Zahedan University of Medical Sciences Taking Action on Childhood Obesity: Ending Childhood Obesity (Iran ECHO) program report 2019

Report from: ZAUMS Community Nutrition Department
Published on: 19 August 2019

Childhood obesity is one of the most serious public health challenges of the 21st century, and the prevalence has increased at an alarming rate. Globally, in 2016 the number of overweight children under the age of five is estimated to be over 41 million. Almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa (1).

Figure 1- Number of children aged 5-19 living with overweight or obesity in 2016, and the increase in prevalence from 2010 to 2016, by WHO region

Overweight and obese children are likely to stay obese into adulthood (2). Consequences of childhood obesity are not just aesthetic. Being overweight or obese can lead to a host of physical and mental health problems, including: developing the metabolic syndrome, cardiovascular disease, type 2 diabetes and its associated retinal and renal complications, nonalcoholic fatty liver disease, obstructive sleep apnea, polycystic ovarian syndrome, infertility, asthma, orthopedic complications, psychiatric disease, and increased rates of cancer, among others (3).

Figure 2- Age-related consequences of childhood obesity

The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain (4). Most obese children do not have an underlying endocrine or single genetic cause for their weight gain.

Prevention and management of childhood obesity remains a public health priority and necessitates an integrated chronic care approach (5). Obesity prevention efforts should focus on healthy family-based lifestyle modifications. Providing suitable strategies and novel interventions should be considered by the entire health care system for prevention and management of obesity (2).

In response to the childhood obesity epidemic, all countries have agreed a set of global targets for halting the increase in obesity. This includes no increase in overweight among children under age 5, school-age children or adolescents by 2025 (from 2010 levels). Action to reverse the epidemic is the focus of the recommendations made by the WHO Commission on Ending Childhood Obesity and is one of the main objectives of the Decade of Action on Nutrition.

The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program is a comprehensive program on prevention and control of overweight and obesity in Iranian children and adolescents. The IRAN-ECHO program considers multi-sectoral interventions through population and individual approaches. The multi-component interventions of this program address the obesogenic environment by considering the life course dimensions. It is expected that, by its life course interventions, it could help in primordial and primary prevention of non-communicable diseases (6).

The IRAN-ECHO program uses 5210 training tools for promoting healthy habits in combating childhood obesity. The 5210 messages are evidence-based, originating from the Childhood Obesity: Assessment, Prevention and Treatment Expert Committee, and endorsed by the Canadian Pediatric Society. The recommendations adapted align with Iranian Ministry of Health recommendations for food, activity, screen time and sleep in children and adolescents. The 5210 training tools encourage families to eat 5 or more fruits and vegetables, have 2 hours or less of recreational screen time, have 1 hour or more of physical activity, and drink 0 sugary drinks every day.

The statistics show that 2 percent of children and adolescents in Sistan and Baluchestan province are overweight and obese. In Zahedan University of Medical Sciences, the IRAN-ECHO program was launched since February 2018 and it has been implemented at the level of comprehensive health service centers.

As part of the Health Transformation Plan, a total of 20 nutritionists have been recruited to serve in the urban and some rural comprehensive health centers to provide free nutrition counseling to the families. Implementing nutrition promotion programs, physical activities and reducing sedentary life style, prenatal care, providing healthy lifestyle strategies, proper diet, family-centered services based on healthy lifestyle, are the most important prevention programs for overweight and obesity control in Zahedan University of Medical Sciences.

The prevention and control of overweight and obesity in children and adolescents through raising awareness among families about the causes and the consequences of obesity and the importance of adopting a healthy lifestyle are among other programs for the prevention of overweight and obesity.

Implementation of educational programs promoting proper nutrition; adequate physical activity and informing children and adolescents in the Institutes for Intellectual Development of Children and Young Adults other educational centers during the holiday season were among the programs carried out by nutrition experts. Moreover a total of 200 kindergarten teachers have participated in workshops on healthy nutrition promotion programs and they promote healthy lifestyles at educational centers.

Performance of Iran Eco Program at Zahedan University of Medical Sciences

1. Holding a workshop on "Prevention and Control of Obesity in Children, Introducing Iran- ECHO Program and Diet Therapy in Obesity" for nutritionists and healthcare workers recruited through the Health Transformation Plan

2. Holding a briefing session at the provincial level and 5 session at the district level on implementing the Iran-EHCO program with the participation of representatives of partner institutes and organizations

3. Collaboration with Zahedan Radio Station to produce a total of 12 engaging and insightful radio programs on childhood obesity and its control strategies

4. Providing training for a total of 231 trainers at the Intellectual Development Institutes for Children and Adolescents by nutrition experts, along with anthropometry, calculating BMI and providing iron and vitamin D supplementation

5. Training of 5600 children and adolescents about obesity and its control strategies in the Intellectual Development Institutes across the districts covered by ZAUMS

6. Training of 364 healthcare workers and Behvarzes in the districts covered by ZAUMS

7. Distribution of 1000 pamphlets entitled "Obesity is a disease, even in children" in Zahedan health centers and kindergartens

8. Identifying more than 2000 overweight and obese children and adolescents and providing nutritional counseling and follow up