Ministério da Saúde Secretaria de Atenção à Saúde Departamento de Atenção Básica Coordenação-Geral de Alimentação e Nutrição EDUCATION FOR CHILDHOOD OBESITY PREVENTION: A LIFE-COURSE APPROACH National Programs The Brazilian experience WORKSHOP EDUCATION FOR CHILDHOOD OBESITY PREVENTION: A LIFE-COURSE APPROACH Brazilian Nutritional Scenario National surveys since (1970, 1980, 1990, 2003, 2006 & 2009) Overweight Undernutrition ENDEF 1974-75; PNSN 1989; PNDS 1996 e 2006; POF 2008-2009; VIGITEL 2006 a 2009. Nutritional status – children under 5 years Demographic Health Survey (DHS - 1996, 2006) 16 14 13.4 12 10 8 6.8 7.3 7.4 1996 6 2006 4 2.5 2 1.6 0 Déficit de altura para a Stunting idade Excesso de peso overweight Déficitwasting de peso para a idade Trends of overweight – children and adolescents (1974 – 2009) Adolescents Children de 5 to 9 years boys girls Stunting boys girls Overweight boys girls Obesity boys girls Undernutrition boys girls Overweight boys girls Obesity Trends of overweight and obesity among adults (1974 – 2009) Male Female Undernutrition Male Female Overweight Male Female Obesity Evolução da prevalência de adultos (18 ou mais anos de idade) com excesso de peso e obesidade, Vigitel 2006 a 2010. 47.2 52.1 38.5 44.3 42.7 48.1 11.4 masculino feminino total 14.4 masculino excesso de peso 2006 11.4 15.5 feminino 11.4 15 total obesidade 2007 2008 2009 2010 Excesso de peso: aumento populacional médio de 1,08% ao ano Obesidade: aumento populacional médio de 0,72% ao ano Prevalence of overweight and obesity – beneficiaries from “Bolsa Família” Brazilian cash transfer program 45.0 (Brasil - SISVAN, 2010) 27.2 23.5 18.1 16.2 17.3 9.5 8.1 15.7 13.0 9.9 4.0 Meninas Meninos girls boys Menores 5 anos Under 5deyears Meninas Meninos girls boys anos 5 5– a99years overweight Excesso de peso Feminino female Feminino female Adolescentes Adultos adolescents obesity Obesidade adults Brazilian Nutritional Scenario • Nutritional carency: • Anemia • Vitamin A deficiency • Vitamin B deficiency • Special feeding necessities GUIDELINES OF NATIONAL POLICY OF FOOD AND NUTRITION 4. Management of Food and Nutrition Actions 5. Social control and Participation 7. Research, Innovation and Knowledge in foodand nutrition 3. Food and Nutrition Surveillance 2. Healthy Diet Promotion 6. Workforce Qualification 1. Organization of Nutritional Care 8. Food Control and Regulation 9. Cooperation and Articulation for Food and Nutrition Security National Strategies to Promote Breastfeeding and Healthy Complementary Feeding + Between 2008 and 2011, the two strategies have capacitated over 4,000 tutors and involved over 30,000 primary health care professionals in Brazil. New National Strategy for Breastfeeding and Healthy Complementary Feeding Promotion What is intended? Encourage the nutritional guidance as routine practice in health services, contemplating the formation of healthy eating habits from childhood, with the introduction of complementary feeding in a timely and quality, while respecting the cultural identity and food from various regions of Brazil Inadequate feeding practices during the first years of life: Overweight and their comorbidities in childhood and adulthood . Infectious diseases, respiratory diseases, dental caries, malnutrition, micronutrient deficiencies. Formation of unhealthy eating habits. Median of exclusive breastfeeding (in days) children under 6 months. Brazilian cities, 2008 Brasil: 54,11 Belém Exclusive breastfeeding Median 1999 – 23,4 days 2008 – 54,1 days Florianópolis Campo Grande Distrito Federal Macapá Vitória Teresina João Pessoa Curitiba Porto Velho Palmas Boa Vista Natal São Luís Rio de Janeiro São Paulo Belo Horizonte Porto Alegre Aracaju Manaus Recife Rio Branco Goiânia Salvador Maceió Fortaleza Cuiabá 0 10 20 30 40 50 60 70 80 90 100 School Health Program Schools: 56,848 Students: 11 946 .778 Primary Health Care Teams: 14,439 How the school could contribute? Important determinant in the formation of habits of life, including food Health promotor place to prevent and treatment of obesity and other related chronic diseases School Should be a protector and healthy place Schoolars, teachers, professionaols, families, health service and comunity should be involved in the educative process. School Health Program Intersectoral Politcs between Ministries of education and Health Decreto presidencial Nº. 6.286/2007 Integral attention (prevention, promotion and care) to the heatlh children and adolescents of brazilian public schools Actions articulated between school team and health team. School and Basic Care Units – Family Health program PRINCIPLES The program is basead in the garanty of rights, right of life and it´s grounded in 3 principles: 1) Intersectoral: performed by the challenge of shared management, in which scientific knowledge, popular and places are taken into consideration, including the subjects and participation in a dialogic exchange (dialogue), a meeting that is produced again. 