Foro Global sobre Seguridad Alimentaria y Nutrición (Foro FSN)

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¿Existen políticas y programas exitosos en el combate al sobrepeso y la obesidad?

Estimados colegas:

Es para nosotros una gran satisfacción invitarles a una discusión en línea sobre políticas y programas exitosos en el combate al sobrepeso y la obesidad. Para ello les solicitamos leer el siguiente documento y compartir sus experiencias respondiendo a las preguntas de discusión.

Breve contexto para el fórum de discusión:

La formulación e implementación de políticas públicas y programas para la prevención, control y reducción del sobrepeso y la obesidad representan un reto tanto para América Latina y el Caribe (ALC) como para la mayoría de las regiones en el mundo.

En muchos países, el sobrepeso y la obesidad son clasificados como un problema de salud pública severo que requiere medidas de acción urgente a todo nivel, incluyendo el diseño, implementación, monitoreo y evaluación de políticas y programas. Según la Organización Mundial de la Salud (OMS) al 2014 existían 1.900 millones de adultos (mayores de 18 años) con exceso de peso, de los cuales 600 millones presentaban obesidad. Así mismo, al 2013 existían 42 millones de niños menores de cinco años con sobrepeso u obesidad.

Para asegurar mayor éxito en la implementación de iniciativas para enfrentar el sobrepeso y la obesidad, es importante consultar y basar el trabajo en la evidencia científica y/o en intervenciones probadas. Sin embargo, la realidad parece mostrar que existe limitada información sobre los resultados e impacto de políticas y programas que hayan enfrentado estos problemas de una forma amplia e integral. 

Como respuesta a esta brecha, surge el “Estudio de evidencia internacional en la reducción de obesidad: Lecciones aprendidas de estudios de caso” a cargo de la FAO y la Pontificia Universidad Católica de Chile (PUC) en consulta con la OMS. Los objetivos principales del mismo son:

  • Recopilar y describir las principales y más efectivas políticas y programas existentes en la esfera internacional para hacer frente al sobrepeso y la obesidad.
  • Poner a disposición de parlamentarios y tomadores de decisión (en políticas públicas) los resultados obtenidos, para orientar mejor el diseño e implementación de iniciativas para enfrentar de manera efectiva el sobrepeso y la obesidad en la región.

Actualmente, el estudio se encuentra en desarrollo y ha identificado algunas intervenciones clasificadas en las categorías de: acceso (provisión de alimentos nutritivos a grupos vulnerables, prohibición de comida chatarra en escuelas y otras instituciones públicas), educación (guías alimentarias, educación nutricional dentro del contexto escolar, promoción de actividad física, campañas públicas de promoción de dietas saludables, etiquetado nutricional, restricciones de la publicidad de comida chatarra), oferta (mayor oferta/acceso de alimentos saludable en zonas de desiertos alimentarios, facilitación de circuitos cortos, mejora de la calidad nutricional de productos alimentarios) y económicas (impuestos, subsidios y cambios en los precios de alimentos).

Con miras a fortalecer los esfuerzos realizados hasta ahora, este fórum y su participación serán cruciales para recolectar más evidencias y experiencias de buenas prácticas y casos de éxito donde se refleje el trabajo a nivel global, regional y de país en ésta área.

Es por esto que los invitamos a responder una o más de las preguntas presentadas a continuación y así compartir su conocimiento sobre políticas y programas exitosos en el combate al sobrepeso y la obesidad. Por favor tomar en cuenta que estamos muy interesados en utilizar esta plataforma para recibir y compartir ejemplos de iniciativas ejecutadas por los gobiernos u otra institución en su país u otros países.

Preguntas de discusión

De acuerdo a su experiencia y/o conocimiento:

  1. ¿Cuáles políticas y/o programas para la prevención del sobrepeso y la obesidad se han implementado en su país o región? Considerar acciones a nivel de:
  • Políticas e iniciativas nacionales/locales (i.e. etiquetado nutricional, impuestos/subsidios a alimentos, promoción del consumo de frutas y vegetales, guías alimentarias, políticas para la promoción de la actividad física, educación nutricional en los otras políticas)
  • Intervenciones y/o programas en entornos comunitarios y escolares.

Nota: Por favor compartir enlaces/links, artículos científicos y/o documentos que complementen sus respuestas.

  1. De las políticas y/o programas mencionados anteriormente, ¿cuáles han sido efectivos en cuanto a la reducción de los niveles de sobrepeso y obesidad? Complementar su respuesta con las siguientes sub-preguntas:
    • ¿Cómo se evaluaron los resultados y/o se determinó la efectividad?
    • ¿Cuáles fueron los factores de éxito que contribuyeron a la efectividad de estas estrategias?
    •  ¿Cuáles fueron los principales retos, limitaciones y lecciones aprendidas?
  1. Finalmente, ¿Qué ELEMENTOS SON CRUCIALES para apoyar efectivamente políticas, estrategias y/o programas dirigidos a la prevención del sobrepeso y la obesidad?
    • Considerar elementos a nivel de gobernanza, recursos, desarrollo de capacidades, mecanismos de coordinación, liderazgo, redes de intercambio de información, entre otros.

Por favor no duden en compartir sus experiencias y conocimientos en el tema. Esperamos recibir sus comentarios para discutir y trabajar juntos para combatir estratégicamente este problema mundial.

Francisca Silva Torrealba, PUC Chile y Rodrigo Vásquez Panizza, FAO Chile

Facilitadores de la discusión

Esta actividad ya ha concluido. Por favor, póngase en contacto con [email protected] para mayor información.

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Obesity has become a major global health challenge due to established health risks and substantial increase in  prevalence. Being a complex condition it contributes to burden of chronic diseases by affecting all ages and socioeconomic groups. This study aims to indentify the prevalence of obesity and blood lipid profile and their associated factors in Afghanistan.

A cross-sectional study was conducted in Jalalabad within May-June 2013. Multistage random sampling technique was used to enroll 1200 adults of 25-65 Years. Physical measurement including height, weight and blood pressure was collected and blood samples were drawn in fast condition for biochemical measurement including blood lapids. Obesity was defined and categorized using body mass index. Descriptive and inferential analyses were erformed using SPSS v.20.

Approximately one third of adult population in Jalalabad city is suffering from obesity which is a cause of concern. Blood lipid profile is either borderline or more that average among study participants which could contribute to non-communicable disease. Measures such as raising awareness and lifestyle modification may help to reduce the burden of obesity the adults.

 

Dear FSN Forum Moderator,

To deeply look at the policies and programs to overcome overweight and obesity is very important. What we are noticing at the present moment is that there are some foods which people are going for the tests only. These are food such as hamburgers, chicken and chips and many more and these are mostly found in shops such as MacDonalds and others. In most cases many people are rushing for already pre-cooked foods which they buy and put into the so called microwaves to heat and eat. Many high working class communities prefer eating in restaurants also with their children as for them it is the easiest way. With my knowledge white bread is taken to be so special and people look at you if found eating brown bread. We have abandoned the knowledge by which we used to sit together as families and enjoy our food at home. More time is given to jobs at the work place and children are not interested in preparing their food at home. From these few comments I think there is more work needed to be done in sensitising consumers.  We need to build the collaboration between the food producers who are practising agroecological farming systems and consumers. There is also the need to lobby our Governments for policies that protects the Human Rights.

These are just a few to mention.

Wishes

Elizabeth

In India formal education in agriculture starts at 10+2 level. This consists of theory and practicals. Cereals, industrial crops and horticultural crops are dealt with in detail. Food and nutrition education starts at home for girls and at 10+2 level to boys. There are graduate and diploma programmes in Food science and nutrition under the overall programme of home science. There are 63 full fledged state agricultural universities/deemed universities/central universities offering home science education. At diploma level there are a large number of Food craft and catering institutions. There are premier institutions like Central Food Technological Research Institute Mysore and Defence Research Development Organization, Bangalore and BARC Mumbat doing front line research on food and food safety. FSSAI is mandated with certification for safe food. There is seperate Ministery for Food at Central and State Level taking care the safety of food consumed. Awareness on nutritious food at affordable price is being created. In India 60% of population (1200 million) are producer-consumers and as such food is considered as medicine. India lives in families where mothers food is sanctum sanctorum.

A number of the policies we worked on in New York City have been associated with decreased obesity. These involve primarily efforts to change the environment, although they were accompanied by education. These included 2007 regulation of food, physical activity and screentime in childcare settings which lead to decreased obesity and disparities. Prior to the regulations many centers served unhealthy food or sncaks or allowed parents to send them. Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations.Sekhobo JP, Edmunds LS, Dalenius K, Jernigan J, Davis CF, Giddings M, Lesesne C, Kettel Khan L. Prev Chronic Dis. 2014 Oct 16;11:E181.  Changes in the school food environment which went to low fat dairy, more fruits and vegetables, more water, no sugary drinks were associated with slight decreases especially in younger children Obesity in K-8 students - New York City, 2006-07 to 2010-11 school years..MMWR Morb Mortal Wkly Rep. 2011 Dec 16;60(49):1673-8. Placing water dispensers on school lunch lines was associated with reduced obesity: Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity, Schwartz AE, Leardo M, Aneja S, Elbel B.JAMA Pediatr. 2016 Mar 1;170(3):220-6, consistent with other studies on water access. Passage of taxes on sugar sweetened beverages has been associated with reduced consumption of these products in Mexico BMJ. 2016 Jan 6;352:h6704..Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study.Colchero MA, Popkin BM, Rivera JA, Ng SW, and we are seeing very similar preliminary results now in Berkeley, CA, the first such tax in the US, soon to be published. This policy is spreading rapidly globally and can raise revenue for prevention, healthier food, or for other social needs such as Philadelphia's recent;y passed measure which will fund early childhood education. Modelling studied suggest very significant impacts of soda taxes  on obesity, diabetes and health care costs.  Excise taxes and school nutrition standards have been estimated by Gortmaker to be cost-saving. In NYC and in an increasing number of locations public procurement policies, using the economic clout of government purchasing for schools, hospitals, jails or the military are playing a role in changing both social norms and production. Policies which prohibit advertising to children, especially of unhealthy food and beverage products are urgently needed. But  the most essential issues lie in creating the food supply and community environments we need. Traditional food supplies are being replaced by highly processed foods and beverages in mega supermarkets worldwide, a trend the US pioneered and is suffering from today.  Many of these policies above are responding after the fact. This is also a major contributor to climate change. Promoting and protecting traditional diets and minimally processed plant based foods will require  a suite of fiscal, agricultural, comercial  and environmental policies to successfully revert the obesity epidemic, assure long term food security, and promote and protect health fro the long-term.   Replacing sugary drinks with generous access to clean water is an important starting point. Assuring food security must bring together access to food and access to healthy food as its two essential precepts to both prevent hunger and and  the growing burden of global noncommunicable disease. Accompanying these changes by the environmental and transportation changes to encourage safe physical activity will also be essential. 

Dear contributors,
 
Thank you to everyone who has shared ideas and provided case studies so far!
 
Very insightful cases of policies and programs addressing obesity and overweight have been presented. Some of them might serve as a model for similar practices, while the analysis of the failed ones will be very useful to avoid making the same mistakes. 
 
In addition, many of you have pointed out the need of a comprehensive understanding of the driving factors behind overeating, and the need to contextualize them taking into account ethnicity, occupation, region and social considerations. It is also important to consider the industry reactions and the ways people change their consumption patterns.
 
Another very interesting contribution was the one that linked trade and obesity, stating that the lack of legally binding health and dietary standards impairs the implementation of national measures.
 
Please keep these cases coming! I am interested to hear about unhealthy food taxes, labelling and restrictions to unhealthy food advertising. Also I would be very interested to know if there are any particular examples of how the industry can be encouraged to provide healthy foods. 
 
Thank you for these and your other rich contributions!
 
Best regards,
 
Francisca

Dear FSN Forum,

  • Eating more animal products than cereals crops (especially wheat and rice) products in your daily food program is a very good strategy to reduce overweight.
  • Using more green tea with no sugar in it also help to reduce weight.
  • Using more water before eating is very helpful to reduce food eating and so reduce weight. Do not use water after eating food which  is not only bad for stomach  & but also harmful to health.
  • Walking/running according to a time table (better in morning) reduce weight loss.
  • Do not sleep after eating at night. Walking after dinner is very good for reducing weight.
  • Eating too much junk food increase wight so reduce or stop eating junk food.

Thanks and best regards

Dear Moderator

Find below my contribution

There is no directional policy that is currently being implemented to fight against overweight and obesity, however there are several strategic direction documents imbedded in both Health and Nutrition policies on how to tackle the problems of overweight and obesity. These documents encourages and promote Nutritional counselling, adherent to dietary guidelines, Physical activities and mandatory Nutritional labeling to provide  individual with appropriate and adequate information as it relates to Nutrients being consumed or eaten – in this regards, people have not being actually sensitized on the importance of reading the instructions on the food label before consumption for their Health and Nutrition benefit. Sometime in 2011, WHO supported a regional workshop in Arusha Tanzania to promotes consumption  of fruits and vegetables among the member states, I am not sure if a single country in attendance at that workshop have done anything to further the implementations of several recommendations that the workshop came up with. Good percentages of these recommendations speaks specifically to overweight and obesity. Looking back to Mid-90s (in Nigeria)  there are a lots of sporting activities imbedded in the school curriculum to promote healthy lifestyle, suddenly all these sporting activities disappeared from schools curriculum and the resulting situation is overweight and obese school children on the rise couple with dangerously changed dietary lifestyle that provide much energy from food consumed  without corresponding energy utilization. One sure way to fight against overweight and obesity is to introduce Nutrition education in primary school and Secondary school and reintroduction of all forms of sporting activities in the schools    

As mentioned above, there is no standalone policy or policies on Overweight and Obesity, but strategic direction documents imbedded in both health and Nutrition targeted School children, adolescent  and adulthood. However in term of effectiveness and success factors, I am not aware of a single study conducted to evaluate these strategic direction documents  either at State or  National levels simply because no dedicated implementation have been initiated   to fight overweight and obesity in the country. The major problem is that government does not see overweight and obesity as an issue for mandatory programme implementation, rather much effort is being concentrated on the other forms of malnutrition-undernutrition   

 The crucial elements are:

  1. There must be a convincing data/statistics of overweight and obesity as a problem either at Local, state or National in case of Nigeria
  2. Government Commitment  to addresses the issue  If validated to be a problem i.e Overweight and Obesity
  3. Stakeholders coming together to develop a multi-sectoral strategic implementable ( most action plans are not implementable)  action  plans to tackle the problem holistically (All key sectors must be involved)
  4. Development of appropriate Key messages to be disseminated using a continuous mass media platforms in conjunctions with other forms of information dissemination strategy.    

Adetunji, O. Falana,

Nutrition Officer,

UNICEF Sokoto  Field Office

Sama Road

Simone Bösch

World Cancer Research Fund International
United Kingdom

Dear FSN Forum members

I am writing to alert you to World Cancer Research Fund International’s NOURISHING food policy database

The NOURISHING policy database currently contains more than 260 policies across over 100 countries. The policy database is updated 3-4 times a year. Starting with the next update this summer, we will include evaluations in the policy database, as well as a country search function. 

The policy database is based on our innovative NOURISHING which formalises a comprehensive package of policies to promote healthy diets and reduce overweight/obesity and non-communicable diseases. Each letter in the word NOURISHING represents one of ten areas where governments need to take action. The ten areas take place across three domains which are each important in influencing what we eat: the food environment, the food system and behaviour change.

N = Nutrition label standards and regulations on the use of claims and implied claims on foods

O = Offer healthy foods and set standards in public institutions and other specific settings

U = Use economic tools to address food affordability & purchase incentives

R = Restrict food advertising and other forms of commercial promotion

I = Improve nutritional quality of the whole food supply

S = Set incentives and rules to create a healthy retail and food service environment

H = Harness food supply chain & actions across sectors to ensure coherence with health

I = Inform people about food & nutrition through public awareness

N = Nutrition advice and counselling in health care settings

G = Give nutrition education and skills

For more information, you can consult our Q&A online, or reach out to me if you have any queries about NOURISHING or World Cancer Research Fund International. 

Best wishes

Simone Bösch

Policy & Public Affairs Manager

World Cancer Research Fund International  

In official relations with the World Health Organization (WHO) since 2016

Second Floor, 22 Bedford Square, London WC1B 3HH

www.wcrf.org

Cancer Prevention Together We Can

World Cancer Research Fund International is holding a conference jointly with World Obesity Federation on 1-2 September 2016, London, UK. The theme is Life Course Influences and Mechanisms: Obesity, Physical Activity and Cancer. Find out more details including the conference programme here

 

The popular Indian News Paper INDIAN EXPRESS carries in its 26 June edition startling data on obeisity and underweight among rural Indian women."Obesity is no more a problem restricted to urban metros. Rural India saw a whooping eight fold increase in obesity in last 14 years" to quote Indian Express. In 2014 there were 20 million obese women in India in 2014, 9.8 million obese men in 2014 where as there were only 0.8 million obese women in India in 1975 and 0.4 million obese men in 1975. World wide obese people in 2014 was 641 million and Indias obese people in 1975 was ranked 19th and ranked third. In Tamil Nadu (one southern state of India) 25.4% of urban women is obese and 36.2 rural women are overweight. As for underweight 18.5 5 of urban women are underweight and 10.0 of rural women underweight. Consequences of obesity like diabetes, cardiovascular diseases and diseases of eye are on rise.