Arab Children Health Congress 2008


Fighting the burden of obesity in children

The third Arab Children Health Congress (ACHC) 2008 was held in Dubai in March with the theme “Healthy Body, Healthy Mind”.

The ACHC was initiated under the directives of His Highness Sheikh Mohammed Bin Rashid Al Maktoum, vice president, prime minister of UAE and ruler of Dubai, in line with his vision to improve the health of children in the Arab world. The congress has the direct support of Her Royal Highness Princess Haya Bint Al Hussein, the wife of His Highness Sheikh Mohammed Bin Rashid Al Maktoum.

The theme of the congress was selected to highlight the burden of obesity in children and related non-communicable diseases, such as cardiovascular disease, type II diabetes, hypertension and stroke.

The congress concluded with the issuing of a number of recommendations for governments and media in the region.

An ambassador – Athra Al Ketbi – was selected to represent Arab children in the region during 2008. Athra, a Grade 12 student at Um Al Emarat secondary school in Al Ain, was chosen for her dynamic presence, commitment and eloquence, which will enable her to confidently and enthusiastically deliver the ACHC message.

Obesity

The three-day event saw many expert speakers giving presentations topics ranging from obesity in children, to dietary intervention programmes for schools, to the role of the media.

Obesity in children was a key them throughout the congress. Speaking at the opening of the congress, Dr Kamel Ajlouni, president of the National Diabetes Centre in Jordan, emphasised that obesity is a major health issue worldwide.

“One in ten children worldwide suffer from obesity,” he said, adding, “It is the most common chronic disorder in industrialised countries.”

He said the main reason for the increase in the prevalence of obesity in children in the past few years was largely due to changing lifestyles, although heredity also played a role.

Fast food, TVs, PCs, an extremely sedentary lifestyle are all major contributors to the rising prevalence of obesity in children, he said.

“However, heredity studies show that obesity is also linked to parents.”

He noted an important finding in obesity studies which shows that obese children are highly likely to become obese adults, indicating that the fight against obesity must be taken up in early childhood.

“In fact the focus on prevention should start with the pregnant mother by ensuring she has a healthy diet,” Dr Ajlouni said.

Dr Ala Alwan, assistant director-general, Non- Communicable Diseases & Mental Health, World Health Organisation, also speaking at the opening of the congress, said “evidence suggests poor maternal nutrition and low birth weight is related to obesity in adults”.

Mortality

He said that 60% of deaths globally in 2005 were due to diet-related non-communicable diseases (NCD).

“Mortality due to NCDs is increasing and over the next 10 years the largest increases are forecast to take place in Africa and the Eastern Mediterranean Region.”

He stressed that NCDs can be prevented “and this is where we must focus” our efforts. In this regard the WHO has introduced a number of global strategies for the prevention of NCDs, he said.

The global strategy, which should be adopted by WHO member states, has three objectives: surveillance; health promotion; and health care.

Strategy

These strategy resolutions adopted by WHO member states include:

● Prevention and control of noncommunicable diseases (2000)
http://www.who.int/ncd/mip2000/documents/wha_53_17_en.pdf

● The WHO Framework Convention on Tobacco Control (2003) http://www.who.int/tobacco/framework/final_text/en/

● Global strategy on diet, physical activity and health (2004) http://www.who.int/dietphysicalactivity/en/

● Prevention and control of noncommunicable diseases: implementation of the global strategy (2007)
http://www.who.int/nmh/B122_9-en.pdf

“These strategies are evidence-based cost-effective interventions,” he said. The interventions range from implementing tobacco tax, to ensuring the availability of affordable healthy food, to transportation policies and environmental design to encourage exercise, such as walking and cycling.

He said it was important that strategies to reduce exposure to risk factors (such as obesity) for NCDs should be combined with strategies to prevent the emergence of these risk factors “which makes this conference so important, as it places the focus on children”.

“Interventions should be of appropriate intensity and sustained over extended periods if health organisations want to see tangible results,” Dr Alwan emphasised.

“These interventions must include community participation, supportive government policy decisions and appropriate legislation,” he added.

WHO’s objective is to mobilise countries, as well as all concerned social and economic groups, and engage them in implementing the Global Strategy on Diet, Physical Activity and Health (DPAS).

Dr Tim Lobstein, director, Childhood Obesity Programme, IASO – IOTF, (International Association for the Study of Obesity <www.iaso.org> - International Obesity Task Force <www.iotf.org> ) UK, said that obesity was not just an issue for children and their parents, but also for governments as well.

He said childhood obesity was rapidly increasing in most parts of the world – US, UK, Spain, Brazil, China and Australia, for example, all show this trend. Dr Lobstein remarked how children’s lives have changed over the past 30- 40 years. “Now there are TVs and PCs. Children play indoors as the streets are considered unsafe. There are more cars and there is more consumer advertising targeted at children.”

He said this has resulted in less activity for children, which means they don’t need so much food, although they still require a balanced diet. “But children are consuming more fats and sugars than before. Fast food companies have moved in and are changing consumer diet habits. For example, McDonalds has dramatically increased its number of outlets around the world in the past 10 years. Add to this their marketing campaigns and it is easy to see how this affects consumer habits.

“Unfortunately the most vulnerable are children, particularly in poor and povertystricken areas,” Lobstein said.

He said the WHO had done a review of intervention carried out in schools to get children to lose weight and found very few had been successful.

