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Determinants of Health

19% of the adult population is daily smoker and 14% of adults are obese.

Tobacco use

1. Key messages

15% of the population were daily smokers in 2018 in Belgium, lower than the EU-15 average. This proportion is higher in men (18%) than in women (12%) and higher in Wallonia (18%) than in Brussels (16%) and Flanders (13%).
The prevalence of daily smoking has decreased by 40% between 1997 and 2018.
4.1% of the population were regular users of e-cigarettes in 2018 in Belgium, higher than the EU-15 average. It is higher in men (5.5%) than in women (2.7%) and higher in Flanders (4.4%) than in Wallonia (3.8 %) and Brussels (3.3%).
Fewer young people (15-24) were daily smokers in 2018 (11% vs 17% in 2013) and 5.5% were regular users of electronic cigarettes.
Socio-economic disparities are large in smoking behavior: the proportion of daily smokers and electronic cigarette users is 2.4 times smaller in the higher versus the lower educated people.

2. Background

Smoking is one of the most important health-related risk factor and leads to high numbers of avoidable deaths and diseases. It is the major cause of lung cancer, is involved in the development of other kinds of cancer, and increases the risk of cardiovascular and respiratory diseases. Smoking habits taken at a young age are more difficult to quit and lead to more years exposed to tobacco. Reducing tobacco smoking is a priority target for health policy. In 2016, the Ministry of Health had set as target to decrease the prevalence of daily smoking to 17% in 2018 [1].

In this report, we first present the evolution of the smoking behaviour: occasional, daily, and heavy smoking. We then put the focus on daily smokers, since this has internationally been selected as a key health indicator (OECD, Sustainable Development Goals).

Electronic cigarettes were first developed as a mean to quit smoking tobacco. Nowadays, the range of products has broadened, vaping has become a fashion trend, and teenagers start using electronic cigarettes before smoking tobacco. It is still too early to assess the long term health effects of this practice, but it is advised that non-smokers do not start vaping. Several questions have been integrated for the first time in Belgian Health Interview Survey 2018 to estimate the prevalence of users and their profiles. In this report, we focus on the indicator 'regular use of e-cigarette', i.e. the use of an e-cigarette at least once a week.

3. Evolution in smoking

In 2018, 19% of the population were current smokers, among them, 15% were daily smokers (including 4.7% of heavy smokers, i.e., smoking more than 20 cigarettes a day) and 4% were occasional smokers. The time trend is reassuring with a 40% decrease in daily smokers between 1997 and 2018. A decreasing part of smokers were heavy smokers, they were 4.7% of the population in 2018 (-52% compared to 1997).

Type of smokers in the population aged 15 and over, Belgium, 1997-2018
Source: Health Interview Survey, Sciensano [2]

4. Daily smokers

Belgium

In 2018, more men (18%) than women (12%) smoked daily. The prevalence of daily smoking in men aged 25 to 64 years is still concerning, as it reaches more than 20%. In women, the prevalence increases with age up to 64 years, where 17% are daily smokers. Between 15 and 44 years of age, twice as many men smoke compared to women. Between 45 and 64, fewer men and more women are daily smokers compared to the previous ages. At older ages, the proportion of daily smokers is lower, with similar rates in both sexes. This can be in some extent due to a health selection effect, for instance because non-smokers live longer.

Prevalence of daily smoking among people aged 15 and over, by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]

Regional specificities

Daily smoking prevalence was higher in Wallonia (18%) than in Brussels (16%) and in Flanders (13%).

Trends

Since 1997, a relative reduction of 38% in men and 32% in women was observed in the prevalence of daily smoking in Belgium. Among youngsters (15-24), an important decrease of daily smokers (-35%) was observed in 2018 compared to 2013. Among women, an increase was initially observed in 2013, causing more young women to smoke than men in 2013; in 2018 this trend has reversed with an important decrease (-59%) in the prevalence of daily smoking.

Prevalence of daily smoking among people aged 15-24, by sex, Belgium, 1997-2018
Source: Health Interview Survey, Sciensano [2]

Daily smoking prevalence has decreased in all regions and in both sexes since 1997; the decline was higher in men in Flanders and in women in Brussels.

  • Men
  • Women

Prevalence of daily smokers in men aged 15 and over, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Prevalence of daily smokers in women aged 15 and over, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Socio-economic disparities

After adjustment for age, people with a lower secondary education had the highest prevalence of daily smokers, and were 3.1 times more likely to be daily smokers than people with the highest educational level in 2018, while people with the lowest educational level were 2.3 times more likely to be daily smokers than people with the highest educational level. The prevalence of daily smoking decreased in nearly all educational levels (except for the lower secondary education). From those successive cross-sectional surveys, one cannot know which part of the trends is due to a change in smoking behavior, or to a health selection effect.

Prevalence of daily smoking by educational level, Belgium, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

International comparison

The prevalence of daily smoking was lower in Belgium compared to the EU-15 average for 2018.

  • Men
  • Women

Prevalence of daily smoking among men, by country (EU-15), 2018 or nearest year
Source: OECD Health Data [3]

Prevalence of daily smoking among women, by country (EU-15), 2018 or nearest year
Source: OECD Health Data [3]

5. Regular use of e-cigarette

Belgium

In 2018, the prevalence of regular e-cigarette use in Belgium (4.1%) was higher in men (5.5%) than in women (2.7%). It is the highest in young men (15-34) and the lowest after the age of 65 years.

