Global Nutrition Targets 2025

Childhood Overweight
Global Nutrition Policy2025
Targets Brief

I. Introduction

There has been a rapid rise in the numbers of children affected by excess body weight. Between 2000
and 2012, childhood overweight increased from 5% to 7%, translating as the increase of the numbers of
overweight children under 5 years of age from 32 million to 44 million.1 The prevalence of childhood
overweight is increasing in all regions of the world, but in particular in Africa and Asia. In 2012, the
overweight prevalence in children under 5 years of age was highest in Southern Africa (18%) and Central
Asia (12%).1 It is estimated that the prevalence of overweight in children under 5 years of age will rise to
11% by 2025, if the trend continues.2
Overweight and obese children are at higher risk of developing serious health problems including type 2
diabetes, high blood pressure, asthma and other respiratory problems, sleep disorders and liver disease.
They may also suffer from psychological effects, such as low self-esteem, depression and social isolation.
Childhood overweight and obesity also increases the risk of obesity, noncommunicable diseases (NCDs),
premature death and disability in adulthood. .

Furthermore, there is increasing evidence from a range of studies indicating the important role of early
life environment in the later risk of obesity. Intrauterine life, infancy, and the pre-school period, which is
around the time of the adiposity rebound, have all been considered as possible critical periods during
which the long term regulation of energy balance may be programmed. Taking a lifecourse perspective
(Figure 1)3, therefore, has great potential for identifying the challenges as well as the opportunities for
taking action to combat the increasing public health problem of childhood overweight and obesity with
an emphasis on prevention.4

Other factors essential to be considered are the social and economic changes that are operating on a
scale and at a speed unprecedented in history, resulting in rapid changes in dietary and physical activity
patterns worldwide. These rapid global changes are the major causes of the increasing global epidemic
of obesity and diet-related NCDs. The process of modernization and economic transition has brought

1
Joint UNICEF/WHO/World Bank Child Malnutrition Database: Estimates for 2012.
2
De Onis, M et al. Global prevalence and trends of overweight and obesity among preschool children. Am. J. Clin. Nutr, 2010,
92:1257-1264.
3
Darnton-Hill I et al. A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutrition,
2004, 7 (1A): 101 121.
4
Diet, nutrition and the prevention of chronic diseases. Report of a Joint WHO/FAO Expert Consultation (WHO Technical Report
Series 916). World Health Organization, Geneva, 2003

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about a number of improvements to the standard of living and services available to people throughout
the world. However, it has also had a number of negative consequences that have directly and indirectly
led to deleterious dietary and physical activity patterns that contribute to the development of
overweight and obesity as well as diet-related NCDs.

Overweight and obesity are complex multi-factorial disorders and coherent and comprehensive
strategies are needed for their effective and sustainable prevention and control. Social determinants for
dietary and lifestyle-related risk factors among all age groups should be well monitored and controlled
in various environmental settings. In some countries, the epidemic of overweight and obesity exist
alongside continuing problem of undernurition and micronutrient deficiencies, creating a double
burden of nutrition-related ill-health. Thus, action to prevent and control childhood overweight and
obesity needs to go hand in hand with the actions to achieve other global nutrition targets (i.e. stunting,
anaemia in women of reproductive age, low birth weight, exclusive breastfeeding and wasting). The
costs of the escalating problem childhood overweight and obesity are considerable, both in terms of the
health burden experienced and in terms of the financial costs, which have yet to be fully appreciated.

There has been an increasing recognition among the global public health community as well as various
national governments in many parts of the world of the need to develop effective strategies for
preventing and controlling childhood overweight and obesity. This has led the World Health Assembly to
set a target in 2012, aiming to achieve no increase in childhood overweight by 2025.

This target implies that the global prevalence of 7% estimated for 20121 should not rise to 9.1% (in 2020)
as per current trends2 and that the number of overweight children under 5 years of age should not
increase from the estimated 44 million in 2012 to approximately 60 million as forecasted.2
The World Health Assembly also established a target of no increase in adolescent and adult obesity by
2025. Furthermore, to accelerate WHOs efforts in addressing the crisis of childhood overweight and
obesity, WHOs Director-General has also established a high-level Commission on Ending Childhood
Obesity (ECHO) in May 2014.

This policy brief aims to encourage national governments and local authorities to increase investment in
nutrition-related programmes in order to improve maternal, infant and young child nutrition, with a
focus on the prevention of unhealthy weight gain among children.

