Béo Phi WHO 2022
Béo Phi WHO 2022
Béo Phi WHO 2022
WHO
acceleration plan
to stop obesity
I I I I
I I
I
I
75th World
At the
Health Assembly in
2022, Member States adopted new
recommendations for the prevention
and management of obesity and
endorsed the WHO acceleration plan to
stop obesity
The WHO acceleration plan to stop obesity1 is
designed to stimulate and support multisectoral
country level action across the globe. Drawing on
policies that are already tried and tested and based
on implementation and delivery science, the plan
offers the prospect of a step change in delivery and
impact in the effort to tackle the growing crisis of
obesity.
1
A public health crisis
T
he global burden and threat of obesity for Noncommunicable Diseases (NCDs)
constitutes a major public health reduction for adolescents and adults. Without
challenge that undermines social and addressing obesity, it will not be possible
economic development throughout the world to achieve a 30% reduction of premature
and has the effect of increasing inequalities mortality from NCDs by 2030, nor will it be
between countries and within populations. possible to end malnutrition (by wasting and
Obesity has now reached epidemic proportions overweight) among children under 5 years of
and it is estimated that by 2030 over one billion age. Both are key targets of the Sustainable
adults globally will be obese.1 Once associated Development Goals (SDGs).
with high-income countries, obesity is now also
prevalent in low-and middle-income countries, Obesity has very significant impacts on
including among lower socio-economic groups. wellbeing and quality of life and is a major
In some contexts, the factors contributing to risk factor in many other NCDs. In 2019, it
obesity are the same as those that contribute contributed to approximately 5 million deaths
to undernutrition. from cardiovascular diseases, diabetes, cancers,
neurological disorders, chronic respiratory
Stopping the growing obesity epidemic is diseases, and digestive disorders.2 People who
one of the 2025 Global Nutrition Targets (for suffer from obesity also experience a four-fold
children under 5) and one of the Targets increased risk of developing severe COVID-19.3
1 World Obesity Atlas 2022. World Obesity Federation. London: 2022 (https://s3-eu-west-1.amazonaws.com/wof-files/World_Obesity_Atlas_2022.pdf, accessed 11 April 2023).
2 Chong, B., Jayabaskaran, J., Kong, G, et al. Trends and predictions of malnutrition and obesity in 204 countries and territories: An analysis of the Global Burden of Disease Study 2019.
EClinicalMedicine. 2023. 57. DOI:https://doi.org/10.1016/j.eclinm.2023.101850.
3 Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic reviewPLoS One. 2020; 15(11):
e0241955.
O
verweight and obesity are largely
preventable. At the individual level,
people may be able to reduce their
risk by limiting energy intake from total fats
and sugars; increasing consumption of fruit
and vegetables, as well as legumes, whole
grains and nuts; and engaging in regular
physical activity. However, the dietary and
physical activity patterns for individual people
are largely the result of environmental and Health
societal conditions that greatly constrain warning
personal choice.1
3
Putting a stop to the rise in obesity:
a complex challenge
O
besity is a public health emergency The answer to the obesity epidemic lies
and an effective global response to in action to address the structural factors
the obesity epidemic is now urgent that are rapidly contributing to the creation
and imperative. However, there is no single of a worldwide obesogenic environment.
or simple solution. The response will demand Governments, supported by all key
ambitious reform on many fronts and on stakeholders, must now take responsibility for
a scale sufficient to address the sum of ensuring the availability of healthy sustainable
environmental influences that exacerbate food at locally affordable prices, for embedding
the likelihood of obesity in individuals or safe and easy physical mobility into the daily
populations and in different settings. These life of all people and for enabling and enforcing
influences are referred to as the “obesogenic an adequate legal and regulatory environment.
environment”. At the same time, an effective health system
response must be mobilized to help prevent,
treat and manage obesity.
Obesity is a chronic complex disease defined by excessive adiposity that can impair
health. It is in most cases a multifactorial disease due to obesogenic environments,
psycho-social factors and genetic variants. In a subgroup of patients, single major
etiological factors can be identified (medications, diseases, immobilization, iatrogenic
procedures, monogenic disease/genetic syndrome). Body mass index (BMI) is a surrogate
marker of adiposity calculated as weight (kg)/height² (m²). The BMI categories for defining
obesity vary by age and gender in infants, children and adolescents. For adults, obesity is
defined by a BMI greater than or equal to 30.00 kg/m². There are three levels of severity in
recognition of different management options.
