Transcript Diapositiva 1

National Agreement for Nutritional Health
Strategy Against Overweight and Obesity
in Mexico
Nutritional interventions for school population
Ljubica Latinovic MD, MHA
Mexico Ministry of Health
PAHO/PAHEF Workshop on Childhood Obesity
Aruba, June 2012
Mexico overview
Mexican Constitution, Article 4:
Every person has the right to
health protection (since 1983)
• Federation with 32 states
• Health Services are
decentralized
• 107 million inhabitants
• Birth rate 18 per 1,000
• 80 million with health
coverage, the goal: universal
coverage by 2012
• Life expectancy 75.3 yr
• Infant mortality 14.7 per 1,000
• 74% Urban population
Main health determinants (DALYs)
Burden disease (% total DALY)
0
.05
.1
.15
.2
Overweight & obesity
Hyperglicemia
Alcohol
High blood pressure
Risky sex
High colesterol
Low physical activity
undernutritiion
Smoking
Water
Fruit and vegetables consumption
Iron deficiency
Indoor pollution
males
females
Zinc deficiency
Vitamine A deficiecy
Source: Mortality and Burden of Disease Attributable to Selected Major Risk Factors in Mexico: Preliminary National Estimates , SSA 2005.
Background
Adult Population with Obesity According to
Income Group and Calendar Year
Obesity prevalence
• Obesity is one of the major public
health challenges of the XXI Century
• From 1980 to this day, the prevalence
in Mexico has tripled, and continues
to grow at an alarming rate, especially
among children.
• The cost is equivalent to 0.2% of GDP.
Constitutes 9% of total health
expenditure
• Obesity is responsible for between
8% and 10% of premature deaths in
Mexico
• In 2008, 46,000 families suffered
adverse health events associated with
obesity
Welfare distribution by income
Where do we stand globally in child obesity?
Prevalence of obesity/ overweight
in Mexican children
School children, 5 to 11 years old
ENN 1999:
ENSANUT 2006:
One in five
One in four
In 7 years the increase was 39.7%
in both sexes
Source: Olaiz-Fernández G, Rivera-Dommarco J, Shamah Levy T, Rojas R, Villalpando-Hernandez S, Hernández-Avila M, Sepúlveda Amor J,
Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública, 2006.
School Health Survey, 2008
• Three out of ten students in primary and junior high school
present obesity/ overweight.
• Fruit, vegetables and milk are not between 10 most consumed
foods in schools.
• Soda and sweetened drinks occupy one of the first 5 places of
beverages consumed in schools.
• Only 28.7% of students that attend public schools practice some
kind of physical activity 60 minutes daily.
• Half of the teenagers spend more then 12 hours per week
watching TV.
Source: Encuesta de Salud en Estudiantes De Escuelas Públicas en México, INSP 2008
Recreational areas, activities and availability of
water in schools by educational level
NATIONAL
Primary school
Secondary
school
Recreational areas availability
Recreational areas availability
Seated conversations
Recess does not include vigorous physical activity
Seated conversations
Recess does not include vigorous physical activity.
Free
drinking water availability
activity
Free drinking water availability
Physical activity patterns
The proportion of people who do physical activity is low and decreases
significantly with age
3.25 do you practice some physical activity?
Age groups and gender
MALE
Yes
No
DNA
12 to 14
63.90%
35.80%
0.30%
15 to 19
58.50%
41.20%
0.30%
20 to 24
45.10%
54.40%
0.50%
25 to 29
34.20%
65.70%
0.00%
Total
National
FEMALE
49.60%
0.30%
12 to 14
47.80%
52.20%
0.00%
15 to 19
40.20%
59.80%
0.00%
20 to 24
19.30%
80.40%
0.40%
25 to 29
15.40%
84.60%
0.00%
Total
TOTAL
50.10%
29.80%
70.10%
0.10%
12 to 14
56.00%
43.80%
0.20%
15 to 19
49.00%
50.90%
0.20%
20 to 24
32.10%
67.50%
0.40%
25 to 29
24.50%
75.50%
0.00%
Total
39.80%
60.00%
0.20%
Source, INSP, Physical activity among 12 to 29 years old population. Mexico, 2005
Obesity as risk factor during life course
Reduced capacity to take
care of grandchildren and
participate in family life
SENIOR ADULTS
Obesity
Overweight
Cancer
NO breastfeeding,
breastfeeding for less then 6
months and unhealthy mom´s
diet
NEWBORNS
High energy diet
Low weight at birth
Sedentary life style, no
early stimulation
Deficient
fetal
nutrition
Lower social
status, poverty
CHILDHOOD
Overweight
MATERNITY
Overweight,
Diabetes,
Hypertension
ADULTHOOD
Overweight,
Diabetes,
NTDs
ADOLESCENTS
High energy diet and
poor physical activity
Overweight
Low income, poor access to
healthy nutrition, single
parent, limited access to
health services, teenage
pregnancy
Low self esteem and
social exclusion
High energy diet and
poor physical activity
Source: Adapted from la Comisión en los Desafíos Nutricionales del Siglo 21 (57)
Strategic plan for healthy weight
Source: Kickbush I., Healthy Societies: Addressing 21st Century Health Challenges, 2008
What do we conclude from this?