2
Figure: Life course: the proposed causal links4

II. Framework for action

Preventive action to address childhood overweight and obesity is complex and achieving the target to
halt the increase in childhood overweight and obesity is possible through the right mix of policies and
actions aimed at improving maternal health and nutritional status and infant and young child feeding
practices, hence focusing on the first 1,000 days from a womans pregnancy to her childs second
birthday. These policies and actions to improve childs health and nutrition and prevent childhood
overweigh and obesity will need considerable political will along with investment of resources, as well as
the participation of a wide variety of sectors and stakeholders.

Policies for childhood overweigh and obesity prevention can be informed by several types of evidence,
including evidence of the main behavioural and social risk factors leading to excess weight gain in
children, evidence of policies which have helped to reduce the influence of these risk factors, and
evidence from direct intervention trials among parents, infants, children and youth aimed at changing
behaviours.

Experience in several countries has shown that successful behaviour change during childhood can be
achieved through a combination of population-based measures, implemented both at the national level
and as part of local settings-based approaches, in particular, school- and community-based
programmes.5 Population-based prevention requires governments taking responsibility for policy

5
Population-based prevention strategies for childhood obesity. Report of a WHO forum and technical meeting, Geneva, 1517
December 2009. Geneva, WHO, 2010 (http://www.who.int/dietphysicalactivity/childhood/child-obesity-eng.pdf)

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development and implementation, acknowledging the wider social and economic factors which
contribute to disease risk. Although local intervention allows action to be tailored to meet the specific
context and nature of a problem, only national leadership (and funding) can ensure effectiveness and
sustainability of action at a population level through changes in social and behavioural norms.

Table 2 shows examples of a range of potential actions that have a strong rationale and good evidence
base6 and therefore, can be proposed although in selecting actions for implementation, their likely
impact, reach and sustainability, as well as feasibility and effects on reducing health inequalities should
be taken into consideration. In many of the suggested actions, the beneficiaries will include other age
groups as well as children.

Table : Examples of interventions for reducing the risk of unhealthy weight gain in childhood

Area for Examples of actions Possible implementation platform

intervention
Addressing early a) Counselling in pregnancy and pregnancy and Health services, community health workers,
life exposures to providing support in post-natal period for bilateral/international agencies
improve exclusive breastfeeding during the first six
nutritional status months, and continued breastfeeding until two
and growth years of age and beyond with appropriate
patterns complementary feeding

b) Targeted subsidies for nutritious foods or Health services, social services, local
provision of foods for: government, NGOs, bilateral/international
disadvantaged, vulnerable women during: agencies
pre-pregnancy and pregnancy period, as
required
mothers with infants (0 6 months) and young
children (6 24 months9, especially for
disadvantaged group
7 Health services
c) Implementing Baby-Friendly Hospital Initiatives

d) Providing breastfeeding facilities in out-of-home Local government, retailers and community

environments facility providers

e) Supporting breastfeeding in workplaces through Employers, including government offices

paid maternity leave, provision of breastfeeding
facilities in workplace

f) Regulating the marketing of breast-milk National regulatory bodies

substitute and inappropriate complementary
foods through implementation of the Code of
Breast Milk Substitute

g) Regulating the marketing of food and non- National regulatory bodies

alcoholic beverages to children
h) Review feeding programmes which encourage National government, NGOs,
rapid weight gain without linear growth in infants bilateral/international agencies

Improving a) Developing and disseminating government- National government, international agencies

community endorsed food-based dietary guidelines,

6
Gill T, et al. State of Food and Nutrition in NSW Series: Best options for promoting healthy weight and preventing weight gain
in NSW. New South Wales Department of Health and New South Wales Centre for Public Health Nutrition, 2005.
(http://sydney.edu.au/science/molecular_bioscience/cphn/pdfs/healthy_weight_report.pdf )
7
This initiative of WHO and UNICEF aims to improve uptake of breastfeeding and has been implemented in many countries.
Extensive advice and guidance can be found at http://www.who.int/nutrition/topics/bfhi/en/

4
understanding including for infants and children, and nutrient
and social norms profiling to classify food products as promoting
or undermining the guidelines

b) Setting standards and guidelines for the Local and national government services
provision of food to be available at pre-school
and nurseries, schools and hospitals, with
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support of licensing and inspection

c) Developing public campaigns to disseminate Health services, NGOs (including consumer

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information on healthy diet organizations), bilateral/international
agencies, in collaboration with social
communications and advertising firms

d) Using social marketing campaigns to support Government information services, NGOs,

proposed legislation for regulating food bilateral/international agencies
marketing and for improving standards for food
provisions for pre-schoos, nurseries and
schools

e) Reviewing TV programmes for messages about Government communications/media

infant feeding and child weight (and height, and regulatory agencies
physical activity) to ensure consistency with
appropriate national and international guidelines

f) Providing fresh drinking water outlets wherever
children (and others) gather (i.e. in pre-schools,
nurseries and schools, play areas, parks, leisure
facilities, primary health care centres and
hospitals)
National and local government, local
communities, schools service providers,
NGOs, bilateral/interagencies

