全球粮食安全与营养论坛 (FSN论坛)

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

It is a consensus that the Mediterranean diet is effective and possibly the most appropriate dietary intervention for the prevention and treatment of cardiovascular disease. This diet is characterized by a low saturated fat intake in addition to a high consumption of vegetables,  fish, and olive oil and a moderate consumption of wine. Nevertheless, adherence to this diet seems to be an obstacle in successfully controlling cardiovascular risk factors. Thus, cultural adaptation seems to be the most appropriate means for its management in countries outside of the Mediterranean region. In Brazil, the Mediterranean diet differs vastly from local customs, and this factor is seemingly related to low adherence to the diet.

Hence, prescription of a Mediterranean diet intervention for CVD to Brazilian populations may be infeasible and lead to low adherence.With a focus on the needs of the mostly low-income Brazilian population, a dietary and nutritional program that provides for these particularities has been developed. The Brazilian Cardioprotective Nutritional Program (BALANCE Program) takes into account access to food and  understanding of the nutrition prescription, which have already been tested in a pilot study. The results showed that the standardized Program diet seems to be feasible and effective, promoting reductions in blood pressure, fasting glucose concentration, weight, and body mass index (BMI) in patients with established CVD. The BALANCE Program trial will investigate the effects of the Program on reducing cardiovascular events—such as cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, and hospitalization for unstable angina—or death in patients with established CVD. Moreover, it will evaluate the effects of the dietary program on reducing CV factors, such as BMI, waist circumference, blood pressure, total cholesterol, low density lipoprotein, triglycerides, and fasting glucose.

2.       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?

Outpatients who were over 45 years of age with established or previous atherothrombotic CVD occurring  in the past 10 years. 

·         In which way were results assessed and/or effectiveness determined? What were the success factors that contributed to the effectiveness?

The primary outcome of this pilot trial was the changes in blood pressures that occurred after 12 weeks of adherence to the Cardioprotective Diet Program. The secondary outcomes of this pilot trial were improved BMIs and fasting glucose levels. Considering that this was a pilot trial, we chose one well-established biochemical, hemodynamic, andanthropometric parameter as the endpoint.

Considering our primary outcome, there was a greater reduction in the systolic (7.8%) and diastolic (10.8%) blood pressures in Group A compared with Groups B (2.3% and 7.3%) and C (3.9% and 4.9%, respectively). Considering our secondary outcome, the fasting glucose levels decreased by 5.3% and 2% in Groups A and B, respectively. In Group C, they increased by 3.7%. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. The BMIs in Group C did not change. Nevertheless, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. We believe that a cardioprotective diet including foods that are widely available in Brazil played a key role in our results. Our findings are of potentially great importance to public health in our country, considering the promising cost/benefit relationship. The financial costs of the foods were not assessed in this pilot study; however, the diet that was proposed by the Brazilian guidelines to control cardiovascular risk factors, which involves components of the Mediterranean diet, is costly for a major proportion of the Brazilian population. Thus, we propose a new intervention with potentially low costs and high feasibility in Brazil. The efficacy of the Brazilian Cardioprotective Diet Program is substantiated by the fact that the diet that has been proposed by the Brazilian guidelines is not widely available nor is it in accordance with the Brazilian culture.

Despite our encouraging results, we cannot generalize and recommend the implementation of a cardioprotective diet following the same format as in this pilot study in all Brazilian regions. Therefore, a national study has been developing, the primary composite outcome will be the occurrence of any of the following cardiovascular events: cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, hospitalization for unstable angina, cardiovascular death, or death from any cause.

• What were the main challenges, constraints and lessons learned?

One factor that must be taken into account is adherence to recommendations. It is estimated that, in developed countries, only 50% of patients with chronic diseases adhere to treatment recommendations.  In Brazil, dietary compliance is roughly 40%.  Within this context, the BALANCE Program was developed with the objective of being a nutritional education tool that is accessible to the population and incorporates guideline  recommendations for CVD management, with a view to improving patient understanding of the dietary prescription and enhancing compliance.