Prevalence of regular (at least 1x/week) e-cigarette use among the population aged 15 years and over, by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]

Regional disparities

The prevalence of regular e-cigarette use was higher in men in Flanders (5.9%) and in Wallonia (5.5%) than in Brussels (3.5%). It was higher in women in Flanders (3.0%) and Brussels (2.9%) than in Wallonia (2.2%).

Prevalence of regular (at least 1x/week) e-cigarette use aged 15 and over, by sex and region, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Socio-economic disparities

People with secondary education were 2.4 times more likely to be regular e-cigarette users than people with tertiary education.

Prevalence of regular (at least 1x/week) e-cigarette use aged 15 and over, by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

International comparison

Eurobarometer 458 constitutes the only comparable source of information about the usage of electronic cigarettes in Europe but the comparison should be interpreted with caution due to the limited samples. In 2017, Belgium had a higher prevalence of users than the average EU-15 countries.

Prevalence of electronic cigarettes or similar electronic devices use, by country (EU-15), 2017
Source: Eurobarometer 458 [3]

6. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Age-standardized prevalence
Since smoking behaviors are strongly influenced by age, comparisons among regions and educational levels need to be standardized by age to have a similar age structure.
Current smokers
Current smokers are people who currently smoke, including daily and occasional smokers.
Electronic cigarette (e-cigarette)
An electronic cigarette (e-cigarette), or similar devices like e-pipe/e-cigar/e-chicha, are small electronic devices that allow simulating the act of smoking but do not burn tobacco and produce vapor from liquids instead. They can contain nicotine or not. A similar definition was used in the Health Interview Survey 2018 and in the Eurobarometer 458.
EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
Heavy smokers
Heavy smokers are people who smoke 20 or more cigarettes per day.
Prevalence of daily smoking
The prevalence of daily smoking is the percentage of the population aged 15 and over that smokes every day.

References

  1. Anti-smoking policy plan, Belgian Federal Minister of Health, 2016. http://www.maggiedeblock.be/2016/04/09/anti-rook-beleidsplan-met-rookverbod-in-wagen-met-kinderen-en-accijnsverhoging/
  2. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/SitePages/Reports.aspx
  3. OECD Health Data, 2018 or nearest year. http://stats.oecd.org/
  4. Eurobarometer 458: Attitudes of Europeans towards tobacco and electronic cigarettes, 2017. https://data.europa.eu/euodp/en/data/dataset/S2146_87_1_458_ENG

Alcohol use

1. Key messages

European countries have the highest level of alcohol consumption in the world. The average consumption of pure alcohol in Belgium is 12 liters per capita per year, which is above the mean European consumption. This makes Belgium one of the countries with a high disease burden related to alcohol.

In 2018, 7.4% of men and 4.3% of women (15 years and over) had a hazardous consumption of alcohol (defined as more than 21 or more than 14 drinks per week for men and women, respectively). This prevalence has decreased over time.

Around one in ten young people in the age group 15-24 years reported a weekly episode of "risky single occasion drinking" (consumption of at least 6 glasses of alcohol at a single occasion), and also one in ten young people met the criteria for "problematic alcohol consumption" (as defined by the CAGE instrument) in the past 12 months.

2. Background

Excessive alcohol consumption leads to a considerable health burden: it is associated with mental disorders, liver cirrhosis, cancer, cardiovascular disease, as well as trauma, and is a leading cause of premature death. Alcohol consumption in European countries is largely above the world average. Reducing excessive alcohol consumption through appropriate strategies is a priority for public health.

At the international level, estimations of alcohol consumption are often based on sales data. While those average estimates are useful to assess long-term population trends, they do not allow identifying harmful drinking patterns. Survey-based data are more appropriate to describe problematic alcohol consumption, although self-reported consumption is subject to under-reporting and social desirability bias.

In this report, we describe three survey-based indicators of excessive alcohol consumption and one indicator based on sales:

  1. Hazardous alcohol consumption: weekly consumption exceeding 21 drinks containing the equivalent of 10 g of pure alcohol in men and 14 drinks in women;
  2. Weekly Risky Single Occasion Drinking (WRSOD): consumption of 6 drinks or more in a single occasion, at least once a week;
  3. Past year problematic alcohol consumption: people experiencing problematic drinking in the last 12 months defined by the CAGE instrument;
  4. Average alcohol consumption per capita: estimations by the World Health Organization, used here for international comparisons.

3. Hazardous drinking

Situation in 2018

Belgium

In 2018, in the whole population aged 15 years and over, the proportion of hazardous drinkers (more than 21 and 14 drinks per week respectively in men and women) was 5.9%. Twice as many men than women are considered to be hazardous drinkers. As the threshold for defining hazardous alcohol consumption in women is lower than in men, those results indicate a much lower consumption in women.

The highest prevalence is observed in the age group 55-64 and the lowest in the age group 75+.

Prevalence of hazardous alcohol consumption in the population aged 15 and over by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]
Regional differences

In 2018, the highest rate was observed in Brussels both for men and women, while the prevalence was lower in Flanders.

Trends

At Belgian level, the prevalence of hazardous alcohol consumption continues to decline. A decrease of 12% in men and 8% in women was observed between 2013 and 2018.

Regional specificities

In men, the prevalence was the highest in Wallonia between 2004 and 2013, and the lowest in Brussels between 2004 and 2013. Since 2004 a continuous decrease of the prevalence in men was observed in Flanders and Wallonia, while in Brussels the decrease stopped in 2008 then markedly increased between 2013 and 2018, resulting in the highest prevalence of the three regions in 2018.

