Taking global action to end childhood obesity

Hannah Brinsden, Head of Advocacy & Public Affairs at the World Obesity Federation, discusses childhood obesity ahead of World Obesity Day 2016

This year World Obesity Day, which takes place on 11^th October, is focusing on childhood obesity. The message is simple:  Governments need to up their game and urgently take leadership and comprehensive action to end childhood obesity.

In the last decade, childhood overweight and obesity has risen significantly around the world. Figures from 2013 show that approximately 222 million school-aged children globally are overweight or obese and our latest estimates suggest that this number is set to rise by about 20% by 2025. The impact of this is not to be underestimated. Not only does it put our children’s future health at risk but it impairs their immediate health, increasing their risk of type 2 diabetes, raised blood pressure and non-alcoholic fatty liver disease. This puts our already struggling health systems under more strain. This is preventable and the need for action is unquestionable, but what will it take for the required action to be taken?

Obesity is a chronic form of malnutrition and in many low- and middle-income countries it is often found alongside undernutrition. This means that nutrition policies that promote healthy growth, ensure household nutrition security and protect children from marketing and advertising of foods which have low nutritional quality will be an essential part of our efforts to end childhood obesity.

Arguably we’ve come a long way in nutrition policy over the last few decades. More and more countries are starting to implement marketing restrictions, school meal guidelines, interpretative nutrition labelling and sugar taxes. But it’s not nearly enough. While best practices can be found, very few countries have implemented the full package of multi-sectoral policies. This is despite extensive research and repeated recommendations for action in this area, most recently in the report of the WHO’s Commission on Ending Childhood Obesity. 

So why the resistance? Some of this will be due to a lack of capacity, in other cases a result of the prioritisation of other issues. But in most cases it comes down to an issue of political will. Not so much a lack of political will to protect the health of our children, I think you’d be hard pushed to find someone who would admit to that (!), but a lack of political will to challenge the commercial drivers of our unhealthy food environments. This leaves governments exposed to weak and voluntary policies and a leniency in favour of private interests rather than the public good. As a result, childhood obesity, and indeed adult obesity, continues to rise.

If we are to improve the global state of nutrition, strengthen national food sovereignty and reduce childhood obesity we need to consider something different and more far-reaching. If we are to have hope of change, we need to explore legally-binding frameworks to protect and support governments, particularly in regional economic areas and smaller nations. Having a legally binding mechanism would help to define minimum nutritional standards to drive commercial food markets and the operation of global food trade. Further, it would help governments to enact the policies required to end childhood obesity and would help to protect governments and citizens from commercial interests and food markets which often undermine efforts to protect health.  

So this World Obesity Day, we are calling on governments around the world to fulfil their commitments made earlier this year and to take urgent action to end childhood obesity. We must also explore the mechanisms that will be required to effectively implement such a comprehensive package of policies. A legally binding framework to protect diets isn’t about hindering governments, it’s about supporting them in taking the required steps, as difficult as they may appear, to protect the health of citizens all around the world, and to ensure a healthier future for all. 

For more information about World Obesity Day visit www.obesityday.worldobesity.org

For more information about Consumer International and World Obesity Federation’s calls for a framework to protect and promote healthy diets see here. 

Junk food World Cup: CI shows football puts profits ahead of world obesity crisis

Competitive sport and junk food should not go hand in hand. Consumers International’s social media campaign during the World Cup in Brazil this month demonstrates that unfortunately they often do, says CI's Nora Blascsok.

The tournament is being used by the food industry to market unhealthy food. Coca Cola is one of FIFA’s major partners and McDonald’s is one of the first-tier World Cup sponsors.

FIFA partners pay between $25-50 million each per year, while first tier sponsors pay between $15-20 million each .

Besides sponsors, other companies like Pepsi, Domino’s and KFC use the World Cup to sell more food and drink products. According to consumer research firm Webloyalty, sales of unhealthy food and beverages tied to the World Cup will reach $459 million in the UK alone.

To highlight the problem, CI asked people to collect examples of adverts in which pictures of footballers and other images relating to the World Cup are used to advertise food and beverage products high in fat, salt or sugar.