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

Although the nutritional composition of a diet designed for prevention and treatment of CVD is clear, the optimal form of prescribing such diets is not yet established, and there are no data on how such recommendations could be achieved using foods affordable for the Brazilian population. Another important factor that must be taken into account is adherence to recommendations. It is estimated that, in developed countries, only 50% of patients with chronic diseases adhere to treatment recommendations. In Brazil, dietary compliance is roughly 40%. Within this context, the BALANCE Program was developed with the objective of being a nutritional education tool that is accessible to the population and incorporates guideline recommendations for CVD management, with a view to improving patient understanding of the dietary prescription and enhancing compliance. It is important to highlight that this is a comprehensive nutritional program, not simply a diet. The BALANCE Program consists of nutritional guidance designed to be fun and accessible, intensive contact with nutritionists through one-on-one visits and group sessions, and telephone calls to reinforce guidance; these three strategies are meant to enhance adherence. The key point of the Program is to achieve a balance among foods in the diet so as to ensure correct proportions of all nutrients recommended for dietary management of cardiovascular disease. Furthermore, the educational strategy of allocating foods into groups based on the colors that appear on the national flag and associating the recommended intake frequency of each food group with the space each corresponding color occupies on the flag should facilitate understanding and, therefore, enhance compliance. The efficacy of this method was tested in a pilot study and The BALANCE Program appeared to be effective in reducing weight, BMI, blood pressure, and fasting glucose levels in patients with previous CVD. In short, the Brazilian Cardioprotective Nutritional Program is a proposed novel intervention with the potential for low cost and high feasibility for use in Brazil. If effective, it could be used to support the development of specific national programs to reduce the incidence of new CV events.

Dear FSN Forum Moderators,

Many thanks for offering this opportunity for stakeholders to share their views. At Nestlé, we are motivated to work in dialogue with nutrition and public health experts, to promote good nutrition, appropriate choices and healthy lifestyles. Nestlé is committed to applying our global organisation, knowledge of human behaviour and extensive research network to help improve people's lives today, while also investing in their health for tomorrow.

I would like to offer some thoughts on the third question ("which elements are crucial to effectively support policies, strategies and or programmes targeting overweight and obesity reduction"):

- successful strategies need to include public-private partnerships, as complex societal challenges require collaboration from both the public and the private sectors. Solving the issue requires further engagement from academic institutions, the private sector, civil society, under the guidance of authorities.The overweight/obesity issue will require a whole of government AND a whole of society approach. Complex global public health problems require a holistic, integrated, long-term, multi-stakeholder approach.

- the environment will be changed thanks to regulatory, co-regulatory and self-regulatory measures. What is important is to agree on realistic targets and that all stakeholders commit to measurable objectives.

- consider measures not only related to offer/improving the food environment but also related to how consumer demand can be shaped through positive public health social marketing campaigns, education and health literacy of the population, in particular vulnerable groups

- leverage industry's research and development capacity. Not only the fundamental nutrition sciences but also innovative product development.

- addressing the complex causative factors in obesity would require a deep understanding of the consumer. Industry is well positioned to support consumer migration towards healthier foods and beverages.

- adopt an "incentive-based" approach: industry participation can be accelerated if there is a level-playing field to compete and if there are incentives to join. Consider mechanisms to transfer know-how to smal and medium sized companies. Protect the ability to innovate and create "healthy" competition among food industry players.

Dear Discussion Facilitators,

Thank you for the opportunity to share our experiences and knowledge on this topic. 

In Canada, the responsibility for obesity health services (prevention and management) lies with provincial and territorial governments. Population level data indicating rising levels of childhood obesity have prompted Canadian federal, provincial and territorial (FPT) governments to make childhood obesity a collective priority. The Curbing Childhood Obesity: A Federal, Provincial, and Territorial Framework for Action to Promote Healthy Weights was signed by all provinces (except Quebec) and territories in 2010.  The Public Health Agency of Canada is responsible for monitoring the implementation of activities that fall within that framework.http://www.phn-rsp.ca/thcpr-vcpsre-2015/index-eng.php Note: Despite having this framework in Canada, there have not been any comprehensive efforts to implement these policy recommendations. 

Unfortunately, the dominant narrative in this public health policy framework is highly simplified, indicating mainly that obesity is caused by unhealthy eating and lack of physical activity. This simplistic view of obesity is also a driver of policy recommendations that focus on individual-level approaches rather than broader societal-level policy solutions. This is despite evidence suggesting that a focus on individual-level solutions rather than on changing the broader societal level factors that have created obesity in the first place (e.g. food industry practices, agricultural policies, food pricing, etc.) have not been effective.