In infants, children and adolescents, BMI categories for defining obesity vary by age
and gender based on WHO growth charts. Children 0 to 5 years have obesity if weight-for-
length/height or BMI-for-age is above 3 standard deviations of the median of the WHO
Child Growth Standards. Children aged 5 to 19 years have obesity if BMI-for-age is above 2
standard deviations of the median of WHO Growth Reference for School-aged Children and
Adolescents.
International classification of diseases for mortality and morbidity statistics (11th Revision). Geneva: World Health Organization; 2018 https://icd.who.int/browse11/l-m/en.
T
he WHO acceleration plan to stop Approaches endorsed in the plan include:
obesity sets out the incremental comprehensive policies to protect people
steps for a comprehensive, systematic from the harmful impact of food marketing;
approach to tackling obesity. The plan is nutrition labelling policies (including front-
assisting countries to navigate the complexity of-pack labelling); fiscal policies (including
of the implementation challenges and deliver taxes and subsidies to promote healthy diets);
results. public food procurement and reformulation
policies; physical activity; as well as school
At the heart of the plan sits a consolidated food and nutrition policies (including school
set of policies which have been selected food standards, food provision and nutrition
based on their proven potential to achieve education).
outcomes. Next, the plan prioritizes existing
policy recommendations in order to focus on A whole- Obesity prevention
those most likely to prove impactful, feasible, of-society and management
acceptable, affordable and scalable. Finally, approach
the plan uses state of the art implementation also requires
necessitates multisectoral
and delivery science to guide how countries actions at policies and actions that go
can best unlock and deliver a programme of subnational beyond the health sector
change. and local
levels and can include collaboration between
The role of the environments that surround organizations working towards a common goal.
communities has long been recognized For example, district administration, education
as a major contributor to obesity. Obesity and health authorities creating and maintaining
prevention and control necessitates multi- public parks that cater for the needs of different
sectoral policies and actions that go beyond age groups, or primary care teams in health
the health sector. Such policies and actions are clinics and school teachers jointly promoting
implemented through a coordinated whole- healthy eating practices, giving oral healthcare
of-society approach with a range of ministries advice, and offering services to ensure timely
and partnerships, while managing conflicts of identification of children at risk of obesity. Within
interest and safeguarding public health. They the school setting, school staff together with food
include structural, fiscal, and regulatory actions service staff can implement nudges, alongside
aimed at creating healthy food environments measures such as setting school food standards,
that make healthier food options available, to further influence children’s food selection
accessible and desirable. towards foods that contribute to a healthy diet.
5
If everything
is important,
The plan also calls for stronger integration of
nothing is
obesity prevention and treatment into primary important
health care services, particularly in low- and
middle-income countries where many health
clinics lack even the most basic diagnostic
tools for checking blood sugar levels, weight If everything
or blood pressure or the resources to provide
prevention and management counselling is a priority,
and health services. Finally, the plan calls on nothing is a
Member States to draw up country-based
roadmaps, bringing together stakeholders and priority
advancing advocacy and communications.
Health system
Social protection system
Sport system
Urban design and built environment
Education system
Information system and digital environment
7
Following the inter-country dialogues organized chosen to adopt sugar-sweetened beverages
by WHO in the six regions (see Box 5), not all (SSB) interventions. By contrast, seven
frontrunner countries choose to adopt all the countries have chosen to progress school
policy interventions proposed in the WHO nutrition interventions and so far, only one
technical package. Indeed, each frontrunner of the frontrunner countries has chosen to
country is making a choice according to its use subsidies. Figure 2 shows at a glance the
own context, prioritization and feasibility. current trend of popularity of the different
For example 10 out of 28 frontrunners have interventions.
Figure 2. Obesity interventions prioritized by frontrunner countries
SSB Taxes
Obesity management 10
health service delivery
10
Marketing
9
Areas of
Standards, legislation,
intervention
regulation Early food
10 and number of
frontrunner environment
countries
8
selecting
Subsidies
1
44 Physical activity
Social marketing and 8
communication
7 7
School nutrition policies Front-of-pack labelling
Okunogbe A, Nugent R, Spencer G et al. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Global Health. 2022, Vol. 7, p. e009773.
Obesity: missing the 2025 global targets: trends, costs and country reports. 2020. World Obesity Federation. https://www.worldobesity.org/resources/resource-library/world-obesity-day-missing-the-targets-report.
