The major goals of addressing the environmental components include improving healthy eating and physical activity behaviours of children. A number of factors influence the obesogenic environment, including political and commercial factors (trade agreements, fiscal and agricultural policies and food systems); the built environment (availability of healthy foods, infrastructure and opportunities for physical activity in the neighbourhood); social norms (body weight and image norms, cultural norms regarding the feeding of children and the status associated with higher body mass in some population groups, social restrictions on physical activity) and family environment (parental nutrition knowledge and behaviours, family economics, family eating behaviours).
Developmental factors change both the biology and behaviour of individuals from before birth and through infancy, such that they develop with a greater or lesser risk of developing obesity. The Commission considers it essential to address both the environmental context and three critical time periods in the life-course: preconception and pregnancy, infancy and early childhood and older childhood and adolescence.
It is the primary responsibility of governments to ensure that policies and actions address the obesogenic environment and to provide guidance and support for optimal development at each stage of the life-course. By focusing attention on these sensitive periods of the life-course, interventions can address specific risk factors, both individually and in combination. Such an approach can be integrated into other components of the maternal- neonatal-child health agenda, and to the broader effort to tackle noncommunicable diseases across the whole population.
When children are already overweight or obese, additional goals include reduction in the level of overweight, improvement in obesity-related comorbidities and improvement in risk factors for excess weight gain. The health sector in each country varies considerably and will face different challenges in responding to the need for treatment services for those with obesity. However, the management of children with overweight and obesity should be included in effective services extended under Universal Health Coverage.
The Commission recognizes that the scope of potential policy recommendations to address childhood obesity is broad and contains a number of novel elements, including a focus on the life-course dimension and on the education sector. A multisectoral approach will be essential for sustained progress.
Countries should measure BMI-for- age to establish the prevalence and trends in childhood obesity at national, regional and local levels. They should also gather data on nutrition, eating behaviours and physical activity of children and adolescents across different socioeconomic groups and settings. Although some data are collected, there remains a significant gap for children over 5 years of age that needs addressing. This data will guide the development of appropriate policy priorities and provide a baseline against which to measure the success of policies and programmes.