion was spent on healthcare costs related to overweight and obesity in Belgium.
Credit: Belga
The role of genetics is the biggest factor at play in obesity, with family predisposition accounting for about 50% of a person's weight. But financial means is also a major consideration. Following the 2018 survey, Sciensano noted that overweight and obesity are strongly related to socio-economic status, with a much higher prevalence among people with a lower educational level.
"This can partly be explained by the fact that healthy food is not always affordable, especially for lower-income groups," said Martijn Schoneveld, abdominal & bariatric surgeon at UZ Brussel. "Bad food is often easier to prepare and is less expensive than healthy alternatives, which is also why you see more obesity among the lower social classes."
This was highlighted in a recent study which showed that around one in ten people could not afford to eat a healthy diet during lockdowns, a problem especially apparent among single-parent households.
The danger to children
The WHO study also showed that obesity has quadrupled among children and adolescents (5 to 19 years of age). In Belgium, the prevalence of overweight (including obesity) in adolescents was around 15% in 2018.
"For me, this increase among children and adolescents is the biggest concern," Schoneveld said. The first 1,000 days of a child's life are extremely decisive for weight in later life. Pregnant women who are overweight can also pass the risk on to their children. As a result, a rising number of young people are also suffering from comorbidities and diseases that children with a healthy weight normally don't suffer from.
On this front, Vangoitsenhoven highlights improvements: a "care pathway" was approved last year to give the right treatment to children and young people with severe obesity. This process will be based on a multidisciplinary approach within hospitals working in collaboration with primary care providers. "This was a huge achievement," he said.
Curbing obesity?
The fact that obesity is recognised as a chronic disease by the World Health Organisation is a big step forward, as it paves the way to longer-term counselling, Schoneveld noted. "This highlights that it is a disease that patients carry with them for life, and that work must be done in the long term."
Vangoitsenhoven stressed that severe obesity is a real disease that cannot simply be treated for in a few months. He points to the importance of medication that is scientifically proven to help reduce weight. Demand for this is massive in Belgium and whilst it is an important tool it is not a panacea and will always be just part of the solution.
"A good assessment by GPs is key. This should include a structured multidisciplinary follow-up and help with exercise and diet that ensure a lifestyle change," Vangoitsenhoven said.
But this has a significant cost and the multidisciplinary approach that involves dieticians and physiotherapists is currently not reimbursed for adults, a shortcoming that Vangoitsenhoven says is "very distressing".
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This makes low-income people who are already more at risk of becoming obese even more vulnerable. "Those who need the help and support most are often not the ones to get it, and this is definitely because of the high cost," said Schoneveld.
Until these costs are reimbursed, healthy food is made more affordable, processed food made less attractive, and prevention efforts through education have improved, the light at the end of the tunnel still seems far off.
Vangoitsenhoven notes that it will take time to turn the tide on the number of people who are overweight and living with obesity. "Without a firm approach, I think the problem will get worse for a few more years before it gets better."
Sciensano is carrying out a new Health Interview Survey on overweight and obesity, and updated figures will be released next year.
