Global Forum on Food Security and Nutrition (FSN Forum)

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Are there any successful policies and programmes to fight overweight and obesity?

Dear colleagues:

We are delighted to invite you to an online discussion on successful policies and programmes to fight overweight and obesity. Please read the background information and answer the discussion questions included below.

Brief context for the discussion forum

The formulation and implementation of public policies and programmes to prevent, monitor and reduce overweight and obesity pose a challenge, both for Latin America and the Caribbean and for most regions in the world.

Overweight and obesity are considered a severe public health issue in many countries, requiring urgent measures at all levels, including the formulation, implementation, monitoring and evaluation of adequate policies and programmes. According to the World Health Organization (WHO), 1.9 billion adults (over the age of 18) were overweight in 2014, and 600 million were obese. Furthermore, 42 million children under five were overweight or obese in 2013.

To ensure a successful implementation of public policies and programmes, these should be based on scientific evidence and/or proven interventions. However, there is little information on the results and impact of policies and programmes addressing these issues in a comprehensive and holistic manner.

In response to this shortfall, the "Study of international evidence of obesity reduction: lessons learned from case studies" (“Estudio de evidencia internacional en la reducción de obesidad: Lecciones aprendidas de estudios de caso”), is being conducted by FAO and the Catholic University of Chile (known in Spanish as PUC), in consultation with the WHO. The study has two major goals:

  • Gathering and describing the major and most effective existing policies and programmes addressing obesity and overweight at international level.
  • Making the outcomes available to parliamentarians and decision makers (in public policies), with the aim of better inform the design and implementation of initiatives effectively addressing overweight and obesity in the region.

The study is being conducted now and has identified several interventions grouped into the following categories: access (providing nutritious food to vulnerable groups, prohibiting junk food in schools and other public institutions), education (dietary guidelines, nutrition education in the school context, promoting physical activity, public campaigns promoting healthy diets, nutritional labelling, restrictions on junk food advertising), supply (increasing the supply of healthy food in areas like “food swamps” and “food deserts”, facilitating short marketing circuits, improving the nutritional quality of food products) and economic (taxes, subsidies and price changes). In order to strengthen the efforts made so far, this forum and your participation will be crucial in gathering more evidence, experiences of good practices and success stories reflecting the work at the global, regional and national area in this field.

This is why we invite you to answer one or more of the following questions, and to share your knowledge about successful policies and programmes to fight overweight and obesity. Please, bear in mind that we are particularly interested in using this platform to gather and share examples of initiatives implemented by governments, or other institutions in your country or in other countries.

Discussion questions

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.

  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?
  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.

Please do not hesitate to share your experiences and knowledge on this topic. We look forward to receiving your contributions and working together to strategically overcome this global problem.

 

Francisca Silva Torrealba, PUC Chile

Rodrigo Vásquez Panizza, FAO Chile

Discussion facilitators

Topics

This activity is now closed. Please contact [email protected] for any further information.

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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.

See the attachments:

Prof. Valentin Son'kin

Institute of Developmental Physiology Russian Academy of Education
Russian Federation

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

See the attachments:

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]

See the attachments:

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.

Ms. Helen Medina

US Council for International Business
United States of America
 
FAO Global Forum on Food Security and Nutrition
Are there any successful policies and programmes to fight overweight and obesity?
June 30, 2016
 
Dear Discussion Moderators,  
 
The U.S. Council for International Business (USCIB) appreciates the opportunity to respond to this complicated question of which policies and programmes that address overweight and obesity have been successful.
 
USCIB is the American affiliate of the International Chamber of Commerce (ICC), the Business and Industry Advisory Committee (BIAC) to the OECD, and the International Organisation of Employers (IOE).  As such, we work closely with intergovernmental entities, including various United Nations bodies, the Organization for Economic Cooperation and Development (OECD) and the International Labor Organization (ILO), to provide input from the business community on a variety of policy issues, including those related to health and nutrition.
 
