Many thanks for the opportunity to contribute to this important policy challenge.
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.
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:
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.
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.
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.
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.
Д-р. Sebastián Peña
Dear FSN Forum Moderators,
Many thanks for the opportunity to contribute to this important policy challenge.
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.
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:
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.
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.
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.
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.