In 2017, 38 million children under 5 years of age were overweight or obese. This is a significant increase from 30 million in 2000, and the rise is most significant in lower and middle income countries. The region with the highest burden is Asia, with 17 million overweight and obese children under five. Regarding primary school age children and adolescents, a recent global analysis showed that mean BMI in children aged 5-19 had increased significantly, particularly in South East Asia. It is important to note that different forms of child malnutrition (stunting, wasting, overweight, micronutrient deficiencies) can co-exist in the same country, the same community and even the same family and individual: the “double burden” of malnutrition. In 2017, 85 out of 140 countries with data have serious levels of overweight together with at least one form of undernutrition.
Evidence shows that low birthweight, stunting and wasting in early childhood are risk factors for later overweight and non-communicable diseases. Overweight in childhood and adolescence predispose an individual to later obesity and NCDs. Studies have shown that interventions to address overweight in early childhood yield greater dividends than interventions among adults. So-called “double duty” interventions in early childhood aim to address all forms of malnutrition.
Addressing child overweight requires a comprehensive commitment by countries. The importance of targeting both individual behavior and the enabling environment is clear. In 2014, WHO established the Commission on Ending Childhood Obesity. This commission issued a report in 2016 with six specific recommendations to address the obesogenic environment and critical periods in the life course. The World Health Assembly requested the WHO Director General to develop an implementation plan, which was subsequently approved in the 2017 World Health Assembly. The six recommendations are:
1. Implement comprehensive programmes that promote the intake of healthy foods and reduce the intake of unhealthy foods and sugar-sweetened beverages by children and adolescents. (This may include policy, legislative and fiscal measures to restrict/reduce unhealthy F&B and social and behavior change communication and marketing to promote healthy F&B)
2. Implement comprehensive programmes that promote physical activity and reduce sedentary behaviours in children and adolescents.
3. Integrate and strengthen guidance for noncommunicable disease prevention with current guidance for preconception and antenatal care, to reduce the risk of childhood obesity.
4. Provide guidance on, and support for, healthy diet, sleep and physical activity in early childhood to ensure children grow appropriately and develop healthy habits.
5. Implement comprehensive programmes that promote healthy school environments, health and nutrition literacy and physical activity among school-age children and adolescents.
6. Provide family-based, multicomponent, weight management services for children and young people who are obese.