Other official information and services: www.belgium.be  belgium

Determinants of Health

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

Tobacco use

1. Key messages

The percentage of daily smokers was close to 19% in Belgium in 2013, which is similar to the EU-15 average prevalence. It has substantially decreased over the past 15 years. It is higher in men than in women. It is slightly lower in Flanders than in Wallonia and Brussels.
Smoking habits start in adolescence, with 17% daily smokers among the 15–24-year-olds in 2013. Since 1997, the prevalence of daily smokers decreased in young men but not in young women, who smoked in 2013 slightly more than men. Young people should be a target for health promotion policies.
There are large socio-economic differences in the smoking behavior: the proportion of daily smokers is 2.5 times smaller in the higher versus the lowest educated people. The decrease in the prevalence of daily smokers is mainly driven by people with a high educational level.

2. Background

Smoking is one of the most important health-related risk factors and leads to high numbers of avoidable deaths and diseases. It is the major cause of lung cancer, plays a role in the development of other kinds of cancer and increases the risk of cardiovascular and respiratory diseases. Smoking habits taken at young age are more difficult to quit, and lead to more years lived with tobacco.

Reducing tobacco smoking is a priority target for health policy. The Belgian Federal Minister of Health aims to decrease the prevalence of adult daily smokers to 17% in 2018 [1].

3. Distribution of smokers

In 2013, 23% of the population aged 15 years or older were current smokers; 19% were daily smokers while 4% were occasional smokers. The proportion of heavy smokers in the population was 7%. The trends seem encouraging, considering the relative decrease of 23%, 27% and 30% in the proportion of current, daily and heavy smokers, respectively, over the last 16 years.

Type of smokers in the population aged 15 or more, Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [2]

4. Prevalence of daily smokers

The prevalence of daily smokers was 18.9% in Belgium in 2013. It is higher in men (21.6%) than in women (16.4%). The age-adjusted prevalence of daily smokers is higher in Wallonia (21.5%) than in Flanders (17.7%) and Brussels (18.3%), and this is true for both sexes. The prevalence has decreased by 27% since 1997, with a greater decline among men than women. It has decreased in all regions and both sexes, except among women in Wallonia.

  • Men
  • Women

Prevalence of daily smokers in men aged 15 or older, by region and for Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [2]

Prevalence of daily smokers in women aged 15 or older, by region and for Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [2]

Daily smokers among youngsters

Among young people (aged 15-24), the prevalence of daily smoking, while slightly lower than in the older age groups, still reached 17% in 2013. Since 1997, the number of daily smokers among young people has decreased by a third. Young men used to smoke more than young women in 1997, but their smoking habit decreased over time, while it remained stable for women, resulting in a slightly higher prevalence of daily smokers among young women in 2013.

Prevalence of daily smokers among individuals aged 15-24 by sex, Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [2]

Daily smokers by educational level

People with the lowest educational level are 2.5 times more likely to be daily smokers than people with the highest educational level, after adjusting for age. The prevalence of daily smokers decreased in people with a high educational level, but remained stable in all other educational levels.

Prevalence of daily smokers by educational level, Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [2]

International comparison

The prevalence of daily smokers in Belgium was similar to the EU-15 average in 2014.

  • Men
  • Women

Prevalence of daily smokers among men, by country (EU-15), 2014 or nearest year
Source: OECD Health Data, 2014 or nearest year [3]

Prevalence of daily smokers among women, by country (EU-15), 2014 or nearest year
Source: OECD Health Data, 2014 or nearest year [3]

5. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Current smokers
Current smokers are people who currently smoke, including daily and occasional smokers.
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 smokers
The prevalence of daily smokers is the percentage of the population aged 15 years 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, 1997-2013. https://his.wiv-isp.be/fr/Documents%20partages/TA_FR_2013.pdf
  3. OECD Health Data, 2014 or nearest year. http://stats.oecd.org/

Alcohol use

1. Key messages

European countries have the highest level of alcohol consumption in the world. Belgium, with an average consumption of 11 litres of pure alcohol per capita per year, is close to the mean European consumption, placing it among the countries with a high burden related to alcohol.
In 2013, 7.2% of the men and 4% of the women had a hazardous consumption of alcohol (more than 21 or 14 drinks per week respectively in men and women). The prevalence of hazardous consumption has decreased since 2004 in men, but not in women.
The prevalence of weekly Risky Single Occasion Drinking (RSOD, consumption of at least 6 glasses of alcohol at a single occasion) in Belgium is higher than the European average. Particularly worrying is the prevalence of RSOD in young men (15-24), that reaches 20%. This is a clear target for prevention strategies.

2. Background

Excessive alcohol consumption is responsible for 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 the 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, but self-reported measures are subject to under-reporting and social desirability bias.

