Summary
Background
The international (International Obesity Task Force; IOTF) body mass index (BMI) cut‐offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based ...on data from six countries fitted by the LMS method, they link BMI values at 18 years (16, 17, 18.5, 25 and 30 kg m−2) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. the World Health Organization (WHO) standard, these cut‐offs cannot be expressed as centiles (e.g. 85th).
Methods
To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut‐offs defined in terms of the centiles at 18 years corresponding to each BMI value. These new cut‐offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data.
Results
The new cut‐offs were virtually identical to the originals, giving prevalence rates differing by <0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5.
Conclusions
Defining the international cut‐offs in terms of the underlying LMS curves has several benefits. New cut‐offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity = 98.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Background
Member states of the World Health Organization have adopted resolutions aiming to achieve ‘no increase on obesity levels’ by 2025 (based on 2010 levels) for infants, adolescents ...and adults.
Objectives
We aimed to assess the scale of the problem facing health planners and service providers.
Methods and Results
Using data prepared by the Global Burden of Disease collaborative for 2000 and 2013, we have estimated that by 2025 some 268 million children aged 5‐17 years may be overweight, including 91 million obese, assuming no policy interventions have proven effective at changing current trends. We have also estimated the likely numbers of children in 2025 with obesity‐related comorbidities: impaired glucose tolerance (12 million), type 2 diabetes (4 million), hypertension (27 million) and hepatic steatosis (38 million). A supplemental table provides estimates for each of 184 nations.
Conclusion
The 2025 targets are unlikely to be met, and health service providers will need to plan for a significant increase in obesity‐linked comorbidities.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
In response to increasing evidence that advertising of foods and beverages affects children's food choices and food intake, several national governments and many of the world's larger food ...and beverage manufacturers have acted to restrict the marketing of their products to children or to advertise only ‘better for you’ products or ‘healthier dietary choices’ to children. Independent assessment of the impact of these pledges has been difficult due to the different criteria being used in regulatory and self‐regulatory regimes. In this paper, we undertook a systematic review to examine the data available on levels of exposure of children to the advertising of less healthy foods since the introduction of the statutory and voluntary codes. The results indicate a sharp division in the evidence, with scientific, peer‐reviewed papers showing that high levels of such advertising of less healthy foods continue to be found in several different countries worldwide. In contrast, the evidence provided in industry‐sponsored reports indicates a remarkably high adherence to voluntary codes. We conclude that adherence to voluntary codes may not sufficiently reduce the advertising of foods which undermine healthy diets, or reduce children's exposure to this advertising.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
► Children’s exposure to marketing is a ‘hot topic’ in policy circles. ► Researchers rarely meet policy-makers to discuss the evidence needs for policy-making. ► This paper reports a series of ...international meetings between researchers and government officials in 2010–2011. ► It identifies specific evidence gaps and opportunities, which can be of value to research institutions and funding bodies.
A series of meetings on the topic of children’s exposure to the marketing of food and beverages was held between researchers and government officials based in Europe and the Americas during 2010–2011. The meetings resulted in a number of outputs, including observations from policy-makers on the types of evidence they needed to strengthen policy-making. Their observations on the definitions of a child, the specification of foods using nutrient profiling schemes, the types of media carrying marketing messages, and the related policy implementation problems, are summarised in this Short Communication. The paper highlights the need for research which can directly support policy-making and which can evaluate its effectiveness.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
To consider the use of systematic methods for categorising foods according to their nutritional quality ('nutrient profiling') as a strategy for promoting public health through better dietary ...choices.
We describe and discuss several well-developed approaches for categorising foods using nutrient profiling, primarily in the area of food labelling and also with respect to advertising controls. The best approach should be able to summarise and synthesise key nutritional dimensions (such as sugar, fat and salt content, energy density and portion size) in a manner that is easily applied across a variety of products, is understandable to users and can be strictly defined for regulatory purposes.
Schemes that provide relative comparisons within food categories may have limited use, especially for foods that are not easily categorised. Most nutrient-profiling schemes do not clearly identify less-healthy foods, but are used to attract consumers towards products with supposedly better profiles. The scheme used in the UK to underpin the colour-coded 'traffic light' signalling on food labels, and the one used by the UK broadcasting regulator Ofcom to limit advertising to children, together represent the most developed use of nutrient profiling in government policy-making, and may have wider utility.
Nutrient profiling as a method for categorising foods according to nutritional quality is both feasible and practical and can support a number of public health-related initiatives. The development of nutrient profiling is a desirable step in support of strategies to tackle obesity and other non-communicable diseases. A uniform approach to nutrient profiling will help consumers, manufacturers and retailers in Europe.
This Commentary considers the different definitions of child overweight and obesity, and reflects on the findings of the paper by Valerio et al. in this issue of the journal.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Summary
A recent review of the literature concluded that advertising of foods on television may influence children's food choices and encourage unhealthy diets, but the review acknowledged there was ...a lack of clear evidence in coming to this conclusion. The present paper examines ecological evidence for a link between advertising to children and the risk of overweight using data from surveys of advertising on children's television and estimates of the prevalence of overweight among children, in the USA, Australia and eight European countries. A significant association was found between the proportion of children overweight and the numbers of advertisements per hour on children's television, especially those advertisements that encourage the consumption of energy‐dense, micronutrient‐poor foods (r = 0.81, P < 0.005). A weaker, negative association was found between the proportion of children overweight and the number of advertisements encouraging healthier diets (r = −0.56, P < 0.10). The quantity of advertising on children's television appears to be related to the prevalence of excess body weight among children. Furthermore, the content of the advertising appears to have a specific effect. The findings justify the need for taking precautionary measures to reduce children's exposure to obesogenic marketing practices.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Estimates of the prevalence of childhood overweight and obesity have been made in several European countries during the last decade. The methods used and the assessment criteria differ from ...survey to survey. The present paper reports the prevalence data from 21 surveys in Europe using a single, internationally accepted definition of overweight in childhood, allowing direct comparisons to be made. A tendency for a higher prevalence of overweight among children in western and especially southern Europe is shown and some possible reasons for this are discussed.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Government action is essential to increase the healthiness of food environments and reduce obesity, diet‐related non‐communicable diseases (NCDs), and their related inequalities. This paper ...proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food‐EPI) was developed, which comprises a ‘policy’ component with seven domains on specific aspects of food environments, and an ‘infrastructure support’ component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week‐long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food‐EPI will be pre‐tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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