DR ABDULLAHEL AMAAN & PROFESSOR DR MA MANNAN

Obesity and being overweight are major public health concerns globally. It is defined by the World Health Organisation (WHO) as abnormal or excessive fat accumulation. Epidemiological studies state that obesity prevalence has tripled over the past four decades globally. Overall, the prevalence of obesity has increased dramatically in children and adolescents.

Obesity prevalence is related to the interaction of many factors, including biological, genetic, socioeconomic and social factors. An obesogenic environment acts at several levels: familial (e.g., practice of physical activity, dietary habits, sleep time, and screen time); local community (e.g., child care, schools, parks, and public transport); and sociopolitical (e.g., food industry and marketing, transportation systems, agricultural policies, and subsidies).

Dietary factors contributing to the obesity risk in children and adolescents include the excessive consumption of energy-dense, micronutrient-poor ultra-processed foods (UPFs), i.e., ready-to-eat foods derived from substances extracted or refined from whole foods, with flavourings, colours, and other cosmetic additives added.

Ultra-processed foods (UPFs) represent foods that have undergone substantial industrial processing, such as the addition of preservatives and various other ingredients, thereby making them more tasty, appealing and easy to consume. UPFs are often rich in sugars, saturated fats and salt, while they are low in essential nutrients.

Consumption of ultra-processed food (UPF) is increasing worldwide. The widespread consumption of UPFs in children has been associated with abnormal metabolic parameters, such as increased body mass index (BMI) and waist circumference (WC), high low-density lipoprotein cholesterol (LDL-C) and triglyceride levels, along with increased fasting plasma glucose and insulin resistance.

Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for obesity. In fact, the consumption of sugar-sweetened beverages (SSBs) and UPFs in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight/obesity. In addition, exposure to sugary foods in early childhood may result in a dietary preference for sweet foods in adulthood, limiting the dietary intake of healthy foods.

High screen time (1–2 h/day) also influences the risk of obesity in children and adolescents at several levels, as it leads to the increased exposure to food marketing, meals with little focus on what is being eaten, an increased sedentary lifestyle, and reduced sleep time. It has been observed how, in children, the increased intake of energy-dense foods and beverages occurs during or shortly after exposure to advertising; therefore, the two are related.

Studies have shown that breakfast consumption and physical activity (at least 60 min of moderate- to vigorous-intensity physical activity per day) are powerful protective factors against excess weight gain in children and adolescents.

A compassionate sociopolitical (e.g., food industry and marketing, agricultural policies) commitment is essential for justified marketing of ultra-processed food (UPF) and sugar-sweetened beverages (SSBs) to save our children.

The writers are the assistant professors of Department of Neonatology at the Institute of Child & Mother Health (ICMH), Matuail, Dhaka, and Chairman of the Department of Neonatology at the Bangladesh Medical University (BMU), Dhaka, respectively. Emails: abdullahelamaan@gmail.com, drmannan64@gmail.com