Childhood obesity is a significant global health crisis, representing a non-communicable disease (NCD) and a risk factor for numerous other NCDs. With the 2030 Sustainable Development Goals (SDGs) approaching, childhood obesity poses a significant threat to achieving these targets. The World Health Organization (WHO) reports a near tripling of obesity prevalence since 1975, with millions of children and adolescents classified as overweight or obese. The COVID-19 pandemic exacerbated the situation, leading to increased weight gain due to school closures, reduced physical activity, and disrupted routines. Children's diets are often suboptimal, characterized by overconsumption of sugar, sodium, and fat, and insufficient consumption of fruits and vegetables. The food environment, encompassing physical, socio-cultural, economic, and political contexts, significantly influences children's diets. The child-oriented food and beverage market is substantial and growing, with advertising, packaging, and regulations impacting consumption. Effective prevention and management strategies require collaboration between multiple stakeholders. WHO has established programs and recommendations for member states, focusing on population-wide policies and community-based interventions, including recommendations to restrict marketing, tax sugary drinks, and regulate nutrition labeling. UNICEF also offers a framework for country-level interventions. This study, based on an international cross-sectional survey by the International Pediatric Association, aims to provide a global overview of childhood obesity awareness and the implementation of preventative measures.

The introduction adequately summarizes existing literature on the global childhood obesity epidemic, its associated health risks, the influence of the food environment and marketing, and the roles of WHO and UNICEF in addressing the problem. It highlights the lack of comprehensive global data on regulations concerning food advertising, packaging, and nutritional content aimed at children.

The study employed a cross-sectional survey designed and distributed by two pediatric endocrinologists and a group of pediatricians specializing in NCDs. The survey, emailed to 132 national pediatric societies between January 7th and 23rd, 2022, utilized Google Forms for data collection. The questionnaire was structured into three sections: an introductory section explaining the study's objectives; a section collecting demographic data (country, region, society, participant designation); and a section containing 15 questions on national obesity data, food labeling, advertising regulations, government and school programs, support from private organizations, awareness of WHO and UNICEF guidance, and suggestions for addressing childhood obesity. The survey included both multiple-choice and open-ended questions and took approximately 5-10 minutes to complete. Data analysis involved descriptive statistics and thematic analysis of open-ended responses. Only one response per country was included, with incomplete or duplicate responses excluded. The final sample consisted of 28 responses from 28 countries across all six WHO regions.

The study included responses from 28 countries across various WHO regions, with participants predominantly from the European and American regions and primarily from upper-middle and high-income countries. Key findings include: most participants (78.6%) reported the availability of national prevalence data on childhood obesity; a significant majority (60.7%) observed an increase in childhood obesity during the COVID-19 pandemic; nutrition information labels providing sugar and salt content were available in about four-fifths of countries, but information on maximum allowable amounts was lacking; advertising rules for children's food were available in only 12 countries; programs or interventions from governments (64.3%) and schools (53.6%) were available in over half of the participating countries; support from private organizations was reported by 71.4% of participants; awareness of WHO guidance on childhood obesity was high (78.6%), with reported uses including informing national policies and programs; awareness of UNICEF guidance was lower (50%), but those aware reported similar influences on national programs; common suggestions for overcoming childhood obesity included developing policies for a healthy food environment, promoting physical activity, educating families, encouraging healthy eating habits, involving schools, and addressing the issue across all ages, beginning in infancy and pre-pregnancy.

The study highlights variations in the implementation of childhood obesity prevention measures globally. Despite the availability of national data and programs in most participating countries, substantial differences exist in the enforcement of regulations concerning food advertising and the implementation of comprehensive national programs. Although support from non-profit organizations and awareness of WHO and UNICEF guidance are relatively high, implementation remains hampered by poor compliance and a lack of public awareness. The COVID-19 pandemic's impact on childhood obesity is also emphasized, highlighting the need for robust and adaptable interventions. The findings underscore the necessity for country-specific interventions to improve awareness, compliance, and progress towards tackling the childhood obesity epidemic. The study suggests that, while many countries have initiatives in place, a concerted and comprehensive effort is needed for effective implementation and impactful results. Multi-sectoral collaboration, informed by WHO and UNICEF guidelines, is essential for achieving lasting change.

This study reveals considerable variation in approaches to childhood obesity prevention worldwide. Despite widespread availability of data and some programs, implementation suffers from poor compliance and insufficient awareness. The study advocates for stricter regulations on obesity risk factors and emphasizes the need for country-specific interventions to enhance awareness and compliance to effectively combat this growing global health concern. Future research should focus on in-depth analysis of specific programs and regulations, alongside factors influencing program effectiveness and compliance in diverse socioeconomic contexts.

The study's response rate was lower than anticipated, potentially due to a short survey period, insufficient promotion, and the targeting of national society presidents who may not have direct access to obesity specialists. This limited representation from low-middle income countries and possibly skewed the findings. Future studies need broader participation and more representative sampling to address these limitations.