Reflect on what is needed for stronger EU action to reduce childhood obesity. The reflection process should include youth voices, and be linked to the emerging movement to make improving wellbeing a central aim of our economies.

Build a new action plan for childhood obesity based on the wealth of knowledge and evidence available across government levels and sectors.

Focus in particular on the commercial determinants of health, and on how to reduce the consumption of cheap, easily palatable and high-caloric foods. These foods are most predominant in countries with the highest rates of overweight and obesity.

Stronger regulation and legislative measures are needed at the EU and national level to protect children from unhealthy food marketing and advertising, notably in digital environments.

At the same time, local governments must be incentivized to take action that respond to the needs of their local contexts. Action at all levels must be co-created with youth, who have the lived experience of growing up in the current world.

Link measures to reduce childhood obesity to the ‘green’ agenda, and emerging movement to put wellbeing at the heart of policy making processes (Economy of Wellbeing), to address the negative externalities and system failures of current economic systems, not least of which childhood obesity.

Advance healthy and sustainable food systems by addressing food production, distribution, and consumption. Health metrics should be an intrinsic part of economic, investment and trade decisions related to food.

The proposed EU legislative framework for sustainable food systems is a significant step towards a multisectoral approach to address obesity. However, recent information that it has been stalled imply that it has taken a step back.

Mechanisms such as the European Semester, which is the EU process of economic and social policy coordination, can further encourage change by integrating an analysis of food system sustainability.

Promote ‘healthy-weight environments’ that support healthy food options, active travel, and physical activity. Local governments must be encouraged and enabled, through sufficient and effective tools and resources, to ensure environments that limit the sale ultra-processed foods, high in fat, salt and sugar, and provide access to adequate green space and safe active travel.

Local governments have a good understanding of and are best able to design and implement measures that respond to the needs and cultural preferences of their populations. It is also relatively easier, at local level, to engage in the cross-sectoral collaboration needed to achieve healthy-weight environments.

Nevertheless, other sectors may not see they have a role in supporting health. Public health actors at the local level must have the resources to engage other sectors, and to demonstrate how this engagement can also benefit them. Local data on health and health equity, and the associated costs of inaction, can be a powerful tool to generate engagement.

EU-level single market legislation needs to be reviewed and revised to ensure that these do not impose limits on national and sub-national level governments to take public health measures to make the healthy and sustainable food choice the easier choice (for instance through sugar taxes.)

Adopt a ‘whole-of-school’ approach that encourages schools to put health and wellbeing at the centre of school policies. This requires collaboration between the education and health sectors, community groups and other relevant sectors such as agriculture and urban planning.

Children and youth spend at least a third of their time in schools, where they consume a large part of their daily energy intake. It is therefore important that schools encourage healthy and balanced nutrition, as well as adequate movement. For most schools across Europe however, price is still the only criterion for the public purchase of food.

Governments at all levels should work together to establish minimum mandatory criteria for the procurement of food. These should cover health and dietary guidelines, and account for environmental impact, local circumstances and existing inequalities, among other things. Providing healthy food in schools can have a life-long impact on eating habits and can incentivise food systems to produce healthier and more sustainable food.

Regional policies and measures in schools and communities should be developed through collaboration between sectors, to ensure that policies align with social and cultural preferences and receive wide support.

Peoples’ diets are a product of the broader daily living conditions in which they are born, live, learn, work and age. Hence, those with a lower socioeconomic status, fewer years of education, insecure working conditions and poor living conditions are more likely to experience food insecurity, eat unhealthy diets and have higher levels of dietary-related diseases.

Indeed, the 2020 WHO health behaviour of school-aged children survey shows that 17% of children and adolescents in Europe in wealthier households have excess weight, compared to 25% of children in less wealthy households.

Following the principle of proportional universalism, policies that aim to promote healthier and more sustainable diets should reach everyone, but aim to ensure that those with greater needs can benefit the most. This approach will reduce health inequalities and reduce overall health costs.

Too often, it is easier for families with more resources to take up public health messaging and responses. Meanwhile, worse-off families benefit less, which worsens health inequalities. It is therefore also important to ensure that policies and measures do not rely on the choice or agency on the part of children or families, and that there is good community acceptance across all social groups.

Every initiative to reduce childhood obesity should also aim to reduce inequalities in obesity rates. For this, we need good monitoring systems across levels of government. It also requires the systematic use of Health Inequality Impact Assessments (HIIA) and Health Equity Audits (HEA) to understand the impacts of policies and measures.

To be able to rely on these tools, we need more investments to improve their capacity. This will pay off in the longer term, through the design and implementation of more effective measures that lead to an overall reduction in health costs.