For first time, more children obese than underweight, UNICEF finds

For the first time, more school-age children and adolescents worldwide are obese than underweight, according to U.N. findings - a trend driven in large part by a rapid increase in obesity among young people in low- and middle-income countries over the past quarter-century, even in places where undernutrition persists.

In wealthy countries such as the United States, where childhood obesity has long been comparatively prevalent, increases were less sharp, according to the Child Nutrition Report published by UNICEF, the U.N. Children’s Fund.

Nearly 1 in 10 school-age children worldwide are obese, the report found.

The proportion of overweight children defined as obese is rising, the report found. In 2022, 42 percent of young people ages 5 to 19 who were overweight were considered obese - up from 30 percent in 2000.

Based on data from more than 190 countries and UNICEF, the World Health Organization and the World Bank Joint Child Malnutrition Estimates, the report found that the prevalence of undernutrition among children ages 5 to 19 has declined since 2000, from nearly 13 percent to 9.2 percent, while obesity rates rose from 3 percent to 9.4 percent during that same time period, in concert with a rise in global sales of ultra-processed foods and beverages.

Low- and middle-income countries including South Africa, Peru and China have seen their share of overweight and obese children more than double since 2000, the report said.

UNICEF defines overweight and obesity across different ages in terms of standard deviations from WHO medians for child growth under optimal conditions. While undernutrition is often a more acute concern, in terms of health risk and developmental impacts, child obesity comes with increased risk of Type 2 diabetes, eventual heart disease and other long-term health problems, research shows. Whether obesity should be understood as a risk factor or a spectrum of illness, and how it should be defined, remains a matter of controversy.

Overweight and obesity numbers among children began leveling off in the U.S. in the 1980s and 1990s once the ultra-processed food and beverage industry saturated the market, supplanting fresh and less-processed foods in people’s diets, said Harriet Torlesse, a nutrition specialist with UNICEF and the lead writer of the report. Overweight and obesity rates began rising in low- and middle-income countries in the early 2000s after the industry moved into those areas, she said.

“The leading driver [of] this change is how unhealthy food environments have become,” Torlesse said. “These are the spaces where children live, where they play, where they learn, and they are becoming swamped with unhealthy foods and beverages, the marketing of those beverages, which makes it extremely difficult for nutritious foods to compete.”

Across 171 countries, 75 percent of children and adolescents had been exposed to advertisements for sugary drinks, snacks or fast food during the previous week, Torlesse said.

Latin America and the Caribbean, the Middle East and North Africa, and North America round out the top three regions with the highest prevalence of overweight children and adolescents, according to the report. Worldwide, East Asia and the Pacific, Latin America and the Caribbean, and South Asia account for more than half of all children and adolescents who are overweight. Meanwhile, the rise in the number of overweight children and adolescents appears to be leveling off in North America and Western Europe, the report found.

Childhood obesity is more difficult to reverse and has a greater risk of serious health conditions than being overweight.

“When we talk about malnutrition, we are no longer just talking about underweight children,” UNICEF Executive Director Catherine Russell said in a statement accompanying the report. “Obesity is a growing concern that can impact the health and development of children. Ultra-processed food is increasingly replacing fruits, vegetables and protein at a time when nutrition plays a critical role in children’s growth, cognitive development and mental health.”

Many schools worldwide serve processed and deep-fried food and sugar-sweetened beverages, and retailers disproportionately expose children in poorer neighborhoods to unhealthy foods and beverages, such as at entrances and within children’s reach or at eye level, all while online grocery stores and food delivery apps continue to expand their reach, making it easier for children to access ultra-processed and fast food, the report said. These trends have become global in recent decades.

Demand for GLP-1 weight-loss medications, including for children, has skyrocketed in recent years in the United States. The U.S. Food and Drug Administration has approved some GLP-1 weight-loss drugs for use in children. The American Academy of Pediatrics has recommended use of the drugs for children ages 12 and up with obesity and, in some cases, for children as young as 8.

But Torlesse said such GLP-1 medications don’t fix the root causes of obesity, and come with concerns about cost and unequal access to treatment.

The report offers eight recommendations intended to limit children’s exposure to ultra-processed food and beverages, including adopting policies such as taxes on unhealthy foods and beverages and raising awareness of the harm of having an ultra-processed diet.

“We haven’t got things the right way around. Prevention is always, always a priority, and must be the focus of attention,” Torlesse said.

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Graphic: https://washingtonpost.com/documents/c6196bfe-d951-46bc-9b89-891d815dcbe7.pdf