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. 

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.

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.