Obesity Among Children and Teens Demands Stronger Response, Lancet Authors Find

Rising rates of childhood and adolescent obesity worldwide demand a stronger, multifaceted response that specifically targets advertising to children, according to authors of an article appearing today in the journal The Lancet.

The article, “Child and adolescent obesity: part of a bigger picture,” led by Tim Lobstein, PhD, of the World Obesity Foundation, was included in a special 6-part series that Lancet published on the topic. In a news release announcing the series, the editors criticized the “unacceptably slow,” progress in combatting obesity, with only 1 in 4 countries implementing a policy on healthy eating up to 2010.

While Dr Lobstein and his co-authors mentioned several nations, they took special aim at the rise of obesity in the United States, where they said the average child’s weight has risen by more than 5 kg (about 11 pounds) in the past 30 years, and one-third of all children are overweight or obese.

Promotion of energy-rich and nutrient poor products, they write, encourages rapid weight gain in early children and exacerbates multiple risk factors for chronic disease. The authors devoted a major section of the article to documenting the connection between rising body mass index (BMI) and stunted height, which they show is occurring around the globe.

The authors called on public health officials worldwide to take aim at marketing campaigns that pitch unhealthy foods to children, in much the same way the promotion of the advertising of breast milk substitutes was counteracted 2 generations ago by efforts to promote breastfeeding, with widespread success. The authors did not mince words about how proactive governments should be: “To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children’s health.”

Among the authors’ findings:

• A search of the PubMed database found that the number of papers on childhood obesity prevention rose from about 20 per year in the 1980s, to about 60 per year in the 1990s, to more than 1000 in 2013.
• Policymakers are often concerned whether interventions into childhood obesity prevention are cost-effective, yet few have been tried outside of school settings. The authors analysed cost-effectiveness of interventions across different countries, and found only 1 that involved limits on television advertising aimed at children.
• In addition to known health effects, such as rising rates of diabetes in the United States, children who are overweight or obese experience serious social and emotional challenges. The authors write that these children have “significantly lower mean scores on quality of life,” face social discrimination, higher rates of poor self-esteem and depression, and lower academic achievement and lower economic productivity.

The authors assert that this last finding, in particular, promotes the economic value of interventions, since it appears that children who grow up overweight or obese are set up for poorer job prospects.

Despite the rise in BMI, the authors said messages to children and parents should not put too much emphasis on this alone. Rather, they said, public health education must focus on the quality of foods children consume; nutrient-rich foods should be encouraged instead of high-energy ones. “Message that promote the avoidance of excess weight might give the impression that children should be restricted in what they eat, rather than encouraged to eat healthy,” the authors write.

The authors took special aim at the promotion of soft drinks, which have been the subject of campaigns in the United States to tax or limit portion size, with mixed results. And, as regulators did decades ago when they halted cigarette promotions aimed at children, the authors pointed out the dangers of failing to limit food marketing aimed at the young.

“The food industry has a special interest in targeting children,” the authors wrote. “Not only can the companies influence children’s immediate dietary preferences, but they also benefit from building taste preferences and brand loyalty early in life, which can last into adulthood.”

The authors recommended a variety of steps by governments, including financial incentives or penalties, nutrient requirements, regulatory oversight of marketing, and public sector purchasing power. That last item has been attempted, with considerable pushback, in the 2010 law that overhauled requirements for the National School Lunch Program in the United States.

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