全球粮食安全与营养论坛 (FSN论坛)

Dear all,

I would like to share with you a paper that describes the Project Energize in New Zealand. 

Prevention of childhood obesity is a global priority. The school setting offers access to large numbers of children and the ability to provide supportive environments for quality physical activity and nutrition. This article describes Project Energize, a through-school physical activity and nutrition programme that celebrated its 10-year anniversary in 2015 so that it might serve as a model for similar practices, initiatives and policies elsewhere. The programme was envisaged and financed by the Waikato District Health Board of New Zealand in 2004 and delivered by Sport Waikato to 124 primary schools as a randomised controlled trial from 2005 to 2006. The programme has since expanded to include all 242 primary schools in the Waikato region and 70 schools in other regions, including 53,000 children. Ongoing evaluation and development of Project Energize has shown it to be sustainable (ongoing for >10 years), both effective (lower obesity, higher physical fitness) and cost effective (one health related cost quality adjusted life year between $18,000 and $30,000) and efficient ($45/child/year) as a childhood ‘health’ programme. The programme’s unique community-based approach is inclusive of all children, serving a population that is 42 % Māori, the indigenous people of New Zealand. While the original nine healthy eating and seven quality physical activity goals have not changed, the delivery and assessment processes has been refined and the health service adapted over the 10 years of the programme existence, as well as adapted over time to other settings including early childhood education and schools in Cork in Ireland. Evaluation and research associated with the programme delivery and outcomes are ongoing. The dissemination of findings to politicians and collaboration with other service providers are both regarded as priorities.

Read more here https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-1849-1

1. In India the new government worked to get global approval (W.H.O) of Yoga.  International yoga day was organized.  Efforts are on to implement Yoga in Indian schools.

2. The international recognition of Yoga reinforced confidence in yoga teachers in India.   This has considerably reduced the marketing efforts required from yoga teachers.   The schools have become active in recruiting new yoga teachers.

3.  We need a comprehensive understanding of overeating before starting the process of taxing food products.  I have prepared a comprehensive understanding of overeating.  The Governments around the world have proposed to tax various food products to stop obesity, diabetes & other non-communicable diseases (NCDs), and they include soda tax, candy tax, sugar tax, high salt and high sugar tax, junk food tax, pastry tax, etc. Even after taxing food products there is still discussion on food supplied in large quantities, and on promotions to children in the form of gifts and toys. There is a need for comprehensive global framework for health related food taxation and it is addressed by my work. https://www.mygov.in/sites/default/files/user_comments/Efficient-Tax-Framework.pdf

   Behavioral insight: This effort has also brought out the business behavior of tickling food consumption in individuals. Markets mechanisms reward the business behavior tickling food consumption as higher sales translates into higher profits.  Governments in developed countries have set up a team to nudge people’s behavior for improving health especially in the area of obesity and non-communicable diseases.   The business behavior of tickling food consumption generates or increases the need for governance efforts like behavior change interventions, and regulating tickling behavior will reduce the burden of governance.

The above framework will be a single basic document for Overeating behavior/Tax based financing for health/ Behavioral insight efforts.

English translation below

L'obésité constitue un phénomène de société encore très mal connu; ce qui constitue un obstacle sérieux au montage de projets et programmes efficaces pour la combattre. On ignore de façon très précise les déterminants de l'obésité. La nutrition seule n'est pas la cause de l'obésité à mon avis. Et l'indice de masse corporelle (IMC) jusque là utilisé ne semble pas pertinent dans tous les cas, dans tous les pays et pour toutes les races. L’IMC ne reflète pas seulement la masse grasse. Le calcul de l'IMC ne convient pas aux enfants, ni aux personnes trop courtes. Un individu dont l’IMC paraît correct, peut très bien souffrir d’un excès de graisse abdominal, potentiellement dangereux pour la santé. L’IMC est une mesure qui correspond à un individu à un instant précis : il ne reflète pas l’histoire du poids. Or, l’évolution du poids est très importante pour détecter un problème de santé. Les athlètes, en particulier les sportifs qui présentent une masse musculaire importante ont souvent un IMC relativement élevé, car la masse musculaire représente un poids non négligeable. La liaison entre l'IMC et la masse grasse semble différente en fonction des races. L’IMC doit être interprété avec prudence à l’échelle d’un individu. Il demeure davantage un bon indicateur pour l’ensemble d’une population.

