ARTICLE 1

Chubbier is Not Better: Stop Childhood Obesity

Dr Tee E Siong, President, Nutrition Society of Malaysia

October 20, 2015.

Nutrition Survey of Malaysian Children (SEANUTS Malaysia) showed that the
prevalence of overweight and obesity for children 6 months to 12 years old were 9.8
% and 11.8 %, respectively.

Other studies conducted by the Nutrition Society of Malaysia (NSM) show a higher
prevalence of childhood obesity in Malaysia:

 NSM study (2010) in Kuala Lumpur, Putrajaya, and Selangor showed that 14.5%
(1 in 7) children aged 1-3 years were overweight and 16.6% (1 in 6) children
aged 4-6 years were overweight.
 NSM NutriStudy project (2010) in Peninsular Malaysia of children aged 4-6
years showed that 16% (1 in 6) were overweight or obese.
 NSM Healthy Kids Programme (2010) and SEANUTS study (2011) showed
that 30% (1 in 3) primary school children were overweight and obese.
 NSM MyBreakfast study (2013, unpublished) showed that 28% (1 in 4) primary
school children were overweight and obese.
What does this mean?
Although these findings may not be strictly comparable because of different references
used in determining overweight and obesity, it cannot be denied that overweight and
obesity have become significant problems among children in Malaysia.

Furthermore, the findings show that the affected proportions of primary school children
are alarming.

What are the dangers of obesity?

 associated with significant health problems (both in childhood and during

adolescence)
 early risk factor for adult morbidity and mortality
 more medical problems happen in obese children/adolescents which affect their:
o cardiovascular health (e.g. high cholesterol, hypertension),
o endocrine system (e.g. high insulin levels, insulin resistance, menstrual
irregularity)
o social stigma (e.g. becoming a bully, or is bullied or ostracised by his peers)
o mental health (e.g. depression, low selfesteem).
As many as 8 out of 10 obese children could have at least one of the above medical
conditions.
Did you know?
Overweight children have a higher risk of growing up to become overweight or obese
adults, thus facing a greater risk of developing diabetes, heart disease, and other
chronic diseases.

How to prevent it

Teach your child healthy lifestyle habits from young – this is important as making
changes is more difficult once he grows up. The key points to focus on are to cultivate
healthy eating habits and a love for physical activity – these are the basics he should
have in order to prevent obesity during his childhood and adolescence. As parents,
you are his role models – lead by example and he will emulate you. You can achieve
this by:

 Encouraging him to engage in regular physical activities both at home and

at school. This can be in the form of both outdoor and indoor sports/games.
 Spend some time as a family on physical activities during weekends.
 Limit the time spent on physically inactive activities such as watching
television or playing computer games.

When it comes to good nutrition, you should provide your family with a diet or meals
that are healthy. Make it a point to offer healthier food choices and when you prepare
meals for the whole family, use healthier cooking methods such as steaming, grilling,
baking, or stir-frying. A healthy diet should incorporate the principles of balance,
moderation, and variety – this means your child (and the rest of your family!) should

 eat a balanced diet that includes foods from all five food groups in the
Malaysian Food Pyramid,
 eat in moderate portions (served according to the recommended number of
servings per food group),
 eat a variety of foods to meet his nutritional needs.
Caution!
Never use food as a reward (e.g. “If you do well in your exams we’ll go for a big ‘makan’
together.” or “Finish your vegetables and I’ll let you have ice cream.”) as its impact will
be far-reaching as not only will your child associate food treats with expected
behaviour, he may even hold you hostage to this by demanding treats for every little
thing that you expect him to do.
When your child is at school, you can do your part by:

 preparing a healthy meal and/or snack for him to eat during his meal breaks
 always providing him with plain drinking water
 always making sure he takes all his meals and this includes a healthy breakfast
every day

Make it a habit to monitor your child’s growth periodically every six months by checking
his body mass index (BMI) to ensure that it is on track. BMI is measured by the
following method:

BMI = weight (in kg) / height x height (both in metres)

