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National Agreement for Nutritional Health Strategy Against Overweight and Obesity in Mexico

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.

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National Agreement for Nutritional Health Strategy Against Overweight and Obesity in Mexico

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  1. National Agreement for Nutritional HealthStrategy Against Overweight and Obesity in Mexico Nutritional interventions for school population LjubicaLatinovic MD, MHA Mexico Ministry of Health PAHO/PAHEF Workshop on Childhood Obesity Aruba, June 2012

  2. 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

  3. 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 males females Indoor pollution Zinc deficiency Vitamine A deficiecy Source: Mortality and Burden of Disease Attributable to Selected Major Risk Factors in Mexico: Preliminary National Estimates , SSA 2005.

  4. Background • 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 Adult Population with Obesity According to Income Group and Calendar Year Obesity prevalence Welfare distribution by income

  5. Where do we stand globally in child obesity?

  6. Prevalence of obesity/ overweight in Mexican children School children, 5 to 11 years old ENSANUT 2006: One in four ENN 1999: One in five 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.

  7. 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 beveragesconsumed 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

  8. 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 Seated conversations Recess does not include vigorous physical activity activity Recess does not include vigorous physical activity. Free drinking water availability Free drinking water availability

  9. The proportion of people who do physical activity is low and decreases significantly with age Physical activity patterns Source, INSP, Physical activity among 12 to 29 years old population. Mexico, 2005

  10. Obesity as risk factor during life course NO breastfeeding, breastfeeding for less then 6 months and unhealthy mom´s diet Reduced capacity to take care of grandchildren and participate in family life SENIOR ADULTS 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 High energydiet and poorphysicalactivity ADOLESCENTS Low income, poor access to healthy nutrition, single parent, limited access to health services, teenage pregnancy Low self esteem and social exclusion Obesity Overweight Cancer Overweight High energydiet and poorphysicalactivity Source: Adaptedfromla Comisión en los Desafíos Nutricionales del Siglo 21 (57)

  11. Strategic plan for healthy weight Source: Kickbush I., Healthy Societies: Addressing 21st Century Health Challenges, 2008

  12. National Agreement for Nutritional HealthStrategy to Control Overweight and Obesity 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

  13. National Agreement for Nutritional Health Is based on: Change of individual habits and conducts (nutrition and physical activity) Modification of the environment

  14. Proposed strategic goals Reverse the rate of growth of overweight and obesity in 2 to 5 years old 1 Slow the rate of growth of overweight and obesity among adults 3 Stop the rate of growth of obesity and overweigh in 5 to 19 years old 2

  15. Objectives • Promote physical activity in all settings (school, work, community, recreational) • Increase availability, accessibility and consumption of plain water • Decrease sugar and fat in drinks • Increase consumption of vegetables and fruits, legumes, whole grains and fiber • Improve decision-making capacity through labeling and promotion of health and nutrition literacy • Promote exclusive breastfeeding in first six months of life. • Reduce the amount of sugar added in food • Decrease consumption of saturated fats and eliminate trans fats in industrialized food. • Elaborate smaller portions in restaurants and food outlets, as well as for processed and industrialized food • Limit the amount of sodium added to foods and reduce sodium intake

  16. Stakeholders Government • Organized civil society • Academy • Industry • SS • SE • SEP • SHCP • SAGARPA • STPS • SEDESOL • SEDENA • COFEPRIS • CONADE • IMSS • ISSSTE • PROFECO • SNDIF • CONAGUA • PEMEX

  17. School as a major stakeholder • Program of Action in School context • Health Promotion and Education • Regular physical activity promotion • Availability and access to healthy food and drinks in schools School as important setting to promote healthy nutrition and physical activity habits Guidelines on Nutrition Standards for Foods and Beverages offered in Schools

  18. 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

  19. 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

  20. 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”

  21. http://www.insp.mx/alimentosescolares/

  22. 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 <= 130 kcal Total fats <= ≤ 35% More reduction of sugar, saturated and trans fats, sodium and fiber Energy per portion < = 130 kcal Total fats <= ≤ 40% Reduction of sugar, saturated and trans fats, sodium and fiber Energy per portion <= 140 kcal Total fats <= ≤ 40% Stage II (School year 2011-2012) Stage I (School year 2010-2011). Stage III (Startingfromschoolyear2012)

  23. 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 FoodEstablishments 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.

  24. 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.

  25. Closure of stage II

  26. Educational materials

  27. 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

  28. 1 2 3 for me/ kids

  29. 1 2 3 for me/ parents and school authorities

  30. Expectations 2012

  31. GRACIAS THANK YOU LjubicaLatinovic MD, MHA General Directorate of Health Promotion Mexico Ministry of Health ljubica.latinovic@salud.gob.mx www.promocion.salud.gob.mx @saludDGPS

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