Skip to main content Accessibility help

Assessment of evaluations made to healthy eating policies in Europe: a review within the EATWELL Project

  • Federico JA Pérez-Cueto (a1), Jessica Aschemann-Witzel (a2), Bhavani Shankar (a3) (a4), José Brambila-Macias (a3), Tino Bech-Larsen (a2), Mario Mazzocchi (a5), Sara Capacci (a5), Anna Saba (a6), Aida Turrini (a6), Barbara Niedzwiedzka (a7), Beata Piorecka (a7), Agniezska Kozioł-Kozakowska (a7), Josephine Wills (a8), W Bruce Traill (a3) and Wim Verbeke (a1)...

To identify and assess healthy eating policies at national level which have been evaluated in terms of their impact on awareness of healthy eating, food consumption, health outcome or cost/benefit.


Review of policy documents and their evaluations when available.


European Member States.


One hundred and twenty-one policy documents revised, 107 retained.


Of the 107 selected interventions, twenty-two had been evaluated for their impact on awareness or knowledge and twenty-seven for their impact on consumption. Furthermore sixteen interventions provided an evaluation of health impact, while three actions specifically measured any cost/benefit ratio. The indicators used in these evaluations were in most cases not comparable. Evaluation was more often found for public information campaigns, regulation of meals at schools/canteens and nutrition education programmes.