All facets of society, including the private sector, have an important role to play in helping to reduce the incidence and burden of non-communicable diseases (NCDs).  This view is supported by World Health Organization (WHO) and OECD strategies recognizing that NCD solutions require a whole-of-society approach, multi-sectoral actions, and collaboration among governments, civil society and the private sector.  Given the complex and multi-factorial nature of NCDs, it is essential that all stakeholders work together to develop holistic, sustainable solutions.
 
The food and beverage industry’s many contributions to global efforts to prevent NCDs are guided by science-based principles that include:
- Providing a range of nutritious product choices and marketing them in ways that promote healthy lifestyles;
- Improving awareness and understanding of nutrition and energy balance; 
- Communicating clearly through labeling, packaging, websites, brochures, and in-store communications to enable consumers to make informed choices; 
- Undertaking responsible advertising practices, taking into account the special needs of children; 
- Emphasizing the importance of achieving a balance throughout life of physical activity and nutrition; and 
- Partnering with other stakeholders in these endeavors. 
 
The food and beverage sector has undertaken significant initiatives across all of these areas, in particular on new and reformulated products, packaging innovations, enhanced nutrition information, communications to promote healthy lifestyles, and partnerships aimed at promoting physical activity and nutrition education. There has been real progress, but the work is not done, and industry is committed to continuing its efforts and to work in collaboration with governments, civil society, and other stakeholders to achieve success.  Below are several examples of the voluntary industry efforts that have proven results.
 
Industry Initiatives
 
Healthy Weight Commitment Foundation (HWCF)
Founded in 2009, the HWCF is a partnership between industry, NGOs and educators whose aim is to reduce obesity, especially childhood obesity.  HWCF members voluntarily pledged to collectively remove trillion calories from their products (against a 2007 baseline) by the end of 2015. It focuses its efforts on families and schools and promotes ways to help people achieve a healthy weight through energy balance – calories in and calories out.
 
A study published in 2014 by the American Journal of Preventive Medicine and funded by the Robert Wood Johnson Foundation found that the companies had, by the end of 2012, collectively cut 6.4 trillion calories, exceeding their 2015 goal by more than 400%. Companies achieved this calorie- reduction goal by developing, introducing and selling lower-calorie options, changing recipes where possible, and lowering the content of current products or reducing portion sizes of existing single-serve products. Researchers at the Hudson Institute evaluated the impact of HWCF’s commitment to sell fewer calories by testing whether lower-calorie products sold by HWCF companies (whose members account for nearly 25% of calories consumed in the United States) grew over the five-year evaluation period and the impact of these sales on total company sales.
 
The study concluded that these lower-calorie products are driving sales growth and recommended these choices should continue to be pursued aggressively:
- 82% of sales growth driven by lower-calories (over four times the rate of higher-calorie products);
- Sales increase of $1.25 billion for lower-calorie products vs. less than $300 million for higher-calorie products; and
- 10 of 15 new products with sales of over $50 million+ were lower-calorie products.
 
HWCF has also created a families and schools programme. The Together Counts™ campaign promotes energy balance, the advantages of family meals and physical activity and the TogetherCounts.com website, designed in partnership with Discovery Education, which provides free, downloadable resources for families, teachers and children for Pre-K through elementary school. Today, more than 19 million children are engaged with the curriculum. This successful U.S. programme is also being implemented in Australia, under the auspices of the Healthier Australia Commitment, an industry-led initiative in partnership with NGOs, to help reduce the incidence of chronic preventable diseases and improve the nutritional quality of the Australian diet.
 
Facts Up Front (FUF)
Facts Up Front (FUF) is a voluntary initiative created in 2011 by the Washington, DC-based Grocery Manufacturers Association (GMA) and the Food Marketing Institute (FMI).  FUF (see example below) is a simple and easy-to-use labeling system that displays key nutrition facts on the front of food and beverage packages – displaying the calories, saturated fat, sodium and sugar in each serving.   
 
Almost 90 percent of U.S. grocery sales by GMA members use FUF.  GMA members have made significant investments to develop the FUF consumer website (www.factsupfront.org), consumer research, and stakeholder outreach including media campaigns and ongoing consumer education efforts.  To continue to improve consumer understanding, GMA and FMI are extending the reach of consumer education efforts through key partnerships with groups such as Share our Strength.  Share Our Strength’s Cooking Matters program, in support of its goal of “No Kid Hungry,” will feature FUF in training materials for teaching basic nutrition, shopping, and cooking skills to individuals in low-income areas. 
 
