• Overview
  • Obesity prevalence
  • Trends over time
  • Population breakdowns
  • Drivers
  • Comorbidities
  • Health systems
  • Actions
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Obesity prevalence

Adults, 2014

Survey type:Self-reported
Age:18+
Area covered:National
References:Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2008-2011

Survey type:Measured
Age:18-79
Sample size:7116
Area covered:National
References:G.B.M. Mensink. A. Schienkiewitz. M. Haftenberger. T. Lampert. T. Ziese. C. Scheidt-Nave. Overweight and obesity in Germany. Results of the German Health Interview and Examination Survey for Adults (DEGS1)Bundesgesundheitsbl 2013. DOI 10.1007/s00103-012-1656-3 (English supplement available online http://link.springer.com/article/10.1007%2Fs00103-012-1656-3 last accessed 28th May 2013)
Notes:NB. Combined adult data estimated. These estimates were calculated by weighting male and female survey results. Weighting based on World Bank Population % total female 2019 (https://data.worldbank.org/indicator/SP.POP.TOTL.FE.ZS - accessed 30.09.20)'
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2005-2007

Survey type:Measured
Age:18-80
Sample size:13207
Area covered:National
References:Federal Ministry of Food, Agriculture and Consumer Protection and Federal Research Institute of Nutrition and Food, Germany, Report of Results 2008 (http://www.bmelv.de/cln_045/nn_1196770/sharedDocs/downloads/03-Ernaehrung/NVS2/NVS_Ergebnisbericht,templateId=raw,property=publicationFile.pdf/NVS_Ergebnisbericht.pdf)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2002

Survey type:Measured
Age:25+
Sample size:3807
References:Helmert U, Strube H. Die Entwicklung der Adipositas in Desutschland im Zeitraum von 1985 bis 2002. Gesundheitswesesn 2004;66:409-415
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1991

Survey type:Measured
Age:25+
Sample size:7398
References:Helmert U, Strube H. Die Entwicklung der Adipositas in Desutschland im Zeitraum von 1985 bis 2002. Gesundheitswesesn 2004;66:409-415
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2014-2017

Survey type:Measured
Age:3-17
Sample size:3,567
Area covered:Regional
References:Schienkiewitz A, Damerow S and Rosario AS. 2018. Prävalenz von Untergewicht, Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland – Einordnung der Ergebnisse aus KiGGS Welle 2 nach internationalen Referenzsystemen. Journal of Health and Monitoring. 3(3). DOI 10.17886/RKI-GBE-2018-080
Notes:IOTF cut-offs used (WHO cut off data also available in paper)
Cutoffs:IOTF

Children, 2008

Survey type:Measured
Age:12-16
Sample size:5623
Area covered:National
References:Blüher S, Meigen C, Gausche R, et al. Age-specific stabilization in obesity prevalence in German children: a cross-sectional study from 1999 to 2008. Int J Pediatr Obes. 2011;6(2-2):e199-e206. doi:10.3109/17477166.2010.526305
Cutoffs:IOTF

Children, 2004

Survey type:Measured
Age:12-16
Sample size:8690
Area covered:National
References:Blüher S, Meigen C, Gausche R, et al. Age-specific stabilization in obesity prevalence in German children: a cross-sectional study from 1999 to 2008. Int J Pediatr Obes. 2011;6(2-2):e199-e206. doi:10.3109/17477166.2010.526305
Cutoffs:IOTF

Children, 2003-2006

Survey type:Measured
Age:5-17
Sample size:15662
Area covered:National
References:Kurth BM & Schaffrath RA. 2007. The prevalence of overweight and obese children and adolescent s living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt, 50: 736 - 743.
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3.
Cutoffs:IOTF

Children, 2002-2003

Survey type:Measured
Age:5-17
Sample size:12863
Area covered:National
References:Kurth & Schaffrath Rosario, The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), Bundesgesundheitsblatt 2007;
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3.
Cutoffs:IOTF

