The case for investing in child and adolescent obesity prevention
Setting priorities and allocating funds to nutrition and health interventions can be challenging for any country, but especially for low- and middle-income countries where resources are stretched.
In recent years, investment cases have become a key tool for countries, funders, and advocacy groups to provide supportive evidence for setting these priorities. One priority area is guiding countries about how best to respond to the rise in overweight , obesity and noncommunicable diseases.
Building an investment case for overweight and obesity prevention among children and adolescents
Overweight and obesity are among the world’s leading and growing health challenges— globally, there are over five million deaths from overweight and obesity-attributable diseases (cancers, cardiovascular disease, diabetes, Alzheimer’s disease, and asthma) each year, accounting for nearly nine percent of annual lives lost. In addition, 80% of children and adolescents affected by overweight and obesity are in low- and middle-income countries. For example, in Mexico in 2021, 43% of children and adolescents are affected by overweight and obesity, and the prevalence has more than doubled since 1990. In the absence of further action, it is estimated than almost 80% of children and adolescents in Mexico will be affected by overweight and obesity by 2060.
Although there is increasing recognition of the issue’s significance, it is not yet the case that all countries—particularly LMICs—are fully aware of the current and future economic and health impacts of child and adolescent overweight and obesity. In addition, the rise in overweight and obesity is often taking place against a backdrop of a double burden of malnutrition.
Recent work by RTI’s Center for Global Noncommunicable Diseases quantified the current and future health and economic costs of obesity in a range of countries, with the aim of highlighting the urgent need for action. An important gap remains, however, in terms of the extent that children and adolescents are affected, now and in the future, and to guide countries about the best interventions to undertake to prevent and reduce overweight and obesity among young people. Early prevention has been indicated to be important for addressing the health and economic burden of these conditions.
With funding from UNICEF, we are developing and piloting a novel investment case methodology focused on child and adolescent overweight and obesity. Each investment case includes an economic analysis of the return on investment in both health and economic terms of implementing priority obesity interventions, and the intervention selection is guided by evidence of cost-effectiveness as well as suitability to the specific national context.
This new child and adolescent overweight and obesity prevention investment case model (to be published in 2022) has been piloted in Mexico in collaboration with national stakeholders and UNICEF. It identifies a cost-effective package of obesity interventions that build upon Mexico’s existing policies and programs, and identifies how the government may invest to increase impact and halt the current growth in overweight and obesity among its young population. The methodology is now being applied in Peru and China.
Formative research to explore weight stigma among young people in LMICs
In addition to having a significantly greater risk of a range of NCDs, children and adolescents who are affected by overweight and obesity may also experience weight-related stigma.
Research in high income countries has found that many young people suffer weight related bullying, exclusion, and marginalization, and internalize negative beliefs about themselves. These young people are more likely to experience psychological distress, depression, and anxiety. There are also adverse consequences for their inability to undertake and maintain health related behaviors such as healthy eating, weight management, and physical activity. Thus, perversely, the experience of weight stigma itself undermines young people’s ability to look after their wellbeing.
Yet while overweight and obesity are increasing most rapidly in LMIC populations, research into the issue of weight stigma in these countries is sparse, especially in relation to children and adolescents.
Researching the relationship of weight stigma and childhood obesity
To address this lack of research, we conducted a real-time, cross-national study in three countries: South Africa, Indonesia, and Brazil using applied mixed methods – qualitative interviews as well as a quantitative telephone survey.
Findings will provide important new insight into the extent and experience of stigma among adolescents in LMIC. It will also identify the implications for policy and practice in relation to adolescent health – mental and physical, as well as the prevention and reduction of overweight and obesity.
Both the obesity investment case and the stigma-related research are intended to help stakeholders understand the importance of addressing overweight and obesity in children and adolescents, provide insight into the impacts upon these populations, and identify effective solutions.
Learn more about our work to address the global burden of noncommunicable diseases
Acknowledgment: We appreciate the support of Jo Jewell, Nutrition Specialist at UNICEF, for his contribution to the preparation of this impact story.