In women, the prevalence has been highest in Brussels in all HIS waves. A slight decrease was observed in Flanders, starting in 2001, with no clear trends in the other regions.

  • Men
  • Women

Prevalence of hazardous alcohol consumption in men aged 15 and over by region, Belgium, 1997-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Prevalence of hazardous alcohol consumption in women aged 15 and over by region, Belgium, 1997-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Socio-economic disparities

There is no clear socio-economic gradient in the prevalence of hazardous drinking.

Prevalence of hazardous alcohol consumption in the population aged 15 and over by educational level, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

4. Weekly risky single occasion drinking

Situation in 2018

Belgium

The prevalence of weekly risky single occasion drinking (WRSOD) was 7.6% in Belgium in 2018. It was much more frequent in men (11.5%) than in women (3.9%). The age group 15-24 had the highest prevalence of WRSOD (10.4%) followed by the 55-64 (9.2%) and the 25-34 (9%).

Prevalence of weekly risky single occasion drinking in the population aged 15 or over by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]
Regional differences

In 2018, a slightly higher percentage of risky single occasion drinkers was observed in Flanders for men, in Brussels for women, but those differences were not statistically significant.

Trends

At Belgian level, after age-adjustment, the prevalence of WRSOD decreased in men (-18%) and remained stable in women between 2013 and 2018.

Regional differences

In men, while the prevalence was significantly higher in Flanders in 2008, the difference between regions has narrowed and is no more significant. Between 2013 and 2018, a declining trend is observed in all three regions.

In women, in Flanders and Wallonia, the percentages remain stable around 4%; while Brussels witnesses a decrease but had still a higher prevalence than the other regions.

  • Men
  • Women

Prevalence of weekly risky single occasion drinking in men aged 15 and over by region, Belgium, 2008-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Prevalence of weekly risky single occasion drinking in women aged 15 and over by region, Belgium, 2008-2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

Socio-economic disparities

There is no clear socio-economic gradient in the prevalence of weekly risky single occasion drinking.

Prevalence of weekly risky single occasion drinking in the population aged 15 years and over by educational level, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

International comparison

The prevalence of weekly risky single occasion drinking is higher in Belgium than the EU-15 average (for the 13 countries with available data), for both men (13 vs 10%) and women (3.8 vs 3.1%).

  • Men
  • Women

Prevalence of weekly risky single occasion drinking in men aged 15 or older by country of residence, Europe, 2014
Source: Eurostat [2]

Prevalence of weekly Risky Single Occasion Drinking in women aged 15 or older by country of residence, Europe, 2014
Source: Eurostat [2]

5. Problematic alcohol consumption

Belgium

Problematic alcohol use is defined based on answers to a specific 4-item questionnaire (CAGE) and is predictive of alcohol dependence. The prevalence of problematic alcohol consumption in the last 12 months was 7% in Belgium in 2018. It was higher in men (9.5%) than in women (4.7%). The prevalence of problematic alcohol consumption was the highest in the younger age group (9.8%) followed by the age group 25-44 and 45-54 (8.8%). The prevalence was similar in men and women in the age group 55-64.

Prevalence of problematic alcohol consumption in the last 12 months in the population aged 15 years and over by age group and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]

Regional differences

The prevalence of problematic alcohol consumption in the past 12 months was the highest in Wallonia for men and in Brussels for women.

Prevalence of problematic alcohol consumption in the last 12 months in the population aged 15 years and over by region and sex, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [1]

6. Total alcohol consumption per capita

According to the WHO estimations for 2016, the total consumption in Belgium was 12.1 liters of pure alcohol per capita (15+), which was higher than the EU-15 average (11.1 liters). The World Health Organization (WHO) European Region has the highest level (9.7 l) of alcohol consumption in the world (6.2 l).

Total alcohol (recorded + unrecorded) per capita consumption (in liters of pure alcohol) among the population aged 15 or over by country of residence, Europe, 2016
Source: GISAH [3]
Total alcohol (recorded + unrecorded) per capita consumption (in liters of pure alcohol) among the population aged 15 or over by region of the world, 2016
Source: GISAH [3]

7. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom. We compare the Belgian health status to that of the EU-15 rather than the one of EU-28 because this historical construction has more socio-economic similarity than EU28.
Hazardous alcohol consumption
Hazardous alcohol consumption, or alcohol overconsumption is defined as a consumption of pure alcohol exceeding 30 g for men and 20 g for women daily; it is equivalent to 21 and 14 standard drinks (of 10 g pure alcohol content) per week respectively.
Weekly risky single occasion drinking (WRSOD)
Weekly risky single occasion drinking is defined as consumption of at least 6 standard drinks (of 10 g pure alcohol content) on the same occasion, at least once a week.
Problematic alcohol consumption
Problematic alcohol consumption is defined as 2 positive answers out of the 4 questions of the CAGE instrument and is predictive of alcohol dependence.
CAGE instrument
The CAGE instrument is a widely used screening test for problem drinking and potential alcohol problems. The questionnaire contains four ‘yes-no’ questions and two positive answers are considered as a warning signal for potential problematic use of alcohol:
1. Have you ever felt the need to cut down on your drinking?
2. Have you ever been criticized concerning your drinking?
3. Have you ever felt guilty about drinking?
4. Have you ever felt the need to take a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?
Total alcohol consumption per capita
The total alcohol per capita consumption is the recorded 3-years average and the unrecorded alcohol consumption per capita in the population aged 15 and over, expressed in liters of pure alcohol a year. Recorded alcohol consumption refers to official statistics (production, import, export, and sales or taxation data. Unrecorded consumption refers to alcohol which is not taxed and is outside the usual system of governmental control. This can be estimated thanks to specific survey questions. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/465

