A new report on nutrition in the 21st century has highlighted the link between foetal and childhood undernutrition and obesity.

"Ending Malnutrition by 2020: an Agenda for Change in the Millennium", was prepared for the United Nations by the Commission on the Nutrition Challenges of the 21st Century, chaired by Prof Philip James.  A pre-publication version of the report was launched in March at a London press conference with the support of the IOTF secretariat. 

The report warns: "Evidence from both developing and industrialized countries suggests a fundamental link between maternal and early childhood undernutrition and an increased susceptibility in adult life to non-communicable diseases (NCDs) such as diabetes, heart disease and hypertension.  These diet-related diseases – including cancers – are already major public health challenges for developing countries.
"Overweight and obesity are rapidly growing in all regions, affecting children and adults alike.  There are about 250 million obese adults already and these problems are now so common in developing countries that they are dominating more traditional public health concerns such as undernutrition and infectious disease.  Obesity, especially abdominal obesity promoted by early fetal and childhood undernutrition is a major risk factor for a number of NCDs, adult-onset diabetes in particular." 

About 30 million children in developing countries - one in four newborn babies - suffer retarded growth in the womb. The Commission Report warns that at present rates of progress, about one billion stunted children will grow up with impaired mental development by 2020. 

Set up by the UN in 1997, the Commission proposes a new key role in mobilizing nutrition action worldwide, the creation of new national nutrition councils around the world to spearhead the introduction of new coherent plans for the development of food and health policies, and improved cooperation between related UN agencies. It also wants governments in the West to make the elimination of malnutrition a sharper focus of international aid as a key step to eliminating poverty.

"All the best predictions show that current approaches are not going to work. We are calling for a much stronger approach to make sure the UN supports nutrition in a coherent way at country level," added Prof James.

Commission members are: Prof Philip James; Dr Ricardo Uauy from Chile, who is also an IOTF member;  Suttilak Smitasiri, Thailand,  Julia Tagwireyi, Zimbabwe; Kaare R. Norum, Norway; M.S. Swaminathan, India; the eighth member, Mahbub ul Haq, Pakistan, died in 1998 before the report was completed. A web version of the report is available on http://www.iotf.org/php.

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With a Latin American Obesity Summit scheduled in Rio de Janeiro in June, and an IOTF obesity workshop in the Caribbean later this year, Dr Naomi Rees looks at a timely new book which highlights the issues for the region.         Obesity and Poverty: A New Public Health Challenge - edited by Manuel Peña and Jorge Bacallao

This new publication from the Pan American Health Organization (PAHO) offers an assessment of the problem of obesity and related diseases for the peoples in the Latin American and Caribbean region. The editors have assembled an impressive range of authors, whose contributions provide strong motivation for addressing this important public health challenge. 

The book surveys existing obesity data across several countries, but more importantly provides the evidence that the underlying reasons (and therefore solutions) can be very different from country to country and even between sub-populations within communities. The case studies nicely illustrate how individual countries have undergone radical social, economic and demographic changes alongside important changes in eating patterns and physical activity. However, the underlying conclusion is the same - it is the poor urban women who suffer the most. 

As a compilation of the most recent data for this region, this is an invaluable and most welcome publication, providing strong evidence that poverty and obesity co-exist. While not proposing or recommending specific policy solutions, the contributors do illustrate how the huge problem of obesity and the related chronic disease such as diabetes, heart disease, hypertension are likely to make subsequent demands on public health services throughout the region. The challenge is to develop effective prevention and management strategies, based on the solid research, to slow and reverse the overweight and obesity rates bearing in mind the economic and social differences found within the Latin American and the Caribbean region. This document is a significant step in the right direction.

Obesity and Poverty: A New Public Health Challenge can be ordered from PAHO by fax +1 202 2069789 or email paho@pmds.com or by post:
PAHO Sales and Distribution Center
PO Box 27, Annapolis Junction, MD 20701-0027 USA