WHO GRC Obesity Briefing

7/24/2019 WHO GRC Obesity Briefing

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HARVARDMODEL CONGRESS

LATINAMERICA

THE OBESITY PANDEMICBy Gabriela Ruiz-Coln

INTRODUCTION

On July 16, 2003, then-US Surgeon General, Richard Carmona, MD,MPH, FACS, announced a health crisis affecting every state, every city,every community, and every school across [the] nation; a dilemma, that if

left untreated, will dwarf 9-11 or any other terrorist attempt. Thedevastating crisis to which Dr. Carmona was alluding was none other thanobesity.

Obesity is the fastest-growing cause of disease and death in America,affecting nearly two out of every three Americans, despite being an entirelypreventable disorder. However, obesity is not a problem limited to theUnited States; rather, worldwide obesity has nearly doubled since 1980,currently affecting both developing and developed nations. In particular, theHarvard School of Public Health, has reported that between 1980 and2008, the average BMI in Central and South America has risen by 1.3-1.4units per decade in women, with men observing slightly milder rates. While

obesity used to be termed an epidemic, today, it is known as apandemicdue to the widespread prevalence of obesity around the world.In addition to affecting individuals livelihoods from all over the globe,obesity is an issue that is further complicated by societal, economic, andcultural factors.

The threat posed by the obesity pandemic is extremely crucial, asobesity is the fifth leading risk for global deaths, accounting for the death ofnearly 28 million adults. When an individual has a Body Mass Index (BMI)higher than 30, they are deemed obese, and an obese person has anexcessive amount of body fat, which impedes other body regulatory systems,in particular the cardiovascular and endocrine systems , from functioning

efficiently. The global burden of obesity is linked to cardiovascular disease,certain cancers, chronic respiratory disorders, renal failure, and prematuredeath in both adult and children.

Moreover, obesity has been strongly linked to Type II Diabetes, anendocrine disorder distinguished by insulin resistance a physiologicalphenomenon that leaves the body unable to recognize insulin, a hormoneproduced by the body to convert food into energy. Ultimately, the beta cellsin patients with Type II Diabetes can cease to produce insulin. This stage of

Score Health Category

30 Obese

Figure 1An obese individual has a

BMI greater than 30. BMI is

a measure of an individuals

weight in pounds divided by

height in inches squared.The American Heart Association

E p i d e m i c widespread

occurrence of a diseasewithin a country during a

specific time period

P a n d e m i c

widespread occurrence of

a disease throughout a

continent or the world

E n d o c r i n e S y s t e m

the body system

comprised of glands that

secrete hormones intothe bloodstream.

Hormones mediate a

wide variety of

physiological process,

most notably, energy

metabolism


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HARVARD MODEL CONGRESS

LATINAMERICA 2015 THE OBESITY PANDEMIC 2

the disease places patients at a risk of blindness, amputation of limbs, sexualdysfunction, miscarriage and stillbirth, diabetic nephropathy (kidneyfailure), while dramatically increasing the risk of cardiovascular disease. Thecost associated with the pandemic makes obesity policy a crucial investmentfor nations across the world. It is evident that an intervention is necessary to

curtail obesity from rising, and it is up to policymakers to draft legislationthat will help individuals lead healthy and safe lifestyles.

EXPLANATION OF THE PROBLEM

Historical Background

Through the centuries of early human history, mans primary strugglewas obtaining an adequate amount of food. During the NeolithicRevolution, around 12,000 years ago, the worlds first agricultural revolutionoccurred. This allowed for the transition from hunting and gathering

lifestyles to a more sustainable lifestyle, framed by the domestication ofplants and animals, allowing for humans to adapt to sedentary societies.

Now, fast-forward to the year 2000. Global wealth has accumulated tosuch a degree that, for the first time in human evolutionary history, thenumber of adults overweight or obese surpassed the number of those thatwere underweight. This obesity pandemic is not only of concern in adults,but also in children. Childhood obesity has more than doubled in childrenand quadrupled in adolescents since the 1980s. Moreover, 77% of obeseyouth become obese adults.

In the modern world, over-nutrition is a pressing health concern, and itis imperative that the World Health Organization considers implementing

policy to control the obesity pandemic and ensure that members of thevarious affected by obesity are able to lead healthy lives.

The Transition from Under- to Over-Nutrition

Throughout the latter part of the twentieth century, it was evident thatobesity was becoming a problem in the United States. Patterns of lifestylehad evidently changed and food sources were beginning to dramatically shiftfrom local produce to processed foods. A key factor in this transition wasthe dramatic rise in

urbanization

. The rise in urbanization led to a dietaryshift marked by an increase in edible oils, which would become a staple of

the typical Western diet. The availability of vegetable oils nearly tripledbetween the years of 1961 and 1990. This increase in oils was associatedwith the increased consumption of animal fats.

Simultaneously, sweeteners made their way into the market, mostnotably in the form of high fructose corn syrup (HFCS). The increase inHFCS came from extensive government subsidies of corn farmers andhas been predominantly used in beverages and as a substitute for sucrose,natural sugar, in processed and packaged foods (Duffey and Popkin).

U r b a n i z a t i o n

A movement characterized

by the increase in inhabitants

in urban areas; as a result,

towns and cities become

larger and accommodate for

the increased population

size by creating more living

and working facilities and

more transportation options

to connect the growing

physical space.


