Preventing Childhood Obesity - Evidence Policy and Practice.pdf

CHAPTER 33
Developing c ountry p erspectives on o besity
p revention p olicies and p ractices
Juliana Kain, 1 Camila Corval á n 2 and Ricardo Uauy 1,3
1 Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
2 School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
3 Nutrition and Public Health Intervention Research Unit, London School of Hygiene and
Tropical Medicine, London, UK
Summary and recommendations
for research and practice
• Developing countries are faced with the double
burden of malnutrition. However, as income rises,
the problem of obesity becomes progressively more
important.
• In most developing countries there is no net food
energy shortage, but limited access to healthier
foods, which are more expensive, and this defines
consumption patterns.
• Poverty is often associated with obesity; increased
consumption of low - cost energy - dense foods and
decreased physical activity are the main causes.
• In transitional societies, foods provided by government
feeding programs to stunted children may
contribute to rising obesity rates.
• Micronutrient-rich foods with no excess of energy
should be provided to stunted children early on, to
promote linear growth, lean body mass gain and
prevent later obesity.
Introduction
The d ouble b urden of m alnutrition
Undernutrition is no longer the dominant form of
human malnutrition from the standpoint of popula-
Preventing Childhood Obesity. Edited by
E. Waters, B.A. Swinburn, J.C. Seidell and R. Uauy.
© 2010 Blackwell Publishing.
tion public health relevance. The coexistence of the
dual expressions of under - and overnutrition are now
apparent globally: in 2001, the estimated number of
people worldwide suffering from overweight equaled
those with undernutrition. Close to a billion people
were estimated to be overweight or obese and an equal
number who were underweight, with the former being
predominantly adults in developed countries and
the latter being predominantly children in developing
countries. 1 – 6 Figure 33.1 shows how overweight
and obesity coexist with underweight; the global
geographic distribution maps show the proportion
of healthy life years lost from conditions related to
excess and insufficient energy intake relative to
expenditure.
There is clearly a need for a common agenda to
address the double burden as in some regions, such as
Northern Africa and the Middle East, most of South,
Southeast and East Asia, there is an appreciable loss
of disability-adjusted life years (DALYs) from both
conditions. In Europe and most of the Americas the
problem is largely related to obesity. The double
burden existing within the same nation is the next
level of aggregation in a descending hierarchy. De
Onis 4,7,8 has provided a perspective on how under - and
overnutrition operate within the same countries, specifically
with reference to children. The percentages of
children in different Latin American nations who are
underweight and overweight relative to the international
reference median are shown in Figure 33.2 .
However, this graph needs to be interpreted in the
light of the cut - off standards used. At each end of a
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