You can keep track of his growth by comparing it against the following:
Regular growth monitoring allows you to ascertain whether or not he is growing
normally or if he is overweight, underweight, or obese. Remaining alert to his growth
status allows you to respond appropriately, i.e. seeing a nutritionist or paediatrician if
the situation warrants it.
ARTICLE 2

Childhood obesity a growing health crisis in Malaysia

By Bernama - July 8, 2019 @ 1:11pm

KUALA LUMPUR: Farhan (not his real name) was taken to a private hospital by his
parents to seek treatment for an infection on his right leg.
For any healthy 12-year-old, medications and aftercare service would suffice to get
them on their feet again.
However, Farhan was far from healthy. His weight at that time was more than 100
kilogrammes and he was referred to a government hospital to treat the complications
that had arisen due to his obesity.
Sadly, due to his weak heart, Farhan lost his fight and passed away at the tender age
of 12.
CHILD AND PARENTAL OBESITY
According to the World Health Organisation (WHO), the prevalence of childhood
obesity has increased at an alarming rate globally – in 2016, the number of overweight
children under the age of five was estimated to be over 41 million.
A 2010 study published in the International Journal of Environmental Research and
Public Health cited genetics as the common non-modifiable cause of obesity, with
greater risk of obesity found in children of obese and overweight parents.
According to UM Specialist Centre (UMSC) paediatric endocrinology senior consultant
Associate Prof Dr Muhammad Yazid Jalaludin, children with at least one overweight
parent are bound to have a four- to five-fold greater chance of becoming obese adults.
“If one parent is overweight the chance of the child being obese is four to five times
more, and worse still if both parents are overweight the risk is 13 times more,” he said
in an interview with Bernama recently.
He said that based on the 2011 National Health and Morbidity Survey (NHMS), among
Southeast Asian countries, Malaysia topped the list with the highest population of
obese adults, at 44.2 percent. In 2015, it shot up to 47.3 percent.
A closer look at the statistics revealed that among childbearing adults (aged 30-35),
34.2 percent were overweight and another 30.5 percent obese.
This in itself is a worrying trend but what is more disturbing is that these same adults
are either parents to growing children or parents-to-be, Dr Muhammad Yazid added.
CHILDHOOD OBESITY DEFINED
The 2013 South East Asian Nutrition Survey cited that 21.6 percent children aged
between six months and 12 years fell under the overweight or obese category.
According to a study in Asia conducted by Prof Dr Poh Be Koon in 2013, Malaysia was
among the top three countries with a high percentage (11.5 percent) of obese children
(aged between six months and 12 years).
In the 2015 NHMS, 11.8 percent of children below 18 years of age were found to be
obese.
“Based on the latest data, 1.65 million Malaysian schoolchildren are expected to be
overweight or obese by 2025 if we don’t do anything,” said Dr Muhammad Yazid.
Breaking up that enormous number, 88,000 of Malaysian children are expected to
have impaired glucose tolerance, 28,000 may suffer from Type 2 diabetes, a whopping
191,000 may have high blood pressure and 264,000 may suffer from first-stage fatty
liver disease, he added.
Unlike adults, overweight is defined as at or above the 85th percentile and below the
95th percentile for children and teens of the same age and sex as plotted on the WHO
body mass index (BMI) chart.
Meanwhile, obesity is defined as a BMI at or above the 95th percentile for children and
teens of the same age and sex.
According to Dr Muhammad Yazid, childhood obesity can also be determined by the
measurement of the child’s waist circumference.
“Based on a study conducted by Prof Dr Poh in 2011 on Malaysian children, boys
aged seven had a waist circumference at the 90th percentile, which is larger than the
children of the same age and gender in the United Kingdom, Hong Kong, Turkey and
Australia,” he said.
This study involved more than 18,000 children in Malaysia aged between six and 18
years.
NOT A CONDITION BUT A DISEASE
“We used to say that the prevalence of obese children is higher among the Malays
and Indians but based on a recent MyBreakfast study, Chinese children are now
leading the pack,” he said.
Dr Muhammad Yazid also said that in the United States, childhood obesity mainly
involved children in the lower socio-economic groups as their parents cannot afford to
buy nutritious, low-calorie foods.
However, in developing countries like Malaysia, childhood obesity is prevalent among
rich and poor families. In the case of the poor, the children tend to consume lower-
priced, less nutritious but high-calorie foods. Rich families, on the other hand, often
make unwise decisions and buy the wrong kinds of food.
Judging from the current statistics and the co-morbidities, obesity among children is
definitely a disease and not just a condition, stressed Dr Muhammad Yazid.
IMPLICATIONS OF CHILDHOOD OBESITY
WHO notes that childhood obesity is associated with a higher chance of premature
death and disability in adulthood. Overweight and obese children also run a higher risk
of developing non-communicable diseases such as diabetes and cardiovascular
diseases.
Dr Muhammad Yazid said the rapid rise in obesity among Malaysian children is cause
for concern because overweight children are at a higher risk of becoming obese adults.