Addressing a) Developing government-led criteria or agreed National government, government and/or

exposure of regional standards for restricting childrens regional communications/media regulator
children to exposure including cross boarder media
marketing of exposure) and a timetable for implementing
foods regulation for marketing food and non-alcoholic
beverages to children, including the setting up
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of monitoring of the implementation

b) Imposing taxes (or removing tax exemptions) on Government taxation authority

advertising for foods high in saturated fats, trans
fats, free sugars or salt, as well as sugar-
11
sweetened beverages

c) Removing incentives to unhealthy dietary National and local government

practices, such as provision of vending
machines in schools (including pre-schools and

8
The use of government purchasing power as a lever to encourage producers to improve standards and to promote markets for
certain products, has been recognized for several purposes. Using procurement standards as an incentive for improving
nutrition has been described extensively in the USAs CDC document Improving the Food Environment Through Nutrition
Standards: A Guide for Government Procurement (http://www.cdc.gov/salt/pdfs/dhdsp_procurement_guide.pdf). See also the
guidance document from Public Health Law and Policy.
9
WHO fact sheet on healthy diet (Fact sheet No. 394), September 2014
(http://www.who.int/mediacentre/factsheets/fs394/en/)
10
General restrictions on marketing directly to children are in place in some countries today including in Sweden and Canada;
specific restrictions designed to limit childrens exposure to the marketing of certain food and non-alcoholic beverage products
are in place in several countries including the UK, Ireland and South Korea. Guidance is available at
http://www.who.int/dietphysicalactivity/MarketingFramework2012.pdf
11
Taxes have been imposed on foods or nutrients (e.g. trans fats) with the stated or implied aim of improving dietary choices in
many countries including France, Hungary, Denmark, Iceland, Mexico and the USA. (See material collated at
http://www.wcrf.org/policy_public_affairs/nourishing_framework/food_price_taxes_subsidies.php.)

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 nurseries) and access to near-school fast food
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caterers

d) Removing incentives to unhealthy impulse Retailers

purchases of foods high in saturated fats, trans
fats, free sugars or salt (i.e. snacks,
confectioneries) at shop checkouts

e) Improving consumer information with improved Government food labeling authority

nutrition labelling which follows the guideline of
the Codex Alimentarius

Influencing the a) Implementing fiscal measures (e.g. sales taxes) National government taxation authority,
food supply chain to influence price and availability of healthy food contracting and purchasing departments of
and the food items (i.e. fresh fruit and vegetables) national and local public catering service
market providers

b) Supporting small shops selling perishable foods National and local government, NGOs
in disadvantaged communities (e.g. freezer
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units for frozen fish, vegetables)

Improving a) Ensuring the planning and regulations to limit Local and national planning authorities
nutrition in the availability of fast food outlets near to
neighbourhoods schools (including pre-schools and nurseries)

III. How to scale up to drive progress against target

Childhood overweight and obesity are interlinked with the five other global nutrition targets (stunting,
anaemia in women of reproductive age, low birth weight, exclusive breastfeeding and wasting). This
presents opportunities for synergistic policy and programmatic approaches to address multiple targets
simultaneously using multisectoral platforms that are being established in a growing number of
countries to improve maternal and child nutrition.

To achieve the target of no rise in childhood overweight, national authorities will need to undertake
regular monitoring of the nutrition status of children, and should also invest in the monitoring of the
status of mothers in pregnancy and children in infancy, and preferably also monitor the relevant
indicators for the interventions they are including in their portfolio of initiatives to prevent excess
weight gain in childhood. Several of these indicators will also serve to support the monitoring of the
drivers of adult obesity and help support policies for meeting the target of no further increase in
adolescent and adult obesity by 2025.

12
Where national or local authorities are responsible for the food provided in educational establishments, nutritional standards
and inspection reports can improve the students diets. Examples the USA where the Healthy, Hunger-Free Kids Act of 2010
specifies standards for foods sold in schools (http://www.fns.usda.gov/cnd/Governance/Legislation/CNR_2010.htm) and
Scotland in the UK (http://www.scotland.gov.uk/Topics/Education/Schools/HLivi/foodnutrition).
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National and local authorities can provide support for the promotion of healthier, more nourishing products through retailer
incentives. Examples include Scotlands The Healthy Living Programme, jointly funded by the Scottish Government and Scottish
Grocers Federation, which provides shops with display facilities to promote fresh, healthy produce
(http://www.scotland.gov.uk/News/Releases/2013/05/promotinghealthyfood07052013).

