Population-based Approaches To CHILDHOOD OBESITY PREVENTION
Population-based approaches toCHILDHOODOBESITYPREVENTION
Population-based approaches toCHILDHOODOBESITYPREVENTION
WHO Library Cataloguing-in-Publication DataPopulation-based approaches to childhood obesity prevention.1.Obesity - prevention and control. 2.Child welfare. 3.Exercise. 4.Food habits. 5.Community health services.6.Consumer participation. I.World Health Organization.ISBN 978 92 4 150478 2(NLM classification: WD 210) World Health Organization 2012All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int)or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland(tel.: 41 22 791 3264; fax: 41 22 791 4857;e-mail: bookorders@who.int).Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercialdistribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright form/en/index.html).The designations employed and the presentation of the material in this publication do not imply the expression ofany opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lineson maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed orrecommended by the World Health Organization in preference to others of a similar nature that are not mentioned.Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information containedin this publication. However, the published material is being distributed without warranty of any kind, eitherexpressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In noevent shall the World Health Organization be liable for damages arising from its use.Printed by the WHO Document Production Services, Geneva, SwitzerlandDesign and layout: blossoming.it
Contents1List of figuresList of boxesAbbreviationsAcknowledgements7789Executive Summary11Introduction131.11.21.31.42Childhood obesityKey global strategies related to obesity preventionWHO Forum and Technical Meeting on Population-based Prevention Strategiesfor Childhood ObesityPurpose and structure of the documentGuiding principles for the development of a population-basedchildhood obesity prevention strategy 2.12.22.32.42.52.62.72.82.92.102.11Integrated strategyPolicy support from multiple levels of governanceEquity and inclusivityEnvironmental supportMonitoring and surveillanceEngagement with multiple sectors and yCoordinationExplicit priority setting131315151616161717181818191919203Key components of a population-based childhood obesity preventionstrategy 214Structures within government to support childhood obesity preventionpolicies and interventions �� policiesDedicated funding for health promotionNCD monitoring systemsWorkforce capacityNetworks and partnershipsStandards and guidelines232324242425265
5Population-wide policies and initiatives5.15.25.36Community-based interventions6.16.26.36.476Policies influencing food environments5.1.1 Marketing of unhealthy foods and non-alcoholic beverages to children5.1.2 Nutrition labelling5.1.3 Food taxes and subsidies5.1.4 Fruit and vegetable initiatives5.1.5 Other food policiesPhysical activity policiesSocial marketing campaignsWhat are community-based interventions?Best practice in delivering community-based interventions6.2.1 Community engagement6.2.2 Programme design and planning6.2.3 Implementation6.2.4 Sustainability6.2.5 Governance and transparency6.2.6 EvaluationComponents of community-based interventionsWhat works in different settings6.4.1 Early childcare settings6.4.2 Primary and secondary schools6.4.3 Other community 4246Conclusions47References48
List of FiguresFigure 1Figure 2Schematic model demonstrating the framework for implementation ofDPAS at Member State levelKey components of a population-based childhood obesity preventionstrategy14Training teachers in the Caribbean to infuse diet and physicalactivity recommendations into the school curriculumFront-of-pack traffic-light nutrition labellingRestricting trans-fatty acidsHealthy food service policies in government institutions,Queensland, AustraliaEncouraging physical activity in Bogotá, ColombiaSocial marketing campaign promoting physical activity in BrazilEPODEThe Pacific Obesity Prevention in Communities (OPIC) projectThe Collaboration of Community-based Obesity Prevention Sites(CO-OPS Collaboration), AustraliaCommunity-based obesity prevention in young children: “Romp& Chomp,” AustraliaA school-based, multi-component nutrition and lifestyleintervention in North IndiaAn example of a school-based childhood obesity preventionintervention in Beijing, ChinaThe school-feeding programme in Jamaica2521List of BoxesBox ABox BBox CBox DBox EBox FBox GBox HBox IBox JBox KBox LBox M2931313234383940414344457
SA8Body Mass IndexGlobal Strategy on Diet, Physical Activity and HealthCardiovascular diseaseEuropean UnionFood and Agriculture Organization of the United NationsGlobal School-based student Health SurveyNoncommunicable diseaseNongovernmental OrganizationOverseas Development AssistanceWorld Health AssemblyWorld Health OrganizationUnited NationsUnited States of America
AcknowledgmentThis document was prepared by Gary Sacks, Boyd Swinburn and Godfrey Xuereb. Thecollaboration and input of Timothy Armstrong, Francesco Branca, and Paul Bloemare also acknowledged. Sections of this document are based on the World HealthOrganization publications: Interventions on diet and physical activity: what works:summary report (2009) and Population-based prevention strategies for childhood obesity:report of a WHO forum and technical meeting, Geneva, 15–17 December 2009 (2010).The development and production of this document was financially supported by theMinistry of Health and Solidarity, France and responds to their interest in ongoingcollaborative work in the development and implementation of policies and programmesto support the prevention of childhood obesity. Their generosity is acknowledged.World Health OrganizationNovember 20129
