The epidemic of childhood obesity in the Americas must be stopped: Governmental and PAHO leadership are crucial

Getting to the root of the problem: the international and domestic politics of junk food industry regulation in Latin America

In response to non-communicable diseases (NCDs) in Latin America, governments have introduced impressive prevention programmes However, the purpose of this article is to better explain why several governments have yet to address arguably the 'root of the problem': i.e. implementing effective regulatory policies restricting the food industries' ability to market and sale their products. Introducing a political science analytical framework merging international relations and domestic politics theory, this article claims that most governments have failed to achieve this process because of their reluctance to transfer their beliefs in human rights to health from the area of NCD prevention to regulation, thus achieving what the author refer to as 'normative transferability'. The research design for this study entailed a documentary analysis of 44 qualitative primary and secondary documentary data sources (combined), i.e. articles, books, policy reports and the usage of these data sources for a comparative case study analysis of Chile, Brazil and Mexico. These qualitative data sources were also used to illustrate the potential efficacy of the author's proposed analytical framework, developed from the political science and public policy literature. Quantitative epidemiological data from the World Health Organization global health observatory were used to provide a contextual backdrop of the obesity and diabetes situation in these countries. Comparing these three countries, Chile was the only one capable of achieving 'normative transferability' due to a strong linkage between activists, supportive institutions and policy advocates within government viewing regulatory policy as a human right to protection from aggressive industry marketing and sales tactics. To better understand differences between nations in achieving normative transferability processes and effective NCD regulatory policy outcomes, political scientists and public health scholars should work together to develop alternative analytical frameworks in the commercial determinants of health.

Understanding the underlying drivers of obesity in Africa: a scoping review protocol

INTRODUCTION

The worldwide prevalence of obesity and overweight has doubled since 1980, such that approximately a third of the world's population is reported as obese or overweight. Obesity rates have increased in all ages and both sexes irrespective of geographical area, ethnicity or socioeconomic status. Due to the high prevalence, related health consequences and costs of childhood and adult obesity, there is a need to comprehensively identify and assess the major underlying drivers of obesity and overweight in the African context.

METHODS AND ANALYSIS

This scoping review will be carried out as per the methodological outline by Arksey and O'Malley. The search strategy will be developed and search performed in the Scopus and PubMed electronic databases. In the first search, we will identify concepts that are used as an equivalent to obesity and overweight. Subsequently, we will search for studies comprising of search terms on the underlying factors that drive the development of obesity and overweight. Lastly, we will check reference lists for additional publications. Abstracts and full-text studies will independently be screened by two authors.

ETHICS AND DISSEMINATION

The proposed study will generate evidence from published data and hence does not require ethics approval. Evidence generated from this review will be disseminated through journal publications and conference presentations.

A Qualitative Study of Child Nutrition and Oral Health in El Salvador

The nutrition transition from traditional diets to processed snacks and sugary beverages has contributed to a higher burden of child malnutrition, obesity, and tooth decay. While child health interventions typically promote nutritious eating, they rarely promote oral health. Mothers’ motivations for child nutrition and oral health practices need to be better understood. A convenience sample of 102 mothers in eight rural Salvadoran communities participated in focus groups addressing child nutrition and oral health. Focus groups were transcribed and coded using qualitative content analysis. Primary themes included generational changes in health environments; health knowledge, attitudes, and practices; and access and barriers to health services. Mothers noted general improvements in awareness of oral hygiene but poorer child oral health, which they attributed to widespread sales of unhealthy snacks and beverages near schools. Distance and cost limited families’ access to dental services. Knowledge gaps included the belief that oral iron supplements cause tooth decay, uncertainty regarding when to start tooth brushing, and until when parents should help children brush. Maternal-child health programs should emphasize the adverse health consequences of feeding young children processed snacks and sugary drinks, and promote dental care access and regulations to ensure health-promoting environments surrounding schools.