This simplistic view of obesity has also the potential to harm people with obesity because it contributes to weight bias and obesity stigma.  The narrative that people with obesity choose to eat unhealthy and to not exercise is not only simplistic but also lacks evidence. Science has demonstrated that obesity is not simply a matter of energy-in and energy-out and that there is a rather complex biological system that regulates and defends body weight. 

The dominant cultural narrative around obesity, which fuels assumptions about personal irresponsibility, has led to a shadow epidemic of weight bias and obesity stigma. There is now extensive evidence that obesity stigma affects a person’s mental health, interpersonal relationships, educational achievements, employment opportunities, leads to avoidance of preventive health care, can hinder weight management efforts, and can increase overall morbidity and mortality.

Therefore, the Canadian Obesity Network recommends that all policies addressing nutrition and physical activity be framed as general measures to improve population health rather than as measures meant to reduce obesity. This approach is prudent considering there is little evidence that any of the suggested food or activity policies can noticeably reduce obesity at the population level and/or in vulnerable populations.  We also recommend that before declaring a public policy or measure as targeting obesity, one would need clear evidence of effectiveness and perform a comprehensive analysis of potential harm, including promotion of weight bias and obesity stigma. Such policies must take into consideration the voices of people living with obesity (especially women) and include experts on weight bias and obesity stigma.

Ximena Ramos Salas, Managing Director, Canadian Obesity Network

Arya M. Sharma, Scientific Director, Canadian Obesity Network

www.obesitynetwork.ca

Attention dear contributors,

We are reaching the end of the online discussion, so please all the people that want to make any final comments or thoughts... now is time!

Best

Rodrigo

Thank you to Muqeem Shah Miakheel for news of your survey work in Jalalabad. Please can you upload the report on obesity? 

Dear FSN Forum,

Lebanon has experienced a nutrition transition resulting in a shift towards a diet high in energy-dense food and sedentary lifestyle. In fact, childhood obesity doubled during the past decade and school-based programmes promoting healthy lifestyles were lacking. In view of that, a scientifically-based program has been developed by the American University of Beirut, Faculty of Agriculture and Food Sciences, under the name –Kanz al Sohat–.

To address the growing problem of obesity in Lebanon, Nestlé joined forces with the American University of Beirut to jointly roll out the programme under the name –Nestlé Healthy Kids - Ajyal Salima– in 2010 to schoolchildren aged 9 to 11, with the support of the Lebanese Ministry of Education.

The educational curriculum of the programme is founded on the social cognitive theory to promote behaviour change, and is implemented through interactive learning and hands-on activities on nutrition, healthy eating and physical activity; it aims to promote nutritional knowledge; better eating habits and an active lifestyle among schoolchildren.

It looks to impact on teachers, school shops, parents and families to boost healthy lifestyles for youngsters (Education and Health article attached)

As a result of the programme’s national roll out on the knowledge and eating behaviours in children, the Lebanese Ministry of Education officially adopted the Nestlé Healthy Kids-Ajyal Salima programme into its Health Education Unit’s curriculum in public schools in 2014.

Study results showed that knowledge and self-efficacy increased in students who received the intervention. Moreover, findings highlighted reductions in children’s probability of consuming chips and sweetened beverages, and an increase in fruits and vegetables consumption. (BMC article attached)

Ownership of the program by the various stakeholders is one of the most key lessons learnt, so engaging the relevant ministries, schools administrators, school-based vendors, parents and of course students is essential for streamlining the implementation of any program and ensuring its success. (Frontiers article attached)

A further publication is in progress to compare the effectiveness of this intervention implemented across three consecutive years, delivered by different teams; in addition to an on-going cohort study that has been launched by the American University of Beirut in 2014 to assess the programme’s impact on the long term.

To date, the Nestlé Healthy Kids-Ajyal Salima programme has reached about 27500 children and 210 schools in Lebanon.

More than 500 teachers and health coordinators have been trained nationwide as part of the initiative.

In Lebanon, the programme is making an impact across the country through the Health Education Unit framework of the Lebanese Ministry of Education.

It has been replicated in Dubai in 2012, in the Kingdom of Saudi Arabia in 2014 and in the Hashemite Kingdom of Jordan in 2015 in collaboration with local health and educational entities.

