المنتدى العالمي المعني بالأمن الغذائي والتغذية

>> English translation below <<

México, como la mayoría de los países de la región atraviesa por un proceso de transición nutricional.  

En menores de 5 años, la desnutrición crónica aunque ha venido disminuyendo en el país (13.6% a nivel nacional),  sigue siendo particularmente alta en grupos vulnerables de población como la población indígena(alrededor del 31%). La prevalencia de anemia a nivel nacional es de 23.3% y la pervalencia combinada del sobrepeso y la obesidad en menores de 5 años es de 9.1% y en escolares de 34.4% . 

Para abordar estos problemas de forma simultánea, se creó a  través del programa de transferencias condicionadas Prospera, antiguamente Oportunidades,  que cubre a más de 6 millones de familias en condiciones de pobreza, la estrategia de comunicación para cambios sociales y del comportamiento EsIAN: Estrategia de Atención Integral a la Nutrición. 

Esta estrategia tiene como objetivo mejorar  la salud y nutrición de las mujeres embarazadas y en período de lactancia y los niños menores de 5 años beneficiarios (con  mayor énfasis en los 1,000 días), con el doble propósito de prevenir la desnutrición y el sobrepeso y la obesidad, a través de los servicios de salud del primer nivel de atención. La Esian incluye la distribución de suplementos de micronutrientes y un componente de comunicación y capacitación para la promoción de alimentación y actividad física saludable, con un fuerte enfoque en  la promoción de la lactancia materna y alimentación complementaria. 

Con mucho gusto podemos compartir con los interesados más detalles sobre esta estrategia. 

Mexico, like most countries in the region, is going through a nutritional transition.

Although chronic undernutrition in children under five has decreased at the national level (13.6%), it is still particularly high among vulnerable population groups, such as indigenous people (around 31%). The prevalence of anemia at the national level amounts to 23.3% and the combined prevalence of overweight and obesity in children under five and school  children amounts to 9.1% and 34.4% respectively.

To address these problems simultaneously, a communication strategy (Nutrition Care Comprehensive Strategy, known in Spanish as ESIAN) targeting social and behavioural changes was created through the Prospera conditional cash transfer program (formerly known as Oportunidades), supporting more than 6 million poor families.

This strategy aims to improve the health and nutrition of both pregnant and nursing women and children under five (paying special attention to their first 1,000 days), with the double purpose of preventing undernutrition and overweight and obesity through the primary health care services. The ESIAN foresees the distribution of micronutrient supplements and communication and training activities to promote healthy eating and physical activity, with a special emphasis on the promotion of breastfeeding and complementary feeding.

We will be delighted to share additional information on this strategy with anyone who is interested.

>> English translation below <<

La problematica parece ser tan compleja que es imposible de tratar desde solo un frente, por lo mismo las politicas publicas ayudan en ofrecer un "paraguas" o un marco a las instituciones del estado para disenar e implementar medidas que vayan en mejorar los niveles de malnutricion en la comunidad.

El mayor problema de los disenos de programas que van en busqueda de revertir estos indicadores, es que se elaboran desde los expertos en forma sectorizada, sin precisamente hacer conversar los programas y ahunar esfuerzos para atacar la problematica y sin considerar a la poblacion objetivo, creando programas con mucho sustento academico pero poco realistas al momento de ser llevados a la practica.

He tenido la oportunidad de trabajar en programas que han puesto el enfasis en la educacion de la poblacion con buenos resultados, lo que es una politica menos paternalista que hace participe a las personas y les entrega las herramoentas para que tomen decisiones de forma informada, que han dado resultados positivos al involucrar a la familia y los centros educacionales como objetivos de intervencion. Interviniendo las mallas curriculares incorporando temas de agricultura, inocuidad y salud; creando politicas de publicidad y venta de alimentos dirigidos a ninos; trabajando con los educadores como parte del diseno de las estrategias; sumando a los centros de atencion primaria;  planificando minutas nutritivas usando productos frescos y variados con identidad territorial en la planificacion de los programas de alimentacion escolar;  supliendo los nutrientes deficitiarios por medio de programas de alimentacion sociales; entre muchos otros se puede ver impacto a largo plazo y de forma sostenida en la poblacion.