These examples were then tweeted or posted on Facebook using the hashtag #JunkFoodWorldCup.

CI Members, as well as many other people on social media around the world, actively participated in the campaign.

Pictures of billboards, TV adverts, interactive marketing promos and publicity stunts involving famous footballers were published on social media, showing how truly global the reach of the food industry and its marketing machine is, especially during events like the World Cup (see our collection of pictures on Facebook).

The social media campaign has reached an estimated 76,090 accounts on Twitter, with the hashtag #JunkFoodWorldCup mentioned in 716 tweets over a period of nearly three weeks.

Many of the adverts tweeted or posted on Facebook use techniques that are known to be appealing to children.

Not only do they star footballers who are well-known and admired by children throughout the world, they also use bright colours, music and often contain an interactive element (such as competitions or games).

CI food expert Anna Glayzer points out: “If children see their favourite footballer advertising crisps or a highly sugared beverage, they will associate that product with sport and with being fit and healthy.”

200 million children globally are either overweight or obese, with 40-50 million classified as obese.

Obesity in childhood has a high likelihood of leading to diseases such as diabetes, cardiovascular disease and cancer in adulthood.

Currently 2.1 billion people are obese and overweight worldwide.

CI is campaigning for global action to address the marketing of unhealthy food. In our publication, Recommendations towards a Global Convention to protect and promote healthy diets, CI calls on governments to restrict advertising that is likely to create an erroneous impression about a product’s health benefits and other characteristics, and to prohibit or restrict the sponsorship of international events by companies and brands associated with unhealthy foods and beverages.

You can see some of the images posted to Twitter  which show the extent of 2014's junk food promoting World Cup.

Amanda Long: We must act now to stop obesity killing millions

As worldwide support for our call for tougher action on unhealthy diets shows, there is an overwhelming consensus that the obesity crisis is out of control. CI's Director General, Amanda Long, on why we need immediate action.

Last week, we launched a new set of Recommendations that call for a Global Convention to protect and promote healthy diets, drawing worldwide media coverage and support.

Developed in consultation with Members of both Consumers International and the World Obesity Federation, as well as a wider network of public health experts, our Recommendations have already received endorsement from the likes of  the UK's Association of Directors of Public Health, the US Public Health Institute, World Cancer Research Fund, European Public Health Association , and the UN's food chief Olivier De Schutter. Not to mention the support of our 250 membership orgainsations around the world.


Such strong support underlines the fact that the case for a Global Convention on healthy diet is now overwhelming. We face an unprecedented health crisis, that is largely preventable – yet action is falling far short of what is required.

Here are a few shocking statistics:

• One person every seven seconds dies of diabetes – nearly half of those deaths (44%) are attributable to overweight and obesity
• 9.4 million people die of hypertension every year – with high salt intake a major risk factor for that disease
• obesity rates have nearly doubled since 1980
• 2.3 billion people will be overweight by 2015.

This crisis is truly global – the highest rates of growth for obesity and overweight are now found in low and middle income countries.

As Margaret Chan said in her opening address to this year’s World Health Assembly:

"We see no good evidence that the prevalence of obesity and diet-related non-communicable diseases is receding anywhere. Highly processed foods and beverages loaded with sugar are ubiquitous, convenient, and cheap."

The figures are absolutely compelling. Yet our collective response is lagging far behind what is needed.

Calling for a Global Convention inevitably draws comparisons with the Framework Convention on Tobacco Control (FCTC). Of course food is not the same as tobacco – but in public health terms we are facing a similar, or even greater, crisis.

The point is about impact.

When it comes to the scale and scope of the impact, tobacco and unhealthy food are directly and very worryingly comparable. 

Smoking still kills six million people a year and rates continue to rise in many countries.  In some countries however, rates are decreasing; in large part because concerted efforts by governments to put public health ahead of the commercial interests.

The FCTC is a major part of this story. It was a ground breaking international agreement that built political will and led to co-ordinated action around the world.

The shocking truth is that, today, poor diet is the number one cause of premature death globally – more than smoking.