“It is very hard to do this. It is like asking a child to swim up a waterfall – to swim against the social current. The pressure is very strong.”

He emphasised that “if government wants big changes, they have to make big changes”.

“They have to make changes to city design to encourage exercise. They have to make changes to school policy to promote healthy food and regular physical exercise and they have to make changes to food policy, which includes a range of initiatives such as appropriate marketing of food to children, correct food labeling, ensuring the affordability of healthy food and so on.”

Professor Kaare R Norum, MD, PhD, Department of Nutrition, Faculty of Medicine, University of Oslo, chairperson of the Reference Group for Global Strategy on Diet, Physical Activity and Health, WHO, Norway, spoke about the European Charter on Countering Obesity <www.euro.who.int/Document/E89567.pdf>, which was adopted by WHO Europe in Istanbul in 2006. Among the important challenges and initiatives the charter outlines is a call for regional and international cooperation in the fight against obesity.

“Obesity is no longer a syndrome of wealthy societies; it is becoming just as dominant in developing countries and countries with economies in transition, particularly in the context of globalisation. Taking intersectoral action remains a challenge, and no country has yet effectively managed to bring the epidemic under control. Establishing strong internationally coordinated action to counteract obesity is both a challenge and an opportunity, as many key measures are crossborder both in character and in their implications.”

Prof Norum remarked that the charter acts as a call to action for European governments to implement economic, social, cultural and environmental policies and initiatives that will reverse the epidemic of obesity.

In this regard he congratulated the WHO EMRO for adopting a resolution in 2007 on Food Marketing to Children <www.emro.who.int/rc54/media/pdf/EMRC54R9.pdf> which urges member states to implement policies to guide industry, education and media to support health diet in children.

Recommendations

The Arab Children Health Congress recommendations will be distributed to governments and governmental agencies across the Middle East.

At the National Level

● Address the prevention of non-communicable diseases (obesity, cardiovascular diseases, diabetes and cancer) as a high health priority on the national agenda, with emphasis on modifiable risk factors.
● Increase awareness among policy makers, community, families and children, and advocate to ensure children’s health, including healthy diet and physical activity
● Promote multi-sectoral action with all stakeholders and relevant sectors, including community, families, children and relevant governmental and nongovernmental institutions.
● Support, contribute and participate in the development and implementation of a Regional Plan of Action (POA) on Diet and Physical Activity and Health (DPAS) to guide national action and to identify priorities for WHO's work in support of Member States.
● Undertake WHO STEPwise risk factor surveillance surveys to monitor risk factors, with emphasis on unhealthy diet and physical inactivity.
● Adopt and implement cost effective strategies identified in the Regional POA at national level to promote healthy diets and physical activity.
● Ensure legislative and regulatory options in support of healthy diet and physical activity, as appropriate
● Identify appropriate entry points for interventions involving community, primary health care, schools and worksites as appropriate, to promote healthy diets and physical activity.
● Develop and implement a mechanism for monitoring the implementation of the Plan of Action.
● Support and facilitate evidence-based research on diet and physical activity for health promotion and healthy lifestyle.
● Assure the collaboration of the Ministry of Health and the Ministry of Education to: -

Develop, review, implement and evaluate national guidelines for school health programs within the following WHO components of the health-promoting school initiative: Health education, physical education, physical environment, mental health and counseling, involvement of family and community, as well as health services and related personnel involved in health promotion.
- Assure that school meals comply with, at least, the minimum nutrition recommended daily allowance (RDA).
- Assure that school physical activity programs provide at least 60 minutes of daily physical activity.

At the Regional Level

World Health Organisation
● Develop a Regional POA for DPAS, with milestones and monitoring indicators, – Leadership – Advocacy – Policy options – Surveillance – Capacity building – Research
● Coordinate the creation of a Regional multi-sectoral ‘Task Force’ for DPAS in consultation with Member States.
● Coordinate and support development of a Regional POA for DPAS
● Provide technical support related to Regional POA for DPAS to support implementation of multi-disciplinary programs, including but not limited to
– Cost effectiveness
– Best available practices
– School based programs on diet and physical activity
– Partnership development
– Research priorities
– Monitoring and evaluation framework
● Ensure linkage between Regional POA and National specific implementation plan
● Incorporate the main components of the global strategy on diet and physical activity in relation to children’s health in promoting school initiatives which are adopted by most of the countries in the region.
● Organise a regional consultation in 2008 to review the draft regional plan with representatives of Member States, regional experts, and other stakeholders, prior to finalisation.

UNICEF

Conduct awareness campaign in collaboration with WHO-EMRO on the rights of children to a healthy life including healthy diet and proper physical activity.

Research Priorities: National and Regional Levels
● Collect prevalence data on risk factors of NCD among Arab children and adolescents.
● Identify cost-effective interventions to prevent obesity among Arab children.
● Identify barriers to implementation of diet and physical activities programs for Ministry of Health and Ministry of Education.

At the Media Level

Media should play a constant active role to:
● Promote the health and wellbeing of children.
● Be a major partner in the awareness campaign to promote healthy lifestyle and wellbeing of children through capacity building of professional journalists and media members specialised in children and health issues.
● Develop, provide and disseminate attractive, culturally appropriate health messages to children, parents and community.
● Monitor food and unhealthy entertainment advertisements targeting children and adolescents.


 Date of upload: 3rd May 2008

                                  
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