Children, 2000

Survey type:Measured
Age:12-16
Sample size:6689
Area covered:National
References:Blüher S, Meigen C, Gausche R, et al. Age-specific stabilization in obesity prevalence in German children: a cross-sectional study from 1999 to 2008. Int J Pediatr Obes. 2011;6(2-2):e199-e206. doi:10.3109/17477166.2010.526305
Cutoffs:IOTF

Children, 1992

Survey type:Measured
Age:5-6
Sample size:16281
References:Kalies H, Lenz J, von Kries R. Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997. International Journal of Obesity 2002;26:1211-1217
Notes:Sample size number included for the duration of the study from 1982 - 1997 Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3.
Cutoffs:IOTF

Children, 1982

Survey type:Measured
Age:5-6
Sample size:16281
References:Kalies H, Lenz J, von Kries R. Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997. International Journal of Obesity 2002;26:1211-1217
Notes:Sample size number included for the duration of the study from 1982 - 1997 IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3.
Cutoffs:IOTF

Overweight/obesity by age and education

Men, 2014

Survey type:Self-reported
Area covered:National
References:Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2014

Survey type:Self-reported
Area covered:National
References:Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Overweight/obesity by education

Men, 2014

Survey type:Self-reported
Age:18+
Area covered:National
References:Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 9 November 2016)
Notes:Total sample size in EU = 35100 (Age 18+) Less than primary, primary and lower secondary education (levels 0-2) Upper secondary and post-secondary non-tertiary education (levels 3 and 4) Tertiary education (levels 5-8)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2014

Survey type:Self-reported
Age:18+
Area covered:National
References:Eurostat Database:http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1e&lang=en (last accessed 9 November 2016)
Notes:Total sample size in EU = 35100 (Age 18+) Less than primary, primary and lower secondary education (levels 0-2) Upper secondary and post-secondary non-tertiary education (levels 3 and 4) Tertiary education (levels 5-8)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2008

Survey type:Self-reported
Age:18+
Area covered:National
References:EUROSTAT Database http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015)
Notes:Definitions are: levels 0-2 = pre-primary, primary and lower secondary education levels 3-4 = upper secondary and post-secondary non-tertiary education levels 5-6 = first and second stage of tertiary education
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2008

Survey type:Self-reported
Age:18+
Area covered:National
References:EUROSTAT Database http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015)
Notes:Definitions are: levels 0-2 = pre-primary, primary and lower secondary education levels 3-4 = upper secondary and post-secondary non-tertiary education levels 5-6 = first and second stage of tertiary education
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2012

Survey type:Measured
Age:3-6
Sample size:1217
Area covered:Subnational - Munich
References:Manios, Y. et al. (2018). Prevalence and sociodemographic correlates of overweight and obesity in a large Pan-European cohort of preschool children and their families: The ToyBox-study. Nutrition. 55-56 (p), pp.1-7.
Notes:IOTF International cut-offs used. Low Maternal education classed as <14 y of education. Medium/high Maternal education classed as >14 y of education.
Cutoffs:IOTF

Children, 2007-2008

Survey type:Measured
Age:2-9
Sample size:2194
Area covered:National
References:Ahrens W, Pigeot I, Pohlabeln H et al. Prevalence of overweight and obesity in European children below the age of 10. IJO 2014;38:S99-S107
Cutoffs:IOTF

Overweight/obesity by age

Adults, 2008-2011

Survey type:Measured
Sample size:7116
Area covered:National
References:G.B.M. Mensink. A. Schienkiewitz. M. Haftenberger. T. Lampert. T. Ziese. C. Scheidt-Nave. Overweight and obesity in Germany. Results of the German Health Interview and Examination Survey for Adults (DEGS1)Bundesgesundheitsbl 2013. DOI 10.1007/s00103-012-1656-3 (English supplement available online http://link.springer.com/article/10.1007%2Fs00103-012-1656-3 last accessed 28th May 2013)
Notes:Last reviewed 2nd November 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2005-2007

