EDITORIAL

ESPERANZA FAJARDO BONILLA, ND, MSc^a

^a Correspondencia: esperanza.fajardo@unimilitar.edu.co - Dirección Postal: Trav. 3 No. 49-00. Facultad de Medicina, Universidad Militar Nueva Granada. Bogotá, Colombia.

Infant malnutrition in Colombia has been a topic of great relevance which has been given the most attention by government agencies; such efforts have had positive results since in different population studies a reduction in prevalence of this nutritional problem has been demonstrated, not only in our Country but in other Latin American Countries.

Nutritional status studies carried out in Colombia during the past years, with national representation, have emphasized on the reduction of malnutrition rates in children. The low weight-for-age percentage in younger than 5 years have decreased from 21.1% in 1965 to 6.7% in 2000, and to 3.4% according to the National Survey on Nutritional Status in Colombia 2010 (Encuesta Nacional de la Situación Nutricional en Colombia 2010 [ENSIN]). A similar situation is observed with chronic malnutrition (height/age): 21% in 1990, 15% in 1995, 13.5% in 2000 and 13.2% in 2010.

Thanks to the National Nutrition Plan, since 1999 an important change in the infant nutritional status was observed when a suitable feeding and nutrition both at the individual and collective level was pursued and feeding safety actions focused on the most vulnerable homes and groups were developed. Moreover, the presence of all types of malnutrition has declined as the formal education level and mothers’ economic level increases.

However, in Colombia and Latin American Countries overweight and obesity problems associated with elevated intake of foods with high carbohydrate-derived energy and fats content along with sedentarism have been added to the original issues of nutritional deficiency in the infant population. This is known as double burden of malnutrition or nutritional transition.

The World Sanitary Statistics introduced by the World Health Organization ratify that the prevalence of overweight and obesity have increased not only in the United Stated and other developed Countries but worldwide which has leaded to state the obesity as a disease, with a special concern for abdominal obesity, and assert that the adverse effects of obesity and abdominal adiposity start in childhood and adolescence.

The obesity, considered in ancient times as a high social status, wellbeing and even beauty symbols, has become nowadays a chronic non transmissible disease contributing in a very important way to the raise in the prevalence of risk factors for cardiovascular and metabolic diseases which represent the first cause of death in the current society. Furthermore, it is associated with a higher occurrence of different types of cancer, osteoarticular disorders, respiratory, immunological and gastric complications as well as behavior disturbances and loss of self-esteem. All this significantly affects the health and physical and mental well-being of children and adults.

The double burden of malnutrition in the infant population (malnutrition / obesity) implies that children and adolescents are confronted with consequences which result in low school performance, learning issues, school absenteeism as well as health and well-being risks in later stages of life. For the society, it involves not only high healthcare costs but a decrease in the population’s productivity and quality of life.

Latin American landscape

According to the Mexican National Health and Nutrition Surveys with official reports from 1988 to 2006, overweight and obesity in children, young and adults Mexicans have increased alarmingly during the last years. Regarding school age children, aged between Revista 20 (1): 9-11, 2012 5 and 11 years, the obesity increased from 18.4% to 26.2% from 1999 to 2006, and to 31.7% in 2011; among adolescents, from 1988 to 2006, it turned from almost 9% to 28.5%; and in adults, in the same years it rose from 34.5% to near 70%.

In Argentina, the Health Ministry reports that obesity and overweight figures in children aged 5 to 11 years between 1999 and 2006 increased from 18.6% to 26%. In adolescents, the prevalence of obesity ranges from 5% to 8% with a trend to rise. It is said that in this country 7 out of 10 children are born within poverty and many of them become obese; recent reports point out that 7.3% of children younger than 5 years are obese.

In Chile, it has been observed in recent years an important increase in obesity as well, thus being categorized as a country under nutritional transition. According to reports of the Chilean Health Ministry, overweight and obesity in school children have moved from 16% to 19.4% from 2000 to 2009. In 2005, preschool children attending infant nursery schools of the National Joint of Nursery Schools (Junta Nacional de Jardines Infantiles [JUNJI]), showed a 22.7% of overweight prevalence and 10.6% for obesity revealing that childhood obesity is the most important nutritional problem in children of intermediate-low and low status of the country.

