We’ve all seen the impact of fast food on children’s weight and health in the UK and US. But now this man-made epidemic is spreading to Asia, where undernutrition is still rampant. Shockingly, in some countries there are equal numbers of children under five who are overweight and suffering from acute undernutrition. Urgent action is needed to address both of these issues.
Non-communicable diseases represent an increasing threat to human health and socioeconomic development. Diabetes, heart diseases, cancers and chronic respiratory diseases cause an estimated 35 million deaths each year, 80 percent of which occur in low- and middle income countries (WHO 2010). The majority of these deaths could be prevented.
Unhealthy diets, leading to overnutrition (overweight and obesity), is one of the key risk factors for these diseases. In 2012, an estimated 43 million children under the age of 5 were overweight or obese, close to three-quarters of them living in developing countries (UNICEF 2013). In the East Asia-Pacific region, UNICEF estimates that 11 million children under 5 are overweight. Rates of overnutrition are rising faster in South East Asia than anywhere else in the world.
At the same time, many developing nations are now confronted with a ‘double burden’ of malnutrition, meaning that they face problems of both under- and over-nutrition. Sometimes this can even exist within the same household.
Stunting, or being too short for one’s age, is the most common form of under-nutrition. The causes of this and overnutrition are intertwined. A child who is born with low birth weight and/or becomes stunted in the first two years of life has an increased risk of becoming overweight later in life, especially when exposed to an environment with widespread availability and promotion of high sugar and fat containing foods and drinks and limited physical activity.
Indonesia is a prime example of this. Here, 13 percent of children suffer from wasting – a form of acute malnutrition where a child is too thin for their height – while at the same time 12 percent of children are overweight (UNICEF 2014).
I have seen this issue first hand. On a recent visit to Indonesia, I met children affected by wasting at the health centre, including a tiny three-year-old girl who had been receiving treatment for wasting for over two months but wasn’t gaining any weight. Her mother was very well-nourished, almost overweight in fact, and sitting next to her in the waiting room was another three year old, much taller, and significantly overweight.
|Under- and overweight three-year-olds seen by the author at the same health centre in Indonesia
© UNICEF EAPRO/2014/Dorothy Foote
Children in Asia-Pacific are on the receiving end of a barrage of fast food and sugary beverage advertising. Exposure to marketing of energy dense, nutrient poor foods and beverages has been shown to adversely affect children’s eating habits, undermining any positive messages that they are receiving about healthy lifestyles and threatening efforts to tackle overnutrition.
A 2008 report by Consumers International, The Junk Food Trap: Marketing unhealthy food to children in Asia Pacific, showed that the response from governments and companies in this region falls far short of what is needed to curb this type of pervasive marketing to children. Multinational companies have been able to exploit the lack of controls and regulations on marketing and advertising in developing countries. Malaysia and Thailand were found to have the strongest regulation in the region but there are still plenty of worrying examples of marketing to be found in these countries.
Other countries have even further to go to comply with international recommendations such as those in WHO’s Set of Recommendations on the Marketing of Food and Non-Alcoholic Beverages to Children (2010). The UK and other European nations are the most advanced in this respect, with regulation of TV and other advertising, companies’ claims, nutrition labelling, and policies banning junk food and soft drinks in schools. However, even here more needs to be done.
UNICEF believes that concerted action is needed to tackle the growing obesity crisis among children in developing countries and to reduce the deleterious effects of the ’double burden’.
This is a new area for the development community. Although UNICEF’s focus up until now has been primarily on addressing under-nutrition (as is the case with most development organizations) we are currently developing a new global approach including actions to address both under and over-nutrition. We are reviewing available evidence from industrialized countries, in order to develop detailed recommendations for strategies to address over-nutrition in developing countries.
We are also finalizing a UNICEF East Asia and Pacific Regional Nutrition Approach, which proposes a comprehensive package. This includes education on healthy eating and physical activity in schools, mass media, social media and other channels. It also contains individual counseling for children and their families, advocacy for legislation to support improved nutritional quality of available foods, appropriate food labelling and to control inappropriate advertising of food aimed at children and youth, and measures to ensure that only healthy nutrition choices are available in schools.
UNICEF will work closely with WHO, national governments and other partners in the region, some of which are already beginning to address the issue of over-nutrition. WHO has already developed an action plan to reduce the double burden of malnutrition in the Western Pacific Region (2015–2020). Its objectives include strengthening and enforcing legal frameworks that protect, promote and support healthy diets, and suggested financing mechanisms to reinforce these, such as food pricing policies and taxation of unhealthy foods.
It is still early days in this evolving field but it is clear that we need to do more to tackle the burgeoning crisis of obesity in Asia and the Pacific. We can learn a lot from efforts in the UK and elsewhere to control the marketing of fast food to children, and reduce its availability in schools. But countries and regions of the world are different and we need to understand how Asian diets, culture, a growing middle class and continued poverty feed into this problem. I’m confident that in the coming years, we will see Asian governments and development agencies take a strong lead in addressing obesity.
Christiane Rudert is Regional Nutrition Adviser at UNICEF East Asia and Pacific Regional Office.