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Workshop on prevention childhood obesity and school environment Aruba, June 2013

RESULTS OF THE IMPLEMENTATION OF THE GENERAL GUIDELINES ON SCHOOL NUTRITION STANDARDS FOR FOOD AND BEVERAGES SOLD AND DISTRIBUTED IN ELEMENTARY AND SECONDARY SCHOOLS. Workshop on prevention childhood obesity and school environment Aruba, June 2013 . Content.

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Workshop on prevention childhood obesity and school environment Aruba, June 2013

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  1. RESULTS OF THE IMPLEMENTATION OF THE GENERAL GUIDELINES ON SCHOOL NUTRITION STANDARDS FOR FOOD AND BEVERAGES SOLD AND DISTRIBUTED IN ELEMENTARY AND SECONDARY SCHOOLS Workshop on prevention childhood obesity and school environment Aruba, June 2013

  2. Content • Overweightand obesity in children and adolescentsCurrentsituation in Mexico • Strategies and actions for the prevention and care of overweight and obesity in Mexico • General Guidelines for Food and Beverage offered in basic education schools • First stage qualitative evaluation • Second stage quantitative evaluation • Conclusions

  3. Overweight and obesity in children and adolescents (2011) • In Mexico 29.3% of the total population (33 millions) are children (0 to 14 years old) (INEGI 2010) • The National Survey on Health and Nutrition (ENSANUT 2012) • shows that: • 34.4% of children from 5 to 11 years old have excessive weight • 19.8% overweight and 14.6% obesity • Between 2006 and 2012 these numbers have not increased • 35% of teenagers from 12 to 19 years old, present overweight or obesity. • The obesity rate is higher in women (23.7%) that in men (19.6%) • Between 2006 and 2012 the overweight and obesity increase in 5% • Instituto Nacional de Estadística y Geografía. Censo de población y vivienda 2010. INEGI, México 2010. • Gutiérrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L, Romero-Martinez M, Hernández-Avila M. Encuesta Nacional de Salud y Nutrición 2012. Cuernavaca, México: Instituto Nacional de Salud Publica, (MX) 2012.

  4. Overweight and obesity in children and adolescents Prevalenceonoverweight and obesity in children. ENSANUT 2012 Male Female National Male Female National Male Female National ENN 1999 ENSANUT 2006 ENSANUT 2012 Overweight Obesity Prevalenceonoverweight and obesity in teenagers. ENSANUT 2012 Female National Female National Male Male ENSANUT 2006 ENSANUT 2012 Overweight Obesity

  5. Causes • Physical activity. ENSANUT 2012 • More than half of children between 10 and 14 years old have not carried out any formal physical activity, in the last 12 months previous to the survey. • Only 33% of surveyed children stay less than two hours (maximum recommended time) in front of the screens. • School diet • Several studies have indicated that the Mexican students consume an average of 433 calories in the school snack, with a change in the consumption pattern: • Children 1 to 4 years old increased calories intake from 165 to 297 kcal. • Students 5 to 11 years old increased calories intake from 190 to 343 kcal. • Energy average allowance of lunch must be of 17.5% of total energy: • Pre-school 227 kcal +/-5% • Primary school 276 kcal +/-5% • Secondary school 382 kcal +/-5% Rivera-Dommarco J, et al. El estado nutricional de la población de México: cambios en magnitud, distribución y tendencias de la mala nutrición de 1988 a 2006. Salud Pública Mex; 2008; 49, 267-269.

  6. Strategies and actions foroverweightand obesityprevention in Mexico • As an answer of Mexico’s government, the Ministry of Health, started the National Agreement for Nutritional Health: Strategy against overweight and obesity (ANSA), January 2010. • 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 as well as individuals and families.

  7. Strategies and actions in school setting School as important setting to promote healthy nutrition and physical activity habits Action Plan for Schools • Health Promotion and Education • Regular physical activity Availability and access to healthy food and beverages in schools Guidelines on Nutrition Standards for Foods and Beverages offered in Schools

  8. Implementation of guidelines • Gradually, (by school years) to allow a sustained and continuous change, enabling acceptance and adjustment of all actors Energy per portion <= 130 kcal Total fats <= ≤ 35% More reduction of sugar, saturated and trans fats and sodium 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 (Startingfromschoolyear 2012)

  9. Closure of stage II

  10. Guidelines criteria

  11. First qualitative evaluation Objective To identified the main factors that facilitate or obstruct the application of the nutritional guidelines Methodology Semi-structured face-to-face interviews • School principals • Parents • Members of Social Participation School Councils • Persons-in-charge of the school store • Primary and secondary school students

  12. Main results • Most of the members of the educational community (teachers, parents and students) knew about the general guidelines (77.14%). • 75.46% of school vendors fulfilled the general guidelines. • The same beverages were offered in pre, primary and secondary schools. • There was some resistance from parentsusedtosending a school snack with a high energy content and sugared beverages.