A recent study was published in September 2015 in the Journal of Consumer Affairs that reflects the FUF communications campaign evaluation survey. The publication provides further support that FUF icons are visible, easy to understand, and helpful to the consumer.
 
Additionally, two important articles on front-of-pack nutrition labeling were published in respected journals in spring 2014.  The first article, published in the Journal of the Academy of Nutrition and Dietetics (JAND), is based on consumer research GMA commissioned the International Food Information Council Foundation to conduct in 2010 to examine consumer comprehension, ease of understanding, and interpretation of nutrition information in the uniformly formatted, voluntary front-of-package labeling system that was under consideration by GMA and FMI.  The research and subsequent JAND article finds that robust front-of-package labeling can significantly improve consumers’ ability to identify and understand a food’s nutrition information, and allows consumers to make informed choices about their purchases.  Several articles in respected journals (see footnote references in attached document) have found that fact-based front-of-package labeling like FUF significantly improves consumers’ ability to identify and understand nutrition information and make informed choices about their purchase. 
 
Product Innovation
Other examples of efforts of leading U.S. food and beverage companies’ efforts to reformulate and innovate products, provide clear nutrition labeling and consumer information, advertise responsibly, enhance workplace wellness and partner with stakeholders in healthy eating and active living programs have been documented by GMA. In 2014, GMA published cumulative results (2002-2013) of these efforts by 69 member companies representing about $245 billion in annual U.S. sales (roughly half of U.S. food and beverage sales).  Highlights include:
 
o 94% of companies reported nutritional improvements in over 30,000 products and sizes, with reductions in saturated fat, trans-fat, calories, sugar and carbohydrates and sodium;
 
o 81% of companies reported providing enhanced front-of-pack labeling information; and
 
o 77% of companies reported sponsorship of national and local initiatives to improve nutrition education and encourage regular physical activity, spending over $300 million in these expenditures between 2002 and 2013.
 
A separate study two years ago by GMA demonstrated a 16% reduction in sodium in member company products purchased between 2008 and 2013, with decreases appearing in those food categories that contributed the most to sodium intakes in the U.S..
 
Children’s Food and Beverage Advertising Initiative (CFBAI)
With regards to advertising, US companies have voluntarily taken concrete steps to help drive changes in the marketplace and improve the types of products advertised to children. In 2006, the U.S. Council of Better Business Bureaus (BBB) and leading U.S. food and beverage advertisers created the Children’s Food & Beverage Advertising Initiative (CFBAI) to respond to calls to action from the U.S. Federal Trade Commission (FTC), the U.S. Department of Health & Human Services (HHS)5 and the Institute of Medicine (IOM) for industry self-regulation and for food companies to do more to address food advertising to children because of the rise in childhood obesity. 
 
CFBAI’s goal is to be part of a multi-faceted solution to the complex problem of childhood obesity by using advertising to help promote healthier dietary choices and lifestyles among children under age 12. Under CFBAI’s Core Principles  participants commit that in advertising primarily directed to children under age 12 (“child-directed advertising”) they will depict only healthier or better-for-you foods. The participants agree to CFBAI oversight and to be held accountable for failure to comply with their commitments. CFBAI extensively monitors covered media for compliance and requires participants to submit detailed self-assessments annually. Each year CFBAI publishes a compliance and progress report.  It has found outstanding compliance every year. The problems that CFBAI has detected or that participants have self-reported have been quickly remedied. 
 
Since December 31, 2013, participants may advertise only foods that meet CFBAI’s category-specific uniform nutrition criteria in advertising primarily directed to children under age 12. CFBAI’s uniform nutrition criteria replaced and are stronger than previously used company-specific nutrition criteria.
 
