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Burden of Proof: Gathering Data to Identify and Reduce the Double Burden of Malnutrition

When asked to picture malnutrition, most of us envisage an emaciated child with a swollen, distended belly. Although this cultural association between malnutrition and undernutrition is understandable, it overlooks half of the picture and reduces our ability to effectively respond to dietary challenges. Childhood obesity has become one of the most serious health challenges of the 21st century, and its prevalence is increasing at an alarming rate. Worldwide, the prevalence of childhood overweight and obesity rose by 47% between 1980 and 2013. In 2013, the World Health Organization (WHO) estimated that the number of overweight children under 5 years of age was over 42 million, with almost 31 million of these living in low and middle income countries. Overweight and obese children are likely to stay obese into adulthood and to develop non-communicable diseases (NCDs) like diabetes and heart disease at a younger age. Although the prevalence seems to be levelling off in some high-income countries, it is still increasing rapidly in most Latin American countries. Latest estimates show that between 42.5 and 51.8 million children and adolescents (0-18 years) in Latin America are overweight or obese, representing 20-25% of children in the region. Many countries in the region experience a double burden of malnutrition, where stunting and micronutrient deficiencies occur at the same time as overweight and obesity, sometimes in the same person.

With the recently-adopted Sustainable Development Goals in mind—which identify the needs to end hunger and to produce scientifically-verified data as the second and 17th goals, respectively—low and middle-income countries (LMICs) are diligently working to address not only undernutrition, which often leads to mortality among infants and young children, but also obesity and related NCDs later in life. In Latin America, experts and policy-makers have noted a growing trend of obesity among children in preschool and elementary school, caused both by poor nutritional habits and a lack of regular physical activity. Reflecting their two-fold objective to reduce malnutrition and to gather data and evidence with which to steer nutrition policies, Member States in Latin America and the Caribbean sought IAEA support with the aim of using nuclear techniques to diagnose obesity and evaluate programmes to reduce all forms of malnutrition in the region.

In 2007, the IAEA launched a regional technical cooperation (TC) project designed to evaluate the success of programmes designed to control childhood obesity in the Latin American region. The project used stable isotope techniques to assess the body composition and energy expenditure of children between the ages of four and nine, as nutritional habits and physical activity levels are established during these ages. The techniques involve the administration of water with a higher than normal concentration of deuterium and oxygen-18 (stable, non-radioactive isotopes of hydrogen and oxygen). Once absorbed, experts can use these isotopes to accurately measure the amount of water in the child’s body and then to calculate how much of their body weight is lean tissue and much is fat.   They can also determine the child’s daily energy expenditure based on the disappearance of the isotopes from their body. This provides information on the effectiveness of programmes to increase physical activity.

Effective policymaking relies on accurate information—without concrete data on the dietary and health status of a population, drafting policies and guidelines to ensure their continuing health is challenging, if not outright impossible. The technical cooperation project, through its many capacity building efforts, aimed to assist Member States in generating the information necessary for decision and policy making. The IAEA organized training events, expert missions and workshops, which helped to develop strong capacity in the assessment of body composition and physical activity among the participating Member States. Data on body composition and physical activity enable regional decision-makers and policy-makers to evaluate the effectiveness of existing nutritional programmes and, wherever necessary, support the drafting of new policies which acknowledge and react to the latest data.

From 19-21 April 2016, six experts from the Latin American region were invited to the IAEA’s Vienna headquarters to take stock of achievements and review the progress made in the region in measuring the incidence of childhood obesity and crafting policies to reduce it. Specialized in nutrition, physical activity and body composition, the visiting experts not only shared their experiences from across the region, but exchanged the lessons they learned in developing, testing and redeveloping policies in their respective countries.

The participants included Dr Manuel Ramirez, Coordinator of the Research Centre for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama (INCAP) in Guatemala; Dr Gabriela Salazar of the Energy Metabolism and Stable Isotopes Laboratory at the University of Chile; and Professor Mauro Valencia, the Head of Nutrition at the University of Sonora, Mexico. All of the experts shared a long history of collaboration with the IAEA through its technical cooperation programme, and have participating in several regional and national projects which target childhood obesity.

During the meeting, we spoke with all three experts to better understand the initial potential and eventual impact of nuclear techniques in the ongoing fight against childhood obesity and the double burden of malnutrition in Latin America and the Caribbean. You can see their responses in the Related Resources section above.

The information and capacities generated across several projects in the Latin American region has already had a tangible effect, most notably in the form of concrete and precise data on the nutritional status of local children. Regional decision- and policy-makers not only have the necessary information within reach, but also have access to an adequately-trained pool of staff, capable of implementing and evaluating sustainable nutritional policies and programmes. Furthermore, the information produced through these body composition assessments was disseminated across the region to increase general awareness of the problems associated with childhood obesity, especially among teachers, caregivers and academics. Echoing the comments made by our counterparts in the above video, the outputs and outcomes of these TC projects have been sustained well beyond the lifetime of the projects themselves, and will continue to bear fruit into the future.

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