Survey type:Measured
Sample size:13207
Area covered:National
References:Federal Ministry of Food, Agriculture and Consumer Protection and Federal Research Institute of Nutrition and Food, Germany, Report of Results 2008 (http://www.bmelv.de/cln_045/nn_1196770/SharedDocs/downloads/03-Ernaehrung/NVS2/NVS__Ergebnisbericht, templateId=raw,property=publicationFile.pdf/NVS_Ergebnisbericht.pdf)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1998

Survey type:Measured
Sample size:7015
Area covered:National
References:Bergmann KE, Mensink GBM (1999) Korpermasse und Ubergewicht.Gesundheitswesen:62:S115-S120, kindly provided by Prof G Mensk
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2008

Survey type:Measured
Sample size:40625
Area covered:National
References:Bluher S, Meigen C, Fausche R, Keller E, Pfaffle R, Sabin M, Werther G, Odeh R, Kiess W. Age specific stabilization in obesity prevalence in German children: A cross sectional study from 1999 to 2008. IJPO 2010;Early online
Cutoffs:IOTF

Children, 2004

Survey type:Measured
Sample size:34649
Area covered:National
References:Bluher S, Meigen C, Fausche R, Keller E, Pfaffle R, Sabin M, Werther G, Odeh R, Kiess W. Age specific stabilization in obesity prevalence in German children: A cross sectional study from 1999 to 2008. IJPO 2010;Early online
Cutoffs:IOTF

Children, 2000

Survey type:Measured
Sample size:17757
Area covered:National
References:Bluher S, Meigen C, Fausche R, Keller E, Pfaffle R, Sabin M, Werther G, Odeh R, Kiess W. Age specific stabilization in obesity prevalence in German children: A cross sectional study from 1999 to 2008. IJPO 2010;Early online
Cutoffs:IOTF

Overweight/obesity by region

Children, 2003-2006

Survey type:Measured
Age:3-17
Sample size:14747
Area covered:National
References:Reinehr T, Holl RW, Wabitsch M. The German Working Group of Obesity in Childhood and Adolescence (AGA): Improving the Quality of Care for Overweight and Obese Children in Germany. Obesity Facts 2008 DOI:10.1159/000113405
Notes:See paper for cut off
Cutoffs:Other

Overweight/obesity by age and region

Men, 2014

Survey type:Self-reported
Area covered:National
References:Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1u&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2014

Survey type:Self-reported
Area covered:National
References:Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1u&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Overweight/obesity by age and socio-economic group

Adults, 2014

Survey type:Self-reported
Area covered:National
References:Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2014

Survey type:Self-reported
Area covered:National
References:Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2014

Survey type:Self-reported
Area covered:National
References:Eurostat http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 25.08.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Overweight/obesity by socio-economic group

Men, 2014

Survey type:Self-reported
Age:18+
Sample size:Total sample number in EU: 35100 (Age 18+)
Area covered:National
References:EUROSTAT Database: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 9 November 2016)
Notes:1st Quintile (lowest income), 5th Quintile (highest income) Please note where data = zero, there were insufficient data.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2014

Survey type:Self-reported
Age:18+
Sample size:Total sample number in EU: 35100 (Age 18+)
Area covered:National
References:EUROSTAT Database: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_ehis_bm1i&lang=en (last accessed 9 November 2016)
Notes:1st Quintile (lowest income), 5th Quintile (highest income) Please note where data = zero, there were insufficient data.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2008

Survey type:Self-reported
Age:18+
Area covered:National
References:EUROSTAT Database http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015)
Notes:SES assessed by annual income.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2008

Survey type:Self-reported
Age:18+
Area covered:National
References:EUROSTAT Database http://ec.europa.eu/eurostat/web/health/health-status-determinants/data/database# (last accessed 17th July 2015)
Notes:SES assessed by annual income.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2007-2008

Survey type:Measured
Age:2-9
Sample size:2194
Area covered:National
References:Ahrens W, Pigeot I, Pohlabeln H et al. Prevalence of overweight and obesity in European children below the age of 10. IJO 2014;38:S99-S107
Notes:SES assessed by annual income.
Cutoffs:IOTF

