The World Health Organisation (WHO) estimates that at least 2.6 million people worldwide die each year as a result of being overweight or obese (2). Whilst the most significant consequences of overweight and obesity may not become apparent until adulthood, overweight and obese children are more likely to stay overweight into adulthood and to develop these complications at an earlier age. There is a proven relationship between overweight and obesity and non-communicable diseases (NCDs) such as cardiovascular disease (including heart disease and stroke), diabetes, musculoskeletal conditions such as osteoarthritis and certain types of cancer (colon, breast and endometrial) (2).

The COVID-19 pandemic also highlighted the risk that obesity poses. Public Health England (PHE) estimated that in the adult population, a BMI of 35 – 40 could increase risk of death due to COVID-19 by 40%, and a BMI greater than 40 increased risk by 90% (3)

Obesity is multifactorial. The Federation of International Societies of Paediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) released a position paper in 2020 to highlight opportunities for preventative work (4). Infancy and childhood is a key time for intervention.

Opportunities to intervene start prior to conception. The concept of fetal programming suggests that environmental factors during intrauterine development influences postnatal development – maternal overweight or obesity at the time of conception is a strong predictor of obesity in children (4), and poor maternal nutrition may influence susceptibility to NCDs in later life (5). Infant feeding is important – rapid weight gain in the first two years of life is associated with later obesity. Breastfeeding has been shown to have a protective effect (4), and infant formulas with high protein contents were shown to increase obesity risk (4).

Dietary interventions may be helpful, as regular consumption of sugar-containing drinks are linked to obesity (6). However, approaches including various risk factors may provide added benefits. External influences such as TV advertising have a significant impact. For every 1 hour increase in TV viewing per day, there is an increase in intake of sugar sweetened beverages, fast food, red and processed meat and overall calories (7). Children who watch more than 3 hours of TV per day are 50% more likely to be obese than children who watch less than 2 (7). As well as advert exposure, sedentary behaviours contribute (4) and physical activity should be promoted. Companies and advertising agencies also have a responsibility to ensure that adverts are responsible. Paediatricians advocate to restrict advertising only to products that have a good nutrient profile, as indicated by a NutriScore A or B.

WHO recommends front of package labelling (FOPL), aiming to guide consumers towards healthier choices by clearly displaying nutritional content.

There are several different systems in use worldwide, including endorsement symbols, multiple traffic light (MTL), NutriScore and warning levels. The European Academy of Paediatrics (EAP) recommends that a consistent, easily interpretable colour-coded FOP food labelling system is introduced as a mandatory labelling requirement for packaged foods marketed in European countries, as one element of a broader obesity prevention strategy and strongly supports the EU-wide mandatory introduction of the Nutri-Score (Dereń, Dembiński et al. 2021).