The Commission on Ending Childhood Obesity (ECHO) presents its final report to WHO (25 January 2016)

After a 2 year long consultation process, the Commission on Ending Childhood Obesity (ECHO) has submitted its final report to the WHO Secretary-General on 25 January 2016.

Background Information:

Body Mass Index (BMI): Body mass index = weight (kg)/height (m2)

BMI-for-age: BMI adjusted for age, standardized for children

Children: Those less than 18 years of age

Young Children: Those less than 5 years of age.

Infants: Those less than 1 year of age


From birth to less than 5 years of age: weight-for-height more than 2 SD above WHO Child Growth Standards median.

From age 5 to less than 19 years: BMI-for-age more than 1 SD above WHO growth reference median


From birth to less than 5 years of age: weight-for-height more than 3 Standard Deviation (SD) above the WHO Child Growth Standards median

From age 5 to less than 19 years: BMI-for-age more than 2 SD above the WHO growth reference median

Obesogenic Environment: An environment that promotes high energy intake and sedentary behaviour.

This includes the foods that are available, affordable, accessible and promoted; physical activity opportunities; and the social norms in relation to food and physical activity.

Unhealthy foods: Foods high in saturated fats, trans-fatty acids, free sugars or salt (i.e. energy-dense, nutrient-poor foods).

Key Messages:

Among the noncommunicable disease risk factors, obesity is particularly concerning and has the potential to negate many of the health benefits that have contributed to increased life expectancy.

Childhood obesity is reaching alarming proportions in many countries and poses an urgent and serious challenge.

Overweight prevalence among children aged under 5 years has risen between 1990 and 2014, from 4.8% to 6.1%, with numbers of affected children rising from 31 million to 41 million during that time. The number of overweight children in lower middle-income countries has more than doubled over that period, from 7.5 million to 15.5 million.

In 2014, almost half (48%) of all overweight and obese children aged under 5 lived in Asia and one-quarter (25%) in Africa. The number of overweight children aged under 5 in Africa has nearly doubled since 1990 (5.4 million to 10.3 million).

In absolute numbers there are more children who are overweight and obese in low- and middle-income countries than in high-income countries.

Many children today are growing up in an obesogenic environment that encourages weight gain and obesity.

The behavioural and biological responses of a child to the obesogenic environment can be shaped by processes even before birth, placing an even greater number of children on the pathway to becoming obese when faced with an unhealthy diet and low physical activity.


Promote intake of healthy foods

  • Implement an effective tax on sugar-sweetened beverages.
  • Implement the Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children to reduce the exposure of children and adolescents to, and the power of, the marketing of unhealthy foods.
  • Develop nutrient-profiles to identify unhealthy foods and beverages.
  • Require settings such as schools, child-care settings, children’s sports facilities and events to create healthy food environments.
  • Increase access to healthy foods in disadvantaged communities.

Promote physical activity

  • Provide guidance to children and adolescents, their parents, caregivers, teachers and health professionals on healthy body size, physical activity, sleep behaviours and appropriate use of screen-based entertainment.
  • Ensure that adequate facilities are available on school premises and in public spaces for physical activity during recreational time for all children (including those with disabilities), with the provision of gender-friendly spaces where appropriate.

Preconception and pregnancy care

  • Diagnose and manage hyperglycaemia and gestational hypertension.
  • Monitor and manage appropriate gestational weight gain.
  • Develop clear guidance and support for the promotion of good nutrition, healthy diets and physical activity, and for avoiding the use of and exposure to tobacco, alcohol, drugs and other toxins.

Early childhood diet and physical activity

  • Promote the benefits of breastfeeding for both mother and child through broad-based education to parents and the community at large.
  • Develop regulations on the marketing of complementary foods and beverages, in line with WHO recommendations, to limit the consumption of foods and beverages high in fat, sugar and salt by infants and young children.
  • Provide clear guidance and support to caregivers to avoid specific categories of foods (e.g. sugar-sweetened milks and fruit juices or energy-dense, nutrient-poor foods) for the prevention of excess weight gain.
  • Provide guidance to caregivers on appropriate nutrition, diet and portion size for this age group.
  • Ensure only healthy foods, beverages and snacks are served in formal child care settings or institutions.
  • Ensure physical activity is incorporated into the daily routine and curriculum in formal child care settings or institutions.
  • Provide guidance on appropriate sleep time, sedentary or screen-time, and physical activity or active play for the 2–5 years of age group.

Health, nutrition and physical activity for school-age children

  • Establish standards for meals provided in schools, or foods and beverages sold in schools, that meet healthy nutrition guidelines.
  • Eliminate the provision or sale of unhealthy foods, such as sugar-sweetened beverages and energy-dense, nutrient-poor foods, in the school environment.
  • Ensure access to potable water in schools and sports facilities.
  • Require inclusion of nutrition and health education within the core curriculum of schools.
  • Improve the nutrition literacy and skills of parents and caregivers.

Weight management

  • Develop and support appropriate weight management services for children and adolescents who are overweight or obese that are family based, multi-component (including nutrition, physical activity and psychosocial support) and delivered by multi-professional teams with appropriate training and resources, as part of Universal Health Coverage.

Key Observation: The greatest obstacle to effective progress on reducing childhood obesity is a lack of political commitment and a failure of governments and other actors to take ownership, leadership and necessary actions. 

Useful Links:

Link to the press release:

Link to infographic on recommendations (JPEG):

Link to the Full report:

Link to commentary in The Lancet:

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