2) Territoriality: respect for local diversity, the local languages, local foods, to art sites, with the inclusion of what is diverse and different and the face of security vulnerabilities / territories vulnerable 3) Integrality: knowledge gathering guided by policies ensuring the health and education as a universal right. Program actions Component I – Health conditions evaluation Avaliação condições de saúde Component II – Actions of prevention and promotion das Component III – Permanent education Component IV – Monitoring and evaluation of health conditions Component V - Monitoring and evaluation of the program Annual week of mobilization School Health Program 2012 – prevention of obesity at school context Target of the week: start the actions that will be developed durind all the year. Annual week of mobilization School Health Program March/2012 – prevention of obesity at school context Target of the week: start the actions that will be developed during at the year. • Cities: 1.938 • schools: 22.096 • Health teams: 10.240 • Schoolars: 9.651.985 MATERIAIS DE DIVULGAÇÃO DA SEMANA DE MOBILIZAÇÃO SAÚDE NA ESCOLA (ENCARTE PARA REVISTA VOLTADA AOS PROFESSORES) MATERIAIS DE DIVULGAÇÃO DA SEMANA DE MOBILIZAÇÃO SAÚDE NA ESCOLA (MATERIAL PARA ORIENTAR NAS ATIVIDADES) School meal program • Laws that restricit the participation of processed food on the school meal program (30%) • Increase of fresh food from familiar agriculture at the school meal program (30%) • Nutritional parameters from menus Agreement between Health Ministry & Private schools federation Goal: joining forces to work together and implement actions aimed at promoting quality of life and prevention factors and / or limitations of diseases and health problems in the school environment Specific Objectives: I-planning, implementation and evaluation strategies with these approaches; II - plan and implement public campaigns and information on health and quality of life aimed at the whole school community; III - develop, define and implement protocol for healthy eating for school canteens, including improving the nutritional quality of meals and snacks offered; IV - establish and define strategies for the recognition of healthy school canteens. FOOD AND NUTRITION SURVEILLANCE FOOD AND NUTRITION SURVEILLANCE Allows the analysis of the population’s food and nutrition situation since the 1970s OVERWEIGHT MALNUTRITION ENDEF 1974-75; PNSN 1989; PNDS 1996 and 2006; POF 2008-2009; VIGITEL 2006 to 2009. Monitoring the beneficiaries of the Bolsa Familia Program Food and Nutrition Surveillance in Health services Commitment of the beneficiary families + Commitment of SUS Regulation on food advertisement: Establishing specific regulation to the advertising of food, especially for children. • Publication of RDC No. 24/2010 - Provides for the offer, advertising, publicity, information and other related practices of foods with high amounts of sugar, saturated and trans fat, sodium, and beverages of low nutritional value. • Placement of consumer alerts visible, legible, prominent and contextualized in printed pieces, television, internet, samples and other advertising materials: •“The (name / trademark of food) contains lots of sugar and, if consumed in large quantities, increases the risk of obesity and tooth decay”. •“The (name / trademark of food) contains too much saturated fat and, if consumed in large quantities, increases the risk of diabetes and heart disease”. •“The (name / trademark of food) and contains a lot of trans fat, if consumed in large quantities, increases the risk of heart disease”. •“The (name / trademark of food) contains too much sodium, and if consumed in large quantities, increases the risk of high blood pressure and heart disease”. •“The (name / trademark food or set) contains a lot (a) [nutrients that are present in high quantities], and is consumed (as) in large amounts increase the risk of obesity and heart disease”. Regulation of advertising of unhealthy foods • Suspension of RDC No. 24/2010 by the Federal Court of Brasilia in favor of theABIA, ANR; ABIR; AFREBRAS; Brazilian Association of Chocolate, Cocoa, Peanut, Candy and Derivatives; ABIMA; CNT; Industry Union of Corn, Soybean and derivatives in the state of SP; ANIB; ABESI and ABF. • AGU Agency recommended the suspension for the same reason Regulation of advertising of unhealthy foods Other movements: • WHO Regional Consultation on Recommendations for the marketing of food andnonalcoholic beverages to children (Brasilia, Jun / 2009) • Release Front in Defense of Food Regulatory Advertising (New York, Dec / 2011) • Launch of publication "Recommendations of the Expert Consultation of PAHO on the Promotion and Advertising of Foods and Non-Alcoholic Beverages to Children in the Americas"