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

  1. Hazardous alcohol consumption, referring to a 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 (RSOD) or "binge drinking", referring to a consumption of 6 drinks or more in a single occasion, at least once a week.
  3. In the international comparisons, we present the average alcohol consumption per capita as estimated by the World Health Organization (WHO).

3. Hazardous drinking

Belgium

In 2013, the proportion of hazardous drinkers (more than 21 or 14 drinks on average per week respectively in men and women) was 6%. 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 suggest a much lower consumption in women. Hazardous drinking is worrying in young men (15-24 years) with an 8% prevalence, but the highest prevalence is observed in the 55-64 age group (12% for both sexes considered together).

Prevalence of alcohol hazardous drinking among the population aged 15 or older, by age group and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [1]

Time trend and differences by regions

At Belgian level, a decrease in the prevalence of hazardous alcohol consumption among men is observed from 12.3% in 2004 to 7.2% in 2013. This decrease from 2004 in men was observed in all three regions. In women, this decrease was smaller and not significant.

A slightly higher prevalence of hazardous alcohol consumption in men was observed in Wallonia in 2013 than in the other regions, but this difference was not significant after adjustment for age. In women, a significantly higher prevalence was observed in Brussels compared to the two other regions.

  • Men
  • Women

Prevalence of alcohol hazardous drinking in men aged 15 and older, by region and for Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [1]

Prevalence of alcohol hazardous drinking in women aged 15 and older, by region and for Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [1]

Differences by educational level

The patterns of hazardous alcohol drinking by educational level (EL) are opposite in men and women. They do not follow a gradient. Instead, in men, hazardous alcohol drinking is more frequent in the lower two than in the higher two ELs. In women, the pattern is reverse, with hazardous alcohol consumption more frequent among highly educated women compared to women with low ELs. The same gender pattern was also observed in all OECD countries [2].

Percentage of hazardous alcohol drinking in the population aged 15 and older, by sex and educational level, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [1]

4. Risky single occasion drinking

Belgium

The prevalence of weekly Risky Single Occasion Drinking (RSOD) was 8.5% in Belgium in 2013, while it was 8.1% in 2008. It is more frequent in men (12.5%) than in women (3.5%). The age group 15-24 years has the highest prevalence of RSOD (14%), followed by the 55-64 years (11.3%). The prevalence is particularly high in young men: almost 20% of the young men (15-24 years) declare a consumption of (at least) 6 glasses of alcohol at a same occasion, once a week or more. There are no differences by educational level.

Prevalence of weekly Risky Single Occasion Drinking (RSOD) in the population aged 15 or older, by age group and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [1]

Changes and differences by regions

The prevalence of weekly RSOD remained almost stable between 2008 and 2013 at national level. In 2008, the prevalence of RSOD was significantly higher for men in Flanders (around 13%) than in the other regions, but the regional differences disappeared in 2013, as the weekly RSOD prevalence remained stable in Flanders but increased in Wallonia and Brussels (from 8.8% and 8.5% to 12% in both regions.

Among women, the prevalence in weekly RSOD remained stable in Flanders and Wallonia and increased in Brussels from 3.3 to 5.2% between 2008 and 2013.

  • Men
  • Women

Prevalence of alcohol weekly Risky Single Occasion Drinking in men aged 15 and older, by year and by region, Belgium, 2008-2013
Source: Health Interview Survey, Sciensano, 2008-2013 [1]

Prevalence of alcohol weekly Risky Single Occasion Drinking in women aged 15 and older, by year and by region, Belgium, 2008-2013
Source: Belgian Health Interview Surveys, 2008-2013 [1]

International comparison

The prevalence in weekly RSODs 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 among men aged 15 or older, by country of residence, Europe, 2014
Source: Eurostat, 2014 [3]

Prevalence of weekly Risky Single Occasion Drinking among women aged 15 or older, by country of residence, Europe, 2014
Source: Eurostat, 2014 [3]

5. Total alcohol consumption per capita

The World Health Organization (WHO) European Region has the highest level of alcohol consumption in the world [4]. According to the WHO estimations for the period 2008-2010, the total consumption in Belgium was 11.0 liters of pure alcohol per capita, which was close to the EU-15 average (11.4 liters).