Sofia Bustos

Directora Ejecutiva Corporacion Actuemos

Promoviendo cultura alimentaria

www.actuemos.org

The problem seems to be so complex that it cannot be addressed in a unique way. Public policies provide an “umbrella” or framework for state institutions to design and implement measures that will improve the community malnutrition levels.

Programs aiming to improve these indicators are designed by experts in a segmented way: this is the greatest problem. Efforts are not pulled together and the target population is not taken into consideration. These programs have a solid academic background but are unrealistic on purely practical grounds.

I have had the opportunity to work on education-focused programs yielding positive results. Based on a less paternalistic approach, they engage the population and provide tools that enable making informed decisions. Results have been satisfactory as family and educational centres have been involved as program targets. Among other ideas making a continuous difference in the long term I would suggest including agricultural, safety and health topics in educational programmes; creating food advertising and sale policies targeting children; working with educators and primary care centres in the design of strategies; incorporating fresh, varied and native products in school feeding programs; or providing required nutrients through social food programs.

Sofía Bustos

Executive Director Actuemos Corporation

Promoting food culture

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Efectivamente, la región de América Latina y el Caribe presenta distintas paradojas en relación a su estado de seguridad alimentaria y nutrición. Por una parte reduce más rápidamente que otras regiones del mundo sus niveles de subalimentación (FAO, 2015) y por otra, aumenta por encima de la media mundial el porcentaje de sobrepeso (al 7,1% de la población infantil según OMS respecto al 6,5% del nivel mundial). La desnutrición crónica infantil de ésta región se redujo en 12,9 puntos porcentuales en los últimos 25 años (aproximadamente el 11,6% de los menores de 5 años en la actualidad).

Los avances en la reducción significativa de la subalimentación coinciden con un periodo en el que el compromiso político situó el problema del hambre en lo más alto de la agenda pública, un periodo de estabilidad política, crecimiento económico sostenido y desarrollo de una amplia gama de políticas públicas enfocadas en reducir los niveles de desnutrición e inseguridad alimentaria. Los progresos han sido mayores cuando ha existido coordinación intersectorial bajo el liderazgo de un ente rector del Estado e involucrando a los distintos poderes del Estado (incluyendo a una amplia gama de actores sociales). Estas condiciones son también necesarias si quiere enfrentarse un problema complejo como el de la doble carga de la malnutrición.

En este sentido, abordar la malnutrición desde una perspectiva de derechos, reconociendo que es parte necesaria para la realización del Derecho a la Alimentación adecuada, ayudaría enormemente a desarrollar los instrumentos políticos, jurídicos e institucionales necesarios para un problema especialmente complejo.

Por último, mi opinión es que cualquier tipo de propuesta de política debe considerar las condiciones en las que se desarrolla la vida de los principales afectados por la doble carga de la malnutrición; sobre todo población pobre urbana y rural (usualmente mujeres y niños). Sus condiciones laborales y  responsabilidades familiares condicionan en muchos casos qué tipo de acciones pueden tomar en el corto y medio plazo para mejorar sus condiciones nutricionales. El Estado también debe velar para que  dichas condiciones sean mejoradas.

Indeed, Latin America and the Caribbean region present various paradoxes regarding its state of food security and nutrition. The region, on the one hand, is reducing its levels of undernourishment faster than other regions (FAO, 2015) and on the other hand, the prevalence of overweight is increasing above the world average (7.1% of the children according to WHO, in comparison with 6.5% of world average). Chronic child malnutrition in this region fell by a percentage of 12.9 points in the last 25 years (today approximately 11.6% of children under 5 years of age).

The progress in significant reduction of malnutrition coincides with a period in which political commitment placed the problem of hunger in the top of the public agenda, a period of political stability, sustained economic growth and development of a wide range of public policies focused on reducing levels of undernutrition and food insecurity. Progress has been greatest when inter-sectoral coordination has been under the leadership of a governing body of the State and involving different state powers (including a wide range of social actors). These conditions are also necessary if you want to address a complex problem like the double burden of malnutrition

In this regard, addressing malnutrition from a rights perspective -recognizing that it is a necessary part of the realization of the Right to adequate food- would greatly help to develop political, legal and institutional instruments necessary in front of a particularly complex problem.

