- Regional report on the battle of SA’s youthful bulge finds obesogenic food environments, population diets & the prevalence of all forms of malnutrition, & associated overweight & obesity
Food environments for children and adolescents in South Asia are becoming increasingly obesogenic, characterised by the ubiquitous availability, convenience, and marketing of unhealthy foods and beverages. Population diets are increasingly characterised by the consumption of highly processed foods and beverages, which are high in salt, sugar, and fat, and low in fibre and essential micronutrients.
In this context, a recent report, titled ‘Overweight and Obesity among Children and Adolescents in Bhutan, India, the Maldives, Nepal and Sri Lanka’ pointed out that children and adolescents in South Asia are affected by all forms of malnutrition while the prevalence of being overweight and obesity is increasing, particularly among children and adolescents aged 5–19 years.
“The rise in screen-based activities is displacing physical activities. Being overweight in childhood commonly tracks into adulthood, increasing the risk of diabetes, hypertension and heart diseases. Obesity also has significant indirect economic costs through reduced labour market productivity, lost life years, reduced quality of life and increased health costs,” the report issued by the United Nations International Children's Emergency Fund (UNICEF) said, adding that children who are overweight or obese may experience weight related stigma, social isolation, depression and low self-esteem.
The study
The report was based on four research questions concerning five countries in South Asia, i.e. Bhutan, India, the Maldives, Nepal and Sri Lanka.
In the context of being overweight and obesity in children and adolescents, the study had paid attention to the prevalence and trends, behavioural, social and environmental risk factors, barriers to and enablers of policy and programme implementation, and the views of adolescents related to their interactions with food environments in schools.
“A major knowledge gap in the region is the lack of a detailed landscape assessment of the rising trends and drivers of being overweight and obesity among children and adolescents, the status of policy and programme action, and potential entry points for corrective actions,” the report, which had surveyed 7,583 adolescents across the five countries, among other parties and sources of information, said.
SL’s situation
With regard to the prevalence of and trends in childhood overweight and obesity, the report, quoting the 2022 National Nutrition and Micronutrient Survey, said that the prevalence of being overweight among children under 5 years of age in Sri Lanka was 1.7%. According to the same survey, the report pointed out, the prevalence of being overweight and obesity among children aged 5–9 years was 6.7%, while the prevalence of being overweight and obesity among adolescents aged 10–19 years was 12.2%. It added that the 2022 World Health Organisation (WHO) Global Health Observatory data suggests that the prevalence of childhood overweight and obesity is increasing rapidly.
Prenatal and perinatal risk factors are another concern observed in the Sri Lankan context, regarding which the report said: “The prevalence of maternal overweight and obesity was 45.3% in 2016 and was higher among older women and women living in urban areas compared to rural areas. The prevalence of maternal overweight and obesity is increasing at 3.8% per annum. Research has shown a positive correlation between maternal and the children’s body mass index in Sri Lanka. Sri Lankan mothers with obesity are more likely to have children who are overweight or obese. The prevalence of a low birth weight (15.7%) was also identified as a risk factor of concern, particularly in rural areas and estates compared to urban areas.”
As per the UNICEF report, when it comes to early childhood risk factors, the rapid growth in the sale of breast milk substitutes and commercial complementary foods (9.8% per annum) in recent years is of concern and threatens to undermine the high rates of breastfeeding in Sri Lanka.
In Sri Lanka, there are dietary risk factors among children and adolescents. Unhealthy diets, characterised by a high consumption of fast food, confectionery and sugar sweetened beverages were identified as a key risk factor for being overweight and obesity among children and adolescents in Sri Lanka. Approximately one in three adolescents did not consume fruit daily and almost one in 10 did not consume vegetables daily. Moreover, about two in five adolescents consumed fast food weekly.
Regarding policies and programmes addressing childhood overweight and obesity, the UNICEF report explained that Sri Lanka has taken a number of steps including the implementation of two key nutrition related policies in 2023 (last year), namely, the National Nutrition Policy 2021–2030 and the National Policy and Strategic Framework for the Prevention and Control of Chronic Non-Communicable Diseases (2023–2033). A number of specific policies and programmes (including policy gaps) for addressing childhood overweight and obesity have also been introduced. Among them are soft drinks containing added sugar and foods high in fat, salt or sugar being required to carry a traffic-light warning label, the 2018 Physical Activity Guidelines for Sri Lankans providing standards for physical activity and screen time among children and adolescents (not specific to schools), and the School Health Promotion Programme including health education on multiple facets of health.