Total alcohol (recorded 3-year average + unrecorded) per capita consumption (in liters of pure alcohol) among population aged 15 or older, by country of residence, Europe, 2010
Source: GISAH, 2008-2010 [5]
Total alcohol (recorded 3-year average + unrecorded) per capita consumption (in liters of pure alcohol) among population aged 15 or older, by region of the world, 2010
Source: World Health Organization, 2014 [6]

6. 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 because these countries have similar socioeconomic conditions.
Hazardous alcohol consumption
Hazardous alcohol consumption, or alcohol over consumption, is the percentage of men and women aged 15 years and older who reports consuming more than 30 g for men and 20 g for women daily, equivalent to 21 and 14 glasses per week respectively.
Total alcohol per capita consumption
The total alcohol per capita consumption is the recorded 3-years average and the unrecorded alcohol consumption per capita for the population aged 15 and over, expressed in litres 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 survey specific questions. More information can be found in http://www.who.int/substance_abuse/activities/gisah_indicatorbook.pdf?ua=1
Weekly Risky Single Occasion Drinking (RSOD)
Weekly risky single occasion drinking is the percentage of people aged 15 years and older who declares a heavy episodic drinking, defined as a consumption of (at least) 6 glasses of alcohol at a same occasion, at least once a week. Also frequently called "binge drinking".

References

  1. Health Interview Survey, Sciensano, 1997-2013. https://hisia.wiv-isp.be/SitePages/Home.aspx
  2. OECD, 2015. http://www.oecd-ilibrary.org/docserver/download/5js1qwkz2p9s-en.pdf?expires=1518691657&id=id&accname=guest&checksum=F8F823E57B77D9806509FD2DFA4CFC10
  3. Eurostat. http://ec.europa.eu/eurostat/fr/data/database
  4. World Health Organization, 2017. http://www.euro.who.int/__data/assets/pdf_file/0007/343744/2017-Alcohol-Fact-Sheet-FINAL.pdf?ua=1
  5. World Health Organization, GISAH, 2008-2010. http://apps.who.int/gho/data/node.gisah.A1032?lang=en&showonly=GISAH
  6. World Health Organization, Global status report on alcohol and health, 2014. http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1

Weight status

1. Key messages

Weight excess is an important problem in Belgium like in most industrialized countries.
In 2013, 48% of the adult population was suffering from overweight; this includes a share of 14% being obese, which is close to the EU-15 mean. Obesity is strongly related to the socio-economic status with a much higher prevalence among people with the lowest educational level. The obesity prevalence is higher in Wallonia than in the other regions, particularly in men. Obesity prevalence has been increasing in Belgium since 1997, but this tendency seems to have stabilized, except for men in Wallonia.
In 2014, 14% of the adolescents were suffering from overweight (including those who are obese). Overweight is more frequent in boys (16% vs 12% in girls), more frequent in the region of Wallonia (15% vs 13% in the Flemish region), and more frequent in families with a lower income.

2. Background

Overweight and obesity are defined as an excessive accumulation of body fat, which favours 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, overweight and obesity are defined as BMI ranges of 25-30 and ≥30, respectively. In children and adolescents, the boundaries of the BMI categories are age and sex specific.

The weight status can be derived either from self-reported information, such as that collected from the Health Interview Survey (HIS) and the Health Behavior in School-aged Children survey (HBSC), or from measured information such that collected during the Food Consumption Survey (FCS). Self-reported data usually lead to some underestimation of the true overweight/obesity prevalence.

We will focus on the obesity prevalence in adults (HIS data) and the overweight prevalence in adolescents (HBSC data). Choices were driven by the possibility to analyze trends and to make international comparisons.

According to the HIS of 2013 (self-reported data) [1]:

  • 48% of the adult population had an excess of weight (14% obese and 34% overweight);
  • 49% had a normal weight; and
  • 3% were underweight.

But according to the Food Consumption Survey of 2014 (measured data) [2], the prevalence reaches up to 53% of the population aged 18-64 (with 19% obese and 34% overweight), 45% had a normal weight and 2% were underweight.

3. Obesity in adults

Belgium

According to the Health Interview Survey, the prevalence of obesity in adults was 14% in 2013, without any difference between genders.

The prevalence of obesity increases with age until the age of 65-74 years; it then decreases again among 75 years and older. This increase starts earlier in women (25-34) than in men (35-44). The percentage of obese people varies from 3.9% at the younger age group (18-24) up to 19.6% at the age-group 65-74.

Prevalence of obesity by age group and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [1]

Evolution over time and by regions

The percentage of obese adults in Belgium increased until 2008 and stabilized afterwards.

Obesity prevalence has been higher in Wallonia than in the other regions, in all the successive HIS for both sexes; the excess is more pronounced in men.

From 1997 to 2013, the prevalence of obesity among men has increased moderately in Flanders and more seriously in Wallonia and Brussels. In women, it has increased moderately in all regions. As the long-term Federal Vision on Sustainable Development aims at a decrease of the share of obese adults, efforts are still needed.