Children, 2003-2006

Survey type:Measured
Sample size:14747
Area covered:National
References:Kurth BM, Rosario AS. Die Berbreitung von Ubergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland. Bundesgesundheitsblt-Gesundheitsforsch-Gesundheitsschutz 2007;50:736-743
Notes:Low, medium & high socio-economic group based on Mother. Kromeyer-Hauschild Cut off 90th Percentile
Cutoffs:Other

Insufficient physical activity

Adults, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Men, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Women, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Children, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Boys, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Girls, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Sugar consumption

Adults, 2016

References:Source: Euromonitor International
Definitions:Sugar consumption (Number of 500g sugar portions/person/month)

Estimated per-capita sugar sweetened beverages intake

Adults, 2016

References:Source: Euromonitor International

Prevalence of at least daily carbonated soft drink consumption

Children, 2014

Survey type:Measured
References:World Health Organization. (2017). Adolescent obesity and related behaviours: Trends and inequalities in the who european region, 2002-2014: observations from the Health Behavior in School-aged Children (HBSC) WHO collaborative cross-national study (J. Inchley, D. Currie, J. Jewel, J. Breda, & V. Barnekow, Eds.). World Health Organization. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org
Notes:15-year-old adolescents
Definitions:Prevalence of at least daily carbonated soft drink consumption (% of at least daily carbonated soft drink consumption)

Prevalence of confectionery consumption

Adults, 2016

References:Source: Euromonitor International
Definitions:Prevalence of confectionery consumption (Number of 50g confectionery portions/person/month)

Prevalence of sweet/savoury snack consumption

Adults, 2016

References:Source: Euromonitor International
Definitions:Prevalence of sweet/savoury snack consumption (Number of 35g sweet/savoury snack portions/person/month)

Estimated per-capita fruit intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita fruit intake (g/day)

Prevalence of less-than-daily fruit consumption

Children, 2014

Survey type:Measured
References:Global School-based Student Health Surveys. Beal et al (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:Prevalence of less-than-daily fruit consumption (% less-than-daily fruit consumption)

Prevalence of less-than-daily vegetable consumption

Children, 2014

Survey type:Measured
Age:12-17
References:Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:Prevalence of less-than-daily vegetable consumption (% less-than-daily vegetable consumption)

Estimated per-capita processed meat intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita processed meat intake (g per day)

Estimated per-capita whole grains intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita whole grains intake (g/day)

Mental health - depression disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with depression disorders

Mental health - anxiety disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with anxiety disorders

Oesophageal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Breast cancer

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000

Colorectal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Pancreatic cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Gallbladder cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Kidney cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Cancer of the uterus

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000

Raised blood pressure

Adults, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Men, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Women, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Raised cholesterol

Adults, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Men, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Women, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Raised fasting blood glucose

Men, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Women, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Diabetes prevalence

Adults, 2017

References:Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org
Definitions:Diabetes age-adjusted comparative prevalence (%).

Health systems

Economic classification: High Income

Health systems summary

Germany has a health insurance system that is mandatory for all its citizens and permanent residents. The system is made up of two types of insurances: “sickness funds” through the statutory health insurance system and private health insurance. The latter is typically held by those with higher incomes who opt out of the statutory insurance and the self-employed, covering approximately 11% of the population. “Sickness funds”, on the other hand, are used by the majority (87%) and are financed by compulsory contributions by employees and employers. There are said be approximately 109 different “sickness funds” available, all of which cover non-earning dependents free of charge. As a result of this described system, Germany is considered to have universal health coverage for all legal residents. Out of pocket expenditure is considerably lower than European neighbours at 12.5% of total health spending in 2017.