As we seek to tackle poor diets we need to learn from the FCTC success, without repeating the thirty years of debate that led to its adoption. We cannot afford to allow the food industry to repeat the foot-dragging strategy taken by the tobacco lobby.

How many times have we said to ourselves – if we knew then the harm caused by tobacco, we’d have done things sooner? Well we do know the damage of unhealthy diets– let’s make amends and prevent a similar catastrophe.

We believe that the global community can, and must, do better than the story of tobacco controls.  The vast majority of deaths from unhealthy eating are preventable. There is widespread agreement about the policies that will have an impact – but we are not doing enough and we are not taking action fast enough.

Of course there are some good examples. Governments that have moved on this such as Finland, or more recently Argentina, with programmes to reduce salt in food. Others such as the UK have pushed for clearer labelling. And of course the recent decision by the Mexican government to tax soda and junk food.

At the city level the excellent lead taken by Michael Bloomberg when he was Mayor of New York, introducing calorie labelling in restaurants, making the food that the city authority provided in schools and hospitals healthier.

Companies are also responding by reducing fat, sugar and salt in food, improving labelling and some efforts to reduce marketing to children.

Many of these developments have been the result of pressure from campaigners all over the globe – including CI Members.

But the response – whether from governments or the food industry - is inadequate.

Ten years ago, the WHO adopted the Global Strategy on Diet Physical Activity and Health. It marked a significant step forward but steadily rising figures for obesity and non communicable diseases show that it is clearly not enough.

Individual related WHO programmes and guidance, and Codex initiatives on labelling are all important steps, but without the political will and comprehensive approach offered by a Framework Convention they are not having the impact that is needed.

The WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases, that was adopted just last year, calls for a ‘halt’ in the rise of obesity and overweight.

Just a halt. Given the rate of increase, this was thought to be realistic. What a sad indictment. It should not be accepted. It is just not enough.

Back in 1998, then director of the WHO, Dr Gro Harlem Brundtland speaking on the FCTC said:
‘Tobacco control cannot succeed solely through the efforts of individual governments, national nongovernmental organizations and media advocates.  We need an international response to an international problem’.

The direct parallel is here.  This problem is global and systemic and requires a global, systemic response.

We need concerted action on a global scale.  In doing so governments will be truly serving their citizens. Putting them first. Acting for those they represent and sparing them the horror story from poor diet that we all saw happen as a consequence of inaction on tobacco controls.

The world cannot wait another 10 years until we find the will to take the action necessary.   And we cannot contemplate the 30 years it took to get the FCTC agreed.  We cannot let history repeat itself.

A global convention on healthy diets? Some lessons from the WHO Framework Convention on Tobacco Control

Jonathan Liberman, director of the McCabe Centre for Law and Cancer, comments on CI's and World Obesity Federation's publication Recommendations towards a Global Convention to protect and promote healthy diets. 

On 27 February 2015, it will be ten years since the WHO Framework Convention on Tobacco Control (FCTC) entered into force. I’ve argued that the FCTC has done a number of great things, including:

• raising the global profile of tobacco control
• strengthening governments in their fight against the tobacco industry, politically and legally 
• reinforcing the view that tobacco products are not normal consumer products, contributing to the ongoing denormalisation of the tobacco industry
• catalysing the formation and deepening of transnational civil society coalitions; 
• facilitating the sharing of experiences, expertise and capacity among and between governments and nongovernmental organisations; 
• and bringing new resources — political, financial and human — into the field.

The FCTC has generated substantial interest in the use of treaties to advance global health (and development). I’ve suggested that it has made treaties the Holy Grail of global health governance. What might our next global health treaty be?

The proposal for a global convention to protect and promote healthy diets, which draws heavily on the FCTC, is an ambitious one – as it should be, given the scale of the health, social, economic and developmental consequences of unhealthy diets and the urgent need for the global community to act.

While it is easy to observe that food is not tobacco (or alcohol) - and the food industry is not the tobacco industry (or the alcohol industry) - it is much harder to articulate exactly what lessons from tobacco control (and the FCTC) are, and are not, applicable to diet.

