One main issue of Nutrition Decade is to end hunger and all forms of malnutrition, undernutrition and obesity will be mainly considered due to the fact that micronutrient malnutrition deserves specific actions nor always feasible. Undernutrition and obesity are quite different or even antagonist situations but their origin is the same: inappropriate nutrition which enables us to deal with both in a general and individual preventive frame. In high-income countries (HIC) overweight and obesity are the predominant form, in low-and middle-income countries (LMIC) traditionally undernutrition in all its forms has been the foremost one, but presently this coexists with a steady trend in obesity , ie the ‘double burden’. Because of the long term consequences of malnutrition adequate nutrition should be a target in the first 1000 days of life that could be extended to all children under five.
As said by the FAO Director-General (UN General Assembly, 20th September 2016, New York) the preventive action ‘start at country level’. This is a crucial point and many of the individual four preventive points that should be carried out by the primary health care provider acting directly on malnourished people are hardly impaired without this national support.
There have been significant advances related to malnutrition in the last decades (UN Agencies) as is the pediatric undernutrition recoil (1990 30.2%; 2015 19.3%) (1), although this not occurring with obesity. It is worth considering that if there are good preventive programs why has obesity been increasing until now and will continue up to 2030 or even 2060 (2): Probably the reasons are: Too many plans/ guidelines not all with the desirable quality and wide covering, the flow from global directions to individual level is slow moving even in HIC with integrative approaches, the difficulty of applying evidence criteria for assessing preventive effectivity. Therefore the continuous evaluation of the applied procedures is far from generalized. Labeling (Flabel in EU), fast food advertising, taxes for sugary drinks, school-lunch programs for malnutrition, epigenome-wide association study (EWAS) and so many others, still have an unknown impact on obesity reduction. In HIC the specific budget for prevention is considerably lower than that of acute care. In LMIC nothing is done apart from punctual and small actions, consequently in a few decades obesity there will be an added problem to the treatment lag of these regions. The country-driven plans are probably the top priority.
- Unicef, WHO, World Bank Group. Levels and trends in child malnutrition. Key findings of the 2015 edition. Unicef/jmedashboard 2015.
- Sabin MA, Kao KT, Juonala M, Baur LA, Wake M. Viewpoint article: Childhood Obesity-looking back over 50 years to begin to look forward. Journal of Pediatrics and Child Health S1 (2015) 82-86. Doi: 10.1111/ipc.12819.
Manuel Moya