10
Executive summaryThe United Nations Political Declaration of the High-level Meeting of the General Assembly on thePrevention and Control of Non-communicable Diseases and the World Health Organization (WHO)Global Strategy on Diet, Physical Activity and Health both identify population-based preventionas being vital to addressing rising levels of noncommunicable diseases, with specific emphasis onchildhood obesity.As part of its commitment to providing technical advice to Member States in implementing theGlobal Strategy on Diet, Physical Activity and Health, WHO held a Forum and Technical Meeting onPopulation-based Prevention Strategies for Childhood Obesity in 2009. The overall aim of the Forumand Meeting was to identify priorities for population-based strategies to prevent childhood obesity,and to define roles and responsibilities for various stakeholders. As a follow-up to the Meeting, WHOwas asked to develop a tool for Member States to determine and identify priority areas for action,and also develop examples of population-based approaches to preventing childhood obesity.This document addresses the latter of these requests and aims to provide Member States with anoverview of the types of childhood obesity prevention interventions that can be undertaken atnational, sub-national and local levels. Where relevant, the document also aims to indicate whichprevention measures are likely to be the most effective.The document first outlines guiding principles for the development of a population-basedchildhood obesity prevention strategy. It is clear that actions to prevent childhood obesity need tobe taken in multiple settings and at all levels of government. They also need to incorporate a varietyof approaches and involve a wide range of stakeholders. Moreover, childhood obesity preventionefforts need to be tightly integrated with other efforts to control the major noncommunicabledisease risk factors. Policies for obesity prevention need to be inclusive and improve equity, withinterventions tailored to suit local contexts. They also need to be carried out in a transparent andsustainable way. Surveillance, monitoring and evaluation are also critical to support effectiveaction. The prioritization of policy actions needs to be explicit, with defined processes for selectinginterventions for implementation in a step-based manner.Approaches for population-based obesity prevention can be divided into three broad components:The first component is the structures within government to support childhood obesity preventionpolicies and interventions. These are structural aspects such as leadership, “health-in-all” policies,dedicated funding for health promotion, noncommunicable disease monitoring systems, workforcecapacity, and networks and partnerships that need to be in place in order to support and enhancethe effectiveness of the more direct policy initiatives and community-based interventions.The second component is population-wide policies and initiatives. These are direct policy actionsthat help to create environments that support healthy diets and physical activity. The types ofpolicy instruments typically used as part of this component of a comprehensive childhood obesityprevention strategy are laws and regulations, taxes and subsidies, and social marketing campaignsthat affect the population as a whole (or large population groups). Policies influencing foodenvironments that are likely to be effective interventions include restrictions on the marketing ofunhealthy foods and non-alcoholic beverages to children, nutrition labelling, and food taxes andsubsidies. Policies influencing physical activity environments that have been demonstrated aseffective include environmental interventions targeting the built environment, policies that reduce11
barriers to physical activity, transport policies, policies to increase space for recreational activity, andschool-based physical activity policies.The third component is community-based interventions. These are multi-component interventionsand programmes, typically applied across multiple settings, tailored to the local environment andimplemented locally. Best practice principles for designing and implementing community-basedinterventions include strong community engagement at all stages of the process, careful planning ofinterventions to incorporate local information, and integration of the programme into other initiativesin the community. Community-based interventions have been demonstrated to be successful whenapplied in multiple settings, including early childcare settings, schools and other community settings.Importantly, single-component interventions may still form an important part of a step-basedapproach to obesity prevention – for example as the first step in implementing a multi-component,multi-setting intervention programme.In summary, there is a broad range of population-level actions that governments can take toprevent childhood obesity. A comprehensive childhood obesity prevention strategy will incorporateaspects of each of the key components. Strategic investment is required to implement effective andculturally appropriate population-based childhood obesity prevention programmes and initiatives,and to ensure that they include vulnerable groups, such as children with disabilities. It is essentialthat such interventions occur across the whole population, in a variety of settings, and throughmultiple strategies.12
