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Care pathway guide: overweight and obesity in adults

This guide describes the care, support and overall follow-up of adults with overweight or obesity. It reasserts the importance of early identification, coupled with a lifestyle assessment. It details the role of professionals (health, social and medico-social field, adapted physical activity, occupational health) and looks at the situations in which the person’s primary care physician may consult them.

Commercial Determinants of Noncommunicable Diseases in the WHO European Region

This report highlights the substantial impact of commercial determinants on noncommunicable diseases (‎NCDs)‎ in the WHO European Region. Nearly 7500 deaths per day in the Region are attributed to commercial determinants, such as tobacco, alcohol,processed food, fossil fuels and occupational practices. These commercial products and practices contribute to 25% of all deaths in the Region. The report’s chapters systematically explore various facets of how commercial interests exacerbate NCDs and key strategies used by commercial actors to negatively influence NCD-related policies at the national and international level. The reportalso provides selected case studies from the Region to illustrate key strategies and outcomes of industry influence on health policies.The report then calls for urgent and coordinated action to address the commercial determinants of NCDs. It advocates for building coalitions based on the values of equity, sustainability, and resilience. Public health actors are urged to develop competencies in economic and legal frameworks, enforce transparency, and manage conflicts of interest effectively. The report underscores the need for robust financial reforms and strict regulation to curb industry power and protect public health. By implementing these strategies, the Region can accelerate progress towards global NCD targets and Sustainable Development Goals by 2030.

JA PreventNCD

Joint Action to Prevent Non-Communicable Diseases and Cancer (JA Prevent NCD) is a three year project funded by the EUforHealth 2021-2027 programme. It is designed to reduce the burden of cancer and NCDs across Europe by supporting member states (22 EU member states and Iceland, Norway, and Ukraine) to implement effective prevention strategies by focusing on both personal and societal risk factors. The project aims to reduce fragmentation and duplication of actions.

PNNS Training

Cnam-ISTNA offers a range of training programmes, in conjunction with PNNS, to improve knowledge of nutrition and physical activity and develop skills to develop or lead nutritional projects. The programmes are intended for health and social work professionals, dietitians, association leaders, community stakeholders, childminders, businesses and employees.

Care pathway guide: overweight and obesity in children and adolescents

This guide updates the good practice guidelines "Overweight and obesity in children and adolescents" published in 2011. This guide describes the care, support and medical follow-up of children/adolescents with overweight or obesity. It reasserts the importance of early identification, coupled with a lifestyle assessment. It details the role of each of the professionals involved in the care pathway, and looks at the situations in which they may be called upon.

PNNS Charter

The new PNNS charter of commitments was launched in 2023. It contains commitments to promote healthy food and physical activity for municipalities, departments, private or public companies businesses and associations. This may involve health education, nutrition training, improving food supply, and providing opportunities for physical activities. Companies and communities that commit to the PNNS charter receive a PNNS logo. Signatories can be based in mainland France and/or overseas territories. (Document only available in French)

Specialised Obesity Centres (CSOs)

Specialised obesity care centres (CSOs) are responsible for providing multidisciplinary care for people with severe and/or complex obesity. There are 37 CSOs located in mainland France and overseas (Guadeloupe, La Réunion and Martinique) attached to public and private healthcare institutions.

Ten-Year Cancer Strategy 2021-2030

The ten-year cancer strategy aims to reduce preventable cancers and increase screenings. It focuses on improving prevention and screening, limiting after-effects, fighting cancers with a poor prognosis, and ensuring progress benefits everyone. One of its objectives to improve prevention is to reduce overweight prevalence by 20% in adults and 30% in children by 2030. (Document in French)

Strasbourg - Cities for Better Health

Strasbourg joined the Cities for Better Health programme in 2020, aiming to prevent diabetes and obesity, especially in children and vulnerable groups. The city has developed physical activity programmes for schools and adults, and installed greenhouses for nutrition education.

