Obesity among children and adolescents, previously considered a health problem concentrated in high-income countries, has come to concern low- and middle-income nations as well, advancing even among rural populations. With childhood obesity rates accelerating in recent decades, the World Health Organization (WHO) issued on Wednesday (7) the first global guidelines on the topic.
The organization warns about the progression of the problem: while only 2% of children and adolescents aged 5 to 19 years lived with obesity in 1990 (the equivalent of 31 million youths), in 2024, 400 million people in this age group were overweight, including 170 million who lived with obesity (8% of the total).
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And this excess weight is increasing in low- and middle-income countries. According to the WHO, in Africa the number of overweight children under 5 years old increased by almost 12% since 2000. Nearly half of these under-5 children who were overweight in 2024 lived in Asia.
Obesity is a chronic disease resulting from complex interactions between environmental and psychosocial influences and biological susceptibility, the organization says. It is characterized by dysregulation of the neurobiological and metabolic pathways involved in appetite, energy balance and adipose tissue function, with genetic variation influencing individual susceptibility.
“The global health challenge of obesity is driven by increasingly obesogenic environments that limit access to healthy, affordable, and sustainably produced foods; restrict opportunities for safe physical activity; and are shaped by market forces and inadequate legal and regulatory frameworks,” warns the agency.
It is also noted that these factors are aggravated by the health system’s insufficient capacity to prevent, identify and manage obesity early. “Facing the challenge requires coordinated action across food systems, built environment, regulatory and fiscal policies, and health systems to strengthen prevention, early diagnosis and multimodal chronic care, including treatment, care and ongoing support.”
According to Luz María De Regil, director of the WHO Department of Nutrition and Food Safety, the foundation of obesity care for children and adolescents is not medication or surgery, but access to comprehensive support that enables healthy eating, physical activity and sustainable behavior change.
“Our priority should be to ensure that every child and adolescent can access quality care and supportive environments from an early age, helping them achieve and maintain a healthy weight and laying the foundations for health and well-being throughout life.”
Read more: Obesogenic environments: how our cities, schools and offices can make us gain weight
Consequences: Health and Economy
The health risks caused by overweight and obesity are being increasingly well documented and understood.
In 2023, a body mass index above the ideal level caused about 3.7 million deaths by increasing deaths from diseases such as cardiovascular diseases, diabetes and cancers (3).
Excess weight and obesity in childhood and adolescence negatively affect physical, mental and social well-being and should be identified and treated as early as possible. They are associated with stigma, discrimination, bullying, poorer quality of life and impaired academic performance. Without timely intervention, obesity often persists into adulthood, increasing the risk and accelerating the onset of noncommunicable diseases (NCDs), including type 2 diabetes and cardiovascular diseases. Early prevention and effective treatment can reduce these health risks in the long term and improve lifelong outcomes.
The economic impact of obesity is also important. If nothing is done, global costs of overweight and obesity are expected to reach US$3 trillion per year by 2030 and more than US$18 trillion by 2060.
Because of these and other factors, the WHO released guidelines on combating obesity among children and adolescents, setting out how health systems and health professionals can provide timely, evidence-based and people-centered care. See some of these recommendations:
Prevention and Management: Guidelines
– Overweight and obesity, as well as their related noncommunicable diseases, are largely preventable and manageable.
– At the individual level, the risk of overweight and obesity can be reduced through preventive actions taken throughout life, from before conception to old age. These include:
1 – achieving a healthy weight before pregnancy and ensuring appropriate weight gain during gestation;
2 – practicing exclusive breastfeeding in the first 6 months of life and continuing to breastfeed up to 2 years or more;
3 – supporting healthy eating, physical activity, good sleep and limiting sedentary behaviors and screen time during childhood and adolescence;
4 – limiting the intake of sugar-sweetened beverages and energy-dense and nutrient-poor foods;
5 – consuming a healthy diet rich in fruits, vegetables, legumes, whole grains and nuts, while limiting foods high in fats, sugars and salt;
6 – engaging in regular physical activity throughout life;
7 – getting adequate sleep and supporting emotional well-being; and
8 – avoiding tobacco use and harmful use of alcohol.
– Health professionals need:
- regularly assess weight status and identify overweight and obesity early;
- provide evidence-based counseling on healthy eating, physical activity, sleep and other healthy behaviors for all;
3 – assess obesity-related complications, comorbidities, hypertension, diabetes, disability, mental health and other noncommunicable disease risk factors;
4 – refer or connect people with obesity to comprehensive multimodal chronic care centered on the person, including behavioral interventions, nutritional counseling, psychological support, pharmacological treatment and metabolic and bariatric surgery, as appropriate;
5 -develop individualized, long-term care plans with regular follow-up to improve cardiometabolic health, support sustained weight control, reduce obesity-related complications and improve quality of life; and
6 – Monitor treatment response, service coverage, quality of care and long-term health outcomes of the treatment.
– The main policy actions include:
– structural, fiscal and regulatory measures to create healthy food environments that make healthier food choices available, affordable and desirable;
– actions in food systems, education, urban planning, transport and social protection to address the broader determinants of health and promote healthy eating and physical activity across the life course; and
– Health system responses that strengthen primary care to identify risks, prevent, diagnose, treat and manage obesity and NCDs through integrated multimodal chronic care programs centered on the person.
– The food industry can play a significant role in promoting healthy diets through:
– reducing the fat, sugar and salt content of processed foods;
– ensuring that healthy and nutritious choices are available and accessible to all consumers;
– restricting the marketing of foods high in sugars, salt and fats, especially those aimed at children and adolescents; and
– ensuring the availability of healthy dietary options and supporting regular physical activity in the workplace.
