Preventing Childhood Obesity - Evidence Policy and Practice.pdf

CHAPTER 2
Lessons from the c ontrol of o ther e pidemics
Mickey Chopra
School of Public Health and Systems Research Unit, Medical Research Council, University
of Western Cape, Parow, South Africa
Summary
The causes of childhood obesity, both at an individual
and at the population level, are now mostly well
understood. Fundamentally overweight and obesity
result from an imbalance between calorie intake and
expenditure. However, changing diets and lifestyles,
as other authors in this book have pointed out, is a
complex undertaking that requires a multi - pronged
approach. Other chapters in this book and review articles
outline the evidence for an effective and comprehensive
approach towards the prevention and
management of childhood obesity. Some of the components
being promoted include: a recognition of the
need for more than individual level educational and
behavioral interventions; taking a settings approach in
schools, public institutions, workplace, and so on; the
responsibility of governments in “ making healthy
choices the easy choice ” .
Introduction
For these strategies to have an impact, there is a need
for a broader evidence base of their efficacy in different
settings (especially in low - resource settings) and
for them to be implemented at scale so that they reach
those who require it the most. However, experience of
converting evidence into policy and practice is not
well documented for childhood obesity. There is good
reason to believe that conversion of evidence to policy
will be particularly difficult for combating changes in
childhood diet and physical activity. Critical drivers of
Preventing Childhood Obesity. Edited by
E. Waters, B.A. Swinburn, J.C. Seidell and R. Uauy.
© 2010 Blackwell Publishing.
the childhood obesity epidemic, such as the marketing
of high - fat foods, poor provision of facilities for physical
activities and the increasing popularity of sedentary
activities are intimately bound with modern
development and globalization. 1 In this sense it shares
many of the challenges of other non - communicable
diseases that are also increasing rapidly in both developed
and developing countries.
This chapter aims to learn from the experience
of attempting to scale up the response to non -
communicable diseases especially in resource poor
settings. What are the strategic lessons to be learnt
from the experience of responding to other non -
communicable diseases?
Despite a continual struggle to move from non -
communicable diseases being regarded as the problems
of the rich, and having to confront the interests
of some powerful private industries, there have been
significant policy developments even in low - and middle
- income countries. China and India have started to
pull together the various initiatives around smoking,
cardiovascular disease, diabetes and so on, into coherent
national plans that go beyond individual level education
or warnings on cigarette packets. Pakistan
launched a National Action Plan on Non - communicable
Diseases in 2003, which is now being scaled up as a
major public health programme; and Vietnam, using
the WHO recommended approach, has invested in the
stepwise approach to the surveillance, prevention, and
control of non - communicable diseases. The lifelong
treatment of HIV/Aids is now being scaled up across
a number of resources - poor settings and is giving rise
to a number of innovations with respect to the way
long - term care is to be delivered.
A comprehensive approach to childhood obesity
shares many of the challenges that have been faced by
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