  13. Second stage evaluation Objective To have the information concerning the application of the general guidelines in the second stage and to identify the factors which support or hinder its fulfillment Methodology National representative sample of 172 schools (122 elementary and 50 secondary) From June 11th to 29th, 2012 The surveys included school principals and teachers, members of the School Store Committee, parents, students and school vendors. Information was obtained concerning: Knowledge about guidelines Perception of change at schools according to several actors Food and beverages sold at school School snack Consumption of plain water Physical activation Educational materials Perception of obstacles and facilitators for the application of the guidelines

  14. Secondstage of theguidelines RESULTS Knowledge about guidelines 90% of teachers and principals and 85% of the members of the committee knew them 60% of parents identified the guidelines as a measure against overweight and obesity Healthy school snack The actors recognized the sale of vegetables and fruit and a healthy lunch as the main criteria which define the guidelines 40% in elementary and 60% in secondary schools also identify drinking plain water as part of a healthy snack Perception of changes in the schools according to different actors 85% of all actors observed a favorable change in the sale of food in both levels and 45% and 55% in the sale of beverages 65% of school vendors in elementary schools and 75% in secondary schools mentioned that they have made changes in the preparation and in the foods they offer

  15. Reasons which help to the creation of guidelines for distribution of food and beverages at schools (elementary) Overweight / Obesity Diabetes Wide availability of high-calorie foods Principals CECE Parents CIAF Teachers

  16. Reasonswhichhelptothecreation of guidelinesfordistribution of food and beverages at schools (secondary) Overweight / Obesity Diabetes Wide availability of high-calorie foods Principals CECE Parents CIAF Teachers

  17. Second stage evaluation RESULTS Food and beverages sold in the school

  18. Foods thatthestudentsreferedtheybuy at school (stage II) RESULTS Cereal bars Salty Snacks Sweet Snacks Fried food or fast food Not fried food Milk/Yogurt Sugarybeveragesorsoda Plain water Fruit or vegetable Secundary Elementary School

  19. Content of school lunch referred by parents and observed in thestudent’s lunchbox (elementary) RESULTS Sugarybeveragesor soda Cereal Bars Plain water Milk / Yogurt Sweet snack Fruit or Vegetable Not fried food Fried food or fast food Student's lunchbox Parents

  20. Content of school lunch referredbyparents and observed in thestudents’ lunchbox (secondary) RESULTS Drinking water Milk / Yogurt Sugary drink or soda Fruit or Vegetable Not fried foods Fried food or fast food Cereal Bars Sweet snack Student's lunchbox Parents

  21. Secondstage of theguidelines RESULTS Access and availability of plain water • 72.9% in elementary schools and 62% in secondaries have any source of drinking plein water. • There are 1.4 drinkingfountainin functionforeach 100 children.

  22. Secondstage of theguidelines RESULTS Elementary School Secondary Physicalactivation In 38% of elementary schools and 19% of the secondaries was observed physical activity the day of the visit with a duration of 14 minutes At the start of the school day Another time With at least one period of physical activity Average duration of AF (min)

  23. Secondstage of theguidelines RESULTS • Educative Material for the application of the guidelines • About 70% of the vendors and 65% of the CECE have them. • 20% of theparents and 7% of theteachershavethis material Secondary Elementary School Vendors Food Committee Physical activity committee Teachers Parents

  24. Educational materials

  25. Secondstage of theguidelines RESULTS • Obstacles and facilitators percieved for the application of the guidelines • 70% of the school members and 65% of parents agree that the guidelines have been fulfilled. • Main obstacles: • Family habits which are not very healthy • The lack of interest of parents • The preferences of students for food with a high content of sugar, fat and sodium • The lack of information about the guidelines • Main facilitators: • Principal’s leadership • Teachers’participation • Parents’support

  26. Benefits of general guidelines in health and nutrition The guidelines benefit about 18 million students 11 954 867 from 65 739 elementary school 5 138 075 from 28 316 secondaries TOTAL CHILDREN: 17 092 942 With the participation of : 64 092 principals 764 949 teachers TOTAL SCHOOL COMMUNITY : 828 041 Source: Census of the Ministry of Education. Academicyear 2001/12OF

  27. Conclusions Duringtheseevaluationswe can observe thefollowing: • In the first stage there was resistance from the vendors because they didn’t have the educational materials and there is also a lack of cooperation from the parents. • In the second stage there is more participation of all actors, the vendors had the educational material, they agreed to follow the guidelines because they knew them and parents take into consideration the guidelines to prepare the lunch of their chidren.

  28. Challenges of theguidelines • To put emphazis in students and teachers about the importance of physical activity, by means of educative campaigns which underline their benefits. • To increase the participation of parents for motivating physical activity. • To intensify the supervision of sale of food and beverages by the committees and principals

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

  30. LNCA. Zaira Valderrama ÁlvarezNutritionCoordinatorMexicoMinistry of Healthzaira.valderrama@salud.gob.mx

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