Overweight, in both adults and children, is a major public health problem which shows no sign of abating. Approximately 50% of Dutch adults are now overweight, and some 10% are defined as obese. This situation is accompanied by considerable effects on disease burden: 22,000 extra new cases of diabetes each year, 16.000 of car-diovascular diseases and 2,000 of various forms of cancer. Approximately 5% of annual mortality is thought to be directly attributable to overweight. Taking into account the postponement of death and other factors, this figure is slightly lower over a period of
20 years: if the prevalence of overweight remains stable, 3% of mortality among today’s adult population will be due to overweight. In terms of the average life expectancy of Dutch men and women aged 40, this entails a loss of 0.8 years due to overweight alone. If everyone in the country were to lose approximately three kilo-grams (1 BMI unit), some 20% of this health loss could be undone. An integrated strategy, combining changes in the physical and social environment with measures to support changes in individual diet and physical activity, is recommended in order to halt and reverse the current epidemic of overweight. Specific attention should be devoted to the lower socio-economic and ethnic groups. In terms of dietary inter-ventions, diets with a low energy-density, and with much fruit, vegetables and cereal products, hold out the best opportunities for success.
In addition to poor energy balance, the average Dutch diet displays shortcomings in other aspects. The main problems are inadequate consumption of fruit, vegetables and fish, and excessive consumption of products with a high concentration of saturat-ed and trans fatty acids. The combination of these unfavourable dietary factors accounts for 38,000 extra new cases of cardiovascular diseases each year, and almost 3,000 cases of cancer. Some 10% of all mortality can be attributed to the combination of five dietary factors. When factors such as postponement of death are taken into account, the estimate is halved: if consumption patterns remain unaltered, approxi-mately 5% of mortality occurring during the coming 20 years will be attributable to unfavourable dietary composition. This is expected to result in the loss of 1.2 years in the life expectancy of all Dutch citizens currently aged 40 and above. It is the inade-quate consumption of fish and fruit which has the greatest effect in this respect. Inter-ventions addressing the five dietary factors and considered feasible will offset approx-imately half of the total health loss. The projected increase in the number of disease-free years resulting from dietary interventions shows that intervention post-pones disease longer than it postpost-pones death and that intervention therefore results in a longer period in good health.
It is recommended that the current dietary problems are addressed by rendering ‘the healthy choice the easy choice’ and by influencing eating behaviour in a positive direction. Making it easier to adopt a healthy diet will demand a combination of improved product composition (particularly that of convenience foods) and support-ing changes to the physical and social environment.
Those in the lower socio-economic groups have, on average, a slightly more unfavourable dietary pattern than those in the higher socio-economic groups. Little is known about the diet of ethnic groups. In some respects, their diets would seem to be healthier than average (fatty acid pattern), while in others they appear to be some-what less healthy than average (particularly with regard to vitamins and minerals).
Attention must also be devoted to the diet of the very young and the very old. The average duration of breastfeeding is currently not long enough. Working mothers experience a number of practical obstacles to breastfeeding. Principles for policy
include removal of these obstacles and changes to the social norms (even limited breastfeeding still has advantages).
As they lose independence, the elderly have an increased chance of undernutrition and particularly of deficiencies of vitamins D and B12. The use of existing screening methods in the health care sector is important in identifying the warning signs of undernutrition in time. Undernutrition among institutionalized elderly can be pre-vented by such means as encouraging physical activity, the use of supplements, forti-fied products and flavour-enhancers, and ensuring a stimulating social environment during meals.
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