The study highlights the need not only to develop harmonized and verifiable procedures but also indicators for measuring effectiveness and success and for comparing between interventions and countries. EU policies are recommended to provide a set of indicators that may be measured consistently and regularly in all countries. Furthermore, public information campaigns should be accompanied by other interventions, as evaluations may show an impact on awareness and intention, but rarely on consumption patterns and health outcome.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Assessment of evaluations made to healthy eating policies in Europe: a review within the EATWELL Project
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Assessment of evaluations made to healthy eating policies in Europe: a review within the EATWELL Project
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Assessment of evaluations made to healthy eating policies in Europe: a review within the EATWELL Project
      Available formats
Corresponding author
*Corresponding author: Email
Hide All
1. Bundred, P, Kitchiner, D & Buchan, I (2001) Prevalence of overweight and obese children between 1989 and 1998: population based series of cross sectional studies. BMJ 322, 326328.
2. Romon, M, Duhamel, A, Collinet, N et al. (2005) Influence of social class on time trends in BMI distribution in 5-year-old French children from 1989 to 1999. Int J Obes (Lond) 29, 5459.
3. World Health Organization (2007) The Challenge of Obesity in the WHO European Region and the Strategies for Response. Copenhagen: WHO Regional Office for Europe.
4. Lobstein, T & Millstone, E (2007) Context for the PorGrow study: Europe's obesity crisis. Obes Rev 8, Suppl. 2, 716.
5. Elmadfa, I (2009) European Nutrition and Health Report 2009 executive summary introduction. Ann Nutr Metab 55, 340.
6. Perez-Cueto, FJA, Verbeke, W, de Barcellos, MD et al. (2010) Food-related lifestyles and their association to obesity in five European countries. Appetite 54, 156162.
7. The Strategy Unit, Cabinet Office (2008) Food Matters. Towards a Strategy for the 21st Century. London: Cabinet Office.
8. Yu, AP, Wu, EQ, Birnbaum, HG et al. (2007) Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data. Curr Med Res Opin 23, 21572169.
9. Goldman, D, Michaud, PC, Lakdawalla, D et al. (2010) The fiscal consequences of trends in population health. Nat Tax J 63, 307330.
10. World Health Organization (2003) Comparative Analysis of Food and Nutrition Policies in WHO European Member States. Copenhagen: WHO Regional Office for Europe.
11. World Health Organization (2008) WHO European Action Plan for Food and Nutrition Policy 2007–2012. Copenhagen: WHO Regional Office for Europe.
12. Lachat, C, Van Camp, J, De Henauw, S et al. (2005) A concise overview of national nutrition action plans in the European Union Member States. Public Health Nutr 8, 266274.
13. Luttikhuis, HO, Baur, L, Jansen, H et al. (2009) Interventions for treating obesity in children. Cochrane Database Syst Rev issue 1, CD001872.
14. Sharma, M (2007) Behavioural interventions for preventing and treating obesity in adults. Obes Rev 8, 441449.
15. Sharma, M (2006) School-based interventions for childhood and adolescent obesity. Obes Rev 7, 261269.
16. Bluford, DAA, Sherry, B & Scanlon, KS (2007) Interventions to prevent or treat obesity in preschool children: a review of evaluated programs. Obesity (Silver Spring) 15, 13561372.
17. Burris, S, Wagenaar, AC, Swanson, J et al. (2010) Making the case for laws that improve health: a framework for public health law research. Milbank Q 88, 169210.
18. Traill, WB, Perez-Cueto, FJA, Shankar, B et al. (2010) EATWELL Project: approaching European healthy eating policies from a multi-disciplinary perspective. Nutr Hosp 25, 867868.
19. World Health Organization (2004) Global Strategy on Diet, Physical Activity and Health. Geneva: WHO.
20. De Bourdeaudhuij, I, Van Cauwenberghe, E, Spittaels, H et al. (2011) School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obes Rev 12, 205216.
21. Kristjansdottir, AG, De Bourdeaudhuij, I, Klepp, KI et al. (2009) Children's and parents’ perceptions of the determinants of children's fruit and vegetable intake in a low-intake population. Public Health Nutr 12, 12241233.
22. Finkelstein, E, Fiebelkorn, IC & Wang, GJ (2005) The costs of obesity among full-time employees. Am J Health Promot 20, 4551.
23. Story, M, Kaphingst, KM, Robinson-O'Brien, R et al. (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29, 253272.
24. Kumanyika, SK, Obarzanek, E, Stettler, N et al. (2008) Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science). Circulation 118, 428464.
25. Mazzocchi, M & Traill, WB (2005) Nutrition, health and economic policies in Europe. Food Econ – Acta Agric Scand, Section C 2, 138149.
26. Puska, P (2009) Fat and heart disease: yes we can make a change – the case of North Karelia (Finland). Ann Nutr Metab 54, 3338.
27. Ashfield-Watt, PAL, Welch, AA, Day, NE et al. (2004) Is ‘five-a-day’ an effective way of increasing fruit and vegetable intakes? Public Health Nutr 7, 257261.
28. Ashfield-Watt, PAL (2006) Fruits and vegetables, 5+ a day: are we getting the message across? Asia Pacific J Clin Nutr 15, 245252.
29. Ashfield-Watt, PAL, Welch, AA, Godward, S et al. (2007) Effect of a pilot community intervention on fruit and vegetable intakes: use of FACET (Five-a-day Community Evaluation Tool). Public Health Nutr 10, 671680.
30. Myint, PK, Welch, AA, Bingham, SA et al. (2007) Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer–Norfolk (EPIC-Norfolk): a population-based cross-sectional study. Public Health Nutr 10, 3441.
