Programming maternal and child overweight and obesity in the context of undernutrition: current evidence and key considerations for low- and middle-income countries

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childhood obesity 10548 randomized controlled trial on promotion of exclusive breast-feeding in Belarus did not find any effect on childhood obesity ([31]). A significant evidence gap remains on whether any relationship between breast-feeding and overweight
childhood obesity 21643 Kenya’s 2013 National Maternal, Infant, and Young Child Nutrition Policy Guidelines also state that childhood obesity is an emerging public health problem.Food systemsThe food system is a critical underlying determinant
obesity 76 Title: Public Health NutritionProgramming maternal and child overweight and obesity in the context of undernutrition: current evidence and key considerations for low- and middle-income
obesity 671 date (ppub): 5/2017NormalThe goals of the present targeted review on maternal and child overweight and obesity were to: (i) understand the current situation in low- and middle-income countries (LMIC) with regard
obesity 958 this, identify entry points for leveraging existing undernutrition programmes to address overweight and obesity in LMIC. Trends reveal that overweight and obesity are a growing problem among women and children in
obesity 1009 undernutrition programmes to address overweight and obesity in LMIC. Trends reveal that overweight and obesity are a growing problem among women and children in LMIC; as in Ghana, Kenya, Niger, Sierra Leone, Tanzania
obesity 1280 approaching 50 %. Four promising entry points were identified: (i) the integration of overweight and obesity into national nutrition plans; (ii) food systems (integration of food and beverage marketing regulations
obesity 2006 for programme officers and policy makers in LMIC with actionable objectives to address overweight and obesity .The increasing prevalence of overweight and obesity among women and children in low- and middle-income
obesity 2058 actionable objectives to address overweight and obesity.The increasing prevalence of overweight and obesity among women and children in low- and middle-income countries (LMIC) represents hindered progress on
obesity 2331 future economic development([1]). Between 2006 and 2015, the cost of lost economic productivity due to obesity -related CVD and diabetes in LMIC was estimated to be $US 84 billion([2]). Moreover, obesity-related
obesity 2423 due to obesity-related CVD and diabetes in LMIC was estimated to be $US 84 billion([2]). Moreover, obesity -related disability-adjusted life years in LMIC have increased dramatically over the past two decades:
obesity 2877 Hunger’, is to end all forms of malnutrition, strategies to address both undernutrition and overweight and obesity globally are urgently needed.The purpose of the present targeted review on maternal and child overweight
obesity 2994 are urgently needed.The purpose of the present targeted review on maternal and child overweight and obesity was not to systematically review trends in the prevalence of maternal and child overweight and obesity
obesity 3097 obesity was not to systematically review trends in the prevalence of maternal and child overweight and obesity in LMIC. Instead, we aimed to conduct a targeted review in order to: (i) understand the current situation
obesity 3409 this, identify entry points for leveraging existing undernutrition programmes to address overweight and obesity in LMIC. We focused on low-income and lower-middle-income countries, particularly in sub-Saharan Africa,
obesity 3745 in this important and almost entirely neglected topic in global nutrition.Trends in overweight and obesity among women and childrenAccording to the 2016 Global Nutrition Report, ‘obesity and overweight are
obesity 3827 in overweight and obesity among women and childrenAccording to the 2016 Global Nutrition Report, ‘ obesity and overweight are now a staggering global burden’([4]). A recent analysis of Demographic and Health
obesity 4527 areas of these countries will increase by 10 % over the next decade. The prevalence of overweight and obesity is lower in rural areas compared with urban areas in most LMIC([5]). However, looking at trends over
obesity 4688 most LMIC([5]). However, looking at trends over time, the recent rate of increase in overweight and obesity in several countries (e.g. Burkina Faso, Kenya, Uganda and Zimbabwe) is greater in rural areas compared
obesity 4960 persist, the gap is narrowing in some countries.While the most recent prevalence of overweight and obesity among adolescent girls was much lower than that among women, trend data indicate that the prevalence
obesity 5417 target for childhood overweight set by the WHO([8]).Context-specific risk factors for overweight and obesity Risk factors were identified via reviewing the seminal Lancet series on obesity (2011 and 2015) and the