Finally, in my opinion, any policy proposal should consider the living conditions of those most affected by the double burden of malnutrition; especially urban and rural poor (usually women and children). Their working conditions and family responsibilities often determine what actions can be taken in the short and medium term to improve their nutritional status. The government must also ensure that such conditions are improved.

>> English translation below <<

Estimados Colegas.

Me complacería mucho poder conocer sus experiencias sobre  la metodología para ¿Qué la educación nutricional sea exitosa?, actualmente muchos  programas han capacitado bastante personal y han elaborado material educativo que a sido redistribuido e impartido en diferentes ámbitos, los cuales no han tenido los resultados esperados.

Se han implementado una serie de estrategias en diferentes niveles con el fin de controlar y manejar la obesidad. Estas estrategias han tenido un efecto moderado porque no han logrando solucionar el problema a nivel nacional, sino de manera local y por poco periodo de tiempo.

Es importante  generar consenso técnico y político a nivel país. Se reconoce la gravedad de la situación y se hace un llamado para abordar este problema en las agendas y planes de acción de los organismos internacionales de Naciones Unidas, y tampoco existe un programa educativo que haya logrado cambios en la salud y nutrición de la población.

La continuidad de políticas públicas que promueven cambios de estilos de vida, no han logrado continuar debido a la realización de evaluaciones que buscan comprobar un efecto sobre la salud dela población al poco tiempo de implementación de las estrategias.  Los cambios de hábito son procesos que toman un mayor tiempo en ser observados, por lo que realizar este tipo de evaluaciones en un corto período de implementación estimula a pensar que la efectividad de este tipo de políticas es baja.

La evaluación sobre el impacto en la salud y nutrición de la población es una respuesta que podrá ser evaluada y observada  a largo plazo y para ello será necesario que la estrategia sea mantenida en el tiempo y mejorada con las retroalimentaciones que el sistema de monitoreo vaya entregando de manera periódica y sobre todo que exista una política de estado, que garantice su continuidad y financiamiento en el tiempo.

Dear Colleagues:

I would be very pleased to hear how you have succeeded in nutrition education. Numerous programs have trained many people and have produced educational material, used and distributed in several areas. However, they have not achieved the expected outcome.

Several strategies at different levels have been implemented to address and control obesity. These strategies have had a moderate impact, as they have proved to be ineffective at the national level and have only managed to solve the problem locally for a short period of time.

Generating technical and political consensus at the national level is important. The severity of the situation is acknowledged and calls to address this issue in the United Nations organizations agendas and action plans are made. No educational program has made a difference in the health and nutritional status of the population.

Public policies promoting changes in lifestyles have not been extended over time as assessments aiming to verify the effect in the health of the population have been undertaken soon after their implementation. Observing changes in habits takes a long time. Hence, it is likely that these short-term assessments are barely effective.

The impact on the health and nutritional status of the population should be assessed in the long-term. This will require maintaining and improving the strategy over time, taking into consideration the feedback periodically gathered by the monitoring system and, primarily, being supported by a state policy ensuring continuity and funding.

Household food insecurity (HFI) plays an important role in the double burden of malnutrition in Latin America and the Caribbean. Experience-based HFI measurement scales such as the Latin American and Caribbean Food Security Scale (ELCSA) have allowed researchers to document that HFI is associated with both chronic undernutrition (i.e., stunting), infectious diseases (e.g., malaria), and maternal anemia, as well as with women’s overweight/obesity  and related chronic diseases including hypertension and type 2 diabetes. Thus it is imperative to add HFI indicators drawn from scales such as ELCSA to the suite of indicators used to monitor food and nutrition security in the context of the double burden of malnutrition in The Region. Over a decade of experience applying ELCSA-like scales through national surveys and monitorign systems tells us that this approach is likely to help policy makers improve the governance of their food security systems in the Latin America and the Caribbean.

