Obesity can have serious effects on children’s health, educational achievements, and overall quality of life. In 2014, a UNICEF-WHO-World Bank joint report estimated that 41 million children under 5 were overweight or obese. Globalization and urbanization mean that many children are growing up in obesogenic environments and that the prevalence of childhood obesity is increasing, particularly in low- and middle-income countries.
This week, the World Health Organization (WHO) Commission on Ending Childhood Obesity (ECHO) released its final report: Ending Childhood Obesity. The ECHO report stresses the importance of a comprehensive and integrated approach to addressing childhood obesity, which includes medical interventions, public education campaigns, and laws and regulations. Today, I’ll consider the role that laws and regulations can play in reversing the shift towards obesogenic environments and addressing the alarming levels of childhood obesity facing communities all over the world.
The Commission on Ending Childhood Obesity
The final report is the culmination of a 2 year process during which 15 commissioners reached a consensus on the interventions most likely to effectively tackle childhood overweight and obesity in different contexts across the globe. The commission was supported by two working groups focused on the science and evidence and implementation, monitoring, and accountability.
Laws and regulations, at both international and domestic levels, form an important part of the report’s comprehensive and integrated approach to childhood obesity. As the report notes, “[t]ackling childhood obesity resonates with the universal acceptance of the rights of the child to a healthy life as well as the obligations assumed by State Parties to the Convention of the Rights of the Child.” Strong national regulatory frameworks, including accountability mechanisms for the development and achievement of policy objectives, can help ensure an effective, whole-of-government approach to obesity prevention and management that is inclusive of vulnerable and marginalized populations. Finally, as explained below, many of the interventions outlined under the report’s six broad recommendations are legal in nature or would be most effective when implemented as legally binding requirements.
Recommendation 1: Implement comprehensive programmes that promote the intake of healthy foods and reduce the intake of unhealthy foods and sugar-sweetened beverages by children and adolescents
Recommendation 1 sets out a range of interventions that discourage the consumption of unhealthy foods, including taxing sugar-sweetened beverages and restricting marketing of foods and non-alcoholic beverages to children. Recommendation 1 also includes interventions that promote the consumption of healthy foods, such as increasing accessibility and affordability of fruit and vegetables and banning the sale or provision of unhealthy foods and beverages in schools and child-care centers. Taxes on unhealthy products and subsidies on healthy products require implementation through law. Many of the other interventions, particularly those that seek to prohibit or compel certain actions, should be implemented as binding law. Although some of the interventions, such as interpretive front-of-pack labeling schemes, could be implemented through non-binding policies and programs, this approach is more susceptible to industry non-compliance and is often criticized for diverting attention and resources from more effective, legally-binding regulations.
Recommendation 2: Implement comprehensive programs that promote physical activity and reduce sedentary behaviors in children and adolescents
Recommendation 2 focuses on guidance on healthy body size, physical activity, and amount of “screen time” and ensuring that adequate facilities are available to facilitate physical activity at school and within communities. Although these interventions can be implemented through non-binding policies and programs, laws and regulations should be considered to strengthen the obligations on schools, local governments, and developers. For example planning laws could be amended to require large-scale developers to provide recreation facilities as part of new developments and governments could offer tax incentives for families who enroll children in approved physical activity programs.
Recommendation 3: Integrate and strengthen guidance for noncommunicable disease prevention with current guidance for preconception and antenatal care, to reduce the risk of childhood obesity
The preconception and antenatal care interventions recommended in the ECHO report focus on medical guidance on nutrition and physical activity and the management of weight gain, hyperglycemia and hypertension during pregnancy. While laws and regulations are not directly relevant to the provision of preconception and antenatal care, it is vitally important that these interventions are provided for as part of public (and private) health insurance schemes, which are often implemented through laws and regulations.
Recommendation 4: Provide guidance on, and support for, healthy diet, sleep and physical activity in early childhood to ensure children grow appropriately and develop healthy habits
Effective laws and regulations are essential to supporting breastfeeding and promoting infant nutrition, which are significant factors in reducing the risk of obesity. Recommendation 4 of the ECHO report highlights a number of laws and regulations to promote and facilitate healthy diets in infancy and early childhood, including laws protecting breastfeeding in workplaces and enforcement of provisions of The International Code of Marketing of Breast-Milk Substitutes.
Recommendation 5: Implement comprehensive programs that promote healthy school environments, health and nutrition literacy and physical activity among school-age children and adolescents
Laws and regulations are also an excellent option for governments to ensure that school environments are healthy environments for children and adolescents. For example, laws and regulations could be adopted to implement many of the interventions recommended in the ECHO report, including:
- banning the sale or provision of unhealthy foods and beverages in schools;
- setting nutritional standards for meals sold or provided in schools (including provision of potable water);
- requiring physical education and nutritional education as part of school curricula; and
- restricting the sale of unhealthy foods and beverages in close proximity to schools.
Recommendation 6: Provide family-based, multicomponent, lifestyle weight management services for children and young people who are obese
Like the ECHO report’s recommendations on preconception and antenatal care, weight management for children and adolescents who are overweight and obese should be provided as part of public (and private) health insurance schemes.
Although law is not necessarily an intuitive or obvious response to addressing growing rates of childhood obesity, the ECHO report reaffirms its importance. The overriding objectives of the commission are underpinned by international law; strong national regulatory frameworks are vital to ensuring effective implementation of obesity interventions; and many of the commission’s recommendations are legal in nature or would be most effectively implemented as legally binding requirements. Going forward, lawyers and regulatory specialists should play a larger part in the multidisciplinary approach required to address the increasing burden of childhood obesity.