They are also susceptible to developing serious health problems such as Type 2
diabetes, high blood pressure and liver disease, and also have cholesterol issues
which will result in cardiovascular disease, hypertension and insulin resistance.
Insulin resistance syndrome is a constellation of risk factors for the development of
Type 2 diabetes mellitus and cardiovascular disease.
“I have been running a paediatric obesity clinic since 2006 and I have witnessed
children as young as 12 inflicted with Type 2 diabetes,” the doctor said.
He cited a case of a seven-year-old obese child who was initially admitted for dengue.
Due to his weight, the child was brought to the obesity clinic where he was scheduled
to see a dietitian, sports medicine specialist and sleep specialist.
The child defaulted his follow-up after a few clinic visits.
Six years after the initial visit, he came back to the clinic with Type 2 diabetes.
According to Dr Muhammad Yazid, more than five years ago, eight out of 10 children
were diagnosed with Type 1 diabetes and the remaining, Type 2. But over the last five
years, five out of 10 children have Type 2 diabetes.
“This is because they are super obese... we have a seven-year-old child who weighs
70 kg and a 12-year-old who weighs 100 kg.
“Most of the cases at our clinic did not come willingly but due to other reasons such
as asthma or dengue, hence the not-so-good outcome (in reducing their weight). We
also have kids who lost a good amount of weight and this happened mainly due to the
initiative of their parents,” he added.
SLEEP PROBLEMS
Apart from a host of serious diseases, obesity is also one of the main causes of
obstructive sleep apnea (OSA) and hypoventilation syndrome in children.
In a study on childhood obesity and OSA that was published in the Journal of Nutrition
and Metabolism in 2012, it was found that OSA occurred in up to 60 percent of obese
children.
The study also noted that OSA is characterised by snoring and recurrent partial or
complete obstruction of the upper airway.
“In obese children the airway becomes narrower because of the increased fat around
the neck and this results in repeated cessation of breathing during sleep due to airway
obstruction. This is termed OSA,” explained UMSC paediatric respiratory and sleep
medicine specialist Dr Eg Kah Peng
She said hypoventilation can occur when one has too much fat around the abdomen
and the chest.
“Their breathing becomes restricted by the fat which in turn results in shallow breathing
during sleep,” she said.
Dr Eg said sleep-disordered breathing may cause a child to have too little oxygen and
too much carbon dioxide in their blood during sleep which, consequently, would affect
their health and quality of life.
Children who suffer from this sleep problem often snore loudly during sleep and they
find it difficult to wake up in the morning. They also complain of headaches and tend
to feel drowsy during the day.
“If the sleep problem is severe, they could fall asleep even while sitting down.”
According to Dr Eg, the long-term lack of oxygen in the blood can also result in heart
failure and early deterioration of memory.
There are medications and medical devices to treat and alleviate the symptoms of
OSA and hypoventilation.
“But the most important step is getting back to the root of the problem, that means
patients need to lose weight or else they will have to rely on these medications and
devices forever,” she said.
Sharing the case of an obese boy who passed away suddenly in his sleep, Dr Eg said
he was diagnosed as having severe OSA and was advised to undergo treatment.
However, his parents were not keen and defaulted on the follow-up.
EDUCATING THE PARENTS
UMSC clinical dietitian and head of Dietetic Services Rozanna M. Rosly said parents
should play an active role in checking childhood obesity.
They should be made aware of the importance of following a balanced diet in
accordance with their children’s age and gender and make sure that the food they eat
contain the essential nutrients to promote optimal growth. They should also make their
children participate in physical activities regularly.
“Parents tend to say that their children are ‘active’ and my questions will always be,
‘How often and how long and what kind of exercises do your children do?’.”
Being active is just half of the story because parents should also focus on their intake
of total calories, fat, protein and other essential nutrients per day, Rozanna said.
The child should also be educated on their food intake portions and requirements for
their main meals and snacks and be told that they may not need any extra calories or
additional portions.
Rozanna recommended that parents use the age-appropriate sectional plates to
educate children on food portions for main meals and measuring cups for snacks and
beverages.
This role-modelling and education always begin at home, specifically at the dining
table.
“Parents should try to eat with their children, and not separately or have separate
meals. If you want your child to eat fresh vegetables or fruits, parents must show by
role-modelling that they love their fresh vegetables or fruits too,” she said.
Parents should also educate their children on the harmful effects of consuming
processed foods or frozen hotdogs, sausages and nuggets as their nutritional benefits
are not the same as that of real meat.
“Entice them with the colours of real foods, such as papayas, oranges, apples, carrots
and tomatoes and enlighten them about the nutritional and health benefits of these
foods,” she added.
ARTICLE 3

