Table II.
Household or societal level actions suggested by stakeholders to contain childhood obesity in India
| Action point | Implementation plan |
|---|---|
| Functional referral health systems | Referral systems exist within National Health Mission - There are over 7500 adolescent health clinics, RKSK clinics and RBSK clinics. Trained counsellors and health ambassadors for behavioural change already exist within these clinics. In addition, services of community workers (ASHA, ANM, AWW and VHNSCs) can be used to link vulnerable individuals and referral mechanism through anthropometric monitoring. These health workers can play a significant role in advocacy. |
| Shaping the eating and physical activity habits at schools | Every child should have an individual growth chart. This is possible through mandatory growth monitoring (BMI-for-age) charts at school/college admissions (transfer certificates). This could be integrated with annual health check-up and assess physical fitness in schools. (i) Two teachers per school to be trained as health ambassadors. NCERT teachers training curriculum should include optimal nutrition and growth monitoring concepts. (ii) Children in private schools also to be focused and mandated for annual physical fitness. (iii) PTA in schools (public and private) to improve diet and physical activity environment in (school canteens) and around schools. |
| Promotion of physical activity | Urban town planning departments and green tribunals shall mandate construction of park, walk-ways, safe play areas, grounds, cycling tracks, etc., in urban localities (i) Physical activity guidelines for workplaces to be issued based on regional contexts. (ii) Integrate physical activity with cultural beliefs - advocacy with religious leaders to include five minutes of exercise after prayers. |
| Social exclusion of HFSS foods | Strong advocacy campaigns to make HFSS foods socially unacceptable. Market will respond to healthy food demands. |
| VHNSC’s to track vulnerable individuals | Nutritional imbalance, substance abuse (smoking and alcohol) is common among migrants, labourers and out-of-school children. VHNSCs through ASHAs and ANMs can locally identify vulnerable individuals and integrate them with existing referral mechanism. (i) Family health cards were recommended under NHM. At present, BMI is not included in such cards. These could be made digital and integrated with national schemes. (ii) Promote VHND once in a month. |
| Grading of obesogenic environment at societies | Develop and implement scientific methods to grade and classify neighbourhoods based on the density of obesogenic environment. This shall be done according to population density and proportion of at-risk individuals in the locality which is correlated with access to HFSS foods. |
| Community Food and Nutrition Units (MoWCD) |
(i) There are 43 CFNEUs in 29 States which could be used to monitor micronutrient availability at village levels. (ii) Support of NCPCR, NCW, NIPCCD, CSWB and RMK can be used. |
RKSK, Rashtriya Kishor Swasthya Karyakram; RBSK, Rashtriya Bal Swasthya Karyakram; BMI, body mass index; PTA, Parent Teachers Association; VHND, Village Health and Nutrition Day; CFNEUs, Community Food and Nutrition Extension Units; NCPCR, National Commission for Protection of Child Rights; NCW, National Commission for Women; NIPCCD, National Institute of Public Cooperation and Child Development; CSWB, Central Social Welfare Board; RMK, Rashtriya Mahila Kosh; AWW, Anganwadi Worker; ANM, auxiliary nurse midwife; VHNSCs, Village Health Nutrition and Sanitation Committee; NCERT, National Council of Education Research and Training; HFSS, high-fat, sugar and salt; NHM; National Health Mission; MoWCD, Ministry of Women and Child Development