Rafael Pérez-Escamilla, PhD

Professor, Yale School of Public Health

References:

1.        Comité Científico ELCSA. Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA): Manual de uso y aplicación. FAO, Santiago, Chile, 2011. http://www.fao.org/3/a-i3065s.pdf

2.        Shamah-Levy T, Mundo-Rosas V, Rivera-Dommarco  JA. [Magnitude of food insecurity in Mexico: its relationship with nutritional status and socioeconomic  factors]. Salud Publica Mex. 2014;56 Suppl 1:s79-85.

3.        Pérez-Escamilla R, Dessalines M, Finnigan M, Pachón H, Hromi-Fiedler A, Gupta  N. Household food insecurity is associated with childhood malaria iCn rural Haiti. J Nutr. 2009 Nov;139(11):2132-8.

4.        Fischer NC, Shamah-Levy T, Mundo-Rosas V, Méndez-Gómez-Humarán I, Pérez-Escamilla R. Household food insecurity is associated with anemia in adult Mexican women of reproductive age. J Nutr. 2014 Dec;144(12):2066-72. 

5.        Pérez-Escamilla R, Villalpando S, Shamah-Levy T, Méndez-Gómez Humarán I. Household food insecurity, diabetes and hypertension among Mexican adults: results from Ensanut 2012. Salud Publica Mex. 2014;56 Suppl 1:s62-70.

6.        Schlüssel MM, Silva AA, Pérez-Escamilla R, Kac G. Household food insecurity and excess weight/obesity among Brazilian women and children: a life-course approach. Cad Saude Publica. 2013 Feb;29(2):219-26.

7.        Pérez-Escamilla R. Can experience-based household food security scales help improve food security governance? Glob Food Sec. 2012 Dec 1;1(2):120-125. 

Sir-My Answer.

Which nutrition problem (s) does your country prioritise? (undernutrition, overweight/obesity, micronutrient deficiencies, all forms of malnutrition)

:- Bangladesh has all of this the problem of obesity is not just food-having plyground & more is milund to this purpose. So tackle any is not just food program-manything is related. 

How is this/are these problems tackled? Please let us know if they are tackled independently or as part of a comprehensive strategy, through policies and programmes that focus on prevention and promotion of adequate, healthy diets.

:- They better not tackle one by one-because you can't. All are a mixup sum of their function. Best take everything at time. Few suggestion i can give- inform people which one is for cattle & which for human. This way they find alternative food.

Have these efforts been evaluated?What in your view could be done more effectively to prevent all forms of malnutrition? Please elaborate on the mistakes to be avoided, possible lessons learned and what needs to be done to ensure that the policies and programmes in place, if any, will succeed in the long term?

:-There is lot of evaluation, that's not problem the thing is fund, trade & other responds. So if long term this better be region & local basis.

What in your view is the role of nutrition education in addressing the double burden of malnutrition? What is needed for nutrition education to be successful in this context?

:- Off course this is needed, because people know from the childhood, could survive or cope better. It better take from school level.

Regards,

Md.Moshfaqur Rahman

To quote Gandhi ji "Poor see God in Bread". Poverty is the worst shame to humanity" he continued in his discourses. He practiced what he preached. The backyard kitchen garden adjacent to his "Asram" in Wardha in Gujarat had all the vegetables, fruits and grains for the inmate. With 240 million homesteads-living space-India can be a model country for self-sufficiency in nutrients." Food is thy medicine" said the famous physician Hippocrates. The just released book "Horticulture for Nutrition Security" published by Astral International Pvt Ltd New Delhi carries 4 preambles one from FAO, two from National Academy of Agricultural Sciences and one from Indian National Science Academy. Forty three scientists in the area of Horticulture and Nutrition contributed chapters all focussed to Nutrition through Horticulture. Despite availability of plants like drum stick, curry leaf, chekkurmanis, basil, agathi and several other vitamin and mineral packed vegetables, hidden hunger is very endemic in India. The book focusses on Food and Nutrition holistically 

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Saludos cordiales.

Respondiendo las preguntas.

1.- ¿Cuáles problemas nutricionales que se priorizan en su país? (desnutrición, sobrepeso/obesidad, deficiencias de micronutrientes, o todas las formas de malnutrición).