#Kurangmanis: the UNICEF Borneo Marathon 2019

Running for a sweet cause
Diana Chai

28 April 2019

The UNICEF Borneo Marathon 2019 kicked off today, celebrating the 3rd year of
running for a good cause. This year's marathon carried the slogan #Kurangmanis
because #ImSweetEnough, a nod towards healthy eating and the practice of asking
for our food and drinks to be #Kurangmanis (less sweet), a staple phrase used in
Malaysian eateries when asking for sugar to dialed down in made-to-order food.

Every year, the marathon highlights a different issue pertaining to child rights and
seeks to use the run as a way to spread the word. You can read more about previous
years right here.

This year was extra special as we were joined by UNICEF's national ambassador, Lisa
Surihani, whose enthusiasm and dedication to the causes UNICEF champions has
see her grace many initiatives since she came on board in 2017.

As usual, the run is inclusive and saw the 3km fun-run attended by children and
persons with disabilities.

Fun-filled activities leading up to the big run

In the days leading up to the marathon, UNICEF organised school outreach

programmes, activities during race pack collection and utilised social media to call for
participants to challenge themselves to going without sugar and entering a healthy
recipe contest.

The activities aimed to help both children and adults think about the food choices they
make and how this contributes to health issues they may encounter.

UNICEFMalaysia/2019/
ARTICLE 4

Battling the bulge

Children in Malaysia have been labelled the fattest in the region, but their weight
carries a greater burden than just their size

SACHA PASSI
APRIL 11, 2013

Children in Malaysia have been labelled the fattest in the region, but their weight
carries a greater burden than just their size

by Sacha Passi

‘Globesity’ is a growing problem often associated with the riches of the developed
world but, as the term coined to describe the global spike in obesity and diet-related
diseases suggests, the phenomenon is making few exceptions.

In Southeast Asia – a region still grappling with the challenges of malnutrition –

Malaysia has earned the inglorious title of the region’s fattest nation, and the sixth
most obese country in Asia. Between 2006-2011 the country recorded a 14% rise in
obesity among people aged 18 and above, counting 2.6 million obese adults in the
country by 2011.

What is perhaps more worrying is that Malaysia has undergone a transition from
under-nutrition to relative over-nutrition within a period of three decades. In April 2012,
a survey by the Ministry of Health revealed that just over a quarter of Malaysian school
children were obese or overweight.

“Developing countries, such as Malaysia, face a ‘double burden’ syndrome. While we

are still grappling [with] the problem of under-nutrition, prevalence of obesity has
clearly increased in the past decade,” said Dr Mohd Ismail Noor, president of the
Malaysian Association for the Study of Obesity (Maso). “In fact, in countries like
Malaysia, there are more overweight/obese children than underweight counterparts.
What’s more striking, the prevalence in rural areas is as bad as those children living
in urban areas.”