Indicators

Where is the country’s government in the journey towards defining ‘Obesity as a disease’?Defined as disease
Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a disease’?Some progress
Is there specialist training available dedicated to the training of health professionals to prevent, diagnose, treat and manage obesity?No
Have any taxes or subsidies been put in place to protect/assist/inform the population around obesity?No
Are there adequate numbers of trained health professionals in specialties relevant to obesity in urban areas?Some progress
Are there adequate numbers of trained health professionals in specialties relevant to obesity in rural areas?No
Are there any obesity-specific recommendations or guidelines published for adults?Yes
Are there any obesity-specific recommendations or guidelines published for children?Yes
In practice, how is obesity treatment largely funded?Out of pocket

Perceived barriers to treatment

  • Lack of political will, interest and action
  • High cost of out of pocket payments
  • Influence of food industry
  • Fragmented or failing health system
  • Lack of training for healthcare professionals
  • Lack of multidisciplinary teams
  • Poor health literacy & behaviour
  • Obesogenic environment
  • Obesity not recognised as a disease

Summary of stakeholder feedback

In July 2020, the German Parliament officially recognised obesity as a chronic disease. Despite this, obesity prevention is considered to be neglected and underfunded, with the few initiatives available provided by health insurance companies. Additionally, the way in which health insurance companies address obesity differs between companies. While some insurers consider obesity to be a disease and act on this by covering some services, it was noted to be extremely variable because insurers were reluctant to provide care for financial reasons.

Stakeholders noted that most people living with obesity entered the system through primary care. Once in the system, it was felt that compliance to disease management was not sufficiently supported and there was inconsistency in referrals to local services. This, compounded by the poor financial coverage for obesity treatment and management, means that the majority receive insufficient care. It was agreed that there is too much variation in what insurers will cover, with coverage often extended to bariatric surgery only and few other treatment options. As a result, it appears that much treatment is paid for out of pocket.

Stakeholders felt that there are inadequate numbers of suitably qualified obesity treatment professionals in both urban and rural areas. Specifically, there is reportedly a lack of psychologists, specialist doctors and dieticians. It was recognised that while there are obesity guidelines, they are only partly followed due to lack of financing and training. It was reported that most obesity training is not mandatory for health professionals.

Based on interviews/survey returns from 3 stakeholders

Last updated: June 2020

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Actions

National Cycling Plan 2020 Ride your bike! (Nationaler Radverkehrsplan 2020 "FahrRad!")

The National Cycling Plan aims at highlighting cycling opportunities within the framework of an integrated transport policy. The main objective of the plan is to initiate new methods and implementation strategies for the promotion of cycling in Germany. The plan provides recommendations for action and aims at contributing towards creating a bicycle-friendly environment.

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2020 (ongoing)
Target age group:Adults and children
Organisation:Federal Ministry of Transport, Building and Housing
Linked document:Download linked document
References:National Cycling Plan 2020

Therapie und PrÃvention der Adipositas im Kindes- und Jugendalter

Clinical guidelines for prevention and treatment in children and adolescents in Germany

Categories:Evidence of Management/treatment guidelines
Year(s):2019 (ongoing)
Target age group:Children
Organisation:Working group Childhood and adolescent obesity (AGA) of the German Obesity Society (DAG)_x000D__x000D_ and the German Society for Children and Adolescent Medicine (DGKJ)
Find out more:www.awmf.org
References:Evidence-based (S3) guideline of the working group Childhood and adolescent obesity (AGA) of the German Obesity Society (DAG) and the German Society for Children and Adolescent Medicine (DGKJ)_x000D__x000D_ _x000D__x000D_ https://www.awmf.org/uploads/tx_szleitlinien/050-002l_S3_Therapie-Praevention-Adipositas-Kinder-Jugendliche_2019-11.pdf (last accessed 29.01.20)

2018 National reduction and Innovation strategy for Sugar, fats and salt in finished products

Information on the Sugar, fat and salt content of finished products will be provided as well as the energy content.