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HFCS is a relatively inexpensive sweetener, so manufacturers of processedfoods havebeen able to produce their products and sell them at a low price. In thisway, consumers have been increasingly purchasing and eating these foods.A causal relationship between HFCS consumption and obesity has been

hypothesized, observed, and supported in mice, the most accurate humanresearch model. However, this relationship has only been observednotprovenin humans. Figure 2 presents this phenomenon by showing thestaggering prevalence of HFCS and the stark corresponding incline in Type2 Diabetes. The use of HFCS went from less than 1 kcal/day in the early1970s to a high 42 kcal/day in 2004. Health professionals across the worldhave become increasingly alarmed at the rise in such a sweetener, given thatthe increased use in HFCS means a higher incorporation of calories intobeverages and meals, contributing to the key energy mismatch, characteristicof obesity.

Obesity and the Urban Lifestyle

The shift toward urbanization around the world has also been ofincreased concern to public health experts, as migrations to urban centersare usually accompanied by increased consumption of processed foods andphysical inactivity. This is mainly explained by greater access to technology,in particular, transportation, meaning reduced motivation and necessity towalk or bike. This observation often leads to lifestyles defined bysedentariness, a condition of little physical exercise. True to the concept ofenergy balance , sedentary males have an average daily energyexpenditure of 2600 calories, whereas an active male will have an averagedaily energy expenditure of 3226 calories. If weight were being conserved

E n e r g y b a l a n c e

Energy balance refers to the

notion that, in order to

maintain a stable weight, the

number of calories released

must equal the number of

calories consumed.

Consistent overconsumption

of energy (food) leads to

obesity.

Figure 2This graph illustrates the

correlation between the

rise in high fructose corn

syrup consumption and the

rise in Type II Diabetes.

Note that while a

correlation may exist, it

does not imply a causal

relationship.Duffey & Popkin, 2008


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and held constant, we would expect for sedentary men to consume fewercalories than their active counterparts. However, we do not observe thistrend. This energetic mismatch due to a surplus of calorie consumptionleads to increased adiposity, which leads to obesity.

In Chile, for example, the urban transition has been marked by a

decrease in produce consumption, with 70% of adults consuming fewerthan two fruits or vegetables daily, an increase in automobiles from 363,150in 1997 to 1,969,128 in 1997, and a rise in TV sets from 12,170 in 1970 toover 2 million in 1997. Additionally, dietary patterns have shifted, reflectingthe now iconic Western diethigh in refined grains, saturated fats, andadded sugars.

The combination of these changes in lifestyle and diet has greatlyimpacted the people of Chile, making them more susceptible to harmfulhealth conditions. This has been supported by studies tracing urbanizationand health patterns in various communities and populations within Chile.The Mapuche populationthe major aboriginal group of Chilehas been

faced with an increased pressure to migrate from their original ruralconditions in the South of urban centers. Comparison between the ruralMapuche and the urban Mapuche reveals that urban lifestyles are associatedwith a higher prevalence of obesity and diabetes. Diabetes was observed in3.4% and 6.1% of the rural and urban Mapuche, respectively. Thisrepresents a statistically significant difference, showing that a shift inenvironment can be highly detrimental.

The story of the Mapuche can be examined alongside the history ofother Amerindian groups, in particular, the Aymara living in northernChile, Bolivia, and Peru. The Aymara have remained rural, consumingtheir traditional, natural diets, alongside high levels of physical activity from

tasks such as that of agriculture, so that the prevalence of diabetes remainseven lower than that of the Mapuche rural.While the etiology of obesity is a complicated one, potentially

comprised of a variety of socioeconomic factors, dietary patterns, physicalactivity, nationality and ethnicity, biomedical researchers continuously workto find genetic information that might lead to biotechnological innovationsor drugs that could ease the global burden of obesity.

Access to Food & Nutrients

It is evident that repeated consumption of nutrient-deficient foods isdetrimental to the health of nations. However, it is also true that the

consumption of these unhealthy foods is not necessarily a choice in themidst of other healthy alternatives. Food deserts, areas with limitedaffordable and nutritious foods, are highly prevalent through lower-incomecommunities and nations.

In the United States alone, more than 29 million people who live inlow-income urban areas do not have a supermarket within a mile of theirhome; this trend is also apparent in rural areas. Policy research based in

E t i o l o g y The cause or set

of causes of a disease

A d i p o s i t y

The condition of gradual

body fat build-up


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New York City, North Carolina, and Baltimore found that in such fooddeserts, where a supermarket is more than ten miles away from acommunity, Americans in all age ranges are less likely to meet the daily fruitand vegetable recommendations, and prevalence of obesity is observed atthe highest rates: 32-40% and 73%-78%, respectively.

Under First Lady Michelle Obamas Lets Move! campaign, the USDepartments of Treasury, Health, and Human Services and Agriculturehave created a grant program to encourage healthy eating practices.Through this program, residents, businesses, local governments, colleges,and others can apply to obtain monetary resources to combat food desertsby promoting domestic agricultural commodities, encouraging thedevelopment of microenterprises, and securing funds for food emergencies.

Obesity and the Media

A study by the American Psychological Association (APA) has revealedthat nowadays, American children spend nearly 44.5 hours per week

interacting with media; that is more time than in any other activity besidessleeping. Because advertisers have begun targeting youth, strong associationshave been found between advertising in children under the age of eightwhen they are unable to understand the persuasive intent of advertisersand rates of childhood obesity (APA). More than 80% of ads in childrensprogramming are for fast food or snacks; for every hour that a child spendswatching TV, they will see an estimated eleven food advertisements. Thisrepeated targeting of youth affects product preferences and the purchasingdecisions of their parents, and potentially encourages a tendency toward theconsumption of unhealthy food.

Recent Developments

Around the world, countries have joined forces to address the obesityissue and create solutions to ensure that their people remain healthy. TheInternational Union of Nutritional Science launched the InternationalObesity Task Force (IOTF) in 1995 to prepare the first scientific researchreport on the global epidemic of obesity. This report served as the startingpoint for the first WHO expert meeting on obesity that took place in 1997.As a result of the work from both the IOTF and the WHO meetings, theWHO published its first official Expert Report on assessing obesity, whichwas distributed to all health ministers. The publication of this documentserved as the WHOs official announcement that obesity is a true concern,and that while it had gone unnoticed, it was extremely crucial.

