Back on the 25th of January 2016 WHO released their final Report Of The Commission On Ending Childhood Obesity. The report includes the most problematic causes of childhood obesity, alarming statistics regarding the prevalence of childhood obesity and overweight, WHO’s goals, a potential framework for tackling the issue, principles and strategies, and who WHO believe should take responsibility.
The map above outlines the prevalence of childhood obesity across the world and how the prevalence has increased almost uniformly across the globe.
As per usual I’ll begin with some outright alarming facts:
- It was estimated in 2014 that 41 million children (under 5 years of age) were overweight or obese1
- The total number of overweight or obese children in Africa has doubled since 1990 from 5.4 million to 10.3 million1(p.4).
- Obesity is equally prevalent in the USA as it is in Mozambique, Argentina, China and Australia despite it being called the ‘World’s Fattest Nation’.
- “In 2014, of children under 5 years of age who were overweight, 48% lived in Asia and 25% in Africa”1(p.2)
- 81% of adolescents do not achieve the recommended 60 minutes of physical activity each day 1(p.21)
I keep coming back to these not-so fun fat facts but I am simply trying to re-iterate the presence of obesity in the global population and the dire need to take action.
The purpose of the commission is to produce guidelines that governments can take, modify and use when implementing their own policies. Holistically the commission aims to “reduce the risk of morbidity and mortality due to non-communicable diseases, lessen the negative psychosocial effects of obesity both in childhood and adulthood and reduce the risk of the next generation developing obesity”(p.1). These aims are achievable if implemented appropriately and acknowledged by the broader community.
WHO also implemented a framework1(p.vii) that addresses the most important risk factors for childhood obesity. This is what it is:
- Promote intake of healthy foods – and reduce the intake of unhealthy food and sugar-sweetened beverages.
- Promote physical activity – and reduce sedentary behaviour.
- Preconception and pregnancy care
- Early childhood diet and physical activity – and sleep to ensure that children grow appropriately and develop healthy habits.
- Health, nutrition and physical activity for school-age children – by promoting a healthy school environment and nutrition literacy.
- Weight management – in family-based, multi-component services.
This framework primarily addresses what WHO refer to as the ‘obesogenic environment’. The ‘obesogenic environment’ can be defined as “an environment that promotes high energy intake and sedentary behaviour”1(p.V). It is believed that this obesogenic environment is the main cause for childhood obesity and has “developed with changes in food type, availability, affordability and marketing, as well as a decline in physical activity, with more time being spent on screen-based and sedentary leisure activities”1(p.vi). However, the obesogenic environment is not this simple. Developmental programming research has shown that obesogenic environments arise before birth1 and that maternal health during pregnancy can epigenetically predispose infants to developing non-communicable disease. Furthermore, the obesogenic environment is not solely comprised of a poor diet and physical inactivity but is also influenced by cultural “perceptions of healthy and desirable body weight”1(p.4). WHO’s framework approaches the major dimensions of an obesogenic environment but as we can see an obesogenic environment consists of multi-factorial elements only further complicating the resolution process. But if there is a will there is a way and I believe if government acknowledge this health issue whole-heartedly, use the WHO’s guidelines and implement appropriate policies childhood obesity could be ended.
As the commission outlines responsibility does not end with WHO but extends to international organisations, Member States, non-government organisations, the private sector, philanthropic foundations, and academic institutions1. Both funding and support from big-body organisations and institutions are necessary for the implementation and success of policies such as this one. It is fundamental to give academic institutions and philanthropic foundations responsibility in ending childhood obesity as these bodies make up a large proportion of children’s psychosocial environment. As we can see with the determinants of health framework an individual’s health is influenced greatly by their education, employment, social gradient, social support and so forth. Therefore, it only seems obligatory to give such influential bodies some responsibility for tackling this issue.
WHO also included some principles and strategies for addressing the multi-dimensional childhood obesity issue. A majority of the ideas have already been discussed but there are a few stand-out principles that are worth mentioning. The first principle is “the child’s right to health”. This outlines the fact that it is society’s and the government’s “moral responsibility to act on behalf of the child to reduce their risk of developing obesity”1(p.8). This is the first ethical principle mentioned with the second being equity. It is necessary to ensure that equitable intervention and change is performed within society and that no marginalised or vulnerable groups who are in fact at higher risk of developing NCDs1 are forgotten. Both principles outline the ethical ground that childhood obesity lies upon. If no attempt is made to address, overcome or end childhood obesity then without a doubt that is ethically wrong.
As we can see WHO has addressed what they deem is most important in ending childhood obesity. Childhood obesity is not a disease confined to developed countries and it is manifesting faster than ever in developing countries. Furthermore, the causes of childhood obesity are multifactorial, including poor diet, physical inactivity, poor neonatal environment, and cultural perceptions, only further complicating the resolution process. For the whole world to address and take action against this health issue it seems it will be a difficult process but no-doubt rewarding. From an economic perspective reducing the mortality and morbidity of non-communicable diseases will be beneficial but more importantly ethically it is our right as members of the present to take action and not only improve the health and quality of lives of those living alongside but give future generations a head-start.
- WHO. Report Of The Commission On Ending Childhood Obesity Geneva, Switzerland 2016.
Image: Ebbeling CB, Pawlak, D. B., Ludwig, D. S. . Childhood obesity: public-health crisis, common sense cure. The Lancet. 2002;360:473-482.