  • Men
  • Women

Prevalence of obesity among men aged 18 and over, by region of residence and for Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [1]

Prevalence of obesity among women aged 18 and over, by region of residence and for Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [1]

By educational level

Obesity prevalence is strongly associated with educational level. In 2013, there were three times fewer obese people among the most educated (7.7%) compared to the less educated (23.5%). This difference between education groups has increased as compared to previous HIS survey (in 2008 the ratio was 2).

Prevalence of obesity among people aged 18 and over by level of education, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [1]

International comparison

The prevalence of obesity in Belgium used to be higher than the EU-15 mean since 2000, but it has been increasing slower since 2008. So, in 2015 and for both sexes, Belgium ranks better and the prevalence of obese adults is lower than the EU-15 mean.

  • Men
  • Women

Prevalence of obesity among men aged 18 and over, by country of residence (EU-15), 2015 or nearest year
Source: OECD Health statistics, 2015 or nearest year [3]

Prevalence of obesity among men aged 18 and over, by country of residence (EU-15), 2015 or nearest year
Source: OECD Health statistics, 2015 or nearest year [3]

4. Overweight in adolescents

Belgium

According to the Health Behaviour in School-aged Children (HBSC) survey of 2014, boys are more frequently suffering from overweight than girls in Belgium; this is observed in each of the specific ages under study (11, 13 and 15 years). Overweight tends to increase with age (but differences are not significant).

Prevalence of overweight in adolescents, by sex and age, Belgium, 2014
Source: Unweighted Belgian average based on the Health Behaviour in School-aged Children survey (IOTF cut-off), 2014 [4,5]

Evolution over time by region

Overweight prevalence among 15-year-old adolescents is higher in the French than in the Flemish speaking community.

The prevalence of overweight among 15-year-old adolescents consistently increased between 2006 and 2014, both in boys and in girls, for the whole of Belgium.

Among 15-year-old boys, the overweight prevalence increased slightly along the successive surveys, in each of the two communities. Among girls, it increased in the Flemish-speaking but not in the French speaking community. The differences between regions are less pronounced in 2014, compared to 2006, for both sexes.

  • Boys
  • Girls

Prevalence of overweight (including obesity) among 15-year-old adolescent boys, by community, 2006-2014
Source: Health Behaviour in School-aged Children survey (IOTF cut-off), 2006-2014 [4,5]

Prevalence of overweight (including obesity) among 15-year-old adolescent girls, by community, 2006-2014
Source: Health Behaviour in School-aged Children survey (IOTF cut-off), 2006-2014 [4,5]

By socio-economic status

According to the HBSC report, higher overweight prevalence was associated with low family affluence for both sexes. These social inequalities result in a 10 percentage-point difference in the Flemish part and a 15 percentage point-difference in the French part of the country in 2014.

International comparison

Belgium ranks quite favorably among the EU-15 countries with an overweight prevalence of 16% compared to 18% for the EU-15 average in 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 adolescent boys, by country of residence (EU-15), 2014
Source:  OECD Health at a glance, 2017 [6]

Prevalence of overweight (including obesity) among 15-year-old adolescent girls, by country of residence (EU-15), 2014
Source: OECD Health at a glance, 2017 [6]

5. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Body mass index
The body mass index (BMI) is a measure of a person’s weight relative to their height that links fairly well with body fat. It is calculated as a person’s weight (in kilograms) divided by the square of his or her height (in meters): BMI = weight (kg) / height (m²). In adults, overweight and obesity are defined as BMI ranges of 25-30 and ≥30, respectively. In children and adolescents, the boundaries of the 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 similar socioeconomic conditions.

References

  1. Health Interview Survey, Sciensano, 2013. https://his.wiv-isp.be/fr/Documents%20partages/NS_FR_2013.pdf
  2. Food Consumption Survey, Sciensano, 2014. https://fcs.wiv-isp.be/FR/SitePages/Accueil.aspx
  3. OECD Health statistics. http://stats.oecd.org/
  4. HBSC Surveys, 2006-2014. http://www.hbsc.org/publications/international/
  5. International Obesity Task Force. https://www.worldobesity.org/about/about-obesity/obesity-classification
  6. OECD Health at a Glance 2017. http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Physical activity

1. Key messages

In Belgium, only 62.5% of adults (aged 18-64) are ‘at least minimally active’. Men are more physically active than women. The proportion of active adults is decreasing with age. Residents of the Walloon Region are less physically active than in the other regions, while women are more active in Brussels. There is no important socioeconomic disparity in the proportion of people that are at least minimally active.
The proportion of people practicing enough physical activity to have a positive impact on health is very low, reaching only 29% of the adult population (aged 18-64). Men practice twice as much health-enhancing physical activity as women. Regional differences are small in this domain, with a slightly lower level of health-enhancing physical activity in Wallonia. No clear evolution was observed over time.