Below are closer descriptions of how individual nations have fought theobesity pandemic and the related problem of discrimination against theobese.

The APA Council on

Communications and

Media has cited that

increased television

during meal times has

been observed to suppress

cues of satiety, often

leading to overeating in

children.

Click hereto read the

WHOs Obesity:

Preventing and Managing

the Global Epidemic,

published in 2000. This

document served as the

official announcement

that obesity, though

having gone unrecognized,

was a threat to our

worlds health.


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Action in the United States

The First Lady of the United States, Michelle Obama, raised awarenesson obesity and the Type II diabetes epidemic, through her Lets Move!campaign in 2010. Lets Move! is dedicated to solving the problem ofobesity within a generation, so that children born today will grow up

healthier and able to pursue their dreams (Obama). Narrowly, thecampaign focuses on creating a healthy start for children by providing healthfoods in schools, encouraging physical activity, and empowering parents andcaregivers. The campaign is aimed at a wide and broad audience, includingchildren, parents, and schools. Lets Move! has called for change andcollaborations across the public and private sectors that has resulted in avariety of key milestones.

Among them, in 2012, the Walt Disney Company announced that allfoods marketed on Disneys television and radio channels will be requiredto meet Disneys nutrition guidelineswhich align with federal standards topromote fruit and vegetables and limit calories, sugar, sodium, and saturated

fat. Furthermore, Disneys reach has extended to the neighborhoodgrocery store aisles with the introduction of the Mickey Check, identifyingproducts and snacks that comply with Disneys nutrition standards. Disneysdrastic initiative has caused food production giants like Kellogg and Pepsi tostop advertising products that fail to meet the USDAs nutritional standardsto children under the age of twelve.

The US Department of Defense has also responded to Obamascampaign and extended budgets for military families to encompass thepurchase of fresh produce. Additionally, the US Olympic Committee,athletes of the 2012 US Olympic Team, and members and athletes ofseveral national bodies contributed free and reduced price athletic

programming and opportunities for nearly 1.7 million kids in 2012 alone.This collaboration represents the growing commitment to make physicalactivity fun, healthy, but above all, accessibleand sustainable.

In response to the call for accessible and sustainable programs, in 2011,the multinational retail store, Walmart, established the Walmart NutritionCharter to make healthier choices affordable, while also addressing theissue of food deserts and building more stores. As a result of the Charter,Walmart has significantly contributed to the reduction of sodium and sugarin commercial products, has saved customers $2.3 billion by offering lowprices on fresh produce and reduced prices on low-fat and fat-freefoods, and has increased its educational outreach through the Walmart

Foundation, the American Heart Association, and the National 4-HCouncil and Alliance for a Healthier Generation.

While Obamas program has drawn a positive response from privateand public sponsors, its impact has not been well documented, given that itis only four years old. Due to the fact that obesity is an ever-growing issuewith even larger health implications, however, the efforts to support this

B i p a r t i s a n

Expressing support

from two, usually

conflicting or

opposing sides


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program and those with similar aims have been renewed and strengthenedin recent years.

To support Michelle Obamas campaign, in 2010, President BarackObama signed the Healthy, Hunger-Free Kids Act of 2010 into law,requiring the availability of nutritious meals in public schools. The Act,

which gathered far and wide bipartisan support, is aimed at reducingchildhood obesity, while instilling positive nutrition habits in children. Theact accomplishes a variety of goals including granting the USDA theauthority to set nutritional standards in all food availabilities, ranging fromthe cafeteria to the vending machine. Moreover, the act aims to increase thenumber of eligible children enrolled in free or reduced price lunches by115,000, by using Medicaid data to certify children who meet incomerequirements. Finally, the Act requires regular auditing of schools to ensurethat they are complying with the USDAs standards and guidelines.

Action in South America

For several years now, the Chilean Ministry of Health has required thatall producers and retailers provide a list of ingredients and nutrient content(including protein, fat, vitamins, sugar, and sodium, etc.) in all foodproducts. In 2012, the Ministry of Health approved the Law of FoodLabeling and Advertising, which permits the issuing of warning labels offoods with high caloric, sugar, fat, and sodium content. On December 17,2013, the Diario Oficial de la Repblica de Chile announced the issuing ofan addendum to the law of 2012 creating stricter nutritional standards andrequiring the use of a colored labeling system.

Ecuador has also joined Chile in using a traffic light system to aidconsumers in selecting healthier foods. Ecuadors system, implemented inNovember of 2013, features horizontal bars indicating the level of sugar, fat,and sodium, each colored in correspondence to it satisfying or surpassingthe recommendations from the Ministry of Health. This program aims toenhance consumers education and awareness to the increasingly highprevalence of chronic disorders as a result of obesity and improper foodmanagement.

Action in Europe

In response to the WHOs action, the European Union (EU) deliveredobesity and health policy reports in 2003 and in 2005, established the EU

Platform on Obesity. This platform, which has now been renamed the EUPlatform for Action on Diet, Physical Activity and Health, was originally ajoint effort of the Health Commission of Europe and the European FoodIndustry. The Platform involves 33 member EU organizations that are eagerto create and promote initiatives and implement solutions. In 2007, thePlatform published a White Paper on A Strategy for Europe on Nutrition,Overweight and Obesity related health issues, which was meant to address

M e d i c a i d an

American federalassistance program

for individuals with

limited financial

resources.


