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In summary, key policy interventions for the prevention of stunting are:
- Improvement in nutrition surveillance activities to identify rates and trends of stunting and other forms of malnutrition within countries. This should be done with an equity perspective, as it is likely that stunting rates will vary greatly between different population groups. The most vulnerable should be prioritized. The same should be done for risk factors such as anemia, maternal under-nutrition, food insecurity, low birth-weight, breastfeeding practices etc. By collecting more detailed information, it is easier to ensure that policy interventions really address the root causes of stunting.
- Political will to develop and implement national targets and strategies in line with evidence-based international guidelines as well as contextual factors.
- Designing and implementing policies promoting nutritional and health well-being of mothers and women of reproductive age. The main focus should be on the 1000 days of pregnancy and first two years of life, but the pre-conception period should not be neglected as it can play a significant role in ensuring the fetus and baby's nutrition.
- Designing and implementing policies promoting proper breastfeeding and complementary feeding practice (focusing on diet diversity for both macro and micronutrients). This can ensure optimal infant nutrition as well as protection from infections that can weaken the child's body. Labor policy ensuring mothers have the chance to breastfeed should be considered where necessary.
- Introducing interventions addressing social and other health determinants of stunting, such as poor sanitation and access to drinking water, early marriages, intestinal parasite infections, malaria and other childhood preventable disease (referred to as “nutrition-sensitive interventions”), as well as the country's food security landscape. Interventions to keep adolescent girls in school can be effective at delaying marriage with subsequent nutritional benefits for both women and babies. Regulating milk substitutes is also very important to ensure that as many mothers as possible breastfeed their babies, unless a clear contraindication is present.
- Broadly speaking, effective policies to reduce stunting require multisectoral approaches, strong political commitment, community involvement and integrated service delivery.
Ensuring proper nutrition of pregnant and lactating mothers is essential. Achieving so by helping women of reproductive age be in good nutritional status at conception is an excellent preventive measure. A focus on the pre-conception period has recently been introduced as a complement to the key phase of the 1000 days of pregnancy and first two years of life. An example of this is are attempts to control anemia in women of reproductive age. A well-nourished mother is the first step of stunting prevention, decreasing chances of the baby being born of low birth-weight, which is the first risk factor for future malnutrition.
After birth, in terms of interventions for the child, early initiation of breastfeeding, together with exclusive breastfeeding for the first 6 months, are pillars of stunting prevention. Introducing proper complementary feeding after 6 months of age together with breastfeeding until age 2 is the next step.
There are no medications currently approved for the treatment of obesity in children. The American Academy of Pediatrics recommends medications for obesity be discourage. Orlistat and sibutramine may be helpful in managing moderate obesity in adolescence. Metformin is minimally useful. A Cochrane review in 2016 concluded that medications might reduce BMI and bodyweight to a small extent in obese children and adolescents. This conclusion was based only on low quality evidence.
Although there are many short- term preventative methods in place to combat childhood, there are some individuals who return to their initial base weight and therefore might turn to surgical measures to achieve a more lasting effect. Bariatric surgery is an effective procedure used to restrict the patients food intake and decrease absorption of food in the stomach and intestines. Proecdures of this type are said to be able to reduce excess body weight of obese or overweight individuals by 50-75%, ultimately maintaining this weight loss for 16 years following.
According to the Brazilian Government, the most serious health problems are:
- Childhood mortality: about 1.51% of childhood mortality, reaching 2.77% in the northeast region.
- Motherhood mortality: about 42.1 deaths per 100,000 born children in 2016.
- Mortality by non-transmissible illness: 65.7 deaths per 100,000 inhabitants caused by heart and circulatory diseases, along with 26.7 deaths per 100,000 inhabitants caused by cancer.
- Mortality caused by external causes (transportation, violence and suicide): 55.7 deaths per 100,000 inhabitants (10.9% of all deaths in the country), reaching 62.3 deaths in the southeast region.
In 2002, Brazil accounted for 40% of malaria cases in the Americas. Nearly 99% are concentrated in the Legal Amazon Region, which is home to not more than 12% of the population.
Obesity in Brazil is a growing health concern. 52.6 percent of men and 44.7 percent of women in Brazil are overweight. 15% of Brazilians are obese. The Brazilian government has issued nutrition guidelines which have caught the attention of public health experts for their simplicity and their critical position towards the food industry. The guidelines are summarized at the end of the document as follows:
1. Prepare meals using fresh and staple foods.
2. Use oils, fats, sugar, and salt only in moderation.
3. Limit consumption of ready-to-eat food and drink products.
4. Eat at regular mealtimes and pay attention to your food instead of multitasking. Find a comfortable place to eat. Avoid all-you-can-eat buffets and noisy, stressful environments.
5. Eat with others whenever possible.
6. Buy food in shops and markets that offer a variety of fresh foods. Avoid those that sell mainly ready-to-eat products.