Trends of weight gain and prevalence of overweight and obesity from birth to three years of age

OBJECTIVE

To examine the changes in children's weight-for-height at six monthly intervals between birth and three years old (3yo) from different counties across Chile and to determine if children had overweight or obesity, and if so, whether it was a transient or persistent change.

SUBJECTS AND METHODS

Longitudinal data were obtained from routine medical check-ups and 8,373 children were selected from nine counties in Chile through a non-randomised sample design. Weight-for-height z-scores (WHZ) were generated and categorized as wasted, normal, overweight, and obese using WHO standards. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements as well as based on having normal, overweight, or obese WHZ at 3yo. The number of times having overweight or obesity was counted (from 0 to 7 times). The timing of having overweight and obesity was computed as well as all combinations of the patterns.

RESULTS

Mean WHZ significantly increased up to 18months of age and declined thereafter (p<<0.001). Overall mean WHZ was 0.743, prevalence of overweight 31.2% and prevalence of obesity 10.0%. Children categorised with overweight or obesity at 3yo showed significantly higher and sustained pattern of weight gain compared with children with normal WHZ. Once a child had overweight or obesity they tended to remain with it and did not return to a weight-for-height in the normal range.

CONCLUSION

The increasing prevalence of overweight and obesity in Chilean children is of concern. There is a need for greater healthcare promotion and prevention of this disease from infancy.

The fight against overweight and obesity in school children: Public policy in Mexico

Excess weight in schoolchildren is a serious health problem in Mexico. In 2010, the government established General Guidelines for Dispensing or Distribution of Foods and Beverages at School Food Establishments (SFEs) in Elementary Schools with the objective of stopping the epidemic of overweight and obesity. This study aimed to evaluate compliance with the Guidelines during two academic years. With a sample of 39 schools already randomly selected, we carried out a follow-up study. The research team recorded foods and beverages available at schools in two academic years, and compared their nutritional characteristics to those established in the Guidelines. At the schools in both stages of the study, we found broad availability of energy-dense foods not allowed in the SFEs. Vegetables, fruits, and plain water accounted for less than 7 per cent of the foods and drinks. We observed no changes between stages in the compliance the Guidelines.

The association of excessive growth with development of general and central obesity at 7 years of age in every period after birth in Chilean children

OBJECTIVE

To determine whether overweight or obesity between 0 and 6 y increases the probability of developing general/central obesity at 7 y.

METHODS

Weight, height, and waist circumference were assessed between 0 and 6 y in 628 Chilean children. Body mass index, incidence of overweight (IOW), incidence of obesity (IOB), and prevalence at birth and 0 to 6, 6 to 24, 24 to 48, and 48 to 72 mo and odds ratio (OR) and 95% confidence interval (95% CI) for developing obesity/central obesity at 84 mo were calculated by sex.

RESULTS

IOW was highest at 6 to 24 mo (20.3% and 21.1% for girls and boys, respectively); IOB was highest at 6 to 24 and 24 to 48 mo (11% and 10%, respectively). OR for developing obesity at 7 y was significant if overweight was present 24 to 48 mo in girls and 6 to 24 mo in boys OR 2.47 [95% CI, 1.5-4] and OR 2.26 [95% CI, 1.30-3.92], respectively, and much higher for children who were obese, OR 6.1 (95% CI, 3.03-12.21) for girls 6 to 24 mo and OR 6.57 (95% CI, 2.55-16.86) for boys 0 to 6 mo. IOW or IOB was not associated with obesity at 84 mo, except for the previous period. Overweight also increased the risk of central obesity very early on, after 6 mo in girls and after birth in boys OR 3.8 [95% CI, 2.3-6.2] and OR 2.5 [95% CI, 2.04-3] at 6 to 24 and 0 to 6 mo, respectively, whereas obesity in all periods was associated with a significantly higher OR of presenting central obesity at 7 y.

CONCLUSION

There is tracking not only of obesity but also of overweight after birth for developing general or central obesity at 7 y. Prevention should begin very early on.