Obesity, diet, and inflammation in Filipino schoolchildren: an opinion paper

Department of Biochemistry, Molecular Biology and Nutrition, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines

The global surge in childhood obesity, concurrent with persistent micronutrient deficiencies, presents a profound nutritional paradox that disproportionately burdens low- and middle-income countries (LMICs). Two recent investigations by Amarra et al. (1, 2) provide critical epidemiological insights into this dual burden among a cohort of 166 apparently healthy Filipino schoolchildren aged 5 to 9 years in Metro Manila. The initial research article entitled “Obesity and micronutrient status predict inflammation and weaker immune function in Filipino schoolchildren” published in February 2025 reveals a high prevalence of Epstein-Barr virus (EBV) seropositivity and demonstrates that overweight/obesity, low serum vitamin C, and elevated iron levels are significantly associated with CRP-defined inflammation and abnormal neutrophil profiles. Their subsequent brief research report entitled “Processed snacks and baked goods predict inflammation risk in Filipino schoolchildren” published in May 2025 shifts the focus to dietary patterns, demonstrating that the habitual consumption of ultra-processed foods (UPFs), specifically commercial baked goods, cereals, and processed rice snacks, is significantly correlated with elevated inflammatory biomarkers.

To delineate the dietary classification framework utilized in this analysis and to be consistent with the classification used in the second study of Amarra et al. (1) this paper adopts the internationally recognized NOVA food classification system, which categorizes food products into four distinct groups based on the extent and purpose of industrial processing, independent of their nutrient profile (3). While “processed foods” (NOVA Group 3, such as canned vegetables, salted nuts, or artisanal cheeses) undergo basic preservation methods to extend shelf life, “ultra-processed foods” (UPFs; NOVA Group 4) are industrial formulations containing minimal intact whole foods. These products are characteristically formulated with additives, such as emulsifiers, stabilizers, and colorants, designed to induce hyper-palatability. Although the second study of Amarra et al. (2) occasionally utilizes the terms “processed snacks,” “processed foods,” and “ultra-processed foods” interchangeably, the specific dietary items highlighted in their cohort, including commercial baked goods, instant noodles, and packaged cereals, fall unequivocally under the classification of ultra-processed foods (NOVA Group 4).