2. Background

Lack of physical activity is one of the leading risk factor in terms of morbidity and mortality for a series of chronic conditions, like cardiovascular diseases, cancer and diabetes. Moreover, regular physical activity, when reaching a certain threshold, can have significant benefits for health (“Health-enhancing physical activity”). In Belgium, the recommendations are usually to devote at least 30 minutes to moderate or intense physical activity at least 5 times a week, or to walk 10,000 steps a day [2].

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 moreover, 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), physical activity is measured with the short version of the International Physical Activity Questionnaire (IPAQ) [1]; the questions include all types of activities and measure their intensity. In the 2014 wave of the European HIS another questionnaire (EHISPAQ) was used; consequently, the comparison of the results in Belgium with the other EU member states is not available up to now.

In this report, we used the indicators as defined by IPAQ and calculated the values from the HIS survey data:

3. Proportion of people with at least a minimal physical activity

Belgium

In Belgium, men are more physically active than women: in 2013, the prevalence of being “at least minimally active” was 69% among men and 56% among women. In other words, 31% of the men and 44% of the women can be considered to be insufficiently active.

  • Men
  • Women

Proportion of male adults (18–64) minimally active and with health-enhancing physical activity level*, by year, 2001–2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2001–2013 [3]
(*) The sum of people minimally active and people with health-enhancing physical activity corresponds to the people “at least minimally active”.

Proportion of female adults (18–64) minimally active and with health-enhancing physical activity level*, by year, 2001–2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2001–2013 [3]
(*) The sum of people minimally active and people with health-enhancing physical activity corresponds to the people “at least minimally active”.

The proportion of people that are at least minimally active did not change much over the period 2001–2013.

For both sexes, the proportion of people with at least minimal physical activity gets lower with age:

  • It is decreasing from 85% of the 18–24 to 61% at the age of 55–64 years among men
  • It is decreasing from 70% of the 18–24 to 43% at the age of 55–64 years among women (we see here however an exception for women aged 45–54 for which there is a slight increase).
Proportion of adults (18–64) at least minimally physically active, by sex and age group, 2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2013 [3]

Trends and regional disparities

For Belgium as a whole, the proportion of men physically active slightly increased over time after a small decrease in 2004. In women, no important change was observed at Belgian level.

In 2013, the proportion of men at least minimally active was significantly higher in Brussels (74%) and in Flanders (73%) than in Wallonia (61%). In women, the regional disparities were still more pronounced with a significantly higher proportion of women at least minimally active in Brussels (71%) and Flanders (60%) than in Wallonia (46%).

Since the HIS2001, people have been more physically active in Brussels than in the other regions, and this in particular for women. The proportion of people at least minimally active has decreased over time in Wallonia regardless of gender, while it has increased in the other regions. The proportion of men at least minimally active was the lowest in Flanders in 2001 and 2004; it has however increased dramatically since then and reached the Brussels’ level in 2008. Among women, the regional differences remained quite stable over time.

  • Men
  • Women

Proportion of male adults (18–64) at least minimally physically active, by year and region, 2001–2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2001–2013 [3]

Proportion of female adults (18–64) at least minimally physically active, by year and region, 2001–2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2001–2013 [3]

Disparities by educational level

In contrast to many risk factors for health, no clear gradient was observed for the practice of physical activity, for both sexes.

Prevalence of active adults, by sex and level of education, 2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2013 [3]

4. Proportion of people with a health-enhancing physical activity

Belgium

In Belgium, 29% of the population are practicing physical activity enough to have a health-enhancing effect (HEPA). Men have twice as often health-enhancing physical activity (39%) than women (21%) in 2013 (sex ratio of 1.9).

The proportion of men practicing HEPA stayed a bit under 40% during the whole period 2001–2013. Among women this proportion has decreased significantly between 2001 (29%) and 2013 (21%).

Trends and regional disparities

In 2013, the proportion of men having HEPA was similar in the 3 regions, slightly below 40%, while the proportion of women was higher in Brussels (25%) and Flanders (22%) than in Wallonia (17%).

In men, the proportion of men practicing HEPA tends to converge in the three regions, resulting in 2013 in a similar level of HEPA. In women, on the contrary, the regional differences tend to be more pronounced in 2013 than in the previous years.

  • Men
  • Women

Proportion of male adults (18–64) having health-enhancing physical activity, by region of residence and year, 2001–2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2001–2013 [3]

Proportion of female adults (18–64) having health-enhancing physical activity, by region of residence and year, 2001–2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2001–2013 [3]

The sex ratio for HEPA in Wallonia (2.2) was the highest of the three regions, meaning that the difference between men and women was the most pronounced. Inversely, the sex ratio in Brussels (1.5) was the lowest one.