1Introduction1.1Childhood obesityOver the past three decades the prevalence of overweight and obesity has increased substantially(1). Globally, an estimated 170 million children (aged less than 18 years) are now estimated tobe overweight (2). The highest prevalence of childhood overweight is in upper-middle-incomecountries, and, when taken as a group, low-income countries have the lowest prevalence rate.However, overweight is rising in almost all countries, with prevalence rates growing fastest in lowermiddle-income countries (1).The high prevalence of overweight and obesity has serious health consequences. Raised body massindex (BMI) is a major risk factor for diseases such as cardiovascular disease, type 2 diabetes andmany cancers (including, for example, colorectal cancer, kidney cancer and oesophageal cancer)(3, 4). These diseases – often referred to as noncommunicable diseases (NCDs) – not only causepremature mortality, but also long-term morbidity. In addition, overweight and obesity in childrenare associated with significant reductions in quality of life (5, 6) and a greater risk of teasing, bullyingand social isolation (2).Due to the rapid increases in obesity prevalence and the serious public health consequences,obesity is commonly considered one of the most serious public health challenges of the early 21stcentury (1, 7).1.2Key global strategies related to obesity preventionIn 2004, the World Health Assembly endorsed Resolution WHA57.17 on the Global Strategy on Diet,Physical Activity and Health (DPAS) (8). The Global Strategy addresses the increasing prevalence andburden of NCDs, and, more specifically, global diet and physical activity patterns.Subsequently, in 2008, WHO developed a framework to assist Member States in monitoring andevaluating the implementation of DPAS at Member State level (9) (see Figure 1). This frameworkproposes that national governments demonstrate leadership and facilitate collaborative action inthe implementation of policies and programmes to promote supportive environments for health.These actions are expected, in turn, to facilitate positive changes in diet and physical activitybehaviours, with related health, social, environmental and economic outcomes.13
1Schematic model demonstrating the framework for implementation ofDPAS at Member State level (9)PROCESSNationalstrategicleadershipon diet andphysicalactivityOUTPUTSupportive environmentSupportive policiesSupportive programmesOUTCOMEBehaviour oring, evaluation and surveillanceIn 2011, the United Nations (UN) General Assembly adopted the Political declaration of the high-levelmeeting of the General Assembly on the prevention and control of non-communicable diseases (UNPolitical Declaration on NCDs) (10). This UN political declaration recognises the scale of the NCDcrisis, including obesity, and the urgent need for global action. By acknowledging the direct impactof noncommunicable diseases on social and economic development, and recognising that suchdiseases pose a major threat to the economies of many Member States, the UN Political Declarationon NCDs provides a strong impetus for governments to take preventive action and demonstratesound leadership (10). Both DPAS and the UN Political Declaration on NCDs recognise that effectiveNCD prevention requires the involvement of many different stakeholder groups, and multisectoralapproaches involving, amongst others, health, education, agriculture, industry and trade, andfinance (10).In 2012, the World Health Assembly endorsed Resolution WHA65.6 on the Comprehensiveimplementation plan on maternal and young child nutrition (11). The Resolution urges Member Statesto put into practice the implementation plan, including the strengthening of nutrition policies thataddress the double burden of malnutrition.14
1.3WHO Forum and Technical Meeting on Population-basedPrevention Strategies for Childhood ObesityAs part of its commitment to providing technical advice to Member States in implementing DPAS,WHO held a Forum and Technical Meeting on Population-based Prevention Strategies for ChildhoodObesity in 2009 (12). The overall aim of the meeting was to identify priorities for populationbased strategies to prevent childhood obesity and to define roles and responsibilities for variousstakeholders.Participants of the meeting proposed a series of actions for addressing childhood obesity includingthe development of suitable tools for Member States (12). Specifically, WHO was asked to developa tool for Member States to determine and identify priority areas for action as well as examples ofpopulation-based approaches to childhood obesity prevention. The latter of these is addressed bythis document.1.4Purpose and structure of the documentThis document aims to provide Member States with an overview of the types of childhood obesityprevention interventions that can be undertaken at national, sub-national and local levels. Themain focus is on primary school-age children and adolescents, but several interventions also benefityounger children. Where relevant, prevention measures that are likely to prove most effective areindicated.Guiding principles for the development of a population-based childhood obesity preventionstrategy are outlined and the three key components of a population-based childhood obesityprevention strategy then identified. These are then discussed in turn and the types of approachesthat Member States can take and considerations of design are laid out. Where possible, countryexamples are also provided.In defining population-based prevention strategies to childhood obesity, this document is bestused in conjunction with the document Prioritizing areas for action in the field of population-basedprevention of childhood obesity (13) and other WHO documents related to childhood obesity andNCD prevention.15