Towards sustainable food: A major health, social, territorial and environmental issue for France

Government report outline strategies for sustainable food. Both a short 20 point brief and full report are available.

2019 Recommendations for eating, physical activity and physical inactivity for adults

Recommendations for adults on diet and physical activity (& inactivity), taking into consideration the population's knowledge, behaviour and beliefs.

Annex III to Regulation (EC) No 1925/2006 of the European Parliament and of the Council as regards trans fat, other than trans fat naturally occurring in fat of animal origin

Measures to limit or virtually eliminate industrially-produced trans fatty acids in food intended for the final consumer and/or for supply to retail. Adopted by The European Commission from April 2019. (Available in multiple languages)

European practical and patient-centred guidelines for adult obesity management in primary care

This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected.

Multidisciplinary educational healthcare circuit for bariatric surgery in France.

Educational healthcare circuit for bariatric surgery which offers a multidisciplinary approach based on medical, psychological and dietetic expertise to combat obesity proves to be a feasibile alternative to usual care in France.

National Council for Collective Catering (CNRC)

The CNRC was set up in 2019 to monitor obligations set by the EGAlim law and the Climate and Resilience law to ensure that at least 50% of food served in collective catering is high-quality and sustainable, including at least 20% organic products. In 2024, another commitment was made to ensure that 60% of products in the “meat” and “fish” categories are high-quality and sustainable.

National Nutrition and Health Programme (PNNS) 2019-2023

The National Nutrition and Health Programme, originally launched in 2001, aims to improve the health of the French population through nutrition and physical activity. The 4th PNNS outlines key strategies to achieve this goal over the 2019 to 2023 period, including improving the nutritional quality of food, reducing marketing pressure, promoting active transport, supporting food education and physical activity in schools, improving healthcare for obesity, and promoting breastfeeding.. It sets specific objectives to reduce the prevalence of obesity in adults by 15% and stabilise the prevalence of overweight, and to reduce the prevalence of overweight and obesity in children and adolescents by 20%. (Available in French and English)

National Sport Health Strategy 2019-2024

This strategy aims to improve the health of the French population by promoting physical activity and sport for everyone, on a daily basis, at all times of life.

Obesity Management 2019-2022 Roadmap

Roadmap which aims to aims to structure and implement coordinated and graded health care programs that are suitable for those who are obese or at risk of becoming obese. particularly to reduce inequalities of access to care and improve the quality of care.

The French National Nutrition and Health Program

In France, the recommendations on diet and physical activity are elaborated and disseminated by the public health authorities since the implementation of the first National Nutrition and Health Program (PNNS) in 2001. The first official FBDGs were published in 2002 for adults, in 2004 for children, in 2006 for the elderly, and in 2008 for pregnant women. The revised version of the guidelines for adults was published in 2019. The new guidelines for children from birth to 17 years old and adolescents will be published in 2021. Other revised guidelines for elderly and pregnant women will be published in 2022.

National Health Strategy 2018-2022

National strategy aiming to reduce chronic diseases and their consequences, promote a healthy lifestyle, and ensure the health system is adapting to demographic, epidemiological and societal challenges amongst other goals. (Summary available in English)

Priority on Prevention: Staying healthy for life

The Priority Prevention plan is an intersectoral project to improve the health of the population by addressing the determinants of health across all stages of life. It aims to reduce avoidable premature death, and is part of the National Health Strategy 2018-22. (Document in English)

The effect of the French vending machine ban on school snacking and sugar intake

This study found that the vending machine ban generated a 10g reduction in sugar intakes from morning snacks at school, and a significant reduction in their frequency. However, they found no evidence that the ban affected total daily intakes, suggesting compensation effects.

Update on Soda Tax

The new tax, which is part of the government's 2018 Social Security budget, is an update of the initial "soda tax" that was brought in in 2013 whereby fizzy drinks with added sugar was taxed at €7.5 euros a hectolitre (equal to 100 litres). A sliding scale tax will be introduced in 2018 for drinks that contain 1g of sugar per 100ml. It will rise to the point where the most sugary drinks will be taxed at €20 a hectolitre for drinks that contain more than 11g of sugar per 100ml.