obesity 5496 factors for overweight and obesityRisk factors were identified via reviewing the seminal Lancet series on obesity (2011 and 2015) and the Bellagio Conference on Program and Policy Options for Preventing Obesity in
obesity 5828 development, urbanization and globalization of the food system are thought to be key drivers of the global obesity epidemic, and are described in detail elsewhere([9],[10],[12]). Several risk factors may be of particular
obesity 7104 gestational weight gain due to a lack of counselling by health-care providers([14]). Given that maternal obesity and excess gestational weight gain have been associated with increased adiposity in offspring, largely
obesity 9002 respect to postnatal growth, a meta-analysis of fifteen studies reported an 84 % increase in risk of obesity at 10 years of age per 0·67 sd gain of weight in infancy([25]). Data from the COHORTS study suggest
obesity 9888 faltering in early life on adult stature([28]) are likely to outweigh any negative effects on adult obesity resulting from rapid ‘catch-up’ growth during this period([26]).While several systematic reviews
obesity 10101 meta-analyses, including a WHO-led review([29]), have found protective effects of breast-feeding on obesity in developed countries, including the USA, Canada, UK, Germany, Australia, New Zealand and former Czechoslovakia,
obesity 10558 controlled trial on promotion of exclusive breast-feeding in Belarus did not find any effect on childhood obesity ([31]). A significant evidence gap remains on whether any relationship between breast-feeding and overweight
obesity 14847 have sales and service jobs, especially in urban settings, and that this is linked to overweight and obesity , potentially through time pressures in addition to increased sedentary time([43]). Further research
obesity 15348 beliefs about body size may be an important barrier to programmes aimed at preventing overweight and obesity . For example, in urban areas of Pakistan, where 64 % of adult study participants were overweight, most
obesity 15917 him/herself as not being overweight([44]). In some sub-Saharan African countries, such as Nigeria, obesity is perceived as a sign of ‘power, respect, and an evidence of good living’([41]). Further research
obesity 16087 of good living’([41]). Further research is needed to understand beliefs relating to overweight and obesity , particularly in areas with a high prevalence of HIV/AIDS, as there may be a stigma attached to thinness
obesity 16256 there may be a stigma attached to thinness in these contexts([47]).Entry points for overweight and obesity programming within existing undernutrition programmesBased on our analysis of context-specific risk
obesity 16510 (Fig. 1) that highlights programmes and policies that could be prioritized to address overweight and obesity in LMIC. The WHO’s Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020([48]),
obesity 17095 Table 1. The four promising entry points identified were as follows:1.integration of overweight and obesity into national nutrition plans;2.food systems (integration of food and beverage marketing regulations
obesity 17867 such as increased uptake of optimal nutrition and health practices, and how they impact overweight and obesity and other forms of malnutritionTable 1Examples of programmatic approaches to address overweight and
obesity 17975 and other forms of malnutritionTable 1Examples of programmatic approaches to address overweight and obesity in low- and middle-income countries in the context of existing nutrition programmes largely focused
obesity 18901 ensures intra-household allocation of foods to infants and young childrenIntegration of overweight and obesity ∙Restrict marketing of unhealthy foods to children∙Food-based dietary guidelines∙Nutrition label
obesity 19132 curricula should include what constitutes a ‘healthy diet’, the health consequences of overweight/ obesity and the importance of physical activity∙Adolescent girls are an important target population∙Schools
obesity 19502 non-pregnant women and adolescents, through community channels or schools∙Develop overweight and obesity polices and guidelines and provide budgetary allocations for implementation at district and health facility
obesity 20609 community levels∙Include overweight indicators in national development plansIntegration of overweight and obesity into national nutrition plansStrong nutrition governance, including setting SMART (specific, measureable,
obesity 20879 linked to achieving undernutrition goals such as stunting([4],[51]). Few LMIC address overweight and obesity in their national nutrition plans. Kenya is an example of one such country. The Kenyan National Nutrition
obesity 21090 Nutrition Action Plan (2012–2017) outlines specific activities to address the increase in overweight and obesity in Kenya, including the following: review, develop and disseminate a comprehensive strategy and guidelines
