Childhood Obesity as a Global Problem: A Cross-sectional Survey on Global Awareness and National Program Implementation

The study addresses the global public health challenge of rising childhood obesity, a multifactorial condition and a key risk factor for noncommunicable diseases. With obesity rates in children and adolescents increasing worldwide and further exacerbated by COVID-19-related disruptions to diet and physical activity, progress toward the 2030 Sustainable Development Goals is at risk. The food environment—shaped by marketing, labeling, pricing, and policy—plays a central role in shaping children’s diets, yet global information on regulations and practices is limited. The objective of this study was to characterize global awareness and national implementation of prevention and management measures for childhood obesity, particularly around food environment regulations, and the uptake of WHO and UNICEF guidance, using an international cross-sectional survey of national pediatric societies.

Design: International cross-sectional survey. Instrument and development: Questionnaire developed by two pediatric endocrinologists (co-chairs of the IPA Strategic Advisory Group on NCDs) with input from pediatricians across regions. Sampling and recruitment: Electronic survey sent to 132 national pediatric societies affiliated with the International Pediatric Association (IPA). Field period: January 7–23, 2022. Participants: Presidents of national pediatric societies or designated representatives; one response analyzed per country. Survey structure: Three sections: (1) consent and objectives; (2) demographics (country, region, society name, respondent role); (3) 15 items on national childhood obesity data, nutrition labeling (sugar/salt), regulations on advertising/packaging of children’s foods, governmental and school-based programs, private/civil society support, awareness and use of WHO/UNICEF guidance, and open-ended suggestions for tackling childhood obesity. Mix of multiple-choice and open-ended questions; estimated completion time 5–10 minutes. Data handling and analysis: Responses collected via Google Forms; descriptive statistics for quantitative items; open-ended responses summarized by thematic approximation of semantic similarity. Double or incomplete country responses were excluded, retaining one complete response per country.

Sample: 28 responses from 28 countries across all six WHO regions; region distribution predominantly Europe (35.7%) and the Americas (21.4%). Country income levels: upper-middle (46.4%) and high (35.7%); no low-income country respondents. National data and trends: - National prevalence data on childhood obesity available in 78.6% of countries. - During COVID-19, 60.7% reported an increase in childhood obesity; 39.3% not aware of an increase. Food environment and regulations: - About 80% reported nutrition labels include amounts of sugar and salt. - Most (60.7%) reported no information on maximum allowable sugar/salt; 7 reported yes; 4 did not know. - Advertising rules for children’s food packaging available in 12 countries; 13 reported none; remainder did not know. Programs and support: - Government prevention programs: 64.3% reported available. - School-based programs: 53.6% reported available. - Support from private or civil society organizations: 71.4%, mostly local or national in scope (75%). Awareness and use of guidance: - WHO guidance awareness: 78.6%. Reported influences included: used as reference for national policies/regulations (35%), applied via national programs (15%), prioritization (5%), awareness raising (5%), participation in WHO Europe COSI (5%), development of specialized centers (5%); barriers included poor compliance (15%) and uncertainty about influence (15%). - UNICEF guidance awareness: 50%. Reported influences included: reference for national policies/regulations (28.6%), applied via national programs (21.4%), campaigns/advocacy (14.3%), awareness raising (14.3%); one reported improved cooperation with Chamber of Commerce. Stakeholder suggestions (most frequent themes): strengthen regulations and policies for a healthy food environment (11); facilitate exercise/promote physical activity (10); educate and empower families at community level (9); encourage healthy eating habits (8); involve schools as key stakeholders (8); build national programs including weight management services (7); prevention across all ages (4), including breastfeeding (5) and actions in pre-pregnancy/pregnancy (2); recognize obesity as a disease (3); adopt holistic, multi-stakeholder approaches (5); additional suggestions included public awareness, addressing commercial vs public health tensions, limiting screen time, sleep promotion, and family support.

Findings indicate that while many countries report availability of childhood obesity prevalence data and some prevention programs, substantial gaps persist in the regulatory components of the food environment, particularly in restrictions on marketing and packaging of foods for children and in specifying maximum sugar/salt levels. Awareness of WHO guidance is relatively high and has influenced policy and programs in several countries; however, implementation is frequently hindered by poor compliance and limited awareness, and UNICEF guidance is less well known. The observed increase in childhood obesity during the COVID-19 pandemic underscores the urgency of comprehensive, multisectoral approaches encompassing policy, schools, healthcare, and community engagement. Aligning national strategies with WHO and UNICEF recommendations, enhancing regulations (e.g., front-of-pack labeling, marketing restrictions, fiscal measures), and strengthening school and community interventions can address key determinants and foster healthier food and activity environments.

Despite widespread availability of national data and nutrition labels reporting sugar and salt content, prevention practices and statutory regulations (especially on food advertising to children) vary considerably across countries. Support from non-profit organizations and awareness of WHO/UNICEF guidance are relatively high, but implementation is limited by poor compliance and insufficient public awareness. Given the escalating childhood obesity epidemic, stronger, enforceable policies targeting known risk factors—tailored by country and region—are needed to improve awareness, compliance, and progress toward global nutrition and health targets.

Lower-than-expected response rate due to short survey window, limited promotion, and targeting society presidents who may lack direct access to obesity/NCD experts. Consequently, regional representation is uneven, with under-representation of low- and lower-middle-income contexts, limiting generalizability and the comprehensiveness of insights.