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the rise in hypertension, Type 2 diabetes, and the rise in prevalence ofoverweight children, recorded at 30% in 2006. The White Paperencouraged implementation of intricate networks, characterized bystakeholders and players in different areas of health and nutrition. Thisencouraged collaboration between the government, NGOs, private

businesses, the health care system, and of course, the constituents.These publications propelled the reformation of the CommonAgricultural Policy (CAP) of the EU. Striving to make healthy food optionsavailable to all consumers, CAP has shaped the European diet, whileensuring that all have access to food. CAP has been largely successful,having reformed the Common Market Organization, so that fruit andvegetables are largely available in schools. It also encourages the EU toincrease its funding programs by 60% to meet the needs of manufacturers ofprocessed goods, including canned foods, oils, biscuits, and other sweets, toreformulate the composition of their food to boost nutritional value.

The EU has also championed a comprehensive food labeling policy,

which will be in effect through December of 2014. The policy requires thatall food labels, with the exception of fresh fruits and vegetables, vinegarsfrom a single extract, and carbonated water, include all ingredients and/orchemicals, while making the nutritional facts clearly legible and easilyunderstandable. The EU legislature on food labeling beyond December of2014 has already been established and requires manufacturers to includemandatory origin of unprocessed meat, improve legibility by setting aminimum font size for text, and clear articulation of any allergens. This EUlaw also calls for the information on allergens to be included in food sold atrestaurants and cafes. The holistic approach taken by European nations canserve as a model for other nations.

Discrimination Protection

While the task of addressing ways to combat obesity and ensure thatpeople are maintaining healthy lifestyles remains a major priority in the eyesof policymakers, the issue of discrimination against those who are obese hasalso come to the forefront in recent years. With the rise of obesity policy inthe media and government, many individuals have expressed concern overthe increasing frequency of weight-based discrimination. Reports suggestthat such weight-based discrimination has increased by 66% in the pastdecade, reaching the same levels as racial discrimination or gender-baseddiscrimination in the workplace or in employment situations. Thesepractices include but are not limited to reduced or unfair wages, unequalhiring practices, prejudice from employers and co-workers, and wrongfulemployment termination.

In the United States, the individuals that have been victim to suchdiscriminatory policies have sought protection from the government;however, body weight is not a protected class in anti-discriminatory clauses.To correct for this increasing issue, in 2011, the Supreme Court ruled in the

Figure 4This is a summary label for

commercially available

cereal. This label is

included in the anterior

end of the package, while amore comprehensive list of

ingredients and mineral

content is included in the

posterior end.Food Production Daily

Figure 5This graph shows the

obesity rates in various

European nations. For a

better view, click here.Deutsche Welle


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case of US Equal Employment Opportunity Commission v. Resources forHuman Development that basic obesity, due its debilitating and negativeimpact on walking, bending, digestion, and stamina, is a physical disabilityunder the Americans with Disabilities Act (E.D. La. 2011). Even with thepresence of this ruling, policymakers are faced with the issue of writing

legislation to ensure that these types of discriminatory practices areeliminated from the workplace.

FOCUS OF THE DEBATE

While most government officials recognize that obesity is a threateningand rising problem afflicting our world, the key questions lie in sorting outhowto address this complex issue. In particular, as delegates of the WHO,it is crucial to evaluate current prevention and recovery systems in individualnations. You should collaborate to create standards, regulations, andevaluations to ensure that all countries are receiving the highest quality of

care and enjoying the healthiest lifestyle.

PERSPECTIVES HELD BY MAJOR

STAKEHOLDERS

The European Union

The EU views obesity as a strong threat against the economic, social,and political development of its constituent nations. After the IOTF

announced that more than 200 million adults and 14 million children in theEU were overweight and/or obese in 2005, the EU launched the Platformon Diet, Physical Activity, and Health and several specific initiatives. Theseefforts focused specifically on ameliorating the number of schoolchildrenthat were overweight or obese to prevent the transmission into adulthood.To address this problem, the EU has collaborated with the European HeartNetwork, Eurocommerce, the Confederation of the Food and DrinkIndustries of the EU (CIAA), and the World Federation of Advertisers.Several individual countries have taken action to curtail the rise of obesity inchildren, for instance, Sweden does not permit advertising aimed atchildren under 12, and Ireland enforces the Childrens Advertising Code,

which mandates health warnings for soft drinks and fast foods. However,the EU has demanded cross-European solutions. These solutions haveincluded disallowing BBC to use childrens TV characters to be used in adspromoting items high in fat, sugar, or salt. In turn, large food companieslike Kelloggs and Nestl have chosen to alter their marketing tactics, andinstead have launched clearer nutritional labeling initiatives and partneredwith local towns to increase education programs for children. In addition,


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the 33 members of the Platform on Diet, Physical Activity, and Health havelaunched their own initiatives, including Media Smart from the WorldFederation of Advertisers, aimed at improving lifelong strategies to evaluateand make wise food choices.

Childhood obesity remains a key issue in the political agenda of many

western European nations but is poorly incorporated in the easternEuropean nations. Because some eastern European nations are facingpolitical and economic transitions, this issue of health might not beconsidered a top priority. However, the EU strives to communicate theimmediacy of this issue to those nations and create solutions that aresensitive to their current political and economic states, while keeping thehealth of their constituents a top priority.

The World Bank

In 2011, the World Bank called for immediate global attention on the

rise of chronic diseases, including cardiovascular disease, diabetes, andchronic respiratory conditions, all linked to obesity. The World Bank hasreported that the rise of such chronic disorders can be detrimental to theeconomic health and stability of countries in particular, least-developedand developing nations.

The World Bank has predicted that, if trends continue the way theyhave, Sub-Saharan Africa will be incredibly burdened. The Bank haspredicted that under todays conditions, by 2030, chronic disorders willaccount for 46% of all deaths in the region, a 28% increase since 2008.Beyond sub-Saharan Africa, the Bank predicts a similar rise in South Asia,likely increasing from 51% in 2008 to 72% in 2030.

