Prevention of childhood overweight and obesity in Mongolia, the Philippines and Vietnam: identifying priority actions.

Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments.

Obesogens and Obesity: State-of-the-Science and Future Directions Summary from a Healthy Environment and Endocrine Disruptors Strategies Workshop.

On September 7 and 8, 2022, Healthy Environment and Endocrine Disruptors Strategies, an Environmental Health Sciences program, convened a scientific workshop of relevant stakeholders involved in obesity, toxicology, or obesogen research to review the state of the science regarding the role of obesogenic chemicals that might be contributing to the obesity pandemic. The workshop's objectives were to examine the evidence supporting the hypothesis that obesogens contribute to the etiology of human obesity; to discuss opportunities for improved understanding, acceptance, and dissemination of obesogens as contributors to the obesity pandemic; and to consider the need for future research and potential mitigation strategies. This report details the discussions, key areas of agreement, and future opportunities to prevent obesity. The attendees agreed that environmental obesogens are real, significant, and a contributor at some degree to weight gain at the individual level and to the global obesity and metabolic disease pandemic at a societal level; moreover, it is at least, in theory, remediable.

An improved algorithm to harmonize child overweight and obesity prevalence rates.

BACKGROUND: Prevalence rates of child overweight and obesity for a group of children vary depending on the BMI reference and cut-off used. Previously we developed an algorithm to convert prevalence rates based on one reference to those based on another. OBJECTIVE: To improve the algorithm by combining information on overweight and obesity prevalence. METHODS: The original algorithm assumed that prevalence according to two different cut-offs A and B differed by a constant amount dz on the z-score scale. However the results showed that the z-score difference tended to be greater in the upper tail of the distribution and was better represented by b × dz , where b was a constant that varied by group. The improved algorithm uses paired prevalence rates of overweight and obesity to estimate b for each group. Prevalence based on cut-off A is then transformed to a z-score, adjusted up or down according to b × dz and back-transformed, and this predicts prevalence based on cut-off B. The algorithm's performance was tested on 228 groups of children aged 6-17 years from 20 countries. RESULTS: The revised algorithm performed much better than the original. The standard deviation (SD) of residuals, the difference between observed and predicted prevalence, was 0.8% (n = 2320 comparisons), while the SD of the difference between pairs of the original prevalence rates was 4.3%, meaning that the algorithm explained 96.7% of the baseline variance (88.2% with original algorithm). CONCLUSIONS: The improved algorithm appears to be effective at harmonizing prevalence rates of child overweight and obesity based on different references.

A better understanding of the science and reality of obesity is urgently needed.

Efforts to prevent and treat obesity need to be grounded in science. A historical focus on individual responsibility has been ineffective in halting the rise in obesity prevalence. There needs to be a better understanding of environmental and biological drivers of weight gain to help reduce weight bias and stigma and identify more effective policies for action.

Exploring an algorithm to harmonize International Obesity Task Force and World Health Organization child overweight and obesity prevalence rates.

BACKGROUND: The International Obesity Task Force (IOTF) and World Health Organization (WHO) body mass index (BMI) cut-offs are widely used to assess child overweight, obesity and thinness prevalence, but the two references applied to the same children lead to different prevalence rates. OBJECTIVES: To develop an algorithm to harmonize prevalence rates based on the IOTF and WHO cut-offs, to make them comparable. METHODS: The cut-offs are defined as age-sex-specific BMI z-scores, for example, WHO +1 SD for overweight. To convert an age-sex-specific prevalence rate based on reference cut-off A to the corresponding prevalence based on reference cut-off B, first back-transform the z-score cut-offs zA and zB to age-sex-specific BMI cut-offs, then transform the BMIs to z-scores zB,A and zA,B using the opposite reference. These z-scores together define the distance between the two cut-offs as the z-score difference dzA,B=12zB-zA+zA,B-zB,A . Prevalence in the target group based on cut-off A is then transformed to a z-score, adjusted up or down according to dzA,B and back-transformed, and this predicts prevalence based on cut-off B. The algorithm's performance was tested on 74 groups of children from 14 European countries. RESULTS: The algorithm performed well. The standard deviation (SD) of the difference between pairs of prevalence rates was 6.6% (n = 604), while the residual SD, the difference between observed and predicted prevalence, was 2.3%, meaning that the algorithm explained 88% of the baseline variance. CONCLUSIONS: The algorithm goes some way to addressing the problem of harmonizing overweight and obesity prevalence rates for children aged 2-18.

What is a "high" prevalence of obesity? Two rapid reviews and a proposed set of thresholds for classifying prevalence levels.

Categories such as "low" and "high" have been used for several decades to describe the prevalence of stunting and wasting in populations of children aged under 5 years. They provide support for public health risk assessment and policy-making, including alerting health departments and aid agencies to national trends and local needs. In the light of the need for monitoring progress to meet globally agreed targets for overweight and obesity, the classification of their prevalence will be a valuable to aid in policy development, to target resources, and to promote public health interventions. This paper reviews the current use of categories to describe obesity prevalence in policy, advocacy, and research literature. Where prevalence categories have been formally proposed, this paper compares their application on large-scale datasets. The paper then develops a set of recommended threshold values to classify prevalence levels for overweight and obesity among children under age 5 years, children aged 5-19 years, and adults.

