The early stage of IN FORM has now been completed. It has served, among other things, to develop instruments and structures for the implementation of the National Action Plan, to integrate into the IN FORM process already existing measures and activities that promote healthy diets and increased physical activity, and to launch and support new projects in different living environments.

To date, almost 250 projects have been supported by the Federal Ministry of Food and Agriculture (BMEL) and the Federal Ministry of Health (BMG) under the IN FORM initiative.

In the years to come – during the so-called consolidation and dissemination phase – activities will mainly concentrate on:

• establishing (and stabilising) measures and projects supported under the IN FORM initiative in the longer term,
• disseminating findings and results, and
• promoting both the exchange of experiences and networking between actors within the projects.

IN FORM thus facilitates the dialogue between policy-makers, industry, the science community and civil society with regard to all questions concerning a healthy lifestyle. This, among other aspects, is reflected on the initiative's internet platform.

Overweight and physical inactivity on the one hand, eating disorders and malnutrition on the other – a number of representative studies show that, in Germany, unbalanced diets and a lack of physical activity are major problems. They lead to an increasing danger of ill health and to a growing number of diet-related illnesses.

A growing number of Germans are overweight

According to recent figures of the DEGS Study carried out by the Robert-Koch-Institute, 67 percent of men and 53 percent of women in Germany are overweight or obese while 15 % of children and youth under 18 are also affected. During the past decade, the share of overweight or obese young men increased by about eight percent, that of young women rose by about seven percent. Not all sections of society are equally affected by over-weight. As per capita income rises, the share of overweight or obese men and women diminishes. The higher an individual’s educational level, the lower his/her average Body Mass Index (BMI).

The BMI is calculated from height and weight. Slight overweight (BMI of 25 and above) does not necessarily indicate an increased health risk. Problems arise especially with increased quantities of body fat gathered in the abdomen. An increased abdominal girth (of 94 centimetres and more with men, of 80 centimetres and more with women) is considered as an important risk factor with respect to diabetes mellitus and cardiovascular diseases. There is a high likelihood that obesity (a BMI of 30 and higher) leads to chronic diseases such as cardiovascular diseases, diabetes mellitus, metabolic/ lipid disorders or to orthopaedic medical conditions.

Lack of physical activity prevails

Germans are too inactive physically: 37 percent of men and 38 percent of women do not engage in any kind of sports. And even though children and youth are more active than adults, their physical fitness and motor skills are less well-developed than in previous years. The health-sustaining effects of physical activity and their positive contribution to stress management have been scientifically proven. Physical activity prevents chronic illnesses and health risks, in particular overweight and obesity. People who frequently engage in physical activity together with others strengthen their sense of self, they promote their spiritual well-being and foster social interaction.

Eating disorders on the increase

Young people suffer from eating disorders particularly often. One fifth of the population aged between 11 and 17 show respective symptoms, with girls/ young women being affected almost twice as often as boys/young men. Eating disorders or pathological consumption such as bulimia, anorexia or binge eating are psychosomatic illnesses which require medical treatment. Obviously unusual dietary habits should be considered a first alarming sign of eating disorders and should be treated as early as possible. Strict limitations (such as the decision to never eat sweets again), extreme dietary habits or a distorted perception of one's body can also be first indications of eating disorders.

Malnutrition increases with age

In terms of nutrition, the situation of healthy, active and young seniors who live in their private households is comparable to that of adults in general. It changes, however, where elderly people are concerned who suffer from age-related illnesses, physical or mental handicaps (dementia) and psychological problems or whose social situation has changed. In this group, especially among seniors aged 75 and older, people are increasingly underweight and malnourished. Reasons can range from a modified vitamin intake, the side effects of medication, a lack of appetite or lack food intake to the reduced consumption of certain foodstuffs.

Aims and objectives of the National Action Plan

With its National Action Plan, the German government aims to foster healthier environments for children to grow up in, to encourage adults to adopt healthier lifestyles and to see society as a whole enjoy a higher quality of life and physical fitness. The action plan also intends to significantly reduce illnesses and diseases to which unhealthy lifestyles, unbalanced diets and lack of physical activity contribute.