Recommendations towards a Global Convention to protect and promote healthy diets does not shy away from the complexity of global and domestic food policy.

It offers definitions to distinguish between ‘healthy food’ and ‘unhealthy food’, which include both foods and beverages.

It covers food supply, production, price, marketing, standards and labelling, and consumer information and education.

It acknowledges that cross-agency coordination within the United Nations system is needed on health, trade, food security, environment, and economic and international development.

It recognises that the action and inaction of a large number of government departments and agencies affect diet, mentioning agriculture, regional development, social support, education, health services, defence, justice, telecommunications, transport, energy, trade, industry and finance.

Against this complexity, I offer a few suggestions as the idea is taken forward:

• Make sure the proposal is manageable in the real world. If it’s too ambitious in its scale and breadth, it’s unrealistic to expect that the many government departments that need to be engaged in a treaty negotiation will be able to come to whole-of-government positions at a meaningful level of commitment. Let alone that the 194 Member States of the World Health Assembly will be able to reach agreement over a realistic number of treaty negotiation sessions (that many States will be reluctant to fund).
• Work out whether / where you’re looking for a framework that encourages and facilitates ongoing, coordinated global action versus states agreeing to very specific detailed legal obligations (for example, on marketing unhealthy foods to children). In saying “versus”, I don’t mean to overstate the either/or quality, but trade-offs inevitably have to be made, and sometimes at the outset, rather than at the death, if the proposal is to get moving.
• Make sure that the proposal is flexible enough to have truly global application, across the very different situations in different countries in what foods are eaten, and how they are produced and sold.
• Think carefully through the relationships with other international agencies whose mandates affect diet. If WHO is to be (or to house) the treaty’s Secretariat, don’t burden it with responsibilities it is not functionally equipped to perform.
• Don’t discuss the proposal through draft legal text. Focus on concepts, and discuss text at the appropriate time. Nothing can kill off meaningful conceptual discussion quite like poring over, and suggesting amendments to, legal text.

At its most recent session, in Seoul in November 2012, the FCTC’s governing body, its Conference of the Parties, expressed “a need to examine the impact of the Convention as a tool in promoting public health in general and tobacco prevention in particular”.

Just how such an “impact assessment” might best be performed will be discussed at the upcoming session of the COP  in Moscow in October this year.

This impact assessment is bound to be an interesting exercise. It should yield valuable lessons for other areas of global health governance in general, and the use of treaties for global health in particular, including the proposed Global Convention to Protect and Promote Healthy Diets.

Can a food app make you healthier?

Boyd Swinburn, Professor of Population Nutrition and Global Health at the University of Auckland explains how a popular new app is identifying the healthiness of our food, by partnering consumers with scientists.

If unhealthy food environments are driving up the obesity epidemic, then how are governments and the food industry responding and are the food environments they are creating for us getting healthier? 

For example: Are processed foods reducing in salt, sugar or fat? Are our children exposed to less unhealthy food marketing on TV, the internet, and through sponsorship? Is healthier food getting cheaper? Are food labels getting easier to interpret? Is the proportion of schools meeting healthy food guidelines increasing?

I think these are all good questions – in fact critical for our nutritional health - but who is answering them?  All countries signed up to World Health Organisation’s plan for monitoring changes in non-communicable diseases and its risk factors like high blood pressure, high cholesterol and obesity.

But this monitoring framework will not answer any of the food policy and environment questions I posed above. A group of academics at a dozen or so universities around the world and several global non-government organisations, including Consumers International, thought that this was not good enough. So we decided to create our own monitoring system to complement WHO’s efforts. 

We set up a group called INFORMAS which stands for International Network for Food and Obesity/NCD Research, Monitoring and Action Support (www.informas.org).

It seems all organisations and projects need acronyms these days and interestingly, ‘informas’ turns out to be Esperanto for the present tense of the verb to inform, so I think it is quite appropriate (and easily searchable which is important in the electronic age).

