World Health Organization. (2016). Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: report of the ad hoc working group on science and evidence for ending childhood obesity, Geneva, Switzerland.
The prevalence of childhood obesity is increasing in all countries, with the most rapid rise in low- and middle-income countries; the majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that of developed countries. Children who are overweight or obese are at greater risk of asthma and cognitive impairment in childhood, and of obesity, diabetes, heart disease, some cancers, respiratory disease, mental health, and reproductive disorders later in life. The consequences of the rapid rise in obesity include not only health consequences but also negative impacts on the opportunity to participate in educational and recreational activities and increased economic burden at familial and societal levels. The rapidlyrising rates of childhood obesity and subsequent increasing burden of disease and disability has grave social and economic consequences, contributing to rising cost of health services and limiting economic growth.
Overweight and obesity are critical indicators of the environment in which children are conceived, born, and raised. Childhood obesity is driven by biological, behavioural, and contextual factors. Biological drivers include maternal malnutrition (including both under- and overnutrition) during pregnancy, and gestational diabetes. Inappropriate infant feeding behaviours include inadequate periods of exclusive breastfeeding and inappropriate complementary foods, as taste, appetite and food preferences are established in early life. Physical activity behaviours are also established in early childhood. Contextual and wider societal factors include socioeconomic considerations, nutritional literacy within families, availability and affordability of healthy foods, inappropriate marketing of foods and beverages to children and families, lack of education and reduced opportunity for physical activity through healthy play and recreation in an increasingly urbanized and digital world.
Childhood obesity is a critical target as part of a strategy to promote a healthy life expectancy. Life-course studies suggest that interventions in early life when biology is most “plastic” are likely to have sustained effects on health, particularly because it can influence responses to later lifestyle factors. Early life represents a phase in the life-course when most societies are able to intervene constructively. It is also an area in every society where there is strong political consensus that action is desirable, including considerations of equity. This combination of short-term direct and indirect benefits and longer-term effects on the primary prevention of noncommunicable disease creates a powerful economic and social argument for action.
Addressing childhood obesity has a compelling logic and the science offers many opportunities for intervention. However, at present there is no clear consensus on what interventions and which combinations are likely to be most effective in different contexts across the globe and no global accountability mechanism for stakeholders currently exists. If childhood obesity could be successfully addressed, the spill-over benefits could be enormous. In addressing childhood obesity as a specific target, it is likely that there would be improvements in both maternal and child health in general, there would be benefits for cognitive development and a reduction in other comorbidities in children, the nutritional status in the whole family would improve and there would certainly be major effects on long-term burden of noncommunicable disease.
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