Children s nutrition a global emergency
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Children's nutrition: a global emergency Philip James IPA WHF IDF IUNS IOTF LSHTM and Chair of IOTF and the Presidential Council of the Global Prevention Alliance Malnutrition: a continuing outrage TMRU, Kingston, Jamaica, Christmas 1966 % underweight children in the world

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Children s nutrition a global emergency l.jpg

Children's nutrition: a global emergency

Philip James

IPA

WHF

IDF

IUNS

IOTF

LSHTM and Chair of IOTF and the

Presidential Council of the Global Prevention Alliance


Malnutrition a continuing outrage l.jpg

Malnutrition: a continuing outrage

TMRU, Kingston, Jamaica, Christmas 1966


Slide3 l.jpg

% underweight children in the world

Millions of underweight & stunted schoolchildren

IFPRI Projections with free market mechanisms

Potential response on the basis of Thailand's achievements

%

World Food Summit goal

Desired UN response with major change in policies

Elimination malnutrition: a global deficit in policies and priorities

UN Millennium report. James et al. Food & Nut Bulletin 2000, 21:Supplment 3



Slide5 l.jpg

Reduced

capacity to

care for baby

Inadequate

foetal

nutrition

Lifecycle: the proposed causal links

Epigenetic susceptibility to chronic diseases if diet becomes inappropriate

Higher mortality rate

Impaired mental development

Baby

Elderly

Inadequate growth

Low Birth

Weaning

Malnourished

Untimely / inadequate

Weight

Frequent infections

Inadequate food, health & care

Inadequate food, health & care

Child

Stunted

Woman

Reduced mental capacity

Malnourished

Pregnancy

Low Weight

Inadequate food, health & care

Adolescent

Gain

Stunted

Higher maternal mortality

Reduced mental capacity

Adapted from James et al. SCN Millennium Rep. Food & Nutrition Bulletin, 2000, 21, 3S.

Inadequate food, health & care


British wartime feeding based on novel nutritional concepts l.jpg

Cod liver oil

Milk

Orange juice

British wartime feeding based on novel nutritional concepts



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A quarter-pound cheeseburger, large fries and a 16 oz. soda national securityprovide:

  • 1,166 calories

  • 51 g fat

  • 95 mg cholesterol

  • 1,450 mg sodium


1900 2000 prevalence of overweight and obesity for 5 15 yr old australian children l.jpg

40 national security

Raw data

30

All data

% overweight or obese

20

10

0

Year

1900

1900

1920

1940

1960

1980

2000

1900 – 2000: Prevalence of overweight and obesity for 5 - 15 yr old Australian children

Norton K et al, Int J Pediatr Obes 2006


Projected overweight incl obesity rates for school age children l.jpg

Global total national security

Obese 74 mil.

O/wt 287 mil.

Prevalence

e.g. US

S.Arabia

e.g. UK

%

e.g. China

e.g. India

Projected overweight (incl. obesity) rates for school age children

Wang and Lobstein, IOTF, 2006.


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Nutritional Contrasts national security


Childhood overweight obesity l.jpg

Prevalence % national security

35

Overweight

Obese

Overweight

Obese

Americas

30

25

Near & Middle East

20

Europe

15

10

World

5

Asia-Pacific

0

Sub-Sahara

Childhood overweight & obesity

Lobstein et al., Obesity in Young Children. 2004, Obesity Reviews 5 (Suppl. 1), 4–85


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Reduced national security

capacity to

care for baby

Disordered

foetal

nutrition

Child overweight

Adolescent

O/W-obese

The impact of inappropriate Western diets on most of the world's susceptible populations: health systems already overwhelmed

Diabetes, strokes, heart disease, cancers

arthritis

Fat Baby

Elderly

Normal/high growth

High Birth

Early Weaning

Untimely / inadequate

Weight

Frequent fast foods

Rapid

weight gain

Inadequate physical activity

Inadequate health care

system

Abdominalobesity

Woman

Reduced play and social isolation

o/w or obese

Pregnancy

Glucose intolerance/

diabetes

Poor school conditions

Reduced fertility; CVD, HT Cancers

Early onset Type 2 Diabetes

Reduced job opportunities

Adapted from James et al. SCN Millennium Rep. Food & Nutrition Bulletin, 2000, 21, 3S.

Inadequate obstetric care


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The increasing risk of adult coronary heart disease if adults in childhood ( 7-13 yrs) had modest weight increases

Copenhagen school children's study of 276,835 children measured from 1955 - 1960 with National Death and Hospital Discharge Registries. Hazard relates to one BMI Z score: linearly related to events at all ages but hazard ratio progressively increases with age during childhood.