Cette réalié fait que très peu de programmes sont efficaces contre l'obésité. Je n'en connais pas au Bénin. Même dans les pays développés, l'obésité se développe. Ce qui se passe aujourd'hui est que l'on est tenté de déclarer qu'il y a problème alors même que la personne concernée (en surpoids ou obèse) se sent encore bien dans sa peau. C'est la confusion entre indice et indicateur. Au Bénin par exemple, les femmes en point et les plus appréciées sont généralement celles en surpoids ou obèses si l'on doit considérer leurs IMC. Il s'ensuit que les questions de surpoids et d'obésité doivent être contextualisées. Les programmes à mettre en oeuvre doivent encore être des programmes de recherche pour identifier de façon plus ou moins précise les déterminants de l'obésité. Une typologie des groupes de communautés est nécessaire. Cette typologie doit être faite en fonction des races, de l'activité exercée, des régions et des considérations sociales (systèmes alimentaires, valeurs, ...). Aussi, doit-on distinguer les études d'incidence et de tendance (au niveau d'une population) des études au niveau individuel. Car, une situation qui s'avère alarmante au niveau de la population n'indique pas forcément que toutes les personnes concernées sont malades. Pour ma part, je crois qu'au niveau de l'individu, l'obésité est moins engendrée par l'alimentation que par la richesse nutritionnelle de l'aliment (surtout la richesse en nutriments synthétisés) et les facteurs de l'environnement: l'hérédité et la pression mentale. Une personne heureuse est plus prédisposée au surpoids et à l'obésité qu'une personne soucieuse, qui n'accepte pas encore sa situation. De plus, on remarque qu'il y souvent des personnes qui mangent beaucoup sans présenter aucun signe de surpoids ou d'obésité. De même, l'excès de graisse abdominal, que j'ai beaucoup observé en Italie par exemple, surtout chez les femmes et les filles, est rare au Bénin et en Afrique. La question est donc sérieuse et demande plus d'investigations.   

Obesity is still a very badly understood social phenomenon which creates a serious obstacle for the development of projects and programs that can combat it effectively. We very precisely ignore the causes of obesity. Nutrition alone is not the cause of obesity, in my opinion. And the currently used body mass index (BMI) does not seem pertinent in all cases, in all countries and for all ethnicities. The BMI does not reflect only body fat. The calculation of a BMI is not appropriate for children, or for shorter people. A person whose BMI is normal can very well have potentially dangerous excess abdominal fat. The BMI measures an individual at a specific point in time: it does not reflect weight history. However, weight change is a very important factor to detect health problems. Athletes, particularly those who have elevated muscle mass often present relatively high BMI because muscle mass represents a significant amount of weight. The connection between BMI and body fat seems different depending on ethnicity. The BMI must be interpreted with caution on the scale of the individual. It does however remain a good measurement for a population as a whole.

This reality means there are few effective programs against obesity. I do not know any in Benin. Even in developed countries, obesity is increasing. What is happening now is that we try to declare that there is a problem even when the person in question (overweight or obese) feels good about themselves. This is where confusion between index and indicator comes from. In Benin, for example, the most appreciated women are generally those overweight or obese if we consider their BMI. This leads to the need to contextualise questions of overweight and obesity. The programs to be put in place should still be focused on research to determine, more or less precisely, the determinants of obesity. A typology by community groups is necessary. This typology should reflect ethnicity, occupation, region and social considerations (diet, values, …). Also, we should distinguish studies referring to incidence and tendencies (at the population level) from those at the individual level. Because, a situation that seems alarming at the population level does not indicate necessarily that everyone concerned is sick. Personally, I believe that at the individual level, obesity is less a cause of consumption than of nutritionally rich foods (particularly with regards to synthetic ingredients) and environmental factors: heredity and psychologic pressure. A happy person is more predisposed to overweight and obesity than a worried person who does not yet accept their situation. Furthermore, we notice often people who eat a lot without presenting any indication of overweight or obesity. Likewise, an excess of abdominal fat, which I have observed a lot in Italy, particularly in women and girls, is rare in Benin and in Africa. The subject is therefore serious and requires more investigation.