Noor adds that irrespective of age, ethnic and social status, the prevalence of obesity
is largely a result of rapid development in Malaysia. “As our economy grows – one of
the fastest in the region – food shortage is basically unheard of. The accelerated phase
of industrialisation and urbanisation in recent decades has inevitably brought changes
to our lifestyle.”
With strong economic growth, a relatively stable government and free trade, Malaysia
is on track to become a developed nation by 2020. Furthermore, the Asian
Development Bank states that the country’s achievements in battling poverty and
improving enrollment in primary education, gender equality, and access to healthcare
services are well ahead of the 2015 target.

Lifestyle choices, genetic predisposition, learned behaviour and a lack of health

awareness are all known contributors to growing numbers of obesity and overweight
populations.

The fact that obese children are more likely to become obese adults, and the
connection between obesity and chronic diseases such as diabetes, heart disease
and cancer is not lost on the Malaysian government.

In 2011 the local government introduced an initiative for school report cards to include
a student’s Body Mass Index (BMI) – a number calculated using height and weight
measurements to determine whether a person falls within a healthy weight percentile
– as a way for teachers and parents to monitor a child’s health. Under the initiative,
students with unhealthy BMIs are referred to government clinics and given counselling
on healthy living. Implementation of the programme however has fallen under the
discretion of individual teachers, and is loosely applied across the country.

“I’ve heard stories where teachers just sit at their desk and ask the children to ‘shout-
out’ their weight,” said Noor. “In short, it is a good initiative but how well it is being
implemented is anyone’s guess.”

In January 2013, Health Minister Datuk Seri Liow Tiong Lai, again stepped up the
battle of obesity in schools with the introduction of a ‘healthy lifestyle with skipping’
initiative to encourage children to become more active with the distribution of skipping
ropes to 200 schools nationwide.

The most basic determinant of excess weight is a simple imbalance between calories
consumed and calories expended. The fact that adults worldwide are struggling to
grasp the concept is particularly concerning when their responsibility becomes raising
healthy children.

“[Malaysian] parents should pay greater attention to monitoring the meals of their
children. In many families both parents are working and very often this aspect is
neglected,” Dr E Siong Tee, president of the Nutrition Society of Malaysia, said.
“Children skip breakfast… meals are high in meat, fat, salt and low in vegetables and
fruits. Sugary drinks including soft drinks, cordials and syrups are another popular
group for children, [as are] sweet cakes and local snacks.”

Many energy-dense foods are nutrient poor, taste good and are readily available in
Malaysia. With more than 500 KFC outlets in the country, the international company
dominates Malaysia’s fast food sector, marking a 41% share of industry sales in 2011.
Furthermore, charitable initiatives such as KFC’s Projek Penyayang, which donates
meals to over 6,500 children each year in an effort to enable “thousands of orphans
and underprivileged children to enjoy KFC meals”, seems a misguided concept
considering the country’s current battle with the bulge.

Source: BMC Public Health

On average, a healthy nine-year-old requires approximately 1,800 calories a day. Two

pieces of fried chicken, mashed potato and a soft drink can total 1,300 calories – or
just under three-quarters of the child’s total recommended daily energy intake.

A diet of fast food is high in energy and low in nutrition, proving a double-edged sword
for the needs of a growing child.

“A good nutritional start is vital for children to grow and develop optimally, and to be
able to achieve well academically,” Tee said. “Prevention of obesity and other chronic
diseases must start from a young age.”

The implications of a prolonged lack of nutrition are serious for growing bodies, and
are a known precursor for hindered brain development and intellectual capacity, as
well as posing a potential risk for irreversible stunting of physical growth.

In Malaysia, widespread calcium deficiency in children is cause for concern, as is the

fact that almost one in two children are low in vitamin D, based on the Recommended
Nutrient Intakes (RNI) as outlined by the Malaysian Ministry of Health. Both are
essential components for growth and development, but deficiency is also easily
preventable.
The recommended calcium intake for a child aged from nine years is 1,300 milligrams
per day, which can be achieved with the introduction of foods such as tofu, yoghurt
and cheese to a child’s diet.
Additionally, vitamin D deficiency is easily alleviated through adequate exposure to
sunlight, but Tee says an increasingly sedentary lifestyle led by Malaysian children is
another challenge.