Baker, Olsen & Sorensen. NEJM 2007, 357: 2329-32


The keys to success in the food business and in obesity and chronic disease prevention l.jpg
The keys to success in the food business and in obesity and chronic disease prevention

  • Price

  • Availability

  • Marketing


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Fundamental changes in physical activity: inevitable and optional changes

Inevitable:

  • Rural to urban transition

  • Labour changes;

  • Mechanisation/computerisation of standard work; also home duties e.g. cooking, washing, cleaning

    Optional:

  • Urban building policies: high intensity or US style sprawl?

  • Road and community design

  • Office & supermarket location policies

  • Car policies versus preference for cyclists/pedestrians

  • Policies on free spaces for children's play; lighting for safety e.g. for older people

  • Park/leisure/sports facilities/school PA lessons

  • Ease of transport of perishable foods into towns/cities


Obesity time watching tv overwhelms leisure activity in australia l.jpg
Obesity: time watching TV overwhelms leisure activity in Australia

28

Leisure time sport & activity

Increasing TV time

27

26

Average BMI for each group

TV time

25

24

23

22

21

High

Moderate

Inactive

Low

Total daily physical activity

Adapted from Salmon, Bauman et al IJO 2000;24:600-606


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Individual responsibility Australia

Complementary approaches to obesity & chronic disease prevention

e.g. Focus on Health Education; campaigns selectively help upper socio-economic groups

Changes to the "toxic" environment

  • Progressively adapt all towns/cities to favour pedestrian/cycling as norm with car restrictions

  • Nutritional standards for food in all government facilities/schools; eliminate trans fats;catering on Finnish scale: fruit + veg. within meal costs

  • Limit/abolish all marketing to children

  • Selectively increase costs of high fat/sugary products; soft drinks

  • Social/employment/medical policies for breast feeding as the norm

Adapted from Puska P, 2001


Prevalence of obesity in schoolchildren in singapore weight kg for height m 120 l.jpg
Prevalence of obesity in schoolchildren in Singapore Australiaweight (kg) for height (m) >120%

%

16

14

12

10

8

6

4

2

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

New growth charts used since 1994. Source: Ministry of Health, Singapore

Dramatic response to intense focus on obese children's diet and physical activity



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Manipulating children's behaviour: evidence from the UK government's systematic analysis

  • Food industry promotions:

    • Can confuse nutritional knowledge, e.g. whether fruit is in product

    • Change food preferences

    • Change purchasing behaviour

    • Influence choice and consumption by brand

    • Alter balance of food categories eaten

Hastings Report, UK Food Standards Agency, 25th September, 2003.


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The most cost-effective community (not national) interventions in Australia

InterventionCost in Australian $ for each DALY saved

Restrict TV advertising 4

Soft drink intervention at school 3,000

Walking buses to school 770,000

Cycling (travel SMART schools) 260,000

After-school community programmes. 90,000

Doctors targeting the overweight children 32,000

School multiple interventions, but no physical education 14,000

Add Physical Education 7,000

School education to reduce TV viewing 3,000

Family-based program for obese child 4,000

School program targeting overweight & obese children 3,000

Medical treatment with drugs, e.g. Orlistat 14,000

Victoria State Analyses: Sept 2006


Strategies for combating childhood obesity l.jpg
Strategies for combating childhood obesity interventions in Australia

Protecting children at least up to 12 yrs:

  • Breast feeding

  • Proper weaning practices

  • Regulated child minders: food and play

  • Legislate on all forms of marketing: TV, radio, text messages, internet, food product labelling, games etc.

  • School environment : major changes needed

  • Supermarket practices

  • Pricing policies : affect school aged children

  • Policies on density of available fast foods outlets in town centers


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Health professionals interventions in Australia

10

Advocacy orgs.

Parents

Ministry of Health

Teachers

Children

Scientists

5

Church

Ministry of Education

Food inspectors

Parliament

Treasury

Farmers

Ministry of Trade

0

President

Retailers

Ministries of Transport

& Agriculture

Media

-5

INTEREST

Advertising industry

Food/drink industry

-10

0

5

10

INFLUENCE

The interest and influences of different stakeholders

Lobstein T : Analyses based on UK Food Commission's experience and new EU policy work.


Five practical priorities l.jpg
Five Practical Priorities interventions in Australia

  • Major drive to increase/ sustain breast feeding: facilities at work important; maternal leave + cultural change

  • Marketing restrictions(not just TV advertising) - statutory for children & adolescents: rights of child extend to 18 yrs

  • Control of foodin nurseries, all school facilities and school environment: avoid choice - all foods of high nutritional quality + facilities to allow spontaneous play - not TV

  • Fruit and vegetable availabilityroutine in canteens and restaurants (within main cost)

  • Transformation of physical facilities for spontaneous & leisure time activity: urban design changes with novel traffic policies; pedestrian only areas immediately adjacent to houses/apartments


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