INFORMAS has got straight to work and recently  published a set of papers on how we should be monitoring and benchmarking food environments. The next question, once we are through pilot testing the measurements in several countries, is how do we see consumers being involved?

This to me is one of the really exciting parts of this whole INFORMAS endeavour. Working with Bupa Australia, our INFORMAS colleagues at the George Institute for Global Health are already using crowdsourcing of data in some countries where a free smartphone app called Foodswitch has been launched.

Consumers can use it to scan the barcodes of foods and get nutrient information in the form of traffic lights to reflect low, medium or high amounts of salt, saturated fat, and sugar and it even suggests alternative healthier choices if appropriate.

This app has been very popular wherever it has been launched and in fact consumers have also been able to help keep the database up to date because if the barcode is not recognised the consumer is asked to take photos of the package and send them in so that the food can be added to the database – truly a collaborative effort of scientists and consumers.

But we have even more in mind as INFORMAS progresses. We eventually want to have the same sort of crowdsourcing for instances of marketing to children and we plan to include the public in our systems for rating how well governments and companies are doing in terms of giving us the type of food environments that make healthy food choices the easy or even default choices.

One thing that has seriously been lacking in the whole debate on preventing obesity and other diet-related health problems is the strong voice of the consumer.

We need this to create the demand for governments and companies to act more in the public interest on food matters. We hope that INFORMAS will provide the platform for that voice.

How can we tackle the shocking levels of childhood obesity in The Middle East?

With the number of  overweight 13-15 year olds reaching 1 in 2 in parts of the region, CI's Middle East coordinator Ahmed Al Harthy reports back on a recent WHO consultation to tackle the issue.

Childhood obesity may not be the most obvious challenge facing the region, but the figures that we have are worrying. 

Kuwait tops the tables, with 51% of children aged 13-15 overweight, followed by the United Arab Emirates (UAE) with 38.4% and Egypt with 32.5%.

The prevalence of obesity among children aged 13-15 years is highest in Kuwait with 22.7%, followed by the UAE (14.4%), Libya (8.2%) and Iraq (7.9%).

We also know that changing diets in the region are contributing to this. On average 50% of adolescents drink one or more soft drinks daily.

The highest prevalence is found in Kuwait (74.3%), followed by Qatar (62.5%), Lebanon (60.2%) and Palestine (58.2%).

For a number of years, CI has campaigned for restrictions on the marketing to children of foods high in sugar, fat and / or salt.

Last month CI was pleased to attend a World Health Organization (WHO) regional consultation in Amman, Jordan. 

The aim of the meeting was to bring some urgency to the challenge of protecting children in the Eastern Mediterranean Region from harmful food marketing - so that we can start addressing these shocking figures.

Despite this growing public health challenge, little has been done by governments in the region to tackle the marketing of high fat, salt and sugar (HFSS) foods- a known contributor to poor diets and to childhood obesity.

 In May 2010, the WHO agreed a Set of recommendations on the marketing of foods and non alcoholic beverages to children. The recommendations give guidance to governments on how to limit the power of advertising over children.

Of the countries that responded to a WHO survey ahead of the Amman meeting, only 2 had any kind of measures in place to restrict HFSS food marketing. 

Meanwhile, the amount spent on advertising by the food and beverage industry in the region continues to grow steadily.

Taking part in the consultation were experts from a mixture of backgrounds including from ministries of health, media networks, lawyers, the Arab League and UNICEF.   Consumer groups were very well represented.

As well as CI, two CI Members from the region participated: the Network for Consumer Protection in Pakistan; and Consumers Lebanon.

This strong consumer presence was no accident.  The consumer movement has a vital role to play in helping develop controls on food marketing:  monitoring media channels to produce evidence of the levels of marketing, raising public awareness of the problem; pressing policy makers to act; and monitoring the effectiveness of policies once introduced. 

Indeed, CI Members in other parts of the world have successfully taken on this role.

Since opening the CI office in Oman a year ago, we have been working to strengthen our Members in this region to articulate, serve and defend consumer rights. 

Sharing the tools we have developed, and our experience of campaigning to protect children’s health from the harmful effects of HFSS marketing, will be an important continuation of this work.