References

  1. Health Interview Survey, Sciensano, 1997-2018. https://hisia.wiv-isp.be/SitePages/Home.aspx
  2. Eurostat. http://ec.europa.eu/eurostat/fr/data/database
  3. World Health Organization, GISAH, 2016. http://apps.who.int/gho/data/node.gisah.A1036?lang=en&showonly=GISAH

Weight status

1. Key messages

  • Weight excess is an important problem in Belgium like in most industrialized countries.
  • In 2018, nearly half of the adult population aged 18+ (49%) was overweight (BMI ≥ 25) and 16% was obese (BMI ≥ 30) based on self-reported height and weight from the Belgian health interview survey.
  • Objective height and weight measurements (from the Belgian health examination survey) reveal even higher figures, with as much as 55% of the adult population being overweight and 21% being obese.
  • The overweight and obesity prevalences are higher in Wallonia than in the other regions.
  • After a regular increase from 1997, the prevalence of overweight remained stable in men between 2013 and 2018, but increased slightly in women. The prevalence of obesity increased in men but remained stable in women between 2013 and 2018.
  • Overweight as well as obesity is strongly related to the socio-economic status with a much higher prevalence among people with a lower educational level.
  • In 2018, among adolescents, the prevalence of overweight (including obesity) was 15.5% in boys and 14.5% in girls.

2. Background

Overweight and obesity are defined as an excessive accumulation of body fat, which favors the development of chronic diseases (diabetes type 2, cardiovascular diseases, cancers). The body mass index (BMI), calculated as the weight divided by the square of the height, is a simple tool allowing to classify the weight status into broad categories: underweight, normal weight, overweight, and obesity. In adults, obesity is defined as having a BMI ≥ 30. A person is considered overweight if they have a BMI ≥ 25, a definition including overweight-non obese as well as obese people. It is to be noted that the same term (overweight) is sometimes used to designate overweight-non obese people (BMI between 25 and 29.9). To avoid any confusion, in this report, it will be always specified if overweight percentages include obesity or not. In children and adolescents, the cut-offs of the BMI categories are age and sex-specific, the cut-offs recommended by the International Obesity Task Force (IOTF) [1] are used.

The BMI categories can be assessed either from self-reported information about weight and height, such as that collected in the Health Interview Survey (HIS) [2] and the Health Behavior in School-aged Children survey (HBSC) [3,4], or from measured information such as that collected by the Health Examination Survey (HES) [5] and the Food Consumption Survey (FCS). The HES is a subsample of the HIS; for 1184 participants in the HIS a second visit was realized by a nurse who performed physical measurements and collected biological samples. Self-reported data usually lead to some underestimation of the true overweight/obesity prevalence. People are not exactly aware of their exact height and weight and tend to overestimate their height and underestimate their weight.

We first present results for the adult (18+) population. The prevalence of self-reported overweight and obesity are based on the HIS 1997 to 2018 data, and that of measured weight status on the HES 2018. Results for adolescents are based on the HBSC surveys conducted in the Flemish and the French Community. We computed a Belgian average based on the results by community. For socio-economic disparities and international comparisons, data are used from the most recent international reports published by the World Health Organization.

3. Overweight and obesity in adults

Situation in 2018

Belgium

According to the HIS, based on self-reported height and weight, the prevalence of overweight (including obesity) was 49% and the prevalence of obesity was 16% in 2018. More men (55%) than women (43%) were overweight (incl. obesity), and more men (17%) were obese than women (15%) (the latter is however not significant).

According to the HES, the prevalence of overweight (including obesity) (55%) and obesity (21%) based on measured height and weight were higher than those based on self-reported data. The difference between self-reported and measured rates was higher among women.

The measured prevalence of overweight (incl. obesity) was higher among men (59%) than among women (52%), as was the case for the self-reported prevalence. The measured prevalence of obesity was higher among women (23%) than among men (20%), but this difference was not statistically significant.

Prevalence of overweight and obesity among the adult population aged 18 years and over, self-reported and measured, by sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [2] and Health Examination Survey, Sciensano [5]

The prevalence of self-reported overweight (incl. obesity) increased with age until the age group of 65-74 years where it reached a peak in both men (68%) and women (56%); it then decreased among people aged 75 and older, in both sexes. This increase starts earlier in men (25-34 years) than in women (35-44 years).

Self-reported obesity follows the same age pattern as overweight and reached its highest level in 65-74-year-olds, in both men (26%) and women (20%).

  • Men
  • Women

Self-reported prevalence of overweight and obesity among men by age group, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]

Self-reported prevalence of overweight and obesity among women by age group, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]

Regional differences

The prevalence of both overweight and obesity was higher in Wallonia than in the other regions in all HIS waves and in both sexes.

Trends

At the Belgian level, the prevalence of overweight (incl. obesity) has continuously increased when considering both sexes together. From 2013, the prevalence remained stable among men but continued to increase among women. The prevalence of obesity also slowly and continuously increased over all HIS waves, with a stronger increase between 2013 and 2018.

Regional differences

At regional level, the prevalence of overweight and obesity has always been higher in Wallonia than in the other regions. Among men, the trends of obesity and overweight were similar, and similar to the ones described for Belgium; among women, a stabilization of overweight and obesity was observed in Flanders.

