Without action, soaring child obesity is a sad predictor of things to come

Fighting obesity is no kid’s play. Emilio Labrador, CC BY

The most comprehensive global study ever undertaken for obesity was just released and the need for serious population-wide action is no longer up for debate. The study’s key findings make for grim reading – not a single country saw a decline in obesity over the past 30 years.

Instead, between 1980 and 2013, the prevalence of global overweight and obesity increased by 27.5% among adults. What is even more worrying still is that overweight and obesity in children soared by nearly a half (47.1%) in just three decades. Emmanuela Gakidou, from the Institute for Health Metrics and Evaluation at the University of Washington and author of the study, believes the evidence is now clear on which way obesity is trending.

Unlike other major global health risks, such as tobacco and childhood nutrition, obesity is not decreasing worldwide. Our findings show that increases in the prevalence of obesity have been substantial, widespread, and have arisen over a short time.

Earth is now home to approximately 2.1 billion overweight and obese people, with only ten countries accounting for more than half of the world’s obese: the US (13%), China and India (15% combined), Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia. Among high-income countries, Australia and New Zealand saw the greatest increases.

Get them while they’re young

The good news is that consensus is emerging on where we should focus our obesity prevention strategies – on children.

This latest study tells us the greatest increases in adulthood were found among people aged between 20 and 40, but the highest prevalence of obesity has moved slowly to younger and younger ages over the last 33 years. Well-evaluated studies, including several from Australia, show that long-term reductions in childhood obesity are possible.

In the face of such a startling reality check, the World Health Organisation (WHO) launched a commission to ending childhood obesity at its annual assembly last week. Obesity in childhood is a robust predictor of adult obesity, and children are far more responsive than adults to interventions that provide healthier food and environments of physical activity – so it makes sense to intervene as early as possible.

Children who are overweight or obese are at higher risk of asthma, cognitive impairment, diabetes, heart disease, some cancers, respiratory diseases, mental diseases and reproductive disorders later in life. There are also negative impacts on opportunities to participate in educational and recreational activities, and increased economic burden at familial and societal levels.

All the evidence points to the need for action in multiple settings. The challenge now facing the new commission will be how to encourage countries to invest in this approach on a large scale. It won’t be an easy assignment.

The commission will compile a report specifying which approaches and which combinations of interventions are likely to be most effective in different contexts around the world. While many countries have approved many high-level WHO documents, such as recommendations on reducing the marketing of unhealthy foods and beverages to children, it is their implementation at a country level which is missing.

Multiple actors, including those responsible for food manufacturing, marketing and retail, maternal health and nutrition, child health, education and health literacy, physical activity, and public policy, will be called upon by the commission to play their part in turning the best available evidence into a coherent and achievable plan.

No small order

Heads of state were challenged by the United Nations in 2011 to halt the rise in diabetes and obesity by 2025. The UN called together governments for a special meeting to address the challenges of obesity and other risky health behaviours, such as tobacco and alcohol abuse, and reduce the global burden of non-communicable diseases (NCDs), such as heart disease, cancer and diabetes. The new commission to end childhood obesity is part of the WHO’s Global Action Plan to reduce these diseases and meet the 2025 targets.

But authors of the new global obesity study believe their findings throw doubt on the feasibility of achieving the “no increase” target for obesity. Gakidou predicts we will go well wide of the mark unless urgent global action and leadership is put in place to help countries more effectively intervene. She said:

Our analysis suggests that the UN’s target to stop the rise in obesity by 2025 is very ambitious and is unlikely to be achieved without concerted action and further research to assess the effect of population-wide interventions, and how to effectively translate that knowledge into national obesity control programmes.

Governments around the globe have been slow in coming to terms with the enormous burden of obesity. It is without doubt one of the major public health challenges of the 21st century, and the foremost reason behind increased rates of diabetes, certain cancers and heart disease. Any recommendations tabled at the 2015 World Health Assembly by the new commission will need to be a major step up on the current global approach, which is to carry on as normal, if countries are going to truly deliver on ending childhood obesity, and with it adult obesity.

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