To reach the aim of sustainably improving people’s habits concerning diets and physical activity, the following actions shall be taken:

• Positive approaches towards healthy diets and sufficient physical activity shall be bundled and oriented towards the targets they have in common. Their implementation shall be monitored regularly.
• Strategies and measures which include individual behaviours and take both the regional and national levels into consideration shall be developed.
• Structures shall be created which will enable people to lead health-sustaining lifestyles.

With its target-oriented measures, the National Action Plan addresses everyone in Germany.

Implementing the National Action Plan

For Germany to get in shape (i. e. IN FORM), the National Action Plan establishes the following five fields of action to set central aims, determine concrete approaches and take initial measures:

• Government, federal laender and municipalities serve as exemplary models
• Information on food and nutrition, on physical activity and health
• Physical activity in everyday life Improved quality of food supplied outside the home (in kindergartens, schools, canteens, hospitals, rehabilitation centres and facilities for senior citizens
• New debates to be triggered for and within the scientific community Evaluation

The effectiveness of programmes and projects which Germany has been funding through the National Action Plan has always been a central issue. Interim and final reports as well as evaluations are necessary to determine whether or not a project will be funded.

Malnutrition is a serious issue, not only in Germany. Numerous countries around the globe have initiated National Action Plans due to rising numbers of people being overweight, poorly nourished and physically inactive. Some countries place slightly different focuses than Germany but even in low-income countries worldwide, malnutrition, overweight and obesity are problems that must be taken seriously.

In 2004, the World Health Organisation (WHO) adopted a „Global Strategy on Diet, Physical Activity and Health“. It asks its member states, among other things, to develop national strategies for the prevention of non-communicable, lifestyle-related diseases through health-sustaining diets and increased physical activity. In November 2006, the WHO ministerial conference, held in Istanbul, adopted a Charta for the European WHO-Region to fight obesity.

The EU recognizes malnutrition and lack of physical activity as core challenges

In 2005, the EU Commission published the "Green Paper on promoting healthy diets and physical activity: a European dimension for the prevention of overweight, obesity and chronic diseases“ and stressed the importance of the issue for European politics. Its White Paper on „A Strategy for Europe on Nutrition, Overweight and Obesity-related health issues" in 2007 developed the matter further. Also, in 2005, the EU Commission established the „European Platform on Diet, Physical Activity and Health“, in which the industry, professional associations and organisations have committed to take verifiable steps towards the prevention of obesity.

Encouraged by experiences in the USA and Europe, efforts strive to harmonise activities with other European countries.

During its presidency of the Council, Germany stresses certain points

During the German Presidency of the EU Council in 2007, the German government made disease prevention by means of diets and physical activity one of the key issues. In this context, the European Council adopted the conclusions on „Health promotion by means of nutrition and physical activity“.

The European Commission does its share. The „High Level Group on Nutrition and Physical Activity“ deals particularly with the reformulation of foodstuffs. In addition, the EU Platform on Diet and Physical Activity was established to appeal to the industry and to civil society to commit themselves to motivating people towards improving their diets and engaging in physical activity more frequently.

Key issues paper lays down fundamental principles

With its text on the major issues of „Healthy diets and physical activity – Keys to a higher quality of life”, adopted on 9 May 2007, the German government established the fundamental principles and delineated the central fields of action of a National Action Plan for the prevention of malnutrition, lack of physical activity and overweight-related diseases. The National Action Plan „IN FORM – Germany’s initiative to promote healthy diets and increased physical activity” was adopted on 25 June 2008.

Since then, various programmes and projects have been gathered, promoted and funded under the umbrella of the IN FORM National Action Plan. Particular mention should be made here of the development of quality standards for food supplied outside the home, in kindergartens, schools, canteens and hospitals, for instance; of the Kinder Leicht Regions as well as of countless other activities organised by a wide range of actors.

An international issue

Fighting hunger is a pressing problem to be solved by the international community. Next to absolute hunger, hidden hunger affects a growing number of people. Contrary to people who suffer from hunger, those suffering from hidden hunger are not affected by an absolute lack of calories but by deficient supplies of minerals and vitamins. Hidden Hunger often goes hand in hand with harmful dietary habits, overweight or obesity. It particularly affects population segments who, as their economic situation improves, abandon their traditional foods and favour unbalanced diets based on highly processed and high-calorie finished products instead – a phenomenon called nutrition transition.