obesity 21653 2013 National Maternal, Infant, and Young Child Nutrition Policy Guidelines also state that childhood obesity is an emerging public health problem.Food systemsThe food system is a critical underlying determinant
obesity 21961 and retail. Two aspects of food systems that are particularly important for addressing overweight and obesity in LMIC include: (i) implementing the WHO recommendations on marketing of food and beverages to children;
obesity 22392 children is likely to be one of the most cost-effective interventions available to governments to address obesity ([49],[52]). Three upper-middle-income countries (Brazil, Thailand and South Africa) have drafted resolutions
obesity 24419 in order to address micronutrient deficiencies, but now play the additional role of overweight and obesity prevention([60]). Several LMIC have also adopted food-based dietary guidelines. For example, the Dietary
obesity 24807 healthy eating and the prevention of malnutrition including micronutrient deficiencies and overweight and obesity ([61]). These Guidelines could be adapted to other countries as part of a comprehensive policy package
obesity 24967 countries as part of a comprehensive policy package to address malnutrition, including overweight and obesity .In 2005, the Ghana Ministry of Health adopted the Regenerative Health and Nutrition Program with the
obesity 29226 fish to ten primary schools where enrolment has increased by 15 %([71]). Prevention of overweight and obesity could be an important co-benefit of such programmes.Health systemsCurrently, programming during routine
obesity 29497 facility levels in LMIC focuses on reducing undernutrition without consideration of overweight and obesity . However, these are unique opportunities to address maternal diet and weight gain during pregnancy,
obesity 29708 well as infant and young child feeding practices that are important risk factors for overweight and obesity .Few studies in LMIC have evaluated the impact of antenatal counselling on appropriate gestational weight
obesity 30538 Accra, Ghana, found that they were willing to reduce their body size in order to reduce the risk of obesity -related illnesses such as hypertension, diabetes, CVD and myocardial infarction([72]). Education, income,
obesity 31016 diet and weight gain during pregnancy during antenatal care can potentially address overweight and obesity in LMIC.Another important point of entry is existing health promotion-based interventions such as complementary
obesity 32925 pregnancy([74]) in the context of LMIC.∙Studies on the association between maternal overweight and obesity , gestational weight gain and child health outcomes.∙Studies of the long-term impact of dietary intake
obesity 33096 of the long-term impact of dietary intake during infancy and early childhood on adult overweight and obesity .∙Drivers of food choice, especially among overweight mothers, and how this information can be used
obesity 34610 extreme conditions, such as war and famine, no country has witnessed a decline in the prevalence of adult obesity ([11]). Current expert opinion holds that a package of initiatives including multisectoral policies and
obesity 35117 a systematic review and meta-analysis of specific programmes and policies to address overweight and obesity in LMIC. In addition, to date, programmes have struggled with operationalizing overweight and obesity
obesity 35219 obesity in LMIC. In addition, to date, programmes have struggled with operationalizing overweight and obesity within the context of undernutrition, and programmatic and routine data from health systems are largely
obesity 35564 in the coming years to inform such a systematic review.The first step to addressing overweight and obesity in LMIC is integration into national nutrition plans and setting SMART targets. Nevertheless, even with
obesity 35728 setting SMART targets. Nevertheless, even with these commitments, implementation of overweight and obesity prevention programmes and policies will be a challenge. To aid in this process, we have developed a
obesity 36214 messages and an implementation plan.Fig. 3Step-by-step implementation guide to address overweight and obesity in low- and middle-income countries (DHS, Demographic and Health Survey)The 2016 Global Nutrition Report
obesity 36487 issues of wasting, stunting and micronutrient deficiencies persist in the face of rising overweight and obesity ([4]). Integration of efforts to address overweight and obesity within existing programmes focused on
obesity 36550 in the face of rising overweight and obesity([4]). Integration of efforts to address overweight and obesity within existing programmes focused on undernutrition is needed to maintain gains in maternal and child

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