Double‐ and triple‐duty actions in childhood for addressing the global syndemic of obesity, undernutrition, and climate change: A scoping review

Abstract

Summary Obesity, undernutrition, and climate change constitute a global syndemic that disproportionately affects vulnerable populations, including children. Double‐ and triple‐duty actions that simultaneously address these pandemics are needed to prevent further health, economic, and environmental consequences. Evidence describing the implementation and evaluation of such actions is lacking. This review summarized the literature on whole‐of‐population actions targeting children that were designed or adapted to be double or triple duty. Six academic databases were searched (January 2015–March 2021) using terms related to ‘children’, ‘intervention’, ‘nutrition’, ‘physical activity’, and ‘climate change’. Data were extracted from 43/15,475 studies, including six randomized controlled trials. Most (58%) described triple‐duty actions targeting food systems in schools such as implementing guidelines for healthier and environmentally sustainable school meals programs, and 51% reported engaging community in the design, implementation, and/or evaluation of actions. Changes in dietary intake, diet composition, greenhouse gas emissions, and food waste were the most frequently reported outcomes and 21 studies (three randomized controlled trials) showed positive double‐ or triple‐duty effects. This review is the first to demonstrate that double‐ and triple‐duty actions for addressing the global syndemic in childhood have been implemented and can have a positive impact on obesity, undernutrition, and climate change.

Environmental sustainability and food provision in the early childhood and education setting

“…The measurement of menu compliance alongside food waste ensured that we were able to consider both healthfulness and environmental sustainability of the food provided. Finally, our research sets the stage for future triple-duty action research and interventions in childcare settings, which has been found to be more effective than addressing each component in isolation ( 44 ) .…”

Chilean children’s adherence to sustainable healthy diets and its associations with sociodemographic and anthropometric factors: a cross-sectional study

“…For adequacy components, consumption equal to or above the recommended percentage of total energy intake is given the highest score while consumption below the recommended percentage of total energy intake is given proportionally lower scores; for ratio and optimum components, consumption equal to or close to the recommended percentage of total energy intake is given higher scores while consumption either above or below the recommended percentage of total energy intake is given proportionally lower scores; lastly, for moderation components, consumption equal to or close to zero is given higher scores while consumption above zero is given proportionally lower scores. Of note is that consumptions outside the recommended range of percentage of total energy intake for each component are given zero points based on sustainable healthy dietary guidelines [35] along with policies limiting access and exposure to unhealthy food and beverages [2], can help achieve this goal. In Chile, the introduction of the Food Labelling and Advertising Law at the end of June 2016 [36] may have reduced children's intake of added sugars and saturated fats from ultra-processed products consumed at schools [37]; however, it is still unknown whether this policy has improved their adherence to sustainable healthy diets.…”

Determinants of overweight and obesity among children between 5 to 11 years in Ecuador: a secondary analysis from the National Health Survey 2018

“…This approach should incorporate triple-duty actions, considering the distinctive aspects of diverse life stages. [41].…”