Childhood Obesity: Is There a Glimmer of Hope on the Horizon?

May 07, 2015

PRAGUE — Despite some dire projections for obesity among adults over the next 15 years, there is a glimmer of hope for the future in terms of rates of overweight and obesity among children, which appear to be stabilizing in a few higher-income countries and may even be declining in others.

New data reported at the 2015 European Congress on Obesity this week suggest a plateau in childhood overweight and obesity levels in Norway, for example.

And countries in Southern Europe, such as Italy and Portugal, have even seen a decline in childhood obesity, for reasons that are unclear, João Breda, PhD, from the WHO Regional Office for Europe, Copenhagen, Denmark, told Medscape Medical News.

Nevertheless, there is little room for complacency. There remain high rates of overweight and obesity among children in many countries in Europe. And there are large discrepancies between socioeconomic groups and by region — for example, in Norway, the rural areas fared worse than metropolitan ones.

Asked to comment, Tim Lobstein, PhD, director of policy at the World Obesity Federation, London, United Kingdom, told Medscape Medical News: "We have seen from several surveys now evidence that the previous rapid rise in child obesity has leveled off in several countries and possibly even declined in some.

"We've also seen evidence that that decline is greatest among better-educated or more well-off families, indicating that they are responding to whatever policies and messages are coming through better than the lower-income or less well-educated families.

"But in a sense, this is creating a wider divide in the health outcomes for those [poorer] children," he commented.

And Dr Lobstein admitted that, in many cases, it isn't clear why obesity rates in children are stabilizing or even falling.

"It's odd because you will find declines in countries where you wouldn't necessarily expect it — in some Southern European countries tht are not instituting the sorts of policies which you find in the [north of Europe]. And you are finding it in Australia and New Zealand, and they haven't instituted the marketing restrictions that we have in the UK, for example."

There is also evidence that the obesity epidemic may be on the turn in some parts of the United States, but again it's not clear why, he said. "In America, there are some programs in schools but not much else — it's very fragmented."

And Dr Lobstein stressed to Medscape Medical News that there is a much bigger problem percolating in many lower- and middle-income countries with emerging economies, where there is a double burden of dealing with malnutrition on the one hand and obesity on the other, which presents its own unique challenges.

Norway's Success Story, but Many Groups Still Vulnerable

Although Norway has traditionally had among the lowest rates of childhood overweight and obesity in the world, new research from the Norwegian Child Growth Study shows that the prevalence of overweight among children aged 8 there has stabilized in recent years.

Reporting the findings, Ragnhild Hovengen, MscPH, from the Norwegian Institute of Public Health, Oslo, described the study, which involved nurses at 125 schools measuring height, weight, and waist circumference to determine waist-to-height ratio among more than 10,000 8-year-olds across the country during three waves of data collection: 2008, 2010, and 2012.

She explained that waist-to-height ratio is a better measure among kids because "body mass index [BMI] tends to underestimate obesity in children."

For both sexes combined, the overall prevalence of overweight (including obesity) was 16.2% and the prevalence of abdominal obesity was 8.4%, or to put it another way, "every sixth child in Norway" is affected, she noted.

Importantly, there was no increase in overweight or obesity during the period from 2008 to 2012, "so it seems like the prevalence might have stabilized," Ms Hovengen observed.

She explained that Norway has instituted mass obesity-prevention programs targeted at kindergartens and schools that are likely having an impact

But she stressed that "childhood overweight/obesity and abdominal obesity are distributed unevenly among children in Norway," adding, "There is a need to be aware of vulnerable groups to encourage good health and prevent social inequality in early childhood."

Among the vulnerable groups identified were children living in rural areas, those of divorced parents as opposed to married parents — boys, it seems, were particularly adversely affected by family breakdown — and certain ethnic-minority groups.

Much Better Data Collection Needed

Despite these encouraging data from Norway, much better surveillance is needed throughout the whole of Europe to try to better understand these latest trends, Dr Breda told the meeting.

It is extremely important that the prevalence of overweight and obesity among children is properly documented, he said, but in much of Europe, this is not yet happening.

Indeed, research carried out by PhD student Rebecca Jones, of Emory University, Atlanta, Georgia, and reported in a poster at the meeting in Prague, bears this out.

Ms Jones reviewed publicly available nutritional surveillance data on children aged 5 and under collected from the year 2000 in any European region member state.

"The most surprising thing we found was the lack of data — only 32 of 53 states had data," she told a press briefing, and only two had more than two sources.

The data also differed between countries in terms of the age ranges evaluated, cutoffs used (WHO criteria, the International Obesity Task Force [IOTF] criteria, or country-specific ones), whether it was nationally representative, and the method of evaluation — self-report vs direct measurement.

In terms of individual countries, Ireland (27%) and the United Kingdom (23%) had the highest levels of obesity in this young age group, followed by Albania (22%), Georgia (20%), Bulgaria (20%), and Spain (18%). Low-prevalence nations included the Czech Republic (6%), Belgium (7%), and Sweden (8%).

Because evidence suggests that early intervention before the age of 5 is necessary if the trajectory to overweight is to be stopped, concerted action is needed to try to get countries to develop consistent surveillance on this important pediatric population, she concluded.

None of speakers reported any relevant financial relationships.

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