• Both government and society must
act to combat the epidemic of
obesity
• National policies should encourage
and provide opportunities for
increased physical activity and
improve the availability and
accessibility of healthy foods
• The severity of the problem calls for
the participation and responsibility
of different government sectors, civil
society, private sector and individuals
and families
National Agreement
for Nutritional Health
Strategy to Control
Overweight and
Obesity
National Agreement for Nutritional Health
Is based on:
Modification of the
environment
Change of individual habits
and conducts (nutrition and
physical activity)
Proposed strategic goals
Reverse the rate
of growth of
overweight and
obesity in 2 to
5 years old
Stop the rate of
growth of obesity
and overweigh
in 5 to 19 years old
Slow the rate of
growth of
overweight
and
obesity among
adults
Objectives
1. Promote physical activity in all settings (school, work, community,
recreational)
2. Increase availability, accessibility and consumption of plain water
3. Decrease sugar and fat in drinks
4. Increase consumption of vegetables and fruits, legumes, whole
grains and fiber
5. Improve decision-making capacity through labeling and promotion
of health and nutrition literacy
6. Promote exclusive breastfeeding in first six months of life.
7. Reduce the amount of sugar added in food
8. Decrease consumption of saturated fats and eliminate trans fats in
industrialized food.
9. Elaborate smaller portions in restaurants and food outlets, as well
as for processed and industrialized food
10. Limit the amount of sodium added to foods and reduce sodium
intake
Stakeholders
Government
 SS
 SE
 SEP
 SHCP
 SAGARPA
 STPS
 SEDESOL
 SEDENA
 COFEPRIS
 CONADE
 IMSS
 ISSSTE
 PROFECO
 SNDIF
 CONAGUA
 PEMEX
 Organized civil society
 Academy
 Industry
School as a major stakeholder
School as important setting to
promote healthy nutrition and
physical activity habits
Program of Action in
School context
•
•
•
Health
Promotion
and
Education
Regular physical activity
promotion
Availability and access to
healthy food and drinks in
schools
Guidelines on Nutrition
Standards for Foods and
Beverages
offered in Schools
Main goal of Guidelines
To establish nutritional criteria and
guidelines for foods and beverages
that are produced, distributed and
sold at primary and secondary
schools and to promote schools as a
healthy environment where healthy
eating habits are reinforced and
practiced, with an emphasis on the
reduction of the caloric value of
school’s snacks.
Applied in all primary and secondary public and private schools that
are part of National Public Board of Education
Key principles
• Establish clear recommendations on which foods and beverages can
be distributed and prepared at school, including industrial products
and prepared food
• Give recommendations based on healthy nutrition standards, taking
into consideration cultural, social and geographical context of every
region.
• Reinforce the capacities of educational community to decide about
foods and beverages offered and consumed at schools based on
guidelines.
• School snack/ lunch contemplates a combination of:
• One portion of fruit or vegetables
• One portion of prepared food
• Water on free demand
The Guidelines also include…
•
•
•
Total amount of calories and micronutrients recommended
for school snacks
Maximum amount of saturated and trans fats, added sugar
and salt in a healthy meal
Examples of combinations of
foods that can be used to make a
healthy school snacks based on
“Eat well plate”
http://www.insp.mx/alimentosescolares/
Implementation of guidelines
Gradually, (by school years) to allow a sustained and continuous change,
permitting the process of acceptance and adjustment of all actors involved as
well as the industry to develop new products.
Energy per portion <=
140 kcal
Total fats <=
≤ 40%
Stage I (School year
2010-2011).
Energy per portion < = 130 kcal
Total fats <= ≤ 40%
Reduction of sugar, saturated
and trans fats, sodium and
fiber
Stage II (School year 20112012)
Energy per portion <= 130
kcal
Total fats <= ≤ 35%
More reduction of sugar,
saturated and trans fats,
sodium and fiber
Stage III (Starting from
school year 2012)
Achievements
• Publication of the “Agreement for establishing General Guidelines
for the Dispending and Distribution of Food and Beverage in
establishments of food consumption in all Schools of Basic
Education ”, that became effective from January 1, 2011.
• Distribution of 16 millions of handbooks for parents and family
members, oriented towards the elaboration of healthy snacks.
• Distribution of 250,000 handbooks for the preparation and hygiene
of food and beverage in the school consumption establishments.
•Organization of Food Establishments and Physical Activity
Promotion Committees as part of the School Councils of Social
Participation to promote and supervise the actions oriented to
healthy eating in schools.
Achievements
• At the end of Stage I, 1920 products were registered. When applying
the criteria for Stage II, the number of products dropped to 413.
• The category in which the most significant reduction was registered is
the one that includes cakes, cookies and desserts, followed by snacks.
• In the case of snacks, since Stage I, fried snacks were eliminated; just
baked ones maintained.
Cookies,
Sweet
bread,
Desserts
and Candies
Total
Stage I
1480
Products
Total
Stage II
143
Products
Snacks
Total
Stage I
Total
Stage II
191
60
Products Products
Closure of stage II
3000
2500
2000
1500
Cookies, sweet bread,
desserts,Pastelillos,
candies Postres y
Galletas
1920
Confites
Snacks
Botanas
1480
TotalProductos
of products
that
fulfill
Total
que
cumplen
theCriterios
nutritional
criteria
con
Nutrimentales
1000
500
191
0
EtapaI I
Stage
413
545
143
193
60
Inicio Etapa
II II
Beginning
of stage
108
ClosureEtapa
of stage
Cierre
II II
Educational materials
26
Campaign 1-2-3 for me
Target: Primary school girls and boys
Objective: Promote consumption of vegetables and fruit, physical
activity and drinking of plain water
1 2 3 for me/ kids
1 2 3 for me/ parents and school authorities
Expectations 2012
To position
plain water as
first choice
drink and the
best option for
hydration.
Increase in
infant and adult
population the
realization of
physical activity
according to
the
recommendations
for their age.
Convert the
school retailers
into healthy
foods
promoters.
Reduce the
prevalence of
obesity in
children,
maintain in
adolescents and
halt progression
in adults.
Ljubica Latinovic MD, MHA
General Directorate of Health Promotion
Mexico Ministry of Health
[email protected]
www.promocion.salud.gob.mx
@saludDGPS