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Action on childhood obesity amidst COVID-19: greater challenges, new opportunities

By Dr. Víctor Aguayo, Associate Director, Programme Division, and Global Chief of UNICEF Nutrition Programme, and Ms. Johanna Ralston, CEO, World Obesity Foundation

Unhealthy diets are a leading risk factor for illness and death globally. Since 2012, Bloomberg Philanthropies has supported efforts around the world to promote healthier eating. The COVID-19 pandemic has both exposed the fault lines in our food system and reinforced the relationship between nutritious diets and health, bringing a new urgency to the need to ensure that everyone can access foods that nourish. On this World Children’s Day, we are pleased to host a guest blog from two organizations that are working to do just that: UNICEF and World Obesity Federation. As they describe below, there are important opportunities to get this right and doing so will require listening to and engaging young people.


It is increasingly recognized that the COVD-19 pandemic and the response strategies, such as school closures, country lockdowns and trade restrictions, are exacerbating existing challenges for child nutrition and wellbeing around the world, with potential for unprecedented negative impact. For example, an estimated 370 million children have been deprived of essential school meals as a result of school closures. This is a threat not only to the quantity, but also the nutritional quality, of the food children are getting, with effects that will persist long after the pandemic has subsided.

The increase of wasting, or low weight for height as a result of acute food shortages, may be the most acute impact of food and health system disruption and increased household poverty. UNICEF reports from the early months of the COVID-19 pandemic suggest a 30% reduction in the coverage of essential nutrition services in low and middle-income countries (LMICs) and declines of 75–100% under lockdown contexts. Without timely action, the global prevalence of child wasting could rise by a shocking 14% and the number of children who are wasted could increase by 6 to 7 million.

However, wasting is not the only malnutrition challenge that risks being exacerbated by COVID-19. Overweight and obesity—themselves risk factors for adverse outcomes from the disease—may also increase more rapidly if current conditions persist.

Due to COVID-19, many communities are facing financial and physical barriers to accessing nutritious foods and healthy diets. Critical actions to promote better nutrition for children, such as counselling and support for optimal infant and young child feeding, access to healthy school meals, and front-of-pack labelling efforts, are being disrupted or delayed indefinitely. In addition, during COVID-19 there have been reports of opportunistic marketing and inappropriate distribution of breastmilk substitutes and unhealthy foods that runs counter to public health nutrition goals.

A picture is emerging from countries as diverse as Australia, Brazil, Italy, Portugal, and the United Kingdom of increased snacking, intake of ultra-processed foods, higher levels of sedentary behaviour and screen time – all of which elevate the risk for excess weight gain in children. A study from Italy reported that nearly half of all children surveyed had increased their consumption of sweets and spent an additional five hours per day in front of screens. A similar survey by UNICEF Brazil found that a third of families had started to consume more ultra-processed foods and soft drinks. These alarming figures cannot be ignored.

Figure 1: countries predicted to have over 1 million school-age children and youth living with obesity in 2030

1. China (62 million)

2. India (27million)

3. United States of America (17 million)

4. Indonesia (9.1 million)

5. Brazil (7.6 million)

6. Egypt (6.8 million)

7. Mexico (6.5 million)

8. Nigeria (6 million)

9. Pakistan (5.4 million)

10.  South Africa (4.1 million) 

11. Bangladesh (3.6 million)

12. Iraq (3.5 million)

13. Turkey (3.4 million)

14. Philippines (3.4 million)

15. Iran (3 million)

16. Algeria (2.7 million)

17. Russian Federation (2.6 million)

18. DR Congo (2.4 million)

19. Argentina (2.2 million)

20. Tanzania (2.2 million)

Source: World Obesity Federation, Atlas of Childhood Obesity (2019)

For LMIC countries – where the large majority of children with overweight or obesity live – rising levels of overweight coupled with the continuing problem of undernutrition already present a complex challenge. It is more important than ever that these countries pivot to ‘win-win’ or ‘double duty’ policy approaches that tackle the ‘double burden’ of undernutrition and overweight in children. If comprehensively implemented through multiple systems (e.g. food, health, water, education, social protection), such efforts could make a significant contribution to addressing all forms of malnutrition, including overweight and obesity.

Despite headwinds, opportunities lie ahead.

There is a growing political consensus that future food systems must deliver both healthy and sustainable foods for all. The rationale for this is clear:  when governments invest in the systems that protect children against malnutrition — in all its forms —children’s nutrition dramatically improves. To make this happen, genuine commitment is needed from governments to drive down the cost of, and drive up families’ access to, nutritious, safe, affordable and sustainable diets. Getting there will require critical transformations, including a renewed commitment to generate and share policy-relevant data and evidence, test innovative approaches, and scale up the implementation of evidence-informed interventions at across both countries and cities.

But to truly ensure long lasting and sustainable change for future generations, we also need to nurture the contribution and leadership of young people themselves. They tell us that they are fed up with the status quo, that their day-to-day environments are not conducive to better food choices, and that they want to see change. Fully leveraging the voice and influence of young people will open doors to positive change at scale, but it requires a commitment to work together with them in true collaboration. All too often their voices and ideas are missing from conversations affecting their nutrition and wellbeing.

On World Children’s Day we pay tribute to the young people – many of them children under 18 − fighting tirelessly for healthy and sustainable food systems. They are ready to reimagine a better future – let’s join them!