  • Men
  • Women

Age-adjusted prevalence of overweight and obesity among men aged 18 and over, by region, Belgium, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Age-adjusted prevalence of overweight and obesity among women aged 18 and over, by region, Belgium, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

Socio-economic differences

Overweight, and even more obesity, are associated with the educational level. The lowest educated group (61%) had a prevalence of overweight (incl. obesity) 1.5 times higher than the most educated group (41%). There were two times more people obese among the less educated (23%) compared to the most educated (12%).

Age-adjusted prevalence of overweight and obesity among people aged 18 and over, by level of education, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [2]

International comparison

In 2018, the prevalence of overweight (incl. obesity) among men was lower in Belgium (55.3%) than the EU-15 average (57.6%). Women in Belgium (43.4%) were at the same level of the EU-15 average (43.9%) in 2018.

  • Men
  • Women

Prevalence of overweight (incl. obesity) among men aged 18 and over, by country of residence (EU-15), 2018 or nearest year
Source: OECD Health statistics [6]

Prevalence of overweight (incl. obesity) among women aged 18 and over, by country of residence (EU-15), 2018 or nearest year
Source: OECD Health statistics [6]

4. Overweight and obesity in adolescents

Situation in 2018

In 2018, the prevalence of overweight (incl. obesity) in adolescents was around 15%, calculated as the average of the estimates in the French and Flemish HBSC 2018. It was higher among boys (15.5%) than among girls (14.5%) and tended to increase with age (the statistical significance is unknown). The lowest prevalence (around 13%) was observed among the younger girls (11-14 years) while the highest prevalence (around 16%) was observed among boys aged 15-16 years and girls aged 17-18 years.

The prevalence of obesity in adolescents was 4.0% among boys and 3.6% among girls and was relatively similar across age groups.

  • Boys
  • GIrls

Prevalence of overweight and obesity among adolescent boys, by age group, Belgium, 2018
Source:  Own calculations, unweighted Belgian average based on the HBSC [3,4] (IOTF cut-off [1])

Prevalence of overweight and obesity among adolescent girls, by age group, Belgium, 2018
Source:  Own calculations, unweighted Belgian average based on the HBSC [3,4] (IOTF cut-off [1])

Trends and differences between Communities

In 2018, overweight (incl. obesity) prevalence among 15-year-old adolescents was slightly higher in the French than in the Flemish Community. This was especially pronounced among boys, with an overweight prevalence of 19% in the French Community and 13% in the Flemish Community (the statistical significance is unknown). Overweight prevalence among girls was more similar in both Communities.

The overweight prevalence increased between 2006 and 2014 in each Community and for both sexes. Between 2014 and 2018, among boys, the prevalence decreased in the Flemish Community while it continued to increase in the French Community. Among girls, the overweight prevalence increased in a same way in both Communities.

Trends in obesity prevalence are not available at the moment.

  • Boys
  • Girls

Prevalence of overweight (incl. obesity) among 15-year-old boys, by Community, 2006-2018
Source: HBSC [3-4,7-9] (IOTF cut-off [1])

Prevalence of overweight (incl. obesity) among 15-year-old girls, by Community, 2006-2018
Source: HBSC [3-4,7-9] (IOTF cut-off [1])

Socio-economic differences

According to the HBSC report, being overweight (incl.obesity) is associated with low family affluence for both sexes. In the Flemish Community, boys and girls from the lowest socio-economic group were 1.8 more likely to be overweight than boys and girls from the higher socio-economic group. In the French Community, boys and girls from the lowest socio-economic group were respectively 2 times and 3 times more likely to be overweight than boys and girls from the higher socio-economic group. Low- and high-affluence groups represent the lowest 20% and the highest 20% in each Community.

Age-adjusted prevalence of overweight (incl. obesity) among adolescents, by sex, Community, and family affluence status, Belgium, 2018
Source: HBSC international report [10]

International comparison

Based on the results for 2014, Belgium ranks quite favorably among the EU-15 countries with an overweight prevalence of 16% compared to 18% for the EU-15 average among boys. The prevalence of overweight is similar to EU-15 average (12%) among girls.

  • Boys
  • Girls

Prevalence of overweight (including obesity) among 15-year-old boys, by country of residence (EU-15), 2014
Source:  OECD Health at a glance [11]

Prevalence of overweight (including obesity) among 15-year-old girls, by country of residence (EU-15), 2014
Source: OECD Health at a glance [11]

5. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Health-Behaviour in School-aged Children (HBSC) survey - French Community

Health-Behaviour in School-aged Children (HBSC) survey - Flemish Community

Definitions

Body mass index (BMI)
The body mass index (BMI) is a measure of a person’s weight relative to their height that is reasonably well related to body fat. It is calculated as a person’s weight (in kilograms) divided by the square of his/her height (in meters).
BMI categories
In adults:
• Underweight: is defined as a BMI lower than 18.5.
• Normal weight: is defined as a BMI range of 18.5-24.9.
• Overweight: is defined as a BMI between 25.0 and 29.9. We often referred to overweight including obesity i.e. with a BMI ≥ 25.
• Obesity: is defined as a BMI ≥ 30.
In children and adolescents, the cut-off points to define BMI categories are age and sex-specific.
EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have a similar socio-economic situation.