Sex ratio (men/women) of adult (18-64) having health-enhancing physical activity, by region of residence, 2013
Source: Own calculation based on Health Interview Survey, Sciensano, 2013 [3]

Disparities by educational level

The usual socio-economic gradient is not observed for HEPA. Only among men with secondary education, the proportion of men practicing HEPA tends to be higher, but the difference is not significant.

The proportion of women practicing HEPA is similar and around 18% in all educational levels.

Proportion of adults (18–64) having health-enhancing physical activity, by sex and level of education, 2013, Belgium
Source: Own calculation based on Health Interview Survey, Sciensano, 2013 [3]

5. Read more

View the metadata for this indicator

Definitions

Metabolic Equivalent of Task (MET)
Metabolic Equivalent of Task are commonly used to express the intensity of physical activities. MET is the ratio of a person's working metabolic rate relative to their resting metabolic rate. It is measuring the amount of energy consumed according to the type practiced sport and the speed adopted. Multiply this MET value by the number of minutes during of which the activity has been practiced, the number of MET-minutes is obtained.
Prevalence of people being at least minimally active
According to the IPAQ threshold, the prevalence of people being at least minimally active is the percentage of people who meet any one of the following 3 criteria:
• 3 or more days of vigorous activity of at least 20 minutes per day OR
• 5 or more days of moderate-intensity activity or walking of at least 30 minutes per day OR
• 5 or more days of any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 600 MET-min/week.
Prevalence of people having health-enhancing physical activity
According to the IPAQ threshold, the prevalence of people having health-enhancing physical activity is the percentage of people who meet any one of the following 2 criteria:
• Vigorous-intensity activity on at least 3 days and accumulating at least 1500 MET-minutes/week
• 7 or more days of any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 3000 MET-minutes/week

References

  1. International Physical Activity Questionnaire. www.ipaq.ki.se
  2. Vlaamse Instituut voor Gezond Leven. https://www.gezondleven.be/projecten/10-000-stappen
  3. Health Interview Survey, Sciensano, 2001-2013. https://his.wiv-isp.be/FR/SitePages/Accueil.aspx
  4. Metabolic Equivalent of Task (MET). http://www.who.int/dietphysicalactivity/physical_activity_intensity/en/
  5. IPAQ threshold. https://sites.google.com/site/theipaq/scoring-protocol

Nutrition

1. Key messages

The Belgian diet is characterized by excessive consumption of red meat, processed meat and sugar sweetened beverages on one side and by insufficient consumption of fruits, vegetables, nuts and seeds, milk, eggs and fish. Over time, these patterns have only slightly improved.
In 2014, the mean usual fruit and vegetable consumption was 255 grams/day. Only 14% of the population met the WHO dietary guidelines of 400 grams per day. The consumption of fruit and vegetables has slightly increased over the past years. It was higher in women than in men and increased with educational level.
In 2014, 97% of the Belgian population consumed sugar sweetened beverages. The mean usual consumption was 151 ml/day. The consumption was highest in adolescence and higher in men than in women. The consumption decreased in 2014 compared to 2004. The consumption is decreasing with increasing educational level.
The consumption of ultra-processed foods (UPF) in Belgium represented 30% of the total energy consumed. This proportion was higher among children (33% of the total energy consumed). No difference could be observed between men and women in the consumption of UPF. In 2014 the consumption of UPF did not significantly differ compared to 2004. In Wallonia the consumption of UPF was higher than in Flanders. It did not vary with the education levels.

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 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]. The focus in this report has been put on:

  1. Consumption patterns for 9 food groups compared against international recommendations [2].
  2. A more detailed analysis of three indicators related to the diet quality, i.e. fruit and vegetable consumption, consumption of sugar-sweetened beverages and consumption of ultra-processed foods.

Fruit and vegetables are low-energy density foods and are important sources of dietary fiber, 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 [8]. The WHO recommends a daily consumption of 400 grams of fruit and vegetables [9].

Contrarily, 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;8]. The WHO strongly recommends restricting the intake of free sugars to less than 10% of the total energy consumption, throughout the life course [10]. With respect to this guideline the consumption of sugar-sweetened beverages should be avoided.

Ultra-processed foods (UPF) are food products formulated from industrial ingredients with little or no content of intact foods. Such foods are often characterised by lower nutritional quality. They have been associated with a higher incidence of dyslipidaemia and a higher risk of overweight, obesity and hypertension. The consumption of UPF should thus be avoided as far as possible [11-12]. For the analysis of the Belgian data performed here, the food items have been classified by the NOVA classification based on the extent and purpose of industrialised processing. The results are presented as dietary share of the proportion of daily energy consumed [13].

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, 2004-2014 [7]
hsr en nutrition overview

4. Consumption of fruits and vegetables

Belgium

In 2014, the usual fruit and vegetable consumption was 255 grams per day. Only 14% of the population met the WHO guidelines of 400 grams per day.

