Letter: Obesity in Children and Adolescents: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity (J Obes Metab Syndr 2024;33:11-9)

I read with interest the recent article published in this journal about the prevalence of obesity in children and adolescents, which has gradually increased in recent years to become a major health problem. The authors rightfully emphasized that childhood obesity can be prevented and treated using appropriate treatment goals and safe and effective treatment strategies.¹ I firmly support this call for prevention, as obesity has emerged as a serious health problem not only in highly developed countries like Korea but also in developing nations like the Philippines. In relation to the authors’ emphasis about the need for effective strategies, I propose that a holistic approach is necessary for a successful prevention program. With this in mind, I aim to present the status of childhood obesity in the Philippines, explore its contributing factors, and propose interventions for this approach to address the issue.

Obesity is a condition marked by an abnormal or excessive accumulation of fat that presents a health risk. The vast majority of overweight or obese children lives in developing countries, where the rate of increase has been >30% higher than that in developed countries.² Childhood obesity in the Philippines is becoming an alarming public health issue as rates continue to increase. The latest survey showed that the incidence of obesity increased from 8.6% in 2015 to 11.7% in 2018, with the highest rates noted among those >10 to 19 years old. Overnutrition is more prevalent in children from urban areas (15.8%) compared to rural areas (8.2%) and in the wealthiest quintile (6.9%) compared to the poorest quintile (3.4%).³ Supplementary Table 1 presents data on overweight and obesity among children in the Philippines by age groups of <5, 5–10, and 10–19 years by region.⁴

Local experts have identified several key drivers of obesity in the country, one of which is the surplus of fast-food chains and “all-you-can-eat” restaurants. Most fast-food meals are energy-dense and nutrient-poor, containing high levels of sodium, sugar, and saturated and trans fats. There is also a prevalence of unhealthy foods in the Philippine market, which unnaturally encourage food cravings, as well as television and social media advertising/marketing campaigns promoting unhealthy food. Children prefer and even request foods with enticing effects, such as those promoted by their favorite celebrities/influencers, cartoon characters, superheroes, and idols. Despite their “junk” ingredients, the affordability of unhealthy foods can also convince parents to buy them, especially when the family is on a tight budget, since they are cheaper and greater quantities can be purchased with the bigger discounts offered by manufacturers. Finally, the limited physical activity among children further adds to the problem.⁵

As mentioned, addressing this problem requires a holistic approach. While other approaches focus on what health professionals have suggested about the “dos” and “don’ts” regarding children’s everyday diet and activities or what the latest research says about non-healthy foods, a holistic approach would integrate the essential roles of not only experts and academicians/researchers, but also the government and families, who must collaboratively help one another and implement strategies for a robust fight against childhood obesity.

Understanding the causes of childhood obesity can direct government policy interventions and help families determine healthy choices. The government must include and be stricter in its policies regarding the packaging labels of food products, especially those with high fat, sugar, and salt contents. Legislation to restrict the marketing of junk foods must be implemented. Regarding cheaper but unhealthy food items, the responsible government agency must subsidize alternative healthy foods so that their lower prices can compete with those of the cheaper but unhealthy food items. In addition, the government should also complete additional infrastructure projects like nature parks and sports facilities to promote play, exercise, and other outdoor activities, especially for children. Regular exercise remains one of the best ways to improve the immune system and stay physically/mentally fit.

Among individual families, parents, nannies, and other caregivers are the first line of defense against an unhealthy diet. Sufficiency of vitamins and minerals starts during pregnancy. A mother who eats right can influence a baby’s preferences and nutritional status upon birth. In addition, breastfeeding is a crucial healthy habit, with optimum benefit from exclusive breastfeeding from birth to 6 months and then starting complementary feeding with continued breastfeeding up to 2 years. Babies who are not breastfed and instead fed formula milk have a higher risk of becoming overweight. In the same way, parents must monitor their children’s eating habits, especially in school, where they spend ample time. They can also communicate with the school’s administrators about the availability of more healthy snacks/meals in the canteens. As much as possible, they must allocate time to prepare personally healthy meals for their children despite their busy schedules. Buying cheaper but unhealthy foods must also be avoided as health should be more important than money. If all these institutions do their part and be consistent in their application, then the possibility of significantly improving childhood obesity is within reach.

SUPPLEMENTARY MATERIALS

Supplementary materials can be found online at https://doi.org/10.7570/jomes24022.