WHO Director-General addresses Commission on Ending Childhood Obesity
Dr Margaret Chan
Director-General of the World Health Organization
Distinguished members of the Commission, ladies and gentlemen,
The work you were asked to undertake is extremely challenging. The complexities of childhood obesity make it an especially stubborn problem to address. The science is also complex. Weaving together the various strands from different lines of study requires great skill.
The issues that need to be addressed are multiple, inter-related, and sometimes highly-charged, politically and economically. No stand-alone intervention or single-pronged strategy will work.
Many of the factors that contribute to childhood obesity or stand in the way of its prevention reside in non-health sectors. Persuading these sectors to add health concerns to their mandates is not easy, though our experiences with tobacco control show that it can be done. Compelling evidence helps, especially when this evidence is translated into a menu of feasible policy options.
Never forget the importance of what you are doing. The work of this Commission creates a high-profile opportunity to communicate state-of-the-art science, backed by your authority and recommendations, directly to the policy-making community.
I asked the Commission on Ending Childhood Obesity to look deeply at the best and latest science. I challenged you to approach the huge problem of childhood obesity with some new thinking.
Given the patchy and entirely inadequate progress to date, I stressed the importance of coming up with some novel approaches. The interim report delivered magnificently on all of these requests.
That report cleared the air, and settled some controversies, in a number of areas. Let me mention a few that strike me as especially important.
You spelled out the rationale for focusing on childhood obesity and tracked the spillover benefits this has for society at large. You also cited evidence that the negative health consequences of childhood obesity can persist, even if normal weight is attained in adulthood. In other words, childhood obesity can leave a permanent imprint. Who would want to see a person permanently impaired so early in life?
You adopted a life-course approach as a novel way to tackle a risk that tends to be passed on from one generation to the next. You recognized that different life-course groups require packages of specific, coordinated interventions that should be applied in sequence, with a cumulative effect.
Adoption of the life-course approach also led to some startling observations. For example, some children are on the pathway to obesity from the day they are born, or even before they are born, as the emerging evidence shows.
You introduced some new concepts. Risks once thought to be either genetic or acquired may be a combination of both. This is important as some epigenetic changes can be modified or reversed through appropriate interventions.
You clarified the scale of the challenge by stressing the need for a multi-pronged approach that engages multiple non-health sectors. Addressing the obesogenic environment is not enough, but no approach that fails to address this environment can be successful.
You sounded the alarm, time and time again. Childhood obesity can erode the benefits that arrive with social and economic progress. Childhood obesity must be accepted as a significant and urgent threat to health that is relevant in all countries. Governments must take the lead.
You signalled the group of countries at greatest risk: those undergoing rapid socioeconomic and nutritional transitions, where evidence on effective interventions is often patchy or non-existent.
You placed things in perspective. You identified many factors that help explain why the prevalence of infant, childhood, and adolescent obesity is increasing in all countries, but you singled out one particularly pervasive driving force: the globalized marketing of unhealthy foods and beverages. In fact, you described the evidence of its impact on childhood obesity as “unequivocal”. That, too, clears the air.
You pointed the finger at the larger role played by food, trade, and investment policies, and by trade and agriculture agreements.
You reminded everyone that real progress depends on establishing constructive, transparent engagement with the private sector, and encouraging policies that support the production of healthier foods.
But you also issued a warning: voluntary initiatives are not likely to be sufficient. To be successful, efforts aimed at reducing the marketing of unhealthy foods and beverages need support from regulatory and statutory approaches.
As noted, the impact of taxation measures on purchasing behaviour is well-supported by the evidence.
You included novel policy options, such as zoning around schools to curtail the sale of unhealthy foods and beverages.
Finally, and perhaps most importantly, you defined a moral responsibility and stated where it must lie. None of the factors that cause obesity are under the control of the child.
Childhood obesity does not arise from lifestyle choices made by the child. It arises from environments created by society and supported by government policies. The argument that obesity is the result of personal lifestyle choices, often used to excuse governments from any responsibility to intervene, cannot apply to childhood obesity.
As stated in the report, “This singular conclusion places a moral responsibility on all societies to act on the child’s behalf to reduce the risk of obesity through a variety of actions.”
This, in my view, is one of the Commission’s most compelling conclusions.
Members of the Commission,
The Interim Report provided the basis for a public consultation. This has now been completed. We are all sharply aware of the challenges and sometimes divisive views. These certainly surfaced during the public consultation.
The task now before you is to turn the best science and new thinking into further recommendations and menus of policy options. Your recommendations need to be appropriate to the magnitude of the crisis and have the best chance of making a difference in a diversity of settings.
Over the next months, the ad-hoc working groups can continue to provide technical support to the Commission, as needed.
During the May World Health Assembly, reaching agreement on how WHO should engage with non-state actors was one of the most difficult issues in an especially challenging session. In particular, in engaging with industry, two red lines must not be crossed, as I have stressed time and time again.
Industry must have no say on the technical guidance issued by WHO. And industry cannot participate in the formulation of public health policies. Both areas are prone to conflicts of interest. Both must be protected from influence by industries with a vested interest.
Combatting obesity involves many industries, including the sports industry. We must get the targets right, and here the Interim Report helps again.
The biggest harm comes from the marketing of sugar-rich non-alcoholic beverages and ultra-processed, energy-dense, and nutrient-poor foods, which are often the cheapest and most readily available, especially in poorer communities.
As noted in the report, these industries seek voluntary agreements and strongly oppose regulatory approaches. Both industries are powerful economic operators. Economic power readily translates into political power.
Let them make their promises. Welcome their proposals to reformulate their products. Then watch very closely and hold them accountable for what actually happens.
This is the approach being followed by some countries. Give these industries enough rope to hang themselves if they fail to deliver on voluntary agreements and marketing codes. But we cannot exclude them from the outset without giving them a chance.
Members of the Commission,
I am most pleased with the progress to date and deeply appreciate your brilliant work.
I look forward to receiving the next report, which will form the basis of a final round of consultations during the second half of this year.