Science and Technology in childhood Obesity Policy

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Publications

Diminishing benefits of urban living for children and adolescents’ growth and development

Publication . NCD Risk Factor Collaboration (NCD-RisC)

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1,2,3,4,5,6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

2023-03-29Journal article

Open access

Improving data on overweight, obesity and undernutrition among children under the age of 5 years in the WHO European Region

Publication . Wickramasinghe, K.; Heinen, M.; Buoncristiano, M.; Pudule, I.; Rito, Ana; Spinelli, A.; Ahrens, W.; Borghi, E.; Flores-Urrutia, K.; McColl, K.; Sassi, F.; Williams, J.; Rakovac, I.

Introduction: It is important for countries to be able to examine their progress toward the Sustainable Development Goals on malnutrition. Unfortunately, in the WHO European Region, there is limited and sparse crosssectional anthropometric measured data at national level from children under five years of age. The WHO European Office for the Prevention and Control of Noncommunicable Diseases in collaboration with WHO Headquarters and as part of its participation in the European Union funded project “Science Technology Obesity Policy” (STOP), is exploring to address these data gaps. Therefore, in October 2022, the WHO Regional Office for Europe convened an expert meeting to discuss the current overview of data availability, data collection, and next steps to move forward. Methods: Key stakeholders working in the areas related to childhood obesity surveillance were invited to this meeting to discuss and explore the availability of data, the feasibility, generalisability and practicality of anthropometric data collection in children under five and suggest next steps to move forward. Results: Addressing the challenge of childhood obesity in Europe was discussed, as well as the importance of anthropometric data on children under five years of age. Results of a survey from 31 European countries on the availability of anthropometric data in this age group were presented, focusing on data available from “routine health checks”. Future work is needed to identify the feasibility of accessing this data for surveillance and research purposes. Three Member States, namely Italy, Portugal and Latvia, presented their experience in data collection and perspectives on how to improve data on children under five. Discussions took place on the feasibility, generalisability and practicality of anthropometric data collection, and expected challenges and solutions. It was discussed that further explorations need to be done to harmonize joint data collection efforts coming from different sources within national health information systems. Conclusion: We concluded that it is important to move on from the idea of a perfect, ideal data source. All data sources — and the possibility of combining data from different sources — should be explored. Latvia has demonstrated the feasibility of a kindergarten-based survey and several countries have indicated willingness to participate in similar surveys. Other data sources should be further explored — it is important to gather enough information from routine data sources to be able to use and interpret these data (and combine them with other data). This is particularly important because kindergarten-based data will reach the older children in the under-five age group, while there tends to be higher coverage of younger children through routine data from paediatric systems.

2023-05-19Conference object

Restricted access

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Publication . NCD Risk Factor Collaboration group; Rito, Ana

Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

2024-02-29Journal article

Open access