Childhood And Adolescent Obesity Increases Tenfold In Four Decades – Analysis


More obese children and adolescents than underweight by 2022

On October 10, The Lancet journal published an extensive study covering the trends in underweight, overweight and obesity of adolescents and adults from 1975 to 2016 in 200 countries. More than 1,000 researchers contributed to the study led by Imperial College, London (UK) and the World Health Organization (WHO).

The researchers found that since 1975, there is ten-fold increase in the number of children and adolescents with obesity. In 1975, there were 5 million obese girls. In 2016, their number rose to 50 million. The number of obese boys was 6 million in 1975 and 74 million in 2016.

However, globally, more children (75 million girls and 117 million boys) in 2016 were moderately or severely underweight than obese. Almost two thirds of the world’s moderately or severely underweight children lived in south Asia. If the present trend continues, World will have more obese children and adolescents than underweight by 2022.

Being underweight, overweight or obese causes many adverse health consequences. Underweight children and adults face higher risks of infectious diseases. Underweight girls are more likely to suffer from adverse pregnancy outcomes including maternal mortality, complicated deliveries, preterm births, intrauterine growth retardation etc.

Once you gain extra weight, it is not easy to lose it. Maintaining the weight is equally difficult.

The researchers listed many reasons to show how important it is to prevent and reverse excess weight in children and adolescents:

  • “First, weight loss and maintenance after weight loss are hard to achieve, therefore gaining excess weight in childhood and adolescence is likely to lead to lifelong overweight and obesity.”
  • “Second, being overweight in childhood and adolescence is associated with greater risk and earlier onset of chronic disorders such as type2 diabetes”
  • “Third, childhood and adolescent obesity has adverse psychosocial consequences and lowers educational attainment”
  • “Finally, children and adolescents are more susceptible to food marketing than adults, which makes reducing children’s exposure to obesogenic foods necessary to protect them from harm”

In some islands in Polynesia, the rates of child and adolescent obesity were highest (above 30%). The rates were around 20% or higher in the USA and some countries in the Middle East and North Africa (e.g. Egypt, Kuwait, Qatar and Saudi Arabia) and the Caribbean (e.g. Bermuda and Puerto Rico). Overall, the global prevalence of child and adolescent obesity increased from 0.7% to 5.6% for girls and from 0.9% to 7.8% for boys.

“India had the highest prevalence of moderately and severely underweight under-19s throughout these four decades (24.4% of girls and 39.3% of boys were moderately or severely underweight in 1975, and 22.7% and 30.7% in 2016). 97 million of the world’s moderately or severely underweight children and adolescents lived in India in 2016.” a press release from Imperial College London said.

In developed countries, food-processing industries dictate what people and even children should eat. Since the industry already has profound influence and is well, entrenched in society, how can anyone encourage healthy food habits?

Dr. Juana Willumsen from the World Health Organization (WHO) responded thus to my email query:

“Children are especially vulnerable to marketing and measures to improve dietary habits need to include protecting children from marketing of unhealthy foods, making healthy options the easy choice through front-of-pack labelling and making healthier options more affordable and accessible than unhealthy options. Raising public awareness of the consequences of obesity in childhood and later life and the importance of improving diet and physical activity is key.”

“Quebec, Canada, for example, bans any commercial advertising directed at children under 13 and use of promotional items. Evaluation suggests reduced fast-food consumption by US$88 million per year,” she noted.

Presently, even in developing countries, food intake among children belonging to the economically upper strata tends to depend on food processing industry. “What do you prescribe as the effective measures to encourage healthy food habits among children in developing countries?” I asked Dr. Willumsen.

“The interventions to improve dietary habits in low and middle-income countries are also important  for children who are affected by under-nutrition and can focus on making healthy foods affordable and accessible, as well as restricting the marketing of unhealthy options. School environments, where children spend a lot of their day, should provide healthy school meals that will address all forms of malnutrition and foster healthy food habits and include nutrition and health education (and practical skills in food preparation) into the core curriculum.” Dr. Willumsen clarified.

She gave a few examples:

  • “Chile introduced regulation on front-of-pack labelling in June 2016, with restriction on marketing to children and provision and sale in schools of any labelled product. Early evaluation indicates consumers acting on the front-of-pack information.”
  • “Mexico introduced an approx. 10% tax on sugar-sweetened beverages and have seen a sustained decline in consumption – reduced by 7.6% over 2 years since introduction (2014), with 2.1% increase in purchases of untaxed beverages, particularly purchased bottled water.”
  • “In the Philippines school food is placed into three categories which indicate how often a food item can be served: green, yellow, and red (never). The order also regulates marketing through branded vending machines, promotion, signs and sponsorship to ensure a healthy school environment.”

To my question whether she expects the trend in increase in BMI, overweight and obesity among children and adults in developing countries to continue unless drastic measures are implemented she affirmed that the current trends would suggest that, without concerted efforts, rates will continue to rise.

“Particularly worrying is the more rapid rate of increase in low and middle income countries,” she cautioned.

Does she think that the measures, if implemented in developing countries now will be more effective than in developed countries as the trend in relevant factors is yet to reach a plateau in developing countries?

“Given that the prevalence of overweight and obesity is still relatively low (although increasing rapidly) in low- and middle-income countries, this provides a valuable window of opportunity in which to act and protect children and adolescents from developing obesity and improve diet and physical activity opportunities,” she asserted.

In countries such as India, both severe underweight and extreme obesity among children are issues. When both parents are working, they depend more and more on processed foods. Once children develop a taste for such foodstuffs, it is difficult to wean them away. India must emulate the laudable actions taken by Chile, Mexico and Philippines referred to by Dr Juana Willumsen to safeguard the health and wellbeing of its schoolchildren.

Body Mass Index (BMI) is the basis of the Lancet study. BMI is a person’s weight in kilograms divided by the square of height in metres. Is BMI a perfect health indicator? Professor Keith Devlin, Stanford University, The Math Guy on National Public Radio (NPR) gives ten reasons to show that BMI is bogus. According to him, BMI is “scientifically nonsensical “and “physiologically wrong”…. “it ignores waist size, which is a clear indicator of obesity level.”

“It makes no allowance for the relative proportions of bone, muscle and fat in the body. But bone is denser than muscle and twice as dense as fat, so a person with strong bones, good muscle tone and low fat will have a high BMI. Thus, athletes and fit, health-conscious movie stars who work out a lot tend to find themselves classified as overweight or even obese,” he noted.

Be it as it may, in the absence of a better concept, people will believe in BMI and WHO despite the following assertion on BMI by Professor Devlin:

“It is embarrassing for one of the most scientifically, technologically and medicinally advanced nations in the world to base advice on how to prevent one of the leading causes of poor health and premature death (obesity) on a 200-year-old numerical hack developed by a mathematician who was not even an expert in what little was known about the human body back then.”

Dr. K S Parthasarathy

Dr. K S Parthasarathy is former Secretary, Atomic Energy Regulatory Board and a former Raja Ramanna Fellow in the Strategic Planning Group, Department of Atomic Energy, Mumbai. Dr. K S Parthasarathy may be contacted at [email protected]

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