Best regards,

Healthy Kids-AJyal Salima team

American University of Beirut

Dear forum participants, dear FAO,

In answer to question 1, we would like to flag the useful resources on the World Obesity Federation website, including a map-based interactive database of policies and interventions related to obesity, available at http://www.worldobesity.org/resources/policies-and-interventions/.

In addition, the World Cancer Research Fund International website has a database of specific policy actions being taken to promote healthy diets, available at http://www.wcrf.org/int/policy/nourishing-framework.

In answer to questions 2 and 3, one of the issues that must be addressed is to ask why some policies are failing and especially who might be resisting the introduction of health-promoting policies. From the experiences gained in Mexico (imposing taxes and restricting advertising of snacks and sugar-sweetened beverages), New York City (e.g. beverage potion sizes), France (taxes on beverages), and many other regions, it is clear that commercial interests in these products will resist attempts to restrict their marketing activities and market expansion plans, as this is not in their shareholders’ interests. If we are to get serious about protecting and promoting healthy diets in a rapidly globalising market for unhealthy products, then we will need to find ways of holding commercial interests fully to account for their impact on health, and find mechanisms which can effectively limit their ability to undermine health-promoting policies.

We at the World Obesity Federation look forward to seeing the results of the FAO discussion on this important topic.

Dear colleagues,

From the Netherlands, we would like to share our experience with our integral community approach. Currently we are active in 108 municipalities, reaching over half a million young people (0-19 yrs old). Many of these municipalities have shown positive results. Below this message you will find some information about our programme and please also have a look at our attached brochure. Don't hesistate to contact me in case you have any remaining questions.

Kind regards, Lideke Middelbeek

Jongeren Op Gezond Gewicht (JOGG/Young People at a Healthy Weight)  is a movement which encourages all people in a city, town or neighbourhood to make healthy food and exercise an easy and attractive lifestyle option for young people (0-19). It focuses on children and adolescents themselves, along with their parents and direct environment. JOGG advocates a local approach in which not just the parents and health professionals, but also shopkeepers, companies, schools and local authorities join hands to ensure that young people remain at a healthy weight. The Dutch JOGG-approach is based on the successful French EPODE approach (see also the contribution of Ms. Pauline Harper on this forum) and consist of 5 pillars:

– Political and governmental support

– Cooperation between the private and public sector (public private partnerships)

– Social marketing

– Scientific coaching and evaluation

– Linking prevention and healthcare

Currently 108 municipalities in the Netherlands are using the JOGG-approach to promote a healthy weight among their youth. At national level JOGG is coordinated by the  foundation Jongeren Op Gezond Gewicht, based in The Hague.

Dear FSN Forum,

The abdominal obesity epidemic (independent of weigth) may be curtailed if we may be able to stopping the myths about health and nutrition.

1- a high intake of potassium and vit.c daily is the best resistance to sick, providing a good defense to illness, particularly infection diseases.

2- a high intake of magnesium daily is the best resistance to danger of free iron and copper, particularly in the maintenance of insulin resistance, the fisiopatogenetic event in the etiology of obesity.

3- as the automatization advances in the "globalizated world", people, especialy poor people, eat quickly, without any sense of conscience, and the more fast eating, the more lack of satiety, because insulin resistance is increasing (brain insulin resistance).

4- in peru the obesity, diabetes and cancer are epidemic, even in the childhood (leukemic disease): moreover, we have the best sea in the world, the best forest (after brazil). 

5- thank very much for this opportunity

I congratulate you and fao if the revision: "nutritional culture and medical art in the reduction of poverty"

is published.

Sincerely

Juan Ariel Jara Guerrero

primer comite de nutricion medica

colegio medico del peru-  cmp 20288

English translation below

Estimado moderador:

Junto con saludar y felicitar esta iniciativa, le hago envío de mis respuestas

1.¿Cuáles políticas y/o programas para la prevención del sobrepeso y la obesidad se han implementado en su país o región?

A nivel nacional, se han desarrollado una serie de medidas que abordan distintos aspectos de la alimentación y nutrición con el propósito de mejorar la alimentación de la población y contribuir así a la disminución de la prevalencia de obesidad a través del curso vital.

1.En relación a intervenciones relacionadas con el acceso a alimentos, destaca el rol de los Programas alimentarios nacionales (PNAC y PACAM); programas que ofrecen alimentos que responden a las necesidades nutricionales de grupos específicos de la población, teniendo el PNAC un carácter universal y el PACAM está dirigido a  grupos vulnerables de adultos mayores.