Estimados se estima que en el mundo hay alrededor de 17 millones y medio de niños menores de 5 años con sobrepeso. En los Estados Unidos, la prevalencia de niños con sobrepeso se ha duplicado y la de adolescentes con sobrepeso se ha triplicado, desde el año 1980. En tanto, la prevalencia de obesidad en niños y niñas de 12 a 17 años ha aumentado de 5 a 13% y de 5 a 9%, respectivamente, entre 1970 y 1991, en los Estados Unidos. Por lo tanto, es un problema que ocurre en todas partes del mundo, no sólo en los países desarrollados, sino también en los países en vías de desarrollo.

En Chile, la Encuesta Nacional de Salud entregó datos fidedignos sobre nuestra realidad y demostró que las tasas de sobrepeso son relativamente altas, lo que de por sí es inquietante, porque esta situación se asocia con riesgos de salud. No es un estado normal; muchos pacientes con sobrepeso tienen comorbilidades que es preciso tratar en forma agresiva. Los porcentajes de obesidad observados fueron 19,4% en hombres y 27% en mujeres, con un promedio de 23,2%; además, 0,2% de los hombres y 2,3% de las mujeres son obesos mórbidos, con un promedio de 1,3%.

En estudios realizados entre 1988 y 1992, en el área suroriente de Santiago, se demostró que la obesidad aumentó, tanto en hombres como en mujeres. Lo mismo se demostró en el estudio CARMEN (Conjunto de Acciones para la Reducción Multifactorial de Enfermedades No transmisibles), de Valparaíso, en el que se comprobó una prevalencia importante de obesidad en todos los niveles socioeconómicos, sobre todo en mujeres de nivel socioeconómico bajo.

En los niños, las encuestas realizadas por la JUNAEB demuestran que la obesidad ha aumentado significativamente en las últimas décadas, a diferencia de otros cuadros, como el retraso en talla y la desnutrición, y que constituye definitivamente un problema importante. Existen muchas instituciones que en lso programas de intervencion  han incorprado varios pilares en el tratamiento que la son dieta hipocalórica, promoción de la actividad física, educación, apoyo conductual, fármacos y cirugía. Si analizamos los limitantes de algunso de estos pilares vermeos porque la obesidad continua.

La influencia de la industria alimentaria incorporando la alimentación chatarra ricas en grasa y carbohidratos, que vende sabores que son apetecibles y de fácil adquisición, rompen los esquemas de un tratamiento saludable. El costo elevado de los alimentos saludables no son accesibles en la canasta familiar.

Actualmente la gente no realiza actividad física y cuales son los elementos que impiden realizar ejercicio son los barrios inseguros, las condiciones laborales,. Otra barrera es la automatización de la vida moderna, que induce a realizar cada vez menos actividad física, al proporcionar escaleras mecánicas, controles remotos, computadores, etc.

La falta de incorporación del ejercicio en programas integrales de tratamiento de la obesidad puede deberse también al factor económico, porque el costo suele ser alto, desde todo punto de vista, ya que se necesita calzado, ropa y lugares adecuados.

La educación e información sobre la importancia de la alimentación saludable han sido muy difíciles de aplicarlos en la población, porque los hábitos y costumbres alimentarias tienen un poder de influencia que están provocando trastornos que pueden llegar a ser muy peligrosos llegada la edad adulta.

Con el fin de paliar esta situación, las instituciones solo han realizado diversos estudios para analizar las causas y buscar soluciones y también se han implementado programas de intervención en alimentación y actividad física para personas con malnutrición por exceso.

Existen muchos programas de interevncion el problema es que están trabajando en forma desarticulada, y una muestra son los datos del incrementó de obesidad, sedentarismo y enfermedades crónicas.

Best regards.

I am pleased to address the guiding questions:

1. Which nutrition problem (s) does your country prioritize? (undernutrition, overweight/obesity, micronutrient deficiencies, all forms of malnutrition)

It is estimated that around 17.5 million children under five are overweight worldwide. In the United States of America, the prevalence of overweight children and teenagers has doubled and tripled respectively since 1980. Furthermore, the prevalence of obesity in boys and girls aged 12-17 years has increased from 5% to 13% and from 5% to 9% respectively between 1970 and 1991. Therefore, this is a worldwide problem, not just limited to developed countries but also affecting developing countries.