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Countries will have access to data of differing levels of depth and completeness, and will have to make
practical decisions about the feasibility of collecting adequate data, and the frequency of obtaining that
data in order to monitor trends.

National authorities will also need to consider their priorities for making interventions and the costs for
ensuring they are implemented and sustained. In some cases, such as controls on advertising to children
or requirements for food labeling information, a sustained intervention can be enforced through
regulation and the costs, both to government and private companies, are relatively low. In other cases,
such as support for breastfeeding through better maternity leave, the costs to employers and to social
support payments may be higher. Lastly, some policy initiatives can be delivered through the
governments own services, both through health services (e.g. pregnancy and breastfeeding support,
growth monitoring) or through other government departments (e.g. school services) and through
government leverage on private companies (e.g. through catering contracts or research and
development support).

In the development of interventions, such as those identified in the table above, national and local
authorities will need to assess the context and relevance for their own situations. School food policies
may be less important in countries where schools do not routinely provide food services. Controls on TV
advertising may be less relevant in regions where TV-watching is not common. Measures to promote
physical activity in children may not be needed where children are already active.

More importantly, national government authorities need to assess the best types of intervention that
maximize nutrition security of their population, taking account of existing undernutrition problems as
well as increasing public health problem of childhood overweight and obesity, in particular among at risk
groups, such as those in low-income households or in areas with poor food supplies. Infant feeding
programs need special attention: guidance on the most appropriate forms of complementary feeding
and infant supplementary feeding programmes need to ensure that the programmes and the foods
supplied are fully conscious of the need to avoid excess weight gain and to ensure adequate linear
growth in the first two to three years. Energy-dense foods may not be the most appropriate if they
encourage weight gain without ensuring age-appropriate height-for-weight.

Tackling childhood overweight and obesity is an investment: it aims to prevent obesity in adulthood with
its high costs to society and to the health services, and it aims to ensure optimum growth for a healthy
population. The investment is partly institutional, strengthening capacity and changing social norms, and
it is partly political as it requires ensuring adequate regulatory oversight and control of markets and the
accountability of commercial interests. While not large financially, the investments will reap
considerable rewards over the longer term.

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IV. Suggested Policy actions

The target of no further increase in childhood overweight may appear modest, as it accepts the high
levels of overweight and obesity already existing. However, the driver of childhood overweight and
obesity especially the promotion of over-consumption of unhealthy diet and low physical activity
continue to expand worldwide and will continue to increase the risk of rising childhood overweight and
obesity. Commercial interests which benefit from this expansion need to be regulated, while families
and communities need to be supported through education, information and the setting of standards in
public food provision.

In order to develop their leadership on nutrition, governments will need to develop their institutional
capacity and ensure effective coordination across departments and across sectors. Food supplies
depend on a range of associated government policies: agriculture, trade, retail competition, transport
facilities and fuel prices; while physical activity is dependent on local and national planning policies for
transport infrastructure, on school facilities and education policies, on broadcasting and media
regulation, on green space and urban planning. For infant feeding, maternal employment laws,
workplace and community feeding facilities, crches and nurseries and policies on the marketing of
breastmilk substitutes and complementary foodstuffs are involved.

Governments policies in the food systems need to assess the availability, accessibility and acceptability
of healthy food, and aim to ensure good nutrition in all policies. To this end, governments may
consider to:

Ensure that there are a set of nationally approved, authoritative Food-Based Dietary Guidelines,
on which can underpin actions to improve nutrition in the population

Form a cross-governmental task-force to oversee the development and/or strengthening of

nutrition policies and nutrition-related health targets. This task force should include
representation at a high level from other ministries to ensure that policies which, for example,
affect agricultural supplies, food imports, commercial investments, school education, food
labeling, or food taxes, can be adequately addressed. The task-force should report on progress
publicly, and be reviewed by an external panel including NGOs, experts and donor agencies
where relevant. Care should be taken to avoid the involvement of commercial stakeholders in
policy formation where conflicts of interest could arise.

Consider taking measures to address early life exposures to improve nutritional status and
growth patterns; improve community understanding and social norms; influence the food
supply chain and the food market; improve nutrition in neighbourhoods

Underpinning these actions is an assumption that governments are able to intervene and have political
and popular support to do so. Early stages in this process require) making the financial argument that
doing nothing is more costly than implementing interventions, and that national treasuries and trade
ministries should therefore support the strengthening of public health on economic as well as
humanitarian grounds, and (ii) strengthen public support through awareness-raising campaigns for
parents and educators on the benefits of healthy child growth and the need for action, making the case
for stronger child protection and fulfilling their duties under the Convention on the Rights of the Child.