At the United Nations Summit on Non-Communicable Diseases,World Bank Vice President for Human Development stated, What makesthe development impact of chronic diseases so daunting for lower andmiddle income countries is that they dont have the money and the healthsystems to treat their way out of this crisis, and theyre facing it at far earlierstages of economic progress than their better-off developed neighbors hadto. In this way, it can be seen that attempting to treat those with seriousmedical issues associated with or resulting from obesity may place significantfinancial strain on a countrys economic resources.

Taking a quick glance at the map referred to on the left, it is evident thatthe majority of countries are spending a mere $10 per person per year oneach individuals healthcare. Having lent 2.6 billion dollars for healthcarepurposes alone in 2011, the World Bank has noted an increasing trend inloans to treat chronically ill patients. The World Bank promotes andrecommends that all nations take a prevention approach in order to sustaintheir own long-term healthcare systems. The World Bank cites risk factors,including physical inactivity, unequal access to fresh foods, infantmalnutrition, poor environmental conditions, and unhealthy diets, as thekey roots of the problem and urges countries to prioritize these causes.

The World Bank

predicts that, in SouthAsia, chronic diseases

will account for 72% of

all cases in 2030.

Click hereto see an

interactive

international map

highlighting health

expenditure per capita

in USD.


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In particular, the World Banks Food Price Watch has cited high foodprices as a critical factor affecting the number of overweight and obeseindividuals in a country. Between January and April 2014, the price ofinternationally traded foods increased by 4%, beating the all-time high fromAugust of 2012. The World Bank has attributed the rising costs to

inconsistent weather and climate conditions, political instability in EasternEurope, and currency fluctuations. As a result, these rising prices of foodcould limit access to fresh and nutritious food options.

The Corn Refiners Association

The Corn Refiners Association (CRA) has been under scrutiny forproducing HFCS and its correlation with Type II diabetes and otheraforementioned diseases. In an effort to defend HFCS, the CRA attemptedto change the name of HFCS to corn-sugar. However, the United StatesFood & Drug Administration (FDA) rejected the name change, stating thatHFCS was not real sugar. While the FDA may have settled the science

issue at hand that is, the chemical classification of the product the publicdebate on HFCS persists. To shed a positive light on HFCS, the CRAlaunched their Sweet Surprisecampaign.Sweet Surpriseswebsite providesa variety of educational resources as well as advertisements meant tovalidate the nutrient content of HFCS.

The CRA acknowledges the presence of obesity and believes thatphysical activity and a well-balanced diet is necessary to ensure the health ofa country. They believe that countries can address these obesity risk factorswithout compromising the lucrative position of HFCS within theinternational market.

While the FDA declared that HFCS is not real sugar, the

classification of HFCS worldwide is a crucial classification that has causedeconomic and trade disputes. One remarkable case is that of the US-Mexico Sweetener Discord. The CRA upholds the North America FreeTrade Agreement NAFTA)

and requests that NAFTA remainuntouched, without any imposition from the government or otherinternational organizations. The CRA notes that any perturbation toNAFTA can cause great harm to the US economy, as it did in theSweetener Discord, where, in 2001, Mexico imposed a high tax on the USuntil the World Trade Organization settled the dispute in 2006, leading theCRA to incur heavy losses.

The WHO ought to take into consideration the fact that agricultural

exports tend to account for a significant proportion of a nations revenue. Itis recommended that any policies based on food production shouldconsider the yearly revenue from agricultural exports.

Click hereto see a

sample

advertisement from

the CRAs Sweet

SurpriseCampaign.

N A F T A

The trade liberation

agreement that

removes barriers to

trade such as tariffs

for the United States,

Canada, and Mexico.


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The World Obesity Federation

The World Obesity Federation (WOF) is a nonprofit organizationcomprised of members from the scientific, medical, and research

communities, all striving to lead and drive global efforts to reduce, preventand treat obesity. The WOF serves by publishing four obesity journals,serving as a

think tank

for policymakers worldwide, providing educationalresources and providing grants for research. The WOF mentions theincessant cost of obesity care in the United States, totaling $147 billion inmedical expenditures, and calls for the continued mobilization of resourcesand policy intervention from governments to curb this cost.

POSSIBLE SOLUTIONS

Implement Micronutrient Assistance Programs

The WTO subsidy rules allow countries to provide domestic food aidto sections of their populations in need. The United States SupplementalNutrition Assistance Program (SNAP) is the largest program of this kindunder the WTO. Administered by the USDAs Food and NutritionServices, SNAP has served 40 million Americans in recent years.Traditionally, these programs have been used to solely serve impoverishedand chronically under-nourished populations. However, with the rise ofobesity, the WHO could seek to enforce the establishment ofMicronutrient Assistance Programs (MAPs), providing federal aid for the

exclusive purchase of foods high in micronutrients that meet certainhealth standards declared by the countrys Ministry of Health and approvedby the WHO. Countries should consider the risks and benefits of creating arestrictive policy in an assistance program similar to this one, knowing thatwhile it might increase familys access to nutritious food, the increaseddemand of foods could cause an increase in price (a phenomena known asExcess Demand conditions), requiring an increase in national food budgets.

Alternatively, countries can seek to exclusively provide micronutrients inthe forms of vitamins or syrups. Countries can distribute thesemicronutrients freely to all constituents, or perhaps to a portion of thepopulation based on income levels or results from a health screening.

Countries should seek to find the solution that is most appropriate based onthe number of residents in countries, the availability and distribution ofmedical professionals, and the total percent of GDP spent on healthcare.

