Established in 1981, World Food Day is celebrated on October 16, the date of foundation of the Food and Agriculture Organization (FAO), an agency of the United Nations (UN). Its creation was linked to the need to alert and raise awareness in the world to the various problems related to food, namely the eradication of hunger and the fight against food waste, but it also involves the growing concerns with the sustainability of food systems and with the rise of obesity in the world. According to UN data, while 820 million people do not have access to enough food, more than 2 billion human beings are overweight and obese.
The World Health Organization (WHO) reports that global obesity has tripled since 1975 and, according to data from 2016 — there is no current data available — about 650 million adults were obese, that is, almost 13% of the older adults. 18 years old around the world.
It is true that the vast majority of the world’s population lives in countries where the problems associated with being overweight kill more than the lack of food. However, childhood obesity is no less worrying: in 2020, about 39 million children under 5 years of age were overweight and more than 340 million between 5 and 19 years of age were overweight and obese (data from 2016). Obesity is therefore a serious public health problem, but the good news is that it is preventable. This is the great challenge of the 21st century and must be considered a priority by governments, which have an important role in creating an environment favorable to the adoption of best practices. Examples such as Sintra Grows Healthy (see box on the side), which raises awareness among children and families about the importance of healthy eating and a change in habits, may be replicated across the country, bringing results to public health in the coming decades.
According to data from the Portuguese Society for the Study of Obesity (SPEO), Portugal has a rate of child overweight of 29.6%, with 12% of these situations already constituting obesity. For its part, the Portuguese Association against Childhood Obesity (APCOI) estimates that there was still an average weight gain of 10% in children during confinement. Specific data are not yet available, but on the association’s website it can be read that, according to the calculations carried out, if each child per day has ingested an average of about 200-300 extra calories without having increased in the same proportion. energy expenditure through physical activity means that in the last two months of confinement, 12 thousand to 18 thousand more kilocalories will have been accumulated, which corresponds to an increase in weight of at least two kilograms.
The report Health at a Glance, of 2019, carried out by the OECD (Organization for Economic Cooperation and Development) places Portugal in ninth position in the ranking childhood obesity, with a prevalence of 37.1% in children between 5 and 9 years. It is ranking is led by the United States, with an incidence of 43% in this age group. Also with regard to adults and adolescents over 15 years of age, Portugal is in a bad position: 67.6% of the Portuguese population from this age onwards is overweight, which indicates an ever-increasing approximation to the degree of obesity. It is worth clarifying, in a simplistic way, that the extra weight is revealed by calculating the relationship between weight, height and gender, resulting in the body mass index (BMI), and that above 25% is considered overweight, 30% to 40% obesity and above that morbid obesity.
Action on obesity should start before pregnancy
Carla Rêgo, pediatrician at the Center for Children and Adolescents of Hospital CUF Porto, member of the Scientific Council of the Platform against Obesity of the Directorate-General for Health and also vice president of SPEO, was responsible for creating and implementing the first consultation of the country of pediatric obesity, in 1998, then at the Pediatrics Service of Hospital de São João. because almost 98% of obesity is caused by behavioral factors”, explains this specialist. This gave rise to the first multidisciplinary consultation for childhood obesity, which involved a pediatrician, nutritionist and psychologist.
Since then, much has been done, but much more remains to be done. “The problem with obesity is that it is a reflection of behavior from 10 or 12 years ago. In other words, we have a time delay of more than a decade. The first factor I identify is the lack of responsibility on the part of decision-makers and educators”, it says. In other words, for this specialist, when there is a situation of obesity, the great tendency is to point the finger at the child, when this is only obese due to their pediatric trajectory. “Decision makers have to realize that changes have to exist in the global environment, whether school or family, but, above all, at the level of primary care in the NHS to intervene early in the life cycle”, he explains. “If I want to reverse the increase in the prevalence of obesity, the first point where I must act is in the initial environment, even before pregnancy, because this is where we are going to stop the progression of obesity in the life cycle”, he reveals.
This means that primary health care should be strongly equipped with multidisciplinary tools and teams to sensitize future mothers to adopt a healthy lifestyle, not to gain too much weight and know how to monitor the infant’s growth in the first months, especially when it is born into more susceptible families. “We mustn’t forget that the first year of life is a window of opportunity to shape eating behaviors. When a child progressively increases their BMI up to 5 or 6 years above what was expected, the number of fat cells is increasing, number that will never be lost again, because the fat cell does not die”, he explains. It adds that this child only has a 50% chance of being a properly nourished adult. If you enter 12 or 13 years old and continue to be overweight and obese, then you will only have 10% to 15% of being a properly nourished adult. If you are a woman and become an obese pregnant woman, you will transmit genetic susceptibility across generations and thus perpetuate the obesity cycle.
According to the EPACI – Study of Food Pattern and Child Growth Portugal 2012, which assessed the way in which children between 0 and 3 years old grow up in Portugal, at 2/3 years of age the prevalence of overweight and obesity was of 30.8%. “This shows that obesity in Portugal starts earlier and earlier, and either work is done thinking about the next ten years or we will continue with this level of increase”, reveals Carla Rêgo, who also coordinated this study.
We have had a bad orientation in food education
For this specialist, “any campaign developed at school level or in society is important, but it is in health surveillance that the bulk of the investment must be made”. At school level, for example, some important measures have been taken, but still insufficient, because they are restrictive and not pedagogical. The government order, of August 17 this year, prohibited, as of this school year, the sale of less healthy products in public schools as an incentive to the consumption of healthy foods. Pastry cakes, pizzas, hamburgers, soft drinks and a whole range of less healthy foods are at the school gates. It may not be enough but it is a first step on the right path. “Children know the theory, they have already learned it, but there has been a misconduct in the way in which the advantages of healthy eating are explained. It is not enough to debit information, it is necessary to internalize it so that they can make their choices”, says this doctor. He defends that nothing should be forbidden to a kid, even if he is morbidly obese, because that’s not where you get results. “The worst thing they can do to us is to put restrictions ahead, so it has to be a constructive education based on co-responsibility for healthy choices”, he concludes.
According to his experience at the CUF Hospital in Porto, in the last two years of the pandemic, weight gain occurred mainly in boys aged 7 to 12 years. “Interestingly, this increase was not only in the obese, but above all in adequately nourished children, which leads us to suppose that behavioral changes, especially in the reduction of physical activity, were the most dramatic aspect of this period.” Obesity brings comorbidities, implies a poor quality of life and a significant reduction in life expectancy, therefore, more burdens on health. “I think we’re all sleeping because we still don’t understand the consequences of this pediatric population that has been obese for more than 20 years. It’s going to be a complete catastrophe in terms of cardiometabolic disease, whether it’s hypertension, diabetes, coronary heart disease or cerebrovascular disease.” Carla Rêgo finishes off.