En relación a la prohibición de la venta de comida poco saludable en el ambiente escolar, destaca la implementación de la Ley 20606 sobre la sobre la composición nutricional de alimentos y su publicidad y la Ley 20869 sobre publicidad de los alimentos.

Por otro lado en materia de fomento y protección de la lactancia materna exclusiva (factor protector de la obesidad infantil), destaca el apoyo al Código Internacional de Comercialización de los Sucedáneos de leche materna (OMS/UNICEF), la implementación de la Ley 20545 en octubre de 2011, que modifica las normas sobre protección a la maternidad e incorporación del permiso postnatal parentaly la implementación de la Estrategia de establecimientos amigos de la madre y del niño (OMS/UNICEF) y el proyecto de ley para  la protección de la lactancia materna y su ejercicio.

2.En materia de educación y promoción de estilos de vida saludables destacan las siguientes iniciativas:

Ley 20670. Sistema Elige Vivir Sano en comunidad.

Estrategia de intervención nutricional a través del Ciclo Vital (OE3,en actualización) cuyo propósito es contribuir a disminuir la prevalencia de obesidad y otras ECN a lo largo del ciclo vital.

Programa Vida Sana, cuyo propósito es contribuir a la disminución de 3 factores de riesgo para el desarrollo de  Diabetes Mellitus tipo 2 y enfermedades cardiovasculares (Factores de riesgo: 1) Dieta inadecuada, 2) Deficiente condición física   y 3) Sobrepeso/Obesidad - en niños, niñas, adultos y mujeres post-parto de 2 a 64 años, beneficiarios de FONASA”.

Guías alimentarias basadas en alimentos (GABAS).

Junto a lo anterior, se cuenta con normativas como:

Norma para el manejo ambulatorio de la malnutrición por déficit y exceso en el niño(a) menor de 6 años (en actualización).

Estándares de evaluación del estado nutricional a través del ciclo vital.

• Minsal (2014) Norma técnica para la supervisión de niños y niñas de 0 a 9 años en APS.
• Minsal (2016) Norma para la evaluación nutricional de niños, niñas y adolescentes de 5 a 19 años de edad.
• Minsal (2015): Guía clínica perinatal

Además se cuenta con una Guía de alimentación del menor de 2 años hasta la adolescencia (2016).

También se cuenta con campañas públicas de promoción de una alimentación saludable como el "Plato de tu vida".

Por otro lado la implementación de un Etiquetado nutricional obligatorio de los alimentos (ENOA) y la inclusión de señales de advertencia sobre nutrientes crítico en la cara frontal de los alimentos (Ley 20606) ha permitido a la población realizar elecciones informadas al momento de la compra de alimentos.

3.En relación a medidas económicas, el año 2014 la Reforma tributaria modifica la tasa actual de vinos y cervezas (de 15% a 20,5%), destilados (de 27% a 31,5%), bebidas azucaradas (13% a 18%) y bebidas no azucaradas (de 13% a 10%) y en la actualidad se encuentra trabajando una  Comisión Asesora Ministerial para Analizar Propuestas para Gravar con Impuestos Otros Alimentos con Alto Contenido de Azúcar Distintos a las Bebidas.

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?

Dada que la mayoría de las iniciativas mencionadas, tienen un carácter estructural, los resultados de estas intervenciones (de todas, en conjunto) se observarán en el largo plazo, se estima que en un periodo de 10 a 30 años. En este momento se está diseñando el modelo de evaluación de la efectividad de la implementación de la Ley 20606, con lo cual se espera poder analizar los resultados de esta iniciativa de forma aislada.

3.    Finalmente, ¿Qué ELEMENTOS SON CRUCIALES para apoyar efectivamente políticas, estrategias y/o programas dirigidos a la prevención del sobrepeso y la obesidad?

Todos las aristas mencionadas anteriormente, son cruciales para el éxito de cualquier iniciativa orientada a la prevención de la malnutrición por exceso. El acceso, la oferta,  y las variables económicas generan el entorno alimentario adecuado para que las personas realmente puedan elegir una alimentación saludable. Si bien las intervenciones pasadas se han enfocado en la responsabilidad individual  en torno a la alimentación; intervenciones que han demostrado ser poco efectivas, la incorporación de un enfoque estructural, basado en la responsabilidad del Estado en esta materia (incluyendo el tema de la salud en todas las políticas y esfuerzos integrales de todos los Ministerios), debiese materializarse en resultados positivos en torno a este tema.

