Interpretation of WHO Guideline: Assessing and Managing Children at Primary Health-care Facilities to Prevent overweight and Obesity in the Context of the Double Burden of Malnutrition

摘要

Along with the transitions of social and economic development, dietary patterns, physical activity and life-styles, the prevalence of childhood overweight and obesity has increased at an astonishing rate in the past decades, and has become one of the most serious public health challenges. Meanwhile, the stunting rate has declined with slow pace, while millions of young people are still threatened by wasting all over the word. The present situation of double burden of malnutrition should be recognized clearly and addressed seriously, which refers to, the common presence of both obesity and underweight in the same populations, communities and even families. In order to provide guidance on the appropriate assessment and management of infants and children presenting to primary health-care facilities, and to reduce the risk of overweight and obesity among children, the guideline Assessing and Managing Children at Primary Health-care Facilities to Prevent Overweight and Obesity in the Context of the Double Burden of Malnutrition was developed and released by WHO in 2017 using the procedures outlined in the WHO handbook for guideline development. The WHO Guideline (2017) is intended primarily for use in low- and medium-resource settings where both under-nutrition and obesity are prevalent. In this guideline, there are three prioritized specific areas and questions for infants and children presenting to primary health-care facilities: anthropometric assessment, care of infants and children with acute or chronic malnutrition, and care of children who are overweight or obese. It is recommended that for infants and children aged < 5 years presenting primary health-care facilities, weight and length/height should be measured and evaluated adequately, general nutrition and physical activity counselling should be provided for the caregivers and families, identification and appropriate management plan should be developed at primary health-care level. The discrepancies of the recommendation on the three prioritized areas in different guidelines are compared in this paper. All the related guidelines emphasize the importance of anthropometric measurement and monitor of growth for primary care workers and suggestions of dietary and physical activity's counselling for obese people. Almost all the guidelines provide recommendations on breastfeeding and continued feeding counselling from the aspect of improving the status of acute or chronic malnutrition. The setting conditions should be carefully considered when taking the guidelines of different organizations and countries into practice.