Fruit and vegetable consumption in children was similar as in adolescents (206 grams/day and 210 grams/day respectively). In adults the consumption was 269 grams/day. There were no difference in fruit and vegetable consumption between boys and girls during childhood and adolescence. Conversely, in adults (18-64 years), men eat less fruit and vegetables than women (258 grams/day versus 284 grams/day).

Consumption of fruit and vegetables (in grams per day) in the population aged 3-64 years, by age group and sex, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Time trends

The mean usual consumption of fruit and vegetables, slightly increased from 243 grams/day in 2004 to 269 grams/day in 2014. The increase over time was similar in adolescents and adults. The proportion of the population that meets the recommendations increased from 7.5% to 16%. Consumption data of children (3-14 years) could not be compared with 2004 since the food consumption survey of 2004 did not comprise children.

Average usual consumption of fruit and vegetables (in grams per day) in the population aged 15-64 years, by age by year, Belgium, 2004-2014
Source: Food Consumption Survey, Sciensano, 2004-2014 [7]

Differences by region

In all age groups the mean usual consumption of fruit and vegetables was higher in Flanders than in Wallonia (275 grams/day versus 212 grams/day). In total, 16% of people living in Flanders met the recommendations for fruit and vegetable consumption compared to 8% in Wallonia.

Mean usual consumption of fruit and vegetables (in grams per day) in the population aged 3-64 years, by age and by region of residence, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Differences by educational level

Fruit and vegetable consumption increased with the educational level with a mean usual consumption of 211 grams/day for individuals in the lowest educational level and on average 300 grams/day for individuals in the highest educational level. Only 6% of the lower educated population meets the recommendations for fruit and vegetable consumption compared to 22% for the higher educated population.

Consumption of fruit and vegetables (in grams per day) in the population aged 3-64 years, by educational level, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

International comparison

In all age groups, the mean fruit and vegetable consumption in Belgium was below the EU-15 average. However, the difference with the EU-15 average was smaller in children 3-9 years (206 grams/day versus 210 grams/day) than in adolescents (210 grams/day versus 226 grams/day) and adults 269 grams/day versus 307 grams/day).

  • Children
  • Adolescents
  • Adults

Mean usual fruit and vegetable consumption (in grams per day) in children (3-9 years), by country of residence, EU-15, EFSA food consumption surveys
Source: EFSA comprehensive food consumption survey, chronic intake from 12 countries; data from Luxembourg and Ireland are missing [14]. Usual fruit and vegetables consumption calculated as the sum of the average chronic food consumption and the average chronic vegetable consumption

Mean usual fruit and vegetable consumption (in grams per day) in adolescents (10-17 years), by country of residence, EU-15, EFSA food consumption surveys
Source: EFSA comprehensive food consumption survey, chronic intake from 12 countries; data from Greece, Luxembourg and Ireland are missing [14]. Average usual fruit and vegetables consumption calculated as the sum of the average chronic fruit consumption and the average chronic vegetable consumption

Fruit and vegetable consumption (in grams per day) in adults 18-64 years), by country of residence, EU-15, last food consumption surveys
Source: EFSA comprehensive food consumption survey, chronic intake from 12 countries; data from Luxembourg and Greece are missing [14]. Average usual fruit and vegetables consumption calculated as the sum of the average chronic fruit consumption and the average chronic vegetable consumption

5. Consumption of sugar sweetened beverages

Belgium

In 2014, the usual consumption of sugar sweetened beverages was 151 ml/day, and 97% of the population consumed sugar-sweetened beverages. The consumption was highest in adolescents (220 ml/day); it was also higher in men than in women (196 ml/day and 112 ml/day respectively).

Consumption of sugar sweetened beverages (in ml per day) in the population aged 3-64 years, by age and sex, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Time trends

In 2014 compared to 2004, the consumption of sugar-sweetened beverages decreased from 387 ml/day to 298 ml/day in adolescents (15-17 years) and from 250 ml/day to 211 ml/day in young adults (18-39 years). In the older adult population (40-64 years) the consumption did not change in 2014 (89 ml/day). Consumption data of children (3-14 years) could not be compared with 2004 since the food consumption survey of 2004 did not comprise children.

Mean usual consumption of sugar sweetened beverages (in ml per day) in the population aged 15-64 years, by age and year, Belgium, 2004-2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Differences by region

The consumption of sugar sweetened beverages was slightly higher in Flanders (167 ml/day) than in Wallonia (148 ml/day), but this difference was not significant.