References

  1. International Obesity Task Force. https://www.worldobesity.org/about/about-obesity/obesity-classification
  2. Health Interview Survey, Sciensano, 2018.  https://his.wiv-isp.be/fr/Documents%20partages/NS_FR_2018.pdf 
  3. HBSC French Community, ULB, 2018. http://sipes.ulb.ac.be/
  4. HBSC Flemish Community, UGent, 2018. http://www.jongeren-en-gezondheid.ugent.be/
  5. Health Examination Survey, Sciensano, 2018.https://his.wiv-isp.be/fr/Documents%20partages/HES_FR_2018.pdf
  6. OECD Health statistics. http://stats.oecd.org/
  7. Inchley J et al. eds. Growing up unequal: gender and socioeconomic differences in young people's health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the 2013/2014 survey. Copenhagen, WHO Regional Office for Europe, 2016 (Health Policy for Children and Adolescents, No. 7). http://www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf?ua=1
  8. Currie C et al. eds. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey. Copenhagen, WHO Regional Office for Europe, 2012 (Health Policy for Children and Adolescents, No. 6). http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf?ua=1
  9. Currie C, Nic Gabhainn S, Godeau E, Roberts C, Smith R, Currie D, Pickett W, Richter M, Morgan A & Barnekow V (eds.) (2008). Inequalities in young people's health: HBSC international report from the 2005/06 Survey. Health Policy for Children and Adolescents, No. 5, WHO Regional Office for Europe, Copenhagen, Denmark. http://www.euro.who.int/__data/assets/pdf_file/0005/53852/E91416.pdf?ua=1
  10. Inchley J, Currie D, Budisavljevic S, Torsheim T, Jastad A, Cosma A. Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data [Internet]. Copenhagen: WHO Regional Office for Europe; 2020 [cited 2020 Jun 15]. Available from: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/health-behaviour-in-school-aged-children-hbsc/publications/2020/spotlight-on-adolescent-health-and-well-being.-findings-from-the-20172018-health-behaviour-in-school-aged-children-hbsc-survey-in-europe-and-canada.-international-report.-volume-2.-key-data
  11. OECD Health at a Glance 2017. http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Physical activity

1. Key messages

Less than one third (30%) of the adult population (18 years and older) meets the WHO recommendations of doing at least 150 minutes of moderate-intensity aerobic physical activity throughout the week. More men (36%) comply than women (25%). Residents of Flanders (37%) and people with tertiary education (38%) were more likely to meet the recommendations.

Among children aged 11 to 18 years, one boy out of five (20%) and one girl out of eight (13%), meet the WHO recommendations of performing at least 60 minutes of moderate- to vigorous-intensity physical activity per day.

2. Background

Lack of physical activity is one of the leading risk factors in terms of both morbidity and mortality for a series of chronic conditions, including cardiovascular diseases, cancer, and diabetes. Moreover, regular physical activity, when reaching a certain threshold, can have significant benefits for health. The World Health Organization (WHO) [1] recommends that adults aged 18-64 perform at least 150 minutes of moderate-intensity physical activity throughout the week. They further recommend that children and teenagers aged 5-17 perform at least 60 minutes of moderate- to vigorous-intensity physical activity per day.

To date there is no consensus on the method for estimating levels of physical activity based on self-reported surveys: the use of different instruments and of different cut-off points for classifying the levels of activity make it very difficult to compare results within and between countries. In the Belgian Health Interview Survey (HIS), in waves 2001 to 2013, physical activity was measured with the short version of the International Physical Activity Questionnaire (IPAQ). Since 2018, the EHIS-PAQ questionnaire is used as recommended by the European Health Interview Survey (EHIS) whereby time trend analysis is no longer possible, but international comparability is enhanced.

In this report, we evaluate physical activity among adults based on the share of adults meeting the WHO recommendations to do at least 150 minutes of at least moderate-intensity aerobic physical activity throughout the week, based on the self-reported data from the Belgian Health Interview Survey (HIS).

Physical activity among adolescents is evaluated based on the share of adolescents aged 11-18 who meet the WHO recommendations to perform at least 60 minutes of moderate- to vigorous-intensity physical activity per day, based on self-reported data from the Health Behavior in School-aged Children (HBSC) survey.

3. Physical activity in adults

Situation in 2018

Belgium

In Belgium in 2018, 30% of the population aged 18 years and over did at least 150 minutes of at least moderate aerobic physical activity per week. More men (36%) than women (25%) met the recommendations, and this at all ages. The prevalence was the highest in the youngest age group (47%) and the lowest in the highest age group (12%).

Proportion of the population aged 18 years and over who do at least 150 minutes per week of at least moderate-intensity aerobic physical activity by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [2]
Regional differences

More people were meeting the physical activity recommendations in Flanders (43% in men and 34% in women) than in Brussels (29% and 18%, respectively) and Wallonia (27% and 15%, respectively).

Proportion of the population aged 18 years and over who do at least 150 minutes per week of at least moderate-intensity aerobic physical activity by sex and region, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [2]

Socio-economic disparities

After age standardization, people with tertiary education were more likely to meet the recommendations (38%) than people with an upper secondary education (26%), a lower secondary education (22%), and primary education (12%).

Proportion of the population aged 18 years and over who do at least 150 minutes per week of at least moderate-intensity aerobic physical activity by educational level, Belgium, 2018
Source: Own calculation based on Health Interview Survey, Sciensano [2]

4. Physical activity in adolescents

Situation in 2018

Belgium

In Belgium in 2018, more boys (20%) than girls (13%) met the WHO recommendations to perform at least 60 minutes of moderate- to vigorous-intensity physical activity per day. Young adolescents aged 11-12 years old were more likely to be sufficiently physically active than older adolescents.