DFI, in collaboration with the Department of Nutrition and Food Safety, has developed a
simple, easy-to-use tool to assess the short- to mid-term impact of interventions to tackle
the obesity epidemic.
The tool builds primarily on the methodological assumptions used in the WHO-CHOICE
analysis,1 specifically from the evidence supporting Appendix 3 of the Global Action Plan
for Noncommunicable Diseases,2 and applies it on country-specific demographic data. It
models the impact of one to three policies aimed at reducing overweight and obesity on
population-level body mass index (BMI) distribution.
The modelling tool helps the country in their decision-making process to prioritize areas of
intervention for prevention and management of obesity. It will also help monitor progress
and inform course-correcting and advocating for accelerated action as part of the WHO
Acceleration Plan to Stop Obesity.
1 WHO-CHOICE programme.
2 Technical briefs - Updating Appendix 3 of the WHO global action plan for the prevention and control of noncommunicable diseases 2013–2030.
3 https://www.worldobesity.org/news/changing-perspectives-and-advancing-national-action.
9
Workstream 2: Delivery for impact
The delivery for impact workstream brings together technical expertise on obesity with
implementation science expertise on programme delivery.
Focusing initially on a subset of countries, the plan supports the development and
implementation of country-specific data-driven incremental strategies for slowing and
reversing obesity trends and uses the WHO impact cycle to unlock solutions and deliver the
progress that is needed.1
Achieve impact
at country level
Countries reach
20252 and 20303
global nutrition targets
Sustain change
and expand Prioritize
Interventions
Countries strengthen and
sustain system changes to Based on the WHO
support long-term progress technical package to stop
within the country, while obesity, countries select
expanding and sharing their specific national priorities.
knowledge and capacity
beyond national borders.
Implement, track
progress and adjust Identify and agree
on solutions
Countries establish routine Countries develop
practices pairing action with acceleration roadmap based
accountability. While tracking on selected interventions
progress, they use delivery and theory of change,
science and tools to identify identifying strategic
implementation challenges
and solve them or correct
Communicate objectives, indicators,
and engage targets, needed resources
course as needed. and budget.
Countries identify and
engage with stakeholders
and partners using the
acceleration roadmap to
guide implementation,
engage, communicate
and gain buy-in.
1 Feature story on WHO delivery case study + Impact playbook (forthcoming): https://www.who.int/about/accountability/results/who-results-report-2020-2021/delivery-case-study.
2 https://www.un.org/nutrition/sites/www.un.org.nutrition/files/general/pdf/2-nutrition_decade_flyer_commitments_for_web.pdf.
3 https://www.sdgsdashboard.org/.
3. Develop and roll-out clear delivery plans, focused on identifying and addressing
3 implementation bottlenecks.
4. Conduct accountability routines with all stakeholders, designed to keep momentum and
4 focus during implementation.
55. Use analytics and modelling to assess issues, design solutions, track progress, course
correct and re-programme as needed throughout the policy implementation cycle.
7. Report on accountability cycles at national, regional and global level including at the
7 World Health Assembly.
BOX 4 It’s all about measurable impact — the WHO delivery approach
The WHO delivery for impact approach provides a structured framework for
implementation that helps to accelerate progress towards the impact that countries want
to achieve. It is based on the core principles that data and planning are not sufficient
endpoints in and of themselves; it is about challenging a business-as-usual mindset and
pushing for actions that increase the likelihood of reaching the desired results. While
other technical resources provide details on what needs to be done, delivery is centered
around how to go about doing it: from identifying priority issues and setting measurable
targets, through to problem-solving and creating an institutional culture of data-driven
action.
The delivery for impact approach is centered on an impact Cycle, with a lens for
on-the-ground implementation and strong emphasis on long-term sustainability for
transformational change. The impact Cycle provides a clear framework accompanied with
tested tools to systematically and effectively advance implementation efforts.
The impact cycle was developed in collaboration with the WHO Evidence-Informed Policy Network (EVIPNet) and adapted from its “evidence ecosystem for impact” framework. For additional
information see: Tracking the Triple Billions and delivering results (who.int).