Endocrine-disrupting chemicals and obesity risk: A review of recommendations for obesity prevention policies.

Emerging evidence indicates that industrially produced endocrine-disrupting chemicals (EDCs) may be as obesogenic as poor dietary patterns and should be considered in obesity prevention policies. The authors conducted two reviews: (a) a systematic search of four electronic databases for papers published since January 2010 to identify the policy recommendations contained in scientific reviews of EDC exposure and obesity risk and (b) a narrative review of obesity policy documents published since January 2012 to identify the recommendations of national and international agencies. A search of four electronic databases found 63 scientific reviews with policy recommendations, of which 26 suggested individual responsibility to avoid exposure, 11 suggested medical interventions to counter the effects of exposure, and 42 suggested regulatory control of hazardous chemicals. Of sixty policy documents examined, six mentioned pollutants as a possible risk factor for obesity, and only one made explicit reference to strategies for reducing exposure to EDCs. The UN Sustainable Development Goals include targets to prevent ill health from hazardous chemicals (Targets 3.9 and 12.4) and to remove unsafe industrial chemicals from the environment (Targets 6.3, 11.6, 12.4, and 14.1). The authors suggest these should be explicitly linked to World Health Assembly targets to halt the rise in obesity.

Social disparities in obesity treatment for children age 3-10 years: A systematic review.

Socio-economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio-economic and ethnic background. Sixty-four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty-one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family-level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family-level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.

Obesity: a Ghost at the Feast of the Sustainable Development Goals.

PURPOSE OF REVIEW: Despite its rapidly rising global prevalence, obesity is not featured in any of the Sustainable Development Goals (SDGs). This review highlights the multiple points at which obesity is affected by the Goals. RECENT FINDINGS: At least 14 out of the 17 thematic SDG targets play a role in driving the obesity epidemic, including health, food, education, water quality, land and ocean quality, urbanisation and employment. Although the SDGs recognise the need to reduce 'malnutrition in all its forms', the Goals underplay the role of urbanisation and unregulated markets on dietary health. Furthermore, adherence to the SDGs may be weak and compromised by conflicted interests. Nonetheless, governments have shown that they can, when pressed, respond to health challenges, and we anticipate how the rise in the numbers of people experiencing excess bodyweight may itself lead to greater demand for collective responsibility to ensure our environments are fully health-creating.

Correction to: Obesity: a Ghost at the Feast of the Sustainable Development Goals.

A Correction to this paper has been published: https://doi.org/10.1007/s13679-020-00417-7.

Costs, equity and acceptability of three policies to prevent obesity: A narrative review to support policy development.

Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost-effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front-of-pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost-effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front-of-pack nutritional labelling is likely to be highly cost-effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child-directed advertising are likely to be highly cost-effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.

Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews.

The aim of this overview of systematic reviews was to summarize evidence from up-to-date reviews of the effectiveness of interventions aimed at preventing overweight and obesity in adolescents aged 10 to 19 years. We searched nine databases for systematic reviews published between January 2008 and November 2019. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 to assess the quality of reviews, excluding those of critically low quality, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to grade the certainty of included evidence. We included 13 reviews. Three reviews focused on dietary behaviour, six on physical activity, and four on both types of behaviours. Individual-oriented and school-based interventions dominated. Results across reviews showed little or no effect on body mass index, or physical activity levels of adolescents, whereas results from a couple of reviews suggest possibly beneficial effects of public health interventions on dietary behaviours (i.e., consumption of sugar-sweetened beverages). The certainty of evidence was low to very low for all outcomes. Overall, the evidence base for the effect of primary interventions to prevent overweight and obesity in adolescents is weak. In particular, there is a lack of reviews assessing the impact of environmental interventions targeting adolescents, and reviews addressing social inequality are virtually absent from this body of literature.

Clinical care for obesity: A preliminary survey of sixty-eight countries.

Obesity is a chronic relapsing condition affecting a rapidly increasing number of people worldwide. The United Nations has stated that universal health coverage is an essential element of the globally-agreed sustainable development goals. This article provides a preliminary report of a survey of relevant health professionals and other interest groups on the readiness of health systems to provide obesity treatment services. Interviews and questionnaires were completed by 274 respondents from a total of 68 low, middle and high income countries. Respondents in the majority of countries stated that there were professional guidelines for obesity treatment, but that there was a lack of adequate services, especially in lower income countries, and in rural areas of most countries. Lack of treatment was attributed to a broad range of issues including: no clear care pathways from primary care to secondary services; absent or limited secondary services in some regions; lack of trained multi-disciplinary support professionals; potentially high costs to patients; long waiting times for surgery; and stigma experienced by patients within the health care services. Defining obesity as a disease may help to overcome stigma and may also help to secure better funding streams for treatment services. However, the survey found that few countries were ready to accept this definition. Furthermore, until countries fully adopt and implement obesity prevention policies the need for treatment will continue to rise while the necessary conditions for treatment will remain inadequate.