Childhood obesity in low- and middle-income countries.

Overweight and obesity in childhood is an increasing problem for the less affluent countries of the world. The prevalence of overweight/obesity varies, not only between countries but across countries, depending on the environments in which children live. Changes in physical activity and diet are having adverse effects on children's nutrition. Greater affluence and urbanisation with more technology such as television in homes are associated with overweight. Affluence also brings the ability to purchase commercial, prepared 'fast-food' items, leading too often to disadvantageous effects on children's diets. The solutions to this rising tide of overweight/obesity seem to lie with broad-based programmes initiated at central government level or at more local community level but which are designed to reach across and throughout societies to enable families and communities to modify the unhealthy lifestyle which too often accompanies increasing affluence and development.

Complementary feeding and non communicable diseases: current knowledge and future research needs.

Early diet and nutrition may set in place growth patterns and/or metabolic pathways that promote risk factors for later NCDs. Most relevant studies so far available have a cross-sectional or retrospective design and are thus of limited validity for evaluating the impact of early feeding on later disease. Standardised protocols for prospective research should be developed. The contribution of protein intake in early life to later NCD development has been the object of several studies; however future research should specifically target the effects of early protein intake on (a) how protein intake influences body composition, (b) how different body composition in infancy contributes to later NCDs, (c) whether there is an age 'window' when high protein intake is particularly associated with later overweight and obesity, (d) what levels of protein intake may protect against later overweight/obesity, (e) what level of cow milk intake in the first years of life minimises risk-inducing growth whilst meeting recommended calcium intakes. The role of the quality of fat and carbohydrate intakes at early ages should be better investigated. There is a dearth of data from many communities about the foods introduced as complementary feeds, the ages at which they are introduced and why mothers use these foods. Definitely more information is needed on how and to what extent mothers' behaviour is influenced by media, advertising and other commercial pressures and why formula fed infants are started on other foods much earlier than breast fed infants. Standardized protocols are needed to develop more data on complementary feeding in different regions, different countries and different socio-economic environments.

Countries in transition: underweight to obesity non-stop?

The rise in childhood overweight and obesity in less developed countries and those with transitional economies is widely recorded. In many cases, this increase in overweight is occurring in societies where levels of under-nutrition remain high. Overweight particularly affects children in affluent families and urban families and is usually much less in rural areas. Changes such as the availability of more Western-style foods, the prevalence of snacking, a decline in physical activity, less sleep and the inactivity associated with watching television may all be contributing to the rise of overweight. The complications of overweight/obesity are already being seen in some affected children. Efforts to treat and prevent overweight in children are needed urgently if the appalling levels of overweight currently seen in the well established market economies of Europe and North America are to be avoided by less developed and transitional economies.