11
Workstream 3: Global advocacy
2X 60% $1 800
PEOPLE CHILDHOOD TRILLION MILLION
People living with obesity Childhood obesity (age 5 to 19) The medical 800 Million people
are twice as likely to be is expected to increase by 60% consequences of around the
hospitalized if tested over the next decade, reaching obesity will cost over world are living with
positive for COVID-19 250 million by 2030 US$1 trillion by 2025 obesity
Source: https://www.worldobesityday.org/assets/downloads/Factsheet_-_English_1.pdf.
The plan places a strong focus on increases; that improved policy efficiency
accountability and reporting to monitor the and coverage and expanded access to obesity
execution of the acceleration plan at global prevention and management services can
level, and for the frontrunner countries. be evidenced; and that the current upward
The key outcomes on which the plan will be trend in obesity rates across the life course
measured are: that the number of countries slows. The reporting process will also provide
implementing effective policies to address an opportunity to identify and learn from
prevention and management of obesity emerging practices.
• Halt the rise of obesity in children under 5, adolescents and adults by 2025
Outcome
• Ending all forms of matnutrition
targets
• Reach 3% or lower prevalence of overweight in children under five years of age by 2025
• Free sugars to less than 10% of total energy intake in adults and children
Intermediate
targets • Increase the rate of exclusive breastfeeding in the first 6 months up to at least 70% by 2030
• 15% relative reduction in the gtobal prevalence of physical inactivity
• Increase coverage of PHC services with prevention, diagnosis and management of obesity in children and
adolescents
• Increase density of nutrition professionals to a minimum levet of 10/100 000 population
Process by 2030
targets • lncrease number of countries with regulations on marketing of foods and non-alcoholic beverages to
children
• AII countries implement national public education communication campaigns on physical activity
• All countries have a national protocol for assessing and counselling on physical activity in primary care
Source: https://www.worldobesityday.org/assets/downloads/Factsheet_-_English_1.pdf.
13
BOX 5 Putting the plan into action through inter-country dialogues
Following the endorsement of the WHO acceleration plan to stop obesity at the
75th World Health Assembly (WHA75), a series of inter-country dialogues were convened
with the frontrunner countries in the six WHO regions. The frontrunner countries were
selected under WHO Regional Office guidance, based on epidemiological data and strategic
priorities, policy and political environment, country capacity and expressed interest in or
need for technical assistance in this area.
These countries are receiving combined technical and delivery support from WHO until
2030 with the expectation that the process of test and learn will generate evidence and
expertise for future expansion of the acceleration plan across the globe.
The inter-country dialogues also established a community to unite countries and other
stakeholders around a shared vision for the response to the obesity epidemic and for
strengthening political commitment to support and finance the response in the 28
frontrunner countries and beyond.
United
Kingdom
Slovenia
Portugal Türkiye
Iran (Islamic
Jordan Republic
Kuwait Of)
Egypt
Mexico
Bahrain Qatar
Thailand Philippines
Barbados
Trinidad And Tobago
Panama
Malaysia
Seychelles
Peru Brazil
Tonga
Botswana Mauritius
South Eswatini
Chile Africa
Argentina
Frontrunner countries Uruguay
Not applicable
The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of WHO concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Dotted and dashed lines on maps represent approximate border lines for which there may not yet
be full agreement.
15
No country is immune
to the obesity epidemic
T
he WHO acceleration plan to stop WHO will be reporting on the implementation
obesity focuses on evidence-based, evidence, the challenges and the successes of
cost-effective interventions, which the roll-out in countries in the short, medium
can be adapted to fit country needs. These and long term, and will report on a yearly
include a range of policies to address the basis to Member States through the World
obesogenic environment that is driving the Health Assembly and Regional Committee
trajectory of the epidemic right across the Meetings.
globe. The plan also includes a new WHO
health service delivery framework for the Time is short and the challenge is complex.
prevention and management of obesity.1 This is why the WHO acceleration plan to stop
obesity has taken brave decisions around
The plan is moving towards its execution prioritization, selection and feasibility and
phase with ambitious but achievable drills down to the granularity that can enable
roadmaps agreed by a selection of the most implementation and ensure concrete progress
affected countries for the delivery of their on the ground. The plan provides the recipe
chosen national priorities. for success and the tools to deliver. Now WHO
invites politicians, donors and communities
to rally around a whole of society response
“With strong political to meet one of the world’s most serious
commitment and accountable emerging health crises.
1 https://www.who.int/publications/i/item/9789240073234.
2 https://www.worldobesity.org/news/changing-perspectives-and-advancing-national-action.