7. Develop, practise, share, and enjoy your skills in food preparation and cooking.
8. Decide as a family to share cooking responsibilities and dedicate enough time for health-supporting meals.
9. When you dine out, choose restaurants that serve freshly made dishes. Avoid fast-food chains.
10. Be critical of food-industry advertising.
Obesity in children is treated with dietary changes and physical activity. Dieting and missing meals should; however, be discourage. The benefit of tracking BMI and providing counselling around weight is minimal.
The main treatment for obesity consists of dieting and physical exercise. Diet programs may produce weight loss over the short term, but maintaining this weight loss is frequently difficult and often requires making exercise and a lower food energy diet a permanent part of a person's lifestyle.
In the short-term low carbohydrate diets appear better than low fat diets for weight loss. In the long term; however, all types of low-carbohydrate and low-fat diets appear equally beneficial. A 2014 review found that the heart disease and diabetes risks associated with different diets appear to be similar. Promotion of the Mediterranean diets among the obese may lower the risk of heart disease. Decreased intake of sweet drinks is also related to weight-loss. Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%. Dietary and lifestyle changes are effective in limiting excessive weight gain in pregnancy and improve outcomes for both the mother and the child. Intensive behavioral counseling is recommended in those who are both obese and have other risk factors for heart disease.
Five medications have evidence for long-term use orlistat, lorcaserin, liraglutide, phentermine–topiramate, and naltrexone–bupropion. They result in weight loss after one year ranged from 3.0 to 6.7 kg over placebo. Orlistat, liraglutide, and naltrexone–bupropion are available in both the United States and Europe, whereas lorcaserin and phentermine–topiramate are available only in the United States. European regulatory authorities rejected the latter two drugs in part because of associations of heart valve problems with lorcaserin and more general heart and blood vessel problems with phentermine–topiramate. Orlistat use is associated with high rates of gastrointestinal side effects and concerns have been raised about negative effects on the kidneys. There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death.
The most effective treatment for obesity is bariatric surgery. The types of procedures include laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, vertical-sleeve gastrectomy, and biliopancreatic diversion. Surgery for severe obesity is associated with long-term weight loss, improvement in obesity related conditions, and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all cause mortality when compared to standard weight loss measures. Complications occur in about 17% of cases and reoperation is needed in 7% of cases. Due to its cost and risks, researchers are searching for other effective yet less invasive treatments including devices that occupy space in the stomach.
Obesity in Argentina is a growing health concern with health officials stating that it is one of the leading causes of preventable deaths in the Argentina. According to FAO/UNO, the prevalence of obesity among adults in Argentina was of 29.4% in 2008.
Obesity in Saudi Arabia is a growing health concern with health officials stating that it is one of the leading causes of preventable deaths in Saudi Arabia. According to "Forbes", Saudi Arabia ranks 29 on a 2007 list of the fattest countries with a percentage of 68.3% of its citizens being overweight (BMI>25). Compounding the problem, according to a presentation at the 3rd International Obesity Conference in February 2014, is that obesity-related surgeries are not covered under Saudi healthcare.
Obesity in North Africa and the Middle East is a notable health issue. In 2005, the World Health Organization measured that 1.6 billion people were overweight and 400 million were obese. It estimates that by the year 2015, 2.3 billion people will be overweight and 700 million will be obese. The Middle East, including the Arabian Peninsula, Eastern Mediterranean, Turkey and Iran, and North Africa, are no exception to the worldwide increase in obesity. Subsequently, some call this trend the New World Syndrome. The lifestyle changes associated with the discovery of oil and the subsequent increase in wealth is one contributing factor.
Urbanization has occurred rapidly and has been accompanied by new technologies that promote sedentary lifestyles. Due to accessibility of private cars, television, and household appliances, the population as a whole is engaging in less physical activity. The rise in caloric and fat intake in a region where exercise is not a defining part of the culture has added to the overall increased percentages of overweight and obese populations. In addition, women are more likely to be overweight or obese due to cultural norms and perceptions of appropriate female behavior and occupations inside and outside of the home.
A lack of exercise is a cause of obesity. A study showed that children only got 30 minutes of exercise instead of the hour that is required. Proper skeletal development, muscle building, heart and circulation are among the benefits of exercising during childhood.
Obesity rates in Italian two-year-olds are the highest in Europe with a rate of 42%. Causes are lack of a Mediterranean diet and lifestyle choices such as exercise and getting enough sleep.
The usual treatments for overweight individuals is diet and physical exercise.
Dietitians generally recommend eating several balanced meals dispersed through the day, with a combination of progressive, primarily aerobic, physical exercise.
Because these general treatments help most case of obesity, they are common in all levels of overweight individuals.
Obesity in Austria has been increasingly cited as a major health issue in recent years. Forty per cent of Austrians between 18 and 65 are considered overweight while eleven per cent of those overweight meet the definition of obesity. Forbes.com ranks Austria as the 52nd fattest country in the World with a rate of 57.1%. Approximately 900,000 people are considered overweight or obese.
Obesity in China is a major health concern according to the WHO, with overall rates of obesity below 5% in the country, but greater than 20% in some cities. This is a dramatic change from times when China experienced famine as a result from ineffective agriculturalization plans such as the Great Leap Forward.
