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

Mary K. Caffrey
Lancet editors criticized the "unacceptably slow" global response to rising rates of childhood obesity.
Rising rates of childhood and adolescent obesity worldwide demand a stronger, multifaceted response that specically targets advertising to children, according to authors of an article
in the journal The Lancet.1
The article, “Child and adolescent obesity: part of a bigger picture,” with Tim Lobstein, PhD, of the World Obesity Foundation as the lead author, was included in a 6-part special section on the topic that appeared February 18, 2015. In a news release announcing the series, Lancet editors criticized the “unacceptably slow” progress in combatting obesity, with only 1 in 4 countries having implemented a policy on healthy eating as of 2010.2
While Lobstein and his coauthors mentioned several nations where obesity rates are climbing, they took special aim at the rise of obesity in the United States. Authors wrote that the average child’s weight has risen by more than 5 kg (about 11 lb) in the past 30 years, and one-third of children are overweight or obese. Promotion of energy-rich and nutrient-poor products, they write, encourages rapid weight gain in early childhood 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, and showed how this is occurring around the globe.
The authors called on public health ofcials worldwide to take aim at marketing campaigns that pitch unhealthy foods to children. They called for a campaign similar to one 2 generations ago that counteracted the marketing of breast milk substitutes by promoting breastfeeding, which has seen 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’ ndings:
• 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.
• Policy makers are often concerned about whether interventions into childhood obesity prevention are cost-effective, yet few have been tried outside of school settings. The authors
analyzed 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 on tests of quality of life, these children have signicantly lower mean scores; they also face social discrimination and have higher rates of poor self-esteem and depression, lower academic achievement, and lower economic productivity.

The authors assert that this last finding, in particular, promotes the economic value of intervention, 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 believe messages to children and parents should not put too much emphasis on limiting food. 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. “Messages 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 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.3 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 inuence children’s immediate dietary preferences, but they also benet 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 nancial incentives or penalties, nutrient requirements, regulatory oversight of marketing, and public sector purchasing power. That last item was attempted, with considerable pushback, in the 2010 law that overhauled requirements for the National School Lunch Program in the United States. 
1. Lobstein T, Jackson-Leach R, Moodie ML, et al. Child and adolescent obesity: part of a bigger picture [published online February 18, 2015]. Lancet. doi:
2. The Lancet: obesity series exposes “unacceptably slow” progress in tackling soaring global obesity rates over last decade [press release]. London: The Lancet Journals; February 17, 2015. Distributed via e-mail.
3. Caffrey MK. After the Republican wave, what will election 2014 mean for ACA Medicaid managed care? American Journal of Managed Care website. Published November 5, 2014. Accessed February 19, 2015.
4. Caffrey MK. School lunch changes for 2015 may be just the start of rollback. Am J Manag Care. 2015;21(SP2)SP51-SP52.
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