Increase Community Involvement

The WHO should seek to implement initiatives that are cost-effectiveand sustainable. Governments should aim to establish community programs

T h i n k t a n k a non-

profit organization

devoted to research a

cause to be used by

policymakers. Think

tanks are comprised of

experts in the field in

question

M i c r o n u t i e n t s-

chemicals that are

necessary for the

development of the

human body in miniscule

or micro amounts.

Slight deficiencies can

cause infertility,

developmental

challenges, and stunted

growth

Click hereto learn

more about supply

and demand

economics.


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that change families habits by empowering them to take control of theircooking, physical activity, and increase childhood obesity awareness. Forexample, in the United States, the Healthcare Georgia Foundation hasmade grants available to communities to create programs that engagefamilies in combating childhood obesity. In Washington, Georgia, local

community leaders have called for local restaurants to offer healthier menuoptions, established safe biking and walking trails, and encouraged localgrocers to provide healthy cooking demonstrations at community eventsand schools. This program has established initiatives that promoteimmediate action and encourage a change in behavior, particularly in eatingand exercising. Additionally, the program not only educates the public onrecommendations from the US Department of Health, but also facilitatesthe changes in behavior.

Additional community-centered approaches can mimic those such asthe Albuquerque Alliance for Active Living in New Mexico, where studentsliving less than one mile from their school are provided with an adult

supervisor to walk to school, or the call of the Vermont and NewHampshires Upper Valley Trails Alliance to celebrate rather thanhibernate during the winter months. To inculcate this notion, the Alliancehas developed the longest ice skating trail in the country, while generatingenthusiasm by focusing statewide festivals on winter sports, including skatingand sledding. Countries should seek to invest in and utilize existingresources and cultural traditions, while forming partnerships withincommunities, to create effective programs to elicit the desired behavioralchange toward healthier practices. Countries should strive to keep safety,efficiency, and feasibility as top priorities.

Broaden Educational ProgramsA majority of global health efforts in obesity prevention stem from the

concept of educating the public on making informed choices. TheInternational Journal of Preventative Medicine has reported that theintegration of health curriculum into schools has successfully led to healthynutrition practices and physical activity promotion (Karnik and Kanekar,2012). Schools are valuable institutions, because they have the capacity toreach students as young as age five and guide them toward a path of lifelonghealthy living. Additionally, school administrators hold a key role inaddressing obesity by establishing physical education or athleticrequirements. By enforcing at least one hour of physical activity per school

day, schools play a crucial role that the government can rely on for long-term wellness.


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Preventative educational campaigns can also come through the media,as Michelle Obama has done with her appearances on various DisneyChannel programs and ads. This campaign, called The Magic of HealthyLiving features famous faces, in this case, Disney Channel actors andactresses. These famous faces including Olympic athletes, journalists,

community leaders, and government officials can be strong advocates forhealthy living through raising awareness and emphasizing education.One largely successful campaign of this kind is the Got Milk?

campaign ads. While the purpose of the campaign was to originallypromote the consumption of cows milk, as of February 24, 2014, thecampaign was renamed Milk Life. The change in name reflects a shift inpriorities toward an educational venture by the Milk Processor EducationProgram to inform the general public of the benefits associated with milkconsumption as part of a healthy diet. Because of its versatility, the use ofthe media can be a powerful tool.

While school and community education programs can be highly

effective, delegates should consider the implementation of educationprograms for medical professionals. Obesity is an interdisciplinary disorder,requiring training beyond endocrinology, but also cultural practices,nutrition, natural medicine, and psychology; recording a patients weightand height is not sufficient to treat the pandemic. While the Association ofAmerican Medical Colleges has called for the incorporation of socialsciences in medical schools admissions requirements, a comprehensiveeducational program should include training and practice for doctors.Leading medical schools such as the University of California, San Francisco(UCSF) has paved the way for these programs by creating an elective whichallows first and second-year students to teach about the psychosocial

determinants of obesity and its consequences, increasing their knowledgebase of the behavioral aspect of illness. Associate Dean for curriculum asUCSF, Susan Masters said that their efforts are part of a mission to, bringmore social and behavioral science into [their] curriculum, which had beena gap in [their] curriculum (Time Magazine).

In considering the implementation of such education programs,delegates should keep in mind the necessary measures to reach a widenumber of citizens, especially in areas where resources may be scarce.

Reapportionment of Food Subsidies

While the aforementioned solutions strive to change the behaviors of

communities, a persistent problem is community members limited accessto healthy foods due to prices. Given the recent increase in foods, asdocumented by the World Bank, it may be appropriate to reapportion food subsidies. The premise behind agricultural subsidies is simple: farmersthat produce certain crops including corn are guaranteed to receive apredetermined quantity for their crop, regardless of the market demands.This agreement allows for farmers to have a predictable and stable income

Click hereto watch one

of the ads from the

Disney Channel The

Magic of Healthy

Living Campaign

R e a p p o r t i o n - the

reassignment or

redistribution of

resources in a different

manner based on a new

or revised criteria


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despite uncontrollable factors including inclement weather or politicalupheaval. This money allows for farmers to run their farms, however, theymust abide by the requirements established by the government to produce apre-determined amount of each crop and grow them with their desiredantibiotics or pesticides. Because these subsidies go directly into crops that

are later sold in the free market, one strategy for encouraging healthy eatingcould be to reapportion subsidies so that certain, more nutritious foods aremore accessible. This bottom-up approach would require lawmakers andpolicymakers to evaluate which foods are more crucial for a healthy,balanced diet and which should be limited, while simultaneously ensuringthe stability of prices.