Currently, obesity in China is mostly confined to the cities where fast food culture and globalization have taken over, in comparison to poorer rural areas. Despite this concentration of obesity, the sheer size of China's population means that over one fifth of all one billion obese people in the world come from China.
Weight management has two steps: weight loss and weight maintenance. In the weight loss phase, energy intake from food must be less than the energy expended each day. Achieving weight loss in cats and dogs is challenging, and failure to lose weight is common.
Medical treatments have been developed to assist dogs in losing weight. Dirlotapide (brand name Slentrol) and mitratapide (brand name Yarvitan) were authorized for use in the EU by the European Medicines Agency for helping weight loss in dogs, by reducing appetite and food intake, but both of these drugs have been withdrawn from the market in the EU. The US Food and Drug Administration approved dirlotapide in 2007. Up to 20% of dogs treated with either dirlotapide or mitratapide experience vomiting and diarrhea; less commonly, anorexia may occur. When these drugs are stopped, the dog's appetite returns to previous levels. If other weight-loss strategies are not employed, the dog will again gain weight.
According to 2007 statistics from the World Health Organization (WHO), Australia has the third-highest prevalence of overweight adults in the English-speaking world.Obesity in Australia is an "epidemic" with "increasing frequency." "The Medical Journal of Australia" found that obesity in Australia more than doubled in the two decades preceding 2003, and the unprecedented rise in obesity has been compared to the same health crisis in America. The rise in obesity has been attributed to poor eating habits in the country closely related to the availability of fast food since the 1970s, sedentary lifestyles and a decrease in the labour workforce.
Several studies have shown that obese men tend to have a lower sperm count, fewer rapidly mobile sperm and fewer progressively motile sperm compared to normal-weight men.
Obesity in Germany has been increasingly cited as a major health issue in recent years. The federal government has declared this to be a major issue.
Data released by the World Health Organisation in 2014 showed that while an issue of growing concern, within the European Union, Germany had a lower incidence of overweight and obese adults as a percentage of the total population at 54.8% in comparison with France at 60.7%, Spain at 60.9% or the United Kingdom at 63.4%.
There are many options available in treating obesity, such as: altering one's diet and exercising regularly. Moderate forms of exercise, such as walking, can lead to healthy weight loss. Some people who are obese turn to gastric bypass surgery in order to reduce their appetites. It is always advised to consult a physician regarding any obesity treatment.
It is recommended that obese women should try to lose weight before becoming pregnant, yet women should not diet during pregnancy because sufficient nutrition is important for pregnant women and women planning pregnancy. Women with gastric banding can have normal pregnancies and better outcomes than women who do not have the surgery, but in most cases, doctors have agreed that pregnancy should wait until surgery-related weight loss has stabilized. Clinicians have been encouraged to talk to women who are pregnant or may become pregnant about getting enough folic acid, quitting smoking, and avoiding alcohol. Women are also recommended to have appropriate calorie intake and exercise adequately.
The two most common forms of treatment that are crucial for individuals to carry out to combat obesity include changing to a healthier diet and increasing their physical exercise. In extreme cases, if children are morbidly obese bariatric surgery may be carried out.
Obesity in Nauru is a major health concern for the nation. In 2007 Forbes.com reported that, according to the World Health Organization's (WHO) latest estimate, Nauru has the highest percentage of overweight inhabitants among all countries. The estimation identified 94.5% of its residents as overweight. The obesity rate is 71.7%, the highest in the world. The definition of "overweight" and "obesity" are based on body mass index (BMI). People with BMI more than or equal to 25 are classified as overweight, and people with BMI more than or equal to 30 are classified as obese.
The average body weight among Nauruans is estimated to be approximately . Nauru has an average BMI between 34 and 35.
During pregnancy, doctors recommend light exercise. Doctors state that exercise can help the comfort of the mother and the well-being of the unborn child. Some benefits include, but are not limited to: reduced back pain, decrease in constipation, less likely to gain excess weight, decreased chance of gestational diabetes, easier labor, quicker recovery, and better physical and emotional health of the baby.
If negative signs and symptoms occur after exercising, pregnant females should stop immediately. Some signs include: dizziness, faintness, headache, shortness of breath, uterine contractions, vaginal bleeding, fluid leaking, or heart palpitations.
Obesity in Pakistan is a health issue that has attracted concern only in the past few years. Urbanisation and an unhealthy, energy-dense diet (the high presence of oil and fats in Pakistani cooking), as well as changing lifestyles, are among the root causes contributing to obesity in the country. According to a list of the world's "fattest countries" published on "Forbes", Pakistan is ranked 165 (out of 194 countries) in terms of its overweight population, with 22.2% of individuals over the age of 15 crossing the threshold of obesity. This ratio roughly corresponds with other studies, which state one-in-four Pakistani adults as being overweight.
Research indicates that people living in large cities in Pakistan are more exposed to the risks of obesity as compared to those in the rural countryside. Women also naturally have higher rates of obesity as compared to men. Pakistan also has the highest percentage of people with diabetes in South Asia.
According to one study, "fat" is more dangerous for South Asians than for Caucasians because the fat tends to cling to organs like the liver instead of the skin.