At present, it is well known than Colombia in not immune to this problem with reports showing that already in 1995, 2.6% preschool children were overweight. In the National Survey on Nutritional Status and Food Intake in Colombia 2005 (Encuesta Nacional de la Situación Nutricional en Colombia 2005 [ENSIN]) it was observed that 4.3% of children between 5 and 9 years and 10.3% of children between 10 and 17 years were overweight taking into account the weight for height, with no difference by gender, age or region being observed. The ENSIN 2010 reports that at the national level, 13.4% of population between 5 and 17 years are overweight and 4.1% are obese, being obesity more common en the group aged 5 to 9 years, with predominance of overweight in girls and obesity in boys

Different studies by countries report a low intake of fruits and vegetables with a high intake of foods regarded as sources of carbohydrates and fat, pointing out, additionally, the increase in the intake of fast foods, sodas, artificial juices, soft drinks and sweetened beverages which only provide energy and are lacking in vitamins, minerals or proteins.

On the other hand, obesity is no longer an issue of populations with high socioeconomic status as has been demonstrated in different countries. It is worth mentioning that the association between alimentary unsafety and childhood obesity has been proposed and although it hasn’t been demonstrated, this may be a point of interest to be studied since increasingly greater number of cases is observed in populations of low socioeconomic status.

One plausible explanation for the above mentioned is that foods rich in energy, producers of high satiety, with high fat and carbohydrate content are cheaper; therefore, people counterbalance those periods where food is scarce with an increased intake, both in frequency and amount when there is availability. Such behavior promotes cyclic changes in the body weight which lead to metabolic changes turning more efficient the mechanisms to accumulate body fat and giving rise to a weight increase. To the poor feeding behaviors adds the sedentarism in children who spend many hours in front of the TV or computer having increasingly less opportunities to perform sportive or recreational activities, either due to low economic income or their parents’ fear to the urban street violence, unsafety in parks, or just the family’s life style preventing a higher energetic output by the children.

In Colombia, the ENSIN 2010 reveals that 57.9% of children aged 5 to 12 years watch TV or play video games 2.4 hours or more per day and the adolescents, 2.8 hours a day. It was evidenced that overweight or obese children had a higher prevalence of watching TV or playing video games compared with children with normal Body Mass Index. The World Health Organization recommendations state that school age children should do 60 minutes or more of physical activity each day and spend approximately a maximum of two hours watching TV for this group of population, so as to not displace the time destined to vigorous activities.

Intervention

The obesity prevention should begin in childhood, including promotion of healthy lifestyles. This is the key for success. The intake of foods such as fruits and vegetables should be promoted avoiding the excess of fats and flours. It has been demonstrated that it is easier to teach than it is to modify behaviors since latter generates higher costs in the interventions and greater failures.

School age is an important period to promote and consolidate abilities in every area of development and to reaffirm healthy feeding behaviors. Thus, children and youngsters can reach an excellent quality of life and ensure the needed reserves to cover the energy output demanded by the new activities assumed during this life time.

Then, it is necessary that the society as a whole, governments, industry and mass media get involved in order to joint efforts in the fight against childhood obesity, approaching the problem of excessive weight as from the early stages from a perspective of public health.

The physical activity as a key constituent in the prevention of childhood obesity should encompass activities which can persist over time, which are appropriate for the child’s development and are so pleasant that allow enjoying the activity, and avoid those intense or difficult to maintain as is usually attempted with the adults.

Fighting the obesity through a healthy feeding and an active lifestyle is a task that involves the whole community. The consequences are not only on health but on society and economy and it is essential to generate changes in the minds of people who are responsible for healthcare in our country where we still need to assume the obesity as a serious public health problem.

Considering the worldwide overweight and obesity increase, effective interventions have been conducted in different countries at the school level with the joint aim of improving the feeding patterns and physical activity thus preventing the diseases associated with obesity and sedentarism. Furthermore, there are guidelines or rules to increase the physical activity levels in children, released by the World Health Organization.

A more active performance with infant population is needed to be able to fight this scourge of obesity in order to integrate the previous, present and future national efforts to generate sufficiently compelling evidence at the Colombian population level. Let’s remind that the World Health Organization has estimated the obesity prevalence in the adult population (with BMI ≥30), inferring that Colombia will have between 30% and 45.5% obese people by 2015. Colombia already relies on the Law 1355 - 2009 where obesity and chronic non transmissible associated diseases are defined as a public health priority, and measures for its control, attention, and prevention are adopted. Thus, there is the need to implement it and support healthcare interventions in the community for primary prevention of obesity, which at the same time can be useful to reduce the prevalence of chronic diseases in the population.