Consumption of sugar sweetened beverages (in ml per day) in the population aged 3-64 years, by age and region, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Differences by educational level

The proportion of the population that consumes sugar sweetened beverages is equally high in all educational groups. However, there is a socio-economic gradient for the amount of sugar sweetened beverages consumed, i.e., 227 ml in people with the lowest educational level versus 89 ml/day in people with the highest educational level.

Consumption of sugar sweetened beverages (in ml per day) in the population aged 3-64 years, by education level, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

6. Consumption of ultra-processed foods

In 2014, the mean proportion of daily energy intake from ultra-processed foods (UPF) was 29.9%. This proportion was slightly higher in young children (33.3%) compared to adolescents (29.2%) and adults (29.6%.) The daily energy intake from UPF was not significantly different between women and men.

Consumption of ultra-processed foods (in% of the total energy intake) in the population aged 3-64 years, by age and sex, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Time trends

The daily energy intake of UPF did not change in 2014 (29.9% of the total energy intake) compared to 2004 (29.8%).

Mean usual consumption of ultra-processed foods (in % of the total energy intake) in the population aged 15-64 years, by age and year, Belgium, 2004-2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Differences by region

The proportion of the usual daily energy intake from UPF was higher in Wallonia (36.8%) compared to Flanders (28.7%). This difference was more pronounced in children compared to adults.

Mean usual consumption of ultra-processed foods (in% of the total energy intake) in the population aged 3-64 years, by age and region, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

Differences by educational level

Within all age groups there was no significant difference in the proportion of energy intake from UPF between the different educational levels.

Mean usual consumption of ultra-processed foods (in% of the total energy intake) in the population aged 3-64 years, by age and education level, Belgium, 2014
Source: Food Consumption Survey, Sciensano, 2014 [7]

7. Read more

FCS: Food consumption survey

Definitions

NOVA classification
NOVA is a food classification tool that groups foods according to the extent and purpose of food processing. Food products are divided in four distinct food groups, i.e. ‘ultra-processed’, ‘processed’, ‘unprocessed or minimally processed’ or ‘processed culinary ingredient’ [10].
Ultra-processed foods
Ultra-processed foods (UPF) are foods formulated from industrial ingredients with little or no content of intact foods. UPFs are often characterised by lower nutritional quality and have been associated with a higher incidence of dyslipidaemia and a higher risk of overweight, obesity and hypertension. The consumption of UPF should be avoided [9].
Usual intake
Usual intake is the average daily intake over a long period of time.

References

  1. Amine EK, Baba NH, Belhadj M, Deurenberg-Yap M, Djazayery A, Forrestre T, Galuska DA, Herman S, James WPT, M'Buyamba Kabangu JR (2003) Diet, nutrition and the prevention of chronic diseases. World Health Organization technical report series .
  2. GBD 2017 Risk Factor Collaborators (2017) 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 392 (10159): 1923-1994.
  3. Vanhauwaert E. De actieve voedingsdriehoek: een praktische voedings- en beweeggids. Brussel; 2012.
  4. Lebacq T, Ost C. Recommandations alimentaires. In: Tafforeau J, editor. Enquête de consommation alimentaire 2014-2015. 2016.
  5. De Ridder K, Bel S, Brocatus L, Lebacq T, Ost C, et al. (2016) Résumé des résultats 2014-2015. In: Tafforeau J, editors. Enquête de consommation alimentaire. Bruxelles: WIV-ISP.
  6. Debacker, N, Cox, Bianca, Temme, Liesbeth, Huybrechts, Inge, and Van Oyen, Herman (2007) De Belgische voedselconsumptiepeiling 2004: voedingsgewoonten van de Belgische bevolking ouder dan 15 jaar. Wetenschappelijk Instituut Volksgezondheid.
  7. Sciensano (2019) Website of the Belgian National Food Consumption survey 2014. https://fcs.wiv-isp.be/SitePages/Home.aspx.
  8. EFSA Panel on Dietetic Products, Nutrition, and Allergies (2010) Scientific opinion on principles for deriving and applying dietary reference values. EFSA Journal 8 (3):1458.
  9. World Health Organization (1990) Diet, nutrition, and the prevention of chronic diseases. Report of a WHO Study Group. 
  10. World Health Organization (2015) Guideline: sugars intake for adults and children. 
  11. Vandevijvere S, De Ridder K, Fiolet T, Bel S, Tafforeau J (2018) Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium. European Journal of Nutrition 1-12.
  12. Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Allès B, Méjean C, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ 2018;360:322.
  13. Monteiro CA, Cannon G, Levy R, Moubarac JC, Jaime P, Martins AP, Canella D, Louzada M, Parra D (2016) NOVA. The star shines bright. World Nutrition 7: 28-38.
  14. European Food Safety Authority (2019) The EFSA comprehensive food consumption database.

Sciensano    KCE    Inami-Riziv SPF-FOD