Categories:Industry/Government regulations - voluntary /pledges
Year(s):2018 (ongoing)
Target age group:Adults and children
Organisation:Bundesministerium fur Ernahrung und landwirtschaft
Find out more:www.bmel.de
Linked document:Download linked document
References:Bundesministerium fur Ernahrung und landwirtschaft. Nationale Reduktions- und_x000D__x000D_ Innovationsstrategie für Zucker, Fette und Salz in Fertigprodukten. Available from: https://www.bmel.de/SharedDocs/Downloads/Ernaehrung/NationaleReduktionsInnovationsstrategie-Layout.pdf?__blob=publicationFile [accessed 31 july 2019].

Current Guidelines to Prevent Obesity in Childhood and Adolescence

Reccomendations by the 'German Alliance of Non-communicable Diseases' include one hour of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory quality standards for meals at kindergarten and schools as well as a ban on unhealthy food advertisement addressing children.

Categories:Evidence of Management/treatment guidelines
Categories (partial):Evidence of National Obesity Strategy/Policy or Action
Year(s):2016 (ongoing)
Target age group:Children
Organisation:German Alliance of Non-communicable Diseases
Find out more:www.ncbi.nlm.nih.gov
Linked document:Download linked document
References:Blüher S, Kromeyer-Hauschild K, Graf C, Grünewald-Funk D, Widhalm K, Korsten-Reck U, Markert J, Güssfeld C, Müller MJ, Moss A, Wabitsch M, Wiegand S. Current Guidelines to Prevent Obesity in Childhood and Adolescence. Klinische Padiatrie. 228 (1) pp. 1-10.

Join the Health Boat

Kindergarten and pre-school targeted intervention aiming to increase fruit and vegetable intake and physical activity and decrease sugar sweetened beverages and total screen time.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Physical Activity Guidelines/Policy
Evidence of Community Interventions/Campaign
Year(s):2016-2017
Target age group:Children
Organisation:"Baden-WÃrttemberg Foundation"
Find out more:www.gesundes-boot.de
Linked document:Download linked document
References:https://www.gesundes-boot.de/kindergarten/gesundheitsstudie-2017/

White paper on obesity 2016

White paper on obesity [article in german].

Categories (partial):Non-national obesity strategies
Year(s):2016 (ongoing)
Target age group:Adults and children
Organisation:S.Klien et al
Find out more:www.iges.com
Linked document:Download linked document
References:S.Klien et al. Weißbuch adipositas versorgungssituation Deutschland. 2016 Available from: https://www.iges.com/presse/2016/weissbuch-adipositas/e14613/e14614/attr_objs14616/Weissbuch_Adipositas_Klein_et_al_ger.pdf. Accessed 31 July 2019.

2014 - Interdisziplinare Leitlinie der Qualitat S3 zur â Pravention und Therapie der Adipositas✠( Interdisciplinary guideline of quality S3 for Prevention and treatment of obesity)

Interdisciplinary guideline of quality S3 for Prevention and treatment of obesity [article in german]

Categories (partial):Evidence of Management/treatment guidelines
Non-national obesity strategies
Year(s):2014 (ongoing)
Target age group:Adults and children
Organisation:Deutsche Adipositas-Gesellschaft (DAG)
Find out more:www.adipositas-gesellschaft.de
Linked document:Download linked document
References:Deutsche Adipositas-Gesellschaft (DAG). 2014. Interdisziplinäre Leitlinie der Qualität S3 zur_x000D__x000D_ „Prävention und Therapie der Adipositas“. Available from: https://www.adipositas-gesellschaft.de/fileadmin/PDF/Leitlinien/S3_Adipositas_Praevention_Therapie_2014.pdf [accessed August 2019]

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

Categories:Transnational Obesity Strategies/Policy or Action Plan
Year(s):2014-2020
Target age group:Children
Organisation:Ministry of Health
Find out more:ec.europa.eu
Linked document:Download linked document
References:EU Action Plan on Childhood Table of contents [Internet]. Available from: https://ec.europa.eu/health/sites/health/files/nutrition_physical_activity/docs/childhoodobesity_actionplan_2014_2020_en.pdf &amp;amp;amp;amp;amp;amp;amp;zwnj;

Guidelines for prevention and treatment of obesity ("InterdisziplinÃre Leitlinie der Qualitt S3 zur "PrÃvention und Therapie der Adipositasâœ)

Evidence-based guideline on the prevention and treatment of obesity, aiming to improve the perception of the health problem of obesity,and give specific information and recommendations on prevention.