Ban on unlimited sugary drink refills

The Order of 18 January 2017 prohibits the provision of unlimited drinks, free or for a fixed price, with the addition of sugars or artificial sweeteners. Restaurants and other spaces catering to the public in France have been banned from offering unlimited sugary drinks in an effort to reduce obesity.

Nutri-score Labelling

The French government signed a decree backing the voluntary adoption of the 'Nutri-Score' front-of-pack nutritional labelling scheme (31 October 2017).

School Fruit, Vegetables and Milk Scheme

"Applicable since 1 August 2017, the EU school fruit, vegetables and milk scheme combines two previous schemes (the school fruit and vegetables scheme and the school milk scheme) under a single legal framework for more efficiency and an enhanced focus on health and educational. The scheme supports the distribution of products, educational measures and information measures. The scheme supports the distribution of fruit, vegetables, milk and certain milk products to schoolchildren, from nursery to secondary school. EU countries approve a list of products (in collaboration with their health and nutrition authorities) which will help achieve the schemes objective of helping children to follow a healthy diet. Priority is for fresh fruit and vegetables and for plain milk. In order to support a varied diet and/or specific nutritional needs, EU countries may also make processed fruit and vegetables such as juices and soups and certain milk products such as yoghurt and cheese, available. Additionally, under stricter conditions, milk-based drinks may be included." - EU Commission

The Public Health Act

There is a ban on unlimited offers of sweetened beverages for free or at a fixed price in schools, public restaurants and any facility used to teach, accommodate or receive children under the age of 18.

ePPOP- Electronic-personalized program for obesity during pregnancy

ePPOP is an electronic-personalised lifestyle intervention combining nutritional, behavioural and physical activity counselling during pregnancy, to reduce instrumental delivery and improve health of obese pregnant women and their babies.

GNPR 2016-2017: Infant and young child nutrition - Breastfeeding promotion and/or counselling

This programme was reported by countries for the 2nd WHO Global Nutrition Policy Review 2016-2017 module on actions related to infant and young child nutrition. Information provided by WHO GINA Programme.

Physical activity strategy for the WHO European Region 2016-2025

The strategy focuses on physical activity as a leading factor in health and well-being in the European Region, with particular attention to the burden of non-communicable diseases associated with insufficient activity levels and sedentary behaviour. It aims to cover all forms of physical activity throughout the life-course.

The European Food and Nutrition Action Plan 2015-2020

The aim on this action plan is to significantly reduce the burden of preventable diet-related non-communicable diseases, obesity and all other forms of malnutrition that are still prevalent in the WHO European Region.

Charter for the Promotion of Healthy Diets and Physical Activity during TV Programmes and Advertising (updated version)

Food charter that aims to promote a healthy diet on television. Note that the charter was updated in 2013 and applicable from 1 Jan 2014.

European Union (EU) Action Plan on Childhood Obesity 2014-2020

EU Action plan. To contribute to halting the rise in overweight and obesity in children and young people (0-18 years) by 2020

EU Regulation 1169/2011

Passed in 2011, EU Regulation 1169/2011 on the Provision of Food Information to Consumers requires a list of the nutrient content of most pre-packaged food to be provided on the back of the pack from October 2011.

Evaluation of the EU school milk and fruit scheme

This report found that the EU School Milk Scheme has had a very limited real impact on schools, and makes recommendations based on its shortcomings for the EU School Fruit Scheme.

French National Nutrition and Health Program 2011-2015 (PNNS)

The PNNS involves the ministries in charge of national education, sports, consumer affairs, social cohesion, and higher education and research to promote healthy eating as part of the nutritional prevention.