Proportion of adolescents 11-18 years old who perform at least 60 minutes of moderate- to vigorous-intensity physical activity per day, by age and sex, Belgium, 2018
Source: Own calculation, unweighted Belgian average based on HBSC French Community [3] and HBSC Flemish Community [4]
Regional differences

More adolescents in the Flemish Community (21% of boys and 14% of girls) met the WHO recommendations than in the French Community (18% of boys and 11% of girls).

Trends

In the Flemish Community, the proportion of boys meeting the WHO recommendations increased between 2014 and 2018, while in the French Community, it decreased. These opposite evolutions led to a stable Belgian average.

In the Flemish Community, the proportion of girls meeting the WHO recommendations increased between 2014 and 2018, while in the French Community, it remained stable. Both evolutions combined led to an increasing Belgian average.

  • Boys
  • Girls

Proportion of boys aged 11-18 years old who perform at least 60 minutes of moderate- to vigorous-intensity physical activity per day, by Community, Belgium, 2014-2018
Source: HBSC French Community [3] and HBSC Flemish Community [4]

Proportion of girls aged 11-18 years old who perform at least 60 minutes of moderate- to vigorous-intensity physical activity per day, by Community, Belgium, 2014-2018
Source: HBSC French Community [3] and HBSC Flemish Community [4]

5. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Health-Behaviour in School-aged Children (HBSC) survey - French Community

Health-Behaviour in School-aged Children (HBSC) survey - Flemish Community

Definitions

Age-adjusted prevalence
Since lifestyle factors are strongly influenced by age, comparisons among regions and educational levels need to be standardized by age to have a similar age structure. 
EHIS-PAQ questionnaire 
The EHIS-PAQ is a domain-specific physical activity questionnaire compounded of eight questions. It takes into account physical activity related to work, going from and to places, and sport. The EHIS-PAQ was tested in different regions and cultural settings in Europe. It allows estimating the health-enhancing physical activity recommendation defined by the WHO.
Performing at least 150 minutes of at least moderate aerobic physical activity throughout the week
To calculate this indicator in the HIS, three questions were asked to the participants to assess the time they spend bicycling to get to and from places and the time they spend on sport leisure activities.
Performing at least 60 minutes of moderate- to vigorous-intensity physical activity per day
To calculate this indicator in the HBSC, the participants were asked how many days over the past week they had been physically active for a total of at least 60 minutes.

References

  1. Global recommendations on physical activity for health. Genève: WHO; 2010. https://www.who.int/dietphysicalactivity/global-PA-recs-2010.pdf
  2. Health Interview Survey, Sciensano, 2001-2018. https://his.wiv-isp.be/fr/SitePages/Rapports_complets_2018.aspx
  3. HBSC French Community, ULB, 2018. http://sipes.ulb.ac.be/
  4. HBSC Flemish Community, UGent, 2018. http://www.jongeren-en-gezondheid.ugent.be/

Nutritional habits

1. Key messages

The Belgian diet is characterized by excessive consumption of red meat, processed meat and sugar sweetened beverages, and by insufficient consumption of fruits, vegetables, nuts and seeds, milk, eggs and fish. Over time, these patterns have only slightly improved.
In 2018, only 12.7% of the population aged 6 years and over consumed the daily recommended amount of fruit and vegetables (at least 5 portions).
In 2018, 20.4% of the population drank sugary drinks on a daily basis; 4.1% even drank a litre or more daily.
Women, older people, people with a tertiary education and people living in Brussels had better nutritional habits.

2. Background

Dietary quality is an important factor in health and disease burden. A healthy diet helps protect against non-communicable diseases (NCDs) including diabetes, cancer, heart disease and stroke [1]. Recommendations for each food groups have been established at international [2] and national [3,4] levels.

In Belgium, information on dietary consumption patterns are available from two national Food Consumption Surveys (FCS), conducted in 2004 and 2014 [5–7]. More data about the nutritional habits are available from the Belgian Health Interview Survey (HIS) in 2001, 2004, 2013, 2018 [8]. Data from the FCS are obtained from 24h dietary recalls, while the HIS uses self-reported usual food habits questions, which are more prone to biases linked to recollection and adequate estimation of quantities.

In this report, we present consumption patterns from the FCS and two additional indicators from the HIS:

  • The consumption patterns for 9 food groups (vegetables, nuts and seeds, milk, fruits, eggs, fish, red meats, sugar sweetened beverages, processed meats) are compared against international recommendations in 2004 and 2014 [2].
  • The proportion of the population aged 6 years and over that consumes the daily recommended amount of fruits and vegetables (at least 5 portions). Fruit and vegetables are low-energy density foods and are important sources of dietary fibre, vitamins and minerals. A high consumption of fruit and vegetables has been significantly associated with a decrease in the risk of coronary heart disease, stroke and obesity [9]. The WHO recommends a daily consumption of 400 grams of fruit and vegetables (i.e. 5 portions) [10].
  • The proportion of the population that drinks sugary drinks (no "diet") daily and those that drink at least 1 litre of sugary drinks (no "diet") daily. A high intake of free sugars, particularly in the form of sugar-sweetened beverages, is associated with poor dietary habits, unhealthy weight gains, risk of dental carries and other NCDs [1,9]. The WHO strongly recommends restricting the intake of free sugars to less than 10% of the total energy consumption, throughout the life course [11]. With respect to this guideline the consumption of sugar-sweetened beverages should be avoided.