In Chile, the National Health Survey delivered reliable data and showed that overweight rates are relatively high. This is quite worrying, as overweight poses health risks. Many overweight patients evidence co-morbid conditions requiring aggressive treatments. Obesity rates in men and women amounted to 19.4% and 27% respectively, with a 23,2% average ; in addition, 0.2% of men and 2.3% of women are morbidly obese, 1.3% in average.  

Studies conducted between 1988 and 1992 in the southeast area of ​​Santiago show that obesity increased both in men and women. The CARMEN (Actions for Multi-factorial Reduction of Non-communicable Diseases) study came to the same conclusions and showed a significant prevalence of obesity in all socioeconomic levels, especially in women with a low socioeconomic status.

Surveys conducted by the JUNAEB show that childhood obesity has increased significantly in recent decades, unlike other health-related problems like stunting and undernutrition, constituting therefore a major problem. Many institutions have included low-calorie diets, physical activity promotion, nutrition education, behavioural support, drugs and surgery in their intervention programs. The constraints of some of these actions explain why obesity persists.

The influence of the food industry, offering junk food rich in fats and carbohydrates and appealing flavours readily available, contravenes the principles of a healthy diet. Furthermore, healthy food is expensive and therefore not affordable to many households.

Currently, people are not physically active, majorly due to unsafe neighbourhoods and working conditions. Another constraint is modern life automation: escalators, remote controls, computers and other devices do not encourage physical exercise.

The absence of physical exercise in comprehensive obesity treatments may be explained by economic motivations. Practicing physical exercise is usually expensive, as appropriate footwear, clothes and venues are required.

Educating and informing the population about the importance of healthy food has been an arduous endeavour. Food habits are highly influential and are leading to disorders that can pose serious risks in adulthood.

To avoid this situation, institutions have only conducted several studies to analyze its causes and seek solutions. Intervention programs to improve nutrition and physical activity have also been implemented targeting the malnourished.

There are many intervention programs. However, they are working in an uncoordinated manner, as shown by the increase in obesity, sedentary lifestyle and chronic diseases.

>> English translation below <<

En Ecuador los problemas nutricionales son diversos y la doble carga de la malnutrición es evidente.  Por lo que las políticas públicas saludables se focalizan en atacar el problema en dos frentes.  Es interesante notar que luego de los resultados obtenidos por la ENSANUT ECU2012, se han abierto posibilidades de una intervención integral a través del ciclo de vida y con un enfoque comprehensivo.  

Los problemas de malnutrición se enfocan como una estrategia integral, como ya lo he anotado y a través de las Instituciones coordinadores, se busca cubrir las necesidades de la familia, con un enfoque en el ciclo de vida, por ejemplo el Programa Niñez Plena, que actualmente se está desarrollando en el país.

Los gobiernos locales también están trabajando en cubrir espacios de comunicación y educación a través de campañas comunitarias, y ya que Ecuador tiene un gran % de población urbana, estos programas pueden llegar a un gran número de personas, por ejemplo el Programa Salud al Paso del Municipio de Quito.

De mi experiencia y conocimientos, es muy importante que en el país se realice una investigación en las diferentes regiones del país, para conocer formas efectivas de comunicar y sensibilizar, en temas de salud nutricional y alimentación. Ecuador es un país pluricultural y multiétnico y es necesario conocer cómo llegar a cada segmento de la población con mensajes y estrategias eficaces.  Para mí esto es una falla de la mayorìa de programas de nutrición y alimentación en mí país.

El rol de la educación nutricional es fundamental, pero es importante anotar que se deben buscar mensajes adecuados para cada segmento de población, además de formas interactivas, motivantes y hasta lúdicas para sensibilizar, que es el primer paso para lograr un avance hacia el cambio de comportamiento.  No debe conformarse el equipo de salud en dar "charlas informativas" que de nada sirven.  Otro aspecto fundamental es trabajar en proyectos digitales y en diseño de aplicaciones para incentivar a una mejora en la salud de la población.

Gracias por la atención

María del Carmen Gangotena

Magister en Ciencias de la Nutrición

In Ecuador nutritional problems are varied, and the double burden of malnutrition is evident. Therefore, healthy public policies are focused on tackling the problem in two directions. It is interesting to note that, following the results gathered by the ENSANUT ECU2012 survey, new opportunities have arisen for a comprehensive intervention through the life cycle following an integrated approach.