Food marketing to children is a priority area for CI.

CI debate: Does being poor prevent people from eating healthily ?

Television chef Jamie Oliver - whose books and television programmes have been shown all over the world  - caused big headlines in the UK when he questioned whether there was a link between poverty and healthy eating.

He claims to have seen families eating badly even though they own expensive televisions. Critics attacked Oliver, insisting that he had simplified a complex problem.

We asked the consumer movement and our Facebook friends for their thoughts.

No - you can still eat healthily on a low budget. A lot of fresh, filling and healthy basics are cheap - fruit and veg in season, potatoes, pasta etc. And you can make a little meat go a long way. Processed food is pretty expensive and you don't know what's in it!
Julie Hunter

If people are willing to buy store brands instead of famous brands of food, it can be affordable to prepare healthy meals. But the mentality of poor English people is another matter altogether for another day. Fast foods are favourite of lazy poor people over here! Jamie Oliver is doing a programme to prove that on Channel 4. Most poor people in my old neighbourhood, they live off the little plot of land they have. Growing spinach, pumpkin, using pumpkin leaves for morogo, potatoes, you name it. It is a multi dimensional subject.
Mantinini Moroka

Access and not only affordability also affect the ability of those living in poverty to choose healthy diets. For example, it is quite common for low income communities to have few if any healthy food grocery stores in their neighbourhoods thus limiting people's access to securing healthy foods. Furthermore the intersection of race and class in certain countries, makes this an even more complex topic.
Onica Nonhlanhla Makwakwa, CI Head of Africa

I think that there is a connection, not the least when it comes to making sustainable choices and other links to health that might be a bit less apparent. To buy food where there's not been and compromise with quality such as animal health (antibiotics), unsafe pesticides or slaughter products with unclear origin, simply costs more in the store, so of course there's a link there...
Emma Wieslander

In our context poverty and ignorance can be so strongly linked and the poor have increased chances of receiving cheap unhealthy foods such as hydrogenated fats, imported food snacks with high quantities of salt, additives and sugars. Distracted advertising confounds choices among the poor and this may stop health eating habits.
Youth Education Network

Junk food may be cheaper now, but who will pay the doctor's bills in 10 or 20 years from now? Once you start on hypertension or diabetes medicines, you normally can't stop. Finally, try buying directly from small farmers or local fresh markets (if you can). Food is generally better in quality and lower in price as the middlemen (supermarkets) are left out of the chain.

Hubert Linders

In Greece poverty has watered down all consumers' rights. According to a survey we conducted in May, 40.3% of consumers use price as the basic criteria for choosing the goods they purchase. 70% of consumers whose income is below 600 euro have decreased the purchase of food. Poverty undermines the right to consumption the right of satisfaction of basic needs. So all the other consumer rights that are based on this one are also undermined. Recently a young couple with two kids 4 and 5 years old and who had both lost their jobs asked for our help so that the bank would not confiscate their home. The mother told us that she had fed her two children for one week with 2 euro. She has bought 2 kilos of flour and made bread and one kilo of rice and made soup. If this is not poor nutrition for these two kids I do not know what else is poor nutrition.
Evangelia Kekeleki,  KEPKA Consumers Protection Center Greece

The US supermarket price of a nice white fish; for example, a red snapper is ($7) + romaine lettuce & tomato salad ($3) compared to a fish fillet + french fries menu meal at a fast food restaurant for ($5). It costs more to eat better. Then, factor in that fast food restaurants serve Coke and Pepsi products which are empty calories, which cause weight gain among other health consequences. Unfortunately, when govt. tries to do anything about unhealthy choices, as recently Mayor Bloomberg did in NY, they are ridiculed and told it is not their place. Meanwhile, some two-thirds of American kids are obese. Denial ain't just a river in Africa.

Global Alliance for Legal Aid

Poverty affects your judgement of opportunity cost; eating healthily for some is related to how they value themselves. Unfortunately, many consumers weigh their own value on the scale of the purchasing power.

Dieunedort Wandji