“School children are just too tied down with school work, homework, tuition classes
and extra curricular classes that they do not have the time and opportunity to do
outdoor activities, such as games and sports,” Tee said.

The physical burdens of excess weight are worrisome, but the mental impact of
carrying extra weight, such as peer isolation and the development of low self-esteem
in Malaysia’s youth, also cannot be ignored.

Fundamentally, what differentiates adult obesity and childhood obesity worldwide is

that grown-ups choose the lifestyle they lead, whereas children are destined to follow
the path adults tread before them.

Malaysia is no doubt reaping the benefits of rapid development, but it is also feeling
the additional burden of curbing a trend that the majority of the developed world has
found difficult to reverse.
ARTICLE 5

Taking Action on Childhood Obesity

Childhood obesity is one of the most serious global public health challenges of
the 21st century, affecting every country in the world. In just 40 years the
number of school-age children and adolescents with obesity has risen more
than 10-fold, from 11 million to 124 million (2016 estimates).1 In addition, an
estimated 216 million were classified as overweight but not obese in 2016.1

The condition also affects younger children, with over 38 million children aged under
5 living with overweight or obesity in 2017.

In response, all countries have agreed a set of global targets for halting the increase
in obesity. This includes no increase in overweight among children under age 5,
school-age children or adolescents by 2025 (from 2010 levels). 4,5 Action to reverse
the epidemic is the focus of the recommendations made by the WHO Commission on
Ending Childhood Obesity6 and is one of the main objectives of the Decade of Action
on Nutrition.7

The epidemic has been growing most rapidly in low- and middle-income countries,
particularly in Northern and Southern Africa, the Middle East and the Pacific Islands.

Although most countries are still off-track to meet the 2025 targets, many are taking
action and some have achieved a levelling-off in childhood obesity rates.

In this document we illustrate the progress being made, with examples of

actions at national level.

Effects of overweight and obesity

Obesity in adulthood is a major risk factor for the world’s leading causes of poor
health and early death including cardiovascular disease, several common
cancers, diabetes and osteoarthritis. Preventing obesity has direct benefits for
children’s health and wellbeing, in childhood and continuing into adulthood.
Compared with children with a healthy weight, those with overweight or obesity are
more likely to experience negative consequences, including poorer health in
childhood, including hypertension and metabolic disorders, lower self-esteem, higher
likelihood of being bullied, poorer school attendance levels and achievements, poorer
health in adulthood, including a higher risk of obesity and cardiovascular disease and
also poorer employment prospects as an adult, and lower-paid job.

Health is an investment

Acting on childhood obesity can have major benefits for the health care services and
wider economies of all countries. An initial economic analysis in 2014 estimated that
globally, adult obesity was costing US $2.0 trillion annually. 9 Further economic
analysis are needed to understand the full impact of increasing levels of obesity. 10 A
strategy including obesity prevention and treatment can be cost saving in the short
term and provide large economic and fiscal benefits in the
longer term in Australia.

Preventing childhood obesity must be a part of such a strategy. There are significant
benefits from investing in children’s health12, and although the economic value of
investing in childhood obesity prevention has not been

calculated at a global level, several national estimates indicate that interventions can
be highly cost-effective:

• Republic of Ireland: Action to reduce childhood BMI by an average of 5% would

save €1.1 billion in total lifetime costs.13

• Mexico: Action on childhood obesity could save

the economy up to Mex$110 billion annually for the treatment of diabetes,
hypertension and complications by the year 2050.14

• USA: Investing $2 billion a year would be cost- effective if it reduced obesity in

children aged 12 years by just one percentage point.

What needs to change?

Early nutrition

Obesity prevention requires action throughout the life course, starting before
birth.

Maternal nutrition
Mothers with a high bodyweight or who are poorly nourished before or during
pregnancy, and mothers who put on excess weight during pregnancy, are more likely
to have children that develop overweight or obesity.

While undernutrition in women has been declining over the last two decades, maternal
overweight and obesity have been increasing. Governments need to ensure that they
update their guidance with recommendations on obesity prevention during pregnancy.