QUESTIONS FOR POLICYMAKERS

It is evident that due to its complex etiology, obesity is a crucial, yet

complicated, problem to solve. This briefing has explored the role that thefederal government, media, private industries, promotional campaigns,communities, and schools can play in preventing chronic disease, asopposed to treatingit. To set the base for all resolutions, delegates shouldfocus on the concepts of sustainability and feasibility. With reportsforecasting nearly 2 billion obese individuals by the year 2030 if action is notimmediately taken (Robert Wood Johnson Foundation), it is imperativethat the delegates of the World Health Organization think collaborativelyand creatively to construct policy that reflects the complexity of the issue.

Who is in charge of determining nutritional guidelines? The WHO?Each countrys Ministry of Health? Additionally, it is important to consider

whether the standards will or should be uniform throughout a continent,country, or the world. When considering these standards, the questions ofwhether there should even be nutritional guidelines, and how the guidelineswill be enforced also arise. Will the WHO play a role in theimplementation of said guidelines? Are these guidelines permanent? If not,who has the power to change them and under what circumstance?

The proposed solution of broadening educational programs also raisesthe question of whether educational programs useful and effective. Whenconsidering this, policymakers must think about what form educationalprograms will take, who they will target, and where they primarily will bebased. Will they be based in schools? Will they be part of media

campaigns? Will they be community-based programs? Furthermore, whattype of educational content will be communicated and how will theeducational content be transmitted? How can you ensure that youreducational programs reach underserved areas? In thinking about thesequestions in particular, it is important to consider whether technology orother tools should be used to increase your reach, and what types of coststhe implementation of these programs will incur.

Health policy calls for theintegration of government

regulations, infrastructure,

education, and community

involvement.


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Individuals dedicated to the cause of eliminating the obesity pandemic,however, may need additional support in coming up with solutions. Whatrole will the government play in curtailing the heightening incidence ofobese individuals? Will they be required to consider agricultural subsidiesand markets, as well as taxes or bans on certain foods? Finally, what types of

resources and funding will be needed to support government action? Whilethere are many questions to be answered, each one plays an integral role inensuring that policymakers make informed decisions that are in the bestinterests of preserving health around the world.

CONCLUSION

A large number of questions, factors, and determinants are required tounderstand obesity. By tackling the issue from multiple fronts, the delegatesof the WHO will be able to create a comprehensive, detailed, efficient, andsustainable resolution. Because the WHO is an international program,

collaboration will be extremely important, as resolutions must be sensitiveand useful for nations regardless of their economic or developing status.The work and research that you will be doing as a member of the WHO isimperative to a countrys economic stability, technological capacity,agriculture, military, and safety. Our world relies on our peoples health.

GUIDE TO FURTHER RESEARCH

Delegates of the WHO should understand their countrys basichealthcare system, the prevalence of obesity in their countrys population,

and their countrys economic, infrastructural, and human resources tofacilitate change. In addition, delegates should investigate their countrysfood production systemwhere is it coming from? Are they imports? Is itregulated? In addition, you should be aware of any laws or programs whether successful or not that your country may have initiated todocument effective policies that may work in countries with similarconditions.

You can find general information on obesity here, including previousWHO action. In 2008, the WHO drafted a 2008-2013 action plan toaddress the rise in non-communicable disorders. The full report can befound here. This document addresses the complications that can result

from obesity, including cardiovascular disease, the leading cause of death inthe world. Thispresentation from the Center for Disease Controls GlobalHealth Promotion Office outlines what global health interventions typicallylook like, in this case in the reduction of obesity along the US-Mexicoborder. Note that theyve included a research and evaluation stage, two keycomponents of policymaking. This document summarizes key findingsfrom the National Health and Nutrition Examination Survey of 2005-2008,discussing the confounding role of socioeconomic status and obesity.


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Finally, theYale Rudd Center for Food Policy & Obesityprovides a widevariety of resources to understand the role of food production andregulation in obesity.

BIBLIOGRAPHYAmerican Psychological Association. (2003). The impact of food advertising on

childhood obesity. Retrieved 01 May 2014, from

http://www.apa.org/topics/kids-media/food.aspx

Andreyeva, T., Puhl, R. M., & Brownell, K. D. (2008). Changes in perceived

weight discrimination among Americans, 19951996 through 2004

2006.Obesity, 16(5), 1129-1134.

Barnes, B. (2012). In Nutrition Initiative, Disney to Restrict Advertising.

Retrieved 01 May 2014, from

http://www.nytimes.com/2012/06/05/business/media/in-nutrition-initiative-disney-to-restrict advertising.html?pagewanted=all&_r=0

Bernstein, M. S., Morabia, A., & Sloutskis, D. (1999). Definition and prevalence

of sedentarism in an urban population.American Journal of Public

Health,89(6), 862-867.

Caballero, B. (2007). The global epidemic of obesity: an overview.Epidemiologic

reviews, 29(1), 1-5.

Center for Disease Control. (1980). CDC - Obesity - Facts - Adolescent and

School Health. Retrieved 01 May 2014, from

http://www.cdc.gov/healthyyouth/obesity/facts.htm

ChildrewNow (2014). Children Nowobesity. Retrieved 01 May 2014, from

http://www.childrennow.org/index.php/learn/obesity/

Duffey, K. J., & Popkin, B. M. (2008). High-fructose corn syrup: is this what's

for dinner?. The American journal of clinical nutrition, 88(6), 1722S-

1732S.

DW.DERising EU obesity rings alarm bells in Brussels | Europe | DW.DE |

18.05.2013 N. p., 2014. Web. 24 Jun. 2014.

Ec.europa.eu Public Health Europe - European Commission - EU - EuropeanCommission Ec.europa.eu,. 'Public Health Europe - European

Commission - EU - European Commission'. N. p., 2014. Web. 24 Jun.

2014.

