National childhood obesity‐related intervention systems and intervention programs in China in 1949 to 2020: A narrative review

Abstract

Objective This review examines main government and nongovernmental institutions for childhood obesity prevention and control in China, as well as major national interventions for childhood obesity. Methods PubMed, China National Knowledge Infrastructure (CNKI), Wanfang, official websites of national governments and professional institutions/associations, Baidu.com, and Google.com were systematically searched in March 2020 to April 2020. A total of 20 international and national experts on childhood obesity were surveyed. Results “Government‐led multisector cooperation” obesity‐related intervention systems have been formed. National‐level interventions were mainly implemented by the Chinese State Council and its administrative departments, along with national professional institutions/associations. Provincial, municipal, and county governments and their subordinate departments coordinated local works. Actions taken by these sectors to fight childhood obesity included developing and implementing regulations and laws, health standards and practice guidelines, surveillance for obesity and related determinants, governmental budget and research funds, and interventions. A total of 14 major national childhood obesity‐related interventions were found: comprehensive interventions (e.g., “Healthy Lifestyle for All campaign,” 2007), diet and nutrition (e.g., “Chinese Rural Compulsory Education Student Nutrition Improvement Program,” since 2011), and physical activity (e.g., “Happy 10 Minutes Program,” 2006). Conclusions Although obesity‐related intervention systems and national interventions were implemented, more efforts and stronger government leadership and commitment are needed.

Secular trends in physical fitness of rural Chinese children and adolescents aged 7–18 years from 1985 to 2019

“…To improve the health of poor rural students, the state launched the "Nutrition improvement program for rural compulsory education students" in 2011, with the financial department providing nutritional meal subsidies for rural compulsory education students (approximately 7-15 years) in poor areas of central and western areas. In the beginning, each student was provided with a subsidy of 3 yuan per study day, which was increased to 4 yuan in 2014 and 5 yuan in 2021, and the subsidy amounted to 34.8 billion yuan in 2021 74,75 . Through this, the average height and weight of students increased, and the gap between urban and rural areas narrowed; micronutrient deficiencies such as anemia decreased; the intake of foods rich in high-quality protein and micronutrients such as fish, poultry, meat, eggs and milk increased, and rural students' nutrition levels improved 74,75 .…”

“…In the beginning, each student was provided with a subsidy of 3 yuan per study day, which was increased to 4 yuan in 2014 and 5 yuan in 2021, and the subsidy amounted to 34.8 billion yuan in 2021 74,75 . Through this, the average height and weight of students increased, and the gap between urban and rural areas narrowed; micronutrient deficiencies such as anemia decreased; the intake of foods rich in high-quality protein and micronutrients such as fish, poultry, meat, eggs and milk increased, and rural students' nutrition levels improved 74,75 . A study from CNSSCH found an increase in the percentage of children and adolescents meeting one hour of in-school physical activity 76 .…”

Secular trends and urban–rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019

“…Second, the prevalence of stunting in urban children and adolescents in China decreased from 8.6% to 1.4% between 1985 and 2014, while it decreased from 24.2% to 3.2% in rural areas (Song et al, 2019). During this period, the Chinese government noted serious nutritional deficiencies in rural areas, and to improve the growth and development of rural children, the state launched the “Nutritional Improvement Program for Rural Compulsory Education Students” in 2011 (Li, Taerken, et al, 2023; Ma et al, 2022). Through this initiative, rural children's diets have changed and their nutritional levels have improved, contributing to an increase in adult height.…”

The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study

“…Historically, these interventions focused on school-based nutrition and physical activity programs. 5 For example, in 2008, the Bureau of Disease Prevention and Control National Health Commission revised the Guidelines for the Prevention and Control of Overweight and Obesity Among School Aged Children and Adolescents in China. 5 Infant nutrition has also been a focus with nutrition assessment and dietary guidance before and during pregnancy.…”

“… 5 For example, in 2008, the Bureau of Disease Prevention and Control National Health Commission revised the Guidelines for the Prevention and Control of Overweight and Obesity Among School Aged Children and Adolescents in China. 5 Infant nutrition has also been a focus with nutrition assessment and dietary guidance before and during pregnancy. While not initially implemented as an obesity control and prevention policy, in the 1990s China began implementing the ‘Baby-friendly hospital initiative’ (BFHI) to promote exclusive breastfeeding, which is now known to reduce the risk of OAO later in life as is considered by nutrition researchers as a ‘double-duty’ intervention.…”