“Current policies aimed at addressing nutrition among infants and young children were viewed as strong. A lack of human and financial resources to support essential policy processes was viewed as a key barrier to policy development and to the monitoring and enforcement systems of policies being implemented.,” the report said, adding that it has been perceived in the Sri Lankan context that the food and beverage industries contributed to unhealthy food environments and posed a barrier to policy development and implementation through corporate lobbying.
Regarding survey related responses, the report said: “A total 266 respondents in Sri Lanka were included in the analysis sample. One in three respondents reported choosing freshly cooked meals and fruits and vegetables when hungry at school, with a similar proportion of respondents reporting choosing foods such as fast foods, packaged snacks and chocolates, candies or sugary drinks. Key reasons why respondents chose these food types were that these were the only foodstuffs available (one in three), convenient (one in five) or affordable (about one in five). One in two respondents also reported that food choices such as fast foods, packaged snacks and chocolates, candies or sugary drinks were available in food service facilities in their school and about two in five respondents reported that freshly cooked meals and fruits and vegetables were available from food service facilities in their schools. Of the five countries, Sri Lanka had the highest proportion of respondents (one in four) reporting that they did not eat when they were hungry at school and the most common reason for not eating at school was not having sufficient money (about two in five). Two in five respondents reported the presence of food brands and logos on their school premises and one in three said that such brands and logos influenced their food choices, but about four in five respondents said that unhealthy food brands and logos should not be allowed to be advertised on their school premises.”
In addition, obesogenic environments (with a focus on certain types of food such as sugar sweetened beverages, sweet and salty snacks and confectioneries being highly accessible and marketed to children and adolescents), and physical activity levels among Sri Lankan children and adolescents being relatively low, were also pointed out.
Conclusion
The report concluded that children and adolescents in South Asia are affected by all forms of malnutrition and the prevalence of overweight and obesity is increasing, particularly among children and adolescents aged 5-19 years.
“Policy and programming in South Asia have often focused on under-nutrition among children, with inadequate attention to the prevention of being overweight and obesity. Strengthening existing policies and programmes for being overweight and obesity prevention through best practice policies and programme designs and improved monitoring and enforcement systems is critical for the five countries in South Asia. Despite the ongoing efforts to stem increases in being overweight and obesity among children and adolescents, many policy and programme gaps remain. The adoption and implementation of a comprehensive suite of actions will be required to adequately address the rising trends of obesity in South Asia. This will require the substantial management of conflicting interests in the policy development process.”
Recommendations
Based on the abovementioned findings, the report presented several recommendations in order to strengthen policy actions to prevent childhood overweight and obesity.
The recommendations read: “Strengthen the monitoring and enforcement of existing obesity prevention policies. For example, Bhutan, India, Nepal and Sri Lanka have all enacted legal measures to limit the availability of unhealthy foods and beverages in and/or around schools. However, it has been reported that adherence to these policies is low as monitoring and enforcement mechanisms are suboptimal.”
“Second, create an enabling environment to support nutrition policy adoption. This should include an overarching national nutrition or obesity strategy that includes targets for overweight and obesity for children of all age groups and resources dedicated to an implementation plan to achieve these targets. The development of a context specific food classification model should also be prioritised as this underpins many other food and nutrition policies, such as food labelling laws, food marketing controls and the provision of healthy and unhealthy foods in schools. In addition, countries should implement strategies to reduce the influence of the ultra-processed food and beverage industries on policy development and implementation, such as strong conflict of interest regulations.”
Thirdly, countries were recommended to take actions, including best practices, considering under-nutrition and being overweight and obesity. These actions include key recommended overweight and obesity prevention policies, including a tax on sugar sweetened beverages, restrictions on unhealthy food and beverage marketing, interpretive front of pack nutrition labels, and improving the healthiness of school food environments.