Categories:Evidence of National Obesity Strategy/Policy or Action
Evidence of Management/treatment guidelines
Year(s):2014 (ongoing)
Target age group:Adults and children
Organisation:Deutsche Adipositas Gesellschaft
Find out more:www.adipositas-gesellschaft.de
Linked document:Download linked document
References:Deutsche Adipositas Gesellschaft (2014). Interdisziplinäre Leitlinie der Qualität S3 zur_x000D__x000D_ „Prävention und Therapie der Adipositas“. Available from: https://www.adipositas-gesellschaft.de/fileadmin/PDF/Leitlinien/S3_Adipositas_Praevention_Therapie_2014.pdf. [Accessed 14 December 2018].

Ten guidelines for wholesome eating and drinking from the German Nutrition Society

These guidelines aim to help people enjoy eating and maintaining a balanced diet.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2013 (ongoing)
Target age group:Adults and children
Organisation:German Nutrition Society
Find out more:www.dge.de
Linked document:Download linked document

Let's go - every step counts

Promotes physical activity through health hiking courses and a campaign to collect kilometres walked during one year to earn a hiking badge.

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2010 (ongoing)
Target age group:Adults and children
Organisation:The German Hiking Association (Deutscher Wanderverband)
Find out more:www.gesundheitswanderfuehrer.de

Obesity Surgery guidelines (S3-Leitlinie: Chirurgie der Adipositas)

Guidelines which expand and specifies surgical aspects of obesity therapy used in the_x000D__x000D_ Guideline of the German Obesity Society (DAG) "Prevention and Therapy of the_x000D__x000D_ Obesity ".

Categories:Evidence of Management/treatment guidelines
Year(s):2010 (ongoing)
Target age group:Adults and children
Organisation:Deutsche Gesellschaft Fur Algemein und Viszeralchirurgie
Find out more:www.adipositas-gesellschaft.de
Linked document:Download linked document
References:Deutsche Gesellschaft Fur Algemein und Viszeralchirurgie. Deutsche Adipositas-Gesellschaft (DAG) Deutsche Gesellschaft fur Psychosomatische Medizin und Psychotherapie Deutsche Gesellschaft fur Ernahrungsmedizin. S3-Leitlinie: Chirurgie der Adipositas.

Healthy Start â Young Family Network

The main aim of this network is to support pregnant women and young parents by providing uniform information on nutrition, physical activity and allergy prevention. The network publishes and regularly updates recommendations on nutrition and physical activity in infants and young children and during pregnancy. Dissemination of information is via face-to-face training of health professionals, development and distribution of materials and media such as flyers, stickers, posters, and apps, as well as an extensive PR work.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2009 (ongoing)
Target age group:Adults and children
Organisation:Healthy Start Young Family Network is part of the Federal Centre for Nutrition as well as of the National Action Plan IN FORM (Germany's initiative to promote healthy diets and physical activity)
Find out more:www.gesund-ins-leben.de
Linked document:Download linked document

Fit In Seniority â Healthy Eating, Better Living

Promoting a healthy lifestyle for older people through information about healthy nutrition, physical activity and social interaction.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Physical Activity Guidelines/Policy
Year(s):2008 (ongoing)
Target age group:Adults
Organisation:German Association for Nutrition (DGE) and the Federal Association of Elderly Organisation (BAGSO).

Guide to Prevention and Health Promotion (Ratgeber zur PrÃvention und GesundheitsfÃrderung)

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2008 (ongoing)
Target age group:Adults and children
Organisation:Federal Ministry of Health
Find out more:www.bundesgesundheitsministerium.de
Linked document:Download linked document

IN FORM: Deutschlands Initiative fÃr gesunde ErnÃhrung und mehr Bewegung, or Initiative for healthy nutrition and physical activity

The overall aim of INFORM is to promote healthy diets, physical activity and reduce obesity

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Physical Activity Guidelines/Policy
Year(s):2008 (ongoing)
Target age group:Adults and children
Organisation:The Federal Ministry of Health and the Federal Ministry of Food, Agriculture and Consumer Protection
Find out more:www.in-form.de
References:The Federal Ministry of Health and the Federal Ministry of Food, Agriculture and Consumer Protection

KITA Vital

"KITA Vital" is an action for health-promoting children's day care facilities in the Rhein-Sieg district. The implementation is carried out by the association kivi in collaboration with the Health Office of the Rhein-Sieg-Kreis.

Categories:Evidence of Community Interventions/Campaign
Year(s):2008 (ongoing)
Target age group:Children
Organisation:Kivi association
Find out more:kivi-ev.de

Fit50+

Aims at improving the general working ability among unemployed. Core elements are healthy living and eating, physical activity and coping.

Categories (partial):Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2007 (ongoing)
Target age group:Adults
Organisation:RegioVision GmbH developed the modules, modification and optimization between 2007 and 2010 with the Institute for Preventive Medicine, University of Rostock.
Find out more:www.gesundheitliche-chancengleichheit.de

IDEFICS Delmenhorst

This intervention focuses on diet and physical activity of children in kindergartens and schools.

Categories (partial):Evidence of Community Interventions/Campaign
Year(s):2007-2012
Target age group:Children
Organisation:The IDEFICS study is co-ordinated by the Bremen Institute for Prevention Research and Social Medicine, University of Bremen, in Germany.
Find out more:www.ideficsstudy.eu

The JuvenTUM project; physical education program on physical activity, fitness, and health in children

A prospective study assessing eight Bavarian primary schools (n=724 children) randomized one to one to either an intervention school (427) or a control school (297). Children in the intervention school attended 10 health-related lessons at school over 1 year and their parents and teachers attended 2 and 3 educational health-related lessons,respectively, and received 10 newsletters on health issues. Daily physical activity, physical fitness, and anthropometric data were then obtained.

Categories (partial):Evidence of Community Interventions/Campaign
Year(s):2006-2007
Target age group:Children
Organisation:Siegrist et al. 2013.
Find out more:www.ncbi.nlm.nih.gov
Linked document:Download linked document
References:Siegrist et al. 2013. Effects of a physical education program on physical activity,fitness, and health in children: The JuvenTUM project. Scand J Med Sci Sports. 23. pp. 323–330.

Fit am Ball

Fit Am Ball is a collaboration between schools and sports clubs to promote ball games, especially football, in extracurricular activities. The national scheme started in 2003 and targets children in grades 3-6.

Categories:Evidence of Community Interventions/Campaign
Year(s):2005 (ongoing)
Target age group:Children
Organisation:The Institute for Social and Cultural Hermeneutic Research (ISK) in Frankfurt
Find out more:www.fitamball.de
References:Information provided with kind permission of HEPA Europe (European network for the promotion of health-enhancing physical activity): http://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/activities/hepa-europe

Germany becomes fit , join us (Deutschland wird fit, Gehen Sie mit)

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2005 (ongoing)
Target age group:Adults and children
Organisation:Ministry of Health
Find out more:deutschland.wirdfit.de
References:Information provided with kind permission of HEPA Europe (European network for the promotion of health-enhancing physical activity): http://data.euro.who.int/PhysicalActivity/?TabID=107126

Peb Online

The Platform Nutrition and Exercise eV (peb) is an open alliance with numerous members from the public sector, science, business, sport, health care and civil society. At peb, they are all actively committed to a balanced diet and regular and sufficient exercise as essential components of a health-promoting lifestyle for children and adolescents. Many documents and links available on website.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Physical Activity Guidelines/Policy
Evidence of Community Interventions/Campaign
Target age group:Children
Organisation:Die Plattform Ernährung und Bewegung e.V.
Find out more:www.pebonline.de

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