3. Overall consumption patterns

Overall, the Belgian diet is characterized by excessive consumption of red meat, processed meat and sugar sweetened beverages and by insufficient consumption of fruits, vegetables, nuts and seeds, milk, eggs and fish. Overall, these patterns have only slightly improved between 2004 and 2014. For red meat consumption, however, an improvement was observed, with the proportion of excessive consumptions dropping from 59% to 36%.

Proportion of the Belgian population (15-64) above or below international dietary recommendations, by food group, 2004-2014
Source: Food Consumption Survey, Sciensano [7]
hsr en nutrition overview

4. Consumption of fruits and vegetables

Situation in 2018

Belgium

In 2018, 12.7% of the population aged 6 years and over consumed the daily recommended amount of fruit and vegetables (at least 5 portions). More women (15.6%) than men (9.8%) consumed the recommended amount. Children and young adults were less likely to meet the recommendations than middle-aged and older adults.

Proportion of the population aged 6 years and over that eats daily the recommended amount of fruits and vegetables (at least 5 portions), by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [8]
Regional differences

In men as in women, after age standardization, more people were meeting the recommendations on daily fruit and vegetable consumption in Brussels (13.3% in men and 19.2% in women) and Wallonia (12.5% and 18.0%) than in Flanders (8.7% and 14.7%).

Age-adjusted prevalence of the population aged 6 years and over that eats daily the recommended amount of fruits and vegetables (at least 5 portions), by sex and region, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [8]

Socio-economic disparities

The socio-economic position has a strong influence on the probability of meeting the recommendations concerning the consumption of fruits and vegetables (at least 5 portions). People with a tertiary education (18.0%) were 2.9 times more likely to meet the recommendations than those from the lowest education group (6.3%). People with a secondary education (9.2% to 9.9.%) were also nearly twice less likely to meet the recommendations than people with a tertiary education.

Age-adjusted prevalence of the population aged 6 years and over that eats daily the recommended amount of fruits and vegetables (at least 5 portions), by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [8]

5. Consumption of sugary drinks

Situation in 2018

Belgium

In 2018, 20.4% of the population drank sugary drinks on a daily basis; 4.1% of the population even drank at least 1 litre or more per day. More men (24.9%) than women (16%) drank sugary drinks daily. The prevalence of daily consumption was higher amongst those aged 15-24 and 25-34 (29.2% and 28.6%, respectively) and decreased in older age groups.

Proportion of the population that drinks sugary drinks (no "diet") daily, by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [8]
Regional differences

The prevalence of the population that consumes sugary drinks daily is 16.3% in Brussels, 20.1% in Flanders, and 22.9% in Wallonia.

Trends

Belgium

There were less people drinking sugary drinks in 2018 (20.4%) than in 2013 (25.5%). This trends was observed both in men (decreasing from 30.2% in 2013 to 24.9% in 2018) and women (from 21.1% to 16%).

  • Men
  • Women

Age-adjusted prevalence of men that drink sugary drinks (no "diet") daily, by region, Belgium, 2013-2018
Source: Own calculations based on Health Interview Survey, Sciensano [8]

Age-adjusted prevalence of women that drink sugary drinks (no "diet") daily, by region, Belgium, 2013-2018
Source: Own calculations based on Health Interview Survey, Sciensano [8]

Regional differences

After adjustment for age, the same decreasing trend was observed in the three regions.

Socio-economic disparities

Based on age-adjusted prevalence, people with a tertiary education were less likely to consume sugary drinks daily compared to people with a lower educational level.

Age-adjusted prevalence of the population that drinks sugary drinks (no "diet") daily, by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [8]

6. Read more

View the metadata for this indicator

FCS: Food consumption survey

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Age-adjusted prevalence
Since lifestyle factors are strongly influenced by age, comparisons among regions and educational levels need to be standardized by age to have a similar age structure.

References

  1. Amine EK, Baba NH, Belhadj M, Deurenberg-Yap M, Djazayery A, Forrestre T, et al. Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser. Vol. 916. Geneva: World Health Organization; 2003.
  2. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159): 1923–94.
  3. Vanhauwaert E. De actieve voedingsdriehoek: een praktische voedings- en beweeggids. Brussel; 2012 p. 1-108.
  4. Lebacq T, Oost C. Recommandations alimentaires. In: Tafforeau J, editor. 2016.
  5. De Ridder K, Bel S, Brocatus L, Lebacq T, Ost C, Teppers E. La consommation alimentaire. Résumé des principaux résultats. In: Teppers E, Tafforeau J, editors. Bruxelles: WIV-ISP; 2016.
  6. Debacker N, Cox B, Temme L, Huybrechts I, Van Oyen H. De Belgische voedselconsumptiepeiling 2004: voedingsgewoonten van de Belgische bevolking ouder dan 15 jaar. Wetenschappelijk Instituut Volksgezondheid; 2007.
  7. Sciensano. Website of the Belgian National Food Consumption survey 2014. https://fcs.wiv-isp.be/SitePages/Home.aspx.
  8. Drieskens S, Charafeddine R, Gisle L. Enquête de santé 2018: Habitudes nutritionnelles [Internet]. Bruxelles, Belgique: Sciensano; Report No.: D/2019/14.440/64. Available from: https://his.wiv-isp.be/fr/Documents%20partages/NH_FR_2018.pdf
  9. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). Scientific opinion on principles for deriving and applying dietary reference values. EFSA J. 2010; 8(3): 1458.
  10. World Health Organization. Diet, nutrition, and the prevention of chronic diseases. Report of a WHO Study Group. Geneva: World Health Organization;1990.
  11. World Health Organization. Guideline: sugars intake for adults and children. Geneva: World Health Organization; 2015.