31. Borys, JM, Romon, M & Raffin, S (2007) Long term outcomes of a successful childhood obesity prevention program in France: FLVS (Fleurbaix Laventie Ville Sante). Int J Obes (Lond) 31, Suppl. 1S, S200 (abstract).
32. Romon, M, Lommez, A, Tafflet, M et al. (2009) Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes. Public Health Nutr 12, 17351742.
33. Capacci, S & Mazzocchi, M (2011) Five-a-day, a price to pay: an evaluation of the UK program impact accounting for market forces. J Health Econ 30, 8798.
34. Świątkowska, M (2009) Advertising of product categories as a tool to support the development of dairy sector in Poland. Roczniki Naukowe Stowarzyszenia Ekonomistów Rolnictwa i Agrobiznesu 11, 366371.
35. Ransome, K, Rusk, J, Yurkiw, MA et al. (1998) A school milk promotion program increases milk consumption and improves the calcium and vitamin D intakes of elementary school students. Can J Diet Pract Res 59, 190198.
36. Kaiser, FG & Schultz, PW (2009) The attitude–behavior relationship: a test of three models of the moderating role of behavioral difficulty. J Appl Soc Psychol 39, 186207.
37. Papadakis, S & Moroz, I (2008) Population-level interventions for coronary heart disease prevention: what have we learned since the North Karelia project? Current Opin Cardiol 23, 452461.
38. Lemmens, V, Oenema, A, Klepp, KI et al. (2008) A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults. Obes Rev 9, 446455.
39. MacLean, LM, Clinton, K, Edwards, N et al. (2010) Unpacking vertical and horizontal integration: childhood overweight/obesity programs and planning, a Canadian perspective. Implement Sci 5, 36.
40. Sallis, JF & Glanz, K (2009) Physical activity and food environments: solutions to the obesity epidemic. Milbank Q 87, 123154.
41. Frieden, TR, Dietz, W & Collins, J (2010) Reducing childhood obesity through policy change: acting now to prevent obesity. Health Aff (Millwood) 29, 357363.
42. Herrero-Lozano, R & Fillat-Ballesteros, JC (2006) Estudio sobre el desayuno y el rendimiento escolar en un grupo de adolescentes. Nutr Hosp 21, 346352.
43. Morales, IF, Vilas, MVA, Vega, CJM et al. (2008) Relation between the breakfast quality and the academic performance in adolescents of Guadalajara (Castilla-La Mancha). Nutr Hosp 23, 383387.
44. Macdiarmid, J, Loe, J, Craig, LCA et al. (2009) Meal and snacking patterns of school-aged children in Scotland. Eur J Clin Nutr 63, 12971304.
45. Pollitt, E & Mathews, R (1998) Breakfast and cognition: an integrative summary. Am J Clin Nutr 67, issue 4, 804S813S.
46. Musaiger, AO, bin Zaal, AA & D'Souza, R (2009) Dietary habits associated with obesity among adolescents in Dubai, United Arab Emirates. Nutr Hosp 24, 437444.
47. Fernandez, AC, Weigand, CM, Pomar, MDB et al. (2011) Changes on dietary habits of the late-breakfast in a school population. Nutr Hosp 26, 560565.
48. Rahmani, K, Djazayery, A, Habibi, MI et al. (2011) Effects of daily milk supplementation on improving the physical and mental function as well as school performance among children: results from a school feeding program. J Res Med Sci 16, 469476.
49. Naylor, PJ & McKay, HA (2009) Prevention in the first place: schools a setting for action on physical inactivity. Br J Sports Med 43, 1013.
50. Salamon, P, Pfau, C, Grillenberger, M et al. (2010) School milk demand: design and first results of the German federal research project ‘Focus on school milk’. Landbauforschung 60, 110.
51. Harker, D, Sharma, B, Harker, M et al. (2010) Leaving home: food choice behavior of young German adults. J Bus Res 63, 111115.
52. Millimet, DL, Tchernis, R & Husain, M (2010) School nutrition programs and the incidence of childhood obesity. J Hum Resour 45, 640654.
53. Sallis, JE, Cervero, RB, Ascher, W et al. (2006) An ecological approach to creating active living communities. Annu Rev Public Health 27, 297322.
54. Ventura, AK & Birch, LL (2008) Does parenting affect children's eating and weight status? Int J Behav Nutr Phys Act 5, 15.
55. Brown, T & Summerbell, C (2009) Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev 10, 110141.
56. Campbell, KJ & Hesketh, KD (2007) Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature. Obes Rev 8, 327338.
57. Mohebati, L, Lobstein, T, Millstone, E et al. (2007) Policy options for responding to the growing challenge from obesity in the United Kingdom. Obes Rev 8, 109115.
58. Kim, D & Kawachi, I (2006) Food taxation and pricing strategies to ‘thin out’ the obesity epidemic. Am J Prev Med 30, 430437.
59. Murimi, MW & Harpel, T (2010) Practicing preventive health: the underlying culture among low-income rural populations. J Rural Health 26, 273282.
60. Rothman, KJ (2008) BMI-related errors in the measurement of obesity. Int J Obes (Lond) 32, Suppl. 3, S56S59.
61. Perez-Cueto, FJA & Verbeke, W (2009) Reliability and validity of self-reported weight and height in Belgium. Nutr Hosp 24, 366367.
62. Resano, H, Verbeke, W, de Barcellos, MD et al. (2010) Obesity and overall satisfaction with pork meat and derived pork-based products. Nutr Hosp 25, 123124.
63. Sharma, B, Harker, M, Harker, D et al. (2010) Youth transition to university in Germany and Australia: an empirical investigation of healthy eating behaviour. J Youth Stud 13, 353367.
64. Lagiou, P, Trichopoulou, A & Contributors, D (2001) The DAFNE initiative: the methodology for assessing dietary patterns across Europe using household budget survey data. Public Health Nutr 4, 11351141.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Material

Perez-Cueto Supplementary Material
List of Policy interventions by country

 PDF (94 KB)
94 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed