Forum global sur la sécurité alimentaire et la nutrition (Forum FSN)

Dear FSN Forum Moderators,

Many thanks for the opportunity to contribute to this important policy challenge. 

1. Which policies and/or programmes have been implemented in your country or region to prevent overweight and obesity? Please consider:

At the Municipality of Santiago de Chile we have been implementing since 2014 an intersectoral health promotion programme called Santiago Sano. Santiago Sano uses a Health in All Policies approach to tackle NCDs with population-based interventions. The programme uses a conceptual framework through the AMA model that includes three areas of proven cost-effectiveness: Availability, Marketing and Affordability. Santiago Sano’s main objective is to improve health and quality of life of the people that live, work and study in Santiago and experience high risk factors for NCDs, such as, unhealthy diet, physical inactivity, alcohol and tobacco consumption. Along the process, the programme has also included interventions in mental health and sexual and reproductive health (see more in http://www.saludstgo.cl/?page_id=315).

Within Santiago Sano, interventions addressing nutrition and physical activity in schools are grouped in a program called the 9 Step Agenda, focusing on nine topics or intervention areas, including: (1) preschool and primary school nutrition, particularly promoting healthy snacks, school food programs, and healthy kiosks; (2) construction of healthy school gardens and orchards; (3) food and nutrition education; (4) ensuring quality of physical education classes; (5 and 6) providing sport and leisure infrastructure that promote movement; (7) active transportation to and from schools; (8) extracurricular activities and (9) intensive prevention programs. The 9 Step Agenda is led by the Municipal Department of Education together with the departments of Health, Sports, Local Economic Development and Environment.

1. Which of the policies and/or programmes mentioned before have succeeded in reducing overweight and obesity levels? Please complete your answer answering the following queries:

During 2015, the 9 Step Agenda was implemented in 3 schools, in one of which there is an evaluation aimed at measuring impact (Salvador Sanfuentes Primary School) located in Santiago, targeting nearly 700 children from preschool up to 3rd grade (4 to 8 years old) and over 60 adults, including both school staff and student’s parents. The main interventions carried out were the following:

1. School Nutrition:

Promotion of healthy snacks. To promote the consumption of healthy snacks during recess, a ‘healthy snack contest’ was developed. By means of a nutrition education session, students from 1st to 3rd grade learned to identify healthy foods adequate for snacking during recess and unhealthy foods to be eaten occasionally (e.g. birthdays or other celebrations). Next, the class voted which healthy foods they would bring each day for recess and together created their weekly ‘healthy snack calendar’. Periodical supervisions were made and registered in a panel in each classroom to monitor calendar compliance. Classes competed against each other for the highest compliance rate, which was rewarded with a trip to a swimming pool.

Results: From a sample of 240 children from 1st and 2nd grade, this contest achieved a decrease in the amount of children that ate unhealthy snacks during recess. Consumption of salty snacks (e.g. chips, doritos) decreased in 31,1%,  juice boxes in 36,6% and candy bars in 13,8%. On the other hand, the amount of children that ate healthy snacks increased. The consumption of hard-boiled eggs increased in 3,1%, vegetables in 1,2% and nuts and dried fruits in 2,5%. Before the intervention, these healthy foods were not considered as alternatives for school snacks, but were considered as such after the intervention, demonstrating improvement of student’s eating habits.  Additionally, juice boxes were replaced for water, which increased in 15,8%.

Healthy kiosks. In preparation for a binding tender in 2016, a voluntary programme was designed to reach 30% of healthy snacks sold on school kiosks. This was offered to 38 kiosks in Municipal public schools and 10 of which achieved the target, including the Salvador Sanfuentes Primary School.

1. Food and nutrition education. Knowledge and skills required for accomplishing healthy diets were developed among students, staff and parents in over 60 educational sessions, addressing topics such as: healthy snacks, food groups, consumption of legumes, healthy plate, food labeling, and family meal planning.  

2. Leisure infrastructure that promotes movement. Fun recess kits (i.e. baskets with balls, hoops, ropes, etc) were made available in each classroom from prekinder up to 3rd grade to be used by students during breaks.

Intensive prevention program.  This aspect of the 9 Step Agenda consists of implementing a   program from the Ministry of Health called Vida Sana (Healthy Life), which aims at improving the nutritional and metabolic status, as well as  physical condition of children, teens, adults and postpartum women with risk factors for diabetes and cardiovascular diseases. This program is a 12 month intervention based on nutritional counselling, education, and physical activity sessions; following an individual-based approach. However, within Santiago Sano’s context it has been adapted and given a population-based approach, reaching healthy community members as well.

Results: From a sample of 163 children with overweight and obesity aged 2 - 19 years who completed 9 months of intervention, 21,5% improved their nutritional status (from obese to overweight or normal or from overweight to normal). Regarding the adult population participating in the program, an average reduction of 4,3 kilos in body weight was observed.

1. Finally, which ELEMENTS ARE CRUCIAL to effectively support policies, strategies and/or programs targeting overweight and obesity reduction?

​Even though the experience is new and the impact results preliminary and uncontrolled, we have learned important lessons for implementing integral health promotion interventions. First, the existence of political will from the Mayor’s Office (who lead Santiago Sano) was essential to ensure that processes are followed according to schedule. Second, intersectoral structures and processes to achieve effective policies and programmes to fight overweight and obesity, since coordination between the different sectors in order to ensure availability and access to healthy environments and opportunities (foods, sports, etc). In our case, this is done through an Executive Committee led by the Mayor’s Office and a specific committee led by the Department of Education. This provides an institutional platform that ensures sustainability and facilitates the intervention in each school.

Another crucial element -and at the same time one of the main challenges encountered- is community involvement. Given that the 9 Step Agenda takes place within school environments in which academic education is the main objective; issues such as healthy diets and exercise are not always relevant and therefore not much time is given to fully implement the activities. Therefore, commitment from behalf of school directors, teachers, as well as parents and students is necessary to address overweight and obesity inside and outside the classroom. Furthermore, community involvement is the stepping stone for other necessary elements such as capacity building and empowerment.  

Finally, most reported interventions in schools in Chile have been funded by the food industry. The interventions by the Institute for Nutrition and Food Technology (INTA) from University of Chile have been funded by Nestlé and Nutresa. Other interventions have been directly funded by the food industry per agreements with Municipalities. A key challenge has been to ensure financial support free of conflict of interest, for which several funding sources from the Ministry of Health, Education and Municipal funds had to be pooled. We have also had to reject several attempts from the food industry to permeate the interventions. All of these has required a great deal of political commitment and understanding from all partners in Municipal departments.

English translation below

Уважаемые участники форума FSN,

Проблемы ожирения и метаболического синдрома, характерные для современного человечества, во многом усугубляются недостаточной научной разработанностью тех метаболических причин и следствий, которые формируют проблему метаболических нарушений на фоне сниженной двигательной активности современного человека. В последние 20 лет большое число исследователей во всех технологически развитых странах заняты поисками эффективных мер по противодействию распространяющемуся ожирению. Недавно обнаружено. что в составе тела человека присутствует несколько разновидностей жира, причем если одни их них являются потенциально опасными и причиняют их носителю много неприятностей в области здоровья, то другие, так называемые "бурый" и "бежевый" жир, являются естественными помощниками человека в борьбе с ожирением. Так появилась надежда выйти победителями из сражения с всемирным ожирением за счет активизации бурого и бежевого жира. Однако эта уникальная ткань относится к разряду факультативных, то есть встречается не у всех людей, а в той или иной степени - только у примерно 70% населения Земли. Наука пытается сегодня разобраться, как можно это использовать для борьбы с метаболическим синдромом. Именно об этом говорится в небольшом обзоре. который мы с коллегами подготовили в прошлом году на основе анализа новейшей литературы. Возможно. некоторые высказанные в статье идеи могут оказаться полезными для кого-то из участников данной дискуссии.

С пожеланиями крепкого здоровья и всяческих успехов,

профессор Валентин Д.Сонькин, Москва, Россия

Dear FSN Forum members,

Obesity and metabolic syndrome that are typical for modern people are largely worsen by inadequate scientific development of the metabolic causes and effects that form the problem of metabolic disorders affected by reduced motion activity of modern people. For the last 20 years a large number of researchers in all technologically advanced countries has been searching for effective measures aimed at preventing the growing problem of obesity. It was recently discovered that there are several types of fats in human body; while some of them are potentially dangerous and cause a lot of health problems, other so-called “brown” and “beige” fats are natural helpers in the fight against obesity. So there is a hope to win the battle with global obesity by activating brown and beige fats. However, this unique tissue is facultative, which means that not all people have it; approximately 70 percent of the population have it to various extents. Today the science is trying to understand how it can be used to fight the metabolic syndrome. It is stated in a small review, which my colleagues and I prepared last year, and which is based on the analysis of the latest publications. Perhaps some of the ideas expressed in this article may be useful for some of the participants of the discussion.

Wishing you good health and every success,

Professor Valentin D. Sonkin, Moscow, Russia

Dear FSN Forum,

I would like to contribute the attached information sheet on EPODE International Network (EIN) and EPODE.  

We are a not for profit organisation supporting community-based programmes for the prevention of overweight and obesity.  

We have evidence-based results to demonstrate very encouraging results in the decrease and prevalence of overweight and obesity through community-based interventions.

We need more policies to put the obesity prevention as a priority on agendas and to support our ongoing efforts including PPP (one of our 4 pillars).

Best regards, Pauline

Pauline Harper

EPODE INTERNATIONAL NETWORK

To: FAO Global Forum on Food Security and Nutrition (FSN Forum)

Subject: Response to FSN Forum’s Online Discussion on “Are there any successful policies and programmes to fight overweight and obesity?”

Date: 4 July 2016

Dear FSN Forum Moderators,

Across Asia, obesity, malnutrition and chronic diseases are some of the biggest health challenges of the 21st century. To facilitate a multi-stakeholder platform to initiate a dialogue on an integrated approach to solving these challenges, the Asia Roundtable on Food Innovation for Improved Nutrition, or ARoFIIN, was inaugurated on 30 January 2015 in Singapore.

With an initial focus on Southeast Asia and China, senior delegates from government, academia, industry and the rest of society exchange views on the current landscape as it relates to the social, economic and health opportunities for food and nutrition-based R&D, as well as consumer behavioural changes in the food and nutrition arena.

As a member of the Asia Roundtable on Food Innovation for Improved Nutrition (ARoFIIN), please find below our contribution.

The number of obese adults in the ASEAN+6 countries (Brunei, Indonesia, Malaysia, the Philippines, Singapore, and Thailand) increased at a faster rate than that of the United Kingdom and the United States of America from 2010 to 2014, according to data gathered by the Economist Intelligence Unit (EIU).

In response to the nutrition double burden problem in Asia, ARoFIIN was formally launched in January 2016 to leverage public-private partnerships and bring together experts from across government, academia, industry and civil society, to initiate and sustain a regional, multi-stakeholder dialogue on the role of food innovation in tackling obesity and chronic disease. ARoFIIN was convened by the Health Promotion Board (HPB), the Agency for Science, Research and Technology (A*STAR), the Singapore Institute for Clinical Sciences (SICS) and Food Industry Asia (FIA). 

ARoFIIN was established based on these three principles:

1. Whole-of-Society Approach

We believe in the power of bringing senior actors from government, academia, industry and NGOs together to analyse the existing landscape in Asia as it relates to:

1. Social, economic and health opportunities for food and nutrition-based R&D
2. Consumer behaviour changes in the food and nutrition arena

ARoFIIN is a unique partnership centred on using innovative ways to deliver science-based solutions. It works on four broad areas for collaborative activity that draw on the collective strengths of its delegates:

1. Platform: Establishing an evidence-based knowledge hub and facilitating the nutrition dialogue
2. Consumer: Enhancing nutrition literacy and understanding consumer behaviour

1. Regulation: Understanding the barriers and enablers of innovation

1. Double Burden: Optimising nutrient accessibility, food innovation and reformulation to tackle malnutrition

1. The First Obesity Study for Asia

ARoFIIN is collaborating with the Health Promotion Board of Singapore on a benchmarking obesity study, which is being undertaken independently by the Economist Intelligence Unit (EIU). The study aims to provide visibility on the obesity and NCD interventions that have been shown to be effective in tackling obesity in the region and what the economic impact and resulting healthcare costs. This study is unique because it is the first-of-its-kind in Asia to allow policy-makers to compare the prevalence of obesity and related NCDs, as well as direct and indirect healthcare costs in the region.

The study is conducted in two phases:

1. Phase 1: Economic cost analysis

The purpose of the survey will be twofold: gathering prevalence rates and gauging cost of treatment. Two populations will be: obese people and medical practitioners who are involved in treating obesity-related conditions.

1. Phase 2: Policy interventions

In this phase, an overview of potential interventions will be conducted that can be used to prevent and control obesity with policies that have been deployed in South-east Asia. The framework is structured around four intervention areas: Activity, Psychology, Physiology, and Food.

1. Scaling up Projects

The results of the Asian obesity study, which is expected to be released before the end of 2016, will act as the first reference document for tackling nutrition challenges in Asia. It will guide ARoFIIN’s next steps in designing and scaling up feasible intervention projects to help address obesity and chronic disease in the context of Asia.

ARoFIIN taskforces are identifying other key potential projects that are scalable that focus on the double burden challenge in Asia.

Best regards,

Matt Kovac

Food Industry Asia

Member of the Asia Roundtable on Food Innovation for Improved Nutrition (ARoFIIN)

For more information, visit www.ARoFIIN.org  or e-mail us at [email protected]

Brazil has an Intersectorial Strategy for Prevention and Control of Obesity. This Strategy was elaborated under the Chamber of Food and Nutrition Security (coordinated by Ministry of Social Development) that brings together 20 ministries. It also has the participation of civil society through the National Council for Food and Nutrition Security (CONSEAs) and the Pan American Health/World Health Organization (PAHO/WHO).

The Strategy covers 6 axes of action. The focus in these actions explains the country's efforts towards the strengthening and integration of public systems (public health care, education, social assistance) as guarantors of social rights. Also strengthening family farming as a way of bringing the production and consumption of food in a sustainable way (social, economic and environmental). Also reflect efforts to promote intersectoral actions in food and nutrition. These proposals, however, are focused of an intense discussion and may be improved. All these propositions are addressed in the Strategy, although some actions have not yet been implemented effectively.

Below information of the Intersectoral Strategy for Prevention and Control of Obesity. There are 81 initiatives that the federal government is promoting their achievement at the state and municipal level. The biggest challenge of this government initiative is to scale the recommended actions reaching 5,570 municipalities.     

I.        Availability and access to adequate and healthy food

- Conducting institutional purchases of healthy food from family farms to public facilities,

- 712 million reais invested in the purchase of food from family farms for school feeding depending on the requirement of the minimum purchase of 30% of family farming. 43 million children are fed daily in schools;

- Restrictions on buying processed foods and ultra processed in school meals and minimum supply of 3 servings of fruits and vegetables per week;

- Studies on fiscal measures to promote greater access to healthy foods, such as the taxation of soft drinks and sugary drinks;

    II.        Actions in education, communication and information

- The Food Guide messages dissemination for the Brazilian population that drives the consumption of foods fresh and minimally processed;

- Promoting voluntary and autonomous practice of healthy eating habits

- Virtual network to support the actions of food and nutrition education - Ideias na Mesa (http://www.ideiasnamesa.unb.br/);

   III.        Promoting healthy lifestyles in specific environments

 - Promotion of healthy food in schools, health units and social assistance:

- Health in School Program today with 78,934 schools (2015) present in 4787 municipalities with a total of 18,313,214 students;

- EAN actions in the social assistance network present in the states and municipalities;

- Orientation of Breastfeeding and Complementary Feeding (Breastfeeding Strategy and Food) in 1348 Health Units;

  IV.        Food and Nutrition Surveillance

  V.        Comprehensive health care of the individual with overweight/obesity: attention nutrition under the National Health System, the weight of excess carrier among others.

  VI.        Regulation and control of the quality and safety of food

-       Improving standards of labeling in packed food (ANVISA).

-       Regulation of food marketing to children

o   Resolution of the National Council for the Rights of Children and Adolescents (CONANDA) defines the unfairness of targeting advertising and marketing communications to children and teenagers.

o   Ministers of the Supreme Labor Court ruled that advertising to children is inconstitutional.

o   Regulation of sales and food marketing at school (27 municipalities and 11 states already have a law)

See more in: http://issuu.com/informecaisan/docs/estratprevcontobesidade_versaoingle.

Dear FSN Forum,

Attached is a presentation introducing the Alliance for Food & Health (AFH), a new platform to address food and health issues.  The purpose of AFH is to suggest actionable, innovative and effective polices and initiatives by facilitating collaboration between diverse stakeholders, including NGOs, governments, academia, the public health and medical communities and the food and agriculture industry.  The creation of thought leadership drawn from highly diverse participants is a unique value-add of AFH since its breadth may allow it to create new ideas that could influence policy and other commitments in unique ways.  If implemented, this joined-up thinking could significantly improve global health outcomes.

Eric B. Trachtenberg

Director, Food & Agriculture Sector | McLarty Associates

900 Seventeenth Street, N.W., Suite 800 | Washington, DC  20006

Dear Colleagues,

On behalf of Dr. David Allison and myself, please find below our contribution.

The belief that any particular public policy or public policies in general may be effective in helping to reduce obesity rates is intuitively a sound idea and might be true in some cases. However, intuitive plausibility does not imply that they will always be successful, especially if these programs do not mesh well with the social norms, values, and culture of the targeted communities. Policies need to be evaluated. As stated by Dr. Griffin Rodgers (Director of NIH’s NIDDK) and Dr. Francis Collins (Director of NIH), “….research is important to determine which of these well-intentioned policies and programs are working and for whom…. what seems reasonable to try is not always effective and may even have unanticipated effects,” (The Next Generation of Obesity Research: No Time To Waste, 2012). Hence, we strongly believe that policies and programs addressing obesity should be evaluated with the most rigorous evidence possible. To date, despite many efforts at the local, national, and international levels, there is little evidence that existing programs are both effective and sustainable.

Unfortunately, many claims about the demonstrated efficacy of various programs are exaggerated as, for example, discussed in a talk found at this link (https://www.youtube.com/watch?v=RSLWt_g6JOs). Such exaggerations and distortions can lead to misperceptions of causal relations and misunderstood beliefs about the effectiveness of programs that target those identified causal relationships. In consequence, ‘myths’ seem to abound about obesity and its treatment and prevention (see “Myths, Presumptions and Factors about Obesity).

NIH-funded Short Courses organized by the University of Alabama at Birmingham’s Nutrition Obesity Research Center can be found at this link (http://www.norc.uab.edu/courses/shortcourse) and brings together multidisciplinary researchers in clinical and public health settings to discuss recent evidence addressing prevention and intervention strategies in obesity research, as well as fostering a community of scientists in which resources, techniques, and methods to evaluate scientific evidence are shared among the participants. Individuals interested in evaluating the effects of policies may find these courses useful. 

Best Regards,

David B. Allison

Anarina L. Murillo

English translation below

La obesidad está acompañada por múltiples factores, aparte del nutricional. Los hábitos de sedentarismo y falta de ejercicio son componentes importantes ( algunas causas son cada vez más aceptadas, tal el caso de estar sentado frente a unordenador ) . Muchas acciones se ven minimizadas por el gran flujo de publicidad de productos que no ayudan, en contraposición de la información que llega sobre alimentación sana.Pero se están generando miuchas iniciativas insistiendo en estos malos hábitos. Ahora, cómo competir contra los intereses y prácticas de los productos - y las empresas - que promueven los alimentos nocivos ? Recíen se acaba de aprobar un impuesto en Inglaterra contra el " azúcar " en los refrescos ( Ver comentarios en el adjunto ),como una medidad contra la obesidad, será que hay disposición para hacerlo en otros productos alimenticios ? Además, las agencias o ministerios de agricultura carecen en su mayoría de controles y programas de apoyo, para producir lo que es realmente necesario para evitar la obesidad. Cuántos agricultores piensan en cultivar - y si sus condiciones y recursos lo permiten - productos saludables por iniciativa propia pensando en la salud y en este caso en la obesidad ? En Costa Rica, se realizan campañas y la prensa a tocado el tema con insistencia, las autoridades de salud carecen de un enlace directo con el sector

http://www.incap.int/index.php/es/publicaciones/publicaciones-conjuntas…

http://latino.foxnews.com/latino/espanol/2014/10/30/costa-rica-lanza-es…

Saludos cordiales !

Obesity is caused by many factors, other than nutrition. The sedentary habits and the lack of physical exercise are key drivers. Some causes, like the amount of time spent in front of a computer, are becoming increasingly accepted. The impact of many initiatives is outweighed by the abundance of advertising promoting unhealthy products, in contrast to messages fostering a healthy diet. However, numerous initiatives highlighting these poor eating habits are being developed. Now, how to compete against the interests and practices of companies selling products containing unsafe food? In England a new sugar tax on soft drinks has been introduced in an attempt to tackle obesity (please refer to the attached for more information). Is there a willingness to follow the same approach with other food products? Furthermore, most agriculture agencies/ministries do not have the necessary control mechanisms and support programs in place to ensure that the food produced is truly suitable to fight obesity. Assuming they have the necessary conditions and resources, how many farmers are planning to grow healthy products on their own initiative taking into account human health, and obesity in this case? In Costa Rica, despite campaigns are being undertaken and the issue has been repeatedly addressed by the press, health authorities lack of a direct link to the sector.

English translation below

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.

• Programa Vida Sana MINSAL
• Programas de Promoción de Salud MINSAL
• Programa Elijo Vivir Sano de Ministerio de Desarrollo Social
• Escuelas Deportivas del Instituto Nacional del Deporte
• Escuelas Saludables de JUNAEB
• Experiencia Casablanca INTA

2.    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?

• Escasa sostenibilidad de la intervenciones asociada a recursos inestables para estas políticas .  

3.    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.

En comunidades educativas se describen como fortalezas .

• Intervenciones que sean sostenibles en el tiempo que aborden integralmente alimentación sana y actividad física.
• Involucramiento de todos los actores de la comunidad educativa
• Diagnósticos participativos
• Linea base
• Metodologías innovadoras
• Transferencia de habilidades y conocimientos a profesores de NT1-Nt2 y profesores de educación física
• Actividades diferenciadas para padres, profesores, alumnos
• Actividades permanentes en espacios aula/ Currículo ,  recreo, huertos, actividades extra programáticas al menos 3 veces por semana con actividad física , actividades comunitarias masivas .
• Utilización del comedor como espacio educativo y tecnología adhoc
• Contar con bebederos de agua
• Contar con infraestructura básica para la implementación de actividad física
• Manejo de política de quioscos saludables
• Manejo y conocimiento de ley de etiquetados
• Retroalimentación permanente de resultados y conformación de masa critica sobre el problema de obesidad y sobre peso.

According to your experience and/or knowledge:

1. Which policies and/or programmes have been implemented in your country or region to prevent overweight and obesity? Please consider: National/local policies and initiatives (i.e. nutritional labelling, food taxes/subsidies, promoting the consumption of fruits and vegetables, dietary guidelines, policies to promote physical activity, nutritional education in other policies); Interventions and/or programs in community and school environments.

Note: Please share links, scientific papers and/or documents to enrich your answers.

• Healthy Life programme (Programa Vida Sana) (Chilean Health Ministry, MINSAL)
• Health Promotion programs (Programas de Promoción de Salud) (Chilean Health Ministry, MINSAL)
• Choosing a Healthy Living programme (Programa Elijo Vivir Sano) (Chilean Social Development Ministry)
• Sport Schools (Chilean National Sports Institute)
• Healthy Schools (Escuelas Saludables) (Chilean National Board of Student Aid and Scholarships, JUNAEB)
• Casablanca Experience (Experiencia Casablanca) (Chilean Institute of Nutrition and Food Technology, INTA)

1. Which of the policies and/or programmes mentioned before have succeeded in reducing overweight and obesity levels? Please complete your answer answering the following queries: What was the target population? In which way were results assessed and/or effectiveness determined? What were the success factors that contributed to the effectiveness? What were the main challenges, constraints and lessons learned?

• Limited sustainability of the interventions due to the instability of the resources allocated to these policies.

1. Finally, which ELEMENTS ARE CRUCIAL to effectively support policies, strategies and/or programs targeting overweight and obesity reduction? Please consider elements regarding governance, resources, capacity building, coordination mechanisms, leadership, or information exchange networks, among others.

They are considered as strengths in education communities.

• Sustainable interventions comprehensively addressing healthy eating and physical activity
• Involvement of all the education community stakeholders
• Participatory analyses
• Base line
• Innovative methodologies
• Transfer of skills and knowledge to NT1-Nt2 and physical education teachers
• Differentiated activities for parents, teachers, pupils
• Permanent activities in classrooms/curriculum areas, playground, gardens. Extra-curricular activities featuring physical exercise at least 3 times a week. Collective community activities.
• Utilization of the school canteen as an educational area and tailored technology
• Installation of water fountains
• Basic infrastructure for physical exercise
• Healthy kiosks policy management
• Labelling law management and expertise
• Continuous feedback on results and creation of a critical mass on the obesity and overweight problem.