EEOC v. Resources for Human Development, Inc., 827 F. Supp. 2d 688 (E.D. La.

2011).


18/20



El Diario Oficial,. (2013).Modifica descreto N 977, de1996, que aprueba el

reglamento sanitario de los alimentos. Santiago.

Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global

trends in body-mass index since 1980: systematic analysis of health

examination surveys and epidemiological studies with 960 country-years

and 9.1 million participants. Lancet. 2011;377:557-67.

Jalongo, M. R. (2005). On Behalf of Children.Early Childhood Education

Journal, 32(6), 349-352.

Genographic Project,. (2007). The Development of Agriculture. Retrieved 01

May 2014, from

https://genographic.nationalgeographic.com/development-of-agriculture/

Health Care Georgia. (2008). Healthcare Georgia Foundation: Our Mission &

Goals. Retrieved 01 May 2014, from

http://www.healthcaregeorgia.org/about-us/mission-and-goals.cfm

Heart.org,. (n.d.). Obesity Information. Retrieved 01 May 2014, from

http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/

Obesity/Obesity-Information_UCM_307908_Article.jsp

Karnik, S., & Kanekar, A. (2012). Childhood obesity: a global public health

crisis.International journal of preventive medicine, 3(1), 1.

Kornis, M. (2006). US Corn Sweeteners Agreement at Last!.Journal of

International Commerce & Economics, 51.

Office of the Surgeon General. (2003). The Obesity Crisis in America. Retrieved

01 May 2014, fromhttp://www.surgeongeneral.gov/news/testimony/obesity07162003.html

Park, A. (2014). The Need for Better Obesity EducationIn Medical Schools |

TIME.com. Retrieved 01 May 2014, from

http://healthland.time.com/2013/10/10/the-need-for-better-obesity-

education-in-medical-schools/

Prez-Bravo, F., Carrasco, E., Santos, J. L., Calvilln, M., Larenas, G., & Albala,

C. (2001). Prevalence of type 2 diabetes and obesity in rural Mapuche

population from Chile.Nutrition, 17(3), 236-238.

Results from the National Health and Nutrition Examination Survey, 19992004.PLoS ONE 3(10): e3431. doi:10.1371/journal.pone.0003431

Shoham DA, Durazo-Arvizu R, Kramer H, Luke A, et al. (2008) Sugary Soda

Consumption and Albuminuria

Rudolph, C. W., Wells, C. L., Weller, M. D., & Baltes, B. B. (2009). A meta-


19/20



analysis of empirical studies of weight-based bias in the

workplace.Journal of Vocational Behavior, 74(1), 1-10.

RWJF,. (2012). New Report Finds Adult Obesity Rates Could Exceed 60 Percent

in 13 States by 2030. Retrieved 01 May 2014, from

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-

content/2012/09/new-report-finds-adult-obesity-rates-could-exceed-60-percent-in-13-states-by-2030.html

Steckel, R. H., & Floud, R. (1997). Front matter" Health and Welfare during

Industrialization". InHealth and welfare during industrialization(pp.

12-0). University of Chicago Press.

Stitt, C., & Kunkel, D. (2008). Food advertising during children's television

programming on broadcast and cable channels.Health

Communication, 23(6), 573-584.

Strasburger, V. C. (2011). Children, adolescents, obesity, and the

media.Pediatrics, 128(1), 201-208.

Sweetsurprise.com,. (2014). SweetSurprise.com | The Facts about High Fructose

Corn Syrup. Retrieved 01 May 2014, from http://sweetsurprise.com/

TangPeronard, J.L. Heitmann, B.L. (2008). Complications of Obesity: Stigmat

ization of obese children and adolescents, the importance of gender. Ob

esity Reviews, 9,522-534.

United States Department of Agriculture. (2013). Smart Snacks in School:

USDA's "All Foods Sold in Schools" Standards.

USA Today. (2012). 'Milk Life' replaces 'Got Milk?' ad campaign. Retrieved 01May 2014, from http://www.usatoday.com/story/news/nation-

now/2014/02/24/got-milk-milk-life-campaign/5776421/

Ustr.gov,. (2012). Mexico | Office of the United States Trade Representative.

Retrieved 01 May 2014, from http://www.ustr.gov/countries-

regions/americas/mexico

Walmart News. (2012). Walmart Corporate - Walmart Launches Major Initiative

to Make Food Healthier and Healthier Food More Affordable. Retrieved

01 May 2014, from http://news.walmart.com/news-

archive/2011/01/20/walmart-launches-major-initiative-to-make-food-

healthier-healthier-food-more-affordable

Web.worldbank.org,. (2011). News & Broadcast - Obesity, Diabetes, Heart

Attacks, and Other Chronic Diseases Threaten Health and Economies in

Poor and Middle-Income Countries World Bank Report. Retrieved 01

May 2014, from

http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK

:23001154~pagePK:64257043~piPK:437376~theSitePK:4607,00.html


20/20



Webber, L., Kilpi, F., Marsh, T., Rtveladze, K., Brown, M., & McPherson, K.

(2012). High rates of obesity and non-communicable diseases predicted

across Latin America. PloS one, 7(8), e39589.

WHO.int,. (2014). WHO | Obesity and overweight. Retrieved 01 May 2014, from

http://www.who.int/mediacentre/factsheets/fs311/en/

Worldbank.org,. (2014). Food Price Watch, May 2014: First Quarterly Increase

Since August 2012; The Role of Food Prices in Food Riots. Retrieved 01

May 2014, from

http://www.worldbank.org/en/topic/poverty/publication/food-price-

watch-may-2014

World Obesity,. (2000). World Obesity Federation | About Obesity. Retrieved 01

May 2014, from http://www.worldobesity.org/aboutobesity

WHO GRC Obesity Briefing

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