Promotion of physical activity in the Youth (Promouvoir lâ activite physique des jeunes)

School meal standards Decree No. 2011-1227

Decree No. 2011-1227 set mandatory nutritional standards on schools meals and nutrient content regulations in France.

Education statement on TV advertising

TV advertising of food or drink of low nutiritonal value must be accompanied by a speicific health education statement approved by the National Institute of Health Education

EU health and nutrient claims regulation

Regulation nº 1924/2006 establishes EU-wide rules on the use of specified health and nutrient claims. The European Commission approves claims provided they are based on scientific evidence and accessible consumers. The European Food Safety Authority is responsible for evaluating the scientific evidence supporting health claims. Nutrition claims may only be used on food defined as "healthy" by a nutrient profile.

Second national nutrition and health programme 2006-2010 (PNNS)

The main role of the PNNS is to encourage various public and private sector players to act, by providing cohesive guidelines, references, government-designed tools and a framework for permanent dialogue.

Eat and Move for Health (La sante vient en mangeant et en bougeant)

Guidelines on nutrition and physical activity - document in French

Law regarding the public health policy (Law no 2004-806)

The law of August 9, 2004, marked a new era with a step in a new direction for defining a process to develop health policy in France. The five-year law provided a framework to formalize public health objectives. Health policy was articulated around four ambitions: improvement of health outcomes, reduction of inequalities, efficiency of the health system, and the advancement of health democracy.

The Public Health Act of 2004

"The Public Health Act of 2004, through the implementation of the Second National Nutrition and Health Programme, comprises two articles concerning food advertisements and the banning of food vending machines in schools. The first article stipulates that television and radio commercials for beverages with added sugar, salt or artificial sweeteners and manufactured food products must contain the following health messages: “For the sake of your health, do not eat foods that contain too much fat, sugar or salt”; “For the sake of your health, eat at least five servings of fruit and vegetables every day”; “For the sake of your health, avoid eating snacks”; and “For the sake of your health, do regular physical exercise”. The same obligation applies to the promotion of these beverages and food products (however, advertisers can avoid this by paying a tax equal to 1.5% of the annual amount they pay for advertising these types of product)" - WHO

EPODE (Together Let’s Prevent Childhood Obesity)

"EPODE (Together Let’s Prevent Childhood Obesity) is a methodology designed to involve all relevant local stakeholders in an integrated and concrete prevention program aimed at facilitating the adoption of healthier lifestyles in the everyday life. The programmes developed on the basis of the EPODE framework are long term, aimed at changing the environment and thereby the unhealthy behaviours. The approach is ‘positive, concrete and stepwise’ learning process with no stigmatization of any culture, food habits, overweight and obesity. The first EPODE programme was started in France in the 2003 and EPODE now extends to nearly 1,8 million inhabitants in 167 French cities, 20 cities in Spain and 8 cities in Belgium."

Multidisciplinary approach to treat childhood obesity based on multicomponent lifestyle interventions and family-based actions

Study assessing the short term and long term impact of paediatric obesity care management offered by nine French regional health networks which is based on multi-component lifestyle interventions.

Health comes through eating (La sante vient en mangeant)

Nutrition programme - see document in French

ICAPS (Intervention Centred on Adolescents' Physical activity and Sedentary behaviour)

"The ‘Intervention centred on adolescents' physical activity and sedentary behaviour’ (ICAPS) was designed to reduce weight gain and, as an underlying objective, cardiovascular risk in adolescents of eastern France. It is aimed at improving lifelong PA patterns by implementing a programme that motivates and enables adolescents to use opportunities for PA inside and outside school, and also by providing social support and an environment that encourage them towards PA during everyday life and leisure."

National programme for nutrition and health 2001-2005 (PNNS)

A programme containing 9 nutritional objectives to improve the health of the general population.

Active cities

Aims to create a favourable environment for good nutrition in municipalities.

NCD targets for France

• Reduce obesity by 15% and stabilise overweight in adults by 2023 • Reduce overweight and obesity in children and teenagers by 20% by 2023