Complementary feeding

Complementary feeding is an opportunity to ensure good nutrition at an early age, but

can be undermined by inappropriate marketing of commercial products. Governments
need to prevent all forms of misleading marketing of complementary foods. WHO has
published Guidance on Ending the Inappropriate Promotion of Foods for Infants and
Young Children Implementation Manual.21 For many countries legislation on
complementary foods may need to be strengthened to include all recommendations.

What needs to change?

Food environments

Children need to be supported by food environments where the healthy choice

is an easy and affordable choice, and they need to be protected from exposure
to powerful marketing of foods and beverages.

Restrictions on promotional marketing

Marketing restrictions were recommended as an effective strategy in 2010 and are

also recommended as key policy actions in WHO’s Global Action Plan for the
Prevention and Control of NCDs 2013-2020.23 Some progress is being made and
governments are strengthening their restrictions on marketing of food and non-
alcoholic beverages to children. Of 177 countries surveyed in 2015, 49 had
government policies implemented on food and beverage marketing to children, of
which 25 were government legislated and the remainder were voluntary or industry
self-regulated.

Taxes on sugar-sweetened beverages

School-based health surveys have found that a third of adolescents in

many high- and middle-income countries say they are drinking at least
one sugary drink every day.27 Taxes or levies on sugar-sweetened beverages are
recommended by WHO as a measure to reduce consumption of sugar-sweetened
beverages.28 Most recent data show 45 countries – nearly a quarter of all WHO
Member States – are currently implementing some form of tax or levy on sugar-
sweetened beverages.

Front-of-pack labelling

To encourage greater understanding of the nutrition content of food products, several

countries have encouraged or required nutrition information in front-of-pack labelling
(FOPL)systems,in addition to the nutrient declaration.

Most FOPL systems are voluntary. A standardised approach across all packaged
foods can provide easy-to-understand information. Such systems can also serve to
encourage manufacturers to reformulate their products, benefiting all consumers.

What needs to change?

Monitoring childhood obesity

Monitoring children’s health and bodyweight will help to evaluate a country’s

childhood obesity strategy, both for prevention and treatment. Almost all
countries track child growth in early childhood, and a significant number
monitor obesity indicators during later childhood and adolescence.

In the European region several countries have adopted a common protocol under the
WHO’s Childhood Obesity Surveillance Initiative.38 Monitoring of physical activity is
weak in most countries with almost no data activity in under 5 years and 6-10 year
olds. Strengthening of regular surveillance and the use of device based objective
measures is needed for countries to monitor physical activity and sedentary
behaviours in all children.

In addition, countries are recognising the need to monitor and report on their policy
developments for tackling childhood obesity, improving health and meeting the targets
for reducing noncommunicable disease. Several mechanisms already exist to assess
progress on countries’ policy development and implementation and published by WHO
and include: Assessing National Capacity for prevention and control of NCDs 26,29
and Global Nutrition Policy Review.

Physical activity

Physical activity levels in adolescents is poor, with some 81% of adolescents globally
(78% boys, 84% girls) falling below minimum recommended levels. 26 Similar low
levels of activity are found in all WHO regions, and in low- as well as middle- and high-
income countries.
Recommended actions for Government to promote physical activity are detailed in the
WHO’s Global Action Plan on Physical Activity 2018-2030,33 launched in June 2018.
The report notes that measures to encourage greater physical activity not only
improves health but can result in reduced use of fossil fuels, cleaner air
and less congested, safer roads. These outcomes are interconnected with achieving
the shared goals, political priorities and ambition of the Sustainable Development
Agenda 2030.

School environments

Schools offer an important opportunity to address childhood obesity by improving

children’s and adolescents’ nutrition through providing healthy food and drink options,
promoting physical activity and providing health education. Governments can take
various actions to create a healthy school environment: setting nutritional standards
for school meals, banning certain products or forms of retail (e.g. a ban of vending
machines), restricting the marketing of food and non- alcoholic beverages in and
around schools to minimise exposure to advertisements of foods and beverages high
in fat, sugars and salt.

A 2016 survey of school policies in 153 countries found 53 (24%) regulate food and
beverage marketing in schools and 28 (18%) have some form of ban on food and
beverage vending machines in schools.