WHO Europe identifies significant socioeconomic disparities in diet of adolescents

28 May 2024 --- The latest World Health Organisation (WHO) Europe report, based on data from 44 countries participating in the Health Behaviour in School-aged Children (HBSC) study, shows a rise in unhealthy eating habits, rates of overweight and obesity, and low levels of physical activity among young people — disproportionately affecting those from less affluent families. Based on the findings, WHO calls for urgent action to address these trends. 

Fewer than two in five adolescents (38%) eat fruit or vegetables daily, with these figures declining with age. More than half of adolescents report eating neither fruit nor vegetables daily (56% of boys and 51% of girls aged 15).

“Parents should ensure healthy foods and meals are provided at home and ensure that family meals are balanced and nutritious including a variety of fruits, vegetables, whole grains, lean proteins and healthy fats in meals,” Stephen Whiting, technical officer in the nutrition, obesity and physical activity program at WHO Europe, tells Nutrition Insight. 

“They should reduce the availability of sugary snacks, sugary drinks and ultra-processed foods in the home. Sugary drinks, in particular, are significant sources of added sugar and empty calories. Parents can create a positive mealtime environment and aim to have regular family meals without distractions like screen devices and smartphones.” 

Poor dietary habits
The findings of the HBSC study have implications for achieving global health targets, such as those under the UN Sustainable Development Goals (SDGs). The report’s focus on adolescent health aligns with SDG target 3.4, which urges countries to reduce premature mortality from noncommunicable diseases by one-third by 2030. 

By addressing the root causes of health disparities and promoting healthy behaviors among adolescents, countries can contribute to a healthy population and less stress on the healthcare system.

WHO’s new report observes a decline in healthy eating behaviors and a rise in unhealthy choices. The consumption of sweets and sugary drinks, for example, remain high with one in four adolescents (25%) reporting daily consumption of sweets or chocolate. The trend is higher among girls (28%) than boys (23%) and has increased since 2018. 

Whiting explains: “It is useful to involve children in meal planning and preparation and help children understand the benefits of healthy eating and motivate them to make better choices. 

This could be through explaining the basics of nutrition that is easy for them to understand or interactive learning using games, apps or activities that teach about different food groups and their benefits.”

“Importantly, they should lead by example and model healthy eating behaviors, for example, by making healthy food appealing, using a variety of fruits and vegetables and cooking methods and recipes.”

Although daily soft drink consumption has declined slightly since the previous survey, it still affects around 15% of adolescents, with higher rates in boys (16%) than girls (14%) and those from less affluent families. 

The report shows that adolescents from lower-income families are more likely to consume sugary drinks and less likely to eat fruit and vegetables daily. According to WHO, the disparity highlights the urgent need to address the underlying socioeconomic factors contributing to these trends. 

“The WHO/Europe Nutrient Profile Model enables the classification of food products to determine whether they are healthy enough to be advertised to children. It can be used by decision-makers to regulate the marketing of unhealthy products to children, reducing pressure on children and parents and supporting the promotion of healthier diets,” Whiting explains.

Longstanding concernsA key recommendation from WHO Europe is to revise the marketing around unhealthy foods. 
Adolescent overweight and obesity has been a severe public concern for a long time and the figure has only risen since the previous survey in 2018 from 21% to 23% in 2022. The survey also shows low levels of physical activity among adolescents. WHO recommends that young people get at least 60 minutes of moderate to vigorous physical activity (MVPA) daily. 

Overall, only 25% of boys and 15% of girls achieve 60 minutes of MVPA daily, with participation declining with age, particularly among girls. About 60% of adolescents meet the WHO’s recommendations for vigorous physical activity (VPA) at least three times a week and is also lower among girls (51%). 

This gender gap widens with age, with 65% of 11-year-old girls meeting the recommendation compared to just 46% of 15-year-old girls. Socioeconomic inequalities are evident, with adolescents from more affluent families reporting higher levels of both MVPA and VPA. This suggests that factors such as access to safe spaces for physical activity and participation in organized sports may be influenced by family income.

“The affordability and accessibility of healthy food options are often limited for families with lower incomes, leading to a higher reliance on processed and sugary foods, which can have detrimental effects on adolescent health,” says Dr. Martin Weber, team lead, quality of care and program manager, child and adolescent health at WHO Europe. 

Recommended strategies for alleviation
The report recommends a strengthened focus on regulating food marketing by implementing stricter regulations on marketing unhealthy foods and drinks to children and adolescents to address the crisis.

“Regular physical activity, healthy eating habits and maintaining a healthy weight are essential elements of a healthy lifestyle. The report’s findings signal a need for targeted interventions to enable adolescents to adopt healthier behaviors and avoid habits that affect not only their current health and well-being but also their future trajectories as adults,” says Dr. Hans Henri Kluge, regional director of WHO Europe.

“Furthermore, the socioeconomic disparities in adolescent health behaviors contribute to a vicious cycle of disadvantage. Children from less affluent families are more likely to experience adverse health outcomes, which can hinder their educational attainment, employment prospects and overall quality of life. This perpetuates social inequalities and limits opportunities for upward social mobility,” he says.

The report advises European nations to improve access to affordable, nutritious food, particularly for disadvantaged families, and implement policies to discourage the consumption of unhealthy foods and beverages.

Countries are urged to develop tailored interventions such as school-based programs, community-based initiatives and public health campaigns to support and create awareness about healthier behaviors among adolescents, particularly those from disadvantaged backgrounds.

“Investing in adolescents’ health is an investment in the future. By addressing the underlying factors that contribute to unhealthy behaviors, creating an epidemic of inequality, we can improve the health and well-being of young people, reduce health disparities and build a healthier future for all,” says Kluge.

By Inga de Jong