As mentioned before, malnutrition problems are addressed adopting a comprehensive approach.  Through coordinating Institutions, family needs are addressed paying special attention to the life cycle. As an example, the Fulfilled Childhood Program, that is currently being developed in the country.

Local governments are also working on addressing communication and education through community campaigns. Since Ecuador has a large percentage of urban population, these programs can reach a large number of people. As an example, the Fast Health Program in the city of Quito.

According to my experience and knowledge, conducting research in different regions of the country to learn effective ways to communicate and raise awareness on nutritional health and food issues is important. Ecuador is a multicultural and multiethnic country and knowing how to reach each segment of the population with effective messages and strategies is necessary. To me, this is a major failure in most food and nutrition programs in my country.

The role of nutrition education is essential. However, it is important to note that appropriated messages for each segment of the population must be sought, along with interactive, motivating and even playful ways to raise awareness, as this is the first step to make progress in behaviour change. Health personnel should not be resigned to useless “informative talks”. Another key aspect is working on digital projects and the design of applications to foster an improvement in the health of the population.

Thank you for your attention.

María del Carmen Gangotena

Master in Nutritional Science

As it is a problem of universal occurance today, I would like to make a few general suggestions that may be of some use across the board. I think it is important for us to understand the two main causes of the problem, which seem to be logically linked.

I envisage public ignorance and indifference to what constitutes a given individual's nutritional needs as a significant cause of obesity and some deficiency diseases distributed throughout the world. Sometimes, aggresive and colourful advertising appears to affect the eating and drinking habits of even those who know what food and drinks may best serve those needs.

Therefore, it would be useful to make nutrition an integral part of education of everybody from the earliest possible age. Moreover, it should reinforce the individual's ability to resist harmful advertising, and it should help each person to understand that the traditional food and drink of a given area would best serve the nutritional needs of the people there. Of course, these may be improved, and new food items may be introduced, but its replacement for commercial or fashion reasons could be disastrous.

It is crucial for people to understand that one's nutritional needs are also influenced by the climatic conditions. For instance, in tropical countries, one requires less carbohydrates to sustain body heat for simple physical reasons, while in cooler climes, maintainance of body temperature requires a relatively greater intake of the same item.

At the same time, one must understand that when the use of 'labour saving' devices becomes prevalent, individual energy needs diminish in proportion. Then, if one does not adjust one's diet appropriately, obesity becomes inevitable unless one finds some other suitable outlet for the excess energy. I do not regard eating and drinking as simple fuel intake, but we should understand and pay attention to their fundamental purpose. I think this should be a part of one's general education.

Now, a word about the second major cause of malnutrition. I think agricultural production of an area should be subserviant to the nutritional needs of the inhabitants there. While the chemical ingredients of those needs such as proteins, carbohydrates, etc., are universal, their specific sources and required quantities are subject to an immense variation. Climatic and geographical conditions play a significant role in determining to what sources one may resort to obtain them, eg. variation in cereal types and sources of protein. Traditional eating habits have been fashioned by our awareness of this for a very long time, hence, should not be dismissed as some tend to do.

But unfortunately, in many countries, agricultural production is governed by economic considerations which are motivated by the desire to gain profit. I think most people have heard about instances where farmers were induced to switch over to growing 'cash crops' instead of food crops, which in turn increased the incidence of under nourishment in the area. A different variation of the same sad theme is getting the farmers to export a food crop for more cash leading to a shortage of a local food item. This happened in Senegal and the Cameroons when most of the annual peanut production was exported for cash, and as a result the local chidren began to suffer from protein deficiency as peanuts were an important source of their protein intake.

I think the local agricultural producers and consumers ought to get together to ensure that they first act for their mutual benefit, and then, if it does not entail any environmental degradation, producers may help out their neighbouring communities to make up their short falls. Under careful supervision, such help may be extended to national, regional, and even global levels. But in each case, the guiding principles are the nutritinal needs of the individual at a given place, and never the 'needs' of the abstract entity, the economy.

Lal Manavado.