Saludos cordiales                      

Dominique Masferrer

Nutricionista

Msc. Nutrición y Alimentos 

Profesor asistente - Departamento de Nutrición

Facultad de Medicina - Universidad de Chile

29786754

Dear facilitator:

Apart from welcoming this initiative and congratulating the promoters, I would like to share my contributions:

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

At the national level, several initiatives addressing different food and nutrition aspects have been developed with the aim of improving our diets and contributing as a result to the reduction of the prevalence of obesity throughout the life cycle.

1. Regarding food access interventions, the role of National food programs (Supplementary Feeding National Program, known in Spanish as PNAC, and the Supplementary Feeding National Program for the Elderly, known in Spanish as PACAM) stands out. These programs provide food that meets the nutritional needs of specific population groups: the PNAC is universal in scope, while the PACAM targets vulnerable groups of elders.

Regarding the ban on the sale of unhealthy food in schools, the implementation of Law 20606 on the nutritional composition of food and its advertising, and Law 20869 on food advertising, stand out.

On the other hand, in terms of the promotion and protection of exclusive breastfeeding (a childhood obesity protection factor), the support for the International Code of Marketing of Breast-milk Substitutes (WHO/UNICEF), the implementation of law 20545 in October 2011 amending the regulations on maternity protection and introducing the paternity leave, the implementation of the Baby-friendly Hospital Initiative (WHO/UNICEF) and the bill to protect breastfeeding are noteworthy.

2. Regarding education and the promotion of healthy lifestyles, the following initiatives can be highlighted:

Law 20670. “Choose a community-based healthy life” system

Nutritional intervention strategy throughout the life cycle (SO3, currently updated) aimed at reducing the prevalence of obesity and other nutrition-related diseases throughout the life cycle.

Healthy Life Program, aimed at reducing three risk factors (inadequate diet; poor physical condition; and overweight/obesity) linked to the development of type 2 diabetes mellitus and cardiovascular diseases in children, adults and postpartum women aged 2-64, beneficiaries of the National Health Fund (known in Spanish as FONASA)

Food-bases dietary guidelines (known in Spanish as GABAS).

In addition to the above, the following regulations are in force:

Regulation for the outpatient care of malnutrition in children under the age of 6 (currently being updated).

Nutritional status assessment standards throughout the life cycle:

•         Health Ministry (2014) Technical Standard for the PHC supervision of children aged 0-9.

•         Health Ministry (2016) Standard for the nutritional assessment of children and teenagers aged 5-19.

•         Health Ministry (2015): Perinatal clinical guide

A dietary guide from early childhood to adolescence (2016) is available.

Public campaigns promoting healthy diet (e.g. the "Meal of your life"- "Plato de tu vida") have also been launched.

On the other hand, the implementation of a Compulsory food nutritional labelling (known in Spanish as ENOA) and the inclusion of warning messages about critical nutrients on food packaging (Law 20606) have enabled consumers to make informed choices when buying food.

3. Regarding economic measures, the 2014 tax reform modifies the current levy on wines and beers (from 15% to 20.5%), distillates (from 27% to 31.5%), sugary drinks (13% to 18%) and sugar-free drinks (from 13% to 10%), and an Advisory Ministerial Committee is currently assessing proposals aimed at taxing other food with high sugar content other than drinks.

2. Which of the policies and/or programmes mentioned before have succeeded in reducing overweight and obesity levels?

As most of the initiatives mentioned before are structural, their overall results will be noticed in the long term, in an estimated period of time of 10 to 30 years. The effectiveness assessment model of the implementation of Law 20606 is currently being designed. Therefore, an independent analysis of the outcomes of this initiative is expected.  

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

All of the above mentioned aspects are key to the success of any initiative aimed at preventing malnutrition. The access to food, the choice of food, and the economic variables generate an appropriate environment for the adoption of a healthy diet. While past interventions have focused on individual responsibility, they have proven to be barely effective. Adopting a structural approach, based on the State's responsibility in this field (including health in all policies and comprehensive efforts of all ministries) should yield positive outcomes.

Kind regards,

Dominique Masferrer

Nutritionist

MSc in Nutrition and Food Science