In 2014, the BBB analyzed television ads aired in children’s programming, a repeat of analyses conducted in 2009, 2010, 2012 and 2013.  Of the 1,274 ads analyzed, 23% were for food and beverages. In 2014, ninety percent of the ads were for foods containing fruit, vegetables, non/low-fat dairy, whole grains, or at least a “good” source of what the 2010 Dietary Guidelines for Americans call “nutrients of concern” because they are not consumed in sufficient amounts (calcium, fiber, potassium and vitamin D) up from 83% in 2013 – confirming an upward trend based on past analyses.
   
Industry Partnerships to address Childhood Obesity
With more than 20 years of experience and a rigorous scientific evaluation, the EPODE (Together Let’s Prevent Childhood Obesity) methodology developed in France has been recognized by the international scientific community as innovative in tackling the problem of childhood obesity. EPODE's methodology is based on community based interventions (CBIs) aimed at changing the environment and behaviors of children, families and local stakeholders with the ultimate goal of promoting healthy lifestyles in families in a sustainable manner. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. Peer-reviewed studies indicate that this multi-stakeholder approach has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France.
 
The methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases. The Epode European Network (EEN) and the EPODE International Network (EIN) have been created to support the worldwide implementation of CBIs. The major partners in the EEN program include four committees, each one headed by one of four major European Universities (Amsterdam, Gent, Lille, Saragoza), and four private partners, including USCIB members: The Coca-Cola Company and Nestlé. These international networks allow the sharing of experience and best practices for the continuous improvement of the programs. By 2012, CBIs inspired by the EPODE methodology had been implemented in 17 countries. The South Australian and Mexican Health Ministers adopted the methodology to conceptualize and implement their “National plan on nutrition and Physical activity (Obesity Prevention and Active Lifestyle program and 5 Pasos strategy, respectively).
 
Public-Private Partnerships Responding to Global Health NCD Challenges
The ITU and WHO, the UN information and communication technologies (ICTs) and health agencies, have come together in a groundbreaking new partnership, Be He@lthy, Be Mobile, to focus on the use of mobile technology to improve NCDs prevention and treatment. This initiative aims to contribute to global and national efforts to save lives, minimize illness and disability, and reduce the social and economic burden due to NCDs. The initiative will harness the best mobile technology available and make it accessible for all countries to fight NCDs.
 
A number of countries are already using mobile technology to deliver health promotion messages on the NCD risk factors, to survey the epidemic, to persuade users to change unhealthy behaviors and to help countries implement national laws on NCDs. These successful pilots will be used as templates, scaled-up and customized to each country’s need. MHealth operational projects will be set up in participating countries, and a Mobile Health intervention package will bolster and support the more traditional existing methods of combatting NCDs.
 
Mobile solutions will be primarily SMS- or app-based, and will include a range of services including mAwareness, mTraining, mBehavioural Change, mSurveillance, mTreatment, mDisease management and mScreening. These services will build on the existing successful pilots and scale them to fit population levels. Countries will be able to choose the interventions that are the most feasibly affordable, and most suited to their needs.
 
Addressing NCDs at the Workplace
Industry also adds value in improving public health not only through innovating and generating effective responses for the prevention and control of NCDs, but also by leveraging the workplace as a means of providing information and healthcare provisions for all workers, their families and communities. USCIB thus recommends that governments work closely with local business since its involvement is crucial for the successful outcomes of these goals. Identifying barriers and challenges and working with national employers’ organizations, as well as local private sector representatives, is a good path to address the issue effectively and to drive progress.
 
One example of a partnership with an employer is China’s National Centre for Cardiovascular Disease’s “Healthy Heart - New Life.” This pilot project, which received support from Pfizer, focuses on developing multiple healthcare services, such as worksite health monitoring and guidance, disease guidelines-based health risk appraisal, individualized health intervention and follow-ups and information services, to explore the effective and sustainable model for chronic disease control amongst the working population.
 
Thank you again for the opportunity to provide our thoughts on these vitally important matters.  We hope we have demonstrated the depth and breadth of industry’s commitment, and we look forward to continued engagement.
 
Helen Medina
US Council for International Business
See the attachments:

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

See the attachments:

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.

 

 

Maria Alejandra Vidal Jaramillo

JUNAEB - Dirección Nacional, Gobierno de Chile
Chile

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.