On October 7, the World Health Organisation (WHO) issued the first-ever guidelines for integrated management of obesity in children aged 29 days to under 10 years. The evidence-informed recommendations include guidance on dietary interventions, physical activity, sedentary behaviour and sleep, behaviour-changing interventions, digital health interventions, pharmacotherapy, and bariatric surgery.Childhood overweight and obesity is caused by an energy imbalance between the consumption and expenditure of calories. It is on the rise globally as a result of a shift towards the intake of foods that are high in fat and sugar (that are deficient in diversity as well as vitamins, minerals and micronutrients) and less energy-intensive recreational activities and transportation.AdvertisementThe surge in childhood obesity is critical for several reasons. Non-communicable diseases (NCDs) such as Type 2 diabetes, cardiovascular diseases and metabolic dysfunction-associated steatotic liver disease (MASLD), which are diseases of adulthood, are increasingly being diagnosed in children and adolescents with obesity. The net for screening of these conditions therefore has to be cast increasingly at younger ages because of this shift. Further, complications of NCDs such as chronic kidney disease, chronic liver disease or certain obesity-driven malignancies will be manifest in younger productive ages.UNICEF’s Child Nutrition Global Report 2025 marked a watershed moment — with obesity among school-aged children and adolescents, for the first time, surpassing underweight globally as the most common form of malnutrition. With childhood obesity no longer a marker of affluent societies, this report put the number of children living with obesity at about 188 million, i.e., one in ten.The prevalence of obesity is growing rapidly in low- and middle-income countries across the world, including in India. In 2000, South Asian countries had the lowest prevalence of overweight children and adolescents; by 2022, the prevalence was up nearly five-fold across all three age bands, 5–9 years, 10–14 years, and 15–19 years. The projections suggest that by 2030, India will have over 27 million children and adolescents (5-19 years) living with obesity, about 11 per cent of the global burden.AdvertisementAlso Read | Rubio in Jamnagar, and the power of capital in diplomacyThe South Asian subcontinent, while ethnically diverse, shares genetic commonalities and is characterised by a distinct “normal body mass index (BMI)-high body and abdominal fat-low muscle mass” phenotype. This renders a “central” distribution of adipose tissue — in the truncal and abdominal regions — and has serious metabolic implications, i.e., obesity-related disorders.It would be naïve to assume that undernutrition is no more a concern. In fact, low- and middle-income countries such as India are battling a double burden — the unfinished agenda of communicable diseases and undernutrition on the one hand and rising prevalence of risk factors of NCDs including obesity and overweight at younger ages. The explanations lie in inadequate prenatal, infant and child nutrition, followed by growing children experiencing exposure to high-fat, energy-dense, and micronutrient-poor foods and not enough physical activity.The policy approach is to address the obesogenic environment, that is, “an environment that promotes gaining weight and one that is not conducive to weight loss” within the home or school. The magnitude of childhood obesity in China has been larger than in India, and there is a wealth of experience and lessons to be drawn from their successes and gaps in the policy and programmatic approaches. The urgency is also manifest in some of the recent initiatives in India.The big message is that the government’s role is critical — the union and state governments for agenda and policy framing, and local and municipal governments for adaptation and implementation in local settings. The major pillars include addressing the food environment and lifestyles, including promoting physical activity, establishing meal and obesity guidelines, and implementing health education and early intervention programmes such as limiting sweetened beverages at schools.you may likeThe food environment is the toughest challenge — with weak interventions in marketing through television and other media, and front-of-package labelling. A key implementation imperative is tailoring these to sub-national and regional variations, ethnicities, and cultures. These also entail increased capital investment; to a certain extent, sin taxes can generate revenue for specific public health interventions.In conclusion, three aspects will matter: Meaningful multisectoral alignments across health, food, agriculture, education, business and commerce, transport, environment, culture and media, and other sectors to shape and support a healthy environment; business enterprises demonstrate responsibility to consumer health; and the focus shifts from managing childhood obesity in the short term to sustaining long-term benefits in reduction and control of obesity susceptibility.The writer is Chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University and former editor, Indian Journal of Public Health. Views are personal