2Guiding principles for the development of apopulation-based childhood obesity prevention strategyThe following guiding principles for the development of a population-based childhood obesityprevention strategy are based on those developed as part of the WHO Forum and Technical Meetingon Population-based Prevention Strategies for Childhood Obesity (12).2.1Integrated strategyThe determinants of obesity are complex and varied and it is important to recognise that no singleintervention is likely to prevent childhood obesity (14). Actions to prevent childhood obesity needto be taken in multiple settings and incorporate a variety of approaches and involve a wide rangeof stakeholders. Sustained interventions are likely to be required at several levels – at an individuallevel in schools and community settings to effect behavioural change, and in sector changeswithin agriculture, food manufacturing, education, transportation, and urban planning (15). Eachintervention may have minimal effects when assessed in isolation but can constitute significantcomponents to an overall strategy.Childhood obesity prevention efforts need to be tightly integrated with other efforts to control allmajor NCD risk factors (including tobacco use, alcohol intake, unhealthy diet and low physical activity)(1). This requires intervention at all levels of society, from communities through to governments,private organizations and nongovernmental organizations. Noncommunicable disease risk factorsare embedded in the framework of society and influenced by many areas of national policy (1).For many low- and middle-income countries, actions for obesity prevention – and NCD preventionmore generally – need to be integrated with the related issues of food security and undernutrition(16).Finally, interventions for childhood obesity prevention need to be part of existing plans andprogrammes that aim to improve diets and
1.1 Childhood obesity 13 1.2 Key global strategies related to obesity prevention 13 1.3 WHO Forum and Technical Meeting on Population-based Prevention Strategies for Childhood Obesity 15 1.4 Purpose and structure of the document 15 Guiding principles for the development of a population-based childhood obesity prevention strategy 16
Understand the importance of early childhood education for 0-6 years Learn the need and scope of early childhood education. 18.2 Importance/ Need for early childhood care and education 18.2.1 Significance of early childhood years i. Early childhood is a period of life not just quantitatively different from that of an adult
Childhood Obesity Childhood obesity has both immediate and long-term effects on health and well-being. The increas-ing number of children who are obese has led federal policymakers to rank childhood obesity as a critical health threat. Multiple approaches are necessary to address the challenge of childhood obesity, and health profes-
6th Grade Social Studies: World Geography and Global Issues SS60301 Unit 3: Population and Migration Lesson 1 Michigan Citizenship Collaborative Curriculum Page 1 of 11 Oakland Schools November 9, 2012 Graphic Organizer Population Patterns Population Growth Population Distribution Population Density . 6th Grade Social Studies: World Geography and Global Issues SS60301 Unit 3: Population and .
Every population of organisms is founded by some initial population. This portion of the module will examine how characteristics of the initial population can impact how quickly the population can grow. In sexually reproducing organisms, at least one male and one female must be present in the founding population for the population to ever grow.
Effective Population Size Census population size often inappropriate for population genetics calculations Breeding population size often smaller For genetic drift, historical events or nonrandom mating patterns might reduce EFFECTIVE size of the population Effective Population Size is an ideal population of size N in which all parents have an equal probability of being
Approaches to Web Application Development CSCI3110 Department of Computing, ETSU Jeff Roach . Web Application Approaches and Frameworks Scripting (or Programmatic) Approaches Template Approaches Hybrid Approaches Frameworks . Programmatic Approaches The page is generated primarily from code
work/products (Beading, Candles, Carving, Food Products, Soap, Weaving, etc.) ⃝I understand that if my work contains Indigenous visual representation that it is a reflection of the Indigenous culture of my native region. ⃝To the best of my knowledge, my work/products fall within Craft Council standards and expectations with respect to
Sharma, O.P. (1986). Text book of Algae- TATA McGraw-Hill New Delhi. Mycology 1. Alexopolous CJ and Mims CW (1979) Introductory Mycology. Wiley Eastern Ltd, New Delhi. 2. Bessey EA (1971) Morphology and Taxonomy of Fungi. Vikas Publishing House Pvt Ltd, New Delhi. 3. Bold H.C. & others (1980) – Morphology of Plants & Fungi – Harper & Row Public, New York. 4. Burnet JH (1971) Fundamentals .
